Coronavirus Anxiety

The Coronavirus (COVID-19) rapid spread and potential for severe respiratory illness and death, for the most vulnerable, has dramatically increased anxiety.

The current crisis calls for an understanding of anxiety states, getting help for severe anxiety, preventing the emotional overload, making a poor decision, viral spread, and vulnerability to infection.

Too much fear and anxiety can lower immunity, reduce needed restorative sleep, and increase vulnerability to infection. Some fear and anxiety probably have value in motivating people to practice all the public health guidelines to prevent getting the virus, carrying the virus, and infecting other people. The public health measures are essential to prevent the healthcare system from becoming overwhelmed and contributing to a higher death rate of vulnerable people with impaired immunity, infirmity, or other illnesses. The low anxiety people in our population who may not follow the strict public health guideline can be contributing to the loss of control of the viral spread with the potentially dire consequences.

Too much anxiety can lead to increase hoarding, but fear in the right amount can help motivated people to get needed supplies for isolating and staying at home. Risk in these anxious times is becoming overly obsessed and addicted to watching too much TV and news reports, that feeds fears and worry. For those feeling overwhelmed in the current crisis with increasing levels of anxiety, panic attacks, or obsessive thoughts and actions, it may be the time to consider additional support or outside help.

Most with anxiety don’t seek or receive help.

It has been estimated that anxiety disorders affect 40 million adults or 18.1% of the U.S. population every year during regular, non-Coronavirus times – the most common mental/emotional/psychological condition in our country.

Anxiety and related disorders account for a significant portion of the U.S. mental health budget. A considerable number of people with an anxiety disorder have at least one other accompanying psychiatric condition. See: http://www.adaa.org/about-adaa/press-room/facts-statistics

These disorders cause overwhelming, even debilitating, anxiety, and fear that can become worse if not treated. Less than 30% of individuals with these problems seek treatment, and many go undiagnosed by their primary care physicians.

Common signs of anxiety may include:

• Being nervous, hypersensitivity, irritable, moodier, or on edge
• Feeling a sense of impending danger or doom
• Increased or rapid pulse/heart rate, palpitations, and dizziness
• Fast or troubled breathing sweating, and shaky
• Increase tiredness, weakness, and wanting to sleep more
• Muscle tension, fatigue, and trembling
• Difficulty concentrating and getting things done
• Having trouble sleeping with more frequent nightmares
• Experiencing digestive problems and changes in appetite
• Spending more time on TV, movie watching, computers, tablets, or cell phones

Mounting anxiety can contribute to panic attacks.

In regular non-Coronavirus times, panic attacks have been estimated to occur in 20% of American’s at least once in their lifetime or in as many as 3% of our population at any given time. Now with the heightened fears over Coronavirus and related concerns as the dangers to personal and family safety, work, career, paying the bills, getting needed food, shelter, medications, etc., panic attacks are probably much more prevalent and widespread. The public health measure to prevent spread as social distancing, sheltering in place, and avoidance of public activities makes the vulnerable individual more vulnerable to panic episodes.

Panic is different from fear and other types of anxiety. Panic attacks are often unprovoked, appear suddenly and increase in intensity over several minutes, peaks, and then rapidly goes away over 20-30 minutes. An episode can occur as a one-time event only or can repeatedly happen, triggered by something remembered or appear without warning –occasionally awakening from sleep.  Other symptoms of panic are

• An unexpected, overwhelming feeling of terror
• Feeling flushed, lightheaded, faint, nauseous, or dizzy
• The sensation of chest constriction and difficulty breathing;
• Heart racing and pounding in the chest
• Thoughts of dying, losing control, of going crazy, or of impending doom
• Sweaty palms
• Feeling numbness and tingling in the extremities, especially if hyperventilating
• Sensing an unreality about things
• Extremely avoidant of fear or anxiety triggering situation or physical sensations, as loud noise, an odor, or a stuffy, hot room

These episodes can be very disruptive, disturbing, and disabling. One explanation for the cause of the panic attacks is that the body’s typical alarm system of mental and physical responses to an actual threat – “fight or flight response,” gets triggered and activated when there is no real threat present. Panic increases in severity with hyperventilation, focusing on catastrophic worries and fears, and from escalating anxiety.

