A year after the Coronavirus pandemic wrecked our collective lives, our society has been grappling with fear and insecurity. As a result, we have seen misinformation spread like wildfire, and many resorting to bizarre and incorrect methods of dealing with the virus. With this column, which will be published every Sunday, we aim to address any health or vaccine-related question our readers might have about the coronavirus pandemic.
In this week’s column, Dr. Prabha S Chandra, a Professor of Psychiatry at NIMHANS, Bangalore, has answered questions related to mental health and COVID-19. The pandemic has caused as well as amplified people’s anxiety, insecurities, and fears. Those with serious mental health issues have been left even more isolated and alone during this time. As we celebrate Mental Health Month, Dr. Chandra addresses such issues and tells our readers how to cope with vaccine anxiety, stress, and ICU trauma.
Many people are suffering from vaccine anxiety before taking the first jab. How can they address it? Does this anxiety affect their bodies and the vaccination process?
One of the reasons for Vaccine Anxiety is getting a lot of misinformation about side effects and hence there is a fear of the unknown. Also, most adults in India have not really had a vaccine in their adult lives so it seems really anxiety-provoking for those who fear injections and hospitals. For others, there is worry about actually being able to get an appointment and go to a vaccination centre where they feel they may have chances of COVID infection if there are lots of people.
So, the way to handle anxiety is to talk to someone who has already received the vaccine and find out their experience and how they handled the pain in the arm or the fever that might have happened after the vaccine. Get informed about what a vaccine does. And if you have doubts ask a doctor to give you the correct information. Prepare yourself beforehand by having a painkiller or paracetamol tablets at home so that if there is fever or some pain you know how to handle it.
Tell yourself that if you and everyone around you get vaccinated- ultimately you will be able to go out without much fear and anxiety about getting COVID 19 infection. Anxiety will not affect your immunity or the vaccination. Wear comfortable clothes when you go for the vaccine so that your arm is not tense. Tell your workplace that you may take a day off if there is pain or fever and want to rest. If anxiety is too much- try square breathing- Inhale 1-2-3-4, hold 1-2-3-4, exhale 1-2-3-4 and hold 1-2-3-4. Do this 5-6 times a day whenever you see anxious thoughts coming in
When you go to the vaccination centre maintain 6 feet distance, wear a good mask and sanitise, The nurse will keep you there for half an hour after the vaccine. If you have any doubts and feel you have fever or pain after the vaccine, keep a doctors phone number so that you can contact them. Remember vaccine is a friend and is the best way of tackling the current pandemic
After vaccination, can stress affect the immune or the nervous system? How to deal with it?
Stress if excessive is known to decrease immunity overall and not specifically against COVID 19 alone. It is important therefore to follow a daily routine with four components- work, play and leisure, some social and family interaction which are supportive, rest. Try and balance all these components rather than focusing on one aspect only. Many a times, when you are stressed, it maybe due to HALT- Hunger, Anger, Loneliness, Tiredness. So, if you are getting stressed try and label it, identify it, try to understand what the main cause of worrying is, specify it so that it becomes less overwhelming.
For example, The stress may be because you have a family member admitted with COVID 19. Try and see that you are not always thinking only about that and be aware that if you are too stressed, you will become less effective. Instead, make a list of things you have to do, try to do some chores, spend time with a child or a pet or talking to a friend or relative, water a plant. All these things while appearing mundane, will help you calm down which is required when you have to handle a crisis.
Due to grief and doom everywhere, there is generally an atmosphere of fear and hopelessness. Many have even developed chronic insomnia because of it. How can people find a balance when so many are losing their loved ones and/or going through traumatic experiences?
It is very difficult indeed and we are all going through so many emotions. We hear about so many people dying or being critically ill that it is hard to stay positive. Remember that the pandemic will take time to slow down.
Each of us has our own threshold for feeling sad about the situation and anxious about it. Identify your threshold and be aware of how you are feeling. The moment you feel that you are overwhelmed, try to delink from the news or the conversation and pay attention to something else. While you can’t stay positive always, what you can do is identify what stresses you out most. Is it your fear, is it death and dying, is it the fact that oxygen or beds may not be available- which kind of news makes you feel overwhelmed. Try not to shut yourself away from all news because that will lead to avoidance. Avoidance can increase anxiety because it increases your sensitivity to becoming anxious. You may find that if you are avoiding all bad news, you get triggered even with small things.
