Top 12 tips to relieve COVID-19 stress

Staff Report

March 25, 2020

hand holding umbrella against coronavirus — During this uncertain and rapidly evolving situation, it is important for cancer patients and caregivers to use healthy strategies to help relieve stress caused by COVID-19. iStock

The worst part of any crisis is how it disrupts life and leaves people feeling out of control. That’s why therapist Wendy Balliet, Ph.D., offers these tips to help people affected by COVID-19 to adjust and adapt to a rapidly evolving situation.

Balliet, who counsels patients at Hollings Cancer Center at the Medical University of South Carolina and is associate professor in MUSC’s Division of Bio-behavioral Medicine, said it’s especially hard for cancer patients and others with chronic conditions to navigate this new terrain. Here are her tips to help patients and caregivers find healthier ways of coping and to regain their footing.

1. First, rest assured you are not alone.
It is natural to feel stress, anxiety and worry as we face this time of uncertainty. If you are someone with cancer or other chronic illness, COVID-19 is likely only amplifying already existing feelings of worry and ambiguity. Anxiety typically occurs when we believe we are unable to predict what will happen or control stress. Many of us have been comparing COVID-19 to preparing for a hurricane, which most of us as South Carolinians are quite familiar with. We watch the news, look for trajectories, load up on groceries (and toilet paper) and wait. However, unlike a hurricane, we have no real road map or evacuation route to help guide us. This can lead to feeling panicky, irritable and anxious.

If you are a patient at MUSC and are continuing to come to medical visits, you know this is a scary time. It’s scary even for us, seeing the campus so quiet, having exits closed and answering questions to enter a building. Remember you are not alone. Smile when you pass someone. Make small talk in the elevator. You will be amazed what these small acts can do to lift your spirits (and those around you).

2. Set time aside to breathe.
It may seem silly, but when we face anxiety, our body activates our sympathetic nervous system, which prepares us to fight, flee or freeze. This can be helpful in the short term when there is a clear and present danger, such as being diagnosed with cancer or facing a novel pandemic. A healthy “burst” of the sympathetic nervous system may help you prepare a cancer treatment plan, such as surgery, radiation, or chemotherapy and/or improve health behaviors like hand washing and social distancing. However, feeling constantly overwhelmed can lead to negative physical consequences like hypertension and increased pain and mental consequences such as anxiety and depression. We expect that this is even worse for those trying to manage chronic illnesses.

Setting aside time to practice deep breathing—slow breaths in through the nose counting to four and exhaling for 4 counts—can be the easiest way to reduce what we call a “sympathetic burst” and physically activate a self-soothing response by inducing the parasympathetic nervous symptom. Think of it as a way to recharge your batteries so you can have more “emotional bandwidth” to manage the inevitable stress ahead. It also allows you time to be in the present moment, taking a break from what might happen in the future or thinking too much about the past. I would suggest doing this for 10 minutes at least three times throughout the day.

Apps to try that offer guidance on breathing:

Prana Breath: Calm & Meditate
Breathe2Relax
Universal Breathing: Pranayama

3. Know it is OK to ask for help.
Asking for help is difficult for many people, especially for those who already have been using social support to navigate the cancer experience. Typically, it is not the act of asking others for help but the fear that hides beneath it—fear of being a burden, of being vulnerable, fear of rejection. The reality is most people not only want to help, but it brings them joy, meaning and purpose during these uncertain times, knowing their actions are helping others. Let your neighbor pick up some groceries. Allow your daughter to fill your car with gas. Accept rides from healthy support people to medical appointments. It makes them feel good, too. Don’t steal peoples’ blessing of helping you.

4. Focus on the good and provide acts of kindness.
Now this may seem difficult in a time of social distancing or isolation, but it’s possible if you get creative. Email someone you know who may be alone and scared just to let them know you are thinking of them. Write thank you notes to the people who have helped you. Write positive messages on social media if you use it.

Be intentional about paying attention to the good. It is easy to get wrapped up in news stories about basketball players acting recklessly, toilet paper running out at stores and people hoarding antibacterial soap for a profit. But there is a lot of goodness happening, too. Neighbors checking on one another, restaurants and schools offering free food to children and strangers offering to grocery shop for vulnerable people. It can feel like the universe is against you when faced with the dual stress of dealing with chronic illness and the worry of catching COVID-19. So, each time you look at the news, search for a “tell me something good” story to help balance the narrative.

5. Find a mantra.
This is a short and powerful phrase that you relate to that you can easily think or say when anxiety spikes. Some of my personal favorites are:

This is a marathon, not a sprint.
Be where your feet are.
I have endured (insert here… chemotherapy, brain surgery); I can weather this storm.
Just for today—I’ll take things one day at a time.