Panic disorder episodes might be related to some identified causal or contributing factors as

1. An actual or transient medical problem as a middle ear infection, allergies, mitral valve prolapse (often a mild dysfunction of this heart valve closure), hyperthyroidism, low blood sugar
2. Earlier life history of significant *trauma or post-traumatic stress disorder with embedded memories of prior trauma that are easily triggered by some environmental reminder in an already highly anxious and hypervigilant person.
3. Medications use, or withdrawal; stimulant or substance use, or abuse (caffeine, alcohol, opiates, etc.) can lead to greater vulnerability to panic attacks
4. Overuse of stimulants like caffeine or non-prescribed or unnecessary stimulant drugs, or drugs of abuse as methamphetamine or cocaine
5. Life events involving significant stress, losses, threats of damage, or the feelings of increase vulnerability may precede panic attacks as the current mounting fears over Coronavirus.

Past trauma can cause greater susceptibility to anxiety and panic attacks.

*Trauma is defined by the American Psychological Association (APA) as “an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer-term reactions include unpredictable emotions, flashbacks, strained relationships, and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives”.

Significant trauma can also be defined as a situation or event which may be recurrent over time, as severe emotional or physical abuse. The originating, horrifying experience is usually associated with the overwhelming fear that one’s life, physical, or psychological integrity is threatened without the ability to defend one’s self or to survive intact. The emotional or physical reaction to the event or situation may be immediate or delayed.

Panic disorder can become recurrent and disabling. If the panic episode occurs in a specific setting, as in a store or car, irrational fears or phobias about these situations may arise. If a person begins to avoid these situations, he (or she) can become increasingly housebound, unable to drive and develop agoraphobia (fear of public places). If the person doesn’t receive effective early treatment, increasing incapacitation with life activities may develop.

Appropriate treatment when needed is a wise step.

A high percentage of panic-attack suffer, will be able to prevent and substantially reduce the frequency and severity of panic episodes. Therapies for anxiety and panic, as Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy (CBT) type of interventions, are often beneficial, especially if a history of trauma. These approaches can help retrain and recondition an individual to decrease stress and anxiety. See article from “BetterHelp.”

EMDR and CBT, as well as other holistic, humanistic, transpersonal or Holotropic therapies, may include:

• Education about the body’s physiological reaction to fear and threat
• Use of experiential as well as talk/listening, person to person, or group therapies
• Desensitization to the various physical sensations or triggers of panic through exposing a person to the actual object, situation or thought
• Catastrophic thought reducing techniques
• Learning relaxation, breathing, and stress management techniques
• Restructuring dysfunctional thoughts and patterns
• Assisting the process of gaining personal insights and the realization of one’s strength and inner vision of the power to overcome and survive
• Transformation of being the victim of horrible traumatic experience and memories to the liberation of a constricted range of view to a broader perception of life, one’s own power, and potentialities
• Acceptance that the mind is continually moving toward the healing of its own emotional and mental health and
• Promotes personal commitment to supporting the process and therapeutic work needed
• Supports the person’s process and strengths to release frozen past traumatic memories and constricting defenses, for the restoration of energy flow and vitality

For severe and recurrent anxiety or panic attack help and relief can be possible with effective trauma therapy that helps the person to

1. Get unstuck from unhealthy patterns of behavior, rigid beliefs, and fearful or painful memories
2. Reduce or eliminate anxiety, panic, addictions, and other trauma-related symptoms
3. Learn to focus more on the present, the here and now, rather than the past or future – development of presence, mindfulness, and awareness
4. Improve energy, focus, concentration, daily functioning, and skills to prevent relapse or recurring symptoms
5. Develop the knowledge of broader issues of life, death, pain, and suffering in human life and heritage
6. Regain the wisdom for the balance of personal power and self-needs with the collective needs and occasionally required sacrifice in the service of others
7. Reestablish social support and networks

