How to Work with Anxiety During the COVID-19 Pandemic [Part 1]

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For many clients, the COVID-19 virus has ignited the flames of anxiety. And for those who already struggle with anxiety it’s pouring fuel on the fire.

Problem is, many of our go-to strategies for reducing anxiety can’t always be practiced in quarantine or isolation.

So how can we help clients manage anxious feelings brought on by the pandemic?

The other day, I spoke with Christine Padesky, PhD, and Ron Siegel, PsyD, and they shared their techniques for finding relief from anxiety during these difficult times.

I hope you’ll give it a look.

Click here for full transcript

Dr. Buczynski: One of the things that COVID-19 has brought out is a a sense of anxiety. We’re all focused on who’s getting sick and and what’s happening with testing and so forth, and what happens if it gets worse, and what not. I think in a way it’s going to increase a sense of hypochondriacal tendencies, and also a sense of OCD with all this hand-washing. Both of those are anxiety disorders, and and it will increase other kinds of anxiety as well. I’m wondering what are some strategies that you found that might be particularly appropriate in this time for working with anxiety? Dr. Padesky: There’s a couple of things that we know really can lower help lower anxiety in times of crisis. The first is to really set a limit, a reasonable limit on your TV watching time, your reading time, your internet time. Well COVID-19 is here all the time, we don’t need to be reading about it and learning about it all the time. For most people, once you’ve reached this stage of being isolated at home, you really only need to check the news once or twice a day to see if there’s any updates. What’s much healthier and what lowers anxiety is to be engaged in the here and now, and to not just get obsessed about what you’ve lost but to be grateful for what you’ve gained, and to look for the upside in being at home. I know for myself and for many people, how often do we say I wish I could just have a day at home and we’ve now got many days at home, and to think about how could I use this time that would actually make my life better in some ways. Therefore some people that might be starting projects, or doing some kind of home improvement tasks that you never have time to do, for other people it might be spending time with family in different ways than you typically would spend it, rather than driving to and from different tasks and activities, maybe it’s a chance for the family to do some quiet activity together, it’s a chance for people who want it to maybe introduce themselves to mindfulness, or learning a foreign language or something like that, to devote time to quiet personal time as well. I think those are some of the things that can lower the anxiety. The other thing is to remind yourself that even though we’re meant to stay indoors most of the time, for many of us there’s some place we can go to be outdoors in nature, whether it’s a patio or whether it’s a backyard or some people might even live with larger expanses of nature around them. Getting outside and being in nature has very healing effects for people on both depression, anxiety, lots of different moods. I’m really rededicating myself to spend a portion of every day outside and if you have to stay indoors, open a window and feel the fresh air and experience nature and sounds and things, just enjoy being quiet. Dr. Siegel: I was thinking of this from the point of view of the psychotherapist or the healthcare practitioner, how to help their clients or patients with this, and it seems to me that there are there are several things that we need to keep in balance. One of them is simply acknowledging that this is a scary time for everybody and that this is a scary time for us as professionals as well, because there’s tremendous uncertainty. Most of the time we have this fantasy that we know what the future is going to bring, we have a sense of the structure of our lives and we have all sorts of things on our calendar perhaps that we’re planning to do and all of that is off the table at the moment, we really don’t know how this is going to unfold, experts don’t know how it will unfold, and that naturally brings anxiety for all of us. I think it’s important to validate that we are in this with our with our clients, in that sense one of the dangers, of course, is that we get involved in the the sort of seductive let’s share COVID-19 news together, clients bring this up in treatment and I’ve already witnessed in myself and in my supervisees, there’s this temptation to sort of just go down that path. Going down it to a certain degree to establish a sense of connection and we’re all in this together, but to spend all of our time indulging that is probably not so helpful. The other thing is that many of us, whether we’re physicians or on the medical side or or mental health professionals, are viewed by our clients as somewhat experts in health matters. I think it behooves us to educate ourselves because sometimes they’re really seeking information, and one of the ways to help with anxiety is to help share the information that we have. One doesn’t need to be a physician to read up on this and to become fairly comfortable with what is known and with safety procedures and the like. I think we can be helpful in that realm. One other realm is simply how is this particularly affecting each of us because even though there’s a common humanity aspect to it, a way in which we’re we’re in this all together, we each have our own associations to illness, we have our own associations to aloneness, we have our own fears, our own understandings of this, how this unfolding crisis is dovetailing with our particular cultural and familial histories I think is also an important therapeutic test. I think we have many hats to wear and there are many different elements of a therapy session, for example, that that we might need to keep in balance. Dr. Buczynski: One of the things that I think it brings up is a natural exposure to the whole issue of tolerance for uncertainty, because we’re in such an uncertain time, something like 2008 only in many ways so much worse because health is involved and whereas in 2008 it was more our financial health. But we are in a time of uncertainty. I would add to what Christine said about limiting media exposure the same with if you study a stock market, or your 401k, or your retirement account, it’s probably not something you need to spend and you need to check on every day, it’s it’s going to go up, it’s going to go down, it’s gonna do that for a while. But it’s going to come back and it’s just not going to come back right away. I think the more we can take it as an experience of looking at a certainty and seeing how we can get to know that and seeing how we can take refuge with that.

Many clients are feeling anxious right now. What are you finding most helpful for clients experiencing COVID-19 related anxiety? What are you finding most challenging about client work during the COVID-19 pandemic?

Please let us know by leaving a comment below.

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91 Comments

Marcia Harms, Marriage/Family Therapy, Bainbridge Island, WA, USA says

Finding agoraphobia is getting pervasive and worrisome for clients, even for me as a therapist. Have found boardgames have always been a gift to do and great to do these types of things in the home. Leads to relaxed and fun sharing face to face with children or partners for learning or just purely for fun.

Agree rehashing the virus on television pandemics or political information needs to be regulated rather than a monopoly in a discussion while quarantined. Glad you recommended this and I like to do other projects with clients ideas while in the home, i.e. making meals together or even with family if you are challenged as I that my family is spread throughout the country,
Maybe have a brunch together while skyping as I believe Bessel had suggested in another broadcast. That seemed like a great idea. A close Italian family member missing her family thought so, too and share a meal over the internet.

My grandchildren share on the phone their food sharing, like when my granddaughger graduated from college I could share in the wonderful cake on display in the celebration. This time has been so hard for those in school and graduating alone without all those wonderful people you once spent years in school.

Thanks for shairing the ideas NICABM and ways to connect in our isolation to reduce anxiety with is growing exponentially.

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teresa marcin, Physical Therapy, MX says

Meditation, walking, brething are some of the things I suggest my clients to do twice a day or whenever they feel anxious and it is helping them a lot.

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Anonymous says

Thanks for video and tips
Yes I think its helpful to acknowledge the anxiety and uncertainty of this time and also what we can use this extra time at home for and finding ways to enjoy it

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D Schulz, Psychology, Colorado Springs, CO, USA says

Well thought out and excellent encouragement for both what to do personally and within the theraputic relationship.

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Peggy Sealfon, Coach, Naples, FL, USA says

Great advice. Been encouraging clients to practice mindfulness, meditation, etc. Many of those who I work with suffer PTSD and anxiety. To that end, I’ve created easy-to-use recordings (i.e. A Gratitude Meditation) so they may have constant support beyond the time I spend with them. Being in the moment (and reducing news exposure) can be effective. I’m grateful for your offerings! Thank you nicabm for your expertise.

Be well,
Peggy Sealfon
Personal Development Coach, Author
PeggySealfon.com

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Sarah Rice, Other, Phoenix , AZ, USA says

Being alone, not knowing when things will be normal, afraid to socialize, financial loss , works problems, not knowing what to do with elderly parent that lives 2 hours away when she keeps saying she is okay meanwhile I am a walking zombie

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Julie Leblanc says

Living in the now , I believe is the best way to deal with anxiety

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M Pestorius, Social Work, AU says

Addressing Anxiety with clients.

Encourage:
Be engaged in the here and now rather than drawing on our ‘special’, unique avoidant activities
Be engaged in nature.
Limit the time you spend inquiring into the Covid situation.

We should understand the situation so we can share information. But not get caught up in endless conversations about it.

The “Window of Tolerance”: Tolerance for ‘uncertainty’.
Uncertainty and anxiety are closely linked – that is sort of obvious. But it probably requires a complex conversation with clients.

