How to manage the stress caused by Covid-19, the economic crisis, and the conditions of isolation?

Answers provided by the Latvian health tourism cluster “Dzintari Clinic” psychiatrist Dr. Natālija Bērziņa.

1. How to manage the stress and the fear caused by Covid-19, the economic crisis, and the conditions of partial isolation?

The rapid spread of the infectious disease and self-isolation creates many different distressful experiences, such as fear of being infected, worries over your closest ones, which result in trouble concentrating, disruptions in sleep patterns and eating habits, psychoemotional difficulties. Of course, staying informed about the current events is important, but the first thing you can do is limit the time spent on social networks and in the information environment, by reducing it to 1-2 times a day devoted to listening to a reliable source about the situation or the current changes.

Next, you must take care of your body, that is, you must rethink your daily healthy activities, eating habits and sleep patterns. You should give up alcohol and other addictive substances, because they seemingly improve the mood only for a limited amount of time, while making it worse later on and causing serious damage to physical and emotional health.

Caring for your psychoemotional condition includes relaxation techniques, meditation, breathing exercises, mindfulness exercises, which allow to mitigate panic attacks, reduce anxiety, improve the mood. Here we also must not forget about activities that bring us joy, which could be hobbies or shared activities with the family. I must mention the particular importance of having a conversation with your relatives, friends or a specialist, if needed.

2. How to avoid the stress caused by the economic and the social crisis?

Stress and panic attacks are caused by being forced to live in circumstances which we cannot control or significantly change. Furthermore, we also feel bad because our daily routine is suddenly changed and we must quickly adapt to the new circumstances. Therefore, it is important to focus on those things or processes that we can influence by ourselves. Remember for yourself and remind your relatives that it is normal to feel anxious or to be worried during a crisis situation like this. Feelings must be released and for this purpose there are many activities available – art and drawing, music, creative workshops, etc. Stress can also be avoided by following a certain routine, which should be created to structure the day and avoid the unpleasant feeling that there have been even more changes. Even when being in quarantine or losing your job, it is important to create a routine for the day, including physical activities in it. In times of crisis, we all turn to catastrophization, our mind starts to be filled with such thoughts as “But what if…”, which makes us feel even worse, imagining the worst possible scenarios. This is why in times of crisis it is important to think about such questions as “What can I control?”, “What is the probability of the worst possible scenario?”, “What can I do at this moment?”

3. What are the doctor’s recommendations for what to do at home?

Regular physical activity while at home. It could be stretching, exercising, could be an easy walk. Short moments of rest between work tasks. Even if you are working from home, after each 45 minutes, you must take a 10-15-minute break, during which you must get up, walk around, and ventilate the room.

You should also devote time to some activity, which truly brings you joy and comfort. The amount of caffeine and alcohol used should be limited. The basic principles of a healthy diet should be followed, sleep hygiene should be developed and you should properly prepare for sleep in the evening. For example, ventilate the room before sleeping, prepare a comfortable mattress and bed sheets. You could take a warm shower or a bath. Before sleeping, it is healthy to walk in fresh air for a bit, and to limit watching the news in the evening and before sleeping. In contrast, while at home during the day, there can be a wish to take a nap, but it would be advised to not do it for more than 20-30 minutes.

4. If the stress caused by the conditions of the Covid-19 crisis creates problems which impact family life, what are the doctor’s recommendations for solving the problem?

In times of crisis, there can be issues not only between partners, but also in the relationship between parents and children. Children are one of the risk groups of people who have more considerable reactions towards stress, which is why during Covid-19 children should be supported especially strongly. Support can be encouraged by the parents showing an example: by caring about their own and their closest ones’ health, trying to talk calmly to each other, following the principles of a healthy lifestyle. You should listen to children’s feelings, complaints, fears and normalize these feelings. Many parents have encountered difficulties in structuring their children’s day and for the homeschooling process, which is why setting aside a certain time for studies and for everyday activities can ensure successfully following a daily routine. Offer the children various activities that reduce stress or offer them to play games. It is also useful to plan family activities during which the family bonds even more, possibly find out new things about each other. For example, board games together, reading a book out loud, doing exercises together in the family in the morning.

