It goes
without saying that the COVID pandemic has increased levels of anxiety for many
people. The whole thing can be very traumatic. Some have contracted the virus,
while others have family or friends who have been seriously ill or have died. With
the lockdowns have come lost jobs, diminished savings, family conflict, and
substance abuse. The daily news announcements about infection rates, variant
strains, changing guidelines, and death counts can be overwhelming.
For
many people, social distancing has required many lifestyle adjustments. As an
introvert, I experience few problems social distancing. It is almost like I
have been preparing for the pandemic for years. Extroverts, on the other hand,
are basically going nuts, and driving everyone else crazy with their desire for
social interaction and getting out of the house. What is interesting is that it
is the introverts, not the extroverts, who are most vulnerable to being
overwhelmed with anxiety.
It
is not surprising that rates of anxiety disorder among adolescents and adults
have risen over the past year. A recent review of Employer Health Program (EHP)
insurance data at Johns Hopkins shows that, of those people who have been
prescribed medications for anxiety and depression over the past year, many have
no previous history of taking these medications. And these are the lucky ones –
they are receiving help.
While
anxiety may be a reasonable response to a pandemic, it does not feel good. For
many people, the ongoing threat of illness triggers our “fight or flight”
response, shooting hormones throughout our bodies, hearkening back to the days
when we were confronting Pharaohs and fleeing chariots. Yet anxiety is more
nuanced than fear, because it involves a highly evolved cognitive component. In
essence, we have active imaginations and are often adept at jumping to worst-case
scenarios. This is how a simple cough or sneeze can lead to thoughts of crowded
hospitals and ventilators.
The
anxiety disorders actually comprise a number of related conditions that include
generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive
disorder, and post-traumatic stress disorder, among others. While each of these
disorders deserves its own space, I wanted to focus on five anxiety symptoms,
shared by many of these disorders, that seem to be exacerbated by the current
pandemic.
Worry: Excessive worry is a hallmark of
anxiety, occupying the day, interfering with activities. The worries are often
vague and non-specific, making it difficult to concentrate or sleep, and
leaving a feeling of irritability and unsettledness. That some anxiety symptoms
like breathing difficulties and muscle aches can mimic COVID symptoms adds to
overall uneasiness. Many people find that these worries can linger even after
they have received a vaccination.
Fatigue: All of those stress-producing
hormones can cause shakiness, sweating, increased heart rate, and muscle
tension. Combining these physical symptoms with constant worry can be quite
draining – each day becomes much too long. There is now data showing that many
people who have contracted COVID, even if the symptoms were not severe, suffer
from a prolonged fatigue syndrome that can last for months.
Hyperarousal: Experiencing, or even witnessing,
serious COVID symptoms can be traumatic as well. Hyperarousal is a common
response to trauma and includes feeling constantly on edge and easily startled,
as if danger is constantly knocking at the door. People with hyperarousal like
to be left alone, finding social interaction both exhausting and irritating.
Extreme levels of hyperarousal can produce panic attacks, in which the threat
of harm causes symptoms like a pounding heart, nausea, dread, and a need to
escape. During the pandemic, ER doctors have been busy seeing people who
believe that they are having heart attacks when in fact they are experiencing
intense anxiety or panic.
Breathing
difficulties: A
common anxiety symptom is shortness of breath and a tight chest, another “fight
or flight” response aimed at getting oxygen to our muscles in preparation for a
potentially deadly confrontation. Knowing that shortness of breath is a primary
symptom of COVID is likely to exacerbate this symptom in many people.
Headaches and
digestive problems:
Anxiety is often a very physical disorder. Recurring headaches, due at least in
part to constant worry, are common. Our “gut-brain axis,” connected through the
vagus nerve and other processes, likely accounts for the association between
anxiety and digestive problems like irritable bowel syndrome and GERD. A doctor
can help distinguish whether the cause of these problems is medical or
psychological.
* * *
If you are
experiencing any of these symptoms, you are in good company! The good news is
that there are many things we can do to reduce anxiety. Here are three:
Consider lifestyle
changes: Many
commonsense lifestyle changes might be helpful. For starters, stop paying
attention to the news. Exercise regularly and watch your diet, avoiding sugars
and limiting caffeine. Practice breathing exercises and take some time outs
when life feels overwhelming. Stay away from alcohol and other sedatives that
provide some escape but are ultimately unhealthy and dangerous. Use good sleep
hygiene, avoiding caffeine and other stimulants before going to bed, putting
away your phone, and sticking to a routine.
Speak to a therapist: When your own strategies don’t
work, it might be time to speak with a therapist, who at the very least can
help assess if the anxiety requires more intensive treatment. A therapist will
help you recognize and label anxiety, understand possible causes and common
triggers to anxiety, and provide ways to challenge anxiety-provoking thoughts
and tolerate distress. In the era of Zoom, speaking to a therapist has become
much more accessible.
Consider medications: Therapists often work with
psychiatrists who specialize in the treatment of anxiety disorders. There are
now a range of medications that can be helpful, have few side effects, and
convey little to no abuse potential. Many of these drugs work by increasing
levels of serotonin in the brain. A doctor can help you find the right
medicine. A group of drugs called SSRIs (e.g., Zoloft, Lexapro), originally
intended for the treatment of depression, provide considerable anxiety relief
and are often the go-to medication for both adolescents and adults.
Dr.
Kidorf is a clinical psychologist and Associate Professor of Psychiatry and
Behavioral Sciences, Johns Hopkins University School of Medicine.
