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Ask a Doc: Managing Stress, Even During COVID-19

In our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this post, Dr. Betsy Blazek-O'Neill answers questions about managing stress.

Dr. Betsy Blazek-O’Neill, medical director, AHN Employee Health Services, and a physician in the AHN Integrative Medicine Program.

Dr. Betsy Blazek-O’Neill, medical director, AHN Employee Health Services, and a physician in the AHN Integrative Medicine Program.

The American Psychological Association’s 2019 Stress in America report noted that people said they experienced moderate stress — on average, 4.9 on a 10-point scale. Of course, that was before the intensified health worries, isolation, and uncertainty of the COVID-19 pandemic. In April, about half of Americans reported that the pandemic had impacted their mental health, and one federal emergency hotline for people in emotional distress saw a 1,000% increase in calls compared to last year.

For some insights on managing stress, I talked with Betsy O’Neill, MD, medical director of Employee Health Services for Allegheny Health Network (AHN). She emphasized that stress isn’t just a mental health issue, it impacts physical health, including potentially increasing the risk of heart disease, diabetes, and other conditions. The good news is that, even during a pandemic, a little stress management can make a big difference. As Dr. Blazek-O’Neill put it: “There are simple things we can do for a few minutes each day that help counteract stress — you don’t have to spend nearly as much time managing stress as you spent being stressed in the first place.”

Stress and overall health

Emily Laubham (EL): Do people tend to underestimate the impact of daily stress?

Dr. Betsy Blazek-O’Neill (BB): When you ask people what they need to do to be healthier, they’ll say, “I need to eat better” or “I need to exercise more,” but they don’t make the same connection between stress and their health. They think of it as something that makes them feel bad in their head, but don’t take it any further.

There are two ways to think of stress. People create some of their own stress by setting unrealistic expectations, taking on too many tasks, volunteering for things they don’t have time for, not enlisting the help of coworkers or family members, or feeling like they have to do everything for themselves.

Then there’s the stress you can’t cast off or get rid of. Work is often stressful, our families are often stressful, we might have health or financial issues. These are things that we can’t necessarily make go away, so we need to find ways to cope.

EL: A certain amount of stress is natural — even good for you — but how can we tell if our stress levels are entering unhealthy territory?

BB: Stress is an energy zapper. If you’re having trouble sleeping and there doesn’t seem to be another reason, if you’re eating all the time or not eating much at all, if you feel irritable all the time, if you feel more tired than usual — these are all signs that stress is crossing the line into “too much.” It can also show up by affecting your ability to relate to other people, so pay attention to your relationships.

Stress will amplify anything you already experience, too. For example, if you have migraine headaches normally, you might have more of them. But if your symptoms start to get out of control — can’t eat, can’t sleep, can’t stop ruminating — that’s when it is time to seek help.

EL: Can you speak to the unique kind of stress associated with COVID-19?

BB: We haven’t faced this disease before — the element of the unknown is what makes it so scary for people. What tends to fill the gap in information is misinformation and hysteria. That’s a natural response, but it can result in people feeling very uncomfortable. We want people to be informed and stay aware enough to protect themselves — practice social distancing, use a mask, wash their hands, avoid travel if possible. But we don’t want people to become paralyzed with fear.

For the kind of generalized anxiety that people are experiencing with COVID-19, one good tip is to take a “news fast” every so often. You can get a daily update in five minutes, but to sit and watch all day or always be checking, that usually ends up being harmful. Constant monitoring can become an obsession that is hard to dial down.

Healthy coping techniques

Stress management doesn’t need to be complicated; it can be as simple as taking a short break to “just sit.” (<em>Without</em> your phone.)

Stress management doesn’t need to be complicated; it can be as simple as taking a short break to “just sit.” (Without your phone.)

EL: Some ways of coping with stress are unhealthy — eating junk food, smoking, drinking. What healthy alternatives do you recommend?

BB: Simple breathing exercises can be very effective. While you’re involved in a stressful event, just taking three or four deeper breaths than usual can start to calm your body down. There are many apps now that you can use on a smartphone or tablet to de-stress. I advise using relaxation apps that are primarily auditory. For example, I listen to the audio-only versions of relaxation postings I find on YouTube. It could be whatever you like — ocean sounds, nature noises, or someone leading you through a verbal relaxation exercise.

But I also caution everyone about the dangers of too much screen time, which can increase anxiety, depress mood, and interfere with your ability to sleep. With COVID-19, many people are working remotely, so they may be staring at a computer screen even more than usual. At night they’re watching the TV screen, and throughout the day they’re looking at their phone screen to check social media or text or scan the news. It’s important to schedule screen breaks — eat lunch away from any screens, go for a walk, use the phone to call a friend instead of for a screen-based activity. Make sure there is a period of each day when you’re not using electronic devices.

EL: Some people have a tough time with things like breathing exercises or relaxation apps. What other approaches can people use to help manage stress?

