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By: Dr. Jamie Long and Dr. Gabriela Sadurní Rodríguez

Originally posted 4/10/2020; Updated 6/27/2020

Anxiety

Generally speaking, anxiety about COVID-19 and its consequences is not irrational. In its adaptive form, anxiety warns us of danger and motivates survival-enhancing behaviors. Without containment, however, the fears can be endless and debilitating. In a poll by the American Psychiatric Association, approximately half of Americans fear contracting the coronavirus (48%), more worry about a loved one getting sick (62%), and 57% are concerned about financial devastation.

COVID-19 has already hijacked our country’s psyche as evidenced by behaviors such as Panic Buying and Health Anxiety. The lasting consequences of chronic anxiety in times of a pandemic could lead to behaviors very uncharacteristic of the human condition as we’ve grown to understand it.

Agoraphobia

Agoraphobia is the condition in which individuals fear leaving their home, or avoid situations/places that may cause panic. When venturing into the community becomes the object of constant threat, it could eventually lead to total avoidance of the outside world and each other for some people. This is especially true for those who experience the most severe forms of anxiety and panic.

As quoted in The Atlantic, Steven Taylor of the University of British Columbia, who wrote The Psychology of Pandemics states, “My colleagues in Wuhan note that some people there now refuse to leave their homes and have developed agoraphobia.”

Depression & Suicide

For many, the markers of a successful day are gone. The satisfaction achieved after completing a productive work shift, the joy of socializing with peers, and/or the reward of a fruitful paycheck may have vanished overnight.

Social isolation, feelings of helplessness and worthlessness, hopelessness about the future, and lack of routine are all ingredients that lead to the experience of depression. What’s worse? Taking one step forward only to take two steps back. The promise of safety only to be met with more threat creates a sense of hopelessness and helplessness.

A study from Chinese psychologists found that one month into the coronavirus outbreak, those who stopped working suffered from the worst health conditions and mental distress.

Unemployment & Suicide

Four months into the pandemic, several studies show at least 27% of people in the United States are exhibiting signs of moderate to severe depression (three times higher than pre-coronavirus numbers). Similarly, a study released in early May shows that participants were eight times as likely to screen positive for serious mental illness (28% compared to 3.4% in a 2018 study).

Most effected are younger adults and parents. Younger adults (18-44) are experiencing a tenfold increase in serious mental distress.

We know that viruses can kill, but so can poverty and hopelessness. Both the coronavirus and the shutdown of the economy are hurting public health. So this means that physically healthy people are suffering too. For example, it’s well documented and widely accepted that unemployment is a leading factor in suicide.

Nearing 17 million cases as of mid-April, Topping 44 million cases as of June, America is recording the highest rate of unemployment in its history (it’s estimated that the Great Depression-era reached a total of 15 million unemployment cases). Almost 30 percent of suicides occur in response to a crisis within a two week period and 16 percent occur in response to a financial problem.

An analysis of the 2008 banking crisis and economic recession, carried out by Carlos Nordt and colleagues at the University of Zurich, examined the correlation between unemployment and suicide. The researchers attribute 45,000 – or one in five – suicides a year worldwide to unemployment, with 5,000 deaths caused by the 2008 economic crisis.

Across the country, calls to crisis hotlines are increasing at an alarming rate. In Indiana, it was reported that crisis hotline calls increased from 1,000 daily calls to 25,000 daily calls. The “Disaster Distress Helpline” at the Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the Department of Health and Human Services, saw an 891% increase in crisis calls.

Grief & Loss

Some of us are mourning the tragic death of someone we loved, many of us are coping with the adversity of sudden unemployment or financial disruption, and all of us are experiencing the loss of our daily habits. Whether it’s bereavement, economic hardship, or the lamenting of a canceled celebration, collectively, we’re grieving. We’re grieving the loss of security, stability, and the comfortable knowing of routine and predictability.

With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this.