And replace “but” with “and”… to shift negative self-statements:

“But this is a terrible time” changes to “This is a terrible time, and we’ll get through it.”
“But I’m so lonely” changes to “I am lonely, and I’m grateful for the connections I do have.”

6. Know timing is everything.
Avoid news on your TV and phone, etc., first thing in the morning and last thing at night. Do your normal routine in the morning, whether that is showering, coffee, brushing your teeth, etc. Next, write down three things you are grateful for—keep a gratitude journal. This helps to set the tone for the day. For example, you may be grateful for something simple like the rain finally stopping, the unconditional love of your dog or something bigger like good news from your doctor. Purposefully engaging in an “unplugged” morning routine and practicing gratitude before turning on the news will help to start your day in a positive direction and allow you better emotional resources to cope with the inevitable stress you’ll watch on or read in the news.

While it is important to stay informed about this evolving scenario, it is critical to take breaks from the news as well. I would suggest setting aside time twice a day to update yourself on latest developments and avoid reading about or watching the news one to two hours before bed. Sleep is critical, and it is unlikely that anything late breaking will change your actual behavior before morning—except for losing sleep!

7. Stay informed by using reliable sources.
This includes such sources as the Centers for Disease Control and Prevention, the World Health Organization and other reliable well-established news outlets. For example, the New York Times is providing all their COVID-19 information for free. Take recommendations seriously. Avoid blogs and unsubstantiated comments on social media.

Sources I recommend include:

The American Cancer Society guide for cancer patients
U.S. Centers for Disease Control and Prevention (CDC)
World Health Organization (WHO)

8. Focus on what you can do and accept the things you can’t control.
It is a tried and true cliche. Take care of yourself and continue treatments and medical appointments as directed by your treatment teams. Understand that social distancing and isolation are not meant to be punishment but a way to protect the work and treatment you already have undergone to treat or manage your illness. It is the best way we know how to maintain your health. And although we don’t have a set time frame for the need to practice social distancing, it is likely time limited.

Check out this quick guide shared by a colleague Russ Harris, who is author of “The Happiness Trap,” who recommends people FACE COVID by this formula.

Therapist Wendy Balliet, Ph.D., counsels patients about finding healthy ways to cope with stress. Photo by Dawn Brazell

9. Find ways to stay socially connected and engaged.

Social distancing doesn’t mean a lack of connectedness. For those of you who are trying to manage your own illnesses in conjunction with the stress that COVID-19 is generating, this is critical to remember. Isolation can increase anxiety and depression, especially for more vulnerable people.

Use this time to stay virtually connected. Use text messages, video chat and social media to access social support networks. Talk about your concerns and fears. I promise, you aren’t alone, and sharing helps to feel connected at a time when you need it most. Meaningful and fun connection and emotional support is vital to your well-being. If you belong to a cancer support group, inquire about teleconferencing instead of face-to-face meetings.

Call or text friends and family you haven’t talked to in awhile. Check in on others more than you normally would; we are all feeling isolated. If you have internet access, utilize video connections to spend time with others. If you aren’t sure how to use some of these technologies, ask someone who can help. Platforms to consider include Facetime, Zoom, Google Duo and Skype.

10. Set daily routines that include being creative.
It’s important to try to create and maintain a daily routine regardless of the disruption of unfamiliarity and isolation. This helps us to maintain a sense of order and purpose in our lives. If you are able to exercise—do it. If it is OK to walk outside—do that. Try to get fresh air, even if its standing in your driveway for five minutes each day. Read new books. Watch uplifting and humorous television shows. Pull out those puzzles you’ve been saving for a rainy day. Color! If you are able to garden—do it! Learn and practice meditation. This will help both your mental and physical state. Try new recipes and share old ones with friends. Start a journal.

Other activities to consider:

Start a virtual book club with friends. You can read a chapter a day and then discuss it over Facetime, phone or other platforms. This keeps you both stimulated and connected.
Play “Words with Friends,” “Yahtzee,” “Connect 4” or other app games with people you know across the country.
Set coffee dates with friends or family. Each morning call a friend or family member while you both have your morning coffee… or tea.
Watch movies “with” friends on Netflix Party.

11. Explore apps that benefit mental health.
Simple Habit is a meditation app that recently announced free premium memberships for those who cannot afford to pay. Other apps that teach ways to meditate, breathe and manage anxiety that have a free trial period include:

12. Write it out.
Multiple studies demonstrate the effectiveness that journaling can have on one’s health, happiness and ability to manage stress. It is one way to work through anxious or sad thoughts and feelings. When anxiety is left unchecked, it often manifests into rumination, and the problem that has you “stuck” becomes bigger than it is in reality. Writing helps to get your concerns and fears out of your head and into the open. It is also helpful in looking back to have perspective on the many hardships you have overcome. It builds resilience.