Mental health in times of pandemic

Introduction

In the current circumstances of the coronavirus pandemic, both adaptive and maladaptive psychological reactions are inevitable. This Health Charter aims to highlight the psychological aspects that arise due to pandemic-related events and offer recommendations for coping with them.

In the initial part, the document is presented in two columns. The first is a story intended to exemplify behaviors, emotions, and sensations with which a person can identify, and the second shows the explanation of the psychological phenomena that are intuited in each paragraph of the story; psychological phenomena that must be learned to identify and manage, in order to prevent them from becoming maladaptive, dysfunctional, or pathological reactions.

A STORY…

At the end of December last year, Silvia was preparing to celebrate the New Year. She bought salad, cake, and soda at the supermarket. She was very happy because she would be getting together with her parents, aunts, uncles, cousins, and grandmother. On her way home, she turned on her car radio and heard the following news report: “Dr. Li Wenliang from Wuhan, China, suggests being careful of a contagious disease that starts like the flu and ends in pneumonia.” At that moment, Silvia thought, “Wuhan? China? It’s so far away!…Besides, science has progressed a lot, and they’ll find a treatment soon.” She changed the station and put on some music.

In mid-January, Silvia remembered the news she had heard in December; she had almost forgotten it. A friend told her that Dr. Li Wenliang, who first diagnosed the infection in Wuhan, had died from pneumonia caused by the coronavirus, the disease he had discovered.

Her alarm grew when she began seeing the news reports about the progress of the epidemic and the deaths it caused. First in China, then in Italy, later in Spain, and also in Switzerland and Germany. Silvia was filled with fear at the thought that the pandemic would reach Colombia and the risk it posed to her father, her uncles, her grandmother, or to the doctors, who spend most of their time in hospitals.

Gradually the word coronavirus became commonplace, someone always had something to say, some comment, sometimes wrapped in humor.

When the first case was reported in Colombia, Silvia began to feel anxious; her heart started racing, she felt discomfort in her chest, physical exhaustion, and stomach upset. She couldn't concentrate on her activities; her world became saturated with information about COVID-19, filtered through a lens of hopelessness and fear. Her gastrointestinal symptoms worsened, she lost her appetite, and she became certain that something serious was happening in the world, in her country, in her neighborhood, that it could happen in her home and to her personally. The world began to feel alien and strange; she experienced crying spells, sometimes irritability and bad temper combined with anxiety and sadness.

With the declaration of quarantine and the government's stay-at-home order, Silvia understood that the pandemic was definitely a reality in her country. She tried to organize her time and adjust to being constantly at home with her parents. Now she experiences moments of anxiety and sadness, and sometimes becomes irritable, but she has discovered that she must be patient and that the best thing to do is follow the instructions of scientists and authorities. Silvia is very uncertain (unable to predict what will happen); nothing is clear about the situation, and she wonders: When will I be able to leave my house without feeling unsafe and in danger? Will what happened in Italy happen here? Will I get sick? Will I die? Will any of my family members get sick or die?

AN EXPLANATION…

Human beings possess personal resources to protect themselves from adversity and, as an adaptive strategy, employ thoughts, emotions, and actions to adjust to new situations (pleasant, threatening, unforeseen, etc.). The mind devises amazing ways to explain and evaluate situations.

In general, anything interpreted as dangerous to life or psychological stability is perceived as a "threatening event," and one may experience a feeling of a lack of internal resources to cope successfully.

A seemingly unimportant news story gains significance when it is discussed and expanded upon; if it doesn't affect human well-being or any other aspect of life, it tends to be considered unimportant. But if the information continues to be presented, it becomes permanently ingrained in people's knowledge, intensifying when it involves situations of suffering or adversity.

The context of this epidemic, which evolved into a pandemic, generates fears that determine certain behaviors of control, protection, or avoidance when the likelihood of harm to one's own life and the lives of loved ones is perceived. Here, experiences arise that oscillate between the perception of danger and the perception of unreality (as a mental strategy for control or protection).

The need to adapt leads to attempts to normalize, minimize, or maximize the information received, in order to have time to assimilate what is happening. This is why jokes and memes are used to try to quell the perception of imminent danger. People laugh at tragedy as a way to tolerate a dramatic reality. But the situation in the world is increasingly
It becomes more threatening, therefore feelings of vulnerability and persecution by an invisible enemy arise. Faced with these threatening situations for physical or psychological integrity, neurobiological systems equivalent to fear and anxiety are activated in the body, producing a state of hypervigilance that can manifest physiologically as an accelerated heart rate, restlessness, increased respiration, and disturbances in sleep and appetite, among other things.

It's normal to feel fear and anxiety about the current situation, which can be heightened by the uncertainty, but strategies must be developed to manage these feelings. Without these strategies, mental health can be threatened. If fear takes over, if the measures taken aren't accepted with composure, if there's constant regret about things that were left undone, if active control of this new reality isn't taken, there will be no rest or peace of mind. The body will continuously release adrenaline and cortisol, which, while helpful during the initial adjustment period, can lead to depression or abnormal anxiety over the course of several weeks.

