'Escalating Panic': Social Worker On How Coronavirus Pandemic Can Affect Mental Health And How We Can Better Cope

The coronavirus pandemic is a global threat to physical health. But it's also a challenge to mental health.

49-year-old Eliza Williamson of Framingham works in community education for the National Alliance on Mental Illness Massachusetts chapter. She's been managing emotional distress from mental health issues and trauma for years. Williamson says the spread of COVID-19 and the changes in daily life have been anxiety-provoking.

"I'm a control freak just by nature, so the uncertainty of what's going to be happening has been really tough for me — both the worries about contagion and being over-saturated with media updates," Williamson says. "So it's definitely a cycle that I wanted to interrupt as quickly as possible for myself."

"When this initially started... I was finding myself — my wife in bed beside me, the dog sleeping, and me with the phone screen, the blue light sort of on my face, reading about what's happening in China, what was happening Italy, and sort of going down the rabbit hole of stories of how bad things could get," Williamson adds.

For more on how the coronavirus pandemic is affecting our mental health, WBUR's All Things Considered host Lisa Mullins spoke with Karen Zilberstein, a licensed clinical social worker in Northampton. Zilberstein described what she's seeing among her clients and offered guidance to help people cope.

Interview Highlights

"People are telling me that they're very worried about catching the virus, about spreading the virus, about how that will happen. One of the difficult aspects of this for them is that anxiety symptoms can mimic physical symptoms. So when you get very, very anxious, you get short of breath. Short of breath is one of the symptoms of the coronavirus. And there can be an escalating panic over, 'Oh, am I sick?' And I think a lot of people are overthinking the, 'Am I sick?' They're interpreting symptoms in a lot of different spheres and as physical illness that might not be. They also have a lot of anxiety about their family members, about how their life is being disrupted, about what's going to happen financially and other ways in the long term.

Lisa Mullins: What are some of the triggers that people are telling you about?

Triggers are often watching the news, talking to other people, being in the community and suddenly hearing somebody cough. There are lots of triggers that can [set] it off, but it needs to be a reminder of what the stress is.

It's almost like everywhere you look, there's a reminder these days.

Everywhere you look, there's a reminder. So it makes it very, very hard.

Who among these people are you most concerned about?

I'm most worried about people who don't have good support systems, who might be very isolated, so they don't have people who can help them through this. I'm worried about people who don't have very good regulation of themselves, that they don't have very good coping skills. And that might be because they've had preexisting trauma or other problems that have eroded their ability to cope and have really made their stress, as we call it, the stress response system, hyperactive, so that they respond very largely to any stress. People who have a history of substance abuse, because I think that part of what happens is that when people get stressed and if they don't have good coping, they go to maladaptive ways of coping. I also worry about people with poor relationship skills and [who] have a tendency to lose self-control, because another sign of anxiety and another result of anxiety is becoming irritable and having outbursts of anger. And if you don't have enough self-control to contain that, you can get yourself in pretty big trouble.

What could you tell people now? I mean, we're in such uncharted territory that a lot of people who rely on, for instance, social supports, don't have them. What can you say to try and ameliorate that?

I think people need to try and find those social supports. And we are actually lucky that we live in a technological age and that there are opportunities to connect with other people online or through the telephone.

Very often we're hearing how we should really, you know, cut the cord and get off technology. This is not one of those times.

This is not one of these times. Right now we're lucky that we have technology. Technology is giving us lots of opportunities to connect. If your teenager wants to play an online game with his buddies, it's much better to have that social contact than to have no social contact at all.

And I encourage people to make lists of who they can turn to, who they can talk to, to use online support groups, to make sure that they do the activities also that give them a sense of control and purpose and that calm their nervous system.

Like what?

That might mean going for a walk, doing some exercise, listening to music. Everybody has different things that help calm them and focus them. [For] some people it's meditation. It doesn't work for everybody, but mindfulness can certainly help.

What do you tell patients of yours who are being told to stay home, but you know that their home is not necessarily a healthy place or a safe place, emotionally or physically?

Right. And that's very concerning when people are staying home with families and there's high conflict in the family, so that you worry about that exploding. And then there really does need to be systems in place for people to take a break, try to help people practice that when they're irritable, that they actually stay away from people rather than engaging, and that they learn that if somebody else in the family is irritable, that they should take a step back from that person.

We so often get encouraged to say, 'What's wrong with you? What's going on with you? Stop that,' but actually, that just feeds the cycle.

Are your clients coming to you, to your office? Are you talking to them on the phone or FaceTime or one?

Most therapists, I think, are converting to tele-therapy right now. There are HIPAA-compliant platforms that can be used. So that would be over video. People who don't have video, they've just relaxed some of the rules, some of the insurance companies, to allow for telephone contact. I have a very few clients whom I'm still seeing in my office. I don't know how long I can do that. With a lot of restrictions over the [social distancing], I'm wiping down every surface after they leave. And to the extent that I feel that that's safe, I can continue that with people who don't have privacy at home, who don't have another place in who it seems very, very important to have face to face. But I'm not completely sure how long I can continue that.

The federal government addressed this a little bit earlier today. I wonder what kind of guidance you're getting from the state, or in fact, even beyond tele-medicine, from the federal government or from insurers?

Most of the guidance is not coming from the state. I don't think there's been any bulletin that's been sent out widely. The Centers for Disease Control and [Substance Abuse and Mental Health Services Administration], which are the two national organizations, have posted on their websites some tips and guidelines. But I think it's been up to everybody to interpret what that means for their practice ... The initial issues for most therapists was how do I continue working, and is it safe to do face to face meetings. And I don't think that has yet been decided. So everybody's making their own decisions, although people are tending not to do it.

Do you have any success stories? I think we could all use them. But is there — even in the short period that this has been front and center in the past few weeks — do you have a client who you think had ... something that you think worked as a success, that other clients might find help from?

I'm very impressed by the resiliency of people. We worry a lot about the people who aren't resilient, but a lot of people are resilient and they're finding purpose.

So I've had clients who said, 'Well, you know, I've had a list of things to do at home that I never get to. And this is my chance. This is my chance to think with my children who don't have a structured day. How do they learn certain skills of structuring their time and making do and coping?' I think if people can turn it into lessons learned, it can really help.