Tag Archives: stress & anxiety

Fear and anxiety at the ballot box

By Laurie Meyers October 22, 2020

Word began to filter out late morning on Tuesday, Oct. 13, the last day that Virginia residents could register to vote in the 2020 general elections. A severed fiber-optic cable had brought down the commonwealth’s voter registration portal. Officials said the cut was an accident caused by roadwork; skeptics on Twitter had “accidentally” trending. Paper registration was still available — if postmarked or dropped off at local voter registration offices.

By midafternoon, after an approximately six-hour outage, the site was back up. A federal judge ordered an extension of the deadline to compensate would-be voters for lost time. Everyone would still be able to register to vote. All’s well that ends well, right?

And yet. To many people, the snafu seemed like just one more alarming plot twist in the tale of an election season — and year — so fraught with unprecedented crises that it would most likely evoke reader skepticism if found within the pages of a novel.

The U.S. national elections are already set to serve as a proxy for the country’s stance on climate change, universal health care, racism, police brutality and (dueling visions of) democracy. The maelstrom of events that is 2020 has brought everything to the forefront in Technicolor. The death of George Floyd under the knee of a police officer. The ensuing protests against police brutality and the continuing demands for an end to racial injustice. The spread of violence by white supremacist groups. Record-breaking wildfires in California and Oregon. An incredibly active — and ongoing — hurricane season. The death of Supreme Court Justice Ruth Bader Ginsburg and the rush to appoint her successor. All of it amidst a pandemic unlike any other seen in the past 102 years.

When most Americans started staying home in March in hopes of bringing down the levels of infection by the novel coronavirus, they most likely didn’t expect that almost everything about COVID-19 would become partisan. The degree of threat posed by the virus. Whether to close businesses and restrict community movement. To mask or not to mask? In some quarters — albeit fairly fringe ones — the very existence of the novel coronavirus became a partisan matter. Now, less than one month before the election, more than 225,000 Americans are dead — a total that includes a disproportionate number of Black, Indigenous and people of color — and voters have spent months wondering about the best way to cast their vote.

In response to voter anxiety about going to the polls in person, most states expanded absentee mail-in voting by allowing anyone to use COVID-19 to justify their request. But the U.S. Postal Service, which had been preparing for the surge, was subject to organizational and equipment changes that made the mail less timely. So, many voters worried: If they requested an absentee ballot, would it arrive in time? The requirements for mail-in ballots vary from state to state, leaving some voters baffled and bemused. A process that is usually fairly straightforward has become yet another tangle to unravel in a year that has been fraught with knots.

“Our ability to cope with uncertainty is maxed out,” says licensed professional counselor (LPC) Keri Riggs, an American Counseling Association member with a private practice in Richardson, Texas. The pandemic has also effectively put most of our previously established timelines in question.

“We can’t make plans,” Riggs, whose areas of specialization include depression and anxiety, says. “The thing about the election is that we have a theoretical deadline.” We’ve always thought we understood when voting for the election was over, but this year, we can’t even have a sense of certainty about when it might end and when an undisputed winner in the presidential election might be declared, she says. Part of this year’s election anxiety is tied to not being able to rely on that usual deadline as an endpoint to at least one source of uncertainty.

With the exception of the contested vote count in Bush vs. Gore in 2000, modern Americans are used to learning who the winner of the presidential election is on election night or the morning after. But because so many people are voting by mail this year and it will take time to process those ballots, the votes amassed on Election Day will not be the final tally.

“If there is a contested election, it could drag on for a very long time,” Riggs points out. “Everything has already been dragging on for a very long time.”

And it’s not just about the endpoint. Many voters see this election as more than a mere partisan contest; to these voters, it is something upon which the future of bigger picture issues such as climate change, immigration and racial justice rests. In fact, a recent Pew Research Center survey found that 83% of registered voters say it really matters who wins the presidency. These results are an increase from the 74% of voters who said the same thing four years ago and the highest share of voters saying this in two decades of Pew Research Center surveys. In keeping with the anxiety surrounding the election, approximately 50% of survey respondents said they expected that voting will be difficult.

The stories that we tell ourselves play a critical role in how we cope with stress, anxiety and the seeming chaos around us, Riggs says. Too often, clients focus on the “what ifs” of a doomsday future that may or may not come to pass, she explains.

“The Islamic theologian, Sufi mystic and poet Rumi once said, ‘The words you speak become the house you live in,’’’ notes Ryan Thomas Neace, an LPC who is the founder and CEO of Change Inc., a St. Louis counseling practice that focuses on healing and personal growth in the face of pain. A similar dictum is contained in the Hebrew Scriptures, “The power of life and death is on the tongue,” he continues. “In other words, what we say matters.”

Neace is not denying that voters are facing weighty issues as they cast their ballots, but he maintains that the narratives we construct are not solving anything. Instead, people get caught in the trap of thinking that constant worry and panic are somehow equal to civic engagement or political purpose.

Clients can break their “doom” loops with present-moment awareness, Riggs says. For example, when fear of the future and visions of disaster threaten to take over, she has clients practice telling themselves that they and everyone they love are safe in that moment.

Riggs also advises clients to consume social media and news in moderation and to take breaks. She urges clients to channel their energy into productive action, either by engaging in the political process with a campaign donation or volunteering at the polls, or via a smaller personal outlet such as journaling or even cleaning the bathroom.

Riggs says it is also essential to exercise self-compassion and what one of her clients calls “grace.”

“We need to give ourselves and each other grace — the benefit of the doubt,” she says. “We’re not all on our A-game.”

Neace reminds clients that it is OK — indeed helpful — to tell themselves resilience-building stories such as, “There’s a lot at stake here, but we’re going to get through this together, no matter what.”

President Donald Trump and former Vice President Joe Biden, pictured in a nationally-televised debate on Sept. 29.

