Residue of the past: Identifying and treating Covid-19 anxiety

Human beings are wired to crave security and seek a sense of control over their lives and well-being. We can all report an uptick in feelings of anxiety from heightened levels of prolonged uncertainty. 

Alongside claiming 4.74 million lives worldwide, the pandemic has left us feeling stressed, anxious and powerless over the direction of our lives. Its recurring "waves" have drained us emotionally and made us feel trapped in a downward spiral of "what-ifs" and uncertainty about the future. 

For the sake of lucidity, this anxiety can be noted in three parts: anticipatory, mid-recovery, and ancillary. Anticipatory anxiety comes in the form of fear of contraction for ourselves and our loved ones, recklessness of others (regarding mask use and social distancing), limited access to Covid-19 treatment and vaccinations, etc.

Mid-recovery anxiety is experienced by the infected individuals, their caregivers and others in their social network. The uncertainty surrounding the intensity of infection, type of variant, treatment methods, and the potential loss of life, can range from mildly stressful to debilitating for some. 

The ancillary anxiety symptoms are similar but for a wide list of factors ranging from loneliness and isolation, to loss of security, to loss of health, relationships and life itself. 

Among the most affected demographics are frontline workers, the elderly, women, lower socioeconomic groups, and children. As a result, they are significantly more likely to develop major depressive and anxiety disorders.

Frontline workers have to be concerned about getting infected with Covid-19 everyday, resulting in anxiety, insomnia, and symptoms of traumatic stress, as well as moral injury, guilt, and shame around distribution of limited resources that may directly affect patient survival. 

The elderly have been the most at-risk population with weakened immune systems and higher rates of pre-existing health conditions, and thus heavily isolated from friends and family members, negatively affecting their mental health. 

With isolation mandates, women have disproportionately taken on the domestic burden of housekeeping and childcare, all the while being expected to work from home if necessary. 

Men and women alike have faced economic difficulties, such as job insecurity, layoffs and furloughs with millions of essential workers at risk of falling into extreme poverty. Participants in the informal sector of the economy and the marginalised population have especially been affected. Children have not been able to access formal education for more than a year, due to economic inequality, lack of infrastructure and poor internet connectivity. 

Due to such unusual and uncertain conditions, people may develop some kind of anxiety disorder. Symptoms of such development may include: uncontrollable worrying, inability to rest or sleep due to anxiety, frequent mood swings, unusually fast heart beat, faintness, dizziness, nausea, shortness of breath, etc. 

Many individuals with existing anxiety disorders such as Obsessive Compulsive Disorders have reported an exacerbation of their symptoms, namely rumination over and repetition of "checking" behaviours. 

While others have developed symptoms of Post Traumatic Stress Disorder (PTSD) through prolonged exposure to chronic anxiety. Many survivors have reported diminished health and functioning, which continues to affect their mood and self-esteem. Global suicide rates have gone up and so have the onset and relapse into Substance Abuse Disorders from the lack of timely access to professional support.

Irrespective of  how anxious we feel, there are steps we can take to deal with it. Besting uncertainty requires planning and outreach. 

During the first months of the pandemic, Dr Tedros A Ghebreyesus, the WHO Director General, said,  "Be safe, be smart, be kind". His maxim reminds us to be kind not only to each other but also to ourselves. Our capacity to cope with uncertainty varies widely, but it is important to know that we can have shared experiences of feeling overwhelmed by it. This pandemic has been such a shared experience.

When circumstances are out of our control, it is easy to become overwhelmed by fear and negative emotions. With a recent diagnosis of Covid-19, for example, one can lower their stress levels by speaking to their loved ones for support, by managing their symptoms by taking medicine prescribed by a psychiatrist. 

Exercise is a natural and effective stress-reliever and anti-anxiety treatment. Similarly, adding mindfulness to our daily routine can help us feel more relaxed physically. To counter poor quality sleep, which can fuel anxiety and stress, we can improve our daytime habits and take the time to relax and unwind before bed to achieve better sleep at night. Eating healthy meals can help us maintain our energy levels and prevent mood swings. 

There is no shame in seeking mental health support whether it is for anxiety, or for the collective grief we have been experiencing as a society. Our shared global experience of loss of loved ones, of livelihoods, of relationships and health and identities has us all reeling from a collective grief. Even if we have not lost our immediate relatives we have observed and experienced others' suffering and unbearable sadness. 

The Covid-19 pandemic has expanded our textbook chapters beyond normal grief, complicated grief and traumatic grief.  The Kübler-Ross grief cycle has helped us understand grief through the five stages: denial, anger, bargaining, depression and acceptance. 

Her co-author, David Kessler, who has added a sixth stage to the process called "finding meaning", opines that through the group action of mourning someone's death, we can create new meaning for living in this world without that person. 

Recovery, typically, is greatly facilitated by social support and the maintenance of individual, family, community, and national cultural and religious traditions regarding death and grieving. This pandemic has created barriers to this stage, including denying us  a chance to say goodbye to the deceased, due to public health concerns. 

To top it all, others are beset with "self-blame" and "survivor guilt". The resulting combination of irritation, anger and guilt we feel from this deprivation can actually prolong our grief.  

According to the International Classification of Diseases (ICD) -11, "Prolonged grief  (PG) disorder is characterised by at least six months of intense longing, preoccupation, or both with the deceased, emotional pain, loneliness, difficulty reengaging in life, avoidance, feeling life is meaningless, and increased suicide risk." 

The transformation of normal grief and distress into PG and major depressive disorder and symptoms of posttraumatic stress disorder is a very real concern. PG affects approximately 10% of bereaved individuals, but this is likely higher for grief related to deaths from Covid-19. 

After a death occurs, we can prevent and/or treat these diagnoses by proactively identifying family members or friends of the deceased person, who are at highest risk of developing mental health conditions. 

Primary care clinicians can then use validated screening tools, such as the PTSD Checklist for posttraumatic stress disorder symptoms to diagnose them and start delivering evidence-based interventions.

For individuals identified at imminent risk for suicidal and violent impulses and high levels of dysfunction, the goal would be to address their immediate risks to self or to others.

Alongside community support, we can ease our own grief by being self-compassionate. Our feelings of sadness, anger, betrayal, injustice or hopelessness need to be processed without judgment. We can do so by paying attention to them when they arise and record them in journal form. 

For some, this may prove challenging as they struggle to identify/name them. Seeking professional therapy to help us verbalise these complex feelings can significantly lighten the burden. Similar processes affect children and adolescents, who experience sudden loss of a parent or a grandparent to Covid-19. 

Clinicians can help bereaved families find creative ways to safely honor traditions, memorialise the deceased, and improve social support.

If you, or anyone you know might be struggling, please help them access "Kaan Pete Roi" helpline at 01779554391-2 or connect them to PHWC professional services at 09609013000.

Nissim Jan Sajid is the Lead Psychological Counselor & Additional Managing Director at the Psychological Health & Wellness Clinic (PHWC).

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard.