A self help guide to using Cognitive Behavioural Therapy to manage your mental health during difficult times.
by Kelly Watkins, Forensic Psychologist
Infectious disease outbreaks, like the current Coronavirus (Covid 19), can be scary and can affect our mental health. For many of us it is something like we have never experienced before. It seems so surreal but as it is becoming more and more part of our reality and it is likely to have an impact on our mental health.
In times like these, where a global pandemic is taking up most of the conversation around us, it can be even more difficult to stay calm, especially if you already have an existing anxiety disorder, including Obsessive Compulsive Disorder (OCD). It is understandable that many individuals with pre-existing anxiety are facing challenges at the moment.
As well as anxiety being triggered by the current coronavirus situation. As well as the potential impact of being self-isolated, with individuals whom you often do not spend much time with or being alone could trigger feelings of depression, panic, post-traumatic stress disorder as well as problematic personality traits.
Of course this situation can impact your mental health without the need for a diagnosis, the most important thing is that you use the tips and techniques that help you and perhaps share with others if you can see they are struggling.
- Limit or avoid watching, reading or listening to news that could cause you distress
- Seek information only for taking practical steps to look after yourself and loved ones
- Manage the information you are exposed to on social media
- Stay connected with others who have a positive impact
- Wash your hands but not excessively
- Give those anxious and OCD thoughts nowhere to go
- Managing anxious and OCD thoughts
- Create and maintain a self-care schedule
Let’s go into these in a bit more detail …
Limit or avoid watching, reading or listening to news that could cause you distress.
During this time it seems that everything you see, read or hear is about Coronavirus or some related news. It might seem that this is unmanageable but it can be managed. We all want to be kept up to date with the goings on but a way to stop this feeling overwhelming is to set a time every day that you will look for an update and stick to that time and also set a length of time you will look e.g. 7pm for 10 minutes. Ideally do not make it longer than 30 minutes.
Remember when looking for news, this is only to look for practical tips, this does not include scouring the internet or social media to read stories which will not all be fact based and will often increase your anxiety and make you feel worse than you did in the first place. There is a lot of misinformation swirling around so stay informed by sticking to trusted sources of information such as the government and NHS websites.
Consider balancing out the above with positive news websites such as:
Managing Social Media
Consider the other ways you learn of news. Don’t be afraid of having breaks from social media or fine tuning it.
Be aware of what accounts you are following, you may want to unfollow or mute certain accounts on social media. Be mindful of your clicking, consider avoiding clicking on coronavirus or related hashtags.
You may want to mute triggering words on Twitter or hide Facebook posts and feeds that you dislike.
Take some time away from social media. It might be a good time to do something else such as speaking to a friend, listening to music, watching TV or reading books.
When speaking to others it is also okay to mute WhatsApp groups if you find them too overwhelming. If you are in person with someone who is speaking about something, do not be afraid to explain to them that you are finding the conversation distressing and perhaps change the subject to something we love to chat about . . . The Weather.
Stay connected with others who have a positive impact
Of course what we want to do and can do is limited due to certain restrictions at the moment. However do not let your thoughts stop you from contacting others. Focus on what you can do rather than what you can’t.
Such as speak to others on social media or video chat, listen to your favourite music, watch enjoyable films, go outside into your garden, sing and dance, do yoga and smile.
If you are able to don’t be afraid to speak about your anxieties or intrusions as chances are your friends without anxiety or OCD, may also be having a bad day (about anything) or they may be sharing some of the concerns you are, focussing on them and their problems can sometimes be helpful in allowing us to focus away from our own problems and sometimes gives us perspective on our own concerns.
Conversely notice if speaking about it is making your anxiety worse. Sharing the latest details with family and friends will be common. But it keeps us thinking about it, which can influence our sense of threat/risk. To counteract this, don’t initiate the conversation and change the subject if it does come up. If you’re comfortable doing so, ask friends and family to not discuss the Coronavirus news updates with you. This might help you feel less anxious and help others too.
Increasing numbers will join those already in self-isolation so now might be a good time to make sure you have the right phone numbers and email addresses of the people you care about. It might be good to agree regular check-in times and feel connected to the people around you.
If you’re self-isolating or working from home, strike a balance between having a routine and making sure each day has some variety. Get up at the same time, make sure you get dressed and eat and drink at appropriate times.
Wash your hands but not excessively
I know you might be asking well what is excessive? Particularly when we are being overwhelmed by the guidance to wash our hands properly. Please check the current guidance for hand-washing and stick to that.
