Coping with COVID-19 - Part 1: Introduction

The threat that each of us is experiencing with COVID-19 is significant, pervasive and without a clear end in sight. According to recent estimates, even a best-case scenario suggests that tens of thousands of Americans could die. COVID-19 differs from other types of natural disasters (floods, hurricanes, wildfires) in several ways. It is occurring almost simultaneously around our country and around the world so our ordinary sources of social support are similarly at risk for the same thing. Also, the threat to each of us arises from direct or indirect physical contact with others. Consequently, precisely at the time when we most need physical contact with others to help us control our anxiety, we are often denied that option.

The best way to understand how our anxiety about COVID-19 affects us is by looking at its impact on our brain. The brain has three primary parts – 1) the primitive reptilian brain consisting of the brain stem and hypothalamus controlling such basic functions as sleeping, eating and breathing; 2) the limbic system or emotional brain which monitors danger and decides what is good or scary; and 3) the rational cognitive brain or cortex, which leads to planning and empathic understanding. When we have trouble sleeping at night because we are worrying or obsessing about the evening news, the reptilian brain is involved. The effects on the limbic system and cortex are even more apparent. The limbic system transfers sensations from the outside world into the thalamus which sends this information to the amygdala and to the cognitive brain. The amygdala is the limbic brain’s danger detector; it triggers the release of stress hormones leading to the fight-or-flight reaction. With chronic worry and intense ongoing stimulation of the amygdala, we are prone to chronic upset, and are more reactive to stresses and conflict with others. Furthermore, the cognitive brain becomes less able to cope, to think rationally and to empathize with others. Thus, we end up feeling either agitated and over-aroused or passive, depressed and under-aroused.

The situation is even more complicated for people with a history of childhood trauma (abuse, neglect, witnessing domestic violence, bullying, living in a dangerous neighborhood) or adulthood trauma (rape, poverty, combat exposure, or exposure to a natural disaster). For these individuals, anxiety about COVID-19 may trigger all three parts of the brain to react in an even more extreme way.

However, in spite of these serious effects of COVID-19 anxiety on virtually everyone, what we know about resilience can teach us what kinds of behaviors and interventions are useful. Coping with COVID-19 requires us to 1) stay safe; 2) pay attention to our emotions; 3) stay connected with our partner and peers; 4) stay connected with our kids; and 5) somehow find meaning in what we are going through. The following series of blogs will focus on strategies for achieving each of these goals, with an addendum for individuals with a history of trauma.