Fear of racial violence

“There is a lot of evidence that there are a number of groups that actively want to hurt and disenfranchise Black Americans,” says Harrison Davis, an LPC in Atlanta who specializes in depression, anxiety, resentment and helping people overcome personal obstacles. These groups have come out of the shadows and appear to feel empowered by what they — and many Black Americans — perceive as support from the police and from forces within certain parts of the government and judicial system, he says.

The clients and community members he’s spoken to say their sense of security has diminished over the past year because they feel betrayed by people they believed were their allies. Some of his Black clients have told Davis that instead of standing by them in the fight for racial justice and an end to police brutality, some of their white neighbors and friends supported these law enforcement actions and were actively critical of the ensuing protests.

On top of this vulnerability, some of his Black clients have expressed concern that President Trump has not committed to a smooth transition of power if he loses, while white supremacists are threatening violence or even war, Davis says.

Some clients have an almost panicky need to prepare for an emergency — as if by doing so they can keep their darker fears from manifesting, he continues. This sense of catastrophe is fueled not just by the election, but by the many deaths the coronavirus has brought to the Black community.

Although the threat is real, his clients’ response — living in a constant state of anxiety and panic — is neither healthy nor sustainable, Davis says.

Like Riggs and Neace, when working with clients struggling with election anxiety, Davis zeroes on how much news and social media they are consuming. Not only are clients being bombarded with a sense of overall catastrophe—they are engaging in conversations that are often vitriolic and damaging.

“When I grew up, you would just watch the polictical coverage on the TV networks,” he says. Now, everyone can watch a developing story or scandal in real time. So Davis asks clients to notice how they are responding as they track this torrent of information. “Is it causing you to tense up?” he asks. “Lose sleep?” Clients also report irritability and constant worry–not just about the election, but everything. Right now, the constant urgency and concern of news and social media has such a marked effect on clients, that Davis has moved away from recommending that they balance their use. Instead, he has them do a complete detox.

“Channel that energy into positives instead of arguing with people,” he urges clients. Rather than trying to convince others of their viewpoint, they could be helping people register to vote or get to the polls on Election Day. Davis also encourages clients to find hobbies and outlets that have nothing to do with politics or current events.

On a deeper level, he finds that clients are struggling to accept the world as it is. They may have believed that we had grown as a nation and society over the past decade but now may see that things haven’t changed significantly. One way to cope with that reality and find greater peace is to identify ways to help the community, Davis says.

In his own life, Davis’ father, who was an activist in the civil rights era, told him and his siblings that they might have thought things had changed, but they really hadn’t. Black Americans are still engaged in the struggle for racial equality that has been denied them for generations.

That doesn’t mean that clients need to live in fear, Davis says. Living like that only gives power to those who want Black people to be afraid. He urges clients to find a space where they feel like they belong and to be thoughtful about who they invite into their inner world. They may not yet be able to change the world, but they can control elements of their world by removing unsupportive friends or by leaving environments which make them feel triggered or unsafe—such as social groups or toxic work environments.

A number of his clients are very spiritual, Davis adds. They find strength through the Bible, which holds many stories of people who experienced tragedy and injustice but prevailed by relying on faith and their community.

Power and connection amid chaos

Although many of us view the cacophony of the election cycle as something to endure while keeping our sanity in check, ACA member Laura Brackett is encouraging clients to find their personal power in the chaos.

The year 2020 and the years leading up to it have been traumatic in myriad ways, and exploring personal power is a constant component of trauma work, she says. “The beauty of it is that personal power takes countless forms,” says Brackett, the director of community engagement at Change, Inc., in St. Louis. “For some clients, this has meant outward action in the form of voting, protesting and becoming active in the community. For others, it has meant embracing their own emotional reactions and how that is influencing their behavior and empathy toward self and others.”

Often the process involves a combination of both external and internal work, she says. Brackett’s goal is to encourage clients to embrace their personal power without losing sight of how its expression affects others.

“If there is one thing this year has shown us, it’s that we don’t live in a vacuum,” she says. “Our words and actions have real impact on others. I want to help my clients see this interconnectedness and learn how they can best live within it in a way that is compassionate as well as empowered.”

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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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.

Overcoming free-time boredom during COVID-19: Combining a home-based optimal leisure lifestyle with behavioral activation

By Rodney B. Dieser July 7, 2020

As a licensed mental health counselor, I am hearing many of my clients tell me that they are ready to go stir-crazy because of an abundance of free time combined with greater stress during the COVID-19 pandemic. Although many states are reopening their leisure industries, many of my clients feel the safer route — and more thoughtful route toward health care workers and preventing the spread of COVID-19 — is to follow epidemiological and scientific advice by staying home.

Some of my clients are experiencing depression because they have lost their jobs, spend most of their days bored and ruminate on fear-based thoughts. The purpose of this short article is to suggest two interrelated ideas about how to create a psychological breather of positive emotion during your day that can also distract you from worry and stress.

First, develop a home-based optimal leisure lifestyle (OLL), which consists of one serious leisure activity, supplemented by casual and project-based leisure. Serious leisure is centered on acquiring and expressing special skills, knowledge and experience that take months, and sometimes years, to develop. Often, in everyday life, this is known as developing a hobby and is based on mastery gained through hard work and much effort.

My youngest son has taken the extra free time he now has and developed a serious skill-based hobby: He has purchased a watch repair kit and is tinkering away at repairing old watches. I am learning how to play the harmonica to Bruce Springsteen songs.

The Wikipedia page on hobbies identifies hundreds of skill-based hobbies to pursue, many of which are home-based. The internet can help with education and skill development. Often, there are online communities full of people who will welcome and mentor you toward your new serious leisure pursuits.

Casual leisure involves short-lived activities that require little or no specialized training. This type of leisure is based in hedonistic pleasure that requires little effort. For instance, my wife and I are currently watching comedies and documentaries on Netflix and enjoying it.

Project-based leisure is a short-term, one-shot or occasional creative undertaking. My wife is serving her community through her sewing projects and is serving a local nonprofit agency. When our kids were young, they picked a project of leisure learning each week (often it was insects), and we all had fun as we learned together. Just like with serious leisure, you can use the internet to find projects in your community. Often, nonprofit organizations are more than ready to link your personal strengths, passions and skills to a project they are working on.

Developing an OLL will provide transient moments in your day for positive emotion — a psychological breather from going stir-crazy and experiencing brain-numbing boredom. To learn more about OLL and the three forms of leisure I have just described, visit the Serious Leisure Perspective website. There you can learn about Robert Stebbins, who pioneered the academic work over a span of 40-plus years that led to development of the serious leisure perspective and the OLL framework. In addition, this website lists hundreds of studies that provide evidence of how individuals’ positive emotion is increased when involved in serious, casual and project-based leisure.

Research demonstrates that people can remedy stress if they laugh more (casual leisure), find a hobby (serious leisure) and engage in meaning-making activities such as volunteering in their communities or toward social causes (project-based leisure).

Behavioral activation involves having people/clients become more active and involved in life by scheduling activities with the potential to improve their mood. Counselors can help those clients who have an abundance of free time on their hands, whether due to unemployment or wanting to continue self-quarantining, by working with them to create a daily schedule based on developing an OLL. This involves using free time to engage in one serious leisure activity (e.g., starting a new hobby such as digital art, nail painting, cartoon drawing or bird watching), one casual leisure activity (e.g., reading, exploring new musical genres, watching comedies, hanging out with friends virtually) and one project-based leisure activity (e.g., sewing high-grade face masks for health care workers, volunteering at the Humane Society or with a political party, helping a nonprofit with fundraising efforts, creating a family history book by interviewing uncles, aunts and cousins) every day.

Behavioral activation is an evidence-based treatment for depression that has been found to be very effective. In everyday language, it is simply getting people more active and involved in life by scheduling activities that can improve mood. Cultivating an OLL and getting involved in serious, casual and project-based leisure when homebound is one way to create a psychological breather of positive emotion during your day that can also distract you from worry and stress.

 

Self-disclosure of my OLL

The following is a self-disclosure of my OLL during a three-month-plus self-imposed lockdown at home during the COVID-19 pandemic. It is provided so that readers can gain a gestalt of how an OLL can be inserted into everyday life that now may feature much more free time.

Serious leisure: Developing and expressing special skills, knowledge and experience; acquires much effort and is linked to enjoyment.

My daily activities

  • Learning to play harmonica to Bruce Springsteen songs
  • Studying creative writing and attempting to write short stories

Casual leisure: Low skills set focused on distracting; linked to pleasure.

My daily activities

  • Watching more documentaries and comedies on Netflix
  • Reconnecting with “forgotten musicians” of my past (what I used to listen to as a young man). Includes learning about and appreciating musical narrations and sonic arrangements of different genres of music. Examples: Chris de Burgh, James Taylor, Al Stewart, April Wine, Bachman-Turner Overdrive, Thin Lizzy, Supertramp, Triumph and Neil Young. I extended this to the music that my father and mother (both deceased) liked. This included Hank Williams, Waylon Jennings, Stompin’ Tom Connors, Hank Snow and Freddy Fender.
  • Reading the “classics” in literature, such as Mary Shelley’s Frankenstein, Cervantes’ Don Quixote and Arthur Miller’s Death of a Salesman

Project leisure: Short-term activity focused on completing a project

My daily activities

  • Cleaning out parts of the house that have not been cleaned out for years and donating much to Goodwill Industries
  • Gardening
  • Weekly project of exercise for health: Taking a 5- to 15-mile bike ride three days a week; running sprints at an outdoor track one day a week; working out on a Bowflex twice a week

Note: I used my stimulus check to purchase a Bowflex online and set it up in the garage. That piece of exercise equipment, gardening plants/seeds and used books (also bought online) are the only leisure resources I have purchased during the pandemic. Many of my leisure activities, such as playing the harmonica, engaging in creative writing and developing my appreciation of past musicians, have been learned or enhanced through resources on the internet.

 

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Related reading, from the Counseling Today archives (co-written by Rodney B. Dieser): “The serious leisure perspective in mental health counseling

A USA Today opinion piece written by Dieser: “Coronavirus pause: People need people, but it’s risky to resume social activities so soon

 

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Rodney B. Dieser is the author of five textbooks and more than 100 articles on the topic of leisure. His writing about leisure has appeared in USA Today and the Mayo Clinic Proceedings journal. He is a professor of recreation, tourism and nonprofit leadership and an affiliate faculty member in professional counseling at the University of Northern Iowa. He works 10 hours a week as a licensed mental health counselor for Covenant Family Solutions in Cedar Falls, Iowa. Contact him at rodney.dieser@uni.edu.

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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.

For such a time as this: A plan of action for general anxiety and depression

By Esther Scott June 8, 2020

[Editor’s note: This is the first of four articles in a series on action plans for different areas of life during the COVID-19 pandemic. The next three articles will be posted on subsequent Mondays in June.]

With the coronavirus pandemic, everything has changed, from the hygiene habits of washing our hands more frequently to the physical distancing that we must now maintain. For many, the financial stress and rapid changes brought about by the pandemic can be just as scary as the virus itself. Business closures, income reduction and the uncertainty of what might be ahead once we return to “normalcy” has increased stress levels for all of us, and many people are even experiencing symptoms of depression. Understanding what is happening in our brains and having a plan of action can help us manage these new challenges in the different areas of our lives.

Through this four-part series, we will look at a plan of action that can help the rational brain feel in control again and view the new challenges we now face as opportunities to develop our resilience.

Let’s start with a plan of action to help reduce anxiety and prevent depression symptoms.

1) Write down specific worries.

The first step to solving a problem is understanding what is happening. Why are we so stressed out? Perceived lack of control.