BB: There are many more active things you can do to relax, like yoga, Tai Chi, or writing in a journal. What works for me is almost every morning after my shower, before I start work, I do about five minutes of yoga. After that, I read a couple short inspirational quotes, and then I write down three things I’m grateful for in my journal. In total, that takes only about 12 minutes, but it gets my day off to a positive start.

Probably the most effective stress reliever available is to do some form of exercise every day — and it could be as simple as taking a 15-minute walk. People think about exercise to lose weight, or because it’s good for their heart, but regular exercise is essential for mental health. It’s been proven time and time again with people who have anxiety and/or depression — exercise is as effective or sometimes more effective than medication.

Exercise remains very important as we’re dealing with the stress of COVID-19. Maybe you can’t go to the gym right now, but you have many options, including a ton of free classes and videos on YouTube. And we can still go outside while practicing social distancing and wearing a mask — I try to get out every day to walk, run, or ride my bike.

EL: Isolation can cause stress, but because of COVID-19 we’re all isolated to some degree or another. What do you suggest?

BB: Social isolation is really hard. Again, while still trying to limit screen time, you could schedule a Zoom meeting or other kind of video chat. Or just make a few telephone calls throughout the day to check in with people. Also, some people think COVID-19 means you can’t be around anyone at all, but the real goal is to minimize contact and take proper precautions. If you want to go somewhere with a friend once a week and you’ve both been careful, I think that’s OK. A friend and I recently went on a bike ride out in the country. We stayed six feet apart the whole time, and when we were in the car, we wore masks.

EL: What should people keep in mind when it comes to food and stress?

BB: I’ve read several articles about people who had healthy diets before COVID-19 happened but then slipped into bad habits — comfort foods, processed foods, junk food. That kind of food increases inflammation and can make stress worse. It’s natural to crave certain comfort foods when we’re stressed, and it's OK to enjoy them once in a while, but you don’t want it to become your steady diet, because it has a definite impact. Remember, too, that your immune system needs healthy food to work well. Fruits and vegetables have a lot of antioxidants that can help fight off disease.

What you don’t want to do when you’re already stressed about COVID-19 is put additional stress on yourself to maintain a perfect diet. That’s not realistic. Be kind to yourself.

Getting (and giving) support

EL: What do you suggest for times when stress starts to overwhelm us?

BB: First, it can be so helpful to share something that’s stressful with another person who is experiencing it, or someone with an empathetic ear. This could be anyone — a parent, friend, therapist, perhaps a minister.

Sometimes you might need to consider professional help from a psychologist or a social worker. Many employers have Employee Assistance Programs that provide confidential psychological support, often at little or no cost.

In response to COVID-19, most health insurance pays for behavioral health care services right now, so you can contact your primary care provider or call your health insurance plan and explain that you would like to talk to someone in psychiatry or psychology. Many mental health providers are able to offer telehealth options, too.

As always, if someone ever feels like they are in a critical situation, don’t wait for an appointment — there are crisis intervention lines to talk with someone right away.

EL: If we’re not stressed, but our loved ones are, how can we support them?

BB: When it comes to supporting our loved ones, it’s much the same as what you would do for yourself. Anytime you want to help someone change their behavior, modeling can be very effective. Help them reduce their screen time, get outside, exercise, and eat a good diet. All of these things can be done while still following all the COVID-19 safety precautions.

Whether it’s COVID-19 or something else, you have to be sensitive to the fact that someone else might be more worried than you are. But if someone you care about is becoming obsessive, you don’t have to do the same — look for ways to make them more comfortable.

EL: There’s a notion making the rounds on the Internet that quarantine is the time to learn a new language or write the next great American novel — something big that requires time and discipline. While one person may do well with a “big” distraction like that, others might feel plain exhausted and just want to take a break. Are both approaches OK?

BB: Yes, people respond to stress differently, and what helps one person cope with stress may not be the best strategy for someone else.

No one is happy to be in this situation, and I have much empathy for people who are sick or unemployed or have lost loved ones. But one positive thing happening for some people is that they are learning to appreciate a less stressful lifestyle. I have patients who tell me that the social distancing has provided a new way to think about how they spend their time. They don’t have to run from task to task, putting pressure on themselves to get everything done, and they are instead having relaxed time with their families. These are things that can be kept in our lives after the restrictions are over — learning how to not over-schedule, over-plan, and over-think.

It’s healthy to spend a little more time being instead of doing. As Americans, we’re pushed toward always doing, always keeping busy. Like the example you gave, if there is extra time, then we feel the pressure to fill that time by doing a big project. We’re uncomfortable with just being. To get a sense of that, set a timer and sit in a chair for 10 minutes with no book, no phone, no TV, no music. For many people, that gets very uncomfortable.

I also hope that the stigma surrounding mental health may decrease during this difficult time. With so many people feeling like they need a little support, hopefully people get more comfortable reaching out for help, and feel more empathy toward others who need help.

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