Why Widespread Panic isn’t Helpful and How to Avoid Engaging in it:

Jayme Kolbo, MA, LPCC

COVID-19 has created many temporary changes in our daily routines and has prompted anxiety and fear in many of us, even those without anxiety disorders or underlying mental health conditions. Changes in our routines alone can create anxiety and discomfort (we are creatures of habit), but the added anxiety of potentially getting a virus that we have no treatment for and spreading it to others, which could be deadly, has some of our anxieties at an all-time high. Not to mention the economic, political, and societal impact this virus has already had on many of us. This is where panic can arise and we can easily fall into unhelpful behaviors in response to our anxiety. For those without an anxiety disorder or those who have never had treatment for an anxiety disorder, this is a new state of being and can be confusing to navigate which can lead to impulsive actions. Individuals without an anxiety disorder maybe haven’t had to tolerate this discomfort and uncertainty before. For those who have never had treatment for anxiety, they may not have learned that emotions are separate from actions and we can exercise control over our actions despite how we feel. For those with an anxiety disorder, this can heighten anxiety to a new intensity that makes it more difficult to manage.

 

Why we feel anxiety and panic even if we don’t have an anxiety disorder right now:

From an evolutionary perspective, anxiety and panic makes sense right now. We are all biologically wired for survival and COVID-19 is threatening our survival/the survival of those we love. When we feel anxious, our sympathetic nervous system becomes activated. This is our fight, flight or freeze response, which is a protective and effective response when we are in immediate danger and need to get to safety. When our sympathetic nervous system is activated, certain changes occur in our bodies; blood pressure and heart rate increase, blood flow goes to our major muscle groups so your fingers and toes may become cold and clammy, muscles tense to prepare to fight/flight/freeze, digestion and immune functioning stop, sex drive stops, our rational frontal lobe becomes de-activated so we can act quickly without thinking, and our breathing becomes shallow and quick so we have enough air supply to fight/flight/freeze. This response is hard-wired into our brain and has helped us to survive as a species. The problem is, it takes a lot of energy for us to sustain this survival response and we are not built to have our sympathetic nervous system activated for long periods of time without rest. The other problem is that acting without thinking first does not lead to rational decision-making.

 

The impact of panic on our decisions:

Because our rational frontal lobe is “offline” during times of high anxiety or panic, our actions sometimes do not make sense. We can become impulsive in our decision-making and do things that we think might make us safer (or might make us temporarily feel better) even if the long-term consequences outweigh the short-term benefits. Let’s use the toilet paper crisis as an example. It doesn’t really make sense that toilet paper is necessary for our survival right now, but that doesn’t matter to someone who is worried and feels they need to do something to prepare. So the first person panics, buys a ton of toilet paper (among other necessities), and then someone else sees that person with a shopping cart full of stuff and thinks ‘maybe I need all those things too’ and buys a bunch of toilet paper too (not the recommended two-week supply, but all of the toilet paper because they are worried). Soon, the store shelves are empty of certain items. This triggers the panic response in others and now everyone needs toilet paper now. And a lot of it because who knows when it will be re-stocked (the problem with uncertainty). Now, stop and think about the person who didn’t stock up on toilet paper (or who can’t). They eventually run out of toilet paper like everyone normally does, and there is none left. Meanwhile, those of higher SES or those who have panicked more have a closet-full that they don’t need. Manufacturing companies make toilet paper based on previous sales, so a sudden spike is not planned for and takes time to recover from. The person that truly needs toilet paper now is out of luck and suffers. Imagine this same example but for someone who needs food to feed their family and is limited to items that can be bought with food stamps. In terms of hand-sanitizer or hand soap, we collectively need everyone to be using these items so buying all of it out actually makes it harder for others to follow CDC/WHO recommendations, increasing the chances of spreading the virus. Stocking up on face masks and gloves can leave hospital staff without necessary protective equipment, and we need those essential staff members to survive. All of these examples show that panic and impulse-buying does not lead to our collective survival and can cause more problems than solutions. To be clear, I do not think that individuals who have impulse-bought items have any mal-intent; they just want to survive and they aren’t thinking about anything else but that in that moment. To be honest, I went to a store recently, saw a bunch of empty shelves in their food section, and found myself randomly picking up food items that were still available that I did not need. Panic and impulse-buying happens to all of us. Educating ourselves on it helps us to choose more effective behaviors and create positive change.

 

So what should we do?

I want to start by clarifying that I am not recommending that everyone do nothing. Following CDC/WHO recommendations is important right now; we just need to be mindful of our emotions and intentional with our actions so we don’t over-do it. To start, STOP (ironic, but seriously). This is an important skill. The acronym stands for: Stop, Take a step back, Observe what is going on, and Proceed effectively. Before you act, stop and think about your options. Name your emotion and your action urge before you act. Label your thoughts about the situation. Are your thoughts factual? Normally thoughts are not factual when we are at a high level of anxiety or panic. Normally our thoughts are all future-oriented worries about what could happen (not what currently is happening) at high levels of anxiety. Name the facts from trusted sources (https://www.cdc.gov/coronavirus/2019-nCoV/index.html, https://www.who.int/emergencies/diseases/novel-coronavirus-2019). Do a cost-benefit analysis by listing the pros and the cons of the decision. Do the pros outweigh the cons? Think long-term. Think of collective pros and cons, not just personal pros and cons (our decisions impact others). Check out your decision with a trusted friend. *When you’ve analyzed your action urge and decided on what is most effective long-term, then you can proceed mindfully. Don’t let the empty shelves change your mind when you get to the store.

