Pandemic-Related Stress: Understanding Potential Impact

on Mental Health & Implementing Effective

Coping Strategies

MEGAN D. KEYES, PH.D.

Agenda

Impact of previous pandemics on mental health

Early findings regarding mental health impact of COVID-19

Chronic pandemic-related stressors and coping suggestions

Strategies for reducing pandemic-related stress and anxiety

Review of resources

IMAGE BY MIROSLAVA CHRIENOVA FROM PIXABAY

Psychological Reactions to Pandemics

Broad spectrum of emotional reactions ranging from indifference to debilitating distress

Common behavioral responses to threat of infection:• Repetitive checking and reassurance

seeking• Avoidance of infection-related stimuli• Attempts to “decontaminate” potential

sources of infection

Pursuit of counterfeit cures or remedies

Civil unrest or mass panic

TAYLOR, 2020; IMAGE BY GORDON JOHNSON FROM PIXABAY

Personality Traits Associated with Emotional Vulnerability

Negative emotionality

Overestimation of threat

Intolerance of uncertainty

Monitoring versus blunting

Unrealistic optimism bias

TAYLOR, 2020; IMAGE BY FREEPIK

Mental Health Impact of COVID-19: Early Findings

Household Pulse Survey by U.S. Census Bureau (2020)

Reported symptoms of anxiety or depression (national estimate):• 4/23 to 5/5: 35.9%• 7/2 to 7/7: 39.0%

Women, Hispanics and African-Americans, and young adults (ages 18-29) reported more symptoms

NATIONAL CENTER FOR HEALTH STATISTICS, HOUSEHOLD PULSE SURVEY, 2020; IMAGE BY MARY PALKE FROM PIXABAY

APA Stress in America: May 2020

APA Stress in America: May 2020

APA Stress in America: May 2020

Chronic Stressor Definition: Continuous stress that persists for prolonged period of time

Psychological impact: • Anxiety or depression

• Impaired concentration

• Fatigue

Physical impact: • Insomnia

• Hypertension and heart disease

• Pain (e.g., headaches, muscle aches)

• Weakened immune system

AMERICAN PSYCHOLOGICAL ASSOCIATION, 2019; IMAGE BY GERD ALTMANN FROM PIXABAY

COVID-19 Stressors

Fear of infection

Overburdened healthcare system

Work and school-related stress

Financial hardship

Social isolation

Excessive media exposure

Multiple losses

ESTES & THOMPSON, 2020; TAYLOR, 2020; ILLUSTRATION BY THE WASHINGTON POST

Social Distancing, Quarantine & Isolation

Results in decreased:• Sensory stimuli • Social engagement & interaction• Participation in meaningful activities • Access to usual coping strategies

Typical reactions:• Anxiety and fear• Depression• Loneliness• Boredom• Anger and irritability• Uncertainty and frustration

AMERICAN PSYCHOLOGICAL ASSOCIATION, 2020; SAMHSA, 2020; IMAGE BY FREEPIK

Enhancing Social Connection

Virtually connect with others on a consistent basis

Be proactive and strategic

Seek support by sharing negative experiences with trusted contacts

Offer and provide support for others

AMERICAN PSYCHOLOGICAL ASSOCIATION, 2019 & 2020; IMAGE BY FREEPIK

Media & Social Media Exposure

Excessive media exposure about collective crises may amplify distress

Repeated exposure to graphic images may worsen impact on mental health

Social media may exacerbate anxiety more than traditional media sources

GARFIN ET AL., 2020; WEIR, 2020; IMAGE BY GERD ALTMANN FROM PIXABAY

Tips for Viewing Media Coverage

Obtain information from one or two reliable sources

Limit exposure to media

Limit exposure to recurring media stories

Discuss news coverage with children in clear, age-appropriate terms

Share and discuss useful information with friends and family

AMERICAN PSYCHOLOGICAL ASSOCIATION, 2020; WEIR, 2020; IMAGE BY FREEPIK

Loss & Grief Ambiguous Loss:• Most difficult to cope with due to

uncertainty and lack of closure

Anticipatory Grief:• Expected losses yet to come

Complicated Grief: • Uncontrollable circumstances

compound the loss and make it difficult to accept

• Enduring symptoms include disbelief, persistent longing, and rumination that result in impaired functioning