Regarding Nature. I think that nature is helpful because it is simply constantly changing and moving in quite random ways – for people who are used to containing their experiences there a ways of being in nature that is both contained and changing – safe and expansive.

We need to ask:
How could I use this time to make this time better? to make it an opportunity?
[like doing some Continuing Professional Development :)]

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- Marcia Harms, Marriage/Family Therapy, Bainbridge Island, WA, USA says
  
  “We should understand the situation so we can share information. But not get caught up in endless conversations about it.” Love this idea. thanks for sharing these ideas. Nature is so healing in these times, if not mandatory when possible.
  
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Abigail Brown, Other, CA says

I am a patient with extremely bad anxiety disorder and bipolar depression. Since I started home isolating, my anxiety sky rocketed and I thought I was going to need medical help. But then I remembered the skills I’ve learned, and started to practice them. Someone mentioned to me that we will need to find “our new normal” which reminded me that a lot of the structure I have built into my life can’t be upheld. I needed to create new structure.
Things that have helped:
1. I asked a friend to keep me informed on anything important and reduced time on the news.
2. I look for humorous things to make me laugh.
3.I set up reading to my grandsons over the internet every day.
4. I set up listening to one of my grand daughters read to me over the internet every day.
5. I got a medical appointment with my doctor on the phone and talked over me fears.
6.I signed up for a free on line course.
7. I am trying to get some fresh air and exercise every day.
Where I am really struggling is in my eating addictive behaviour: I’m using food again and gaining weight.

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- Rachel Garst, Other, Des Moines, IA, USA says
  
  Abigail, What a great reminder that even when things are difficult ,there are still so many things that we can control. How much we watch the news? How we spend our time? Who we choose to talk to. Love the image of all the reading going on back and forth. It sounds like you are getting a lot of pleasure and reassurance from these connections.
  
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- Marcia Harms, Marriage/Family Therapy, Bainbridge Island, WA, USA says
  
  All wonderful ideas. Have many client reading to their grandchildren over the phone or internet which is so rewarding for all concerned. Love a good belly laugh with is great for our diaphragm and this worry for the virus as it is good breathing for both.
  
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jodi wachspress, IL says

Thank you expect appreciated the counter transference piece

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Anonymous says

Very comforting information. An opportunity being presented to be present to the self and observe how this pandemic is affecting me on a personal level.

Making a choice to use a healthier path by limiting the amount of chaos being introduced into my daily life through the news media. Bringing attention to tending the inner self.

Thank you.

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Rosie Logie, Other, AU says

For me it is about keeping my finger on the pulse of my own life, how am I feeling when I get up in the morning, is there anything I need to do to ensure that I am on track with what is going on in this crazy world.

Realising that I can ration my own toilet paper, can wash off in the shower if it runs out…we are no longer under water restrictions here in NSW.

Today I bought a bike so that I can keep my cardio levels active, walking not quite enough to boost those lungs. Wonder what will come up tomorrow that demands my attention! Dark Chocolate no. 1 thanks to Easter approaching.

Tomorrow morning is new awakening to something else that I might have missed.

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Evelyn Sharp, Other, GB says

I found this very reasuring,thank you.

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Anonymous, Social Work, South Bend, IN, USA says

Radical Acceptance and using mindfulness to stay away from fortune telling are very helpful.

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Christine Schwarz, Counseling, CA says

I would not recommend therapists to engage in a discussion of “facts” about COVID-19. Too many of us think they know, but don’t. Please, let’s stay within our realm of expertise: acknowledge the uncertainty of the situation and support our clients with the accompanying anxiety. Other than that this was very useful. Thank you.

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Barbara Griesmann, Counseling, USA says

This was great for middle and upper middle class folks. What about those who have no stocks, no resources for a back up plan, no safety net at all?

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- Eamon Keane, Psychotherapy, IE says
  
  Thank you for helpful video..good point Barbara – I work with percentage of people on low income .. teaching breath work ( mindful of unhealed trauma which can arise) which costs nothing.. being creative with few resources rather than drumming some forms of positive psychology which deny social issues, have been helpful. Most of mine have a phone and loads of apps and social connection possibilities ..I find validating the reality of their lives is vital – to just be heard can be powerful and at the same time also never buying into hopelessness ..
  
