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Got COVID-19 Anxiety? Cognitive Therapy Techniques Can Help

Got COVID-19 Anxiety? Cognitive Therapy Techniques Can Help

woman putting on a medical mask

During this unprecedented period of uncertainty and mounting stress, it is easy to feel afraid and to panic. Many of the strategies that we may typically use to deal with distress may not be available (to the same degree) or applicable. Due to social distancing protocols, we are unable to derive the same amount of support and connectivity from our social relationships. We also have no instances of comparable previous experiences to refer to and use as a model for coping. With the oversaturation of media coverage on the coronavirus, we are constantly being bombarded with frightening information. With this high degree of media exposure, many people are getting swept up in the pervasive world-wide anxiety.

When we are feeling anxious, our emotions and our thoughts are tag-teaming our system and constantly reinforcing one another. If we can reign in this reciprocal interaction and mitigate our reactions, we can reduce our distress level. But how do we do this? There are some techniques from Cognitive Therapy that can facilitate a lessening of some of our distress. Namely, identification of cognitive distortions and cognitive restructuring. Before I specifically jump into addressing these techniques as they apply to coronavirus anxiety, I want to briefly review these concepts.

First, it is important to recognize that our emotions don’t just surface at random. They are anchored to some sort of stimulus, such as a thought, memory, body sensation, situation, activity, experience, etc. Thus, our emotions and our thoughts (and don’t forget our physical responses and behaviors!) are connected to one another. Most commonly (but not always), the thought precipitates the emotional response. The emotional response can then provoke additional thoughts of a similar nature. Because these areas of our experience are interconnected and reciprocally interact, if we alter one of these areas, we will also enact an effect on the other areas as well. Enter the techniques of identifying cognitive distortions and cognitive restructuring.

What are cognitive distortions? Think about the word distort and its similarity to the words warp or twist. The word distortion is indicative of an unreliable representation of reality. So cognitive distortions are thoughts or thinking traps that have some inaccuracies and deceive our brains into accepting information that may not be entirely true or that may not tell the whole story. Why is this a problem? If we are operating on inaccurate or biased information, it is likely coloring our perspective and influencing our emotions. In the case of the coronavirus, such distortions are heightening our experience of anxiety. A good rule of thumb is that if you are struggling with a negative mood state, that is typically a good indicator that cognitive distortions are at work. Being able to identify the presence of cognitive distortions is the first step in being able to question them (instead of accepting them at face value), begin distancing oneself from their influence, and replace them with more balanced and helpful thinking. One more note on cognitive distortions before we jump into specific examples is that we all – read EVERYONE – experiences these thinking traps. Our focus is not so much on eradicating them entirely, but rather on reacting to them in a more adaptive way.

Some of the primary cognitive distortions that are wreaking havoc during this pandemic include: mental filtering, all-or-nothing thinking, jumping to conclusions and fortune telling, catastrophizing, and emotional reasoning.

  • Mental Filtering occurs when we focus exclusively on the negative or distressing aspects of a situation, while ignoring or dismissing the positive aspects. In other words, we may pay more attention to the information or evidence that supports our anxieties, while filtering out the information that is inconsistent.
    • Focusing on the number of cases in your state versus the number of people in the state who have remained healthy
  • All-or-Nothing Thinking is sometimes also referred to as black or white thinking. This type of thinking is extreme thinking and omits the gray zone. A clue that may alert you to the presence of this cognitive distortion is the use of absolute words, such as “every,” “always,” and “never.”
    • If you contract the coronavirus, you must go to the hospital and you will be put on a ventilator
    • We’re never going to get out of quarantine. I won’t be able to stand being house-bound and isolated from other people!
  • Jumping to Conclusions is at work when we make a judgment (usually a negative one) without having evidence to support the conclusion. Jumping to conclusions typically presents in the form of fortune telling, which means predicting a negative outcome for something that has not yet occurred. In other words, anticipating that something bad will happen.
    • My chest feels tight. It must be an early sign of the coronavirus!
  • Catastrophizing is in effect when we overinvest in the probability that the worst- case scenario will actually occur.
    • Since I have asthma, if I were to contact the coronavirus, I would not survive it
  • Emotional reasoning occurs when we assume that our emotions are accurate interpretations of reality even when we may not have concrete proof to support this assertion. In other words, we use our emotions to make judgments and interpretations rather than using facts or evidence. The thought process is something along the lines of “Because I feel this way, it must be true.”
    • Feeling worried about my older family members may lead me to perceive that they are at a greater risk of contracting the coronavirus, despite the fact that their other risk factors are low.

Now that we have become more acquainted with some of the anxiety-fueling culprits in the realm of cognitive distortions, let’s move on to what we can do about them. As a review, our thoughts influence our feelings and our feelings influence our behaviors. These influential pathways are multi-directional, but the most common trajectory is thoughts emotions behaviors. Therefore, if we can intervene at a thought-based level, we can re-route the circuit and curb the negative impact that our thoughts have on our emotions. This is the place where cognitive restructuring comes in handy.