David Kessler co-author of: On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss.

Some celebrations will be able to be rescheduled whereas others will just have to do as they were. Many jobs and businesses will reopen while some workers will need to find another path. Regardless of the amendments that will occur, our world will be forever changed as we anticipate the enormity of rebuilding our lives and healing from this exceptional loss.

Obsessive-Compulsive Disorder (OCD)

Individuals with OCD employ often extreme patterns of behavior (compulsions) in an effort to mitigate distressing thoughts (obsessions). This time of pandemic is being described as a “personal nightmare” for people with OCD.

Psychologist and OCD specialist, Dr. Lissette Cortes explains that “some people with OCD have become concerned that they will get someone sick, or that they might be sick with coronavirus and not know it.” Dr. Cortes admits that such fears aren’t too different from the uncertainty that many folks are experiencing currently. The difference, she explains is that “people with OCD will spend many hours checking and seeking reassurance, as opposed to tolerating uncertainty.”

Dr. Cortes explains that some individuals with the subset of Contamination OCD have been known to go to great lengths in decontamination efforts such as unsafely spraying Clorox on themselves. Other OCD patients are known for hoarding supplies in a desperate attempt for preparedness. Those who are not active in the disorder “are finding themselves fearful of sliding back into old patterns of excessive washing,” she says.

A global response to COVID-19 has triggered a renewed commitment to cleanliness and handwashing standards. These renewed guidelines may not be enough to satisfy decontamination obsessions. Dr. Cortes explains that exposure work in OCD involves helping this population recognize that nothing additional needs to be done after completing a 20-second-wash or using hand sanitizer.

Dr. Cortes reports (and other therapists that we’ve spoken to have made similar observations) that individuals who participate in evidence-based treatments such as Cognitive Behavioral Therapy and Exposure and Response Prevention (ERP), “have been noted to be more adaptable and resilient to the coronavirus pandemic than even some people of the general population. Having developed tools and skills in dealing with uncertainty and facing possible threats, has prepared them to face the coronavirus crisis today.”

Psychological Trauma/PTSD

The ongoing threat of this novel virus is a collective trauma meaning that we’re experiencing it as a society, rather than something that happens to ‘me’ alone. The pandemic is impacting people’s overall sense of safety, security, predictability, and trust. Individuals may experience both psychosocial and traumatic stress during this time.

Traumatic stress can be defined as a “normal reaction to a traumatic event.” According to the ISTSS, traumatic events are “shocking and emotionally overwhelming situations that may involve actual or threatened death, serious injury, or threat to physical integrity.” Some of these stress reactions include:

• Shock and disbelief
• Fear
• Anxiety
• Sadness
• Guilt
• Anger
• Feeling numb/overwhelmed

These traumatic reactions are usually temporary; however, for some individuals, trauma-related symptoms can become long-lasting and cause a significant impact in their personal, social, or academic/occupational functionality (thus potentially developing an Acute Stress Disorder or a Post-Traumatic Stress Disorder; PTSD).

During times of heightened stress, people who have gone through previous traumatic experiences or have PTSD may notice an activation or increase in the intensity of trauma-related symptoms such as:

• Re-experiencing (e.g. nightmares, flashbacks, intrusive memories of the coronavirus pandemic even well after it passes)
• Avoidance of trauma-related stimuli (e.g. saying no to invitations to gatherings, avoiding large events, healthcare settings, etc.)
• Hyperarousal (e.g. being constantly alert/on guard, irritability/anger, reckless/self-destructive behavior, strong startle response to sneezing, coughing, or physical contact, etc.)
• Increased negative beliefs and feelings (e.g. thinking the world is completely dangerous or that others can’t be trusted, persistent fear related to coronavirus, feeling detached from others, etc.)

