Therapists Discuss: Anxiety During Shelter-In-Place

Anxiety During Shelter-In-Place: A Conversation Between Rachel Fleischman, LCSW, REAT, and Laurel Roberts-Meese, LMFT
 
Two therapists discuss what anxiety is and how we work with it now. Anxiety is very common and very treatable.
 
A loose, summarized transcript follows:

RF: Anxiety is a series of physiological sensations that are all uncomfortable, paired with worry about the future stripped of joy and opportunity. We work with it through educating and coaching our clients like a teacher. Anxiety is NOT weakness, and it can be treated. The more you understand it, the easier it is to tolerate the discomfort. If you can change your relationship to anxiety, there’s potential for recovery that lasts. It’s more uncomfortable in the short term, which trends toward avoidance.
 
LRM: And then you see people drinking or engaging in other short-acting soothing behaviors.
 
RF: Yes, and then in the long term the anxiety gets worse. But you can change it. The physiological symptoms can be so unpleasant it becomes the fear of the fear. And there’s so much shame around it. If we can remove the shame, it will be easier for us all to manage our anxiety.
 
LRM: I’m seeing some people now during shelter-in-place that feel they cannot address their own anxiety because they feel they have to care for and make space for someone else’s anxiety.
 
RF: There are three characteristics that highly anxious people have. The first is that sensitivity to that first anxious “whoosh” in the body.
 
LRM: We all know that! Half of our neuroreceptors are in the body, so the physical reaction makes sense.
 
RF: And if we expect a negative sensation to happen, it will happen more often and more severely. Physiological arousal can be triggered by looking for it. The second trait is a disposition toward expecting the worst, and the third is the tendency to catastrophize. And that’s where humor comes in! If you can be silly with it, you can address the anxiety better.
 
LRM: I love using humor and laughter. If you think about the physiological laughter response, it’s a kind of progressive muscle relaxation technique, and there’s no negatives to Progressive Muscle Relaxation. It helps sleep too.
 
RF: That reminds me of Mindfulness Based Stress Reduction, that eight week course, and I think everyone should take it. It’s available online, just like everything else. What phenomenal blessing and overwhelm.
 
LRM: That overwhelm is increasing everyone’s anxiety! There are too many options. We should be approaching shelter-in-place like second semester seniors taking a course pass/fail. All that is required of us is to survive and go on to be in the world as it exists then. You don’t need to participate in the productivity contest.
 
RF: The great antidote to anxiety is being the present, and being curious.
 
LRM: And it’s so hard! Mindfulness is lifelong practice we never master.
 
RF: And sometimes our mindfulness attempts don’t work; if we try to scroll instagram to find a beautiful picture, we are inundated with everyone going live RIGHT NOW.
 
LRM: Yes, and this is a good time to mention that we know from the results of scientific studies that factors that influence anxiety during a pandemic. The number one thing that will drive you anxiety up during a pandemic is social media. We know it’s not reliable, it trends towards sensationalism and fear-mongering. Television is not much better because they have to keep you engaged, so they sensationalize factual information. Print news is the best way to get information while keeping your information factual and current.
 
RF: And with print media there is also art and entertainment and crossword puzzles, which is a gift. I’d love to ask you about something we can do at home, from your EMDR training or other that can help us now.
 
LRM: Sure, but I think first we should talk about the different kinds of anxiety. I think of four big ones: panic or anxiety attacks, generalized anxiety which we all experience and need to some degree, existential anxiety, which I see going through the roof right now as we have to contemplate our mortality. And finally, there are phobias, which are a very specific fears. We work with these three kinds of anxiety very differently.

Without any anxiety, I wouldn’t be able to function and be the professional I am. If it’s Hakuna Matata all the time, you don’t grow. The trouble is if it becomes paralyzing.

EMDR works really well for phobias, as well as other anxiety. I’ve seen so many things be treated effectively with EMDR: fear of flying, fear of choking, fear of foods, fear of a virus, as well as other traumatic events. Some phobias are based in a trauma, and some are not.

But about that specific technique or skill for anxiety, try this: think about something really positive where you feel really engaged, tap your shoulder alternately and you’ll start to feel your body calm. Safer and healthier than a drink!
 
RF: Any last things you want to share?

LRM: I loved your piece about curiosity. Whenever a friend or client is anxious, I ask them to reframe the experience as information your body is giving you. It come mean “this matters to me” or “I’m afraid for someone I love” or “I really need to go to sleep.” If you can take a step back and not judge the anxiety, ultimately, the anxiety goes down much faster.
 
RF: I absolutely agree. There’s so much self-compassion and tenderness in that curiosity. Right now we’re all going through some level of grief and loss, and we’re exploring where we are in it, and movement is so important right now. If your anxiety or panic is through the roof, there is medicine.
 
LRM: Yes, and I’ve seen some amazing progress combining therapy and medication. You can’t just do ONE thing and expect everything to change.
 
RF: And there’s so much more to say. Any last thoughts?

LRM: Get curious, and know your anxiety is not an emergency. You can tolerate it, even though it’s hard.
 
RF: And each time you do tolerate it, it gets easier and you get better at it over time.