Talking about the family as a whole, in relation to the Covid-19 situation, it would be important to do the following: ensure a feeling of safety in the family, calm each other down and provide support, maintain contact between each other and with relatives, friends, as well as encourage strengthening the family. Therefore, it is important to follow all safety measures and to discuss them in the family, which will allow you to feel safer, because you are controlling what you can. Within your family, limit the activities that could increase panic, for example, watching the news. Here once again the entire family should create a daily routine to follow, but do not forget that the daily routine must include fun shared activities, creative activities, working out together. It is also useful to ensure success in decision-making strategies and to develop new skills in the family as a whole, new traditions, principles for constructing a dialogue and a supportive environment. Regardless of what skills you wish to develop or improve, the overall message could follow these principles, “We can beat this together!”, “We don’t always have to be perfect and we can be less demanding of ourselves at times!”  

5. How to help relatives who have lost their work during the crisis?

Most important are support and encouraging a conversation. Losing a job can be a sudden event for which you cannot prepare. Sudden thoughts can enter the mind about what will come next, you can start deeming the future to be negative, have self-blame. But it would be important to remind the person that work is not the only thing which shapes us as personalities. Each one of us has skills, abilities and qualities, which are appreciated, it is only a matter of seeing them once again. We must remember that unemployment is not eternal, the situation will change and other work offers may appear. Frequently we lose perspective, start to have rather negative thoughts. After such an event as losing work, it is important to encourage maintaining social connections, because isolation rather creates even more destructive thoughts and self-blame.

Our organism and brain do, however, like structured everyday life, which is why in this case we should motivate our relative to create a daily routine, small work tasks, which should be completed throughout the day. Special attention should be paid to the mornings, because the morning sets the mood for the entire day.

Another option how to deal with strong feelings after losing a job, when one is overwhelmed by self-blame or disappointment in oneself or one’s surroundings, is to involve the person in activities that are helping others. That allows one to feel needed, significant, feel satisfaction for what has been achieved and keep the motivation to move forward. An activity like this can also allow to reduce feelings of loneliness and isolation, which could occur under these circumstances.  

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   How to exit a stressful condition, what are some treatments? What are the most efficient treatment programs?

Overcoming stress is a series of measures, which includes in itself both psychological techniques for overcoming difficulties, as well as physical activities and psychotherapeutic support.

In cases of experiencing stress, when the stress is too strong or long in duration, it would be best to turn to a team of specialists, which consists of, for example, a psychologist, psychotherapist, psychiatrist, physiotherapist. A treatment includes development of stress management strategies, awareness and expression of feelings, depression prophylaxis, movement therapy, inclusion of physical activities in the healing process, art and music therapy, which allows to creatively express oneself and also acknowledge the feelings that one is experiencing. It is also good to include massages, psychotherapist’s consultations, support therapy, group therapy. The clinics of Latvian health tourism cluster offer various treatments. One of them is the 5-day treatment for overcoming stress called “INTENSIVE”. The program includes doctor’s consultations, nurse services and  therapy involving medications, psychotherapist’s consultations, consciousness activation training, group classes led by a physiotherapist, physical therapy – massages.

 7. What to do to avoid stressful situations and prevent depression?

Stress as such is needed to “train our stress management strategies”, but stress can be too intensive, which is why it can create related disturbances, which also encourage the development of depression. To prevent the development of stress, one must take care of physical and psychoemotional health, even before stress emerges, therefore on a daily basis. The principles are as follows: sufficient amount of sleep and quality (routine, sleep hygiene, go to bed and wake up at a set time every day), physical activity, balanced diet. Taking care of psychoemotional health by doing mindfulness and relaxation exercises, seeking psychological support if needed either in the family or by meeting with a specialist. It is also important to acknowledge and recognize on time various signs of stress – negative thoughts, mood swings, disruptions in sleep and eating patterns, difficulty concentrating, tiredness, irritability, frustration, a feeling of hopelessness and helplessness.