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Coping with COVID-19
Matt Campbell
As we deal with the tremendous changes required to address COVID-19, there are a variety of painful emotions many are experiencing. These changes, fearful messages, and the unknown are fertile ground for our anxiety. Our anxiety is present to alert and protect us from dangers, so its presence is understandable and even appropriate.
1. Following CDC guidelines on social distancing, hand-washing, and avoiding touching our face.
2. Moving our bodies in a meaningful way through exercise.
3. Spending some time outside (when the weather cooperates).
4. Making sure we prioritize a consistent sleep schedule.
5. Trying to maintain contact with others through the phone and video conferencing.
Take care of yourselves.rom a different source.
Even with the appropriate and reasonable presence of anxiety, it’s important to handle it in effective ways. There are a number of great ideas and resources available on social media. Many of the suggestions involve taking care of basic self-care through the following:
2. Moving our bodies in a meaningful way through exercise.
3. Spending some time outside (when the weather cooperates).
4. Making sure we prioritize a consistent sleep schedule.
5. Trying to maintain contact with others through the phone and video conferencing.
6. Finding enjoyable activities.
A significant loss from this time is the loss of our schedule and routine. There are many losses people are experiencing, but the loss of schedule is fairly universal. We rely on our schedules for balance, efficiency, and comfort. It’s important to create a daily schedule for ourselves so that we’re consistently engaged in our life during this time.
It’s important to realize during this time how important it can be to not inundate ourselves with news. While remaining informed is important, finding a short period of the day to keep updated is adequate. Checking news frequently or even constantly can give one the sense of control through knowledge, but is actually feeding our anxiety. Our anxiety is fed by our thoughts and actions. When we’re inundated with information, we’re practicing and exacerbating our anxious feelings. Find a trusted news source, such as the CDC website, check it at a certain time of day, and then get back to your day.
One last suggestion is important. Dr. Jeff Dennis made an important comment during the message Mayor Tannehill, Dr. Waller, and he provided our community after the first confirmed case in Lafayette County. Dr. Dennis noted that engaging in social distancing and taking precautions could be the most important contribution young people make for our community in their lives. Great advice.
Beyond his specific message, his comment also brings meaning and purpose to light. This crisis will be over one day. When that time will be is currently unclear, but it will end. We can ask ourselves now how we would like to look back on our actions during this time. Instead of monitoring news and being driven by anxiety or sadness, it’s helpful to identify how we’d like to be able to look back on our actions during this time.
Meaning and purpose are personal. What people view as important and meaningful varies. So long as we’re not negatively affecting others, there is no “wrong” meaning. My experience is that people’s most meaningful activities typically involve a connection with others or the earth. Perhaps some will want to look back at how they parented their children as meaningful, others may reach out to loved ones or those who are particularly vulnerable, some may focus on gardening, while others may attempt to help with community outreach. There are many possibilities and we can consider how we would like to be able to look back at our actions at this time. Be intentional with your activities.
People are smart. We know what healthy behaviors are. Ask yourself these questions: Is it important to get seven to eight hours of good sleep? Is it healthy to exercise several times a week? Is it good to spend time outdoors? Do we benefit from limiting our time with technology? Is meaningful connection with others positive? Should we consume natural foods? Is it important to limit use of alcohol or other techniques to avoid/escape feelings? These things aren’t rocket science. We benefit from taking care of the basics of our animal nature. We can often look at the areas involved in these questions to get a good idea of how we’re feeling physically and emotionally. The primary roadblock to making good decisions consistent is that we don’t feel like it. More often than not, there’s a short-term approach that is more consistent with how we’re feeling. Maybe it’s excessive use of caffeine, distracting ourselves from concerns, fatigue, something tasty, etc. Our world is filled with attempts to find an easier button. It comes down to realizing we don’t need to feel like doing something to engage in that behavior. Rarely do people consistently feel like exercising, or eating healthily, or getting into a positive sleep schedule. But they can do it through not following their feelings. It’s wonderful (and easy) when we feel like doing the healthy things. Those first few weeks of a New Year’s resolution can work because we’re excited about changes. But what decides our overall physical and emotional health is doing things we know are healthy regardless of how we feel at the time. A common error made is to describe oneself as not having such “will power,” This may be one of the more unhelpful characteristics ever described, as it suggests some quality people either have or don’t have. Yet, the reality is most people can display good decision-making in some parts of their life and not others. Every few weeks, I’ll be posting some ideas on things that can help in our decision-making. Each part involves the basic concept: You don’t need to want to/feel like doing something in order to do it.
