BLOG BY Dr Faye Begeti MBBS MRCP PhD

How To Deal With Stress During The COVID-19 Outbreak

The global pandemic of COVID-19 means that we are living in unprecedented times. It looks like the coronavirus outbreak and the resulting increased stress and anxiety is something that we will have to keep dealing with over many weeks, even months. Chronic stress has negative effects on the brain (1,2). Receptors for stress hormones are found in the hippocampus, amygdala and frontal cortex. These structures are involved in memory processing and emotional regulation and constant exposure to stress hormones can have damaging effects and reduce the volumes of those areas (2). It is therefore important that chronic stress is recognized and actions taken to mitigate it. This blog post is the starting point for doing just that.

Uncertainty and unfamiliarity lead to more stress in the brain

Let’s first explain why our brains are finding this specific situation particularly stressful. A study published in “Nature Communications”, showed that the brain finds it more difficult to deal with uncertainty than it would even with the worst case scenario for a given event (3). In this study, participants were shown two rocks. Under one of the rocks was a snake and, if they picked that rock, they received an electric shock. Researchers found that participants were more anxious when it was uncertain whether they would receive the electric shock than when they knew an electric shock was coming. And it wasn't just psychological stress. There were physiological changes too. Their pupils became more dilated and skin conductance (sweat) increased. Those measures of stress were the highest when there was peak uncertainty and unpredictability as participants couldn't tell one way or another as whether they were going to receive that shock. When an outcome is certain, we can find more ways of coping with it than when it is uncertain which leads to a peak in our stress levels.

The part of our brain that processes fear is called the amygdala; these are two almond shaped structures located deep inside the brain. In addition to fear, novelty also activates the amygdala. An fMRI study, which measures blood flow to specific brain regions, found that there was increased activation in the amygdala when participants were shown pictures of both snakes and flowers as long as the pictures were new whereas once they became familiar the activation reduced (4).

COVID-19 is both new and clearly generates a large amount of uncertainty for the future. It is therefore normal to feel a range of emotions during this time.  Stress, sadness, fear or anger are perfectly valid emotions in the current situation.

Who is more susceptible to stress?

• According to the Centers for Disease Control and Prevention (5), the following groups of people are at higher risk for being stressed during the current outbreak:

• The elderly or anyone with a chronic disease that puts them a higher risk category for COVID-19.

• People who have struggled with their mental health in the past including those with substance misuse.

• Children and teens

• First responders including doctors or other healthcare professionals

Additionally,

• People with previous stress or trauma may be more at risk

• People in a tough financial situation

Ways to deal with stress

1) Don’t forget the basics

People may hyperventilate when panicking or hold their breath when they are stressed and breathe shallower. Stop and take a few deep breaths. Slow breathing has been shown to activate the vagus nerve (6), a really long nerve supplying several organs, such as the heart, the brain and the digestive system, and is a key part of the parasympathetic nervous system.  The function of parasympathetic nervous system is to “rest and digest”, which essentially means that the body relaxes and is the opposite of the sympathetic nervous system, which governs the “the fight or flight” response. Long slow breathing has been shown to modulate the nervous system by increasing parasympathetic activation (6) whilst decreasing sympathetic activation hence reducing stress.

2) Limit exposure to news and social media. Get your facts through a credible source.

Whilst it is important to stay informed, be mindful and know when it’s become more than that. Signs that you are overexposing yourself include reading and researching the same bit of news on several different websites, reading through every comment on coronavirus posts on Instagram and constantly searching for further information on the virus.

Focus instead or a few credible sources, such as the World Health Organization or the Centers of Disease Control and Prevention (CDC) globally plus local ones like the NHS in the U.K. and set specific times and limits when to check them and for how long.

It is important to remind ourselves that information will be constantly changing on a daily and/or hourly basis, but that doesn’t mean that the previous advice given was wrong. We will be aiming to do the right thing at the right time after analysing all the information available. Information will also vary between countries as the situation differs. Being flexible and changing our approach is actually one of our strengths, not one of our weaknesses.

3) Get adequate breaks and rest

Since this situation will be ongoing for many weeks and months, it is important that we all get adequate breaks and rest. Our brain needs rest to function and constantly thinking or worrying about COVID-19 will impact that. Not sleeping well at night is a sign of stress. Good sleep hygiene such as going to bed at the same time each night and avoiding stressful news and screen time in the evening are the first steps to tackle this.

4) Stay connected with people

We are all in this together. Human beings were made to be in a social group so don’t feel like you need to deal with this alone. If you are on your own, ensure that a day doesn’t pass without speaking to someone. If you are self-isolating, please reach out to others through technology. And please do not feel that you will be a burden. People actually find it helpful for their own well-being to help others so reach out and ask for help.

5) Draw on any skills you have used in the past to help you cope

Whether it’s meditation, exercise or just simple distraction techniques, use any skills that you’ve used in the past to help you cope. The World Health Organization warns, however, against using smoking, alcohol or any other drugs to deal with your emotions (7).

If you have suffered with your mental health previously, have a plan of where to go and how to seek help if required.

6) Keep things in perspective and stay positive

It is important to keep in mind that most people only get mild symptoms. Plus, the increased news coverage or the use of the word pandemic does not make the virus more of a threat.

Scientists around the world are working around the clock to see if any of our existing drugs have an effect on this virus and trying to develop a vaccine. At the time of writing, there are 392 trials registered in the International Clinical Trials Registry Platform (8).

As a currently practising doctor in the U.K., rest assured that we are doing everything we can to help you and your family.

This post was written by Dr Faye Begeti. Faye is a neurology doctor working for Oxford University Hospitals, having previously obtained her medical degree and a PhD in Clinical Neurosciences from the University of Cambridge. Faye is passionate about explaining how the brain works and showing people how they can use that knowledge to improve their everyday lives. Instagram: @the_brain_doctor

References

1.    Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Vol. 10, Nature Reviews Neuroscience. Nature Publishing Group; 2009. p. 434–45.

2.    Lupien SJ, Juster RP, Raymond C, Marin MF. The effects of chronic stress on the human brain: From neurotoxicity, to vulnerability, to opportunity. Frontiers in Neuroendocrinology. 2018.

3.    De Berker AO, Rutledge RB, Mathys C, Marshall L, Cross GF, Dolan RJ, et al. Computations of uncertainty mediate acute stress responses in humans. Nat Commun. 2016;

4.    Balderston NL, Schultz DH, Helmstetter FJ. The Effect of Threat on Novelty Evoked Amygdala Responses. PLoS One. 2013 May 3;8(5).

5.    Mental Health and Coping During COVID-19 | CDC [Internet]. [cited 2020 Mar 17]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html

6.    Chang Q, Liu R, Shen Z. Effects of slow breathing rate on blood pressure and heart rate variabilities. Int J Cardiol. 2013;

7.    World Health Organization. Coping with stress during the 2019-nCov outbreak [Internet]. [cited 2020 Mar 17]. Available from: https://www.who.int/docs/default-source/coronaviruse/coping-with-stress.pdf?sfvrsn=9845bc3a_2

8.    ICTRP Search Portal Advanced Search [Internet]. [cited 2020 Mar 17]. Available from: http://apps.who.int/trialsearch/AdvSearch.aspx?SearchTermStat=117&ReturnUrl=~/ListBy.aspx?TypeListing=0

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