There has a been a surplus of information coming out of the all the major news outlets with the president, experts on his task force, political commentators and a whole cadre of other pundits keeping us up to date 24/7 (some might say inundated or even flooded) with primarily news on the medical and economic manifestations/ramifications of this major epidemic affecting the entire planet.What appears lacking, albeit there have been local webinars and articles written by mental health professionals on the psychological correlates this virus is causing others emotionally, is that there is not nearly enough focus on the devastating toll this pandemic is taking on the population in regard to heightened anxiety, fear, uncertainty, sadness and depression. In my own practice, where my wife and I specialize in the assessment and treatment of anxiety and related disorders, the distress is visceral and palpable. Certainly, it makes sense as a primary goal to keep the public medically secure and informed of all the vital safety measures that contribute to the preservation of life through following expert advice. Nonetheless it remains paramount that the mental health of the nation is at stake to an equally significant degree.
In order to avoid repeating the obvious, which one can reference in articles by “Psychology Today” and other periodicals (many of these offerings have been excellent in nature), a Cognitive-Behavioral Therapy (CBT) approach can help ameliorate the anxiety and other unpleasant thoughts, emotions and non-adaptive behaviors that often occur during times of immense (often unfathomable) disequilibrium on such a global scale. The magnitude of human suffering, at all levels, from the significant increase in cases, individuals becoming quite ill and some even passing away from the illness is immeasurable. No psychological approach, even the most evidence-based, can fully shed light on the gravity of this situation. What CBT offers is a way of maintaining perspective, building hope, putting our mindset on trial and using rationality to replace reactivity/stress intolerance, in spite of the dire circumstances we all face as part of a common humanity.
So, what is CBT for those not familiar with this highly tested modality that has years of empirical data to support its efficacy? CBT is aimed at altering the narrative, which is commonly referred to as “cognitive restructuring.” It seems insensitive and implausible, on the surface and at first glance, to ask of those going through such difficult times not to view the Coronavirus other than a tragedy of epic proportion. This is especially the case when those fall prey to the illness, become highly symptomatic and God forbid their families have to face the potential and in more cases than anticipated actual loss of life. Yet, we as Jews are a resilient people and not only the Jewish nation, but the world needs hope and ways to manage the anxiety, traumatic sequelae and other painful emotions that are impacting our lives. CBT attempts to help in putting one’s thoughts on trial and assisting those in need to confront the realities, not avoid or suppress them, of some of the more distressing cognitions and subsequent disturbing emotions. It also is geared to offer alternative ways of thinking about situations, events and topics. By creating a more realistic and positive narrative it looks at our current situation as an evolving process not a sustained and unalterable state. I will have more to say about this when I extrapolate on concrete and specific strategies one can incorporate in their daily life. This therapeutic method also is aimed, via self-discovery and collaboration with the clinician, which is part of the whole enterprise of CBT to allow for healthier behaviors to replace ones that can create the very anxiety, etc. one is aiming towards decreasing. Rav Soloveitchik believed there was nothing more powerful than self-discovering, rather than having something simply spoon fed. I am also reminded of another mantra by Rav Soloveitchik that “faith is tested in adversity.” Having said that, even with emunah and bitachon in Hashem, we must put our most concerted efforts forward to “do what works” to ease our suffering.
Some of the most common strategies that are unique to CBT are the following. It is important to keep in mind before sharing that there is not one CBT, but different variants that all have their individual focus. In addition, Dr. Aaron Beck is the founder of the most classic and traditional version of CBT and has deeply influenced our thinking and served as my mentor. In having explained what CBT is in a nutshell, it now seems vital to move from the conceptual to the practical. Particularly, during these trying times, having tools to face uncertainty and this invisible enemy is of the utmost urgency.
These ideas/techniques form part, not all, of the beginnings of a tool kit to offer solace in what appears to be inconsolable times:
• Cognitive Structuring is aimed to have individuals take a close look at their anxieties and worries to find other more realistic and positive ways to look at the same situation. It is not aimed to dismiss thoughts and feelings, but allows for a greater openness to other perspectives. For example, if a person is constantly worried about getting ill from the virus, the focus would be on what they are doing to prevent getting it (i.e. washing hands, keeping social distance, weighing the evidence if they have actually been around someone infected). This is looking at things more rationally and trying to remain calm.
• Exercise has become popular in CBT circles. The experts are now saying it is the consistency of exercise, not the duration. Thirty minutes three days a week of aerobic exercise can take the edge off anxiety and keep the blues away. It also helps the respiratory system function more effectively.
• Another adaptive behavior is doing things one enjoys. Reading, spending time with family (even if communicating on Zoom, Skype, WhatsApp). Reaching out to others combats social isolation by creating connections so that one is not alone.
• Being mindful of triggers. If watching the news creates increased anxiety, then these behaviors should be limited. For some being informed is helpful, while others become overloaded with too much news. Balance is ultimately the key.
• Get plenty of rest, stay hydrated, try to eat a healthy diet and stay on one’s medication regimen as prescribed by one’s doctor. Discuss with your doctor if any supplements can help boost your immune system.
• Do not read into every bodily sensation as if it were a catastrophe. We call this catastrophizing. Meaning, do not anticipate worst scenarios by “what iffing?”
• If anxiety symptoms are intense, severe, impairing and lasting seek psychotherapy from a competent therapist. Symptoms can also be lessened by seeing a psychiatrist and taking psychiatric medications if needed. There is no shame or stigma in doing so, as these are highly anxiety producing times.
In summary, the hardest challenge during extremely difficult periods is to remain calm, resilient and persevere. The president and his task force, especially Dr. Fauci, have shown a composure and coolness under fire that is exemplary and a model we can all attempt to emulate. Lehavdil, the Sages of Israel as exemplified by HaGaon HaRav Chaim Kanievsky, have encouraged us all that we need to increase our acts of loving kindness, prayer and overall commitment to Hashem. Additionally, the current situation is forcing us all, as the late Charles Krauthammer said, to be mindful of the things that really matter in life. Once the virus is gone for good and health is restored, we will all need to reassess our priorities and not take health, happiness and prosperity for granted. Most importantly, we must cherish each other and be sure to stay in the present moment and be grateful for all the blessings we have in life – both small and big ones. As there are many if we reflect and take note of the “eternal things,” those moments and memories that last and are essential.
Dr. Michael E. Portman, LCSW, ACT is an independent licensed supervisory clinical social worker, fellow of the Academy of Cognitive Therapy and international authority on generalized anxiety disorder. [email protected].
Anna Ostro-Portman, LCSW is a licensed clinical social worker and seasoned in both psychodynamic and family systems therapy. [email protected].
