How to cope with anxiety about Coronavirus (Covid-19)

At the start of this year, almost no-one could have predicted the current health situation. Within the space of a few weeks, a new coronavirus (Covid-19) has emerged, first in China, and gradually, spreading across countries all around the world. Of course it is part of the human experience to feel concerned when we are faced with an unpredictable threat such as this, but this virus is not only a threat to our health, but also a trigger for many people who have health anxiety or general anxiety. This blog post is to introduce you to a couple of ideas to help you to help yourself and manage the problem more effectively.

To be completely honest, I don’t just have professional experience of health anxiety, it is also a problem I have had difficulty with in the past and do have to pay attention to my own vulnerability to this trigger. I wanted to write this post to support anyone looking for tips to manage their anxiety and prevent it from escalating; particularly anyone who might be struggling with their health anxiety, general anxiety or even OCD being triggered by the threat of Coronavirus (Covid-19).

If you consider the people you know, you will probably notice there is a sliding scale of responses to the virus. At one end of the scale you will notice people experiencing high anxiety and panic, at the other end people sticking their head in the sand and saying, “It’s just flu, move on, what’s the fuss about?”, and also frequently (although not necessarily as obvious) the pragmatic and calm middle ground of realistic concern. You can probably see that there are problems at both extreme ends of the scale and that concern is going to benefit everyone the most.

If you stick your head in the sand and ignore the experts, you are more likely to adopt an “I’m alright Jack” attitude, and be less likely to pay attention to measures to slow down the spread of the illness. This has the downside of making it even harder for our wonderful NHS workers to do their jobs. In a worst case scenario this could mean they can’t help everyone who needs help. At the other end of the scale, if you panic, you will be suffering emotionally, lacking sleep, panic buying supplies you may not even need, and generally heaping distress on yourself. At worst, life could become consumed with the thoughts of the virus.

The sweet spot, you’ve guessed it is, to be appropriately concerned about the spread of the virus. Concern is anxiety at a lower level, but it is behaviourally different and less intense than anxiety. It helps us to be prepared, to keep the threat in perspective and to focus on what we can do to help ourselves, our loved ones and others in our communities. So, how can we stay concerned without tripping over into high anxiety…

What triggers the anxiety

Before I move on to the tips, it might help to understand why anxiety is so triggered by this threat. First off, if we are experiencing anxiety, there is always a threat behind it, and this threat may be real or it may be imagined. With the new coronavirus, the threat is real, but there is uncertainty about how big the threat is. There is uncertainty about whether or not you will get it, how severe it might be. There is uncertainty about whether loved ones, or vulnerable people you know will get it. There is uncertainty over how well they will be able to fight it off. There is uncertainty about how dangerous the virus is. There is uncertainty about how this will impact you and how you live your life. Maybe you are starting to see the crux of the problem? UNCERTAINTY! Anxiety can be driven by a need to be certain. This drive for certainty then locks you in to certain behaviours designed to try to achieve the clarity and certainty you are looking for. It also gets your mind on a quest to gain certainty by worrying. Worrying can be the mind’s way of trying to be more prepared, but unfortunately it’s fuel on the flames of anxiety. A quest for certainty where there is none keeps anxiety going, and is extremely distressing over time.

I’m going to list some of the common behaviours which may suggest you are anxious and how you can manage that. In no particular order, here are some pointers to look out for.

Coronavirus anxiety and what to do about it

Checking the news or social media

Hands up who recognises this? If this is you, then consider yourself caught in the trap of reassurance or certainty seeking. If you’re finding yourself regularly pressing refresh on social media hashtags about the virus, or seeking out constant ‘Live’ news coverage of the virus situation, you’re engaging in action which will keep your focus on the threat and keep your anxiety high. While from time to time you might come across a ‘good’ news story, there will be far more to stoke your anxiety and your doubts about how ‘safe’ you are.

