Election-Induced Anxiety

A mere two days before the 2020 Presidential Election, the anxiety people are experiencing is palpable. Many of my patients have been talking about their fears about the election and what may happen immediately following, with much anticipation of riots and acts of violence and aggression. The news is reporting a significant increase in the number of purchases of firearms. Add to that the fact that we are in the midst of a global pandemic. Cases of COVID-19 are surging as the temperatures are dropping and it is getting darker much earlier as we approach the winter months. People are struggling to keep afloat with devastating numbers of unemployment, work stress, and profound isolation. So many of these stressors are out of our control. Such powerlessness is at the root of our anxieties. When people feel helpless to enact positive changes for themselves, they become fearful.

The antidote to this powerlessness, then, is to practice ways to control the things that are within our power to control. I would be naïve to expect people not to watch the news this week, but perhaps people can choose to limit the amount of time they spend doing so. If the news is contributing to a rise in anxiety, then it would be a good idea to consciously limit one’s exposure to the things that are triggering anxiety. Setting boundaries, in this case time boundaries, is a very empowering act of self-care. There are also a large number of concrete activities that people can do to help manage their anxiety. These often involve changing one’s heart rate either by slowing it down or speeding it up. I teach many patients suffering from anxiety disorders deep breathing exercises that help them take in vastly more air and slow down their breathing. With some patients, we start our sessions with ten minutes of a guided meditation, which can help people focus on the present moment and be more aware of their internal emotions and physical sensations, which may have the added benefit of providing some relaxation. Alternatively, you may choose to speed up your heartrate with any number of cardiovascular exercises. Physical exercise, in addition to keeping your body in good health, can help reduce anxiety. One patient who suffers from anxiety told me that she finds it helpful to focus her attention on activities that she enjoys, such as knitting and trying new recipes. And some people find it helpful to engage in activities that require some type of repetitive motion, such as scrubbing a pan.

FDR famously said, “There is nothing to fear but fear itself.” It seems more and more that politicians and many news sources are intentionally playing on our fears with the thinking that this fear will help them earn votes or make them money. In thinking about all the aggression that exists in the world, it seems to be fear that is at the root. Fear can cause people to act in ways that are almost unimaginable. Often, people aren’t even aware that they have these fears; they may simply be in touch with the anger that is fueling them to behave in dangerous ways. If we look closely, we may uncover deeply buried fears, such as fears of scarcity and fears of mortality. As we head into what is predicted to be a difficult week ahead, I invite you to take a moment to reflect on how you can approach the week by being kind to yourself and considering ways you can stave off feelings of powerlessness by taking charge of the things that are within your power and the ways you can actively manage your anxiety.

How to Manage Coronavirus-induced Anxiety

While people with an underlying anxiety disorder may be experiencing a heightened sense of panic or dread during this pandemic, pretty much everyone is grappling with some amount of unease as life as we know it is unhinged or even uprooted. Many people are staying home, which can disrupt our markers of daily life and leave us feeling disoriented and discombobulated. And as of right now, there is no end in sight, adding to our sense of powerlessness and confusion. Here are some simple things one can do to help manage this anxiety.

One course of action to combat anxiety is to slow down one’s heartrate using various relaxation techniques. There are a variety of useful tools such as guided visualization and progressive muscle relaxation. However, the simplest anxiety management technique I teach my patients is deep breathing. Many people have picked up faulty habits and have adopted shallow breathing patterns. Such breathing can actually exacerbate anxiety and panic. I work with patients to retrain their natural breath so that they develop diaphragmatic breathing. This allows the individual to take in vastly more air and slows down the whole process from inhalation to exhalation.

Think of our chest and stomach cavity as a cylinder. Put one hand on your rib cage and the other on your stomach. On a count of three breathe in, first fill your belly, and then, when that is full, expand your chest. You can fill the entire cavity, all the way around the back. Do this in reverse for the exhale. On a count of three, first exhale the air from your chest, followed by your stomach. When you feel that you’ve exhaled all the air in your chest and stomach cavity, pull up from your groin to get the last of the air out. Repeat this cycle three to five times. Try this a few times during the day. This is easy to do because you can do it anywhere and it takes very little time. With practice, this can eventually retrain the way you breathe so that it will be there automatically when you are most anxious. Remember, this is like opening a parachute: you wouldn’t wait until you are in midair to learn how to open it. You need to practice it over and over so that it will be there when you need it. After enough practice, try increasing to a count of four or five for each inhale and exhale.

