Dear doctor,
I’m living away from my family and haven’t been able to go home for some time. I’m so isolated that sometimes I find myself talking to myself. Going out scares me and not going out is making me so sad that sometimes I forget to eat, or bathe. All I do is look at the phone and the COVID news. I feel it’s not getting better. The news is so scary – what if once I graduate I can’t find a job? The worry keeps me up at night. Right now, because of parents I’m able to live in a studio myself – my roommate left for his home country about 6 months ago and I’ve been living by myself since then – but what happens when they can’t pay for me anymore?
A reader who wishes to stay anonymous asks
Answered by Dr Jihene Mrabet, Clinical Psychologist and Assistant Professor at The American University in the Emirates
Dear Reader,
I understand your worries and I know that this pandemic has negatively affected many people. The COVID-19 pandemic was like thunder in the middle of a sunny day. No one really expected that this new virus discovered in China would spread all over the world and change the fragile balance of human life.
Starting from China, a research conducted by Wang and his colleagues (2020) on COVID-19 and anxiety supported that 53.8 per cent out of 1,220 participants experienced severe psychological impacts of the outbreak. Indeed, 16.5 per cent suffered from severe levels of depression, 28.8 per cent reported facing anxiety issues and 8.1 per cent were dealing with continuous stress.
The research of Abdul Majeed and his colleagues in Saudi Arabia (2020) on the psychological impact of COVID-19 pandemic demonstrated that out of 1,160 respondents 23.6 per cent reported moderate or severe psychological impact. The authors also added that almost 28.3 per cent reported moderate to severe depressive, anxiety, and stress symptoms.
Other research conducted by Dubeya and his colleagues (2020) on the psychosocial impact of COVID-19 underlined that nationwide lockdowns provoked acute panic, anxiety, obsessive behaviours, hoarding, paranoia and depression. They also warned about the spread of racist outbursts among citizens that were less able to control their anger and frustration and started behaving aggressively against others.
Indeed, because of the imposed confinement and the increasing number of positive cases, many people have been impacted negatively and started to manifest signs of psychological distress such as insomnia, eating disorders, hallucinations, mood disorders, phobias, addictive behaviours, family violence…
Fear, worry and stress are normal responses to perceived or real threats. As human beings, we need to experience control over our lives. The more predictable the events are, the less anxious we feel. Uncertainty is impeding our capacity to project ourselves in the future and thus hindering the installation of a clear road map.
This is what is happening to you now, you are wondering how your life will evolve, you feel threatened, exposed to an imminent danger without any possible recourse. Many factors are fragilizing your actual situation: being far away from your family, social isolation, fear of getting infected by the virus, overthinking, and fear of the future.
Let’s discuss these manifestations and explain the appropriate coping mechanisms that should be implemented.
Being far away from family
This is a factor that increases worries. The inability to frequently check on our family members, wondering whether they are safe or not, the need to be reassured and protected by our parents are major reasons that sometimes keep us awake at night. Family is our pillar providing us with emotional and spiritual support whenever we need. This is where we have learned to be who we are today, where we have met our first joy, our first pain and where we explored the value of warm relationships. For all these reasons, this estrangement is most of the time very difficult to endure. Nevertheless, leaving the nest and learning to fly using your own wings will help you to become an independent person and will strengthen your personality through exploring and developing your own coping mechanisms on the face of life problems.
Try this
Don’t forget that you can still maintain daily contact with your loves ones wherever they are by using the diverse communication channels on the internet. I agree that virtual meetings will never replace the warmth of a family evening but it gives you the possibility to stay in touch against the odds. Guide your family members through the process of downloading internet applications and use them as much as you wish. You can also agree on a setting a regular time to meet every day and to discuss your respective day’s events.
Social isolation
Even if it advisable to maintain social physical distancing, I advise you to keep social interactions very closely. Be careful! Prolonged social isolation could generate deep disconnection among those who live alone or cannot rely on an adequate social network, increasing the likelihood that depressive symptoms will emerge. Social isolation is very harmful to your mental health but also it impacts your physical health by impairing your cognitive abilities such as concentration, memory and processing new information, by reducing your immunity and also increasing the cardiovascular disease risk.
Loneliness and isolation have been linked to depression, irritability, and preoccupation with negative self-related thoughts. What is also very important to know is that social isolation can persist beyond the crisis and can be experienced even when others are physically present. Researchers have demonstrated that loneliness increases cortisol levels, which would provoke high levels of anxiety and depression.
Try these tips:
- Organise your schedule in order to spend more time to connect with your friends and family.
- Pay attention to the other people in your life and try to be less distracted by your phone or your work.
- Practice active listening in order to enhance the quality of communication with your family and friends. Spend more time to understand their needs and to provide them with emotional support when needed. Always remember that love and care is endless, the more you give, the more you get.
- Express yourself and share your feelings with your friends. Never expect others to guess how you feel or what you want. Remember that everyone is going through his own worries and we should be supportive with each other.
- Recognise unhealthy relationships and avoid spending time with toxic people. Toxic people are individuals that would criticise you all the time. They are not supportive and are always absent whenever you need them. They keep manipulating you for their own interest and would make you feel guilty for no reason.
Fear of getting infected by the virus:
Some researchers (Alisha Arora, Amrit Kumar Jha, Priya Alat and Sitanshu Sekhar Das, 2020) tried to conceptualize the fear of getting infected by coronavirus. Corona phobia is characterised by:
- Physiological response: Constant worry can cause symptoms such as palpitations, tremors, difficulty in breathing, dizziness, change in appetite and sleep.
- Cognitive response: Fear of virus would involve preoccupation with threat-provoking wrong cognitions (such as “I will die if I contract the virus”; “I will not be able to go to my job and will be unemployed”; “My family is under danger and they may die”. The cognitions may further trigger emotional responses, like sadness, guilt and anger.
- Behavioural response: Active engagement in avoidance behaviours such as marked fear of using public transportation, touching any surface, being at open places (markets, beaches, stadiums) and at enclosed places (hotels, shopping malls, movie theatres, indoor stadiums), attending any public gatherings, and standing in queue. The individual fears and/or avoids situations like meeting people or overindulges into health-related safety behaviours (like washing hands). Reassurance behaviours such as constantly checking body vitals, confirming absence of illness, self-medicating or rechecking sanitation perpetuates fear, leading to phobia.
In order to face your fear, you should be reasonable and cautious, but never be frightened.
Let me share with you some strategies that could help you controlling your panic:
Stay away from social media and up-to-the-minute news: Remember that news channels are feeding worst case stories and most of the time don’t focus on positive information about recovery cases. Focusing on horror stories fuels anxiety and fear. Keep in mind that humans suffer from a cognitive bias that makes them focus on negative signs more than positive in order to survive.
Focus on facts: If you would like to have accurate information, please refer to trusted sources such as The World Health Organization or Centres for Disease Control and Prevention (CDC). Stay away from rumours and check any information you read on social media accounts before believing it.
Actively remind yourself of reasons not to worry: Whenever you feel afraid, don’t let yourself get overwhelmed and start rationalizing it by finding out why you are experiencing this emotion. Once you clarify the reasons behind it, think about the behaviours you apply in order to keep yourself safe every day. Reassure yourself with steps you’re taking recommended by the CDC or WHO like washing your hands, wearing masks, respecting social distancing and staying away from concerts and large venues. Never let your fears take control of you!
Create a new routine: Even if your freedom is restricted, it doesn’t mean that you should stay all the time at home and imprison yourself. Revise and reorganize your schedule so that you can plan time for a walk, meeting a friend, going to a restaurant. As long as you are respecting the safety measures, you can enjoy your life. Keep on practicing your hobbies or try new ones such as playing a musical instrument, reading, painting, meditating… These activities can prevent you from panic mode and will distract you from checking news every now and then.
If you are living alone, don’t stay alone! Keep and nurture social relationships!! Call friends or family members. Many studies demonstrated that keeping contact with friends help decreasing anxieties and depression.
Finally, I would like to mention that if you feel that you are not getting better after resorting to these strategies, please seek some help from a mental health specialist (a psychologist or a psychiatrist).
Overthinking and fear of the future:
Keeping on thinking about something in endless circles is very exhausting. Indeed, people that spend most of their time ruminating and pressurising themselves experience very high levels of stress that sometimes exceed their coping strategies.
Overthinking can take many forms: endlessly deliberating when making a decision (and then questioning the decision), attempting to read minds, trying to predict the future, reading into the smallest of details… overthinking persons will be always criticising themselves and running endless commentaries about whatever situation they have encountered during the day. They focus on whatever happened and keep wondering on how it could have been done in a better way, fretting about the terrible future that may await them. They imagine endless situations where they will be judged negatively by others, where they failed their goals or where something unexpected happened.
If you are having any of these thoughts, you may understand now why you can’t sleep at night. You got stuck in the 'overthinking loop' and that would stop your mind from relaxing and getting prepared for sleep. Sleep deprivation is also another factor that increases the likelihood of developing depression and anxiety issues. Indeed, lack of sleep may provoke memory and concentration issues, cause drowsiness during the day and escalate the danger of getting into accidents, impact your immune system negatively, exposing you to diabetes and heart disease risk, and finally provoke mood disorders.
Overthinking is destructive physically and mentally, it makes you more susceptible to depression and anxiety.
How to defeat overthinking
- The only way to defeat overthinking is by training your mind on new patterns of thinking. First of all try replacing the threatening thought by another one. Focusing on erasing the wrong thought won’t be sufficient. Whenever the fearful thought comes to your mind try to replace it by another one and picture it in your mind.
- Second, resort to cognitive restructuring. Be critical and cultivate psychological distance in order to create different interpretations of the situation that would make you look a little bit more on the half-full glass.
- Third, you can resort to some reframing. If you keep overthinking about an idea, try to rephrase it in a way that would emphasise the positive outcome you are hoping for.
- Fourth, you can write your thoughts down in a journal every night before bed or first thing in the morning. That would help you getting them out of your mind and would also facilitate restructuring them and coming up with novel solutions.
It takes practice, but with time, you will be able to easily recognise when you are worrying unnecessarily and choose instead, to act appropriately rather than keep wondering day and night. For example, convert, “I can’t believe this happened” to “What can I do to prevent it from happening again?” or convert “I don’t have good friends!” to “What steps could I take to deepen the friendships I have and find new ones?"
I hope I have provided you with some clarifications and directives in order to overcome your strain and change your perception about your situation.
Life isn’t too dark or too bright. Life is made out of shades of colours. Take initiative, apply positive actions, plan and organise your life goals and most importantly, take a step forward toward the future you would like to have.
If you have questions that you would like answered by a mental health professional in the UAE, please write in to readers@gulfnews.com. Also, please let us know if you'd rather stay anonymous.
Disclaimer: This blog is a conversation and is not an alternative for treatment. The recommendations and suggestions offered by our panel of doctors are their own and Gulf News will not take any responsibility for the advice they provide.