Solution: Try limiting your news addiction to once or twice a day, though certainly not just before bed. Even better, stick to respected sources of information. For example World Health Organisation, Public Health England (if you’re in England) or your local and trusted source of expert information. The press may not be the place to look for keeping anxiety at bay. Journalists, although thorough, are human beings and can make mistakes or misinterpret statistics. Neither are they experts in pandemics, so the facts may be sometimes unfortunately distorted. In some papers the facts may be deliberately misleading to create sensational stories or for political point scoring. Stick with a trustworthy and scientific source and put a limit on how often you look at it. You may need to wean yourself off the checking if you are highly engaged in this activity.

Extensive rabbit hole research

If you, or others, have noticed you are becoming something of a armchair expert in virology or epidemiology, through excessive reading around the virus, then pay attention to how all the knowledge you have been accumulating might be fuelling your anxiety. The purpose of your research is most likely to try to find some vital piece of research to reassure yourself. You’ll know you are severely afflicted as you find yourself trying to download and decipher scientific papers on the coronavirus to see if you can glean the piece of information which might put your mind at ease. Most of these papers, need PhD level scientific knowledge and will be frustrating and lead you down a warren of rabbit holes. For every bit of reassurance you’ll find, you’ll find something else that contradicts it, or places a doubt in your mind.

Solution: Remind yourself that there are people far more qualified than you whose life work it is to make sense of the ongoing information about the virus and its spread. Your activity will only fuel your anxiety and take you away from living your life. This kind of behaviour is highly addictive and you will need to keep an eye on yourself for slipping back into the temptation (as with news/social media above). Hours can be spent down this rabbit hole. Spend this time doing something enjoyable or useful instead. For example, cook a meal for your freezer, catch up or write a note to a friend, spend it with people you care about.

Worrying

Worrying is your mind’s way of trying to protect you, or to prepare you for a worst case scenario. If you can step outside of this persuasive thought for a moment, is it genuinely the worry that protects you from the threat you are facing? Hmm, probably not. Worrying is unproductive and keeps us in a space of overthinking and unable to relax.

Solution: Practice redirecting your attention from worry thoughts which are unhelpful to you. This takes time and practice, acknowledge that your mind has been temporarily hijacked by anxious thinking and a need to achieve certainty about what is going to happen, then refocus on something outside of your mind. Experiment with what works best for you.

If you have a tendency to get stuck in worry mode, why not try The Worry Tree method which can help to put worries to one side and focus instead on what you can reasonably do.

Overpreparing

Overpreparing again keeps your focus in the threat in an unhelpful way. We have no certainty about what will happen over the coming weeks and months. We may have to self isolate, we may not; we may have greater restrictions placed on us regionally or as a whole country, so it’s impossible to plan for every possibility.

Solution: Reasonable planning seems sensible. Panic buying will increase your own anxiety, as well as others’. There’s nothing like an empty supermarket shelf to increase scarcity fears and place an emphasis on risk and danger. Make a proportionate plan in case you need to self isolate. This will be different for everyone, depending on how they live, who they live with, where they live. If you can’t go out and you don’t have reasonable stocks of food in your cupboard to see you through, think about who you could ask to help you out if this was a problem (friend, neighbour), or use online shopping if you don’t usually.

Overcautious actions

This is a tough one. If you have extreme levels of anxiety or OCD around fears of contamination and a highly developed sense of responsibility for preventing harm to your self or others, then you may engage in safety behaviours to prevent the spread of the virus which are above and beyond what is required. If you have had ERP for OCD, you will have heard that to overcome the problem you must tolerate ‘dirty’ hands for example. However, in the case of the current coronavirus, a decent exposure would be to wash your hands once according to World Health Organisation guidelines and resist the urge to go further than that.

Solution: Reasonable hygiene is healthy and helpful. Washing your hands as per NHS or World Health organisation guidelines is effective. Click here to see how to wash your hands. Soap and water is recommended as being as effective as antibacterial gels.

Similarly you can do your bit to prevent the spread by coughing or sneezing into a tissue, binning it and washing your hands after.