Recent research in China revealed post-traumatic stress symptoms were prevalent (96.2%) within COVID-19 survivors. Similarly, studies performed after the SARS outbreak in 2003 reveal the prevalence of PTSD was 25.6% at 30 months post-SARS. Taking this into account, we can certainly expect a rise in PTSD symptoms and significant changes in overall quality of life following this pandemic.

Domestic Violence 

Fear, anxiety, financial stressors and/or unemployment are widely known impetus of domestic violence. Shortly into the onset of the pandemic, several news outlets have reported an increase of domestic violence cases (in France, reports of domestic violence rose 32% in a single week) and a growing number of calls to the National Domestic Violence Hotline with victims commonly citing the following: 

• Perpetrators are using COVID-19 to further isolate them from family/ friends
• Fear of further abuse due to being quarantined with the abuser
• Constant surveillance or controlling/rigid behaviors by the abuser
• The pandemic making it difficult to reach out for help 
• Perpetrators are threatening of throwing them out or withholding money/medical aid

First Responders & Helping Professionals

To an outside observer, health care workers look strong and resilient in the face of the unknown. They inspire us as they go to work every day, at great personal risk, to keep others safe.

Jessica Gold, MD

Truth is, these incredible people are particularly vulnerable to experiencing fear, anxiety, sleep disturbance, depression, and PTSD due to being at the forefront of this pandemic. Psychologist and crisis response expert, Dr. Diana Concannon explains that “during “normal” times, the high-stress nature of the work in which health care first responders engage puts them at higher risk for three psychological/emotional syndromes: burnout, compassion fatigue, and vicarious trauma. The unusual nature of the current crisis — its severity, duration, and surrounding uncertainty — are amplifying this risk, and rendering self-care — and the support of family, colleagues, and our communities — particularly vital.”

Dr. Concannon explains that burnout is characterized by persistent, negative feelings (often toward work) that can be accompanied by exhaustion, and reduced effectiveness/motivation. She adds that it’s associated with feeling empathy while repressing one’s own emotions, and with excessively high or unpredictable work demands.  

Dr. Charles Figley, a university professor and Distinguished Chair in Disaster Mental Health, has described compassion fatigue as the “cost of caring” for others in emotional pain. Dr. Concannon reports that compassion fatigue “results in feelings of physical, emotional, and spiritual exhaustion.”

Vicarious trauma is defined as indirect exposure to a traumatic event through a first-hand account or narrative of that event. Understandably, helping professionals (medical and psychological) are vulnerable to experiencing the aforementioned due to the nature of their work (since they’re directly witnessing not only the impact of the virus but also the current healthcare crisis).

Indeed, these professionals will take time to heal. According to studies on the SARS outbreak in Toronto, “people who dealt with the outbreak were still less productive and more likely to be experiencing burnout and post-traumatic stress” 1-2 years later.

Relationships

“Our natural sense of safety comes from being in tune with other people.”

Bessel van Der Kolk

Loneliness

Humans are social animals, we need ties to others to feel healthy and to ultimately survive. According to a 2018 national survey by Cigna, the experience of loneliness had reached an all-time high. Add in the social isolation of the 2020 coronavirus pandemic, it’s safe to say that these numbers will increase. The health consequences of loneliness are startling, from weakened immune systems to cardiac issues. The elderly — a population that was largely excluded from public life pre coronavirus — is urged to socially distance even further, intensifying their loneliness.

Other populations largely impacted by loneliness are the extroverts and singles. Extroverts get their energy from relating and connecting to others so they’re exceptionally affected by social distancing.

Relationship expert and licensed marriage and family therapist, Kristina Fecik says, “During this period of isolation, singles may experience frustration that their love life is on hold, experience feelings of loneliness or fears that their romantic future is doomed forever.” Fecik suggests that singles can combat loneliness by engaging in activities that have personal meaning. She explains that by doing so, it will result in a greater connection to the self.