In a pandemic like the current one, three components combine to generate anxiety: the threat to life, the disruption of daily routines, and uncertainty. It is impossible to live through a pandemic without feeling fear; mental health professionals, in this situation, have also felt fear, experiencing moments of unease, frustration, uncertainty, and hopelessness.

At other times, feelings of hope, acceptance, and compensation arise, for example, when thinking that this is a lesson for humanity and that, after the crisis passes, our appreciation of life, our fellow human beings, and the planet will be different. Below are some brief descriptions of strategies that can be implemented to
coping with these times of pandemic:

• Talking about the topic: It's common to feel the need to talk about what you think or feel in the wake of the pandemic, the economic crisis, and its social repercussions. You express your concerns, and talk about both positive and negative aspects. Talking produces a psychological effect called catharsis, which involves processing emotional tension by verbalizing tragic situations.
• Think about what you are thinking: Everyone has the capacity to reflect on their thoughts and thus control their mental processes. This is an innate human ability called metacognition. If someone thinks their grandmother will die in the pandemic, this is a catastrophic, maladaptive, and stress-inducing thought, especially if all recommended precautions are being taken to prevent her infection. This person has the capacity to analyze their thoughts and choose to relate to them differently, opting for alternatives that involve less anxiety and lead to more effective behaviors. It's important to constantly review one's thoughts, assess their magnitude, and evaluate them rationally; in this way, one avoids anxiously overvaluing adversity and can assess it in its concrete and fair measure.
• Identify and accept what you are feeling: While distressing emotions arise spontaneously in threatening situations, such as those experienced during this pandemic, recognizing them allows us to regulate them. In addition to conscious breathing (paying attention to and describing your breath), using meditation techniques, listening to calming music, and talking with friends and family, it's important to try to verify the facts (describing them without judgment) to determine whether the emotion you're experiencing is appropriate to the situation. The more objectively you can describe the facts, the less emotional overwhelm you'll experience.
• Use your time wisely: apply the RULE OF EIGHT.

8 hours of sleep
Sleep can be disrupted by the pandemic situation, therefore, it is important to strictly follow the rules of Sleep Hygiene:

1. Establish a set time to go to sleep and wake up.
2. Take a nap of no more than 45 minutes.
3. Avoid heavy meals four hours before bedtime.
4. Avoid coffee, chocolate, or dark drinks in the afternoon or evening.
5. Avoid alcohol, do not smoke.
6. Exercise, preferably in the morning, never before going to bed.
7. Wear comfortable, soft clothing.
8. Have the room at a suitable temperature and also ventilated.
9. Turn off the television and all sources of noise before going to sleep.
10. Use the bed for sleeping, avoid working in it.

One last recommendation: when you want to fall asleep, avoid thinking about having to sleep; sleep is an automatic process. Many people can't fall asleep because they're thinking about it, and this causes them anxiety. When you want to fall asleep, you can follow the sequence of a pleasant story or movie, pray, count sheep, etc.

8 hours of work and development of other mandatory activities

1. Avoid staying in pajamas all day; shortly after waking up, it's important to try to bathe and get dressed even if you don't leave your house.
2. Create a schedule of mandatory activities, including teleworking or online work, and stick to it. Include household chores in this schedule.
3. Use your cell phone in a regulated manner; put it away or silence it during work periods and mandatory activities.
4. Stay informed through reliable and reputable sources. Don't become obsessed with information; watch the news or check for updates only once or twice a day, for periods of no more than half an hour.
5. Strictly follow the recommendations of the health authorities; if you thoroughly comply with the recommendations, the possibility of infection, for you or your family, approaches zero.

8 hours of enjoyable and fun activities

1. Make mealtimes a pleasant opportunity to share and try new recipes.
2. Listening to music, singing, and doing karaoke.
3. Use social media and phone calls to connect with family and friends. Reconnect with relationships you've neglected. Dismiss contacts who send alarming or intimidating information.
4. Exercise 3 or 4 times a week; you will find tutorials online for doing routines at home.
5. Watch movies or series with your family, play cards, Parcheesi, dominoes. The internet offers thousands of entertainment activities for individuals or families.
6. Read books and discuss them with your loved ones.
7. Creating a seedbed and a home garden will bring you great satisfaction, and the seeds will spontaneously appear in your kitchen. Sow vegetables and legumes. You don't need a yard; you can do it in pots in a well-lit spot in your house or apartment.
8. Organizing, painting or fixing up the house is an opportunity that confinement provides.

Important

If you have a history of any disorder that required psychiatric care, it's important to be vigilant. It's crucial to distinguish between a normal adjustment and a symptomatic relapse. If you're not feeling well, contact your healthcare provider.