I know it is not that simple when you have OCD or health anxiety. If you are struggling to know how much is too much? Ask yourself what is the function of me washing my hands?
Wash your hands to the level of advice, rather than at the level OCD is demanding. It may not feel sufficient, but that’s CBT right there, you’re choosing not to do behaviour because of OCD and you’re choosing to ride out the anxiety!
Give those anxious and OCD thoughts nowhere to go
In many respects OCD and anxiety is about worrying about something that might be a problem, because it’s got potential to be a problem.
In an ideal world we will tell ourselves we will worry about it when it does become a problem and not a moment before.
However we often manage to predict things will be a problem before they have even become a “thing”.
Another trick OCD and anxiety have is thriving on uncertainty. For example if you say “I might be contaminated because that person looked like they had a temperature.”
Because of the word ‘might’ we create the uncertainty that anxiety and OCD thrive on. But if you tell yourself ‘I am contaminated and I will get sick’, whilst not a pleasant thought, it actually doesn’t give anxiety and/or OCD much “wiggle” room, because you have already acknowledged the worst case scenario and carried on with your activity/day despite it.
This takes practice, but these subtle changes do help change our focus and can even make OCD and anxious thoughts lose the power to scare and worry us. If you want to make the thought lose its power even more try singing the thought out loud to the theme of “Happy Birthday” or “Twinkle, twinkle little star”.
BUT this is not taking away with the general precautions you are being recommended to take, it is just supporting you having more power over your overwhelming thoughts.
Managing anxious and OCD thoughts
Ask yourself are the thoughts you are having: FACT OR OPINION?
To balance your thoughts you may want to ask yourself: If your loved one said that thought to you what would you say back?
Another way to challenge your persistent negative thoughts is the courtroom technique. Confront your thoughts with a rational counter-statement.
For example, if your persistent thought is something like “Everyone I love will die from this virus” you can counter it with factual statements such as “Actually, most people who get Covid-19 are likely to make a full recovery, and that’s assuming mum, dad and my little sister will even catch it at all.”
We should also be aware of and avoid increasing habits that may not be helpful in the long term, like smoking and drinking alcohol.
Even though we are in a public health crisis, it will get better. Put things in perspective. It’s a worrying time, and many of us, may have loved ones who might be showing symptoms or are vulnerable, but the tendency to jump to the worst-case scenario very rarely reflects reality. Be kind to yourself. It may be a bit cheesy, but this too shall pass.
Self-care is the best care
We have discussed some particular techniques to manage anxiety and OCD symptoms as well as just managing your mental health. Now self-care can be reading, writing, speaking to loved ones. Basically anything that makes you feel good.
- Do exercise. Even if it’s just star jumps in your bedroom, or shaking your body parts like you’re in the warm-up section of a hippie acting class, exercise will help get the adrenaline out of your system and channel the panic elsewhere.
- Gratitude – write down three things you are grateful for every day.
- Meditate – you can follow a guided one or simply sit or lie comfortably. Close your eyes. Make no effort to control the breath; simply breathe naturally. Focus your attention on the breath and on how the body moves with each inhalation and exhalation.
- Yoga you can find some amazing online classes and many yoga studios on Instagram are bringing their sessions online.
- Eat well getting the nutrients you need.
- Stay hydrated with water.
- Treat yo’self – anything that will give you a little boost can help. It doesn’t need to involve spending money: you can also cook yourself something nice, have a hot bath, or listen to a song you love.
Grounding techniques can also be helpful. These are techniques you use to ground yourself in the moment instead of where your head is going.
Use your mind – Choose one or two broad categories, such as “musical instruments,” “ice cream flavors,” “mammals,” or “sports teams.” Take a minute or two to mentally list as many things from each category as you can.
You may want to use a nice smell to bring you back in the moment. Inhale the fragrance slowly and deeply and try to note its qualities (sweet, spicy, sharp, citrusy, and so on).
You can use movement such as bending over to touch your toes and then very slowly standing up starting at the base of your spine.
Use your senses, name 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell and 1 thing you can taste.
Use your breath by counting your in breaths for a minute “normal” breathing rate is between 12-20 breaths.
Another breathing exercise is placing one hand on your tummy and another on your chest. Breathe in for the count of 3 and out for 5. If you like you can increase this to breathing in for 5 and out for 8. Repeat as necessary.
About the author
Kelly is a qualified Cognitive Behavioural Psychotherapist, accredited with the British Association of Behavioural and Cognitive Psychotherapies.
Kelly is also a qualified Forensic Psychologist registered with The Health and Care Professionals Council. She works at Cygnet Hospital Blackheath.