Panic disorder mimics many other medical conditions, and it is not unusual for the sufferer to be seen by a multitude of other medical or health-related services before receiving appropriate help. Some individuals go through extensive testing and cost. The reassurance that “nothing is wrong that’s serious,” or “it’s all in your head,” doesn’t help. Healthcare providers are often not familiar with the potentially devastating effect and disability caused by the improper treatment of anxiety, panic, PTSD, or trauma-related illness. Treatment of anxiety or panic symptoms is often done with a mild tranquilizer or reassurance. Compared with other mental health conditions, untreated panic disorder, for example, has an increased risk of suicidal ideation. There is an almost three-fold increase in actual suicide attempts, independent of coexistence of major depression, alcohol or drug abuse, or agoraphobia.

Integrative, holistic, and natural alternatives therapies can be helpful,

especially if combined with more traditional treatment. There should be coordination of care, however, with a knowledgeable healthcare provider that has skills and expertise in working with anxiety, panic, and mood difficulties.

Some of the complementary approaches commonly considered are:

• Lifestyle modifications and life skill enhancements
• Mind, body and spiritual practice as yoga, chi gong, mindfulness, meditation, creative arts, exercise with mindfulness as running, swimming, biking, or dance
• Stress management and relaxation techniques
• Acupuncture and massage therapies
• Targeted nutritional therapies, botanical medicine, and nutritional education about dietary choices, and micronutrients (as with herbs, vitamins, minerals, essential fatty acids, and amino acids (the smallest units of protein and a precursor of brain neurotransmitters, can sometimes help relieve anxiety and milder depression in combination with other natural and complementary therapies)

Through an integrative approach, individuals can find help and move towards health and wellbeing.

Medication may be of value in resistant or severe panic disorder or depression if more natural or alternative therapies have not worked. Antidepressants as Zoloft, Effexor, Prozac, and tranquilizers as Buspar, Ativan, or Klonopin are used and sometimes bring more immediate relief. However, their long-term use is controversial with the concern for their possible cause of other medical issues. Trying to stop medication can lead to withdrawal, which can be difficult or, in the case of some of the tranquilizing drugs or alcohol can cause withdrawal seizures. They may not have the same lasting effect as the retraining and reconditioning that takes place with useful and appropriate therapy programs with the sometimes addition or use of natural alternatives.

**If severe depression, overwhelmed with severe anxiety, or suicidal thoughts, seek the help of mental health services, a qualified therapist, or psychiatrist, or contact  911, or the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)

Nine ways to reduce anxiety, support yourself, and others through the current threatening and worrisome times:

1. Reduce the time watching, reading, checking, or listening to news stories, on your T.V., computer, smartphone, tablet, or social media. Checking once or twice per day to keep informed would be nice. Hearing about the problems repeatedly during the day can lead to increased worry, anxiety, tension, poor sleep, or worse. Being overly sedentary as in watching the news all day instead of active movement and exercise only intensifies tensions and stress.
2. When you do news check-ins, for your couple times per day or less news fix and to stay informed, only listen or read credible medical sources for information. Avoid misinformation or politically motivated reporting about the virus.
3. Instead of too much inactivity and obsessing with the news, take frequent time outs with regular exercise, stretching, eating healthy meals (avoiding sweat binging and over-snacking on high sugar and caloric food), scheduled relaxation with deep breathing, meditation, or yoga. Stay on a regular schedule. Sleep to get adequate restorative rest. Use your time wisely as it is an excellent chance to cut down or stop smoking as smoking may put you at risk for respiratory (use a nicotine patch if necessary). Avoid alcohol and non-prescription drugs.
4. Keep to a regular exercise schedule as 10 to 30 minutes several times per day. Beneficial exercise can take many different forms. Examples would be walking, biking, walking stairs, housework as cleaning, or an exercise routine of your choice. Other choices would be participating in an online group exercise program, or in a circuit exercise routine as one which includes push-ups, lunges, jumping jacks, high knees, and running in place. Do relax, enjoy, and allow any worries and fears to go to the background of your awareness as you fully embrace the physical movement, breathing, and letting go of tension. After doing a good exercise routine, you can treat yourself with a nice hot bath with a couple of cups of Epson salt and a few drops of lavender oil to melt away any remaining tension.
5. Put some time into enjoyable recreational or artistic activities.  Do art and craftwork as painting. Read a good book. Complete home construction projects or prepare new recipes and meals. It is the time for creative homeschooling if you have children. Enjoy listening to music, dancing, or watching a good movie. Complete a crossword or jigsaw puzzle. Watch a comedy show for some humor and laughs.
6. Stay socially connected with friends, family, and community through video chats, texts, emails, or phone calls. Share your concerns about what you’re experiencing, or about positive things you are doing to manage your day, or about what has made you laugh amid all the outside turmoil.
7. Learn or do yoga, meditation, or beneficial exercise routines to help with destressing and relaxing. Look for some interesting instructional videos that you can watch online via computer, apps, smartphones, or tablets.
8. Let the current crisis – a time of significant disruption and travails – be a time to do an in-depth review of what is truly important and meaningful for you. Meditate and reflect on what is beyond your personal fears and self-preoccupations. Be aware of the more profound connection with everything outside of ourselves and our relationship with the immense complex universe of which we are but a small tiny part. Find some inspirational readings, recordings, or online materials from your own faith or from the perennial wisdom and teachings from the centuries of all the spiritual, mystical, or faith traditions.
9. Find a more profound meaning and purpose in the turmoil and tragedy that surrounds us. Being more centered and grounded will bring better preparedness for what may unfold in the coming days, which may call for the strength and the spirit to both do the best for yourself and others, while not giving in to fear or over-focusing on personal issues. Allow the current crisis and stresses to inspire you towards living a simpler, more meaningful life, to better serve the greater good, our community, our environment, and all creatures large and small.
   
   

Thank you for your interest and review of this article. You are welcome to make comments below.

Ron Parks MD

If you or a loved one needs help or guidance about any mental, emotional, physical, or related spiritual health issues, consultation is available directly with Dr. Parks by telephone or telemedicine services like Skype or VSee. To schedule a session or if you need a question answered, fill in the contact form at https://parksmd.com/scheduling/. Hopefully, I will be able to correspond with you directly about questions or address them in a future article or in my periodic newsletters. see the article on expert mentoring

**The above is for informational and educational purposes only, not as medical or mental health advice. It is the reader’s responsibility to direct personal medical or mental health questions to their primary care provider and specialty physicians. The information and statements contained in this material are not intended to diagnose, treat, cure, or prevent any disease or to replace the recommendations or advice given to you by your primary or direct care providers. Your reliance on any information provided by Dr. Parks is solely at your discretion. You are advised not to disregard medical advice from your primary or direct care providers, or delay seeking medical advice or treatment because of information contained in this article. Management of severe mental or physical health problems should remain under the care and guidance of your primary care physicians, specialist, or psychiatrists.

References and for further information:

Featured image lead into the article: ©boligolovag /123rf.com
Anxiety and Panic – time – COVID-19

See Dr. Parks’ previous articles on Coronavirus (COVID-19):

Coronavirus Natural Approaches

Coronavirus Holistic Health Steps

Other References and for further information:

Resource on Anxiety and Depression from Medscape; 

Information on Anxiety and Depression from ADAA

For support: Anxiety and Depression Association of America, ADAA

For more information see the help guide article on anxiety and panic

Taking Care of Your Behavioral Health during an Infectious Disease Outbreakexternal icon

Harvard’s Health Newsletter re Coronavirus

Learn more from the CDC about Coronavirus 2019/Preparedness, Managing Stress, and Anxiety:

Reducing stress in yourself and others

Information for parents

Information for responders

Information for people released from quarantine

Taking care of your emotional health.

Helping children cope.

Tips for taking care of yourself during emergency response.

Coping with a Disaster or Traumatic Event