This one won’t be a favorite of animal lovers, but it illustrates an important aspect of human life. In an experiment, a dog was placed in a cage with metal grating as the floor and a divider to make two sides. The first part involved turning on an electric current on both sides of the cage. The dog would jump from one side to the other attempting to avoid the shock. It eventually stopped jumping and lay down, as it realized there was nothing it could do to escape the shock. After the shock was turned off and the dog had time to recover, the second part of the experiment began in which the side the dog was lying on had an electric current turned on. Instead of jumping to the other side, the dog remained lying down while getting shocked. Martin Seligman’s experiment had demonstrated that the dog had learned to be helpless – it didn’t believe there was anything it could do to avoid the negative event. Appropriately this is termed learned helplessness. As mentioned above, this comes up more often than you may expect in my experience in treatment. Perhaps the most common experience is when a spouse is extremely frustrated by her partner. As a result, she routinely “punishes” her spouse even if their partner is making attempts to do better. This may take the form of the spouse “not understanding” adequately or not showing my client the appropriate desire to make change. As a result, her spouse ultimately feels there is nothing he can do and stops trying. This can also occur with children, as they may feel they perpetually disappoint parents or teachers and quit trying, as they perceive they are unable to escape the negative consequences. Of course, we all have also experienced times in which we perceived we were helpless. This is often not the case but it certainly feels so. Often the perception that there is nothing we can do comes from our not wanting to experience certain emotions. For example, someone may perceive there is nothing he can do to be able to speak in front of a crowd. He’s tried everything he knows to stop feeling anxious – happy thoughts, imagining their audience naked, medication, etc. Yet he still feels the same way. In these cases, it’s often the willingness to experience a feeling while knowing that it is short-term that gets us through and allows the anxiety to ebb. But what about the situations mentioned in which a spouse, partner, or child is doing something “wrong” and we perpetually give them negative feedback? The correct response is often shaping. Shaping is a behavioral term for reinforcing successful approximations of the desired behavior. One of the best ways I’ve seen this described is “catch them being good.” As the person makes efforts and/or gets closer to the desired change, she is reinforced – given a consequence that is likely to make her do that behavior again. If we can gently also include what we liked and suggest things to get her closer to the needed behavioral change, it can be amazing what can happen. With patience, kindness, and finding ways to tolerate our frustration without taking it out on others, great things can occur.
