How Can We Cope with Extreme Anxiety During a Global Crisis?

What you need to know

• Global crises can make previously irrational fears seem more realistic, challenging traditional therapeutic approaches.
• The context of a pandemic can exacerbate anxiety and obsessive-compulsive behaviors, making treatment more complex.
• Therapeutic techniques may need to adapt to address the reality of trauma-based fears in times of widespread uncertainty.

The challenge of treating anxiety during a global crisis

In February 2020, a young woman was admitted to a psychiatric inpatient unit due to suicidal thoughts. Her usual coping mechanisms for handling distress – compulsive hand washing, disordered eating, substance use, and self-injurious behaviors – were no longer effective. She was consumed by various fears, including the possibility of her mother getting cancer, severe thunderstorms turning into hurricanes, and most notably, the fear of a zombie apocalypse.

Initially, this case seemed like an excellent opportunity to teach and apply cognitive behavior therapy (CBT) and exposure techniques. The patient responded well to reassurance and exposure hierarchies, acknowledging the irrationality of some of her fears. She was discharged after a few days and transitioned to a partial hospital program to continue working on exposure exercises.

However, the onset of the COVID-19 pandemic has brought new challenges to the treatment of anxiety and related disorders. The global crisis has made previously irrational fears seem more realistic, blurring the line between appropriate caution and excessive worry.

The impact of a pandemic on anxiety and OCD

The COVID-19 pandemic has created a situation that, in many ways, resembles the “zombie apocalypse” feared by the patient. People are advised to stay at home, venturing out only for essential activities. There’s a pervasive fear of infection from others, and public health messages emphasize the potential fatal consequences of the virus.

This situation poses particular challenges for individuals with obsessive-compulsive disorder (OCD) and other anxiety-related conditions. Public health recommendations now align with behaviors that would typically be considered excessive in OCD treatment. For example, frequent hand washing and avoiding contamination, which are often targets for reduction in OCD therapy, are now encouraged as protective measures.

The pandemic has also robbed us of one of our primary coping mechanisms: the ability to gather together for human comfort. This isolation adds another layer of difficulty to managing anxiety and fear during this time.

The historical context of psychiatric treatment

The paper highlights how our approaches to psychiatric treatment are influenced by historical and social contexts. For instance:

1. Sigmund Freud’s theories about unconscious conflicts reflected the context of antisemitism in late 19th and early 20th century Austria.

2. The popularity of anxiolytic medications in the 1950s coincided with widespread fear of nuclear warfare in the United States.

3. Cognitive behavior therapy, which involves challenging irrational thoughts, emerged in a post-war context of relative affluence and stability.

These examples demonstrate how therapeutic approaches are shaped by the societal circumstances in which they develop. The current global crisis challenges some of the assumptions underlying these approaches, particularly the idea that catastrophic thinking is always irrational.

Adapting therapeutic approaches for a new reality

Given the current circumstances, the author suggests that dialectical behavior therapy (DBT) might be a more appropriate approach for treating anxiety and fear. DBT, developed by Marsha Linehan, addresses the reality of trauma-based fears and may be better suited to our current context.

Key aspects of DBT that could be particularly helpful include:

1. Mindfulness: Focusing on the present moment rather than being consumed by the enormity of the global crisis.

2. Emotion regulation: Learning to manage our hopes, fears, and grief about societal changes and losses.

3. Interpersonal effectiveness: Improving our ability to communicate clearly and effectively, especially when asking for help.

4. Distress tolerance: Learning to accept and cope with distressing situations that we cannot change.

These skills can help individuals navigate the uncertain and anxiety-provoking landscape of a global pandemic, acknowledging the reality of the situation while developing coping strategies.

The need for flexibility in mental health treatment

The COVID-19 pandemic has highlighted the importance of flexibility in mental health treatment. Therapists and patients alike must adapt to a rapidly changing reality, where previously effective strategies may no longer apply.

For example, exposure therapy for contamination fears in OCD might need to be adjusted to account for legitimate health concerns. Similarly, challenging “irrational” thoughts about widespread illness or societal disruption may be less straightforward when such scenarios have become more plausible.

Mental health professionals need to strike a balance between acknowledging the real threats posed by the pandemic and helping patients manage excessive anxiety and fear. This may involve:

1. Validating patients’ concerns while providing accurate, up-to-date information from reliable sources.

2. Helping patients distinguish between productive and unproductive worry.

3. Focusing on aspects of the situation that patients can control, such as following health guidelines and maintaining social connections virtually.

4. Encouraging self-compassion and acceptance of difficult emotions during this challenging time.

Conclusions

• Global crises like pandemics can blur the line between rational and irrational fears, challenging traditional approaches to anxiety treatment.
• Mental health professionals need to adapt their therapeutic techniques to address the reality of trauma-based fears in times of widespread uncertainty.
• Flexibility, validation of patients’ concerns, and a focus on coping skills are crucial elements in providing effective mental health care during a global crisis.