Behavioral Health Tips to Adapt to COVID-19

With all of the news and changes surrounding COVID-19, anyone can feel overwhelmed and anxious. Adjusting to challenges of the new recommended restrictions related to COVID-19 can be stressful. We know that some stress helps to build a stronger immune system. Too much stress can lead to a weakened immune system, promote diseases, and disrupt your behavioral health. COVID-19 has all the major elements to make our alarm bells sound. Learning healthy ways to manage stress as soon as possible can help prevent long-term troubles. I would like to offer some strategies, based on research findings, that can help you build resilience while coping with the many lifestyle changes related to COVID-19. 

 

Tips to Help Deal With the Stress of COVID-19

Keep a structured day. Staying close to your normal schedule can be helpful for you and everyone in your household. Not having structure often contributes to anxiety in children who have grown accustomed to a daily routine. Structure provides a sense of control. However, within your routine, you can be flexible with normal rules of your household. Decide ahead of time which rules you will continue to hold firm and which rules you will allow some flexibility.

Acknowledge feelings and emotions. Expect a wide range of emotions - including sadness and anger. These are part of adapting to the challenges we are all facing.

Create A Few New Routines. Enjoy family meals together, spend quality time together as a family, or learn a new game or activity. Start a new hobby that you have been putting off until you "had time" or re-engage a hobby you have neglected.

Engage in Physical Activity. If you normally go to the gym, take advantage of online/YouTube fitness classes in your own home. This can be done individually or as a fun family activity. If you are exercising outside, remember the CDC recommended guidelines about social distancing. Consider doing a virtual/video fitness with a friend. If you have not been physically active, this could be a great time to start. Consult with a physician for guidance before you start an exercise program.

Limit media time. Stay informed while avoiding getting saturated and overwhelmed with news through multiple venues (national/local news, Facebook, Instagram, Twitter, etc.). Research finds that social media can escalate anxiety more than traditional media. As more data is gathered about COVID-19, information changes rapidly. There is also mis-information about this virus, treatments, cures, and restrictions. Negotiate with family about the specific amount of time with social media. Social science evidence shows that too much media of any kind can increase stress and anxiety.

Help younger children feel secure. Ask younger children what concerns them, instead of providing information that may be confusing. Model healthy coping behaviors, good hand hygiene and other practices recommended by the CDC, including social distancing.

Embrace Individual Differences. Although we have similar physical reactions to stress and  anxiety, our psychological reactions can be very different. We all deal with anxiety in our own ways. We can use this opportunity to help those around us deal with COVID-19, and learn from others better ways to handle these uncertainties.

Reach out for behavioral health care. If you are struggling, reach out for behavioral health care. Resources for behavioral health are expanding with COVID-19. Please don’t hesitate to contact our medical team with any questions on when and how to seek reputable behavioral health care.

Allow house members social, psychological, and physical space.  Each morning agree to check in with each other throughout the day.

Enjoy sunshine and fresh air. When possible, spend time outside, while avoiding crowds. Sunshine has many benefits, including improving mood. Even 10-15 minutes of sunshine can be helpful. Use sunscreen and always practice extra steps for safety.

Rise to the occasion. Reach out (calls, letters, virtual visits) to loved ones who are homebound, isolated, or self-quarantined. Too much isolation can cause you to feel disconnected and ill-at-ease, which can lead to feelings of anxiety and depression. Rekindle neglected relationships. Evidence supports that a sense of belonging builds resiliency, especially during times of increased stress.

Fight boredom. Boredom can allow your thoughts to go into places that increase anxiety and a sense of loneliness. Boredom can also lead to habits or activities to avoid - overeating, excessive consumption of alcohol. Ahead of time, write a list of activities that you can do to combat boredom. Invite family members to create their own "go to lists" as well.

Give back. Find a meaningful way to support your community, such as dropping off canned goods at donation centers or donating blood. Studies show that giving to others boosts your physical and emotional well-being.

Take One Day At a Time.  In all of this uncertainty, you have an opportunity to flourish. Remind yourself that we are truly all in this together and will remain in this together until the COVID-19 crisis abates.

Resources

• CDC Updates on COVID-19 

• Giving and Emotional Health

• Simple Activities for Children and Adolescents 

• Take Care of Yourself

• Tips on Social Distancing 

If you have any questions about behavioral health concerning COVID-19, please log into your account and send us your question. We are here to help.

Dr. Joseph A. Banken, PhD, Licensed Clinical Psychologist

Tips for Stress Management

I think most people are feeling a little stressed lately.  There are a few very practical things that you can do to stay calm when the world around you seems to be spinning out of control.
  

Here are some things that you can do to help you manage your stress.   

Breathe -
 

Controlled breathing can help to physiologically control your stress.  This is one part of your body over which you have significant control.  Take slow, even, deep breaths - 7 seconds in, hold for 1 second, then 7 seconds out.  Use your watch to time yourself.

Why does this work?  When you control your breathing at a slow pace, you actually slow the circulation of blood flowing through your lungs.  Slowing the circulation through your lungs will slow your overall circulation, leading to a slower heart rate.  Slowing your heart rate can help to make you feel more calm, and can help slow the racing thoughts in your brain.

Be Mindful -
 

When you have a lot going on, and your mind is thinking of all of the worst case scenarios, racing thoughts can take control and get away from you.  Make yourself stop and focus on being exactly where you are for just one or two minutes.  Do this by taking the time to notice:

• 5 things that you can see
• 4 things that you can feel
• 3 things that you can hear
• 2 things that you can smell
• 1 thing that you can taste

You may not be able to notice all of these things, but the idea is to reach out with your senses and notice the things around you.  Maybe you will notice how intense the lights are in the room, or the pressure of your body in the chair, or maybe the sound of a bird outside your window.  Be right here, right now.  Avoid going backward or forward in your mind.  Just be in the moment, in the exact place that you are.
  

Find a Good Distraction -
 

You don't want to be distracted all of the time, but when things seem overwhelming, it can be helpful to distract yourself for a bit.  It can protect your brain, lower your blood pressure, and give you a chance to live outside of the stress for a little while.  Give yourself permission to have a time out.  Watch a funny TV show, or read an engrossing story, or maybe try Duolingo to learn a new language!

Try to Keep Things in Perspective -
 

As bad as things might feel right now, they are likely to get better with time.  Take the time to think about the things that are good right now.  For instance, maybe you are getting to spend more time with your family than usual. 

Things Over Which You Can Have Control, Take Control -

• Try to get enough sleep.  This can definitely improve your stress level.
• Try to eat regularly and in a healthy way.  Try to avoid emotional eating and avoid eating a lot of junk foods.  This can be hard as we all tend to crave junk foods when we are stressed!
• Try to get some exercise on a daily basis.  Even if you are not able to do your usual exercise routine because you can't go to the gym, there are ways that you can exercise at home.  Maybe go for a walk a couple of times a day, even if it is just in your backyard, or around the inside of the house.  Do some jumping jacks or turn on some music and dance.  Maybe you could have a dance party with the kids, and you could all use up some energy!
• Try to get some time outdoors every day if you can.  Even though you may be stuck at home, most of us can get outside without being exposed to others.  If you are not able to get outside, try to get curtains open in every room to get plenty of light in the house.  Sun exposure can improve your mood.  
• Keep your living space clean; not just sanitized, but organized.  Organizing the space around you can give you a significant sense of control.

If you have any questions about managing stress, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

How to Boost Your Immune System

If you are like most people, you have probably been wondering if there is a way to boost your immune function to protect you against infection.  Unfortunately, there is also plenty of misinformation that can make it challenging to know what to do.  Let's talk about what you can do to strengthen your immune function.

