Reading: Reclaim Your Emotional Health — Even During a Pandemic

Before most of us had ever heard of COVID-19, worry was already at a record high across the world, according to the 2019 Gallup Global Emotions Report. Climate change, natural disasters, mass shootings — the constant barrage of frightening news had already taken its toll on our mental and emotional  health. The coronavirus pandemic has only heightened our collective anxiety. 

When the New Normal is Abnormal

“We are living in a world where bizarre is the new normal,” writes psychiatrist Lise Van Susteren, MD, in her prescient book, Emotional Inflammation: Discover Your Triggers and Reclaim Your Equilibrium During Anxious Times, due out later this month. According to Dr. Van Susteren, who coauthored the book with health journalist Stacey Colino, feeling perpetually on edge can have negative repercussions not just for our emotional health, but for our physical health as well. “Pervasive anxiety is a crippling way to live,” she says. “If you are always stressed, you become less able to deal with that stress.” 

Given the terrifying trajectory of the current pandemic, we could all use some advice on how to reclaim our emotional equilibrium. Most of us are taking precautions — such as social distancing and frequent hand-washing — to protect our physical health. Here, Dr. Van Susteren talks to CoveyClub about how to safeguard your emotional health.

CoveyClub: You write in your book that symptoms of what you call emotional inflammation include anticipatory anxiety, nameless dread, a sense of foreboding, and/or an ongoing state of high alert. Sounds a lot like what we are all feeling right now in the midst of this coronavirus pandemic. 

Dr. Van Susteren: Let’s acknowledge that this is a crisis, so it’s not surprising if you’re upset. We’ve been thrown into the water to learn to swim: This threat is new — it’s unlike HIV and SARS and MERS, as it’s more infectious and much harder to control. And if there’s one thing that makes people feel anxious, it’s feeling that they are not in control. Plus COVID-19 is an invisible threat, which makes it worse: People can look healthy but they’re not. And we’re getting conflicting and confusing information. If you are feeling like you are absolutely overwhelmed, you should know that you are not alone. 

Acknowledge that your anxieties are legitimate, and recognize that it’s a spectrum: On one end are people who are more or less in denial, who are downplaying the problems, and on the other end are people who are so panicked that they can’t work effectively to prepare and protect themselves or the people they love. We want to aim for somewhere in the middle. All anxiety is not bad — anxiety is the moving force behind taking action, and it’s how we’ve survived all these years against legitimate threats. If you feel that your anxiety is out of control, that’s a different story. 

How to Change the Channel in Your Head — Away from Anxiety

CoveyClub: So how can we not worry about this 24/7? How do we, as you put it in your book, “change the channel” in our heads?  

Dr. Van Susteren: If you are worrying about this 24/7, some things to keep in mind: Yes, it’s a crisis, but it’s a time-limited crisis. We will not always be struggling with the menace of coronavirus. Every researcher around the globe is working night and day to find a vaccine and medications, and some have already been proposed and look effective. And there are things we can personally do in addition to waiting for health professionals to come in on their white horses with the silver bullets. We can distance ourselves physically from people. We can keep ourselves away from those who may be sick by staying at home. If you can shelter in place and stay with people you know who haven’t been out and about, your risk drops precipitously. 

The number one thing to reduce anxiety — if from a pandemic or anything else — is to exercise. For one thing, exercise promotes the synthesis of something called brain-derived neurotrophic factor (BDNF), brain food which has been dubbed “Miracle-Gro” for brain cells. Among the many benefits of BDNF is that it reduces the effects of anxiety-producing stress hormones — by making sure stress hormones can’t get their hands on the “controls.” With enough BDNF around the invading army, stress may get a few warriors past our defenses, but not enough to bring us down. So while we feel the anxiety of battle — or stress — we are not overtaken by it. 

And if you want to change the channel in your head, you’ve got to literally change the channel in front of you on the TV. You don’t have to hear the same information over and over again — the more you see it, the more traumatized you become. It’s the same as eating too much: If you have a few potato chips or a few high-fat foods nothing is going to happen, but if you eat too much of it you will get sick. So get the information you need to respond in the moment and long term, and then you’ve got to stop it or you are going to get sick. 

There is a real inertia in the brain: Once we are thinking in one direction, certain pathways are facilitated. Recognize the inertia that has you sitting there continuing to watch it. Know to pull away when you are not learning anything new. What if you could say to yourself, let me stop watching it for 15 minutes and start something else, and if I’m still absolutely driven to go back, maybe then I’ll let myself go back. I like to swim for exercise, but when I have a hard time getting motivated, I tell myself to just do it for ten minutes and then reassess. Once I’ve started, I keep swimming. 

Anxiety is as Contagious as the Virus

CoveyClub: Still, most Americans are on edge as we watch what has happened in Asia and Europe, and brace ourselves for what is now happening here. And as you say, “anxiety is extremely contagious.” How do we not catch it? 

