We are currently facing a pandemic of a novel coronavirus that has already killed hundreds of thousands of people worldwide. Until there are effective treatments and an effective vaccine, we all need to be vigilant to protect the safety of our families, friends, and ourselves. According to the Census Bureau there has been a dramatic increase of depression and anxiety in all age groups in the United
States since the onset of the pandemic. Cognitive behavioral therapy can be very helpful in addressing the psychological issues that inevitably arise during this difficult time. Fortunately, we can draw on a wide range of cognitive behavioral models to help us cope. These include cognitive therapy, behavioral activation, acceptance and commitment therapy, problem-solving therapy, mindfulness,
and other approaches. You did not have a choice about whether there was a pandemic, but you do have a choice now as to how you respond to it. This is a chapter in your book—the story of how you live your life. You have a choice as to how you write this chapter.
Let’s look at the 10 key steps to coping better.
1. Normalize and Validate
During one of the greatest psychological, economic, and health challenges of the last 100 years it is normal for us to feel sad, anxious, confused, helpless, hopeless, bored, and angry. Perhaps you have felt many of these emotions. When we are confronted with a threat that is frightening, uncertain, and invisible, our emotions will run the entire range. You may even wake up in disbelief wondering if
you have dreamed that there was a pandemic, only to discover that this is the new reality. So, your emotions make sense. They are part of being human. And we can recognize that these are emotions felt worldwide. But we also have a choice as to how we cope—and this will affect the emotions that we live with daily.
2. Maintain Safety
The first priority is for us to protect our health. Follow the guidelines of the Centers for Disease Control (CDC) and recognize that establishing social distance, wearing a face mask, using proper hygiene, and other recommended behaviors can dramatically reduce the likelihood of getting infected. Many people find these behaviors to be unpleasant or uncomfortable, but it is essential to recognize that
the slight inconvenience of wearing a face mask will be a lot less than the inconvenience of being hospitalized or inadvertently infecting a family member.
3. Distinguish Between Probability and Possibility
Although millions of people worldwide will be infected with the coronarvirus and hundreds of thousands will die, the actual probability of any one person dying from the virus is very small. This is an important point to keep in mind. Yes, it is possible that you could die, but it is highly unlikely that on average any one person will die. The probability today in the U.S. of dying is .0003 (if we assume that
the population is 325,000,000 and there are 110,000 deaths). This low probability does not mean you should ignore CDC guidelines. Rather, it means that the probability will be even lower if you do follow the guidelines.
Moreover, certain groups make up the overwhelming majority of people who die from the virus—for example, people with co-existing medical conditions like hypertension, diabetes, cancer, or obesity or who are over 70 years old. These groups need to take special care to avoid infection.
Productive Worry v. Unproductive Worry
Will I get infected?
Will I lose my job?
Will this ever end?
Do I have enough food at home for the next few days?
Are the other passengers wearing their masks properly and will they keep them on?
Can I leave early enough to get to the store to restock wipes and alcohol?
4. Don’t Isolate
During the earlier phases of the pandemic, when we are all encouraged to maintain social distance and even shelter in place, we may face the likelihood of greater isolation and distance from valued people in our lives. But social distancing does not mean social disconnection. Fortunately, with the Internet and the use of smartphones and technologies we are able to connect with people worldwide
at no cost. We encourage each person to schedule connections on a regular basis with people. This keeps you connected with the people you need in your life for social support. And, you can also connect with groups of people that share your interest. For example, connect with groups on-line for exercise, yoga, meditation, sharing books, religious practice, and other shared interests. You can also
use this as an opportunity to learn new skills by taking on-line courses, learning a musical instrument or new language, or developing a new hobby. Connecting is up to you. All it takes is to pick up your phone or go on-line and the world is open to you.
We encourage each person to schedule connections on a regular basis with people. This keeps you connected with the people you need in your life for social support. And, you can also connect with groups of people that share your interest.
