Worried Sick: Fighting Stress and Anxiety in the Midst of COVID-19

If you’re feeling stressed or anxious about COVID-19, you ought to know that you’re not alone. The virus is dominating news cycles and inundating health care providers. With so much uncertainty surrounding its mounting impact on daily life, it can be easy to feel concerned, overwhelmed, and afraid.

CUIMC Today sat down with Anthony Puliafico, PhD, director of the Columbia University Clinic for Anxiety and Related Disorders–Westchester and its Anxiety Day Program. We talked about the long list of concerns that can accompany a public health pandemic like COVID-19. Here, Puliafico offers some helpful advice for practicing self-care, helping patients problem solve, and not worrying yourself sick.

This interview has been edited and condensed for clarity.

People are understandably nervous in light of the growing number of cases of COVID-19 in New York state and abroad. If I were your patient and I came to you with stress or anxiety associated with this virus, what would be the first thing you’d tell me? 

I’ve been starting by validating patients’ concerns; it’s very reasonable to feel stressed right now. We’re all feeling it.  

Certainly, COVID-19 is a risk. But responding in certain ways can make us feel more anxious about the risk we face. Often, excessive worrying can get in the way of developing clear plans for handling a challenge. I have been encouraging my patients to focus on what they can control. Instead of focusing on “What If?” questions, develop a specific plan for you and your family to stay safe, meet your responsibilities, and stay socially connected. Having and following a clear plan can help us feel more in control and less anxious.

At the same time, right now we are all forced to live with a good amount of uncertainty related to COVID-19. This may seem very difficult for many of us, but it’s important to remember that we all have experience living with uncertainty and risk. Many of us have dealt with the experience of waiting for medical test results or about a job for which we interviewed. I am encouraging my patients to consider what helped them tolerate uncertain times like these in the past and applying it to the uncertainty we face with COVID-19.

Anxiety at the right level can be helpful in spurring us toward positive action and keeping us safe. But what about that rampant anxiety that stokes irrational fears and even catastrophizing? How do we separate helpful anxiety from unhelpful anxiety and determine the right amount of worry? 

I would frame it a bit differently. We have to ask ourselves, “What’s a helpful level of concern and action?”

It is very important to follow safety guidelines, such as washing your hands, avoiding touching your face, or social distancing. But I think it’s helpful to ask ourselves: Is this particular behavior helping me stay safe, or am I doing this just to reduce my anxiety? 

Does it make sense to Purell right now to stay safe, or do I want to Purell because I just read something upsetting and cleaning my hands makes me feel less anxious? Am I following the news because there is information I really need about COVID-19, or am I doing this to reduce anxiety and get as much certainty as I can? Sometimes those efforts—those behaviors that reduce our anxiety in the short term—prevent us from learning how to live with anxiety and with some uncertainty.

So, I’ve been encouraging folks to stay safe but also recognize the things they’re doing primarily to reduce anxiety, particularly if those behaviors aren’t actually helping them minimize risk.  

What about our clinicians and other health care providers? They’re likely dealing with a number of patients who are scared about COVID-19. Any advice for leveraging a positive bedside manner and easing patient fears during this kind of situation?

Like I said before, I think validating our concerns up front is key. It’s important that we’re letting our patients know that we understand that they’re concerned and why they’re concerned. We’re all in this together right now.

I also think it’s important to provide facts and promote problem solving. I’ve been checking in with patients, both adults and children, about their understanding of COVID-19. I try to pick out those areas in which they may not have enough information, or even misinformation, that might be fueling their anxiety. Are they only paying attention to the most threatening information that we have? Are they engaging in catastrophic thinking, which can actually prevent us from appropriate problem solving? 

I’ve also been problem solving with patients about what they can do to actively manage their concerns about themselves or others. For example, we can help our patients think through options for continuing to work or shop while minimizing exposure risk. Or encouraging patients to stay socially connected with family, friends, and coworkers that they can’t see in person these days. Really, helping patients come up with concrete solutions in this way can be tremendously helpful, because problem solving becomes much harder when we’re anxious.

And finally, we really try to encourage self-care for our patients. We should encourage them to keep doing those things that help us feel good, even with COVID-19 risks, whether that’s exercising, or socializing, or engaging in hobbies, provided they can do those things while practicing social distancing. We’re all a bit limited right now, given restrictions, but we have to find ways to keep those things in our lives and ensure that we’re taking care of ourselves.

People working within a health system like CUIMC might experience a unique set of stressors associated with their environment and providing care for those who are ill. Are there extra measures those people can take to ensure they’re practicing self-care and staying well?

Besides the basics—get enough sleep, try to get some physical activity in—I think it’s important that we all set appropriate boundaries and limits for ourselves. I know health care workers are being stretched right now to manage this concern. But it’s important for each and every one of us to carve out time in our lives when we are truly off from work and from COVID-19 concerns. This time should be free of work emails and texts, as well as following COVID-19 news, so that we can fully refuel. Many of us feel guilty when we turn off work completely, but it is especially important these days to prevent burnout. 

Secondly, I would encourage all of us to be checking in with colleagues. I would encourage us to connect about our shared experiences managing COVID-19. These are unprecedented times. Having that sense of connection with our colleagues can help us get through it.  

Finally, it is important that we are kind to ourselves at this time of uncertainty. We are facing a new health care challenge, and guidelines, rules and policies are changing constantly. We can’t expect ourselves to be perfect, and beating ourselves up over mistakes can lead to greater stress.

One of your major specialties is child and adolescent psychiatry. What advice would you offer for those of us with children at home, who may be experiencing their own anxiety related to this virus?

It’s really important to be thinking about how we talk to our kids about COVID-19, and my first piece of advice is just that: Talk about it. 

I would encourage parents or people working with kids to assess our kids’ understanding of COVID-19 and to be curious about what they know. It’s important to know what they understand if they have any misunderstandings about COVID-19 that might be making them more anxious. There are a lot of rumors out there, and kids are more susceptible to believing rumors than adults. 

I also think it’s important to provide our kids information in developmentally appropriate language—to not share too much, but to share enough that helps kids know what we’re dealing with and how to keep themselves safe. NPR has this great little comic strip for kids about COVID-19. I’ve used it with several of my patients and the visual aid has been a terrific help. 

It’s just as important to think about what we’re modeling for our kids. I encourage parents to be aware of how they’re talking about COVID-19 with other adults in the home. In general, it’s important to model an appropriately calm response for our kids. As parents, when we’re in front of our kids, are we engaging in behaviors that might fuel anxiety? Are we Purelling every few minutes or maybe following the news too closely?

The final piece of advice, for adults and children, would be to limit how much news is consumed in the home. I think it’s very easy to have the radio or a news channel on 24/7 these days. The way we consume news today, especially during an event like this, can be anxiety provoking for adults and even more so for kids. Try to limit that exposure.