Dr. Van Susteren: We do. Our anxiety is highly contagious, that’s why the tones that we use are so critical. We are very sensitive beings from a psychoacoustic perspective. So the first thing we can do is modulate the tone that we use when we talk. It doesn’t mean we are Pollyannas, and don’t acknowledge that there are emotions, but we can raise or lower the collective mind and mood of the people around us — and of ourselves. If you are looking for someone to calm the situation the fuck down, then you be that person. We have some really interesting mirror neurons in our brain — we tend to mirror what we see. If someone is about to have a panic attack, the most important thing is for you to have a calm voice — don’t go there with them. Start speaking slowly. If your respiration is slow, your body language relaxed, pretty soon they will start to mirror you. 

CoveyClub: Fears about this new virus have just been superimposed upon already-existing anxiety about other global and national issues. All this worrying, you say, has led to this other “epidemic” — emotional inflammation. Can you define emotional inflammation? How does naming this phenomenon — and recognizing that you might be experiencing it — help? 

Dr. Van Susteren: We’re all familiar with physical inflammation: It’s red and hot and preoccupies us. The same descriptors apply to emotional inflammation: It’s inflamed, it’s angry, it hurts, it draws our attention even when we don’t want it to — it impedes us from doing the things we want to do. We’ve all heard and read stories of medical mysteries, of people going to doctors for ever and ever and no one can say what it is and then finally you get an answer. It may not be that you’re happy about getting it, but at least you know what it is. The bottom line is that once you know the name of the problem you can start beginning to surmount it.

When Your Fight or Flight Response Gets Stuck in “On”

CoveyClub: You explain in your book how living in a continuous state of high anxiety causes your body’s fight or flight response to basically get stuck in the “on” position. What does this do to the body? 

Dr. Van Susteren: Anxiety in the short term is healthy — it’s what enables us to scramble. In the old days if we saw a blade of grass stirring in the savannah, we hurried up into a tree — thanks to the amygdala (the fight or flight center in the brain). If we didn’t have that stress response, we’d be sitting there wondering if we should run up that tree, if it were the wind or a tiger, but by the time we figured it out it would be too late. It’s like an alarm bell in a building: If we hear it, we immediately drop everything and get out of the building. But if that alarm is on all the time — i.e. if we are chronically stressed — it means our body is always in fight or flight mode. Fight or flight mode means you have a quick jump in cardiovascular responsiveness, your breathing and heart rate increase, your muscles constrict — but you’re always in that heightened response. This closes down the frontal lobe, which is responsible for judgement and cognitive ability. We have no time to evaluate when we are in survival mode, so chronically-stressed people tend to not make good decisions. Their judgement is impaired, as is their ability to think clearly or have measured reactions. 

Reclaim Your Brain Tip #1: Reconnect with Nature

CoveyClub: How might we reclaim our equilibrium and channel these distressing emotions in constructive ways? 

Dr. Van Susteren: First, take time to be in nature. Take walks. We have sequestered ourselves into these lifeless steel and glass buildings where you can’t hear the sounds of nature. All you hear is the clatter of keyboards and the rings and other artificial, human-made noises. Those are not natural sounds. It’s the job of the amygdala to say “What the hell was that” — it’s programmed to be constantly on the lookout for a crisis. What we were evolved to hear is the sounds of water, the chatter of insects, the songs of birds — suggesting all is well in our environment. We were evolved to see fractal patterns, to take sunlight, to breathe in air that is free of human contaminants. Nature’s elements are life-enhancing for us, they bring a sense of calm. Studies show that exposure to these elements in nature activate reward centers in the brain, which secrete happiness hormones, activating opioid receptors, and bringing a deep feeling of peace and well-being. 

Meditation is also a remarkable way to reset your psyche. I’m a fan of transcendental meditation, which can bring about permanent positive structural changes in your brain; others speak well of mindfulness, which is helpful in the moment to allow people to break the hold of negative emotions. And it’s important to sleep well. How do you do that? One reality is that we are exposed to screens a good deal of the day and that blue light from screens is highly activating, and can even be anxiety-provoking. Don’t read on a Kindle or laptop before bed unless you have the blue light–canceling software; don’t look at your phone or the TV right before you go to sleep. 

This is a special time. Rather than thinking so painfully about quarantine and lockdown and all these terms that signal great menace, we might think to ourselves is there something that we can learn individually or nationally from this that can be key to putting us into a different space. Let’s ask ourselves: What about my life hasn’t been working right? Do I need to slow down? Do I want to be closer to family (because I see in a crisis I want to be close to them)? This might be a kind of retreat, a forced one admittedly, but one that can help us look at our lives and think of ways that down the road we need and want to make some changes.

Reclaim Your Brain Tip #2: Identify Your Reaction Type

CoveyClub: Part of your prescription for overcoming emotional inflammation is to identify the type of reactor you are, and to identify and address your personal triggers. How can one do this, and how does it help? 