5. Take Action
Along with isolation, passivity is a major predictor of depression. Many people who are sheltering in place will find themselves remaining passive, not engaging in much meaningful activity on a daily basis. But you can schedule specific activities daily from a range of categories of valued action. This can include contacting other people, doing work from home, exercising daily, learning new skills,
practicing mindfulness, engaging in cultural activities, and other activities. It’s useful to schedulet hese activities so that you can look forward to them and actually follow a plan and then keep track of what you do. You may find at the end of the day that you did a lot of things that gave you satisfaction. Keeping busy with specific activities will help you reduce your worry and rumination. It will also overcome feelings of helplessness.
6. Take Control of Worry
It is natural for you to worry through this time, given the threat of infection, economic downturn, and the uncertainty of when the pandemic will end. Worry involves repeatedly focusing on negative thoughts about the future. These can be thoughts like, “Will I get infected?“; “Will I infect other people?“ “Will I lose my job?“; or “Will this ever end?“ It’s natural that you would have these thoughts, but the question is whether repeatedly focusing on them will help you.
We can distinguish between productive worry and unproductive worry. Productive worry leads to action that leads to progress. So productive worry can be, “Do I have enough food at home for the next few days?” since you can actually make progress on this by ordering food or safely going to the
supermarket. Productive worry leads to an action plan today—it leads to problem-solving. Unproductive worry leads to unanswerable questions for which you have no answers. This includes “When will the pandemic end?“ or “Will I get infected?“ When we realize that our worry is unproductive we
have two choices. We can either repeat unproductive negative thoughts, which will make us more anxious and depressed, or we can practice acceptance. This involves acceptance of uncertainty and the acceptance of some lack of control. People who are prone to anxiety often equate uncertainty with a bad outcome and engage in worry to obtain certainty. This search for certainty never works.
The fact is that before the pandemic we accepted uncertainty on a daily basis—traveling, starting conversations, ordering food, or choosing something to do. Uncertainty is not the same thing as a terrible outcome—it is an unknown. The advantage of accepting uncertainty is that you can move on to action in other areas of your life, such as work, exercise, or getting things organized. The advantage
of accepting some lack of control over when the pandemic will end is that you then can focus on behaviors you can control, including those tasks you scheduled for the day.
Another technique that can help you with your worry is to schedule a specific time to worry: Worry Time. This involves setting aside a specific time during the day when you will focus on your worries. You can think of this as “Worry Delay,“ where you have a later appointment with your worries. The advantage of worry time is that it allows you to push off these intrusive thoughts so they
don’t interfere with your productive activity during the day. Even though you may not be able to push aside all of these worries, you may find that you do have some success in setting them aside. By the time you get to Worry Time you may find that you are no longer concerned about these worries. You can also ask if it is productive to repeatedly focus on these thoughts. It may make sense to
practice acceptance of uncertainty and some lack of control and shift to productive action in the present day.
Worry Time / Worry Delay
Worry Time involves setting aside a specific time during the day when you will focus on your worries. You can think of this as “Worry Delay,” where you have a later appointment with your worries. The advantage of worry time is that it allows you to push off these intrusive thoughts so they don’t interfere with your productive activity during the day.
7. Overcome Helplessness
Helplessness is the feeling that no matter what you do it has no effect on the outcome. But the feeling of helplessness has a great deal to do with a specific goal that you have. For example, if you think that you are helpless because you cannot eat at your favorite restaurant you might become depressed. But the question should be, “Which activities do I have control over?” For example, you
do have control over organizing things at home, preparing food, contacting friends or family, exercising, learning, reading, practicing mindfulness meditation, and a full range of other activities, many of which will bring you some sense of effectiveness. Have a menu of specific activities that you can choose among on a daily basis and keep track of these activities as evidence that you are not helpless.
