Counseling Today, Online Exclusives

Adjustment disorder in the time of COVID-19

By Laura Sladky April 21, 2020

The inability to leave home; constantly accessing the 24-hour news cycle; fervent hand-washing and disinfecting; increasing anxiety; sleeplessness. These are just a few facets of the world’s new “normal.”

Doubtless, the COVID-19 pandemic has highlighted the necessity of personal hygiene and the fragility of life. But while projections of decreased mental health states have been rolling in aside a slew of seemingly never-ending bad news, the media have generally failed to normalize the struggle for (nearly) everyone to adjust to this new way of life.

As professional counselors, we are braving telehealth, juggling our own mental health needs amid those of our clients, and helping friends and family members adjust to uncertainty and unemployment, all while trying to pepper in some self-care and generally navigate this unprecedented time for ourselves.

To begin, I would like to normalize adjustment disorder for ourselves as professionals. Depending on the timeline of our geographic location’s response to COVID, we may be relatively early in the process of testing, diagnosing and surviving this pandemic. As a result, most of us (understandably!) meet the criteria for emotional and behavioral symptoms in response to an identifiable stressor occurring within three months of the onset (read: the genesis of COVID-19 and adjustment disorder). Furthermore, we are remiss if we do not acknowledge our own social and occupational impairment as a result of this pandemic.

I share this not to wallow in the current reality but to normalize it. I see my friends and colleagues pouring out their every waking moment to address the needs of clients and families alike. Most counselors have seen a rise in their caseloads as the result of COVID-19, many times taking on new clients without having met them in person. Given these circumstances, truly, when are counselors given the space and time to not be whole? To not “have it together”? To not have the “answers”?

On a personal level, I have consumed more coffee, slept more disruptedly, worked out more, and nibbled on more snacks than I care to admit. I have unceremoniously become a school counselor who works from home (with a 12-step commute) and shares “office space” with my spouse. My cat is thrilled by the constant access to affection, but I cannot help but view my life in terms of discontinuity and extremes.

To you, my dear friends, comrades and colleagues, I say that we are in an unprecedented time with no predictable end date. We are responsible for ourselves both personally and professionally. We must take care of ourselves before we can help others (similar to the guidance we give to our clients). We must practice self-care. We must resist the urge to assuage our lack of control with overexposure to the news. We must resist the downward spiral.

A favorite text to which I often return in trying times or times of uncertainty is The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time by Alex Korb. In this accessible text, Korb highlights how seemingly everyday behavior can improve our neurochemistry and continue to spiral us upward toward healthier levels of functioning. Lately, the aspects of this text I have found most salient are:

  • Work it (out): “Movement increases the firing rate of serotonin neurons, which causes them to release more serotonin.”

Fortunately for those of us quarantined at home, there is an endless supply of free streaming content from major workout companies, live workouts from trainers, and general gym enthusiasts who are willing to share their routines online. Whether you are a novice or a natural, make sure to get your body moving daily.

  • Set goals: “We are often under the impression that we are happy when good things happen to us. But in actuality, we are happiest when we decide to pursue a particular goal and then achieve it.”

This may seem counterintuitive in a crisis, but setting goals for ourselves can help increase our personal happiness. Personally? Running a marathon on my balcony won’t spark much joy, but for you, it might.

  • Get outside: “Bright sunlight helps boost the production of serotonin. It also improves the release of melatonin, which helps you get a better night’s sleep. So if you’re stuck inside, make an effort to go outside for at least a few minutes [in the middle of the] day. Go for a walk, listen to some music, or just soak in the sun.”

I cannot stress this enough: Whether it’s in between seeing clients or on your lunch break, if safety allows, please get outside. Nature provides us one of the most natural ways to improve our mood and connect to something larger than ourselves. This also might be an excellent time to assist your local animal shelter by taking some furry friends out too.

  • Maintain a sleep/wake schedule: “[Q]uality sleep is essential for learning and memory. In particular, sleep selectively enhances memory for future-relevant information, which helps you be more effective at achieving your goals. Furthermore, sleep enhances the learning for rewarding activities, which means you’ll have an easier time focusing on the positive.”

The best thing about sleep is that it resets reality and let’s us try again tomorrow; the worst thing about sleep is that it seems harder to attain in times of high stress. One of the best ways to ease your way into REM is to develop and uphold a sleep schedule that creates predictability for your body between night and day. Resist the urge to check your phone, consume caffeine or alcohol, work out, or engage in emotionally stimulating activities before bed. When we sleep at regular intervals, we are able to do our best thinking.

  • Practice gratitude: “Gratitude is powerful because it decreases envy and increases how much you value what you already have, which improves life satisfaction.”

This one hits differently, doesn’t it? We encourage our clients to practice gratitude and mindfulness often, but how much do we really practice it ourselves? I have recently encouraged myself (OK, maybe held an intervention with myself after a COVID-centered news binge) to begin the practice of physically writing down what I am grateful for on a daily basis. In my “regular life,” I often dismiss this practice on account of time and because it is something I “practice in my head.” Now that I am swimming in nothing but time, I am honing my practice.

While I cannot offer my friends and family members a timeline for this pandemic, I can offer them hope. While I cannot change each aspect of the world that is hurting, I can render psychological first aid to my corner of the world, help clients improve their mental health, and continue to grow despite hard times. Finally, while I cannot (and will not) offer my colleagues empty platitudes about how we can “live, laugh, love” our way through this, I will remind each of you that you are not alone. Your struggle is not a weakness, but rather a sign of your humanity. You are allowed to embrace your adjustment disorder to your new normal, and when you do, I’ll be right alongside you.

 

 

 

 

 

 

 

 

 

 

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Laura Sladky is a licensed professional counselor intern and licensed chemical dependency counselor who currently works as a school counselor in Dallas, Texas. Contact her at l.perry09@gmail.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

3 Comments

  1. Stephan Baltimore, MD

    Thanks for the helpful tips! In these difficult times, many of us suffer from a lack of reliable information, give in to false panic, and sometimes spread it. Aware – means armed and ready to fight. Together and with God’s help, we will defeat this epidemic.

    Best regards,
    Stephan

    Reply
  2. J

    I’m thanks for the information but definitely after Covid 19 I either need to volunteer at Red Cross or United way to get some hours toward my drug counseling credentials. I. Also interested in psychology, and social science and work.

    Reply
  3. Linda

    Laura, from one counselor to another, thank you for your candidness. As therapists we don’t always talk about our struggles but we face many of the same issues that our clients do. As they say, “the struggle is real,” especially right now during this Covid-19 crisis! Stay well and remain calm! Linda

    Reply

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