How can we use what we know about uncertainty and anxiety to support those who find themselves understandably anxious about COVID-19 and all of the fallout surrounding it?

I cannot count how many times over the last few weeks I have either said or heard the phrase “These are unprecedented times” – and they are. Granted I’ve only spent 34 years on this globe, but in that time my government has never before instructed me to limit time outside of my home or weighed in at all with regard to my proximity to strangers. I’ve never purposefully distanced myself from my parents over concerns for their safety. I’ve never seen so many empty shelves in stores, and if you’d told me on New Year’s Day I’d be wearing a mask on a routine shopping trip, I would have been perplexed to say the least. We each have our own lists of news and firsts, ranging from the strange to the devastating. This novel coronavirus brings with it a great many novel experiences.

What seems to be at the forefront during this strange moment are predictions. Some of these predictions are necessary – how many people will be infected and will we have hospital space to care for them all? How can we prevent the spread of this disease? How many jobs have been, and will continue to be, impacted? How can we support those who are without income?

We have some ideas and some answers, all of which are important as we attempt to save lives, maintain our medical system and support those who’ve lost income. All this said, the common thread that binds us all in this uncharted territory is uncertainty. We can’t know the answers. As each day unfolds it is increasingly clear just how uncertain the world is.

This is deeply uncomfortable to many if not most humans. We thrive on patterns that allow us to predict the next step. This ability is key to our survival – we are the biological descendants of predictors, planners and worriers. Given that our brains are machines that crave the ability to predict, we tend to scramble to find stability when things start to feel shaky.

This is especially true of the subset of people who fall into the “worrier” category. In the United States, 18% of adults meet criteria for an anxiety disorder. I’m a psychotherapist who specializes in the treatment of OCD and anxiety disorders, so I have the privilege of meeting and getting to know lots of people who struggle with these conditions. What unites these disorders is that they all involve an extreme discomfort with uncertainty. People with anxiety disorders are overcome by uncertainty about a great many things, such as:

• If they’ll meet an upcoming deadline or pass their next exam
• If someone will judge them positively
• If they have cancer
• If they’ll have a panic attack
• If they’re secretly a murderer
• If they’ll go to hell
• If there are germs on that doorknob

These worries tend to be founded on little to no evidence and are largely irrational. However, whether the worry is warranted or not is irrelevant. Worry isn’t productive. Whether your concern is about getting cancer or getting COVID-19, endless rumination won’t change the outcome. Limited planning can be helpful in both cases. It makes sense to take preventative measures – whether it’s quitting smoking as a way to stave off cancer or practicing social distancing as a way to stave off COVID-19. Likewise, planning financially if you’ve lost work is wise. If you have legitimate markers of either cancer or COVID-19, it makes sense to consult a doctor. But repeatedly reviewing the facts and imagining the disasters that may or may not befall you doesn’t actually help – it just makes you miserable.

We all have thoughts of a frightening nature – they’re non-negotiable. Whether they’re about COVID-19 or the possibility of getting cancer, they’re going to descend upon your unsuspecting brain, inviting you to worry. Those thoughts are out of our control. Worry, however, is a behavior – an invisible behavior but a behavior no less. We have some control as to whether we continue the conversation with ourselves or not.

There are other behaviors that people undertake in response to scary thoughts that are just as unhelpful as the act of worry. In the case of a person with Illness Anxiety Disorder who’s afraid of getting cancer, they might research the symptoms over and over again. They might hyper-focus on bodily sensations and check to see if they’re feelings something that might indicate cancer. They might ask others if they should be concerned. They might get tested more than is warranted or they might avoid the doctor altogether. With COVID-19, these unhelpful behaviors might include incessantly checking the news to see if there have been any updates, asking anyone you can what they think will happen, avoiding news altogether, or avoiding grocery stores entirely when the CDC guidelines are not suggesting this for your demographic.

The choice to respond, whether through excessive worry, checking, avoidance or reassurance seeking, is a choice to perpetuate anxiety. If you keep trying to resolve your anxiety with unhelpful actions, you’ll likely:

• Lose swaths of time engaged in actions that don’t serve you or the pursuit of what’s most important to you.
• Become frustrated because these behaviors don’t lead to answers.
• Want to continue performing these actions repeatedly. This is because if your actions provide relief even once, the behavior is reinforced and more likely to recur.
• Believe your thoughts are more important than they are. When you respond to your thoughts, you teach your brain that they require attention and action.
• Feel even more uncertain. When you spend more time focused on uncertainty, you will likely generate more doubt both by keeping that uncertainty at the forefront, and by recognizing additional uncertainties that you hadn’t considered before.

Given that these actions have so many negative repercussions, in treatment, we teach people with anxiety disorders to stop engaging in these unhelpful behaviors. This is where anxiety treatment can support people with or without anxiety disorders in relating to uncertainty. We cannot get rid of anxiety, but we can relate to it in a healthier, more productive manner – without endlessly worrying, avoiding, checking or seeking reassurance.

So how can we use what we know about dealing with uncertainty and anxiety to support those who find themselves understandably anxious about COVID-19 and the fallout surrounding it? It’s not easy. Even when a person knows rationally that they don’t need to get weekly scans to make sure that they don’t have cancer, the person with Illness Anxiety Disorder still feels a sense of urgency to get another test run. Likewise, most people can clearly see that watching the news constantly won’t make them develop a cure or a vaccine for COVID-19 any quicker. That doesn’t mean that it’s easy to turn off the television or put the article aside. It’s easy to get consumed by trying to eradicate doubt – even when that doubt cannot possibly be eliminated. Our fears can make useless actions feel deeply compelling, even when these behaviors have clearly passed the point of usefulness.

We have to learn how to support ourselves in changing our behaviors when they feel important but objectively are not. First, we must consider whether our actions are helpful or unhelpful. If we clearly recognize that our actions are unhelpful, that provides the impetus to make a different choice. If we continue to behave mindlessly, the process of change is not possible. If you catch yourself trying to get certainty, you have the opportunity to consider if this action is going to help you in a meaningful way.

Second, we can choose to view scary thoughts – however understandable, legitimate or warranted – as “thoughts” rather than as inherently important information. If you think “What’s going to happen in a week? Will I be able to leave my home?” This is a string of words that happened across your mind. They don’t need to be addressed. Instead of responding to them, you might just notice that your brain is “thinking” and move back to whatever you were doing before your mind got distracted.

In order to refocus on what’s meaningful to you, you have to be willing to accept the uncertainty that you cannot change. You have to be willing to embrace the unknown and to feel all the queasy, uneasy feelings that come along with that. We try to get certainty because we want to escape the groundlessness of uncertainty. To stop and say “I’m not going to figure that out right now” can bring with it great discomfort.

If we don’t allow for the emotional experiences, though, then we will just return to the unhelpful behaviors. It’s in our nature and the nature of all beings to avoid pain and seek pleasure. Therefore, it’s no surprise that when it comes to the anxiety that arises as a result of something like COVID-19, most of us don’t want to feel it. We grit our teeth, maybe we even gnash them. We clench our fists. We long for and wish after a different experience. We say, “it shouldn’t be this way!”

There are so many ways in which we resist emotions. The trouble is that resistance doesn’t make the emotional experiences go away or change. It just compounds the experience you’re having with resistance and pushes you to engage in unhelpful behaviors. In treatment, we try to approach emotions mindfully – that is we accept our present moment experience non-judgmentally. Instead of capitulating to the aversion that comes most naturally to us, we try to get curious about what it’s like to feel an emotion.

You might start to notice where an emotion resides in your body. Let’s take anxiety for example. You might notice a tightening in the throat or the chest, a tension in the jaw or forehead, increased heart rate, rapid shallow breathing, a lift or churning in your belly. These things aren’t inherently bad. People pay good money to go to amusement parks or watch scary movies to achieve those physical states. People enjoy the experiences of falling in love or exercising, which share many of those sensations as well. If you can just notice these physical feelings with an air of objectivity, it removes the resistance which is the additional suffering. You might even think to yourself “Oh, look, a feeling.” If you’re willing to feel something, then you are no longer a slave to that emotion.

But if you’re unwilling to feel an emotion, like anxiety, then you’ll continue to take useless actions that aren’t consistent with your values. In practicality, that could mean getting sucked back into the news or the rumination – looking up the symptoms of cancer until they’re memorized, and, even so, checking again.

This brings up an interesting question – where would you like your attention to be? This is where values come into play. Take a moment to consider your values. The following are some big questions that you could easily skim by, but I encourage you to take a moment with them.

• What do you want your life to stand for?
• What qualities do you feel are important to bring to the table, regardless of the circumstances?

Once you have a sense of this, you can practice redirecting yourself toward behaviors that are aligned with your values. If you feel compelled to turn on the television for the umpteenth time, and you value kindness and compassion, you might consider if this action is kind and compassionate toward yourself. If it’s not, maybe you can exercise compassion and kindness toward yourself in some other way – like by reading a book or stretching. Likewise, if you find that actively ruminating about how long this will last leads to isolation, you might consider if this is consistent with your values. If you put a premium on connection, then it would make sense to drop the rumination and bring your attention to people or animals in your home or community.

One way to support this is through a mindfulness meditation practice. I know, everyone’s probably heard the meditation plug about a million times already, but this can directly support your ability to notice when you’re engaged in unhelpful behaviors and also help strengthen your ability to refocus your attention. This is particularly true when it comes to mental behaviors, like rumination.

Meditation is really simple. With focused-attention meditation, we find an anchor in the present moment. Often, we use the felt experience of breathing as our point of focus, but if that’s not to your liking you can also use a sensory experience like sound or touch as your anchor. We generally close our eyes and direct our attention toward our chosen anchor. If you’re using the breath as your anchor, you watch the breath. Then, invariably, your attention wanders and when you notice your mind has wandered – kudos to you. That right there is the moment of mindfulness. You can gently note that you were “thinking” and come back to the present – come back to resting your attention on your anchor. Practicing meditation once a day can help you to catch unhelpful rumination in the act when you’re going through your daily life. Essentially, you’re developing the muscle of noticing when you’ve strayed from the present moment and returning your attention to the here and now.

Ultimately, we’re just trying to bring ourselves back to “now”. No, we don’t know what’s going to happen in a week, a month, a year. While we’d like to know, we also don’t need to know. Most of the time, planning aside, all we need to do is to walk through life, one foot in front of the other, one moment at a time.

Our brains are going to continue to try to get us caught up in what the future has in store for us with COVID-19. Those thoughts – the “what ifs…” – they’ll keep inviting you into conversation. You can mindfully view these thoughts, just as we discussed mindfully viewing emotions. “Oh look, a thought.” You don’t have to engage with it. You can just be the objective observer of what the mind is doing.

Your mind is built to be keenly aware of potential problems and to place attention on possible threats. Ultimately, how you react to the alarm bells in your brain is your choice. You can give them a reasonable amount of attention and then change your actions, or you can continue to accept every invitation to engage in unhelpful behaviors like rumination.

The reality is that we’ve been living with uncertainty all along, we just weren’t as aware of it as we are at this juncture. With everything in flux, our usual sense of perceived security has gone, and in its wake there’s a lot of uncertainty. This needn’t be a problem, though. Uncertainty is our birthright. Learning to live with it is something that can benefit everyone, anxiety disorder or otherwise, throughout this experience and beyond.

There’s a beautiful passage in a book by Pema Chödrön that speaks to the fact that we are constantly in this uncertainty because of the promise of eventual death:

“There is a story of a woman running away from tigers. She runs and runs, and the tigers are getting closer and closer. When she comes to the edge of a cliff, she sees some vines there, so she climbs down and holds on to the vines. Looking down, she sees that there are tigers below her as well. She then notices that a mouse is gnawing away at the vine to which she is clinging. She also sees a beautiful little bunch of strawberries close to her, growing out of a clump of grass. She looks up and she looks down. She looks at the mouse. Then she takes a strawberry, puts it in her mouth, and enjoys it thoroughly.”

~ Pema Chodron
   The Wisdom of No Escape

This is going to be an anxious and uncertain time for many, because we’re more aware that we’re dangling from this precarious vine than we were six months ago, or even a month ago. If there’s a way to take some of your weight off the vine, then do so, but not to the exclusion of tasting the strawberries.

No matter where you are, there will also be the potential for moments of beauty and connection. I talk to people with OCD and anxiety about this regularly, and this also applies to those in the general population with anxiety about COVID-19. Appreciate the moments of joy even if they’re in the midst of struggle. Disengage from the behaviors that don’t help you to live a valued life so that even when the anxiety is looming, you can find contentment at the same time. Take actions that will serve what’s important to you. Don’t miss the strawberries.

• Lauren McMeikan, MFT, is a psychotherapist at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of OCD and related anxiety-based conditions. In addition to individual therapy, the center offers five weekly therapy groups, as well as online therapy, telephone therapy, home visits, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here. Lauren is on Instagram @laurenmcmeikan.