I’m standing in line at the grocery store. The woman ahead of me has a child sitting in the grocery cart as they check out. The child asks for a candy bar and the mother replies “not today.” The child asks in a louder tone of voice and the mother lowers her tone but becomes more serious with “no.” This doesn’t please the child, who then starts crying and screaming for a candy bar. People around notice what’s happening, which is not lost on the mother. As the child’s screaming becomes more and more noticed the mother forces a smile and says to the child “ok, but this is the last time.” It’s pretty easy to understand the mother’s behavior. Each time I’ve seen it happen to a parent I’ve had a lot of empathy. But the process that occurred is ripe for trouble in the future. Behavioral scientists call this the partial reinforcement effect. We can call it the slot machine. Have you ever been to a casino or walked by slot machines? It’s quite interesting. You have people repeatedly feeding money into these one-armed bandits - even becoming agitated if someone uses their machine when they take a break. They can be intense. And focused on playing a game with the lowest payoff in the casino. So what’s going on here? Beyond the amazing use of psychological principles to make people bet more, casinos benefit from the partial reinforcement effect – you will get a payoff but you never know when it will happen. This creates some of the strongest behaviors out there – the ones most resistant to change. The unfortunate consequence for the mother described at the beginning of this section is she has inadvertently strengthened her child’s demands. Regardless of the mother’s admonition that this was “the last time,” the child has actually learned that ramping up his reaction to the mother will eventually pay off. There’s no guarantee where that breaking point is, but the key is to keep at it – it will happen. Parenting is far from the only place this happens. Perhaps a co-worker asks for help on their projects and never seems to notice you’re busy or gives you credit or appreciation for your help. You may eventually give in and help because it means you’ll be able to get back to your work more quickly. You may get frustrated at them for continuously asking, but what you’ve taught them is if they ask enough you’ll help them out/do their work. This is what makes sticking with change, as described in “The Coke Machine” so important – by not sticking with healthy change in our responses to others, we can actually strengthen the very thing we don’t want from others.
One of the most common (and least appreciated) aspects of being anxious is anticipatory anxiety. This involves the time before a feared/anxiety-provoking event. People typically become focused on the what-if’s in terms of the bad things that could happen, and nearly every time they explain afterwards how the event wasn’t nearly as bad as they had feared. The worry people have during these times is important, as it can significantly impact their lives. The enjoyment of what is occurring is limited by the negative tape reel going through their brains. They may even engage in a number of attempts to control the future event through superstitious acts or, at its most extreme, ritualistic behaviors. All of these are driven by the worry over the situation and trying to gain some sense of control over the situation. Of course, the problem with this approach is that it doesn’t reduce anxiety. The majority of the time it will only intensify it. Further, it can lead to more intense superstitions or ritualistic behavior, as the person truly believes that whatever behavior they engaged in kept awful events from occurring (or at the least, that nothing bad has happened when they do it – so why stop?). Being negative beforehand won’t lessen the impact of something negative happening. People sometimes believe negative expectations will lessen the blow if something bad happens. That hasn’t, even remotely, been my experience in working with people. What is far more common is it reinforcing a pessimistic view of life and stealing joy. Recognize the emotion you’re experiencing. Take care of yourself. If there are things under your control that would be healthy and would lessen the feeling, do them. Focus on other parts of your life and let the anxiety move on.
We’ve all been in the position of being hurt or frustrated with someone’s behavior. Perhaps it’s our spouse, partner, friend, child, or another family member. Their repeated actions have left us frustrated to the point of our stating what changes are needed. Appropriate assertiveness is a good thing. The problem can be how we handle their attempts to change. We often have the idea that we can’t budge and need to continue to display our dissatisfaction until they make the change completely. Therein lies the difficulty, as we’re not recognizing the importance of shaping – reinforcement for successive approximations of the goal. In other words, we don’t encourage others as they make changes along the way – we remain irritated until they have completely made the change. Perhaps your children are getting into constant arguments. You frequently get onto them and explain that they need to be able to deal with disagreements without yelling or fighting. One day one of your children comes to you expressing their frustration with one of their siblings. Maybe they’re even tattling. This often leads a parent to respond in an angry manner. “Why can’t you all handle these things?” may be a response. But is this the correct approach? Isn’t the child doing something different and taking a step towards not arguing? While their approach may not be what you’re ultimately looking for, it’s improvement. To scold them is to increase the chance they feel it’s hopeless trying to make the changes you’re asking. Of course, the same occurs in other relationships. Perhaps your spouse has asked for you to help more around the home or get involved in your children’s activities. If you try to take care of some household tasks or spend more time with the kids, only to be criticized for how you did it, how likely does that make you to persist in trying to meet your spouse’s wishes? If each attempt towards a partner’s wishes leads to sharp pain, it’s unlikely a person will continue moving towards the others’ wishes. There are some exceptions to the idea of shaping. In abusive relationships, a partner may display a pattern where they follow abusive behavior by going to the other extreme to “prove” their desire to be better. This is a pattern, with the abused person taking care of their well-being most important rather than following the painful rollercoaster. In many situations of our daily lives, however, it’s important that we recognize attempts at change others make. This doesn’t mean we need to let go of all feelings we have surrounding the problem, but taking a porcupine approach with another’s attempts at change is a way to lead to their helplessness and problems being worse than before.
