by: Barbara J. Brown, Ph.D. for BWHI

For over two years during the pandemic, the world has been tested in ways that the current generations have not known before. Collectively, we are experiencing more mental health concerns and crises than have ever been publicly reported before. We can expect to continue to be tested by personal challenges.  But whether it is COVID-19 variants or something else, it will always be true that the greater the loss of control that we feel from something outside of ourselves, the greater the need will be to find a center of control within ourselves.  The term I have coined for this, Conscious Self-Care, denotes that the tools that are required to manage our stress-induced anxiety are within us and it is more important than ever to learn to cope and manage ourselves.  This does not apply to those who are not fully able due to age, such as children, or individuals with disabilities such as severe mental/physical illness or cognitive/neurological limitations. They need the assistance of others to achieve optimal health. But taking charge of your own self-care does apply to adults that are capable of functioning in society at large.

The most common threats to our mental health and emotional well-being during extreme stress are first, anxiety and secondarily, depression or its flip side, anger. Boosting our internal coping skills is our best defense to manage our mental health. This is a personal challenge, but crisis offers an excellent opportunity for change and growth. If we can mobilize the energy that comes with anxiety and fear to consciously care for ourselves, we can decrease or even prevent more extreme symptoms such as mental paralysis, panic, depression, rage, and/or hopelessness.

At its core, anxiety is the loss of feeling in control.  When we look outside of ourselves for a solution, we are prone to anxiety.  When we do not radically accept that which we cannot control or change, we are prone to anxiety.

Fear is different from anxiety.  Fear is a survival response to an immediate threat.  Fear is useful in activating our fight, flight, or freeze response to survive danger.  Anxiety is the worry that something bad will happen to us.  Anxiety is in the future; it has not happened yet.  We need to control our anxiety so that it does not control us.

Creating positive habits:  In order to build our emotional immunity to stress, attending to core areas of sleep, exercise, and nutrition are necessary to create a foundation for emotional wellness.

Anxiety can keep us awake at night and depression can often wake us up in the middle of the night.  Some common sleep hygiene techniques you can use to improve your sleep and battle insomnia include:

1. Choose a regular sleep and wake time.
2. No electronic devices of any kind (phone, TV, tablet) at least one hour before bedtime.
3. Do a “brain dump” of what is on your mind and/or to do list by journaling outside of your bedroom. Uncensored therapeutic journaling is a proven technique to provide a necessary release for emotions and thoughts that are preoccupying your mind and mood.
4. A wind down routine such as warm milk or soothing tea, a warm bath or shower, reading, prayer, etc.

Anxiety, fear, and anger as well, are mobilized by the hormone, adrenaline, that regulates the fight, flight, or freeze response.  However, because there is no immediate threat with anxiety, additional energy is present. In order to release the excess energy in a healthy way, at least 30 minutes of aerobic exercise, such as walking, running, biking, swimming, is generally recommended daily.  Because regular exercise can also lead to stimulation of mood elevating endorphins in the brain, it is also highly recommended to decrease depression and stress in general.  Exercise also provides a physical release to calm anger. You don’t need gym equipment at home to exercise; free aerobic and yoga routines are accessible on YouTube.com or you can simply walk up and down your steps.  Do what you can based upon your physical fitness and medical advice.

An in depth review of nutrition specific to alleviation of anxiety and depression is well beyond the scope of this article, but general guidelines of eating a balanced diet, staying hydrated by drinking sufficient amounts of water, and limiting or eliminating alcohol and caffeine are standard recommendations.  With both anxiety and depression, food and drink intake are often dysregulated by eating or drinking less or more than usual.  Both excess and deficiencies have harmful consequences.  Staying conscious of eating regularly and nutritiously and staying hydrated is key.  There are specific foods that are associated with the reduction of anxiety and depression as well as for stress in general and I encourage you to research them further.

Creating structure and routine:  In order to feel a sense of control, and to actually take control of our lives in the midst of external uncertainties it is important that we create our own routines.  For the great majority of us, our normal routines such as going to work, school, or places like the gym were disrupted during the pandemic.  If you have not yet created new routines please do so. We know that routine is necessary for children to feel a sense of stability and safety, but adults need it too!  One of my favorite routines is found in the book The Miracle Morning by Hal Elrod. The six steps of silence, affirmations, visualization, exercise, reading, and scribing (SAVERS) create a wonderful beginning for each day.

Beyond a sleep, food, and exercise routine, consider creating structures to decrease or increase certain activities.  One of the effects of telework and essentially having your home become the center of your total world is the blurring of boundaries, especially between work time and relaxation/self-care time.  Setting limits and boundaries for work, watching TV, time spent alone versus connecting with others in your home or by phone/text/or audiovisual devices can help. Being closer to home also presents an opportunity to increase productive and/or creative activities.  Consider completing those rainy-day projects or creating new ones. Read a great book.  Try monitoring your daily activities to see how you are spending your time and make modifications accordingly.

Even when work time at home is during the same hours as we would normally have, it can feel quite different.  We may need new kinds of breaks than we are used to.  Being in front of the computer screen too much may necessitate creating breaks on the hour to get up to stretch and walk around. Four hours per day (or at least two) are generally recommended as the amount of time we should be standing up.  Sitting too much is bad for our health.

