America's Essential Workers Can't Just Stay Home
When it comes to coping with coronavirus—and the crippling stress of a global pandemic that's unraveling the world you once knew before your very eyes—most of the general advice circulating involves staying home, avoiding contact with others, and not overconsuming news. But that doesn't exactly apply if you're an essential worker.
When you're on the front lines—in a grocery store, hospital, delivery truck, pharmacy, or clinic—you can't stay home. You can't avoid all contact with others. You're literally living in the news, so trying to avoid consumption of worldly events can feel pointless. You're exposed, and it's scary.
To boot, your workload has likely increased exponentially, which would leave anyone (pandemic stress or otherwise) feeling pretty overwhelmed. And for many, there are lives on the line—your life, the lives of your loved ones, and the lives of your patients or customers.
Before you chuck your phone out the window in a panic, stay with us: There are a lot of resources for you. We spoke with psychology experts and therapists to find the best coping mechanisms and strategies for all you superheroes on the frontlines. And before we proceed, let us just say: You're amazing. Thank you.
Step 1: Cover Your Bases
The simplest things that make the biggest difference in your health are often the first to go when you're stressed, overloaded, and overwhelmed (counterintuitive, I know). Here's your reminder from the experts to protect your immune system and maintain your energy so you can manage your stresses—knowing that the other tactics won't work if you don't do these things first.
"In times of extreme stress and heightened nervous system responses, it's crucial to get primal and tend to your most basic animal needs," said holistic psychotherapist Kathleen Dahlen deVos, L.M.F.T.
"Try to have a daily check on three essentials: sleep, food, and movement," says clinical psychologist Kevin Gilliland, Psy.D. "Sleep is power, food is fuel, movement is medicine. Those three things help us fight off the common cold and help us recover quicker. They also help us be our best in our jobs and with other people."
This may sound obvious, but when fight-or-flight is activated in a chronic way—aka when you're continuously stressed—even rudimentary care can go out the window, says deVos. When you're pushing your body and mind past their normal limits (which a crisis often requires), it can weaken your immune system and psychological health in the long run, which will likely backfire for you and the people you're trying to help, says Gilliland.
First things first, focus on sleep.
"Sleep is power," agrees Gilliland. "We need to be more aggressive in how we manage our lives when we leave work," meaning you need to prioritize sleep first and foremost. "Counseling is helpful, and so are medications, but neither of those can correct sleep deprivation."
What makes matter worse is that, "when stressed, many people tend to fall into bad sleep patterns which then intensifies the stress and decreases our ability to respond," says clinical psychologist Forrest Talley, Ph.D.
Are crazy work shifts (that you can't change) impacting your ability to get sleep? Try a nap, if you can. "Power naps work, just keep them to 15 to 20 minutes so you don't trigger deep sleep," says Gilliland. "Short naps can help you feel more energy." And if you can't do much about your sleep situation, "focus on the other critical areas like healthy food choices (not too much caffeine or alcohol), some kind of physical activity, and stay connected to meaningful relationships." And if you do happen to get some time off, Gilliland emphasizes prioritizing sleep. "It usually takes a few nights to recover sleep debt," he says.
Recognize the importance of nutrition.
Both Gilliland and Talley also emphasized the importance of proper nutrition during times of crisis. "People tend to either forget to eat or overeat—usually junk food," says Talley. "This also diminishes your capacity to deal with stress."
"When you binge anything, it's usually because of emotional or mental stress," explains Gilliland. "You're not being very present with what you're doing (mindless eating), which isn't a very productive way to manage stress. It actually keeps you from developing the psychological muscles that you need and can use in other situations. Not to mention, most binge behaviors can lead to some serious problems (addiction, diabetes, cardiovascular disease, financial debt, divorce, and—oh yeah, a weakened immune system)."
Don't forget to eat at least three times a day (eating more often will help prevent blood sugar surges and crashes), drink water, sleep when you are able (resist the urge to zone out with screen time instead) and stay connected to your support system, agrees deVos.
Movement is really important too.
