Priory experts: How to handle depression and anxiety as England enters a second national lockdown
Leading Priory psychiatrists and therapists offer 10 practical ways to help you look after your mental health
Pandemic is having a major psychological impact on the population, they say
Charities say millions are struggling with their mental health as a result of fears and uncertainty surrounding Covid-19
Protecting people’s mental health has become “absolutely vital” amid reports of significantly elevated levels of anxiety, depression and stress, Priory experts say.
Studies show a three-fold increase in the prevalence of depression and anxiety problems in the adult population during the last lockdown, evidence that Covid-19 is associated with a mental health crisis.
And mental health charity Mind said: “Millions of people are struggling with their mental health as a result of the pandemic – people with existing mental health problems, people at risk and now the general public are facing the greatest test of our mental health this year.”
Priory psychiatrists and therapists have put together 10 practical tips which they say can be useful for those who need it, while those in serious need should always contact their GP or access professional help online.
Dr Natasha Bijlani, a consultant psychiatrist at the Priory’s Hospital in Roehampton said: “Every single one of us is going to be emotionally affected by the uncertainty of the pandemic, as it poses a very real threat to our lives regardless of wealth or status. Anxiety is likely to be the most common emotion experienced.”
Keep your routine going
She emphasises the importance of maintaining structure and routine: “Maintaining a routine can undoubtedly help give you a sense of purpose and productivity and offer you some distraction from stress and anxiety.”
Dr Paul McLaren, consultant psychiatrist at Priory’s Hayes Grove Hospital, and Priory’s Wellbeing Centres in London, adds: “People need rhythm and pattern in their lives. To ease stress, take a step back and think about the usual pattern of your life pre-Covid. How does it work when you’re at your most content? Break it down into its main elements and see if you can quantify them. For example, social time, family time, partner time, food, exercise and work. Then see how you can replicate that in lockdown. You will need to be proactive and organise your time. Socialising through video calls will never be as powerful as face-to-face, but it could produce some soothing.”
Dealing with stress
Alison Hardy, a cognitive behavioural therapist at the Priory’s Hospital in Chelmsford suggests practical exercises to help relieve feelings of stress and anxiety when they occur.
“When we become anxious, the body’s ‘fight or flight’ response is activated. It is a series of changes in the body including the release of adrenaline and an increase in heart rate which are designed to help you be stronger (fight) or to help you move faster (flight), all very useful if we are under attack, not very useful if you are going out to the supermarket.”
“Breathing deeply – this can help the body settle down to its more natural equilibrium. I think it is useful to imagine you are blowing up a balloon of your favourite colour. Take a deep breath in and notice how your stomach rises as you inhale which allows your lungs to take in maximum air, then let a long, slow breath out as if you are filling your balloon with air, and do this three times.
Question your thoughts – our mind can play ticks on us when we are anxious, and our thinking can become distorted. For example, an abrupt work email may lead you to think that you have made a mistake, or a friend failing to return a text may lead you to think that they are not thinking of you. Before you accept the thought, which will undoubtedly fuel your anxiety, ask yourself is that anxious thought a ‘fact or an opinion?’ If it is an opinion, you may be getting anxious for nothing.
Acceptance – anxiety, although uncomfortable, is a normal emotion. Accepting anxiety, and the way things are at the moment, can be just like accepting that sometimes we feel angry, or sometimes we feel sad and sometimes we feel happy, and just like those other emotions, anxiety will pass. However, if your anxiety is long-term and really affecting your day-to-day life you should always seek professional support.”
Challenging your thought processes
Dr Niall Campbell, consultant psychiatrist at the Priory’s Roehampton Hospital in London, says: “Mindfulness, relaxation techniques and Cognitive Behavioural Therapy are all genuinely useful. Many apps such as Headspace or Calm offer different types of meditation for different concerns, or simply basic meditation. These typically offer meditation as short as 3 minutes and up to 20-minute sessions. You can also access video therapy with a trained professional via Skype or online.
“Progressive Muscle Relaxation can also be done at any time during the day. PMR involves tensing and releasing muscles in certain intervals. There are guided versions available online for free on YouTube.
“Try to stop the train of thought that will always lead you to imagine the worst case scenario. Challenge your negative thoughts. Separate what is in your control and what isn’t. Stay in the present.
“Give yourself a short period each day to think through your worries but then stop and don’t allow intrusive thoughts to impact on your entire day. Think of negative thoughts as a train that you are getting off. Then give yourself a boost by talking to others or listening to music.
“It’s a very worrying time for many but this period will pass. And remember, alcohol is not your friend; it is a depressant.
