Covid and anxiety - going round in circles
Last year, the Lancet medical journal published research into incidence of anxiety during the first UK lockdown. Unsurprisingly, they found that rates went up considerably. Researchers also found, however, that the incidence and severity of the anxiety dropped by the third week of lockdown. Why? After all, our situation hadn’t improved and, by three weeks, infection rates weren’t coming down. Before I attempt to answer this, I’d like to look at what anxiety is, what is does and what causes it.
Anxiety is the result of hormonal responses to threat. This is referred to as our stress response. The changes enable us to be hyper-vigilant and geared up to respond to threat. Fifty thousand years ago, this might have been the threat of being attacked or even eaten. These days, unless we are in a war-zone, an accident or are assaulted, it is most likely that we experience their effects in situations which put us under stress and induce worry. These may seem trivial issues in comparison, but the body doesn’t differentiate this way. The source and perception of threat are at the heart of what we identify as anxiety in modern life and we usually don’t get to choose what we find threatening to our well-being. Some of us spend much more of our lives in this hyper-vigilant, tightly coiled state than others.
The impacts of stress hormones (adrenaline and cortisol) on our body include: increased heart rate and blood pressure; feeling ‘on edge’ (and finding it difficult to focus on a task), difficulty in controlling breathing, ‘clamminess’, loss of appetite and loss of sex drive. They are characteristic of what we refer to as anxiety. So too are sleep disturbances, because the last thing these hormones will promote is rest. When the effects of these hormones wear off, we ‘come down’. The experience has literally pumped up our heart, used up lots of energy, caused muscle tension, prompted firing of neurons all over our decision-making centres and much more. The result is often emotional and physical exhaustion.
Experiencing occasional anxiety is a normal part of life and undoubtedly more common in circumstances such as the current pandemic. Where someone frequently experiences intense, excessive and persistent worry and fear about everyday situations, they may be living with an anxiety disorder. Often, anxiety disorders involve repeated episodes of sudden feelings of anxiety and fear or terror that build to a peak within minutes (what are often referred to as panic attacks). I don’t intend to consider anxiety disorders at length here, as I don’t think I can give them the attention they deserve. If you are concerned about these, it is best to seek professional help. It’s really about finding the best therapy for you, whether that be medicine or talking therapy, or a combination.
What causes anxiety?
We all have our own triggers, but some of us are more vulnerable to anxiety than others. The MIND website (see below) has a helpful guide to the issues that cause or exacerbate anxiety. They include existing physical and mental health problems, the effects of drugs or medication and past or childhood experiences. In each case there may be very good reasons why the body is releasing stress hormones as you deal with pain, the bodily changes caused by external substances or the increased sensitivity resulting from an uncertain past. The effects can be exhausting. Anyone who has only really experienced a short period of stress, due to work, domestic commitments or short-term medical uncertainty can only imagine how exhausting.
The fourth major causative factor MIND address is ‘your current life situation’, otherwise known as ‘situational anxiety’. This is the factor which has had the most attention of late. Along with depression, it is arguably the ‘mental health’ concern most cited as a consequence of the challenges of dealing with Covid. The world of uncertainty, threat to health, social isolation and economic instability into which we have been plunged of late will very likely have affected many people who had not previously experienced on-going anxiety.
There’s a useful way of thinking about the anxiety we all feel in our lives.
It involves the relationship between the things that concern us, and the things we feel we have the ability, or power, to influence through our actions.
The concerns and our influence are represented by two concentric circles. The circle of influence sits on top of the circle of concern. The sizes of the circles differ depending on our circumstances. In an ideal world, our influence would be so wide that is would entirely match our concern, leaving no concern uncovered and nothing to worry about that we couldn't do something about.
Where does situational anxiety come from? For me it's simple. Situational anxiety is the gap between the two circles. It is the result of the threat caused by things in our lives over which we feel we have little or no influence.
In this time of pandemic there are many extra or intensified concerns: The health of our loved ones, our own health, employment, education, social isolation. The list goes on.
Inevitably the more we increase concern, the bigger the outer circle gets and the more anxiety grows. At the moment, some of this is just inevitable. After all, a viral pandemic is not within the control of any one person.
But here’s the thing. Of course our anxiety increases as the outer circle gets wider, but it also increases when the inner circle gets smaller. If our sense of agency reduces; if we feel less in control of our lives and less able to make effective decisions, this shrinks the inner circle. The result here is that anxiety increases even more.
What can we do? We can try to increase the size of our circle of influence and reduce our circle of concern. Doing these things is never easy, but at the moment, it’s a real challenge for all of us. How can we do it?
Where you can, plan
I think this is one situation where the adage to ‘hope for the best and plan for the worst’ is true. I think it is probably best to keep plans as simple as possible and well within what we think the guidelines are going to be at any one time. That way, they are less likely to be sunk by last-minute changes. I think it is, however, important to have plans and structure. Structure for our days, our weeks, our work and, where possible, our socialising (even if it is on the phone or Zoom.) Planning and providing structure are pro-active approaches which increase our sense of control. They help to keep our circle of influence from shrinking.
Challenge negative thoughts
So, why did levels of anxiety fall during the last lockdown? I think the answer is that we had become used to a new way of living. It wasn’t ideal, but there was a rhythm and predictability to life. We had lost freedoms, but we had established patterns of living. We had regained some of our sense of agency. In a limited way, we had expanded our circle of control. As a result, for many, situational anxiety reduced. It wasn’t fun, but levels of anxiety came down for many people as we adapted and found a way to live our lives. If this was true for you, you have evidence that you can manage and bounce back.
Use relaxation techniques
In my experience, people fall into three broad categories: Those who practise relaxation techniques and mindfulness and swear by them; those who would like to practise them but have never found the right one for them and those who think it’s all ‘a bit Californian’. The truth is, there is lots of research to show that relaxation techniques work (see the links below for more) but if they aren’t for you, walking a dog, sitting in a park, following a hobby will all help. So will listening to or playing music. Whatever allows you to stop thinking about the future and focusing on your circle of concern will probably do you a lot of good. If can take the focus away from your circle of concern and reduce its hold over you, it will shrink… and hopefully reduce the situational stress you experience.
I've listed below some useful sources of advice on how anxiety works and how to manage it. There are many more out there. Being aware of what is going on in your body is itself a way of regaining some control and maintaining the circle of influence in your life. So is talking to someone who gets it, and these people do. You may well have others closer to you who will listen and provide support. If this is available to you, take it.
As a final reflection, I think many of us experience immense pressure because we are so unforgiving of ourselves. When most of us are trying really hard to be generous towards others as they manage their lives in challenging times, it would be nice to think we could spare a bit of empathy for our own situation. There’s enough to worry about in the world at the moment without the added burden of meeting the expectations of our own internal critic, who constantly chips away at our perceived circle of influence and increases our concerns.
MIND (mental health charity)
CALM (Campaign Against Living Miserably. A charity providing a mental health helpline and webchat.)
Phone: 0800 58 58 58 (daily, 5pm to midnight)
Anxiety UK (Charity providing support if you have been diagnosed with an anxiety condition.)
Phone: 03444 775 774 (Monday to Friday, 9.30am to 5.30pm)
SANE (Emotional support, information and guidance for people affected by mental illness, their families and carers.)
Textcare: comfort and care via text message, sent when the person needs it most: www.sane.org.uk/textcare
Peer support forum: www.sane.org.uk/supportforum
YoungMinds (Information on child and adolescent mental health. Services for parents and professionals.)
Phone: Parents' helpline 0808 802 5544 (Monday to Friday, 9.30am to 4pm)