Dr. Van Susteren: In the book, we have a series of 12 questions that ask how you react to anxiety-inducing situations. Do you feel primarily nervous, frantically running around trying to do a million things at once? Do you withdraw? Do you get irritable and angry? Considering what triggers you, and how you tend to react as a result, allows you to have more self-awareness, which is really the key to self-mastery. It allows you to unpack the various triggers and responses you engage in, and as a result to control your behavior and how you feel.

CoveyClub: How do we contribute to our own anxiety? 

Dr. Van Susteren: We fail to understand ourselves. If we’re feeling anxious, examine why. Is our anxiety legitimate? Or are we catastrophizing or focusing on the worst-case scenario? We should ask ourselves questions as if we were talking to a child who was worried. The last thing we would want to do is invalidate their feelings, and that goes for ours too. Who doesn’t need a compassionate listener in a time of distress! But what we need to do is to walk ourselves through what might be a rational response to the situation. Disabuse yourself of irrational thoughts by picking them apart — figure out what is driving them. 

As for catching the coronavirus — look at the science — most people have few or mild symptoms. That’s not what makes the news. The news is being made by those who are extremely sick and overwhelming our health system. If you stay home, practice physical distancing, and observe the hygiene rules, the likelihood you will get sick is low. A patient of mine was worried that the food supply was going to be disrupted. I said that’s a legitimate concern, but let’s look at the likelihood. We went through the facts and saw that there are plenty of reasons to think food wouldn’t be disrupted. But she also turned her anxiety into an empowering action: She decided to plant a vegetable garden. Try to turn your anxiety into an empowering action. 

Reclaim Your Brain Tip #3: Help Others

CoveyClub: If you find yourself caught in a spiral of catastrophic thinking, what are some ways to extract yourself, to calm yourself down? How can we help others around us — our families, our friends, our coworkers — to do the same? 

Dr. Van Susteren: Exercise, meditate, turn off the upstream contamination (i.e. stop watching the news). If a friend or family member is about to have a panic attack, the most important thing is for you to have a calm voice. Don’t go there with them. Empathy is always important, allow them to have the space to feel anxious, tell them you understand their worry. But start speaking slower, purposely taking more time between phrases. You be the person they need, the calm presence. Pretty soon they will start to mirror you. People show their anxiety or symptoms to convince you that they need help — make the help easy to come by. 

Husbands and wives — as well as roommates and coworkers — can sometimes drive each other to extremes because they don’t understand that they have different coping styles.  Being tolerant of one another’s different coping styles and using empathy to come to find a middle ground where you can work as partners is obviously ideal. But it doesn’t come from saying “Don’t panic!” or “Why are you not responding?” That does not work. Instead, how about saying: “I understand you feel anxious, or I understand this is difficult to discuss, but can we sit down and figure out what steps we can now take to make this easier?”

Reclaim Your Brain Tip #4: Think Yourself Into a Safe Space

CoveyClub: You note in your book that though we may not be able to control the distressing events occurring around us — and this is certainly true of the coronavirus pandemic — we can exert some control over how we think about and respond to them. How can you, as you put it, “think yourself into a safe space,” when the world is feeling so unsafe? 

Dr. Van Susteren: There’s an old Yiddish saying, You can’t control the winds, but you can adjust your sails. The world has never felt entirely safe, but the rate at which we’re hearing things is different. We hear about everything within seconds after it occurs. The cumulative effect, as a result of technology, is that your mind is constantly being exposed to societal trauma. It’s not just our personal, individual traumas anymore. Reducing your exposure to technology — and the relentless coverage of disasters — is one remedy. 

One thing to consider: What are we grateful for? Appreciate nature, its spectacular diversity, beauty, and life-giving bounty. In the US, again, we’ve got a lot we are upset by, but we’ve got a lot to be grateful for too. Most Americans have enough to eat (not everybody), and most of us have a roof over our heads (again, not everyone). Looking at our familiar belongings around us — and being with our friends and family (whether physically or virtually) — makes us feel safe. The sense of isolation many are feeling — here is where technology is helpful to a society reeling from this pandemic that requires so many dramatic changes. We all have Facebook, FaceTime, Zoom, and if you are not technologically savvy, the telephone. Pick up the phone and call somebody. (By the way, don’t think of physical distancing as restricting our person liberty — think of it as an empowering action that we are engaging in collectively.) 

When we are overthinking things and ruminating about what is happening and could happen to us, it’s one side of the brain that gets activated. But when we engage in activities that involve something outside of ourselves, we are using the other side of the brain, where the antithesis of the “me” center resides. When we do things to help other people — altruistic activities, acts of generosity — this has an immensely healing effect on us (and enables us to forget about ourselves). So do something nice for someone. Drop something off. Leave a big tip. Call someone whom you think might be lonely. Count up how many thoughtful actions you have taken each day that can be added into the column of positive things coming out of this crisis. And behaviors being the contagious things they are, we might be lucky enough to spread something around that is good for us.