Relationship Conflict

With both partners likely working from home and spending much more time together, perpetual problems in areas such as sex life, finances, differing views on parenting, opposing attitudes relating to the crisis itself, and communication deficits in discussing all of the above, might come to the forefront. Kristina Fecik offers the following suggestions for coping:

• Maintain separate workspaces
• Make sure to take time for self-care through exercise or rest as to preserve your own sanity. Taking care of yourself will allow you to be a better partner
• Allow for short breaks during arguments. Walk away when heated. Practice deep breathing or meditating for 20 minutes, but commit to continuing the discussion at a later time, in a calmed state
• Use “I” statements to talk about yourself and your actions as opposed to “you” statements about what your partner is doing (e.g. “I feel afraid of this situation. I need to feel that we are safe. I want your support,” instead of “You are being a jerk, and if you keep going to the store, you are going to make us both sick.”

Fecik reminds happy couples that if boredom is the worst of their problems, to see this as an opportunity to work on your bond. She says, “think of this time as an opportunity to build your relationship through fun and creative ways to connect (e.g. read some of your favorite poetry to each other, or make a video on social media).” 

In a Facebook video, couples expert and founder of the PACT Training Institute, Dr. Stan Tatkin explained that we’ll likely see an increase in “rapid decision making because of the existential threat.” Since times of crisis tend to also come with increased clarity about what’s really important in life, we’ll likely see an increase in people making important life decisions. This might explain why some couples will ultimately decide to break up.

“In all crises, whether it’s the coronavirus, or 9/11, or a war, or the threat of war, people make decisions now when they have been on the fence. So, they’ll break up because they have gotten a sense of what’s important, and they decide I don’t want to do this anymore.”

Dr. Stan Tatkin

The good news, maybe? “Nature also makes us want to add more people, so they’ll be a lot of coronavirus babies and that’s all normal,” Dr. Tatkin says. The increased clarity of what’s important will also likely lead to some couples deciding to work on their relationship and/or get married.

Caregiver Burnout

During the current pandemic, people across the country are working from home and taking care of their loved ones at the same time. This lifestyle change inevitably poses new challenges and heightened stress, which can also contribute to experiencing caregiver burnout. Common symptoms of caregiver burnout include hopelessness, overwhelming anxiety, sleep problems, and difficulty coping with everyday tasks.

This crisis has put a new lens on caregiving — both the family members and the (professional) direct care workers— and is showing us how invaluable their work is to our collective well-being

Janet Kim, Communications Director at Caring Across Generations

According to Mayo Clinic, “about 1 in 3 adults in the United States provide care to other adults as informal caregivers.” Caregivers and parents are experiencing concerns related to “staying healthy, keeping the family well, paying bills, caring for children who are homebound, and the list goes on.” According to one article, many are also “worried they will be exposed to the coronavirus at work and are pondering what is best for their aging parents — to avoid them or to risk infecting them in an effort not to isolate them.”

News outlets continuously evidence the lifestyle changes that are occurring like parents teaching their children at home, family members checking-in from afar or tending to someone who fell ill to the virus, individuals self-quarantining alone in different parts of the house, among others. Adapting to changes in lifestyle will take some time and it will be important to balance caregiving duties with self-care activities to decrease overall distress and burnout.

Substance Abuse

US sales of alcoholic beverages, especially hard alcohol, rose 55-75 percent in the week ending March 21, according to a market research firm. April, May, and June saw a 27% increase in alcohol sales across the nation. Reports say Americans spent $1 billion on beer over the Memorial Day Weekend.

Samara Quintero, a licensed marriage and family therapist and addiction specialist explains, “Turning to alcohol or drugs might be a quick fix to “numb out” either internal or external stress.” Of course, coping by way of drug and alcohol abuse has long-term consequences. “Substance abuse could lead to interpersonal conflict, reckless behavior, and emotional hangovers, which intensify any feelings of sadness, loneliness or depression,” Quintero says.  