"A healthy, regulated body and mind rely on being able to manage the fluctuating levels of hormones and neurotransmitters (brain chemicals that contribute to your feeling states) that are coursing through your brain and body at any given time," explains deVos. "In prolonged states of fight/flight or fear, the stress hormones that are discharged into the body (namely cortisol and adrenaline) can wreak havoc on your physical and emotional health in ways such as spiking blood sugar, reducing blood oxygen levels, slowing digestion, disrupting sleep, and increasing reliance on the more 'primal' parts of the brain, which means that you aren't as able to think logically, reason, and self-soothe." Movement helps to mitigate all this.
"You need to periodically discharge these stress hormones from your system by signaling to the body that it's safe and that it can relax. This is what it means to complete the stress cycle," says deVos. "One of the easiest ways to do this is just to take a short (10- minute) walk, and for very instinctual reasons. If you were being chased by a bear, you wouldn't walk. As such, your brain reasons, if you're walking, you must be 'out of the woods', so to speak. This means it's safe to downshift fight-or-flight to 'rest and digest' mode."
If you can't meet these needs 100-percent of the time…
You're not a failure (despite what your anxious brain might tell you). "In times of great stress, it's not about going for perfection," says deVos. "Accepting that you're not firing on all cylinders—and that's OK—is crucial." (AMEN)
"Panicking that we need to eat well and sleep a full eight hours and fit some movement into our schedules) is actually going to heighten that stress response again," she explains. "Instead, just aim to do one or two things a day, more days than not. Maybe one day you get a full night's sleep, and then next day you're able to walk home from work. Remind yourself that even just one small contribution to your physical or emotional health will make a difference, even if it's just stepping outside on a break to take three big breaths." (Try box breathing: Breathe in for four counts, hold for four, breathe out for four counts, hold the out-breath for four. Repeat three to four times.) "Whatever you're able to do, just let that be enough!" she says.
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Step 2: Identify Your Stressors
If you're stressed for a number of reasons, it's prudent to take a look at and acknowledge where exactly your feelings are coming from. "Essential workers are experiencing different types of stress than people who are quarantined or sick, or have a partner or family member who is sick," says psychotherapist Rachel Wright, M.A., L.M.F.T. "While everyone is one big ball of fear, stress, and anxiety right now—which are three separate emotions and present very differently, though they tend to be interchanged—it's important to identify the root of where the fear, stress, and/or anxiety is coming from." Identifying the specific sources of your stress can help you figure out the right coping strategy to use—more on those, below.
Aside from that, make sure you're listening to bodily cues that may indicate you've surpassed your stress threshold. "These symptoms [below] mean your body has been attempting to function in a fight-or-flight state for too long without being able to downshift into the rest-and-digest mode," says deVos. Keep an eye out for:
- Trouble concentrating and completing tasks
- Heightened emotionality
- Low energy
- Feeling numb
- Fogginess and tiredness
If you're experiencing any of these symptoms, deVos says to remember that this is normal. "It's important to first acknowledge that this makes sense!" she says. "You are functioning under extreme and unprecedented circumstances." (See: Stress vs. Burnout vs. Depression)
As for the next step? "Thank your nervous system for attempting to keep you protected: These symptoms are signs that your nervous system is working overtime to mitigate the impact of stressful thoughts and circumstances and to prevent you from flooding emotionally or operating in a prolonged state of fight or flight," says deVos. "Then, remember to support your body using some of the suggestions [coming up next]."
Step 3: Tackle Them Individually
"Identify one or two of the things that are most stressful," says Talley. Then ask yourself, "Is there something that can be done directly or indirectly to reduce the stress related to these sources of concern?" he suggests. There are two kinds of approaches you can take: direct and indirect.
Direct approach: In essence, getting rid of the stressor. "This includes being able to directly attack the problem," says Talley. For example, if a heavy workload is causing you to feel overwhelmed, is it possible to reduce it to give you a little more breathing room? If the news is stressing you out, can you take the app off your phone or turn off notifications? If you're too tired, make an effort to sleep more. Unfortunately, these direct approaches aren't always possible.
Indirect approach: If you can't directly eradicate the stressor (as in, you can't reduce your workload or stop coronavirus from existing), try to attack it from a different angle. There are a number of example strategies below, but many use the simple act of changing your perspective. For example, "if you intentionally give yourself permission to simply do your best—regardless of the outcome—does it become less stressful?" asks Talley.