Cognitive restucturing is a technique that helps people to examine their thought process, rather than taking their initial thoughts at face value and operating on those assumptions as though they are entirely true. This technique helps us to stop, question our thought, and examine the evidence (both supporting and refuting evidence). A great resource for beginning this process is a worksheet found on therapistaid.com, which provides questions that can be used for challenging your anxious thought, such as:

  • Am I basing this thought on facts, or feelings?
  • Is my thought black and white, when reality is more complicated?
  • Am I looking at all the evidence, or just what supports my thoughts?
  • Could my thought be an exaggeration of what’s true?

*Note: You should see a number of cognitive distortion detectors in these questions*

Asking yourself such questions and really examining your anxious thought from other perspectives should help you to gain some distance from the thought as opposed to over-attaching to it. Once this is done and we’ve discovered that the thought is not as credible as we initially believed it to be, we are ready to develop a reframing statement. Let’s practice with reframing the thoughts featured in the above paragraph on cognitive distortions.

  • Mental Filtering
    • Original Thought: Focusing on the number of cases in your state versus the number of people in the state who have remained healthy
    • Reframed Thought: It’s true that there are XXXX number of people in my state that have contracted the coronavirus. However, there is a much greater number of people in my state who are not infected. The overall percentage of infections in my state is actually low when you take into account the state population.
  • All-or-Nothing Thinking
    • Original Thought: If you contract the coronavirus, you must go to the hospital, and you will be put on a ventilator.
    • Reframed Thought: Many people who have become infected are able to manage their symptoms from home. I am not a member of an at-risk population, and I have been following the guidelines to reduce my chances of exposure. Furthermore, even if I do happen to get exposed to the coronavirus, it is not guaranteed that I will contract it. There are things I can do to boost my immunity to the virus such as eating well, getting enough rest, exercising, and managing my stress.
    • Original Thought: We’re never going to get out of quarantine. I won’t be able to stand being house-bound and isolated from other people!
    • Reframed Thought: This will pass. It is important that proper precautions are followed to keep us safe. I am doing my part in preventing the spread of coronavirus. I am safe in my home, and I can use this time as an opportunity to engage in activities that are fun or relaxing. I can get to things that I have been putting off or have not had time for due to my busy schedule. I will make self-care a priority.
  • Jumping to Conclusions
    • Original Thought: My chest feels tight. It must be an early sign of the coronavirus!
    • Reframed Thought: I am feeling physically uncomfortable. This does not mean that anything is wrong or that my health is in jeopardy. This may be a physical response to all of the stress that I have been under. I have also not been moving around as much as my body is used to, so it is possible that my body might have tightened up or gotten stiff. I will try engaging in an activity that occupies my mind followed by some light stretching.
  • Catastrophizing
    • Original Thought: Since I have asthma, if I were to contact the coronavirus, I would not survive it.
    • Reframed Thought: Aside from my asthma, I am generally healthy. I will closely adhere to the guidelines presented by the CDC. I will do what I can to minimize my risk. If I develop symptoms, I will investigate them early on. In the meantime, I will not focus on what-ifs and worst-case scenarios.
  • Emotional reasoning
    • Original Thought: Feeling worried about my older family members may lead me to perceive that they are at a greater risk of contracting the coronavirus, despite the fact that their other risk factors are low.
    • Reframed Thought: While it’s true that my family members are in an age bracket that is more at risk than others, they do not possess other risk factors. They are healthy and take good care of themselves. They are following social distancing protocols. They are even taking the precaution of having items delivered to their homes, instead of making trips out for essential items. I recognize that I am anxious about their well-being, but I need to keep in mind that their risk is not as high as my anxiety is leading me to believe.

As you can see, cognitive restructuring is much more than “thinking positively.” It does not dismiss or deny one’s concerns, but rather evaluates them and integrates them into a more balanced perspective. Anxiety causes us to focus almost exclusively on negative and threatening information, and that fear can spread like a wildfire. Anxiety fuses possibility with probability, making these terms seem practically interchangeable in our minds. However, it is important to recognize that what is possible and what is probable are very different. We cannot operate on what-if scenarios as if they are what is. These cognitive techniques can help us to challenge and rework our scary, anxiety-provoking thoughts, which typically serve as the catalyst for the experience of anxiety. Having better and more effective ways to manage our anxious thoughts can have a wide ripple effect that enhances our overall well-being and helps us to feel more comfortable during times of uncertainty. During this stressful time, it is of paramount importance that we care for both our physical and psychological health. Having ways to effectively manage our anxious thoughts is critical to our overall well-being. Please refer to other blog entries in this series for additional mental health strategies and techniques to help you cope.

If you believe that you would benefit from specialized treatment and additional support to improve your mental health, please do not hesitate to contact The OCD & Anxiety Center at 630-522-3124 or info@theocdandanxietycenter.com.

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