That’s just a snapshot of ideas which I hope might help. For further ideas, I highly recommend this video by Ali Matthu on coronavirus anxiety.

Despite the inevitable concern this virus has for many people, I hope that this post can go some way to helping you to keep things in perspective… to find the middle ground between overestimating and underestimating the threat. Stay healthy, stay concerned!

Ali Binns is a CBT therapist based in Bath, UK. Her special interest is in helping people to manage a range of anxiety problems.

CBT therapy for health anxiety

Obsessed with your health? Convinced you are ill, despite getting a clean bill of health? If you’ve arrived here, then it’s likely you (or perhaps someone you know) have health anxiety and you’re interested in finding out more about how CBT therapy and counselling can help health anxiety. I work as a CBT therapist in Bath and help clients to overcome their health anxiety using cognitive behavioural therapy. In this introduction, I hope to give you an understanding of what health anxiety is, some of the ways it is maintained and how we can begin to overcome the problem of health anxiety.

What is health anxiety?

Health anxiety is a preoccupation with becoming ill with a serious illness, or of succumbing to a serious illness, despite medical advice that this is not an issue. Many people worry from time to time about their health, but health anxiety is when this worry becomes persistent, taking up a lot of time and leading to restricted lifestyle choices. Someone with health anxiety might imagine they are ill, or overestimate the likelihood that they will become ill, even in the face of a doctor’s evidence to the contrary.

How does CBT help health anxiety?

Cognitive behavioural therapy is rooted in the theory that our thoughts, feelings, actions and physical symptoms (bodily sensations) are all connected. We assess the problem of your health anxiety by building up a detailed picture of it. Each person with health anxiety is unique, so the first requirement in therapy is to take a detailed look at your worries about your health, how you are thinking and what you are doing about these thoughts. Once a thorough assessment has been made, then with your therapist you can begin to deconstruct the problem…

Health anxiety worries

In health anxiety you might become preoccupied with having a serious illness or getting one. Typically, people tend to focus on serious and catastrophic health events, such as having a stroke, a heart attack or chronic, long term illness with uncertain outcomes, such as multiple sclerosis, or cancer, among others. Often what can happen is when one condition is ruled out, physical sensations can convince you that there is still something wrong. You may become an internet expert in digging out rarer conditions which appear to match the symptoms you are experiencing. It’s not uncommon for people with health anxiety to self-diagnose conditions their GP has rarely encountered in their practice.

The first step in health anxiety is to consider the possibility that you have a problem of worry about health rather than this being a real health problem. This is a huge first step and involves taking a leap of faith, possibly with the help of your therapist. Once this is acknowledged then we can begin to test out the theory that it is your problem of worry rather than an actual illness which is the target of therapy!

‘Real’ symptoms

The belief that you have an illness can be complicated by the existence of compelling and very ‘real’ symptoms. In the past, people with health anxiety were labelled rather dismissively as ‘hypochondriacs’ and told that their problem was all in the mind. The truth is that sensations and symptoms in the body are real and do exist, it’s just that the symptoms (sometimes coming from the anxiety itself) are being misinterpreted in a catastrophic way. If you experience health anxiety you may jump to fast conclusions about bodily sensations. In fact, it’s highly likely you are acutely tuned in to your body and how it feels on a day-to-day basis.

When we experience anxiety, we might attribute our bodily symptoms to serious illness: a tension headache might mean a brain tumour or an imminent stroke; a racing heart may be seen as the onset of a heart attack; tingling sensations may be interpreted as a sign of MS or other neurological disorder. Anxiety itself contributes many physical sensations which are in reality harmless, but which can become a focus of attention. When we focus on the symptoms, they take up more of our attention and a vicious cycle of health anxiety can begin.

Beliefs in health anxiety

Health anxiety is often driven by a need to be sure that you don’t have a particular illness. This need for certainty can compel you to find a certainty that is forever out of reach. It leads to a preoccupation with trying to prove with absolute certainty that you don’t have anything wrong with you.