Direct Changes You Can Make
"There are very few things you can do about the virus itself, so it's essential to take advantage of the things you can do to stay strong," says Whatley. Everyone's situation is different, but here are some things you can take control over.
Prioritize your boundaries and needs.
"Where possible, be an advocate for your physical and emotional boundaries and needs," says deVos. In your workspace, "This may include being clear about what shifts you are and are not available to work, the protective wear you need to feel safe and able to complete the requirements of your job, and the ability to accept or decline overtime when requested."
You can get even more refined with this approach. "This may also include more subtle boundaries, such as who you spend time with (or don't spend time with) during your shifts, or what you feel comfortable discussing while working," she said. "Some of these things may not be in your control, but during times of extreme stress and anxiety, focusing on what/where you do have control is an important factor in managing these intense experiences."
Be realistic with your bandwidth.
You're a superhero, that's for sure, but you're not superhuman—you won't be able to keep helping others (including making money for you and your family) if you stretch yourself too thin. "You may feel incredibly passionate about supporting and helping where you can, but to avoid feeling overwhelmed and burnt out, it's crucial to self-monitor for signs of depletion/exhaustion or burnout [noted above]," says deVos.
This includes how far you're stretching yourself at home too. "The workloads are harder than ever, so let the typical household things go a bit so you can concentrate on rest and taking care of yourself until this has passed and your workload is back to normal," says Whatley. Don't be afraid to ask for help where you need it as well. Communicate, and remember that you're human (and all humans need help from time to time).
Limit your news intake.
Is the news a source of stress for you? Turn it off! This is something you can target directly. Focus on what's going on around you, and take in only what is necessary for your job. "Limit your news intake to what is necessary," said Wright. "Personal example, the news—verbal TV, visual news—is very overwhelming for me. I need to know how to stay safe from a very practical level (i.e., do we need to wear masks?). So I get the New York Times two-times-a-day update on what's going on, as well as any CDC updates. I can check when I want and I'm not being inundated with horrible images and sadness. When you feel as though you have control over what is coming in and out of your consciousness, that can help you feel safe, too." (Need a quick pick-me-up? Check out these 25 universal things that make everyone happy.)
Locate your resources.
This is a big one. Elise Groves R.N., B.S.N., C.C.R.N., a nurse at UCSD hospital says that one of her best coping resources has been her "awesome manager" who has provided her with reassurance. "She has been very transparent with emergency plans, equipment needs, and changes in policy," says Groves. "She made us binders with all the information we could need, and provided us with phone numbers if we felt like we needed to talk to a therapist, which is a free service we get through UCSD."
Talk to your manager about what's available for you. Ask questions. Be candid. Every state and organization will have a different protocol, but this is your time to lean on management and ask for the support you need and deserve. "Each service industry will be different," echoes Talley. "For example, hospitals will have their own counselors that can help but for someone working at Target or as an Amazon driver that's likely harder to come by."
"The CDC offers preparedness tools for healthcare providers during this time that are helpful," says Whatley. Additionally, "Several organizations including Methodist Hospital and Mount Sinai are using video conferencing to set up peer support 'connection groups' so clinicians can support one another and discuss their concerns." Government organizations are offering "warmlines"—non-emergency resources for anyone seeking emotional support—as well. "Assistance is provided via phone and they chat on a non-discriminatory basis to anyone in need," says deVos.
- National Alliance for Mental Illness (NAMI) has a directory of state-run warmlines. Find the best number to call for where you live.
- Substance Abuse and Mental Health Services Administration (SAMHSA): From any state, you can call the Disaster Distress Helpline at 1-800-985-5990, or text TalkWithUs to 66746.
Get a counselor.
"If you have insurance, check your benefits for an employee assistance program or mental health benefits and use them," says Gilliland. "During this strange time, just talk with someone, get some wise counsel (counseling) to solve the issues that will most likely go away when this is over. You may not need therapy, but there are a lot of us that need some good counsel," he says.
