Important Conversations: Anxiety Management and Wellness

March 18, 2020

Columns | Awkward Conversations

As coronavirus moves its way across the country, Dr. Kim Gorgens, a psychologist with more than 20 years of experience, recommends that rheumatologists proactively reach out to their patients to address concerns that may lead to stress and ill-advised changes in treatment regimens, such as stopping treatments without consulting a physician.

As COVID-19 continues to disrupt the routines of your practice and the lives of your patients, it's important to recognize how easily every normal or adaptive emotional response (e.g., fear, anger, sadness) can evolve into rumination, despair, panic, and even hopelessness.As a psychologist with more than 20 years of experience in treating clients, training clinicians, and researching the effects of stress, I am sharing tools that I use in my practice, recommend other practices adopt and have even adopted for my own mental health. Now, more than ever, we are called upon to heal ourselves.First, reach out to your patientsâNOW. You may be seeing more of your sicker patients now, but those you haven’t heard from may have some high-stakes questions. Rheumatology patients may be wondering whether to stop or reduce their immunosuppressant medications and risk a flare-up if doing so would outweigh the risks of COVID-19.Rheumatology patients may also have questions about alarming news headlines that suggest anti-inflammatory drugs may aggravate or worsen COVID-19. Consider reaching out proactively to your patients with reassurance and direction. Importantly, recommend preventative measures, such as handwashing and quarantine, plus highlight COVID-19 symptoms rheumatology patients should have on their radar, such as fever, cough and shortness of breath.Because COVID-19 spreads quickly and easily, self-imposed social isolation may be more of a necessity for immunocompromised rheumatology patients. But, isolation, as you know, can have a negative impact on mental health. It can heighten anxiety as a result of inactivity, information overload, and unpredictability.Â (Contributing Author:Â Margaret Port, M.A., project director, Columbia University Department of Psychiatry and New York State Psychiatric Institute.)In the following slideshow, we list some mental health resources and highlight coping strategies I've utilized in my practice.

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Utilize social networks: Research suggests that staying connected with your community reduces loneliness and promotes resilience. Adopt virtual social contact several times a day (phone calls, chat rooms, FaceTime, Skype, Zoom, #spoonie).

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Plan for emergencies: If you are responsible for the care of older parents or younger children, prepare continuity care plans with friends and/or extended family in the event that someone is exposed, requires quarantine or contracts COVID-19.

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Exercise: Try channeling your inner drill sergeant and set a timer for breaks to stretch, walk or exercise. When possible and safe, get outside for those breaks.

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Sleep: Keep a sleep log to track the duration and quality of your sleep and any naps you take. Sleep is the canary in the coal mine and a sleep log can alert you to problems before your mental or physical health suffers. Aim for 7-9 hours each day (including daytime naps).

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Manage your stress before it manages you: Stress is an adaptive response to present circumstances and there are easy, free electronic tools to keep it under control (Breathe2Relax, Headspace, Stop, Breathe and Think, Colorfy, and the Virtual Hope Box). There are also plenty of low-tech techniques like grounding exercises.

My favorite is the mindfulness 5 Senses Exercise: Stop. Look around the room and find five things you see, four things you can touch, four things you hear, two things you can smell, one thing you can taste.

Try progressive muscle relaxation techniques from head to toe: Clench your jaw muscles for five seconds, relax for five seconds; then, move lower to your shoulders and neck muscles. Clench and release. Repeat until you reach your toes.

Stay busy: Lose yourself in a good book, take an online college course, visit online virtual museum tours, or organize your junk drawer. Limit the time you spend getting news updates and spend that time doing something else. Make and keep a routine, however imperfect it may be.

Get help when you need it for as long as you need it: The network of remote mental health resources is vast. There are sliding fee tele-mental health services from Talkspace and Betterhelp (both offer online therapy via text, audio, and video chat). There are no-cost services for immediate support, including the Crisis Text Line (text CONNECT to 741741) and the National Suicide Prevention Lifeline at 800-273-8255.

And, for anyone who is not safe in their home, call the National Domestic Violence Hotline at 1-800-799-7233, text LOVEIS to 22522 or log in at www.thehotline.org.