You may also have beliefs about your worry which motivate you to keep worrying. For example, you may believe that if you don’t worry enough and keep your focus on your health, then you might miss something, and that if you did then you’d sorely regret it. Perhaps you believe it would be irresponsible not to worry, or that worry prepares you for a worst case scenario.

In CBT we really think about our thinking. Your therapist will help you to challenge some of these ways of thinking and to come up with more helpful and balanced thoughts which can help to soothe your anxious mind.

Why do you have health anxiety?

Often clients ask, ‘why do I have health anxiety?’ For this, there’s not a single answer. It can be helpful to explore what has happened to you or around you in your life to understand why you may be predisposed towards anxiety around illness. Factors which come up often are: sudden deaths in the family or among close friends, difficult illnesses in the family when you were growing up, perhaps you’ve had a serious illness in the past yourself, or have experienced a missed diagnosis in the past (either yourself, or others), for example. Often becoming a parent can trigger health anxiety as it becomes especially important to you to stay well and be around for your children. Knowing that we have understandable reasons why we may have a tendency to overestimate the likelihood of illness and perceive this as an ongoing present threat can help to unravel some of the automatic assumptions you might have when you experience a worrying symptom.

Coping in health anxiety

When you are experiencing health anxiety, you likely have developed ways of dealing with this with what therapists call ‘safety seeking behaviours’. Of course, we all strive for peace of mind and contentment, and when you’re anxious about health then you will have come up with ways which help you to feel better (some will be helpful, others not!). In health anxiety, there are some typical ways in which you might try to cope.

A common ‘coping’ method is to consult Dr Google. Dr Google holds a wealth of information for those seeking out symptoms online. The internet certainly has a lot to answer for when it comes to health anxiety. It offers unfiltered, general information and tends to lead to increased doubt and uncertainty, as well as more questions and lines of enquiry to pursue. In case you haven’t realised it yet, the internet is an ‘all you can eat buffet’ as far as health anxiety is concerned.

You might also frequently check out a particular part of your body which is giving you concern by closely monitoring it. If you have health anxiety, do you measure your own blood pressure or heart rate to reassure yourself you are okay? Do you poke and prod at particular areas to check for changes or pain?

Other ways in which you might try to help yourself include frequent visits to the doctor to seek out medical opinions, requesting further tests and visiting different doctors for second opinions. Other ways you might try to cope might be by trying to push aside the thoughts, trying to think positively, or avoiding activities which could, in your mind, put you at risk of something bad happening. You may also avoid talking about illness as if just talking about the illness increases the likelihood of this being true. And lastly, though not exhaustively, you may even avoid TV programmes or newspaper articles where you might come across reference to illness.

What is important to understand in all of the above, is to question how helpful these actions are for you in the short term and in the long term. Do they perhaps have some unintended consequences?

How does CBT help?

Cognitive behavioural therapy counselling for health anxiety helps to break and reverse the cycle which keeps it going. This means addressing thoughts and beliefs about our health. It also means reducing unhelpful coping behaviours which tend to keep our focus on the anxiety. An anxious focus on health unfortunately keeps you on high alert for sensations in the body and at the same time making you more likely to experience sensations which can then be attributed to something other than the anxiety which caused them.

In CBT therapy you learn to face the anxiety and work towards feeling a healthy level of concern for your wellbeing. It’s completely natural to feel concerned about your health, as this will motivate you to look after yourself but without the downsides of pre-occupation and missing out on life because of anxious worry. As an experienced therapist specialising in CBT, I have a wealth of ways to share with you to help you learn to tolerate your uncertainty as you learn to manage your anxiety. We use cognitive methods to soothe your anxious mind, and mindfulness based approaches to increase your resilience and learn to retrain your attention, as you begin to reduce activity which keeps you locked in the grip of health anxiety. It’s hard work, but it’s worth it, so you can get back to the life you value!

Ali Binns is a CBT therapist in Bath offering counselling for health anxiety and other anxiety problems. If you’ve a problem with worry, stress or anxiety, please get in touch if you’d like support in overcoming your difficulties.