Understanding Anxiety During Covid 19 and the December Stress

By Nora Joy, Director of Behavioral Health at The Color of Law Center — December 4, 2020

As we enter into the month of December, we are often reminded of multiple events. December is a time when multiple holidays are celebrated. They include Kwanzaa, Christmas, Hanukkah, and other holidays. They include the organizing of family gatherings and the preparation of family activities. They also include the ideas of vacation, rest, and relaxation. These holidays are often far from relaxing. They trigger negative memories for multiple people. They remind individuals about traumatic experiences that they had when they were children.

For example, a child, who may have lived in poverty and did not receive gifts during a December holiday may have grown into an adult with strong negative feelings about the holiday. A child who remembers unsettling family arguments, domestic violence, and emotional neglect may have grown into an adult that struggles during the month of December. In all of these examples, an adult may not connect one’s previous history and the factors that occurred during December as current stressors. They may not even know that they are struggling with their own childhood memories. It can be in an organic feeling of distaste or disgust that an adult may be suffering from.

Holidays this year will be like no other. The Covid 19 crisis has caused us all to distance ourselves from family and friends in order to protect ourselves from contracting the virus. We learn that two weeks after Thanksgiving is when we will see a very large uptake of people and children who have contracted the illness. It takes 2 weeks for the virus to demonstrate symptoms. Many people celebrating Thanksgiving left town and ignored the Department of Health warnings about spending time with large groups of people.

This December holiday is likely to have more cases of depression and anxiety than ever before. People from different countries are likely to suffer from the grief and the loss that comes with protecting oneself from Covid-19. We will have the opportunity to discuss a factor that many people are experiencing and that is anxiety.

What is anxiety? Kaplan and Sadock’s Synopsis of Psychiatry defines anxiety as worrying about several events or activities for a majority of days at least a six-month span. The feeling of worrying is so difficult to control that it consumes one’s muscles, it presents in an irritable nature, and it affects one’s ability to sleep. So if you or one of your family members is struggling with sleep this may be part of the problem. Most individuals have accepted feelings of grief and loss that have come along with the isolation and unpredictable nature of Covid 19 life.

There are anxiety disorders such as generalized anxiety disorder which can resemble many other mental disorders. Individuals who are afraid to enter into social arenas may be more stunted by their fears as Covid-19 increases death rates. We will see multiple groups of individuals suffering from panic disorders. Those are disorders in which one begins to breathe heavily and they often feel trapped. They can sometimes feel like their throat is closing in on them. They can experience hyperventilating and a sense of claustrophobia. They can feel as though someone or something is trying to shorten their life. Someone who experiences panic disorders in that moment may feel a sense of danger and emergency. This leads to sweaty palms, tight muscles, increased heart rate and difficulty breathing. African American communities refer to this as having a nervous breakdown. Nervous breakdown is a common description of this challenge.

Kaplan and Sadock’s Synopsis of Psychiatry describes general anxiety disorder. In order to meet the criteria of generalized anxiety disorder, one must have six months of significant worrying at activities such as school or work. One must find it difficult to control the worry. It is often associated with symptoms such as restlessness or feeling keyed up or feeling easily fatigued. One will often experience difficulty concentrating or their mind going blank. They may suffer from irritability, muscle tension and sleep disturbance. To meet this criteria, one would have to have three of those items. A child only needs one of those items to meet the criteria.

The anxiety and worry are not necessarily about how to act in that moment but it’s more about fearing being not able to control or understand something. The event brings one into a state of emergency. In order to have a general anxiety disorder, one cannot meet the criteria for obsessive-compulsive disorder or panic disorder or hypochondria. Fourthly, worrying has to be significant enough to cause an impairment in one or several areas such as in the work setting at home or in any other setting. The other factor is that in order to meet the criteria for general anxiety disorder it can’t be related to any type of medical condition such as hypothyroidism or a mood disorder.

There is help for generalized anxiety disorder. Cognitive-behavioral therapy is often effective. In a cognitive behavioral therapy session, the idea is to challenge some of the mental thoughts that occur during the state of anxiety. As each person engages in an action, there is a verbal message or a verbal thought that arrives with a particular belief. For example, imagine that there is a hurricane on its way to one’s area. The message is sent to the brain signaling that there is something threatening that is going to occur in the future. In order to develop the worrying feeling or the anxious feeling each person develops a series of ideas connected to the information that they have received.

For example, a hurricane is being announced on the news and it’s coming to one area. Someone with severe anxiety is likely to think that the coming of a hurricane is equivalent to all of one’s personal items being destroyed. The arrival of a hurricane is equivalent to believing that every hurricane causes physical harm. Often these are the thoughts that we are unable to control partially because we don’t recognize that there is a step process to these thoughts. So cognitive behavioral therapy is when a therapist works with an individual around the spot that occurs and around the belief that occurs. In this example, a cognitive-behavioral therapist would explore what led the client to believe that every hurricane causes physical harm. Does the individual believe that they have superpowers where they can predict the future? Does the individual believe that what may have happened in one occasion will always happen in the same occasion? Did this person see a story on the news and all that story as their own history? These are all the thoughts that a therapist would challenge in several sessions of cognitive-behavioral therapy.

The importance of challenging these thoughts is to identify whether they are realistic or not. The importance of challenging these thoughts are to identify whether they are perceived events or are they factual events. The reality is that we may feel strongly about something but it may not be based in reality. We recognize our feelings but it is our thoughts that launch us into believing whether there is a threat or not. The simple act of challenging those salt thoughts along with identifying when we’re beginning to feel can often be a liberating experience. We also have no clue that we’re even thinking or that we’ve adopted a particular belief.

There are other developmental types of anxiety that are much more difficult to decipher. A child might be anxious because they are too dependent on an adult or they may be anxious because they fear being destroyed or hurt by an adult. These feelings often increase around the holiday because many adults are noticeably much more stressed during the holidays. A child may be nervous due to being separated from an adult especially if the adult has a sense of lacking security. Children feel that they will lose love if the anxiety can be related to a person’s fear the letting down their own ideas and values.

The purpose of this discussion is to help demystify how individuals think about anxiety. This discussion demonstrates how anxiety can disable one’s ability to carry on with a comfortable life. As we enter into the holiday season, we will see people driving recklessly, we will see more road rage, we will see people demonstrating anger. This holiday, we will see families enter into arguments that would never have been taken into account during other years. We will see more hospitalizations due to mental health struggles. We will experience first celebrations without a loved one that they have lost due to Covid 19. New ways to function without that family member will have to be developed among the sadness.

It is important for us and everyone struggling with anxiety to seek counseling and support through their therapist if they have private insurance. If they do not have private insurance there are universities such as George Mason that provide free counseling services to first responders and teachers. There are agencies such as domestic violence agencies and homeless agencies that provide free counseling. Counseling is supported through Medicaid and private insurance. There are many agencies that accept a sliding scale fee for people as they cannot pay full session fees. There are universities that supervise interns and provide free counseling services. It is important as we move through the long-term trauma of covid-19 isolation that individuals seek mental health services and that they allow their children to seek help. It is my hope this discussion allows people to address some of their questions and fears related to seeking help for anxiety in the stress that it produces. This will be crucial in relieving Covid 19 holiday stress.

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