Slowing down one’s breathing may prove a useful way to manage anxiety, but some people prefer to accelerate their heartrate as another anxiety management skill. The thinking is that changing one’s heartrate is the key, whether that means slowing it down or speeding it up. Any type of cardio activity can work: running, jogging, biking, jumping rope, dancing, swimming, and other athletic activities.

Another activity I personally find helpful with managing anxiety is to engage in some repetitive motion. Cleaning is an excellent example of this. Try scouring a pan or cleaning a floor. Something about the physical movement and repetition lends itself to getting the anxiety out of the body. Besides, you can benefit from having a clean surrounding!

This is not one size fits all. Experiment with some of the suggestions here and see which work best for you. You might come up with ideas not mentioned. What’s most important is that you find things that help lessen your anxiety and that you are actually likely to do. And remember, we are all going through this together. You are not alone.

Life in the Age of COVID-19

Everything feels rather upside down as we try to adapt to this new normal of life with the coronavirus pandemic. Most people seem to be at least a little bit unsettled by this outbreak. It’s not at all surprising for us to feel unease when there are so many unknowns and things are so up in the air. Many therapists are grappling with these feelings ourselves as we work to help our patients best manage their anxiety, restlessness, isolation, and relationship difficulties. The following are some initial thoughts I have on these subjects.

Most people are likely to feel some amount of anxiety but people who already struggle with underlying anxiety disorders or depression are particularly vulnerable to having difficulty coping. I recommend trying doable actions such as taking walks, running, meditation, deep breathing, guided visualizations and talking to friends and family for support. I strongly encourage people to limit the amount of time they spend listening to the news, as this can spike anxiety exponentially. In some ways, this crisis is similar to what it was like after 9/11 in terms of our collective anxiety. At that time, as now, limiting one’s exposure to tv was essential to maintaining health and wellness.

Many people are living alone and therefore quite isolated. Reaching out to people is crucial. Perhaps you have one or two close friends who are in a similar situation. Try making an agreement to connect with each other daily. Meeting via an online video platform such as Skype or Zoom is a great idea. I’ve been doing this for all my therapy sessions. While meeting in person is preferred, this is the next best option. Seeing a person face to face goes a long way. Having a pet is another great way to combat loneliness. Reportedly, there has been a rise of the number of people buying pets for this very reason. Now is also a good time to call your therapist if you have one. People need not wait for their appointment to reach out for help.

While some people are having a hard time with so much solitude, others are struggling with having their nerves frayed by spending so much time at home with their partners. Many of these couples were experiencing difficulties before, but even in the healthiest relationships “sheltering in place” can be a true test. If possible, I think it’s vital for individuals to find time alone by getting outside or going into a separate room. I’ve encouraged couples I work with to come up with a code word to signal to a partner they need a time out if things get too heated. Is it possible to call a “truce” to not bring up loaded discussions or arguments while we are bunkered down? Now is the time for us to be extraordinarily gentle with ourselves and others.

It may be hard to structure one’s time when trapped at home. I think it is important to treat one’s life much as you would if you were going to your job. Try getting dressed much as you might if you were going into the office. If working from home, try setting clear time boundaries. Make sure you have start and end times, schedule breaks, and aim to only address personal matters outside of these time boundaries. I suggest scheduling your personal time as well. You can break these down into chores, family time, and personal time. Children obviously require a lot of structured play and learning, but we also may benefit from scheduling our days so that we don’t find ourselves ruminating, festering with anxiety, and struggling to get anything done.

Thankfully, Blue Cross Blue Shield is allowing us to practice online psychotherapy during this pandemic. I foresee more people needing our services due to this crisis. My hope is that people won’t hesitate to reach out in such a trying time. While it certainly doesn’t take the place of seeing patients in the office, I am pleasantly surprised to see how effective remote psychotherapy can be. How very fortunate we are to be living in a time where such a thing is possible! Best wishes for health and calm as we navigate this unknown territory together.