Also, try and involve yourself in helping someone. Even if it a small thing like talking to an elderly person in your family over a call daily, organising food for the needy, doing an hour of volunteering or helping in the neighbourhood with some information. All this will make you feel that you are contributing and feel less out of control.
How does a person’s time in the COVID ICU ward affect his/her mental health? What can be done to help them?
Being in an ICU can be extremely isolating and lonely and scary even in non-COVID situations. In the COVID pandemic, no relative can visit the ICU, the staff, nurses and doctors are in PPE and you can’t see them or identify a familiar face and there may be a lot of suffering and even deaths in the ICU. All this makes it an extremely isolating experience. The main thing which will help them is to stay connected with family and dear ones through frequent video calls or messages. Having something familiar can also be calming and a photo of a loved one, a religious symbol or a good luck charm or some music playing in the ICU can soothe.
Doctors and nurses need to provide information about procedures, what they are doing, and mention any improvement that is happening or when the situation is stable. When speaking to your loved one who is in the ICU or when messaging them, send messages of hope, record your voice with a soothing message or some chants or soothing music, jokes and humour which they can play for themselves or the staff can play for them. If there are grandchildren, let them give messages and cheer them up and provide hope. Make sure they have their glasses or hearing aid, or a pen and a writing pad.
Once they are discharged from ICU and come home, many may continue to have flashbacks of the time in the ICU and relive the trauma. They may get anxious or have nightmares and dreams. Some people may do the opposite and feel numb and not want to talk about it at all. Respect their individual wishes about this. If the anxiety, flashbacks, nightmares and sleep disturbances are too much- that is suggestive of PTSD. If anxiety is overwhelming, we might want to use some grounding techniques like encouraging some sensory stimulation using the five fingers method. In PTSD, people feel that they are in the traumatic situation again rather than realising that they are now out of danger. To make them get back to the present and for the brain to recognize that the threat is over and they are safe, these grounding techniques help: 1.Name Five things that you can see at this time wherever you are. 2. Name Four things you can Hear at this time- the fan, kitchen noises, rain, dog barking, birds chirping are some examples. 3. Name three things that you can Touch – touch different surfaces and describe the sensation. 4. Name Two things you can Smell.
5. Name One thing you can Taste.
This will help in grounding, bringing the person back to the present and decrease overwhelming anxiety. If the problem is too much then, encourage them to seek mental health support.
What should one say to the family members of COVID patients, which is sensitive and empathetic and non-intrusive and doesn’t enhance their fear and trepidation? What are things that one should never say to family members of COVID patients?
First of all, offer support in a more practical manner. When a family member develops the infection, because of anxiety family members may not pay attention to their own well being. See if you can arrange meals, medicines or help them get registered for a bed. Offer to help out with procuring masks, sanitiser etc or groceries. Send encouraging messages and do not give any medical advice unless you are a doctor. Reassure them when they are anxious and ask them to note down their symptoms so that they can have an informed discussion with their doctor. Allow them to rest and don’t call them again and again. Assure them of your support in case of an emergency. Provide them with information about local volunteer group numbers and local triage centres. Provide hope, humour, and lightness.
Because of lockdown, many have found themselves to be extremely lonely in the past year. How can they keep their spirits high?
Loneliness is being considered the new pandemic. What can you do to feel less isolated? Trying to stay connected and allocating time to stay in touch with family and friends including online group activities. Having a routine,
Indulging in some daily rituals – like spending time on your balcony with plants, trying to learn a new skill, using your time to organize things at home- your paper, accounts, clothes. Finding ways of helping and supporting others – like within your circle or a volunteer group. Having a clear boundary between work and home especially if you are working from home. Move a lot. Get up every 20 minutes from a position and move around, stretch and walk a little even within the house.
At the end of each day write down three things that you were able to do- not just work but anything that you did for yourself or others. Maintain a diary – either writing or audio where you jot down your thoughts and ideas. Keep a balance between bad and good news. Don’t avoid keeping up with the current situation, at the same time also pay attention to the happier things. Humour is a good way of forgetting all the problems for just a while.
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