Creating a soothing environment:  Having different spaces for work, sleep, exercise, and relaxation are ideal.  Even in a studio apartment you can use your 4 corners to create and differentiate your view.  If you do not have it already, think about creating a wall, corner, or room to use (separate from your bed) as a place of calm.  Only things that are good for your soul survival are to be allowed there.  Spend some dedicated time there each day and see what a difference it makes.  It’s perfect for your get-a-way from work, family, and all the stressors of the world, even if only for a few minutes.  Calming activities such as self-reflection, journaling, breathing exercises, meditation, yoga, aromatherapy and other creative and unique-to-you activities can be done in that special space.  It is yours and you own it.

Creating a cognitive mindset:  Radical acceptance (Linehan, 1993) saves a lot of emotional time and energy.  Simply put, radical acceptance means that you accept reality as it is, and as a result of that acceptance, you do what needs to be done given that reality.  It also takes away the need to judge it as good or bad, even though you may decide that the impact on you is or is not healthy.  What radical acceptance means in the face of extreme stress is accepting the reality its impact on us mentally, emotionally, physically, financially, and in our relationships. Once we are in touch with how we are feeling, we can focus on how to help ourselves.

Our ability to manage this crisis is exponentially better when we acknowledge what is happening and then act in a self-caring way to handle it to the best of our ability and to the extent that we have control over it.  Being in denial, distorting your personal situation as worse or better than it is, or not paying attention to your own needs at this time will only make things worse.

Creating self-soothing practices:  In addition to the strategies previously listed, tried and true ways to manage anxiety include:

1. Breathing exercises:  Slowing down your breathing helps bring your nervous system back into balance.  As stated previously, anxiety activates our adrenal system and breathing techniques can reduce physical symptoms.  One of the easiest techniques to begin regulating your breath is known as the 4-7-8 or Relaxing Breath Exercise (Andrew Weil, M.D.).  Essentially, the 1^st number is used to count seconds to breathe in through your nose, the 2^nd to hold your breath, and the 3^rd to exhale through your mouth.  The number of seconds used in each part can be changed to match the breath capacity of an individual.  Breathing exercises are commonly used by mental health practitioners to help clients’ calm their anxiety and are a part of many yoga and meditation practices.  The 4-7-8 technique, and other breathing exercises are demonstrated on Dr. Weil’s website www.drweil.com, YouTube.com, and other on-line sites.

• Mindfulness:  Anxiety is an emotional state about a negative situation that has not happened yet and is not based on objective evidence in the present.  Mindfulness is the state of being fully and intentionally present in the moment.  Therefore, practicing mindfulness offers an opportunity to redirect and replace anxious feelings and thoughts with calm and controlled feelings and thoughts. Grounding techniques are methods that help decrease anxious feelings and thoughts through heightened attention to the present using our 5 senses. There are many that are used. 

The ‘54321’ method (unknown developer) is a common grounding technique that is used to rapidly bring your mind back to the present and out of “anxiety-land” as I like to call it.  It goes like this:  Look for 5 things you can see.  Become aware of 4 things you can touch. Acknowledge 3 things you can hear. Notice 2 things you can smell. Become aware of 1 thing you can taste. Repeat as needed to become present.

Being able to be mindful becomes easier to achieve the more you practice it.  Just like calming yourself down physically through exercise and/or breathing techniques, when you are fully present in the moment, anxiety dissipates.  Once anxiety is substantially lessened, our ability to think, solve problems, and cope with reality is greatly enhanced.  Also, what we personally have control of, is only possible in the present.  We cannot control what has happened or will happen, but we can take control now.

• Meditation: Although mindfulness can be used as a form of meditation, there are many meditation methods to achieve a calmer sense of being and emotional balance.  Whereas mindfulness can be done anywhere at any time, we generally think of meditation as a more formalized, intentional practice.  There are seated, walking, or other activity-focused meditations such as yoga, and they can be spiritually based or secular.  All can be useful according to your preferences, values, and beliefs.  Prayer practices and/or guided meditations are commonplace. I often recommend guided meditations by well-known authors including Jon Kabat-Zinn, Tara Brach, and Pema Chodron to my clients. They are readily available through Amazon, Barnes & Noble, Books A Million, Politics & Prose or your other favorite place to get information.  If you use prayer, your religious or spiritual practices dictate what is needed.  During particularly stressful times such as these, regular meditation practice (daily if possible) can create a calm center in your spirit and build resilience.

Seeking specialized assistance:  The techniques listed above can be done on your own for the most part.  However, if you find that they are not working well enough for you, please seek specialized help.  Different types of psychotherapy techniques can help in different ways.  To name a few: Cognitive Behavioral Therapy (CBT) can assist in discovering and managing negative thought processes and their impact on psychological functioning; Dialectical Behavior Therapy (DBT) can teach coping skills, emotional regulation, and healthy interpersonal boundaries; Psychoanalytic therapies can root out and heal underlying causes of psychological states and symptoms; and Existential/Phenomenological therapies can facilitate understanding and clarification of one’s experiences in the world.  If you are already in therapy, speak with your clinician about additional help you may need to feel better.

Managing physical and psychological symptoms of anxiety, depression, and other mental health conditions are often assisted by other health professionals, most commonly by psychiatrists, primary care physicians, nurse practitioners, naturopaths, homeopaths, and certain nutritionists.  Utilizing psychotherapy in addition to one or more of these health care professionals often greatly enhances therapy outcomes.  Medications to calm and manage emotions can be very helpful.  If you need a referral, ask your therapist and/or your insurance provider.

Please do your best to practice Conscious Self-Care, stay safe, and seek professional help as needed during these trying times.