COMMENTARY

How to 'Be Still' During COVID-19

Gregory Scott Brown, MD

Disclosures

June 04, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

I'm Dr Gregory Scott Brown. These days, we are all thinking about COVID-19. We're learning how to navigate life in an age when Zoom hangouts, masks in public, and standing 6 feet apart is the new normal. The coronavirus pandemic has occupied the news cycle and, in many ways, upended life as we knew it.

We're also spending a lot more time having conversations about mental health, which is a good thing. People all over the world are experiencing the impact of social isolation on depression, anxiety, and the tendency to feel more disconnected in general.

A recent statistic garnered a lot of attention. During the month of April, there was one death every 45 seconds attributed to COVID-19. If that number sounds familiar, it's because someone succumbs to suicide at close to the same rate, coronavirus pandemic or not. Collectively, we can do better. I actually believe that drawing public awareness with these types of discussions (eg, articles, blog posts, multimedia), in addition to the important work physicians do every day in the clinic, represents a small step toward dismantling stigma and ultimately saving lives.

There's no denying that patients and physicians alike are all a bit anxious about what's going on right now. In fact, a recent Express Scripts report titled America's State of Mind shows that 78% of all antidepressant, antianxiety, and anti-insomnia prescriptions filled during the week ending March 15 (the peak week) were for new prescriptions. Among these conditions, anxiety seems to be the biggest issue, with a 37.7% increase in new anxiolytic prescriptions recorded between February 16 and March 15.

Other reports suggest that alcohol sales have also increased. There is some concern that with more Americans staying at home, people are turning to alcohol as a coping strategy. All physicians should be cognizant of this and screen appropriately, as patients "self-medicating" is not uncommon.

Over the past few months, I haven't had a single conversation with a patient where the coronavirus has not come up in some form. But I'm also noticing some important trends in the clinic. Whereas some patients are struggling with adapting, others are using this as a time for reflection, perspective, and to be still. Many of my patients have actually been able to successfully lower their antidepressant dose or even completely discontinue medications for anxiety, despite the common belief that everyone is getting worse.

How to Use Quarantine to Improve Mental Health

In trying to understand how this might be possible, let's start with the obvious. Life has slowed down for all of us, which isn't bad. Before the pandemic, how many of us were starting our day in complete disarray? A quick shower, a bite to eat, coffee on the go, and trying not to be 10 minutes late for work.

If anything, we've now been given more time. Time can allow one to become idle and invite anxious ruminations, but it can also create space for a short walk to start off the day, a longer lunch break, or more quality family time. Perspective can help us see a slower pace as an opportunity to emotionally detox and recharge. Plus, we don't have to feel idle if we continue to maintain structure in our day, adopting a schedule that many of us actually have more control over now than before.

The second point worth noting is that being still can impart a sense of control. A metaphor I like to use that resonates with my patients is that of feeling like a pawn on a chess board, being pushed around by life. Being still means coming to the understanding that each of us is in control. We aren't pawns. We are playing the game.

When we're not moving around so much, it can create an opportunity to hear our own empowering thoughts more clearly, if we allow them to be heard. We all have control over how long we wash our hands, and whether we choose to wear a mask and maintain physical distancing. All of these things reduce our risk of getting sick or getting someone else sick. That's a lot of power. Reminding patients about what they do have control over can shift fear of getting sick to the idea that they can protect their own health and the health of those around them.

Finally, and frankly, stillness has taught many of my patients that they do not have a defective brain. The same patients who came to me months ago asking for a pill to fix a neurochemical imbalance are saying to me, "Hey, Doc, since I'm not going in to work every day, the anxiety and the panic attacks are essentially gone. I had no idea how much this work environment made me feel anxious." The toxic work environment, or any type of unsupportive relationships, could make someone feel anxious or even depressed.

Stillness might have several definitions for our patients at the moment, including going for more walks and runs, spending more time enjoying a meal rather than eating on the go, or taking a long bath instead of a quick shower. The key is finding ways to hold onto these interventions when the pace of life picks up again.

Of course, some people are really struggling right now. For those who are, mental health professionals are available. Some of us are even working overtime.

That being said, physicians from any specialty can help patients use the power of perspective to take advantage of this time to be still and to emerge better than before. There's real tragedy in the world, but there's also an abundance of resiliency, which creates space for hope.

I'm Dr Gregory Scott Brown, reporting for Medscape.

Dr Brown is an affiliate faculty member in the Department of Psychiatry at Dell Medical School at University of Texas at Austin. He is also the founder and director of the Center for Green Psychiatry in West Lake Hills, Texas.

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