How to stay grounded during Coronavirus

Photo by Drew Coffman on Unsplash

Is the Coronavirus pandemic affecting your mental health? Has your usual routine has gone out of the window? Do you feel like you’ve lost direction?
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It is well known that public health emergencies can affect individuals in myriad ways. Examples include the following [1]:

• loss of personal freedom, which can cause boredom, stress and frustration
• emotional effects of quarantine such as social stigma, or caring for sick family members
• economic losses
• reduced social connection (social isolation from friends and family, and work or school closure)
• emotional distress such as anxiety, depression, substance misuse, or worsening of pre-existing mental health issues

But it isn’t all bad. Let’s look at some positives.

It’s important to remember that many of us have strengths and resilience, and that communities can pull together in innovative and mutually caring ways which combat the negatives of a pandemic.

The Black Dog Institute have a wealth of practical information on their website specifically to help with anxiety, stress and wellbeing during Coronavirus.

In addition, the Australian Government has pledged a number of packages [2] to support people in the community, such as phone and online support services, ongoing psychosocial support for Commonwealth community mental health clients for a further 12 months and expansion of the Government’s digital mental health gateway Head to Health.

And perhaps we will have learnt some useful lessons by the time we are on the other side of the pandemic: how we want our relationships to be, or how we want to live in the future.
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The good news is that a healthy sleep-wake cycle and good routine are traditional ways that help many people manage their mental health.

Photo by @Alice Lam

​The circadian rhythm

The brain’s hypothalamus gland controls the organ systems of our body via hormones, or chemical messengers. A fall in light (such as during the evening) is detected by our eyes then affects a group of cells called the Suprachiasmic Nucleus (SCN), or ‘master clock’; this in turn causes an increase in production and release of melatonin, which makes us sleepy.
This process provides us with a circadian rhythm, which can be affected by altered bedtime and waking times, shift work and jet lag.
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By the way, our circadian rhythm is just over 24 hours long, as in ‘circa’ nearly and ‘dian’ day and it is believed to have significant effects on body temperature, stress-hormone cortisol, even regulation of mood and body weight [3].

​How much sleep is enough?

The Mayo Clinic suggests adults need between 7 and 9 hours of sleep per night, and teenagers 8 to 10 hours [4]. 

How can we optimise our circadian rhythm?

In the world of chronobiology, “zeitgeber” (German for “synchroniser”) is an external cue that affects the body clock, such as light alerting us to the time of day. Early research by physiologist Jürgen Aschoff found that social cues such as mealtimes or work schedules can also act as zeitgebers [5]
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As well as improving our circadian rhythms with regular mealtimes and exercise, having some sort of routine can assist us in setting and reaching time-based goals, which can improve mental health. For instance, small manageable goals can help lower stress from overwhelm and reduce unhelpful procrastination.

Photo by Ethan Sykes on Unsplash

How do we end up with poorly structured days?

Routine can be disrupted through illness, whether it be physical or mental. This can cause a multitude of symptoms such as poor motivation, low energy, low/unstable mood and poor concentration.

Life events such as loss of employment, loss of regular social contact or interpersonal problems can also upset our balance.

Unhelpful thought processes where we over-identify with our thinking, known as cognitive fusion, can make it difficult to move forwards to a helpful behaviour. Examples might include: “I’m too lazy to do X” or negative thinking like “I’ll never get through everything I need to do. Might as well give up now” or “I don’t think I’m up to doing job Z perfectly so there’s no point.”

It is common human behaviour to experience habitual leaning towards ‘avoidant’ behaviours which usually make us feel better in the immediate moment (e.g. binge-watching TV or drinking excessive amounts of alcohol); unfortunately these avoidant behaviours are performed in place of healthier actions that could build our self-esteem and self-confidence because they follow our true values (e.g. going for a daily walk to improve physical/mental health, making sure to have a daily shower to practise self-care).

However, the thought of rebuilding a healthy, meaningful routine for ourselves can sometimes feel overwhelming.

Let’s look at some recommendations in line with a nifty tool called Cognitive Behavioural Therapy (CBT), where discovering and continually reviewing our personal values can help us to set useful personal goals.

What if I’m struggling to make changes?

Behavioural activation is an evidence-based treatment and maintenance therapy. It is one part of CBT and is used to increase a person’s positive behaviours and reduce negative ones.

Here’s an example of a negative behaviour cycle:

Sleep in for hours to avoid facing a task –>
Feel groggy and poorly motivated with low mood –>
Fell less able to perform the task –>
Experience low mood, motivation and feel guilty and frustrated –>
Sleep in late again.

On the other hand, a person making a conscious effort to perform a positive behaviour (even if they don’t feel very motivated and aren’t enjoying it) will usually find that when the goal has been achieved, their  mood, motivation and confidence improve, making it easier to continue positive behaviours.
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In addition to behavioural activation, it can help to explore our own values, in order to set meaningful goals.

Values & how they can help us set goal-orientated actions

Identification of values helps us work out our personal wishes and motivations, regardless of expectations from other people or society.

By seeing where our current actions are aligned with our values, we are more confident in continuing and strengthening those actions. On the other hand, where we are not heading towards a value we feel is important, this can help focus our efforts. And if we are feeling ‘stuck’ and unsure as to what our values are, it can stimulate a thinking process to move us forwards.