Your immune system is a complex system that includes different types of cells, tissues, and organs that all work together in a complicated pathway.  Healthy immune function is dependent on many factors.  Those factors include your genetic make-up, the germs that you have been exposed to over your lifetime, and your lifestyle.  Lifestyle factors that impact your immune function include:

• Stress level
• Sleep pattern
• Dietary factors
•  Exercise

Here are some things that you can do to strengthen your immune system:
 

Exercise - We have talked about this in previous Health Tips, but it is worth repeating.  Depending on your level of exercise, it can be good or bad for your immune function.

• Maintaining a regular exercise routine, which consists of at least 30 minutes of moderate exercise a day, has been shown to improve your immune response and lead to significantly fewer respiratory infections.
• Excessive exercise, such as participating in high-intensity workouts for more than 90 minutes at a time on a regular basis, has been shown to be associated with significantly more respiratory infections than occur in people who perform moderate exercise.

Stress - Your immune system works better at fighting illness when your body is not under stress.  Several studies back this up.  In one series of studies from Carnegie Mellon University, people were given nose drops containing a cold virus.  The people who reported less stress in their lives were significantly less likely to develop cold symptoms even though they were exposed to the same amount of cold virus.

Worrying about the coronavirus, or the stock market doesn't help your stress level!  Learning techniques to help manage your stress can help your immune system to function better.  This would include things like meditation, controlled breathing exercises, or talking with a therapist.

Sleep - Improving your sleep habits is a good way to strengthen your immune system.  You should try to sleep 7-8 hours per night.  Try to get into a regular routine, with your bedtime and wake time not varying more than about 30-45 minutes each day.  Avoid excessive lighting in the evening, especially screen time late in the evening.  You need the dim light to trigger your natural melatonin release to help you get a better night's sleep.

Dietary factors - Several dietary factors can affect your immune function.

• Vitamin D - There is promising research to suggest that maintaining a normal vitamin D level could help your body fight off respiratory infections.  You might talk with your doctor about checking your vitamin D level, and taking vitamin D supplements if it is low.  There are no clinical recommendations for taking vitamin D supplements for immune function if you have a normal vitamin D level.
• Avoid excessive alcohol consumption - There have been many studies that show a link between excessive alcohol consumption and immune function.  Research indicates that people who drink alcohol in excess are more susceptible to respiratory infections and that they recover from infections and wounds more slowly.  There are several ways that excessive alcohol can decrease immune function.  This is true for binge drinking as well as chronic, daily excessive alcohol use.
• Maintain a balanced diet - A healthy, balanced diet, with plenty of fresh fruits and vegetables, and whole grains, with low levels of simple sugars, can improve the health of the microbiome of your gut.  You may be surprised to know that your gut microbiome has a huge effect on your immune function. 
• Don't waste your money on unproven supplements - Despite many claims to the contrary, there is no single food or natural remedy that has been proven to improve immune function.  You can read various claims about the immune-boosting properties of a number of foods, spices, and supplements, including ginger, turmeric, oregano oil, bone broth, zinc, and more.  According to Dr. Krystina Woods, hospital epidemiologist and medical director of infection prevention at Mount Sinai West, "There are people who anecdotally say 'I felt great after I took whatever.'  That may be true, but there's no science to support that."  There is no harm in eating foods that are touted as immune boosters as part of your balanced diet, especially if you enjoy them, but don't rely on supplements that are unproven instead of a balanced, healthy diet.

If you have any questions about boosting your immune system, please log into your account and send us your question. We are here to help.  And don't forget to keep up the handwashing, trying not to touch your face, and avoiding close contact with people who are sick.

Dr. Anita Bennett MD - Health Tip Content Editor

Coronavirus Update

It has been a few weeks since we last talked about the coronavirus.  A lot has changed since then, so I thought an update was in order.  To start, they changed the abbreviation that was assigned to the novel coronavirus.  It is now being abbreviated as COVID-19.
 