“Changing a difficult situation isn't always possible,” he adds. “So, accept what you cannot change and focus on the things you do have control over - such as regularly connecting with colleagues over video conferencing or online meetings.
“Put on headphones to listen to music can have many benefits, such as helping you relax and focus on something away from work and the outside world. Turn off rolling news and social media platforms such as Twitter, and just check in once a day. Stretch your legs and go outside at least twice a day. Moving around and changing your environment, even slightly, can clear your mind and re-energise you.”
“Observe your thoughts and tell yourself that your mind is reacting to these thoughts and anxiety. These feelings are normal - it's just the body's alarm system doing its job when it doesn't need to.
“Learn to control your breathing. People often hyperventilate during a panic attack. This means taking deeper breaths than normal which results in you feeling short of breath, causing a feeling of dizziness, disorientation and chest pains. By learning to slow your breathing down, you can help prevent the uncomfortable physical symptoms and stop the panic cycle. Try to get a slower and more stable breathing rhythm by breathing in for three seconds, holding your breath for two seconds, and then breathing out for three seconds. As you breathe, ensure that your stomach expands as you take each breath as this helps to ensure the breathing isn't shallow, which can add to the problem.
Learn to use positive coping statements
“When you are feeling anxious and panicky it can be helpful to have 'coping statements' which can be used to remind you that panic is not dangerous and isn't harmful.
Such statements could be:
- Panic is simply high levels of anxiety
- By remembering these symptoms are nothing more than anxiety, I can prevent further symptoms occurring
- My anxiety and panic will pass naturally given time. It doesn't last forever
Reminding yourself of these facts can help to prevent further panic cycles happening.
Keep a journal
Pamela Roberts, a Priory psychotherapist based at Priory’s Woking Hospital, adds that for those who might be self-isolating: “Ensure you are working in a well-ventilated room and following basic self-care, so healthy eating, sleep, lots of hydration, and try to keep to a routine. Set up a ‘buddy group’ with family or friends and regularly check in online or with Facetime.
“If you feel low, journaling can be a helpful way to unload emotions. Go with the flow. Tell yourself ‘what I am doing is enough’. Be good to yourself. If you have slept badly, accept you'll be in a low, more anxious mood. Your energy will be low. Try and relax and focus on positive things knowing that every effort is being made globally to bring about a vaccine. Being able to relax will help you through. When you're tense you tend to dwell on things and make them worse. If you are able, get into your garden and get daily doses of sunshine. For support with grief, anxiety, or mental wellbeing, you can call or text an organisation like the Samaritans, or you can access therapy online with a trained therapist.”
Priory expert Steve Clarke, a psychotherapist and hospital director at the Priory’s Life Works Hospital in Woking, Surrey, explains: ‘Emotional Freedom Technique (EFT) - Repetitive finger tapping - can sometimes help to release negative emotions such as anxiety.
“It has been called a psychological version of acupuncture in that it involves making contact with a number of acupuncture points. The specific points to tap are the end-points of the major meridians (meridians are believed to be channels of subtle energy which flow through our body). So, whilst focusing on your negative emotion you tap on a meridian point (collarbone, under the arm and top of the head trying to avoid the face at these times) three to seven times, repeating your negative thought in your head. After each emotion, take a deep breath and exhale. Continue this until you feel calmer and relieved. When you feel more relieved, repeat the technique whilst you tap through a positive round, repeating more uplifting phrases.”
Dr Bijlani says: “Make time for a nourishing lunch with adequate hydration. Food and drink can greatly affect your physical and mental health. Use time you may have spent travelling to your office to fit in some social calls to friends or family. Avoid drinking too much alcohol or eating unhealthy foods out of boredom. Try and keep to boundaries such as only drinking alcoholic beverages in limited quantities at the weekend. Having to spend endless time each day in our homes with others under lockdown (again) is certainly going to affect our relationships with them, regardless of whether they are our loved family members or not. Emotions can be ‘infectious’ and if those around us aren’t able to keep calm and cope well, we could end up getting stressed, fed up, irritable or low ourselves. It’s important for each of us, where we can, to take responsibility for our own health so that we can help keep up a reasonable level of optimism and engender a healthy environment in our homes which we share with others. Try and do some things together, such as sharing the preparation and eating of meals, and taking daily walks together, while also maintaining respectful boundaries and giving each other space apart for private time alone. Work as a healthy community. Try and be sensitive, flexible and forgiving without losing your own sense of self or identity. The best way to keep your mood swings under control is to look after yourself by keeping to your usual routine of sleep, diet, exercise and other activities. If you have been prescribed medication for your mental health, then take it as advised.”