Long COVID Self-Management - Managing Anxiety

Understanding Fear and Anxiety

Fear is a normal, and even helpful, emotion. Fear is like a smoke alarm that protects us and keeps us safe by alerting us to potential threat or danger. When we call something dangerous, our brain sends signals to our body to increase heart rate, breathing rate, muscle tension, blood pressure, and sweating. Blood is diverted from our digestive system to larger muscles to help fight or run. This can make us feel nauseous or have an upset stomach. We may feel dizzy, light-headed or short of breath. These changes prepare the body to defend itself and it is called the Fight-Flight-Freeze response. You may feel so scared that you are unable to move or react.

The challenge is that we can have a similar reaction and the same bodily responses to possible future situations, where we are not actually in danger. This is about what we THINK might happen, what we ANTICIPATE or WORRY about. This is anxiety.

After illness, people can become very quick to identify changes in their body or in their thinking abilities. This makes sense. Your brain wants to protect you from any potential threat, so it sounds the alarm when any change is noticed (e.g., shortness of breath, mild cough, fatigue, pain). After illness, however, your internal alarm system can become faulty and more sensitive than usual. This can cause people to feel they are in danger even when they are not.

In addition to affecting our bodies, anxiety affects our thoughts and behaviour. When we are anxious, we tend to:

• Focus on the future or the past instead of the present. The future can be the next five seconds, five minutes, or five years. In the same way, the past can be the previous five seconds, five minutes, or five years. Anxiety makes us worry about what COULD happen or what COULD HAVE happened, rather than observing and being present in the current situation.
• Engage in harmful or negative thinking:
  • When anxious, we often predict a negative outcome, and then jump to the conclusion that if this outcome happens, it would be a catastrophe (i.e., worst-case situation).
  • For example, someone may feel a little short of breath and think, “I’m going to end up in the hospital.”
  • Just because we have a thought, doesn’t make it true. Our thoughts can, however, impact our emotions (e.g., increase anxiety), our bodily sensations (e.g., increased heart rate, shortness of breath, tension etc.), and our behaviour (avoid anxiety-producing activities).
• Avoid those things that make us feel anxious, uncomfortable, or unpleasant. While this lessens our anxiety in the short-term, it has negative long-term effects (e.g., reduced fitness and stamina if avoiding exercise, and therefore more shortness of breath; low mood if avoiding social and recreational activities).

Coping with Anxiety

The way we think, feel and behave all impact one another. This means we can reduce anxiety by changing the way we think or behave. We can also engage in activities that change the way our body feels.

Ways to Help Cope with Anxiety

Change your Thoughts

Practice Mindfulness

Instead of focusing on the future or past, focus on the present moment. Mindfulness is the act of purposefully paying attention to the present moment and being non-judgmental. This is to help a person become aware of the full range of experiences, including sensations, thoughts, and emotions. Mindfulness is not always about “fixing” what we think or feel, but rather observing.

• Engage your five senses- what do you see? Hear? Touch? Smell? Taste?
• Listen to some relaxing music. What do you hear? How does it make you feel?

Come up with Ways to Combat Negative Thoughts

• When anxious, it is easy to imagine negative situations. You may think about how you felt in the past and it reminds you of the current feeling. You may remember scary experiences that are the same or similar to worst-case situations that you've imagined. The problem is that your memory can be selective with past negative events (e.g.: being hospitalized). This is because memories of negative events are better remembered than memories with positive outcomes. For example, it takes more effort to think about times where you had shortness of breath and were actually safe and able to cope with it.
• Try to spend time coming up with ideas that are different than the worst-case situations. What is the most likely situation? What is the best-case situation?

Change your Bodily Sensations

Calm the Body (it Helps to Calm the Mind!)

Engaging in relaxation exercises can help calm the body and reduce the Fight-Flight-Freeze response. It calms the mind and tells you that you are safe.

Focus on Your Breathing

Use your breath as an anchor for your attention. Visit the Breathing Techniques page for more information. 

• Notice your breathing without trying to control it (be mindful of your breath).
• Next, see if you can control your breathing. Aim for slow, even breaths.
• If you feel able, you can also try deep breathing. In this case, breathe in through your nose for a count of three, hold the breath for three, and then slowly breathe out through pursed lips for a count of six. You can adjust the pace so it is comfortable for you.
• The goal is to focus on your breathing instead of what happens in the future.  Also, this sends a signal to the brain that the fight-flight-freeze response is not needed at the moment.

Try a Body Scan

Starting at the top of your head or your toes, scan your body. Focus on one part of the body or a group of muscles at one time. Pay attention to any areas of tension and focus on mentally releasing the tension.

Change your Behaviour

Seek Out Information from a Trusted Health-Care Source

Seek out information from a trusted health-care source on what activities are safe versus less safe based on your medical needs.

• Approach, don’t avoid.
• Reflect on: What have I been avoiding? Why do I avoid these activities (i.e. what do I gain by avoiding)? What has been the impact of avoiding (i.e. what do I lose by avoiding)?

Take a Gradual Approach to the Things You are Avoiding

It may be true that avoiding can help reduce anxiety at the start. However, over time, the thing you are avoiding can seem scarier and harder to approach. Avoidance keeps anxiety present and can also lead to feelings of guilt, shame, sadness, and frustration. Taking on activities that cause anxiety can be helpful because you can learn that the people, places, activities, or things you were avoiding are not dangerous. Even if they are a little difficult, you can cope.