Even though we have learned quite a bit since the outbreak first started, we are still learning new things about this disease.  Let's talk about what we know at this time.  In the last Health Tip about COVID-19, we talked about basics of what the virus is and the symptoms, so I won't be going over that in detail again. 

Symptoms and Severity

• Symptoms can include fever, cough, and shortness of breath.  
• Current information suggests that serious illness occurs in approximately 16% of cases.
• Older people and people with certain chronic medical problems, such as heart disease, lung disease, and diabetes, appear to be at greatest risk for serious illness.
• We have learned that some people can have the virus with little, or no symptoms.

How is Covid-19 spread?
 

The virus is thought to be spread primarily from person-to-person.  This usually happens between people who are in close contact (within about 6 feet of each other).  It is spread through respiratory droplets that are released into the air when an infected person coughs or sneezes.  These droplets are generally not visible, but can land on people nearby, or possibly be inhaled into the lungs.  The droplets can land on an infected person's hand, then be transmitted to another person with a handshake.  The droplet then has to make its way to your eyes, nose, or mouth in order to cause infection.

How easily does Covid-19 spread?
 

People appear to be most contagious when they are the sickest.  There have been reports of the virus spreading before people show symptoms, but this is not thought to be the main way the virus spreads.
 

The virus does seem to be spreading easily and sustainably in the community in some affected areas.  This is called "community spread."  This means that people have been infected with the virus in an area, including some who are not sure how they were exposed to the virus.

What is the current situation in the U.S.?

• There have been at least 230 cases of COVID-19 in the U.S., with 12 total deaths.  A total of 21 states are reporting cases.  These numbers are accurate as of 3/6/2020 at 6 am EST.
• Testing is being done in all states, and any person with symptoms and a doctor's order can be tested.
• For most of the American public, who are unlikely to be exposed to the coronavirus at this time, the immediate health risk from COVID-19 is considered low.
• People in communities where ongoing community spread with the coronavirus has been reported are at an elevated, though still relatively low risk of exposure.
• Healthcare workers caring for patients with COVID-19 are at an elevated risk of exposure.
• Close contacts of persons with COVID-19 also are at an elevated risk of exposure.
• Travelers returning from affected international locations where community spread is occurring also are at an elevated risk of exposure.

What can we expect to happen next?
 

More cases of COVID-19 are likely to be identified in the coming days.  It is likely that community spread will continue to occur and that at some point, widespread transmission will occur across the U.S.

How can you protect yourself and your community from COVID-19?

• Avoid close contact with people who are sick
• Avoid touching your eyes, nose, and mouth
• Clean and disinfect frequently touched surfaces
• If you are sick, STAY HOME.  If your kids are sick, keep them home from school.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Use an alternative to handshaking when greeting someone, maybe a friendly wave of the hand.
• Wash your hands using soap and water for at least 20 seconds, especially after going to the bathroom, blowing your nose, coughing, sneezing, or before eating or preparing food.  If soap and water is not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
• Keep up your routine exercise program.  Remember that 30 minutes of moderate exercise each day improves your immune response to fight viruses.

Should you wear a facemask?

• Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others.
• Facemasks are crucial for health care workers or people who are taking care of someone who has COVID-19 or has symptoms concerning for the virus.
• The CDC does not recommend that people who are well wear a facemask to protect themselves in the community from any respiratory disease, including COVID-19

How concerned should you be?

• There is no reason to panic, but you should be concerned and cautious.  
• You should keep up with your local news in order to stay informed about the situation in your local community.  
• If you must travel to another area, make sure you know the situation in that area beforehand.
• Talk with your employer about what the plan might be if the virus starts spreading in your area.  For instance, do you have the ability to work from home?
• Be prepared for the unlikely circumstance that you would need to be quarantined at home for 2 weeks, with little notice.  Have additional canned goods or frozen foods on hand, for instance.  

For more information about the coronavirus, you can use this link to the CDC website, https://www.cdc.gov/coronavirus/2019-ncov/index.html

If you have any questions about COVID-19 (corona virus), please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor