As Cindy puts down her phone after looking at the current news about COVID-19, she realizes her pulse has quickened and her hands feel clammy. Her husband says goodbye, and she runs to the window with her kids to wave as his car pulls away from the driveway for his next ICU shift. She is faintly aware that her mouth has gone completely dry, but this sensation pales in comparison to the worried thoughts racing through her mind as his car disappears from view. Anxiety grips her mind and body as she stares at the empty street, worried that the worst may happen…
“Our thoughts directly impact our mood, sensations, feelings, and behaviors.”
Anxiety is a leading mental health disorder in our nation and around the world. Nearly 20% of Americans experience some form of anxiety every single year. [i] That is almost one in every five adults. Globally, close to 300 million people have some form of an anxiety disorder. [ii]
It’s no surprise that anxiety is currently on the rise as the COVID-19 pandemic is spreading across our globe. There is a lot of fear circulating - fears that are substantial to those seeing the terrible impact of this pervasive infectious disease. Many lives are gravely impacted by loved ones falling ill, job losses, economic implications, and significant deaths tolls.
Yet, even in the face of these tragedies, there are practical, cognitive related steps we can employ to help reduce our anxiety and facilitate a healthier mindset.
Let’s look at several definitions of anxiety. A very simple and direct explanation of anxiety is given by Dr. Judith Beck from the Beck Institute of Cognitive Behavior Therapy. Dr. Beck teaches that anxiety is overestimating threat and underestimating resources and your ability to cope. [iii] Dr. Aaron Beck, one of the founding fathers of cognitive behavior therapy, describes anxiety as when “the alarm is worse than the fire.” [iv]
Dr. Norman Cotterell, of Beck Institute, explains this further, “When people have an anxiety disorder, they are often more afraid of the alarm than the fire, and all their efforts are spent putting out the alarm. In the case of COVID-19, our clients are dealing with a real fire. So their anxiety, for the most part, is warranted, though not necessarily useful in terms of its strength. They are dealing with an identifiable risk, with widespread consequences.”[v]
It’s important to recognize that while many individuals feeling anxious about COVID-19 may not have a diagnosable anxiety disorder, they are still experiencing heightened anxiety and are dealing with a very real “fire.”
Cognitive behavior therapy teaches us the importance of our thoughts and their powerful impact on our emotions and behaviors (Learn more about CBT and cognitive distortions). What we think or tell ourselves directly impacts our mood, sensations, feelings, and behaviors. Yet thoughts are so fleeting and quick that it can be difficult to identify them, especially when experiencing anxiety.
1. Pay attention to changes in mood or your physiological state. Use your emotions or bodily sensations as cues. Can you feel your heart rate increase? Have you lost your appetite? Or gained one? Are you irritable or agitated?
2. Identify what you are thinking. When you notice changes in your emotions, mood, or bodily sensations, stop to ask yourself: What thought just went through my mind? Was I predicting something? Was I picturing or imagining something happening? Was I remembering something? What was I telling myself? Was I thinking about a worst-case scenario?
3. Evaluate the thought. Once you’ve identified your thought, you will want to evaluate it for truth and accuracy. Ask yourself: Is what I’m telling myself true? How true is it? 0-100% true? Is there another way to think about this? If it is true, how helpful is it for me to dwell on this? [vi] Look here for more questions to evaluate thoughts.
It can also be helpful to evaluate anxious thoughts by asking “What’s the worst/best/most realistic outcome?” Dr. Judith Beck says, “When people are anxious, they are likely to imagine a worst-case scenario. It’s important to remind yourself that the worst-case scenario is only one of many possible outcomes. It can be helpful to think about the best-case scenario and the most realistic outcome—which often falls somewhere between the best case and the worst case.” [vii]
4. Respond to and change your old thought. If you find that your original thought is not necessarily true or helpful, you will want to change your thought to one that is more rational.
Let’s examine an example to see how Cindy uses these steps to reduce her anxiety about COVID-19.
Cindy stays at home with her children and works from home. Her husband is an ICU nurse currently working on the front lines with COVID-19 patients. Cases are spreading and, while Cindy tries to stay calm, she is watching the curve spike in the United States and is starting to feel overwhelmed. One afternoon her husband is going in for a shift. Cindy notices her heart rate increase, she is irritable with her children, and she is having difficulty concentrating on the tasks at hand.
“What am I telling myself that is making me feel anxious?”
Because she has learned some cognitive behavioral therapy skills, she knows the powerful impact her thoughts have on her emotions and behaviors. She is able to use her change in mood and body sensations as cues to identify her thoughts. (step 1)
Cindy knows that it’s not only the COVID-19 situation itself that is causing her anxiety, but also what she is currently telling herself about the pandemic. She asks herself, “What thought just popped in my mind? Was I predicting or assuming something? What am I telling myself that is making me feel anxious?” (step 2)
As Cindy does some self-reflection, she realizes she has had some of these thoughts:
My husband is going to get sick or I’m going to get sick. Who will take care of our children? When he does get sick, he will have to quarantine from the family. I will be alone and that will be awful. I won’t be able to handle that! What if we are carriers and are spreading it into the community?