 

*For those with OCD and difficulty making the “right” decision, do not over-analyze. You could stay stuck here forever. If you’re experiencing anxiety about making the “right’ decision, stop the cost-benefit analysis and lean into that fear. Maybe you will make the wrong decision; you don’t get to know. And then make any decision. Or intentionally make whatever the “wrong” decision is in your mind to really expose to that fear (please still follow CDC/WHO recommendations and any Shelter in Place laws right now, which us ERP therapists are aware of and know are temporarily opposite to many ERP recommendations). Talk to your ERP therapist (or reach out to our therapists) for help if this comes up.

 

Sometimes we can’t analyze our decisions very well if our anxiety or panic is too high (that rational brain can be hard to turn back on). This is when we need to start by changing our body’s response to anxiety/panic first. Dr. Marsha Linehan, the creator of Dialectical Behavior Therapy (DBT for short), put together a set of four skills that are called TIPP skills. These skills are evidence-based ways to change our body chemistry and activate our parasympathetic nervous system, the opposite of our sympathetic nervous system fight/flight/freeze response, our state of calm and rest. Our bodies communicate to our brains so changing our heart rate, breathing, practicing relaxation and/or wearing out our fight/flight/freeze response tells our brains that we are safe without having to change your thoughts first. This re-activates our logical, rational frontal lobe in our brain and helps us make more effective decisions and be intentional with our actions. Here is a summary of the TIPP skills:

 

  1. Temperature/Activate the Dive Response: body chemistry (heart rate specifically) changes when we dive underwater. To activate this response:
    1. Put your face in a bowl of cold water or put a zip-lock bag with cold water over your eyes and upper cheeks
    2. Close your eyes and hold your breath for 20-30 seconds while your face is in the water/water is on your face
    3. Take a few deep breaths after 20-30 seconds of holding your breath
    4. Repeat as needed, I recommend following this with a relaxing/soothing activity
    5. Caution: cold water decreases heart rate, consult with a physician if you have pre-existing medical concerns before using this skill and never put ice directly on your face
  2. Intense Exercise: “wear out” your sympathetic nervous system response by expelling that energy with exercise
    1. Generally takes about 20 minutes of exercise (running, jumping jacks, weight lifting, etc)
    2. Exercise also increases endorphins, which trigger positive feelings in the body
    3. Caution: intense exercise increases heart rate, consult with physician if you have pre-existing medical concerns before using this skill
  3. Paced Breathing: slowing your breathing down to ~6 breaths per minute
    1. Be sure to breathe into your “belly” (diaphragm), not your chest
    2. Be sure your exhale is longer than your inhale
    3. Can be helpful to breathe in through your nose and out through your mouth, making a “whoosh” sound with the exhale
    4. Caution: Listen to your body! Find a count that works for you. Some common techniques include 4-4-8 breathing (inhale for a count of 4, hold for a count of 4, and exhale for a count of 8 while imagining making a square with your breath) or 5-7-8 breathing (inhale for a count of 5, hold for a count of 7, exhale for a count of 8)
  4. Progressive Muscle Relaxation: intentionally tensing and releasing tension from muscle groups to experience relaxation
    1. While breathing in, tense muscles
    2. While breathing out, release the tension
    3. Notice the difference in your body
    4. Here is a list of muscle groups and what to do: https://www.uofmhealth.org/health-library/uz2225
    5. Here is a guided version from Johns Hopkins: https://youtu.be/ClqPtWzozXs

 

None of these skills are going to change the current situation. COVID-19 is still going to be a concern and some anxiety is still going to make sense. What these skills will do is decrease the intensity of anxiety and panic, which helps us to make more rational decisions right now and prevent making COVID-19 even worse by creating new problems due to impulsive decisions. Combine these skills and repeat as often as you need. This will help you more effectively tolerate your anxiety and not make things worse. When the intensity of your anxiety has decreased and you are able to identify the facts, try doing a cost-benefit analysis before making a decision and then finish the STOP skill by Proceeding mindfully.

 

Remember that uncertainty and fear are hard to cope with and it’s understandable to feel whatever you feel right now. We don’t need to change the emotions we are having (we need to have compassion for ourselves and others more than ever right now!), but we do need to be mindful of how our emotions are impacting our actions so we can be intentional with our actions. If you need help, many therapists are offering online teletherapy sessions right now and/or COVID-19 anxiety support groups (OCDMN included!). Reach out for support. We are all in this together and we will get through this together.