The effects of COVID-19 could be potentially excavating suppressed feelings of anxiety, depression or loneliness that might have been easier to avoid with external distractions like work or school. Since the day-to-day distractions are no longer available to us, some individuals don’t know how to cope with the intense distress.

Quintero offers, “If you find yourself “numbing out” with alcohol or any other substances, this is a good opportunity to explore what is surfacing that perhaps needs to be dealt with rather than avoided. Seeking professional help will assist you in identifying healthier coping skills to utilize as well as guide you in getting a deeper awareness of what is being suppressed in the first place.”

Online Addictions

During this time of quarantine, Americans are more attached to their devices than ever before — whether it be for work, school, binge-watching television, scrolling through social media, or in attempts to communicate with others. With all four walls seemingly closing in, many individuals are seeking a virtual escape.

Dr. Tenille Richardson-Quamina, a licensed clinical social worker and online addiction specialist explains that, “by default, the Internet has become our escape from our current reality. We have become a captivated audience to online industries and they are taking advantage of this by offering free access to their gambling, porn, and gaming websites.”

Indeed, with video gaming up 75%, gambling up 40% and one major porn site reporting an 11.6% increase since coronavirus sheltering in place began, the statistics are clear, folks are binging on online activities.

“Let’s do the math, more people online, plus an increased need to escape, plus free access to websites, equals a spike in online addictions and affairs,” says Dr. Richardson-Quamina.

Online Affairs

Much like the excessive escape via online activities, some couples may be seeking an escape through fantasy and virtual relationships. Dr. Richardson-Quamina explains that many partners are spending a lot more time together under stressful conditions laying fertile ground for conflict.

Dr. Richardson-Quamina states, “stressful conditions like this can cause arguments and make your partner’s flaws more evident. Online interactions with others outside of our relationship can appear more fun and engaging because they are absent from the day-to-day grind and challenges that are part of any offline relationship. This unique characteristic of the Internet can make a spouse feel as if their needs or fantasies are being met by someone online, which could be the start of an online affair.”

Conclusion

Although nearly half of Americans (45%) report coronavirus is seriously impacting their mental health, only a fraction of these individuals will reach out for professional help. It is okay to ask for help. Please reach out for help. Especially if you notice changes with your quality of life, sleep, appetite, hygiene, or other activities of daily living. These changes are warning signs that your mental healths needs attention. Many counselors are offering their services virtually (via online video therapy) and our practice is doing the same. If you reside in the state of Florida, we can help.

While the current times are scary and distressing, we have no doubt that we’ll get through this. With all of the psychological problems outlined above, take solace in the fact that there is an army of experts that can help you combat them. Besides, human beings are exceptionally resilient.

In times of adversity, us humans are known for getting crystal clear on what really matters most. With this newfound (or remembered) insight, we can resiliently take actionable steps towards a renewed sense of purpose and gratitude towards life. Perhaps the silver lining throughout the midst of this suffering will be increased connection and community, commitment to core values and priorities, widespread awareness of public health matters, and mental health advocacy, research, and funding.

Dr. Jamie Long is a Licensed Clinical Psychologist and Managing Partner of The Psychology Group Fort Lauderdale. She specializes in anxiety, depression, and eating disorders. Call (954) 488-2933 x1 or email today to discuss how her services can help you.

Dr. Gabriela Sadurní Rodríguez is a licensed psychologist at The Psychology Group Fort Lauderdale and is an expert in trauma-related issues, depression, anxiety, life transitions/adjustments, and difficulties in interpersonal relationships. Call 954-488-2933 x 8 or email today to discuss how her services can help you.

Copyright © 2020 The Psychology Group Fort Lauderdale, all rights reserved.

Related Reads: 

How to Cope with Catastrophic Thinking During the Coronavirus Pandemic

Staying Connected While Social Distancing

Coronavirus Information for Our Practice

5 Quick Tips to Reduce Stress and Anxiety

Panic Attack Symptoms and What To Do

Telehealth and Online Therapy