Cindy also has images in her mind of her husband being on a ventilator and her not being able to be with him. Sometimes she pictures herself on a ventilator, dying alone.
Once Cindy identifies the thoughts and images she is having, she needs to evaluate them by asking if they are true and/or helpful. She uses the “filter for accurate thinking” worksheet to determine their accuracy. (step 3)
After evaluating her thoughts, Cindy is able to conclude that while there is risk involved, her current thoughts are not true and especially don’t have 100% accuracy. She also identifies that thinking these thoughts is not helping her reduce her anxiety and unpleasant emotions.
One of the ways Cindy works to de-catastrophize her thoughts is to evaluate the likelihood that her perceived negative outcome will happen, and then to do some problem-solving on how she can cope with that outcome.
She is able to identify the catastrophic thought by asking, “What’s the WORST that could happen?”
My husband will die alone.
She then evaluates how likely that worst case scenario is to happen, “How likely is that to happen, from 0-100%?” “Is there a low, medium, or high chance of that actually coming true?”
He’s healthy, so it’s probably a very low chance of that actually happening.
Cindy then tries to think of the best case scenario (this is helpful to move away from the cycle of always dwelling on the negative) by asking, "What’s the BEST thing that could happen?”
None of us will get sick, and this virus will just go away and stop hurting so many people.
Finally, she asks, “What’s the most likely or most probable outcome?”
Our family may get the virus, but we can boost our immune systems and reduce the likelihood it would have devastating effects on us.
As Cindy works through these questions, she is able to conclude that while her worst fear has a very low likelihood of happening, there is still a risk; but she can now focus on the “fire” instead of putting out the alarm. Overestimating the threat of COVID while underestimating her resources and coping strategies will only add fuel to the pandemic fire.
If Cindy finds herself slipping into anxious automatic and catastrophic thoughts, she can ask herself problem solving questions like: What could I do if ________ happened? How could I cope if _________? How could I solve that problem if it happened?
Cindy can now find comfort in knowing that she does have resources, family, friends, neighbors, and church community who would be willing to help in different ways. She also has a number of coping strategies such as:
Instead of being controlled by anxiety, Cindy can reframe it as energy to take action by engaging in activities to boost her and her family’s immune systems such as providing nutritious, immunity-enhancing meals, exercising regularly even if she does live in a cramped apartment, taking walks and getting outside as much as she can, getting adequate sleep, reading, expressing gratitude, spending time putting God’s promises in her heart, and praying. These are all things she can do to increase her immune system and thus give her a strong ability to cope.
Cindy now responds to her original anxious thoughts (step 4) by saying, “I don’t know for sure that my husband will contract the virus. I also have no way of knowing how our bodies will react to the virus, therefore it’s not helpful for me to worry about whether or not we do catch it. If and when either of us do get sick, then we will decide how to best handle it. We have many friends in our area who could help us in different ways if needed. It’s not helpful for me to imagine or dwell on the worst-case scenario. Instead I will focus on turning that anxious energy into practical ways to boost my immunity to protect myself for if or when I do get COVID-19. There are some things in my control and others that are not. Regardless, I know I can handle difficult situations - I’ve done it before. For what I seemingly can’t handle, there is a God much bigger than me who can take care of what I cannot.”
“You can experience relief.”
Just as Cindy managed her way through the crippling effects of anxiety, you can too. Life will always present to us situations that we don’t have control over, but there is one thing we can always control - that is our thoughts about those situations! We can develop coping skills to handle the mental and physical ramifications of anxiety. Refer back to the four steps Cindy used to work through her COVID-19 induced anxiety to overcome anxiety in your own life. If you still find yourself struggling, please find a licensed therapist to help facilitate your recovery. Click here for steps to find a therapist or check out the new online Nedley Depression & Anxiety Recovery Program™. Whether you are feeling anxious about the current global pandemic or face anxiety in other areas of your life, you can experience relief.
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[i] Any Anxiety Disorder. (2017). Retrieved April 16, 2020.
[ii] Depression and Other Common Mental Disorders. (2017). WHO. Retrieved April 15, 2020.
[iii] Beck, J. (2020). Anxiety is an overestimation of threat and underestimation of resources and coping strategies. CBT for Anxiety Beck Institute online course.
[iv] Beck, A.T. (1979). Cognitive Therapy and the Emotional Disorders. Plume.
[v] Cotterell, N. (2020). Helping Anxious Clients Find Strength and Purpose During COVID-19. Retrieved April 13, 2020 from https://beckinstitute.org/strength-purpose-during-covid-19/
[vi] Beck, J.. (2011). Cognitive Therapy: Basics and Beyond (2nd ed.). The Guilford Press.
[vii] Beck, J. (2020). A CBT Approach to Living with Uncertainty: Control What You Can and Accept What You Can’t. Retrieved April 13, 2020 from https://beckinstitute.org/a-cbt-approach-to-living-with-uncertainty/