A clinician’s guide: managing COVID-19 stress and anxiety

COVID-19 is a marathon, not a sprint

These days, it may feel like you’re running a marathon, except you don’t know the distance, the route is unpredictable and you have no way to judge if you’re fit enough to finish. Feeling scared? Anxious? Stressed? You’re not alone.

Any good running coach would tell you to have faith in your preparation, and to remember to focus, pace yourself, breathe and to recover.

We’ve pulled together a handful of tips to help you do the same in the days and weeks ahead.

 

1. Training

Training drills into you the right actions to take in any given situation. Paradoxically, that’s the grounding you need to adapt and be flexible. Because no one knows what’s coming, expectations, instructions and protocols will change as we learn more about COVID-19. Plan what you can, and then learn to go with the flow. 

We all receive training on hand hygiene, but these days it has become critical. You know it, you do it, keep working at it, remind your co-workers, your family, your patients, your neighbours, anyone who asks you and even those who don’t: wash your hands.

To keep track, ask yourself between patients: am I doing everything I can to protect myself and others (washing hands, not touching my face, wearing a mask and gloves and — where necessary — an eye shield, protective clothing?)

Your training has also taught you to plan for the unexpected. As a clinician on the front lines, you have an elevated risk of contracting COVID-19. Do you have a strategy in place in the event you are asked to self-isolate? Set up an isolation plan that ensures you have adequate supplies for two weeks, as well as childcare and separate living space if your family should need it.

 

2. Focus

The influx and rapid change of COVID-19 information can be overwhelming for all of us. In our own minds, in our conversations, in the news, on social media — it’s everywhere. Do your best to turn down the volume and slow the flow of information.

Your training emphasizes the importance of best evidence ― focus on getting your news from reputable organizations, and policies and practices from official sources, like the Public Health Agency of Canada or your local public health authority.

To slow the flow, try putting limits on how much time you spend on social media or following the 24-hour news cycle. Turn off phone notifications and, if you’re inundated with messages, ask your colleagues to bundle information on a platform outside of group emails, where information can be available without it being a constant. Basically, if it’s making you anxious, step away for a while.

And, while negative and alarming news gets a lot of focus, it’s important to remember to balance those by recognizing the acts of kindness all around us, like the medical students running errands for hospital staff or the businesses donating or manufacturing personal protective equipment.

Stay current on COVID-19

The COVID-19 pandemic is evolving rapidly. The CMA has a COVID-19 collection of public health information, patient handouts, and other resources available for you. This information will be updated regularly using credible sources to keep you up to date.

3. Pace yourself

Marathon runners know you can’t sprint to victory over 42 kilometers.  You have to pace yourself. Things are evolving at a crazy speed, but we can’t keep stretching ourselves physically and emotionally over the long haul. This is a recipe for burnout. Take control of the pace of your life (as much as possible). Start your day with five minutes of planning and visualizing what you want to get done, and over the course of the day, take breaks. At the very least, pause for tactical breathing between tasks.

 

4. Breathe

There’s a risk, in times of high stress that we experience a flight or fight response. To be at your best self, you need to slow yourself down and decrease your physiological arousal. You need to breathe. The Canadian Armed Forces — who know about working in stressful conditions — use tactical breathing to focus, gain control and manage stress. It also helps control worry and nervousness. Here’s how to do it:

  • Visualizing each number as you count, breathe in slowly for a count of four;
  • Pause and hold your breath for a count of four;
  • Exhale slowly for a count of four;
  • Repeat three to five times.

 

5. Recover

Stress builds up under unrelenting demands and may lead to depleted energy. But all of us have “energy makers” that give us strength and build resilience. Yours might be working out, playing with your children, reading, doing something creative or focusing on your spirituality. It won’t be easy to find time for it, but just a few moments can make an impact.

Social distancing does not mean cutting yourself off from other people. If you can’t meet face-to-face, pick up the phone for a chat, FaceTime, or even a text. Spend your break listening to a co-worker, not scrolling through your social media. Maybe hark back to buddy systems and arrange to check in every day with someone you can be open with and talk honestly about what you’re going through. Listen to how they feel.

Listen to your own feelings. Know the signs indicating that you’re stressed out, and when they appear, you need to act. Get some rest, get some distance, find some calm. And remember — research shows emotions are contagious. If you don’t work to mitigate your stress, people around you will be more stressed. Reducing your own stress helps others too.

Indeed, helping others is known to be an excellent way to help yourself. There’s good evidence that being compassionate and empathetic eases stress. Take time to ask colleagues how they’re doing, compliment or thank them. Let them know you’re there for them, or just that you understand what they’re going through. You’ll both feel the better for it. 

In medicine, we embrace certainty. But with knowledge about COVID-19 changing at a rapid pace, we don’t know what the finish line looks like or how we’ll get there. It will be challenging ― it already is ― but we’ll get there.

 


Check in with yourself often using these 5 questions

  1. Am I doing everything I can to protect myself and others (distancing precautions, washing hands, not touching face, wearing gloves/masks as needed)?
  2. Do I have an “isolation” plan set up just in case?
  3. Can I do one thing to help someone else in the community?
  4. Where is my mood on this self-assessment tool (pictured right)?
  5. What is one small thing I can do to keep my spirits up, recharge or move toward the green color?

Graphic adapted from Road to Mental Readiness, Canadian Armed Forces © October 2017 Drs. Kerri Ritchie & Caroline Gérin-Lajoie, The Ottawa Hospital

_
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about this topic? Please connect with us at jouleinquiries@cma.ca.

 

About the author(s)

Dr. Caroline Gérin-Lajoie

Dr. Caroline Gérin-Lajoie is a psychiatrist and the vice-president of physician health and wellness at the Canadian Medical Association.

More Content by Dr. Caroline Gérin-Lajoie
Previous
Lessons from an astronaut: how to stay resilient in isolation
Lessons from an astronaut: how to stay resilient in isolation

Many frontline health care workers are self-isolating to avoid infecting family, friends and colleagues wit...

Next
How to talk to your kids about COVID-19: Considerations for health care providers
How to talk to your kids about COVID-19: Considerations for health care providers

Talking with children about dangerous or scary situations such as the COVID-19 pandemic is difficult for al...