Stress and COVID-19

Stress and COVID-19

COVID-19 and its context are stressful

We are facing a public health crisis unlike any seen in Europe in 100 years. This global health emergency impacts us and our loved ones. The recommendations for lockdown, physical distancing, the changes in working conditions, health risks and changes in our daily routines create worry for many of us. In addition there are so many unknowns about the consequences of coronavirus, we are stressed and   don't intuitively know how to cope and manage.

What is stress?

Stress is a physiological reaction of our bodies to environmental  demands and pressure when we are faced  with a situation where we don’t have control. For example when there is danger., we feel our heart race, our palms become sweaty, we have a lump in the throat.

When we are unable to identify, understand, or explain what is going on within us,  when the physiological changes are abrupt or unpleasant, we experience insecurity. To face this insecurity, and to  release these unpleasant sensations, we have to adapt to the situation.

Stress is not negative in and of itself, but will become  so if the physical tension we feel becomes constant. If we can alleviate this physical tension, we may avoid the physiological responses of our stress hormones which lead to weakening our capacities to recover,  impacting our mental health,  our positive world view and morale, our sleep quality, and our emotional reactions.

Does stress lead to fear?

Stress leads to fear because our body is physiologically in a state of emergency. Stress hormones prepare us to react to danger,  around which we have three possibilities: I fight, I’m stuck, or  I run away.

When we sense  danger, all our attention is directed toward analysis of the environment, we become hypervigilant, our brains freeze. COVID-19 certainly presents this reality to citizens across Europe. As an example of this, recall how many people took the opportunity when national lockdowns were announced to go to the supermarket, purchasing unnecessarily great quantities of  toilet paper or food items. Why did some of us act like this, when others went to parks, enjoying the first sunshine and colours of spring? We see this reaction time and time again. When we see the empty shelves in the supermarket although there is no objective rationale for that level, of stocking up we the message that this is a rational response is reinforced.. This explains why we are led to imitate others regardless of whether or not this is rational.

Why are reactions so diverse?

Some of us are more sensitive to danger signals than others. We label them  “anxious people.” But what is anxiety? Anxiety is feeling stress and fear when there is no immediate danger. It can even mean being afraid of being afraid. Anxiety occurs when one interprets many signals from the environment as threats, and her/his warning system is activated. There is a perceived stress, which is different from that we experience in the current context, but which contributes to this acute anxiety and serves up a double dose of anxiety.

Studies have shown people who are experiencing anxiety, and people with eating disorders have a warning system that is more sensitive. It means that these people will feel threats and insecurity earlier than others will.

Moreover, our beliefs, our representations, our life experiences, our education, and our personalities influence our interpretation of the environment. For example people experiencing panic attacks interpret the physiological changes within their bodies as serious threats, and these physiological sensations are real. During generalised anxiety, individuals perceive in their environments more danger signals and threats than there are in reality.  In obsessive-compulsive-disorder, one will try to reduce  sensations of danger through rituals either in the brain (I count down over and over), or through behaviours (like washing hands).  In the case of  eating disorders, an individual may try to reduce internal tension by  searching for an immediate and efficacious pleasure; food can serve this ruction.

As you can see, many threats (real and perceived), when combined with particular personalities and life circumstances on certain personalities will lead to behaviours intended to reduce stress, fear and anxiety. These behaviours may have undesired consequences.

What should I do if I’m anxious?

Our world has taught us to move really fast, without respecting our feelings, or biological rhythms, or personal sensations. We are no longer listening to our bodies at the deepest levels.  For example, since you woke up this morning, how many times have you focused on your breath? Have you taken the opportunity to observe the difference in temperature between the air you breathe in and the air you breathe  out? How many times have you connected with your body to hear what it wants to tell you? Am I tired? Am I hungry? Is today like yesterday?

By asking our bodies to remain silent, our brains activate, and thinking becomes faster and faster,  preventing us from thinking clearly.  Our brains sends us false information; these impressions may be inaccurate, but will lead us to interpret something about about ourselves and our world.  It can then become more and more difficult to control our thoughts. Thoughts become  like invaders; everything feels like an emergency. This creates an inordinate amount of tension in our bodies, which is difficult to get rid of, and which lead us to undertake comforting behaviours.

There are techniques available which can help us return to a feeling of  security.

One of the first strategies is a  technique of  soothing our bodies through anchoring exercises when we find ourselves experiencing   tension. These exercises focus our attention and are meant to soothe our body through regulated respiration  This approach, cardiac coherence relaxation,  will stimulate internal sensations  of relaxation in the chest and can help regulate cardiac rhythm. Abdominal respiration, also known as diaphragmatic breathing, can  activate our parasympathetic system which has the effect of calming our anxiety.

Another exercise to  help modulate respiration involves  taking a big breath, holding it for as long as you can, and breathe out ,and then breathe as normal.. This exercise is very efficacious when the body feels that it is in a state of panic or when we feel short of breath and have palpitations.

The second technique to support emotional regulation  is intendedf to lead us  back to the present «  here and now » with « orientation body exercises.” The aim of these exercises is  feeling calm  and controlling negative thoughts.

Another exercise, called « 54321 » consists in concentrating on our perceptions, « here and now », analyzsng what we see, hear, and smell, taking a deep breath in between connecting with these senses. For example I look at five things, smell five odours, hear five sounds, take a breath. For the next cycle I would then look at four things, then three, each time repeating the entire cycle.

There are several breathing support applications (apps) that are  free to download on your smartphone.  Mindfulness exercises and medication are very helpful, and there are a range of apps online.

In conclusion, stress is a normal reaction to danger, and under the circumstances it is to be expected that  levels of stress has increased during these difficult times.. In people who may be already  anxious or prone to eating disorders, the stress reaction may be exaggerated and can lead to undesired behaviours.

The exercises proposed here could be helpful and can be used in addition to other tips to fight anxiety and fear. Most of these techniques can be reinforced with widely available free to use applications. In addition, health care professionals are here to help, to evaluate your situation and to assist you in finding the most appropriate solution for your specific circumstances. Please do not hesitate to call on your HCPs.

Aurélie Croiset, Doctor in psychology
Patrick Ritz, Professor in clinical nutrition
Teaching hospital, and obesity reference centre, Toulouse, France