Stress is understandable in a pandemic that threatens our lives and livelihoods. A certain amount can be healthy, putting us in survivor mode, and hopefully prompting us to social distance and wear masks. But too much stress for too long can paralyse us – or push our cardiovascular system into unhealthy overdrive, even resulting in destructive escape in alcohol or even illicit substances. How much stress is too much? And when should we get help?
Stress
We all react differently to stress, depending on our personality, past life experiences, and the family, social and financial support available to us, says Gauteng clinical psychologist Dr Colinda Linde. The US Centers for Disease Control and Prevention report that the people most at risk of responding strongly to stress during the pandemic are those at high risk for severe illness (the elderly, those with underlying health conditions), those who care for loved ones or work on the frontline (nurses, doctors, teachers, those dealing with the public), and those who have lost their income or job, live alone, or have a disability or existing mental health condition.
Even if you’re not among these groups, it’s important to take steps each day to counter stress. Unplug from news media, relax with something you enjoy (a sitcom, a hobby), connect with others and unburden about your fears from time to time (via phone calls or text messages in lockdown), urges Linde. Get regular exercise to release feel-good endorphins and release tension (walk the dog, garden vigorously, dance), and try yoga, meditation and deep-breathing. Also eat well-balanced, healthy meals and get enough sleep by avoiding caffeine and screen-time late in the day.
Be aware of signs of stress, in yourself and loved ones: sleeping or eating noticeably more or less than usual, losing interest in things you used to enjoy, battling to concentrate or finish tasks, headaches, stomach aches, chest tightness and lowered libido, among others, says Linde. If you don’t take steps to manage it, chronic ongoing stress has been associated with cardiovascular disease and immune system suppression – the last things you need in the Covid-19 pandemic.
Anxiety
Anxiety is what you feel when stress puts you in a state of physiological arousal ready for fight or flight, triggered by elevated secretion of the hormones cortisol, adrenalin and inflammatory cytokines, says Linde. The signs are excessive worry, feeling restless or on edge, irritable and tense and struggling to sleep or eat. If this goes on for at least six months, notes the SA Depression and Anxiety Group (SADAG), you may formally be diagnosed with Generalised Anxiety Disorder (GAD). It’s important to see a mental health professional to assess you and prescribe the treatment best suited to you. This usually involves therapy – especially cognitive behavioural therapy, which teaches ways to reframe and manage negative thoughts – and anti-anxiety medication.
Anxiety tends to be experienced differently to depression, where instead of having excess energy leaving you wound up and agitated, with depression you have low energy, and become lethargic, unmotivated, purposeless, hopeless, tearful and withdrawn, says Linde. Again, it’s vital to seek treatment.
PTSD
Post-traumatic stress disorder is an anxiety disorder that can emerge after you experience or witness something traumatic that leaves you feeling afraid, hopeless or helpless. In the current pandemic, that could include losing a loved-one to Covid-19, or getting infected and being treated on a ventilator, isolated from family and friends. It may also include experiencing stigma after you recover, if others in their ignorance shun or insult you.
In a study of PTSD in Covid-19 survivors in China (published in March 2020 in the journal Psychological Medicine), researchers found the prevalence of serious PTSD in patients discharged from five quarantine facilities in Wuhan to be as high as 96%. “According to the treatment guidelines, patients need to be treated in isolated infectious hospitals,” they noted. “Due to social isolation, perceived danger, uncertainty, physical discomfort, medication side effects, fear of virus transmission to others, and overwhelming negative news portrayal in mass media coverage, patients with Covid-19 may experience loneliness, anger, anxiety, depression, insomnia and post-traumatic stress symptoms.”
Signs of PTSD include irritability, angry or violent outbursts, problems concentrating, feeling jumpy and hypervigilant, and disturbed sleep, notes SADAG. You may also have flashbacks to the trauma, hallucinations or bad dreams. Alternatively, you may resort to avoidance – not talking or even thinking about what happened, and steering clear of activities, places or people associated with it. You may feel detached and emotionless.
As with GAD, a professional assessment is needed for diagnoses of PTSD, but effective treatment is available. It usually includes talk therapy and meditation. The therapy can be counselling, “prolonged exposure” (talking about the trauma repeatedly, to regain control of your thoughts) and EMDR (eye movement desensitisation and reprocessing), reports SADAG. A study last year in the journal Psychological Reports suggested TM (transcendental meditation) could also help relieve PTSD, alone or in combination with psychotherapy and medication. Spending 15-20 minutes a day practising TM brought relief to a group of South African students with PTSD in 15 days, and after three months their scores on the clinical checklist for symptoms of PTSD had dropped below the threshold for PTSD.
Symptoms of GAD and PTSD can overlap, and the two conditions can occur together, if you are struggling with GAD and also experience a traumatic event. “Social connectedness is one of the most protective things people can have against the effects of trauma,” says Dr Joshua Morganstein, chair of the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disasters. This means one way to help prevent PTSD is to maintain social connectedness using technology, if you or family are hospitalised and isolated, with apps such as WhatsApp, FaceTime and Skype.
In riding out this stressful pandemic, it’s vital to be alert to signs of unhealthy anxiety or PTSD in yourself and those you love, and get professional support.
For resources, contact SADAG on 0800 21 22 23, sms 31393. The Psychological Society of South Africa has also created a database of psychologists offering free services for those in need. To connect with one, e-mail [email protected].
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