Uncertainty produces hypervigilance in the brain. Our brains are on high alert, increasing our levels of stress. Stress is an automatic defense mechanism that prepares us to face a threat, whether hypothetical or real. It is regulated by the hypothalamus and pituitary gland (in the brain) and the adrenal gland (above the kidneys).

In the face of danger (uncertainty), the hypothalamus activates the alert system (increased heart rate, respiratory rate and muscle tone) and produces cortisol — the stress hormone — secreted by the adrenals, which maintains this physiological alert as long as necessary. If it is perpetuated too long, stress can become a health problem that leads to increased risk of anxiety, depression, substance use and other maladaptive behaviors.

The brain likes organization and predictability. That is why we organize information in categories known as bias or stereotypical organization. Therefore, the first step to overcoming anxiety and depression is making a list of the worries you have about how the coronavirus pandemic has disrupted your life. Examine your worries, aiming to be realistic in your assessment of the actual concern and your ability to cope. Try not to catastrophize; instead, focus on what you can do. Your life is going to be different for a while, but identifying what worries you have and focusing on what you can control will make the difference.

2) Make a list of possible solutions.

Think of all possible options. This is the all-familiar “brainstorming” technique. Include whatever possibilities come to mind that could help you get by, even if it is not your ideal option. The goal is to focus on concrete things that you can problem-solve or change. A solution-focused approach will help you focus on your strengths instead of your weaknesses.

Think about how you have been able to cope with difficulties in the past by asking yourself questions such as “How have I managed to carry on?” or “How have I managed to prevent things from becoming worse?” After you have evaluated your options, accept your new reality and develop a plan.

Remember, anxiety comes from not knowing what will happen, and depression comes from believing there is nothing we can do to change it. Having a plan will move you from paralyzing anxiety to action. Practicing physical distancing, getting enough sleep and doing other activities to support your immune system are examples of positive actions that you can take immediately. Put your attention on your strengths and abilities, and imagine yourself coping and adapting.

3) Know your emotional triggers.

Pinpoint what your emotional triggers are and how you react to them. It is natural to feel stressed about what may happen if our income does not cover our obligations, or if someone we love gets sick, or if we must quarantine longer. In fact, feeling down from time to time is a normal reaction to life’s stressors. But when hopelessness and despair enter the picture or take hold and just will not go away, then we need to pay closer attention because it may be a sign of depression.

Depression is more than just sadness in response to struggles or setbacks. Depression changes your perception and the way you feel, bringing you feelings of emptiness and doom. It impacts your ability to sleep, work, eat, and enjoy your life.

It is also important to remember that the feelings of hopelessness or helplessness we may experience are symptoms of depression, not the reality of the situation. There is hope. There is a solution. Even if we cannot see it right now.

4) Conduct a strength inventory.

Resilience is the ability to withstand, recover and bounce back in the midst of stress, chaos and ever-changing situations. It is the capacity to recover quickly from difficulties, the courage to come back.

Conducting a strength inventory can help you feel stronger and more resourceful. Identify what negative thought you struggle with. Replace or reframe how you are viewing your challenges. The situation you are facing is hard, but is there something you can learn from it or some other silver lining? If you have been through difficult situations in the past — and most of us have been through those at some point in our lives — identify what got you through them, and use it to your advantage.

5) Practice kindness.

Studies have shown that people who consistently help others experience less depression, greater calm and fewer pains. Kind people create joy and satisfaction through helping others. People who can give and accept support in a tough situation tend to feel less depressed.

Kindness toward others can translate into kindness to you. Seek support from your family and friends or a professional mental health provider if you need it. It can help you deal better with hard times.

 

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Esther Scott, LPC

Esther Scott is a licensed professional counselor in Arlington, Texas. She is a solution-focused therapist. Her specialties include grief, depression, teaching coping skills and couples counseling. Contact her through her website at positiveactionsinternational.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.

Coping with the (ongoing) stress of COVID-19

By Lindsey Phillips May 21, 2020

The COVID-19 pandemic is affecting everyone differently. Some are coping with the loss of a job. Some are risking their lives caring for those who are sick. And others find themselves deeply contemplating existential questions of mortality and the meaning of life.

The pandemic could also be compounding underlying mental health issues for some clients, notes Robert Haynes, a member of the American Counseling Association. For instance, clients who were already battling depression or obsessive-compulsive disorder may now be dealing with a significant amount of anxiety and stress on top of that related to COVID-19. Those confronted with social injustices because of their race, ethnicity, sexual orientation or disability may also be more affected, he adds.

“People are going to be all over the spectrum as far as how they’re doing, what they’re doing and how it’s affecting them,” Haynes says. “Don’t assume anything, even if you’ve been working with a client for some time. This [pandemic] may be a huge setback for them.”

Many people have not dealt with this level of stress before, and some are having newfound anxieties, which can be jarring, says Shainna Ali, a licensed mental health counselor (LMHC) in Orlando, Florida. The pandemic may also uncover an unaddressed mental health concern that could benefit from counseling, she adds.

People’s ability to cope with stressful events has been and will continue to be tested by the COVID-19 pandemic. During this time when mental health is moving to the forefront of the public’s consciousness, professional clinical counselors are in a prime position to help clients cope with uncertainty and loss, build resilience, adjust their coping strategies and self-care routines, and identify their individual and community strengths. And counselors, of course, can best help their clients by remembering to also take care of themselves during this challenging time.

Coping with uncertainty

Uncertainty surrounds this global crisis. No one is quite sure what to expect or what the next day will hold. The uncertainty, fear and unknown with COVID-19 creates the perfect formula for anxiety, says Haynes, co-author, with Michelle Muratori, of the recently published ACA book Coping Skills for a Stressful World: A Workbook for Counselors and Clients.

A common response to this uncertainty is trying to seek control, Ali says. Throughout this pandemic, Ali, owner of Integrated Counseling Solutions, has constantly been reminding clients, “Manage what you can. Release what you can’t.” Fixating on what you can’t control leads only to rumination, but focusing on what you can manage is one way of coping with a stressful situation, she says.