As for the difference between therapy and counseling? Think: long-term strategy vs. short-term problem- solving. The idea of running something past your boss or consulting your best friend's opinion before making a decision are both ways of seeking some counsel help figure something out, explains Gilliland. "Right now, we're all trying to solve problems that we didn't know were possible, and it's pretty normal to get some counseling to help."
On the other hand, therapy takes place with a licensed mental health professional and is usually for working through issues that may take longer or more intensive work. For right now, "you probably don't need to talk to someone for the next several months or years, but a conversation with an objective person might help more than you can imagine," says Gilliland. (More: The Best Therapy and Mental Health Apps)
The good news: "Many therapists around the country are offering low-fee or pro-bono virtual sessions for front line workers," says deVos. "Try searching for therapists in your area on psychologytoday.com to get started, and contact therapists directly to see what services they may be offering at this time." Wright is also hosting a free COVID-19 support group, so if you don't have insurance or the ability to find a therapist at this time, this could provide some support.
Mental health app Talkspace is also offering resources, including a 16-day COVID-19 program and free therapist-led Facebook support groups as well as an Instagram COVID-19 channel. If you're a frontline medical worker, you'll receive free therapy from Talkspace to "cope with the anxiety and pressure associated with COVID-19," and even if you're not in the medical field, there's still a significant discount on monthly pricing.
Indirect Tactics for Stress Relief
If you can't make changes to your situation, there are things you can do to manage your stress. This is the 'indirect' method Talley was talking about earlier, and it's all about shifting your self-talk and taking care of yourself.
Embrace the abnormal.
"For front-line workers, you should feel a strange mix of emotions and thoughts—that's normal," says Gilliland. "The front-line workers I treat all talk about this odd mix of gratitude that they can still work and are still making money, worry for family and friends, sadness about the impact on people's lives, and fear about where this will go next," he says. Sound familiar? "Feeling abnormal right now is actually a normal response. That said, you need to make sure it doesn't spill into isolation, anxiety, depression, or all manner of struggles."
Remember: It's hard for everyone.
You're not alone. "It's critical that we all start becoming students of our psychological health and our physical health," says Gilliland. "I'm a clinical psychologist and have been helping people for decades, I love what I get to do for a living—and can't believe how hard this is for me, personally," he admitted.
"Fortunately, I've been reading and talking about the value of being curious for a long time so I'm trying to live like I talk (not easy). Examining how my mind is doing during this time has been really helpful. When you're struggling, try to step back and figure out why: What are you doing? What are you reading or watching? Who are you with or who did you just talk to or text?" "Being curious about how your mind works is something most people already do in other areas of life, but don't think to apply that same skill to themselves," says Gilliland. "If you're lucky enough to love what you do for a living, or if you have children, or if you have a dog, then you know what it means to be curious—You've had the thought 'I wonder if this would work' or 'I wonder why they do that?' or 'Wow, that worked better than I thought' or 'Wow, I've gotta remember to never do that again'...Those are things we say when we are trying to understand something better, or when we are trying to solve a problem—it's how we get to know something really well and get the most enjoyment out of it." (Trainer Jen Widerstrom recommends using curiosity to guide your workouts during COVID-1 too.)
"Feel the intense feelings, like grief—don't ignore them—but also know that this too shall pass," says Whatley. "There will be a day when your life will be back to normal and you won't be under such extreme stress. There is hope that tomorrow will be better."
Focus on your purpose.
"What I found effective when deployed to Iraq, and was a common characteristic of other soldiers, was remembering the bigger picture in which I was involved," says Talley, who worked as the primary psychologist for military and civilian personnel at a base in Iraq in 2008-2009. "That is, remind yourself of the higher purpose of your work. Being driven by a sense of purpose makes it easier to push through exhaustion and maintain a confident attitude. The grocery store workers or baristas, for example, should remember that while so many things have changed due to the coronavirus, he/she is providing a small bit of stability and joy for those they serve." (More here: How to Turn Tension Into Positive Energy)
Try not to overthink.
Easier said than done, eh? "You need to stay anchored in today," to avoid spiraling, says Gilliland. One way to do that is by changing your goals to the more immediate—like today or this week, he says. "Think: 'What do I need to focus on today?' and then worry about the other things tomorrow or next week. Get through this day."
