Director of Psychosocial Services GRAHAM FAWCETT introduces three different ways of understanding our mental health during these tricky times. Why do we feel so anxious? And what can we do about it?

 

The Three U’s

In counselling, people come to us feeling anxiety if their lives feel any one of the following: unpredictable, uncontrollable or uncertain. But in a pandemic, all three of these become a reality, and any reassurance that “all will be well” rings hollow. At this point, counselling stops being a CBT approach to reset our perspectives, and it also stops being a person-centered approach to understand root causes of angst. Instead, counselling becomes an effort to help our clients regain some sense of predictability, control or certainty. We do this by managing the smaller aspects of their lives: setting a routine, cleaning, exercising in novel ways or reducing consumption of news. None of these are a fix, but taken together, these and a myriad of other ideas help to take the edge off our generalised anxiety.

 

A Modified Grief Reaction

In our responses to the virus and its spread, there is compelling evidence that our reaction is experienced in phases. These phases follow a familiar pattern of grief: denial, panic, anger, sadness, bargaining, acceptance and meaning-making.    These can happen in any order, be mixed up together or come in waves.  

Generally, we can see all these reactions at a population level. For example, only a few weeks ago we all knew the virus was coming but carried on as usual (denial).   Then it was as if a collective switch was flicked and suddenly, en masse, we started ‘panic buying’ and hoarding. These behaviours are often irrational (there is plenty of everything to go around, just not all at once) but they seek to restore a sense of control and certainty.

Grief then sets in, which can manifest itself as anger or sadness, often depending on our personality: anger at not being allowed to do things, or sadness that activities are no longer available.  Oddly this can be reinforced with watching TV or other media – most shows involve people mingling and we are reminded of what we have lost.

We also bargain and negotiate with the world around us – it will only be for a few weeks; my vacation is probably ok, I’ll be safe. Again, this addresses the three U’s – we want life to be predictable in a good way and for our plans to work out.

Acceptance begins to emerge too – ‘it is what it is, so let’s make the best of it’; ‘I can read more, catch up on TV more, clear out the garage or the attic (or both!), catch up with friends on social media’.   

Meaning-making emerges once the crisis has subsided – ‘what was that all about!?’, ‘was I who I thought I was?’, ‘is the world as I thought it was’.

Stages of Grief

 

Loss of Epistemic Trust

The Psychologists Fonagy and Allison recently published a speculative work on the development of trust in the world around us to aid our understanding of how psychotherapy works. However, the concept also resonates with our current experience where our generally accepted ideas of safe places (‘I’m going to the bar tonight’; ‘there will be food in the shops next week’; ‘I can plan my holiday’; ‘politicians and experts rarely impact my life’; ‘I’m going to work today and will be back later’) are compromised.  This particular breakdown of ‘epistemic trust’ leaves us in a quandary of uncertainty and increased vigilance.    

We can see this in public places, where normally social and courteous people pointedly avoid each other and the concept of ‘going to the shops’ or even just ‘out’ becomes hazardous. Concern mounts at the potential contamination of surfaces.  Our entire environment of social connection and physical space becomes hazardous. 

The threat is real and can’t be mitigated by perspective taking. Instead an approach of helping others to identify what is happening (a mental model such as grief or shock), seeking out trustworthy sources of information and learning new coping strategies are likely to have a positive impact.

 

Possible Groups of Solutions

  • Reduce the impact of the 3 U’s by making our immediate environment a little more predictable, controllable and certain.  Meet friends for drinks by Skype tonight, have an online pub quiz, do an online course with friends.

  • Recognise the phases of our responses: which phase or phases we are experiencing and gain some extra insight into our behaviour, thoughts and feelings.

  • Recognise the profound nature of the pandemic and its ability to render our experiences of our world as untrustworthy.  Seek ways to understand that and to identify ways of making our immediate world less threatening.

All of these are small changes that can generate a significant improvement in the wellbeing of our clients, colleagues and, of course, ourselves.

Explore more on the Covid-19 section of our website.