For example, an adult client might worry about their parents and how well they are isolating during the pandemic. The client may want to visit their parents but also fear making them sick. Ali would advise this client to find another way to check on them (one that aligns with the Centers for Disease Control and Prevention guidelines) such as calling or doing a video chat.

“Focusing on what we can control might help us to feel more grounded,” says Muratori, a senior counselor at the Center for Talented Youth and a faculty associate in the school of education at Johns Hopkins University in Baltimore. Counselors can help clients set small, achievable goals and take time to reflect on what they have accomplished each day. For example, clients can ask themselves, “What is one thing I can do today to move toward accomplishing my goals?”

People can also control the type and amount of information they consume. As Stephanie Dailey, an assistant professor of counseling at George Mason University, points out, overexposure to media tends to increase people’s levels of distress, fear and anxiety during disaster situations, regardless of whether they were involved in the crisis.

“Accurate and timely information is important,” says Dailey, a licensed professional counselor in Virginia. “But if a client is constantly on social media and is accessing sensationalized or erroneous information, it’s going to undermine their mental health.” She advises counselors to inquire about how much access (or overaccess) to information clients might have.

Coping with loss

Not all loss is obvious. A couple mourn the cancellation of their vacation plans. A high school senior is upset because he won’t be able to experience graduation with his friends. A young child misses her first Broadway show. Neighbors are no longer able to relax and celebrate the end of a workweek by having dinner with one another in their homes on Friday night. Baseball fans lament the start of the season being postponed.

Loss is upsetting because it highlights what we no longer have or what we could have had, explains Ali, a member of ACA. She helps clients more fully understand what they are truly mourning and validates their appropriate emotional responses to the loss, such as sadness, anger and frustration. But she also helps clients see possibilities for experiencing gratitude even in the midst of loss.

For example, if a client is upset about not being able to get married when originally planned, Ali first reassures the client that feeling that way is OK. She may then ask the client to think about something for which they are grateful. The client may respond, “I still have my partner.”

Ali, author of The Self-Love Workbook and the blog A Modern Mentality (hosted by Psychology Today), finds gratitude a particularly valuable coping skill currently because “right now, it’s really easy to get distracted by the negative.” Encouraging clients to be grateful and to look for the positive isn’t meant to undermine or minimize negative emotions, she asserts. Rather, it deters clients from ruminating on the negative. 

Ali might also ask the client upset about their postponed wedding, “How can you still honor what you have?” This question would help the client refocus their energy on what can be managed (such as revising their wedding plans or planning an at-home date night) rather than wrestling with what is beyond their control, she explains.

Building resilience

Haynes and Muratori say that resilience is one of the key components of being able to cope with stressful events. Some people incorrectly assume that resilience is innate, but it can be learned, asserts Haynes, a clinical psychologist and producer of psychology video programs for Borderline Productions. “Resilience is more what you do than it is who you are,” he explains. And like any other skill, it grows stronger with practice.

Counseling techniques that help clients connect with others, adjust their thinking and beliefs, become more optimistic and flexible, practice self-care, attend to the spiritual dimension of life or promote self-compassion can bolster resilience, Haynes says.

In Coping Skills for a Stressful World, Haynes and Muratori share an exercise for strengthening client resilience. It involves clients tracking their reactions to stressful events for a period of two weeks and asking themselves some questions: What did they feel and think about the situation? What actions did they take to resolve the crisis? How effective were those actions? What did they learn? The exercise encourages clients to consider their own strengths and the ways they already cope with stressors. Clients come to the realization that they can use these same tools that they already possess when facing future crises, Haynes and Muratori explain. (The use of out-of-session exercises and activities such as this one is a major focus of their workbook.)

Ali works with clients to create their own toolkits of general self-care and coping skills that may be helpful during difficult times. It is important that people establish a general self-care practice rather than waiting to focus on coping skills during a crisis, Ali notes. She says that everyone’s coping skills during a stressful event will look different, but she advises clients (and counselors) to break into their “emergency coping kit” and find activities that help them manage stress.

Dailey, an ACA member who specializes in disaster mental health, finds ways to tap into her clients’ strengths to promote resilience and coping. If a client enjoys art, for example, Dailey may recommend painting or drawing as a possible coping tool. If a client is a natural helper, Dailey might have them brainstorm ways they could support others during the COVID-19 crisis, such as making masks or volunteering virtually. Spiritual or religious practices also provide an enormous amount of strength for some clients, she adds.

“Communities and individuals are innately resilient,” says Dailey, co-author of the 2014 article “Shelter-in-place and mental health: An analogue study of well-being and distress” for the Journal of Emergency Management. “Everyone has strengths, and this crisis can be an opportunity to find those strengths.”

As Muratori, an ACA member, points out, learning coping skills and resilience is not just something that will help clients get through the current COVID-19 crisis. It will also prepare them for future crises, large or small.

Adjusting coping and self-care strategies

“One of the skills in being resilient is also having some flexibility,” Muratori says. That is particularly relevant now because the COVID-19 pandemic has forced people to constantly shift and reshift their schedules while also creating new routines.

It is natural for people going through challenging times to engage in rigid thinking such as “I can’t stand this,” Muratori says. She advises counselors to remind clients that they are standing this; they are adapting and adjusting.

Many of Ali’s clients thrive with routine, but those routines have repeatedly been disrupted by physical distancing, quarantine and gradual reentry. Some of her clients were used to having a clear distinction between their home lives and work lives, so being forced to work from home has created new challenges for them around establishing and maintaining boundaries.

Ali works with these clients to recognize their personal boundaries and to establish some sort of new routine for themselves. She encourages clients to use a semistructured routine, in which they set their intentions for the day but also remain flexible to accommodate new circumstances as they arise.

Dailey also advises clients to maintain a regular routine as much as possible. She encourages them to focus on the basics, such as waking up, showering, eating and going to bed at the usual times.

Ali says that social connectivity remains an important coping strategy during the COVID-19 pandemic. “Social distancing and social isolation are not the same,” she emphasizes. Ali advises clients to think of creative ways to continue meeting their social needs. For example, if clients previously coped with a stressful workweek by going out to dinner with friends, perhaps they could consider hosting a virtual dinner party.

Likewise, clients may need to adjust their self-care regimens right now. After first defining self-care, Ali says, counselors can help clients brainstorm self-care techniques that have worked for them in the past and then look at how they can adapt those strategies (if necessary) to work in an environment of physical distancing or gradual reentry. For example, if a client previously coped with stress by going to the gym, how could they still fulfill that need while gyms are closed? Could they take a remote fitness class or go for a run instead? (For more on this topic, read Ali’s ACA blog post “Self-care & social distancing: Helping clients adjust during COVID-19” at tinyurl.com/ACAMemberBlogAli.)

“Any tools that will support relaxation are really critical at this time,” Dailey emphasizes. She finds mindfulness an effective technique for helping clients regulate their emotions because it encourages them to pause for a moment and let their bodies catch up with their brains. In turn, emotion regulation helps clients successfully manage their symptoms, maintain focus for day-to-day problem-solving and attend to physical needs such as eating, sleeping and taking the proper medications, Dailey says. Clients can journal, go for walks, spend time outside, exercise, meditate, do breathing exercises or do grounding exercises to manage their anxiety, she adds.

Counselors can also play a role in making self-care fun. To help boost self-care, Ali challenges clients (and herself) to combine various coping strategies. For example, a client could livestream a fitness class with a friend, or a family could do a gratitude reflection together at dinner.

Coping as a community

Muratori says that the COVID-19 pandemic exemplifies communal shared trauma — a traumatic event that affects an entire community directly, indirectly or vicariously. The good news is that community members are finding ways to support one another.

In Dailey’s community, neighbors stood on their porches one night and clapped into empty space to show their support for health care workers. They also placed stuffed bears with hearts on the chests in their windows to show their love for one another. Members of Haynes’ neighborhood also placed stuffed bears in their windows so children could go on a “bear hunt.”

Counselors can encourage clients to look around their communities and notice these resilient acts, Dailey says.

Ali specializes in individual mental health counseling, so her clients typically come to her to work on their own individual concerns. But since the COVID-19 crisis began, Ali has noticed that her clients are also showing more concern for the mental health of those around them, including family members, friends and neighbors.

Ali’s clients are also passing along their coping skills to others. One client noticed a roommate was anxious and suggested that they color together because coloring had previously helped the client manage stress.

Some of Ali’s other clients have been modeling the coping and communication skills they learned in counseling for their children at home. This includes using “I” statements, taking breaks and practicing self-care.

Ali also found a way to use her expertise to serve her community. Ali noticed a pattern of heightened stress among people in her life (herself included) because of the pandemic, but as a counselor, she also knew that this reaction was normal. She realized, however, that others in her community might not understand the emotions they were experiencing or know how to cope with the increased stress.

“This [pandemic] is not just exacerbating mental health concerns for people who are in counseling. This is also highlighting mental health problems for people who are not in counseling,” she says.

Of course, Ali couldn’t provide counseling to her entire community, so she and two other LMHCs, Candice Conroy and Sanya Matani, started offering a free virtual lesson to help people better understand and cope with the stress they might be experiencing because of COVID-19. The three LMHCs made it clear that the lesson wasn’t a substitute for counseling and provided resources for people to seek professional help.

Coping as a counselor

Haynes and Muratori express concerns about the stress levels counselors might experience throughout the pandemic and even after the initial threat subsides. “They need to take care of themselves better than they ever have before,” insists Haynes, author of Take Control of Life’s Crises Today! A Practical Guide.

Counselors need to apply the same coping strategies and tools to themselves that they give to clients, Haynes says. These include getting proper sleep, exercising, connecting with others, taking breaks, processing their emotions, turning off the news and getting outside.

Ali acknowledges that she has been feeling the stress of handling her own anxieties and concerns about the pandemic while also maintaining her current caseload. At first, the pandemic was the main topic for all of her clients, but this is evolving, she says. Now that most of her clients have adjusted to a new routine, they are again discussing their primary concerns that originally brought them to counseling. Still, Ali thinks it is important to do a quick check-in with her clients about how they are coping with the ongoing stress of COVID-19.

Self-care becomes even more important for counselors when sessions all deal with the same topic, giving clinicians few breaks to escape from it, Ali says. She has been coping with her stress by journaling, doing yoga, dancing, walking her dog, practicing mindfulness, reading, doing video chats and exercising.

Counselors need to remember that they are affected (whether directly or indirectly) by this pandemic too. Before the pandemic, most of Ali’s clients used traditional counseling, but with physical distancing rules in place, they now mainly use telebehavioral health. Ali acknowledges that staring at a screen for long periods of time has been taxing for her.

Taking breaks from the screen and using a semistructured schedule for both her personal and work schedules have been helpful coping strategies for her. When she feels particularly overwhelmed, she also practices a “digital detox,” putting her digital devices away for a day and focusing on her self-care to find her equilibrium. If a complete digital detox seems intimidating to counselors or clients, she encourages them to create small, manageable digital boundaries such as stepping away from their devices for a few hours or setting a timer to minimize their use of electronics.

For counselors in private practice, isolation can be another pronounced risk during the pandemic, Haynes points out. He highly recommends that counselors seek out colleagues for consultation, support and supervision during this stressful time.

Much like counselors advise their clients to look for individual and community strengths, clinicians can listen for examples of clients’ resilience, Dailey says. This may result in vicarious resilience, a concept developed by Pilar Hernandez-Wolfe, David Gangsei and David Engstrom in which therapists experience their own personal growth by witnessing and recognizing the growth of their clients.

Adjusting to a new normal

Even after the number of COVID-19 cases subsides, life won’t just go back to normal. The reentry process is going to upset people’s routines all over again, Haynes predicts. For that reason, he and Muratori advise that counselors prepare to take a more directive stance with some clients and focus on their life skills during the transition back toward a “new normal.”

Counselors may need to provide clients with guidelines, instructions or demonstrations, or they may have to model or teach clients new skills, Haynes and Muratori say. For instance, some clients who have been laid off may need help filing for unemployment, conducting a job search or applying for new jobs. Others may need guidance on how to safely reenter their workplace or physically interact with family, friends and community members for the first time in months.

Counselors will also have to help clients manage expectations, Dailey says. For example, many clients may now be dreaming of returning to work, but when that finally happens, they could very well find themselves stuck in meetings again and wondering what their kids are doing at home. Likewise, parents feeling impatient about their children returning to school may have forgotten what the old morning struggle was like to get everyone off to school and work on time.

Adjusting back to something resembling the previously normal routine as stay-at-home orders are lifted will take time. Dailey thinks the adjustment will come in phases. People returning to work will be one round of adjustments. Then there will be another adjustment period as schools attempt to reopen in the fall. 

It is also important to note that clients won’t just be going back to “work as normal,” Dailey says. Even if they return to the same job and the same physical work location, things promise to be different in the wake of COVID-19. These differences may cause some clients to feel relief, whereas others will experience a new round of anxiety and fear.

Dailey compares these adjustment phases to a flipbook. Everybody has their own unique story with the pandemic, and every page of the flipbook represents a new experience, a new adjustment. Counselors can help clients process and cope with these adjustments by “flipping” through their stories, stopping at certain points, and assessing how the clients reacted and coped with that part of their story. The tools they used to cope — making art, meditating, sewing, exercising — are ones they can use again in the future as they adjust to a new phase, Dailey says.

The COVID-19 pandemic possesses the potential to change the counseling field and how professional counselors work with clients now and in the future, Haynes says. Since the turn of the century, it’s true that the United States has experienced major crises such as 9/11, large-scale natural disasters and the Great Recession, but, as Haynes points out, there hadn’t been a crisis on a global scale like a world war until COVID-19. This experience could shift the focus more toward prevention and preparation (both for individuals and for systems on a national level) for future crises, he says.

Adjusting to this new normal doesn’t have to be all negative. Once we reenter society after the threat of COVID-19 subsides, we will be able to celebrate regaining some of our old coping strategies as well as the acquisition or discovery of new strengths along the way.

Counselors are in position to help clients gain greater perspective and self-awareness while coping with the stress and loss that the pandemic has introduced, Ali says. To aid in that process, she sometimes asks clients who have already adjusted and are successfully coping with this stress and loss, “What are you learning during this time?”

In asking that question, Ali has found that several of her clients now understand how the coping skills they previously learned in counseling have helped them handle this stressful moment in history.

How we cope with the stressors of COVID-19 can tell us a lot about ourselves, Ali says. While it may be unpleasant, we can use these times as learned lessons that will help us continue to adapt and manage stressors in the future.

But for now, just take a deep breath.

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.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.

How do counselors support clients during the coronavirus pandemic?

By Yoon Suh Moh and Katharine Sperandio April 9, 2020

It is impossible to deny the extraordinary societal impact of the outbreak of the novel coronavirus, severe acute respiratory syndrome 2 (SARS-Cov-2). All of us are bombarded daily with messages and information related to the pandemic. As this virus garners heightened attention from the media, individuals may have difficulty delineating between misinformation and accurate information about the illness.

We are not writing this article to perpetuate increased fear among the counseling community regarding the spread of the novel coronavirus, but rather to:

  • Provide resources helpful for staying informed about the impact of COVID-19, which is a disease caused by SARS-Cov-2
  • Inform counseling professionals about how they can support clients affected by the virus and its societal impact

What does this outbreak mean to our clients?

It is crucial to understand the social ramifications perpetuated by this outbreak so that we can promote optimal care for the clients we serve.

Individuals who identify as East Asian or appear to be of East Asian descent may be susceptible to experiencing elevated levels of stress related to racism and xenophobia generated by misinformation about the virus. The negative impact on affected individuals ranges from financial and emotional to physical. For example, CNN reported that individuals who appear East Asian have fallen victim to verbal and physical attacks triggered by misguided fears of the infection. Additionally, individuals may be quarantined as a result of suspicions that they have been infected, leading to further stress. Clients who are directly impacted by this wave of racism and xenophobia may experience a vulnerability and lack of safety, perpetuating stress- and trauma-related symptoms.

Although the economic impact of this pandemic has since spread throughout the restaurant industry (and other industries), many Chinese establishments, such as restaurants, were among the first to experience a major decline of business even before community mitigation plans were announced. The financial hit on these establishments has been catastrophic for owners and their families. We must be ready to employ the proper interventions and responses to promote clients’ perseverance, resilience and well-being throughout the tensions that plague our society.

There is no doubt that the novel coronavirus poses a major threat to the entire U.S. economy and the health of our nation as a whole, but concerns are more pronounced among certain populations. For instance, the Pew Research Center reported that approximately 65% of Latinx adults say the coronavirus outbreak is a major threat to the health of the U.S. population as a whole, compared with about 47% of the general public. The same source reports that the outbreak has the potential to hit many of the nation’s nearly 60 million Latinos/as particularly hard. This is in part because a significant percentage of these individuals work in leisure, hospitality and other service industries and have less likelihood of having health insurance.

Of course, many individuals in the general public are fearful (or may become fearful) of contracting the virus. The anticipation of the potential long-term effects of the virus can trigger individual fear and stress-based responses. In addition, an array of compounding or simultaneous stressors can negatively affect individuals’ stress response systems in a chronic manner, meaning that there is no break to return to a healthy physiological state and functioning. These compounding or simultaneous stressors may include:

  • Uncertainty about what might happen next to one’s life and health
  • The exponential curve of virus-confirmed cases and deaths in the nation as reported in the media
  • No access or difficulty in accessing health benefits
  • Financial constraints due to a recent job loss caused by the pandemic

Stress-based responses may be worsened among those who lack resources such as social support.

This brings us to the reality that many states and communities have executed states of emergency, prompting individuals and families to enter into social isolation. Considering the potential negative psychological effects that may be manifested by social isolation, mental health professionals must be ready to intervene and provide support.

Social distancing, taken as a preventive measure to slow the spread of the disease, largely compromises individuals’ daily functioning. People are experiencing disruptions not just in the areas of employment and schooling but also in accessing emotional support from others or even in having regular interactions with others. Individuals who may not have access to technology to virtually stay connected with significant others for emotional support are especially susceptible to social isolation. Social isolation is a risk factor for a number of health-related concerns, including depression.

As the virus continues to ravage communities around the world, it is also important to note that people everywhere are experiencing the loss of their prepandemic normalcy. As a result, many individuals are having feelings associated with grief. Although this pandemic is hypothesized to be temporary, the impact on lives may be much longer term.

Consider that many nonessential businesses have closed their doors, leaving employees without work or a sustainable income to support their families. Most individuals at this point are restrained from engaging in social endeavors such as participating in team sports, attending classes, visiting museums or engaging in other fun-related activities. Most people can no longer meet up with friends or family for regular social events and may feel a sense of loss as their former routines vanish. Social distancing has also called for the cancellation or postponement of important events such as college and high school graduations, preventing new graduates from sharing in a momentous celebration with one another.

Furthermore, the mortality rate associated with COVID-19 continues to rise. People around the world are experiencing the deaths of loved ones and fellow community members. Additionally, family members are assuming the role of caretakers as their vulnerable loved ones fall ill to the virus. As the responsibility to care for loved ones increases, individuals may have to forfeit or abstain from other regular tasks and duties.

Recommendations for counselors

Anxiety management: It is understandable that clients may feel anxious about this situation. Counselors should normalize and validate clients’ fears. Counselors should also talk to clients about factors that they can and cannot control. Some factors that clients can control include getting regular exercise, making plans to meet with friends and loved ones over virtual platforms, determining their exposure to news sources, practicing good personal hygiene, and limiting the time spent in places such as grocery stores where there may be larger crowds.

If clients appear stressed and anxious about the situation, it is a good idea for counselors to help them gain the facts so that clients can accurately determine their risks in collaboration with their health care providers and take reasonable precautions. Additionally, it is ideal to assist clients in developing and enhancing adaptive coping skills, such as grounding techniques or breathing exercises, so that they can effectively manage their anxiety.

Information giving: It is important that counselors stay aware of the latest information available on the COVID-19 outbreak through their local public health authorities and on websites such as those from the Centers for Disease Control and Prevention.

In addition, the World Health Organization (WHO) frequently publishes coronavirus disease situation reports to provide updated information on the outbreak in the world. The WHO website also provides reader-friendly infographics and videos pertaining to protecting yourself and others from getting sick, coping with stress during the pandemic, practicing food safety, and staying healthy while travelling.

Neuroscience News & Research from Technology Networks has provided a short, layperson-friendly video clip titled “What actually happens if you get coronavirus?” that describes how the coronavirus affects the human body.

Counselors should also encourage their clients to stay informed by providing the aforementioned resources.

Culturally responsive service in clinical practice: Counselors can serve as protective and promotive factors when working with individuals who are either directly or indirectly impacted by the coronavirus. Counselors can promote the well-being of clients through the establishment of safety in the therapeutic process and providing them with the opportunity to process the implications of this societal issue. Additionally, counselors can facilitate the process of healing and assist in mediating factors that contribute to individuals’ vulnerability and risk. Therapy can be the catalyst for clients’ adaptability to stressors and adversity brought on by the anticipation of potential consequences from the spread of the virus.

It is crucial that counselors uphold the ethical principles of the profession, including beneficence, nonmaleficence, veracity, justice, fidelity and autonomy, when working with clients. Counselors must be attuned to clients’ well-being and do no harm, as well as treating all individuals fairly and justly. Counselors must normalize and validate clients’ concerns while also providing accurate psychoeducation (not only to our clients but also to the rest of our communities).

Counselors should also be aware that certain ethnic groups, such as those of East Asian descent, may be experiencing additional stressors. President Donald Trump has repeatedly referred to the novel coronavirus as the “Chinese virus” because of its origin in China. We believe such language has contributed to the significant and disproportionate number of verbal and physical attacks on individuals of East Asian descent living in the United States.

We encourage counselors to address these social and societal challenges with these clients, including how such challenges may be affecting their well-being. Counselors should be ready to advocate and provide a voice for individuals who may be marginalized and oppressed due to the societal impact of the outbreak.

Conclusion

Our hope is that this article will give professional counselors and counseling students an opportunity to educate the community with accurate information regarding the COVID-19 pandemic. Furthermore, we hope that professional counselors are informed and effectively equipped to provide support for clients who are affected by the virus and its societal impact. Finally, we encourage all counseling professionals to partake in preventative measures against further expansion of COVID-19 in the nation. After all, prevention is one of the philosophical cornerstones of the counseling profession.

 

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For more on this topic, check out the article “Coping with the (ongoing) stress of COVID-19” from Counseling Today‘s June magazine.

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Yoon Suh Moh is an assistant professor in the community and trauma counseling program at Thomas Jefferson University in Philadelphia. As a licensed professional counselor, national certified counselor and certified rehabilitation counselor, her primary areas of clinical and research interest include the effects of chronic or toxic stress on mental illness, wellness of counseling professionals, and integrative, healing-centered approaches such as neurocounseling. Contact her at yoonsuh.moh@jefferson.edu.

Katharine Sperandio is an assistant professor in the community and trauma counseling program at Thomas Jefferson University. Her main areas of focus include addictions counseling, counselor education, addictions and family systems, and social justice issues in counseling. Contact her at Katharine.Sperandio@jefferson.edu.

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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.