Webinar 4: how to manage COVID-19 induced stress and anxiety

Even under the best circumstances, it’s hard to take care of a child with a chronic disease. It’s even harder under emergency situations such as COVID-19. Making sure there is time for self-care will reduce stress and help us move forward through this situation. However, there is not one straight answer to give on how to manage stress, since everybody experiences stress in a different way. In this fourth WDO Webinar, clinical neuropsychologists Dr. Jos Hendriksen and Dr. Molly Colvin share what you can do to take care of yourself and your children.

Psychosocial issues during COVID-19

Stress is a normal reaction to an abnormal situation. COVID-19 is an abnormal situation, however we have to remember this COVID-19 stress we are experiencing is normal. As we don’t know how long this stress period will go on for, our stress goes on without a clear end point. Therefore we tend to stay in a phase of resistance that can lead to exhaustion.

Stress can be either physical or cognitive, influencing your concentration or memory. It might result in anger or depression, influences your memory or concentration, or can result in stomach ache or headache. Sometimes we’re not even aware we’re under chronic stress and the toll it takes on our minds and bodies. Chronic stress is difficult to observe and may be a silent threat.

1. Stress is a normal healthy reaction to a threat

It’s important to acknowledge your thoughts, worries and uncertainties, especially if you don’t know how long this situation will last. The most important thing is to take care of yourself first.

1. Take care of yourself
   There is a rule called the ‘Oxygen Mask Rule’ coming from aviation. This means you have to help yourself before taking care of others, even if it’s your child. If you don’t take care of yourself, you’re very likely unable to help others.
2. Stay in balance
   Be kind to yourself and stay in touch with your physical body. This is known as mindfulness. Be mindful of what happens and acknowledge it, take a pause and a breath. Relaxing and ‘turning off’ by reading a book or doing sports is important to increase your resilience. Healthy eating, sleeping enough and breathing in and out are a few examples of being mindful.
3. Take a brain pause
   Practice multimedia hygiene to take care of this continuous stream of Corona information. Limit the news and be careful of what you read and watch. It’s helpful to schedule media breaks. If you read or watch something and your heart rate goes up, your breathing becomes more shallow or your mind starts to speed up, these are indicators to stop and take a break.

2. Practice self-care

The second message is to stay in balance, take a brain pause and also allow your boy to take a brain pause and apply multimedia hygiene rules.

1. Break the worry chain
   When you or your child’s brain starts to worry about everything, this is called a worry chain. For example: you have a headache and think it might be the coronavirus. Then you go on and think about passing it to others. This chain of thoughts or images is called the worry chain, where minor events might escalate. You can spend a lot of energy on this.
2. Spend energy only on things you can control
   To help control you or your child’s stress you can illustrate the circles of influence, first described by Covey. The inner small circle is the circle of control, the second outer circle is one of uncertainty. When you worry, you seek control over things you can influence, and you shouldn’t bother too much about the things you cannot control.
   Things you cannot control are about others holding distance, whether you’re allowed to go to school or work. It’s more important to spend energy on what you are able to control: whether you will watch the news, if you’re washing your hands, and if and how you will help people. Helping people gives us a feeling of agency over the things we can control. We can make sure we have our medications, contact information about our providers, or a schedule for virtual visits or therapies.

3. Focus on the things you can control

Stop wasting time on things you can’t control, and focus on the things you can control. The World Health Organization provided information about psychological first aid. It’s about two things: finding support, and finding someone to support.

1. Find support & stay connected
   A buddy system where you offer practical support is brilliant. Also, communication is essential since it helps you talk about your needs and worries and helps you to identify resources. Stay connected with other families and peers.

4. Stay connected and communicate

Schedule time to check in with your family and friends that are not in your house by telephone or web platforms. Pick a time to connect to your extended support network during these periods of isolation, to feel you’re still connected to the broader world.

1. Focus on positive things
   During those visits, try to focus on things that bring you pleasure and are enjoyable. Playing games, talking about movies or books you’ve read instead of what’s happening around COVID. Talk about your experiences, keeping it personal will help center it in the here and now as opposed to shifting to the circle of things you cannot control.
2. Build a routine
   It’s also important to keep regular routines and stick to them very strictly. Think of how you’re going to break the day into regular mealtimes and times for physical activity such as taking a walk. If you can go outside for fresh air, or spend time together singing or playing games. It gives your child a sense there is control in their environment. This helps them break down time, as children don’t have the same sense of time adults have.
3. Discuss facts
   We know that corona is Latin for crown, and you can discuss why it’s a crown. Then it becomes something tangible and a bit more in controllable. Another fact is that there aren’t a lot of kids who get it, and in those who get it tends to be very mild. Your child should not forget there are a lot of helpers out there who are working to protect you, and it’s not their job to worry about this. Allow them to hand the worry over to adults who care and love, as their circle of control is smaller than ours.
4. Practice active listening
   Active listening helps to uncover what your child’s worries are. If a child asks you what happens if he gets sick, don’t give an answer but try to listen and hear his worries. Allow the child to fully answer the question. Ask ‘You sound worried about this, what have you heard?’.
5. Don’t promote anxiousness
   Protect your child from anxious feelings by not promoting it. It is important to set limits and to be very strict in these. For example: it’s advised to wash your hands but it should be limited to 20 seconds and not a second longer. It’s important to practice social distancing, but not to self-isolate completely. Reassurance may alleviate anxiety, but it can become a primary mechanism for dealing with anxiety in the future, and some people might become dependent upon it.