We can prioritise the goals which will lead us to values we find most important. They can help us with time management. For instance, we may decide that initially we need to set aside ten minutes a day on a goal.

It’s also useful if we can keep an open mind for what comes up for us when we plan a goal or are actioning the goal. For instance, we may need to deal with negative thinking like “this needs to be perfect or there will be consequences” or cognitive fusion like “I’m too lazy to do Y”. Or we might spot potential barriers and decide how to work around them.

Some examples of personal values include:

• Creative values e.g. to be imaginative, resourceful
• Experiential values e.g. to appreciate beauty in art, music etc., to love wholeheartedly
• Attitudinal values e.g. to be accepting of myself, to be accepting of others, to be fair, to be appreciative of things I have in life, to be open-minded
• Relationship values e.g. to be caring towards my partner/spouse, to bring up my child in a responsible manner, to be a loyal friend
• Achievement values e.g. to work hard, to improve my knowledge and skills
• Recreation values e.g. to regularly timetable leisure activities
• Health values e.g. to improve physical fitness, to look after mental health, to live life in a way that brings me spiritual meaning (e.g. regularly practising gratitude and patience, yoga, volunteering)
  
  

For a list of many more possible values, you could look at the ‘Card Sort’ exercise [6] for inspiration and ideas. From identifying which values are most important to you, and ones that could benefit from more attention, you have a starting point from which you can begin to set meaningful goals. You might simply categorise your values into Very Important all the way through to Not Important, or just choose the 5-10 most important to you today. As with all things, they are subject to change so review them when you feel ready. 

Image by Shad0wfall from Pixabay 

Be SMART

The SMART acronym apparently first appeared in 1981 in Management Review. Since then, SMART has been used by a tool by countless organisations and individuals to help people identify and reach their goals. There are a few different versions, but we will use a commonly used one for the purposes of the article.

Don’t forget that we may need to break down a single goal into smaller ones, and more than one goal can run at the same time, so write down your ideas and plans.

To make sure your goals are clear and reachable, each one should be:

• Specific (who is involved, what do I want to achieve, where will it take place, why this goal)
• Measurable (how many/much or another indicator of success).
• Achievable (do I have the resources and capabilities).
• Realistic (is this sensible, do I have the motivation to commit to the goal). This one is especially important as a depressed person might be more likely to set low goals.
• Time bound (when do I wish to achieve this goal)

Reward yourself for completion of a goal if that helps, as some tasks are an effort and not always enjoyable.
 
Example 1
Value – I want to give more support to a friend who lives alone
Goal  — I will ring her today and suggest a weekly video chat or phone call. We both have computers and we can find a mutually agreeable time to do it.
 
Example 2
Value – I want to get to healthier weight for my physical and mental health
Goal  — I will start walking 10 minutes after breakfast, starting tomorrow
 
Of course, setting and achieving goals is not always straightforward. If you find yourself unable to reach a goal, first practise self-compassion (for instance “struggling to achieve is the human condition”, “I’m doing the best I can”), kindness and non-judgement. Next you could gently investigate any internal (e.g. feeling tired) and external barriers (e.g. insufficient time) that got in the way of success this time [7]. Problem-solving an issue increases your chance of success next time [7].

Another realisation might be that the goal was unrealistically high, so you might reduce the difficulty of the goal to maximise success.

And finally, don’t forget you can also check in with friends, family, your GP, psychiatrist or psychologist to if you need more support.
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If you think this article might help someone else too, please like and share.

References

1. Pfefferbaum, B., 2020. Mental Health and the Covid-19 Pandemic. The New England Journal of Medicine, [Online]. Available at: https://www.nejm.org/doi/full/10.1056/NEJMp2008017 [Accessed 3 May 2020].

2. Australian Government Department of Health: Factsheet Coronavirus (Covid-19) National Health Plan. Available at: https://www.health.gov.au/sites/default/files/documents/2020/03/covid-19-national-health-plan-supporting-the-mental-health-of-australians-through-the-coronavirus-pandemic.pdf  [Accessed 3 May 2020].

3. National Institute of General Medical Sciences. 2019. Circadian Rhythms. [ONLINE] Available at: https://www.nigms.nih.gov/education/pages/factsheet_circadianrhythms.aspx. Accessed 10 October 2019].

4. Mayo Clinic. 2019. How many hours of sleep are enough for good health?. [ONLINE] Available at: https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/how-many-hours-of-sleep-are-enough/faq-20057898. [Accessed 3 May 2020].

5. Association for Psychological Science. 2016. Controlling Mood Disorders: A Matter of Routine. [ONLINE] Available at: https://www.psychologicalscience.org/observer/controlling-mood-disorders-a-matter-of-routine. [Accessed 10 October 2019].

6. William Miller, University of New Mexico, (2019), Personal Values Card Sort [ONLINE]. Available at: https://www.guilford.com/add/miller2/values.pdf?t [Accessed 10 October 2019].
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7. Don Kattler, Collaborative RESearch Team to study Bipolar Disorder, UBC. (2015). CREST.BD Home & Bipolar Disorder Slides. [Online Video]. 6 March 2015. Available from: https://www.slideshare.net/crestbd/crestbd-home-webinar-slides. [Accessed: 10 October 2019].

All content in this article is for informational purposes only and is not intended to serve as a substitute for individual consultation with a qualified physician.
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#covid19 #coronavirus #mentalhealth #stress #depression #anxiety #wellness #goals #CBT

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