Keeping your focus on the immediate future can also help quell unease about what's to come, says Whatley. "Looking far into the future can exacerbate anxiety so taking things one day at a time will be helpful for anxiety levels," she say.
Find your "medicine."
Pick your new anti-stress "drug" of choice. "Do something today that releases some of the day's stress," says Gilliland. "Regardless of how you feel, force yourself to 'take your medicine' by going for a walk, meditate, call a friend, eat a healthy meal, or read a good novel. All of those are good 'medicine' for dealing with stress." (Example: Shape editors are using self-care practices to stay sane during quarantine.)
"It helps to begin by taking inventory of what coping mechanisms are most effective for you," agrees Talley. Simply brainstorm: What makes you feel good? Some ideas to get you started:
He recommends picking two or three options from your brainstorm list that can be immediately implemented. "Put them to use today," says Talley. "And use that set of coping skills for several days to evaluate which ones work well, and which ones are less effective. Continue in this fashion until you have a set of skills that work best for you in the current situation."
Adjust your self-care routine.
Wright advises you to adapt your usual "me time" to this new normal. "One of the things I've been noticing a lot with clients and in the support group is that somehow, a lot of people are forgetting that while we're in uncharted territory, the things that worked for you before can still be altered to work now," she says. For example, if getting drinks with a friend was how you liked to decompress at the end of the week, it can be done virtually. "It's not ideal, but it can still be done," she says. She suggests asking yourself: "What were my coping mechanisms before I knew the word 'coronavirus?' What did I do? What worked? How did I feel connected? What did I do to relieve stress? How did I manage anxiety? What did I do with fear?" Then adapt whatever that is to your current situation.
Phone a friend.
"There are a lot of books and websites and videos, but what we're most lacking now is real people that can we can talk or interact with," says Gilliland. "If you can, go to a friend's house and sit in your car while they sit on the street or their yard and talk. In person is much better medicine than video, but if video is all you've got, go with video over the phone. If all you have is a phone, it's still better than a text. But a text is better than the noise in your head. If the only voice you hear is the one in your head, that's not good right now."
Talley had similar sentiments. "You may be so preoccupied and exhausted that you withdraw from meaningful engagement with others; this leads to a sense of isolation, even when we spend most of our days around others at work," he said. "It's important to find one or two close friends/family with whom you can regularly connect." Though you may be tempted to vent, watch what you're talking about: "Don't spend more than half that time talking about the coronavirus," he warns. "Instead, talk of good memories and plans for the future." (Here's more therapist guidance on loneliness during coronavirus.)
Talley advises preventing yourself from "dwelling on dark themes." It might sound obvious, but "this intensifies anxiety and sadness," he explains. Again, easier said than done, but if you can "intentionally shift your thinking to other topics," (another great mindfulness technique), you'll see the benefit. "Having worked with abused and neglected children for most of my career, I know how easy it can be to have the tragedies of life crowd into your thoughts," says Talley, "but it's possible to push those thoughts out and focus elsewhere—and that's essential. This can be made easier if you focus during your off-work hours on things of interest."
Let go of fear.
When you're exposed to the world during a pandemic, it can feel extremely frightening. "When it comes to concerns about exposure for those of us that still need to deliver essential services, it's reasonable to be concerned and cautious," says Gilliland. "Stay current on what is recommended, and do those things—social distancing and sanitizing—and then let it go," he says. "Continuing to worry is going to actually weaken your immune system. Once you've done what you can, go on with living and try to stop those thoughts that circle back and create doubt. You don't need that thought so stop it or let it run right past."
Try free mindfulness programs.
"Mindfulness is one of the very best tools for the high levels of anxiety essential workers might be experiencing," says Whatley. "It can be done in 30 minutes, and makes a huge difference in the stress hormones produced in the bodies and keeping those down if at all possible." Apps like Calm and Headspace are offering free resources for managing stress and anxiety, and Oprah and Deepak Chopra created a "Hope in Uncertain Times" 21-day meditation program (also free). (More: The Best Meditation Apps for Beginners)
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