We often notice others’ mistakes more easily than our own. When we have the ability to be objective and not filled with the emotion of a situation, mistakes seem so obvious. One of the more common times this occurs is when we see others making mistakes in relationships – especially when they keep giving chances to others that we can objectively see the person doesn’t appear to deserve. The late Dr. Paul Meehl explained a frequent reason for this through the example of a broken leg. It went something like this: Imagine John and Andy are racing each other. They’ve raced nine previous times, with John winning each race. Who would you predict to win the next one? What if you learned John recently broke his leg? That changes things, right? The idea Meehl explained is that we have strategies/decision rules to predict what will occur in the future and to prepare ourselves – in the case of the race between John and Andy, that past behavior is a good predictor for future behavior. The exception is when we learn of something that could change the accuracy of our previous way of predicting. In this case, despite John’s history of dominance, there is something that changes the effectiveness of our previous approach to predicting (the broken leg). Dr. Meehl used the term “broken leg” to indicate anything that significantly changes the usefulness/accuracy of a formula to predict/anticipate. The reason this is important is that there aren’t many “broken legs” in the real life – things that truly change the accuracy of our decision rules and beliefs, but we sometimes act as if there are. In the case of seeing the mistakes of others, it’s easy to recognize them giving someone chances upon chances and being hurt by it. It’s easy to see that they need to see things as they are and make healthier decisions for themselves. If we’re honest with ourselves, however, we can recognize this tendency in ourselves. We want something to be a certain way, so we try to explain away what is contradictory. This may involve others whom we care for or admire. Sometimes it’s about ourselves. One example is when we’re trying to explain others’ behaviors away. For a variety of reasons, we can dismiss important signs in relationships. The more we feel the need to explain away others’ or our own behaviors, the more we should take notice that we’re treating a lot of things like broken legs – and there are very few of those. Perhaps it’s because of a strong desire to feel cared for or the person has some characteristics that we strongly value. Or maybe there’s a behavior that we believe is wrong or not good for us, but we make an excuse for it. It’s important to realize that a red flag doesn’t necessarily mean that we end the relationship or stop an activity. But recognizing the desire to make excuses allows for us to be in a relationship or activity with our eyes wide open and able to set boundaries within the relationship to where we’re not blindsided, taking on others’ problems, or enabling another person’s behavior. As Maya Angelo said, “when people show you who they are, believe them the first time.”
In the spirit of this time of the year when many make New Year’s resolutions, one of the ways we can think through maintaining changes is thinking long. Years ago, a client mentioned her child had forgotten their lunch at home. I quickly offered for the client to cut our meeting short to get them lunch, to which my client declined the offer and replied “I guess they’ll be hungry today.” This was a bit humbling, as I was quite guilty of tying shoes, bringing forgotten items to school, and repeatedly prompting my children in order to reduce their discomfort or make things easier or look better. My client was doing a much better job of thinking long than I was. This doesn’t just apply to helicopter parenting (though it does include it). We deal frequently with the choice of taking a short-term approach or thinking long. The short-term approach provides immediate relief from discomfort, which is most frequently our motivation. However, it’s rarely going to work best in the long-term. Conversely, thinking long involves dealing with short-term discomfort for longer-term relief and growth. One simple example would involve our diet and exercise. Eating comfort food is wonderful in the short-term, while eating vegetables, fruit, and lean protein don’t quite provide that comfort. Yet, in the long-term, comfort food will result in unwanted weight and all that brings. Exercising is often uncomfortable and not something we want to do. Laying on the couch feels better in the short-term. Yet, in the long-term, that exercise will help us in innumerable ways. Some things to think about in making longer-term changes: 1. Help yourself in this process by setting short-term goals. Instead of focusing on the final goal of a marathon, set a goal for how far you’d like to run by the end of the month. Or perhaps even shorten it to a week. Set a goal for how many meals of fruits and vegetables we have in a week. 2. Remind yourself the short-term discomfort is related to something more important to you. Remembering the things you value most and the purpose of changing is important. 3. When thinking about the behavior(s) you’re trying to change, recognize you may need to replace what the past behavior did for you. Perhaps comfort food means you need to find other ways to take care of how you’re feeling. Maybe laying on the couch for hours meant you need to take care of your sleep. 4. When starting, write down the reasons you want to make the changes and the discomfort that is motivating you – sometimes we can lose sight of the pain that motivated us to want to change. 5. Remember that change creates its own discomfort. Just because it’s not comfortable doesn’t mean its wrong. 6. Make it a habit through a consistent schedule and plan ahead – sometimes our problems with changing diet and other behaviors has to do with a lack of planning and available healthy foods. 7. Realize that slips do not mean failure. Part of the process of change is making mistakes and learning from them.
I was thirteen years old and motivated. I’d just watched Rocky Balboa train in Siberia and take out the steroid-infused monster that was Ivan Drago. I was able to convince my parents to get a weight set and I was getting ready to be a muscle man. I even worked out a few times. Then the training stopped because, well, I didn’t feel like it. Even hearing "Eye of the Tiger" on repeat couldn’t get me feeling it. I’d fallen into the classic trap of behavior change – one I work with people (and myself) on up to this day: The idea that we have to feel like doing something. While it’s wonderful to feel like doing something healthy, the reality is these feelings are usually only temporary. Why do 80% of New Year’s Resolutions fail by February? The excitement is gone. Our feelings naturally fluctuate and won’t continue to provide us with that push. The excitement fades. The key to make better and healthier decisions is recognizing that the behaviors lead and the feelings will follow. Not vice versa in any sustained way. We can do things that don’t fit our feelings – most people do it every day. You don’t feel like getting up earlier than desired to go work. You probably don’t feel like going out on a hot day and doing yardwork. You’re not thrilled about walking your dog on a cold and wet morning. But you do them largely because you don’t give yourself a choice to reflect on whether you feel like it. Allowing our feelings to direct what we do can be a recipe for bigger problems. If someone is anxious over something, their feelings will push them to escape it. If someone is depressed, they’ll feel like isolating themselves and being limited in their activity. These will only worsen their feelings in the long-term. Many wait on the feeling to change in order to be healthier. Unfortunately, this is the wrong order for change to happen and leaves us in a worse position. But this doesn’t just apply to clinical situations. If we want to make healthier decisions in our daily life, it’s important to make a plan and engage in it without reflecting on whether we feel like it. Start with a manageable amount of the healthier behavior – going too extreme can burn us out quickly. Maybe it’s an amount of time or distance for exercise, or certain foods or drinks we get at the grocery store. Set your self up for success and make a plan. Most importantly, realize by starting with a focus on what you do, the results and feelings you desire usually follow. The trap is hoping and waiting to feel like it or viewing it as a problem that we need to figure out through thinking about it over and over. Don’t fall into that – act. Put one foot in front of the other and do what is healthy and gets you to your goals. Your feelings will follow after time.