The Collective PTSD of a Nation

Since the Presidential election of 2016 - even prior to it - there has been a spike in the number of patients who are reporting experiences of anxiety, powerlessness, restlessness, fear, difficulty sleeping, and being more scattered and disoriented than they previously have known themselves to be. This is particularly jarring when their sense of self is shattered and they are exhibiting symptoms that have not materialized before in their adulthood. Still more concerning is when, given the changes in health insurance in recent years, patients can no longer afford their deductibles and therefore opt to discontinue treatment at a time when they might most need to be coming in.

Not long ago I attended a seminar in which the speaker addressed how in ways not previously seen to this extent or magnitude, people seem to be responding to a collective trauma brought on by our current political climate. Clinicians, in addition to our patients, are struggling to manage their own levels of anxiety and powerlessness. Many of the people in our country show a complete dismissal or disinterest in facts, choosing instead the ease of not having to think for themselves and diminishing their personal fears by taking comfort in entrusting those in authority who are disseminating lies and "fake news." On a national (if not global) level, this is incredibly terrifying. Many of us are reeling from the continual onslaught of political egregiousness. This constant bombardment of one horrific incident after another is a form of trauma and the very thing that can disrupt us to such an extent that we are left in the position of having to always be in a reactionary stance, having to brace ourselves for further trauma.

For people who have a history of trauma in their childhood and adolescence, the current political landscape is all the more fraught. It is like walking through a landmine that presents us with ongoing triggers which reawaken those early traumas which may be deeply entrenched. One might react internally in much the way they did when they were young, defenseless children. 

I encourage patients to limit their exposure to the news if it is interfering with their ability to function. Given that it may be crucial to have a safe relationship such as the one that can develop in a therapeutic relationship, I think it is important to work together to figure out how people can continue coming in if their insurance is the barrier that is preventing them from seeking the help they require. Having a support system and appropriate self-care is of the utmost importance for both patients and clinicians during this highly chaotic time. 

Depression and Anxiety as Defense Mechanisms

There is a great deal of confusion between feelings and mood states. Feelings (or emotions) are normal, healthy aspects of being human. Sadness, anger, joy, and fear are all common feelings that every human experiences, often daily. Mood states are not feelings. Depression, anxiety, and Bipolar Disorder (often known as manic depression) are mood states and can be considered mental disorders when severe enough. This isn't necessarily the case, as most people have experienced some type of depression or anxiety in their life time without it being serious enough to constitute a mental illness. We can say that we "feel depressed" or "feel anxious," which adds to the confusion between feelings and mood states.

Mood states may be understood as defense mechanisms that serve to protect us from underlying feelings. For instance, if we experience our anger as unacceptable or threatening, we might "depress" it and end up being "numb," resulting in not being in touch with the underlying anger. People who suffer from depression often describe themselves as being lethargic, fatigued, hopeless, or despairing. We cannot be in touch with our emotions when we are depressed. Reversely, when we are in touch with our feelings, we are not depressed at that moment. Anxiety may also be a way to manage underlying emotions. If our anger becomes too intense, we might react by becoming highly anxious. In this case, the anxiety is in response to a perceived threat induced by our anger. To complicate this further, if our anxiety then becomes too intense, we might then clamp down on it and become depressed. I describe this to my patients as layers upon layers, with the root feeling (which is pure and healthy) being buried deep down. So in this example, anger is the pure, healthy emotion that the individual has come to believe is bad, dangerous, or unacceptable. So Anger -> Anxiety -> Depression. Freud described depression as "anger turned inward." I believe this is what he meant by that explanation. Thus, a person might only experience his depression or anxiety, having suppressed his anger to a point where it cannot be easily accessed. But if a person suppresses one emotion, he suppresses all emotions. So when a person is suffering from depression, he cannot fully inhabit his anger, joy, fear, or sadness.

In psychotherapy I help my patients explore what feelings they might be defending against by employing the defenses of depression or anxiety. By teaching people that their feelings are normal and healthy and not to be feared, they start to shift their relationships to their emotions. Over time, this helps people learn alternate ways to manage their feelings so that they no longer believe they have to push their feelings away at all costs. We may view depression and anxiety disorders as forms of "acting in," i.e. turning inward to try to manage difficult emotions. In my next blog post, I will address "acting out" behaviors that people may employ as alternate ways to attempt to manage internal emotional states.