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Anonymous says

very useful information thank you for sharing

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Miguel Lozano, Psychology, ES says

Thank you so much for your practical suggestions to reduce anxiety. It´s so important to share it with my patients¡

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Shirley Smith, Counseling, Conroe, TX, USA says

Good info. Thanks

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Anonymous says

Thanks, very helpful!

Joan Aldis, London ON

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Jim Len, Counseling, Lexington, KY, USA says

Great comments from all 3 of you. Much appreciated & thanks for reaching out to give support. Be well, & yes, this will be over. Prayer for patience helps me more than anything, esp since I don’t like waiting, & reaching out to others with love is comforting as well. Thanks for your reaching out to do this.

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Maria Nambasa, Other, IE says

Thanks so much ?, this was really helpful..

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Claudia Andrea Strasser, Psychotherapy, CL says

THANK YOU SO MUCH FOR TAKING THE TIME TO DO THIS VIDEOS IS VERY HELPFULL TO KNOW IM NOT THE ONLY THERAPIST THINKING THIS IS TERRIBLE

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kevin, Other, Storrs, CT, USA says

I think that these comments are great

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K Anon, Social Work, Morristown, NJ, USA says

Thank you so very much for all of these videos on uncertainty and anxiety during these difficult tImes. I just had a session with a an incredible hospital worker. I shared these with her along with what Dr. McGonagal (I hope I spelled that right!) shared last week and it really resonated with her. And as a hospital employee, she Particularly liked “I alone did not cause this and I alone cannot cure it”. She was having a very hard time (and she brought tears to my eyes— her stories about the extreme seriousness of this virus). I thank you all for these resources as we try to support our clients and those who are on the frontlines.

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Kimberly Spain, Supervisor, St. Augustine, FL, USA says

Good morning and thank you for the video. I a not a psychologist, however I am a supervisor of an engineering department. I believe you are all spot on with your assessments that recognizing when the ‘what if’ take hold and refocusing that energy to a ‘what then’ contingency plan is a path to self encouragement due to being able to plan and know what you will do during a specific trigger. It helps myself and colleagues to feel somewhat in control if only of ourselves in these very uncertain times. This also allows us the opportunities to be examples to our friends and family of how to cope with these uncertain times. Simply asking ourself ‘so what is the plan here…?’ Refocuses our mind out of the fight or flight to a proactive action plan. Thank you again for the videos they have all been an amazing contribution to my professional development.

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June says

It feels so containing to have NICABM as a support system.

Thank you

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Claire Brown, Counseling, AU says

Thank you Ruth, Christine and Ron. Obviously all our clients are dealing with anxiety at present and you provided some encouragement that we can make a difference!

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Susan Penn, Coach, CA, USA says

Very great point, Ron, about how we all have our ow associations, for instance, to being and feeling alone. This is an important road to travel with ourselves and others.

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Anonymous says

Thank you. It was great. It is so important to share in that emerging field of how to be with our experience during the pandemic.

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Wendy EVERSON, Counseling, Omaha, NE, USA says

Thank you for your suggestions to share with clients to reduce anxiety and fear of the unknown. Being present to those around us (with social distancing in mind) who bring positive energy and calmness can be helpful.

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kare, Counseling, NZ says

It is so good to hear three voices talk both beautifully common sense around the media and boundaries within the theraputic relation.
coming from Christchurch New zealand the need to limit T.v coverage around cov19 is so important especially for parents with young children.

Thank you

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catherine, Medicine, GB says

Thank you for these practical tips

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Britney Smith, Other, CA says

What about those who are in parts of the world that experience low winter temperatures? What would you suggest since it’s not realistic for those people to sit outside and enjoy nature as much as others without winter?

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Anonymous, Health Education, Butler, PA, USA says

I grew up in a very loud violent family. I wanted to get away from my home each day from the time I can remember. I have been able to shelter in place without feeling anxious but feeling like I am in a gentle place. Yesterday had that ahha moment that said this is your first time in this sense of home is safe and fine. More or less that unfinished business that is getting to play out in this crisis. Amazed me pretty much because I am in the age range most vulnerable. But grateful for this experience of how it must feel to be a child in a safe and calm world-small but fine.

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Sue Levy, Counseling, Thousand Oaks, CA, USA says

Thank you so much these wonderful, insightful posts. You and your collegues help me find perspective and educate me on a regular basis!

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