You may have heard of the myth (yes, it’s a myth) of the boiling frog. It goes something like this – if you put a frog in a pot of hot water it will jump out. But if you put it in a pot of tepid water and slowly warm it up the frog will eventually be boiled because it doesn’t notice the gradually increasing temperature. While the story is a myth, the underlying idea is important – we often don’t recognize increasing daily stress. This has become particularly important these days. In my office and outside, it’s obvious that the levels of tension and stress are at a very high level for many people. To state it bluntly, I’ve witnessed more people with overwhelming feelings in the past six weeks than in other similar time frames in eighteen years of clinical work. There seem to be a number of reasons for the level of stress many are experiencing. We’re in the midst of a horrible spike in COVID-19 after many of us thought we were on the tail end of the virus. School has resumed, with many returning to the classroom after an extended time of virtual learning. There is sustained social and political unrest. It’s been brutally hot. Many people have weathered the past eighteen months without being directly affected. When I speak with most of them, they’ll say they’re “fine” or will feel they shouldn’t complain because others have been impacted much more directly. But sustained stress doesn’t make such distinctions on our emotional and physical functioning. The unknown, change, adjustments, fears, frustrations…listing the stressors can go on and on. It's like carrying something - at first it seems manageable but becomes heavier the longer we hold it. For some people, the sustained stress has caused them to experience problems they’re predisposed to – depression, anxiety, and anger are amongst those. But the stress can be experienced in less apparent ways – muscle tension, headaches, irritability, stomach problems, sleep difficulties, skin picking, overeating, drinking more than normal, and memory problems are some that I’ve seen. Being aware of these stressors is important so that we can be as healthy as possible. It’s always important to focus on the things under our control that create our mental and emotional foundation – sleep, healthy consumption, moving our bodies, having some time outside, and having social connection. Engaging in enjoyable and relaxing activities is also important. And finding releases for the tension that is brimming below (and sometimes above) the surface can help calm us. Take care of yourselves.
If you’re trying to change how you act or react to others, especially children, you may not think a Coke machine would be useful to remember. And yet… Imagine you’re thirsty and see a drink machine. It has your favorite drink, so you put your coins in the machine (I know – everything is on debit cards these days, but forgive me dating myself). You press the button. Nothing happens. What do you do? You probably press the button a few more times in case the machine didn’t sense it. Then you may press the coin return. Maybe you push the other buttons to get another drink. Some might become really angry and kick or bang on the machine. When you finally recognize you’re not getting anything, you leave. This example is useful for us because it highlights something called the “extinction burst.” The interesting thing about our reaction to not receiving something we have in the past is that we don’t just accept it and move on - we do the behavior we previously did more when we don’t get the expected response. We appear to believe there’s a glitch and keeping at our normal way will get the result we’re accustomed to. This is especially important in parenting. Consider the example of a grocery checkout line. A child asks for a candy bar. The parent buys it for them. After multiple times, the parent decides it’s not good to buy the child more candy and says no. The child asks louder and the parent, fearing the judgment of others in the grocery line, often relents. As time goes by, the parent decides they simply won’t respond to the child’s loud voice and will deal with the perceived judgment of others. Does the child stop when the parent says “no?” Not usually – they’ll often scream louder and/or cry harder. And here’s the kicker: the more often the parent gives in with the child’s escalated responses, the more likely it is that the child will scream on and on and on – continuing on with his tantrum has been reinforced and the child knows, at some point, the “Coke machine” will give them what they want. This also applies to other relationships. When people are accustomed to us acting a certain way, they’re unlikely to change the way they interact with us immediately. They may think there’s some other explanation – perhaps we’re sick, tired, or another misinterpretation. They’ll only trust the change and start responding differently to us when they experience it consistently. Many give up on making healthy changes because they don’t experience success early on. “It doesn’t work” is the common report. It’s important to remember the Coke machine and the fact that others in our environment have to learn there’s been a change – not only by what we say but by experiencing it over time. Situations like these fit the idea of things seeming worse before they get better. If we back off of making positive changes because we don’t get what we’re looking for early on, however, we’ve actually made it more difficult to change in the future – those around us will believe that our changes aren’t going to stick if they keep responding the same way…or more intensely. So if you’re trying to change and be healthier in how you interact with others, realize it may be rough for a bit, but giving up only makes it more difficult later on. If it’s healthy, stick with it.
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