BERTUCCIO & RUNION, 2020; IMAGE BY GERD ALTMANN FROM PIXABAY

Coping with Grief

Journaling

Social Support

Psychotherapy

WEIR, 2020; IMAGE BY PRESSFOTO FROM FREEPIK

Effective Implementation of Mental Health Skills

Intentional choices and engagement in specific behaviors that promote good mental health

Consistent practice to promote skills acquisition

Rate intensity of mood (0-10 scale) before and after to assess effectiveness and improvement over time

Be strategic and determine what skills work best in different situations

Devotion of time in your daily schedule to implement skills as part of your regular routine

IMAGE BY GERD ALTMANN FROM PIXABAY

Relaxation Training

Purpose: counteract anxiety by engaging in behaviors that elicit the relaxation response, thus changing physiological responses to anxiety

Common techniques:• Breathing

• Progressive muscle relaxation

• Visualization

Common challenge: “I can’t relax.”

DAVIS, ESHELMAN & MCKAY, 2019 ; MONTERO-MARIN ET AL., 2019; IMAGE BY SNOWING FROM FREEPIK

Mindfulness

Definition: cultivating an awareness and acceptance of the present moment without judgment; living fully in the here and now

Common techniques:• Everyday mindfulness

• Mindfulness meditation

• Mindfulness-Based Stress Reduction

Common Challenge: Mind chatter

STAHL & GOLDSTEIN, 2010 AMERICAN PSYCHOLOGICAL ASSOCIATION, 2019; IMAGE BY DANIEL GLAUBER FROM PIXABAY

Resilience Definition: ability to adapt to adversity

Continue to function and progress when experiencing difficulty and distress

Learn skills to build resiliency over time

Four ways to increase resiliency: Build connections

Practice wellness

Find meaning/purpose

Healthy thinking

AMERICAN PSYCHOLOGICAL ASSOCATION, 2012; PECONGA ET AL., 2020; IMAGE BY KIM THOMAS FROM PIXABAY

Seeking Professional Assistance

Potential indicators:

Subjective distress

Impaired daily functioning

Compromised relationships

Excessive symptoms

Safety concerns

Psychology Today: Find a Therapisthttps://www.psychologytoday.com/us/therapists

ASSOCIATION FOR BEHAVIORAL AND COGNITIVE THERAPIES; IMAGE BY MOHAMED ASSAN FROM PIXABAY

Resources

IMAGE BY GERD ALTMANN FROM PIXABAY

COVID-19 Survey Links

National Center for Health Sciences: Household Pulse Surveyhttps://www.cdc.gov/nchs/covid19/pulse/mental-health.htm

American Psychological Association: Stress in Americahttps://www.apa.org/news/press/releases/stress

Online Resources American Psychological Association: COVID-19 Information & Resources

https://www.apa.org/topics/covid-19/

National Center for PTSD: COVID-19 Resources for Managing Stresshttps://www.ptsd.va.gov/covid/index.asp

International Society of Traumatic Stress Studies: COVID-19 Resourceshttps://istss.org/public-resources/covid-19-resources

Center for Traumatic Stress Studies: COVID-19 Pandemic Resource Pageshttps://www.cstsonline.org/resources/resource-master-list/coronavirus-and-emerging-infectious-disease-outbreaks-response

Mobile Apps

Headspacehttps://www.headspace.com/

Calm https://www.calm.com/

COVID Coachhttps://www.ptsd.va.gov/appvid/mobile/COVID_coach_app.asp

Research Opportunity

Mental Health Impact of COVID-19 Pandemic Study

https://www.nimh.nih.gov/research/research-conducted-at-nimh/join-a-study/trials/adult-studies/mental-health-impact-of-

covid-19-pandemic-study.shtml

Training Opportunity

Post-Master’s Certificate Program:

Evidence-Based Assessment & Treatment

of PTSD in Adults

https://brownschool.wustl.edu/Resources-and-Initiatives/Post-Masters-Certificate/Pages/Evidence-Based-Assessment-and-Treatment-of-PTSD-in-

Adults.aspx

Contact

Megan D. Keyes, Ph.D.

megan.keyes@traumaempowered.com

https://traumaempowered.com/

References• American Psychological Association. (2012). Building your resilience. https://www.apa.org/topics/resilience

• American Psychological Association. (2019, October 25). Stress won’t go away? Maybe you are suffering from chronic stress. https://www.apa.org/topics/chronic-stress

• American Psychological Association. (2019, October 30). Mindfulness meditation: A research-proven way to reduce stress. https://www.apa.org/topics/mindfulness-meditation

• American Psychological Association. (2019, November 1). Healthy ways to handle life’s stressors. https://www.apa.org/topics/stress-tips

• American Psychological Association. (2020, March). Five ways to view coverage of coronavirus. https://www.apa.org/topics/covid-19/view-coverage

References• American Psychological Association. (2020, March). Keeping your distance to stay safe. https://www.apa.org/practice/programs/dmhi/research-information/social-distancing

• American Psychological Association. (2020, May). Stress in the time of COVID-19, Volume one. https://www.apa.org/news/press/releases/stress/2020/report

• Association for Behavioral and Cognitive Therapies. Deciding when to seek treatment. https://www.abct.org/Information/?m=mInformation&fa=DecidingWhenToSeek

• Bertuccio, R. F. & Runion, M. C. (2020, June 1). Considering grief in mental health outcomes of COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. http://dx.doi.org/10.1037/tra0000723

• Davis, M., Eshelman, E., & McKay, M. (2019). The relaxation & stress reduction workbook. New Harbinger Publications.

References• Estes, K. D. & Thompson, R. R. (2020, June 1). Preparing for the aftermath of COVID-19: Shifting risk and downstream health consequences. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. http://dx.doi.org/10.1037/tra0000853

• Garfin, D., Silver, R., & Holman, E. (2020, March 25). American Psychological Association. Too much coronavirus media exposure may be bad for your health. https://www.apa.org/pubs/highlights/spotlight/issue-181

• Medical University of South Carolina. (2020. March 18). Managing anxiety related to COVID-19. https://web.musc.edu/about/news-center/2020/03/18/managing-anxiety-related-to-covid-19

• Montero-Marin, J., Garcia-Campayo, J., Perez-Yus, M.C., Zabaleta-del-Olmo, E., & Cuijpers, P. (2019). Meditation techniques v. relaxation therapies when treating anxiety” a meta-analytic review. Psychological Medicine, 49, 2118-2133. http://dx.doi.org/10.1017/S0033291719001600

• PeConga, E., Gauthier, G., Holloway, A., Walker, R., Rosencrans, P., Zoellner, L., & Bedard-Gilligan, M. (2020). Resilience is spreading: Mental health within the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. http://dx.doi.org/10.1037/tra0000874

References• Stahl, B. & Goldstein, E. (2010). A mindfulness-based stress reduction workbook. New Harbinger Publications.

• Substance Abuse and Mental Health Services Administration. (2020, April). Tips for social distancing, quarantine, and isolation during an infectious disease outbreak. https://store.samhsa.gov/product/Taking-Care-of-Your-Behavioral-Health-Tips-for-Social-Distancing-Quarantine-and-Isolation-During-an-Infectious-Disease-Outbreak/PEP20-01-01-007

• Taylor, S. (2020). The psychology of pandemics: Preparing for the next global outbreak of infectious disease. Cambridge Scholars Publishing.

• Weir, K. (2020, March 16). American Psychological Association. Seven crucial research findings that can help people deal with COVID-19. https://www.apa.org/news/apa/2020/03/covid-19-research-findings

• Weir, K. (2020, June 1). American Psychological Association. Grieving life and loss. https://www.apa.org/monitor/2020/06/covid-grieving-life