8. Reverse Hopelessness
Many of us will experience feelings of hopelessness, thinking that the pandemic will never end and that our sadness, anxiety, or anger will always be there. But hopelessness is also about a specific activity or event. For example, you are not hopeless about activities that you can engage in. Often your
thoughts about hopelessness are global and vague: “This pandemic is hopeless” or “I will never feel good again.” Think about specific behaviors or emotions and ask if these are hopeless or will they change at some point. You can think about daily life as a Buffet of possible actions or moods. Perhaps today several things that you liked are not available, but there are many other things on the
buffet table to choose from. You may find that when you shift from your global ideas about the world being hopeless to a specific focus on an activity or an interaction, your hopelessness may dissipate.
Another technique to reverse hopelessness is to refocus to the present moment. For example, if you practice mindful awareness through breathing exercises, you will find yourself focused on the present moment as it comes and goes. It is hard to be hopeless about the future if you are currently focused on the present moment as an observer.
Sometimes we think that our current emotion will last indefinitely. Strong emotions often convince us that our feelings are permanent and out of control. But you can test this out by keeping track of a variety of positive and negative emotions every hour of the week, rate them from 0 to 10 in intensity, and note whether there are changes. You may notice that the intensity of positive and negative emotions will depend on the time of day, your activities, your thoughts, or with whom you are interacting. Thus, if your emotions change during the day, then how could emotions be hopeless?
9. Coping With Financial Insecurity
There have been major shifts in unemployment and financial security for a large number of people and it is likely that some of these downturns will continue for some time. These are real concerns and should not be dismissed. Unemployment is often associated with depression and anxiety and
You may find that when you shift from your global ideas about the world being hopeless to a specific focus on an activity or an interaction, your hopelessness may dissipate.
the longer people are out of work the greater the psychological cost. But finances and employment are fluid and open to change. How can you cope with your present concerns?
One factor in financial security is your opportunity for future earnings. For example, if you are 30 years old you have a great number of years to earn money, and once the pandemic is lifted you may be able to regain some of your financial well-being. You can develop a budget for the time during the pandemic, but also plan a budget after the pandemic is lifted. We often find ourselves thinking
that what we prefer is not essential—like expensive technology, clothing, cars, and entertainment. It is possible to use this time to gain some perspective. For example, during the pandemic you may find yourself not eating out in restaurants, not traveling, not buying new clothes, or not going to theaters or other entertainment venues. Many people will find that they do not miss these things as
much as they thought they would. We may also find that there are some things that are free or low cost that are quite enjoyable and meaningful—such as being with people we love, sharing our thoughts and feelings, learning, relaxing, sleeping, and exercising. We can think about this as an opportunity to simplify our lives—to get down to basics. You can ask yourself what you enjoyed doing
when you had less money. Scaling back does not mean deprivation and defeat, it may mean slowing down to notice what you can enjoy and find meaning in.
10. Help Others
One way to enrich your life is to reach out and help others. It is hard to feel helpless, hopeless, and depressed if your efforts are meaningful to someone. Who do you know who is struggling during this time? Reach out and offer support. For example, you can contact a neighbor or family member and check in on them. You can cook food for an elderly person and deliver it to their home. Showing
that you care—even a simple email, message, or call—may brighten someone’s day. As difficult a time as this is, it is also a time when you can use gratitude to lift your spirits and those of others. Think about the people in your life who have made a difference. They could be family members, friends, teachers, or colleagues. Use your gratitude as a gift to them. Contact them and
tell them how grateful you are for their friendship, their teaching, their support in the past. When you give the gift of thanks you are likely to feel better; then you might realize that you do make a difference, you are not helpless, and you do matter to other people.
What Is Cognitive Behavior Therapy?
Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals. Changes or goals might involve:
A way of acting: like smoking less or being more outgoing
A way of feeling: like helping a person to be less scared, less depressed, or less anxious
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past. They concentrate on a person’s views and beliefs about their life, not on personality traits. Behavior Therapists and Cognitive Behavior Therapists treat
individuals, parents, children, couples, and families. Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.
How to Get Help
If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet. You may, or may not, find a competent therapist in this manner. It is wise to check on the credentials of a psychotherapist.
It is expected that competent therapists hold advanced academic degrees. They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association. Of course, they should be licensed to practice
in your state. You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations. You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"
The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition. These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment
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