Anxiety Goes Viral — Dr. Jonathan Marshall

Within hours of raising the national alert level to Orange, online grocery stores and supermarket shelves were empty. Hand sanitizers and toilet paper were (and still are) only available on the black market; and they are worth their weight in gold. Amidst the spread of the highly contagious Novel Coronavirus, our medical professionals have focused on the physical manifestations of the illness. But there's a very real second issue: anxiety.

Know the Facts about the Virus

One of the most important things you can do to manage this anxiety is to know the facts about the situation. You can then assess if you are sufficiently taking care of your own and other people’s physical needs.

Prime Minister Lee Hsien Loong on the death rate of the Coronavirus

Some Key Facts

1) The prime minister of Singapore has described this disease as more closely resembling a bad flu than SARS, another Coronavirus. According to him, outside China the death rate is under 0.2% while that of the seasonal flu is 0.1%. His point is that while this disease is very contagious, it isn’t particularly dangerous. (The latest information from the Singapore government comes through this WhatsApp group.)

2) The good news is that this new disease is preventable through:

a) washing your hands and not touching your face. That’s a tall order as most of us touch our face 28 times an hour! The reason not to touch your face is because the virus enters into the body through the eyes, nose or mouth. So if you touch your face, and your hand has the virus on it, it’s that much easier to get sick. (The Guardian’s health editor has a great video explaining this.)

b) avoiding places where we may come into contact with the virus, e.g., crowded environments. There you may come into contact with people who have the illness and you may breathe in their germs.

The Guardian's health editor on the Coronavirus

What does that mean for me?

With the facts in place, everybody has to come to their own decision on what level of risk to take. “Should I wear a mask in the supermarket?” “Should my family still take public transport as much as before?” And “Do I need to insist on working from home” are some of the decisions I hear people making.

What Forms Does the Anxiety Take?

In anxiety-provoking situations, most of us feel out of control and regress to what we were like as children. Brain scans show that our amygdala and the hippocampus function differently and we often exhibit F.A.B. responses. (Ironically, they aren’t at all fabulous.)

1) Fear
People may become fearful to the point of paranoia. For example, every elevator button and each person becomes a terrifying vector for the virus. People may start thinking thoughts like, “The taxi driver coughed, now I’ll definitely die.”

2) Acting to Gain the Illusion of Control
Hoarding is a great example of this. While it may be useful in some crises, it isn’t necessary here. People are buying more toilet rolls and packet noodles than they could possibly use in the next year or more. It gives a false sense of control in a situation where they otherwise feel helpless.

3) Blame
We are meaning making animals. To make sense of this otherwise meaningless problem, we often end up bashing people of a different race or religion. One person said to me, “This is God’s punishment for those people who don’t interpret scriptures correctly.” Another person, who believes the virus came from people eating meat, said it is “Nature’s retribution against non-vegetarians”.

So what can we do?

Action: Keep Busy so You Don’t Ruminate

Many of us ruminate when we feel powerless. Rumination eventually leads to depressive symptoms and more helplessness. To avoid that, keep sensibly busy. If you are staying at home, perhaps learn a new skill through YouTube or enjoy Netflix. One colleague of mine is learning Spanish; another is learning to make a website.

Reflection: Mindfulness of Anxiety

A much harder response, and often more valuable, is to be really honest with yourself about the anxiety you feel, and to accept it. For example, I was standing in line for an hour at Cold Storage. I noticed the lady behind me had carefully placed a surgical mask over the mouth of the child in her pram. She made sure the child’s nose was outside the mask. I found myself feeling annoyed. “If she's going to go through all the trouble of putting a mask on her child, she might as well do it properly and cover the nose and the mouth,” I thought. But as I felt into my annoyance, I realized the truth was, I was anxious. I was anxious about being in a crowded environment surrounded by very anxious people, and I was wondering if I should have had a mask for myself. While that insight wasn’t particularly profound, going the extra step of feeling into that anxiety and accepting it helped me feel more at ease. The queue wasn't any faster but I felt more comfortable with the situation. The way other people in line wore their masks then became more a source of amusement rather than irritation.

Essential: Self-Care

Finally, if you come in contact with the virus, your main defense is your immune system. Anxiety compromises immune functioning. So prioritizing self-care is important. In brief:

sleep enough
eat healthy foods
get sunlight everyday
exercise regularly
connect with your friends, either virtually or in person
if spirituality's important to you, engage in those practices
and laugh!

All of those are associated with improving the immune system. And if you have a stronger immune system, you’ll have a better chance of beating the virus if you do meet it.

Dr Jonathan Marshall is a psychologist and executive coach in Singapore. During this period of heightened anxiety, he is offering workshops online and in-person on how to manage the psychological impact of the new Coronavirus. To contact him, click here.