Taking Care of Yourself During a Crisis

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Coping with the upheaval of our daily routine can be stressful any time. Coupling this disruption with uncertainty about the coronavirus creates an even greater trial. Behavioral health specialist Jacob Bishop, MD, and therapist Amber Coffey, with Baptist Health Corbin, connect with Kerri by phone to offer some tips for self-care during these unprecedented times. They emphasize the importance of maintaining a sense of perspective and describe ways to practice mindfulness, experience gratitude, and shift our outlook when we become anxious or fearful. In addition, they explain how to recognize red flags in ourselves, our children, and other loved ones — and advise where to find help when we need it.

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Host: Feeling overwhelmed by self-isolation in COVID-19 is understandable, and we’re providing a number of tips to not only proactively manage stress thresholds but understand the importance of a routine and learn to manage uncertainty with kids during these unprecedented times.
Host: I’m joined on the phone by Dr. Jacob Bishop with Baptist Health Medical Group Behavioral Health and Certified Therapist Amber Coffey to dive into these issues facing our listeners. Thank you for joining me today.
Dr. Jacob Bishop: Thanks for having us.
Amber Coffey: Thank you.
Host: According to the American Psychiatric Association, more than one-third of Americans say that coronavirus is having a major impact on their mental health. We still have several weeks ahead of us in this self-isolation.
Host: To start, how do you recognize distress and anxiety, and what can we do to maintain stability?
Dr. Jacob Bishop: I think a large part of it depends on the person. I think everyone experiences anxiety at some point or another, sometimes severe, sometimes mild. This is unique and kind of groundbreaking time for everybody to experience this event, which leads to a lot of anxiety in and of itself. So I think it presents its own new set of issues and anxiety as well.
Dr. Jacob Bishop: Some people have different tolerance for anxiety and how much it affects them. That can lead to just a wide spectrum of symptoms, whether it be physical symptoms, like a racing heartbeat, upset stomach, nausea, dizziness, to full-blown panic attacks, to more subtle things, like trouble concentrating, kind of clingy behavior in kids is something that we see, kind of obsessional thoughts, I think, which I’m hearing more of these days, partly because of the unknown of everything, partly because there’s lots of news out there, and a lot of it has a very concerning slant to it. So I think being preoccupied with those thoughts leading to stress and discomfort and that sort of thing.
Dr. Jacob Bisho[: I work a lot with our kids over here, and some of the ways that we can recognize stress and anxiety in children are a little bit different because they have a hard time really communicating what makes them anxious or why. They just know it. You know it when you see it, you know when you feel it, and that comes across in different ways. Now, a lot of them-
Host: Are there changes in behavior?
Dr. Jacob Bishop: Absolutely. That’s really the primary one. There are some folks in the field of child psychiatry that say, for the first eight to 10 years of your life, any kind of distress is anxiety until proven otherwise. I think that there’s a lot of truth to that. It doesn’t tell the whole story, but I think a lot of kids are struggling, whether it be with understanding things or new situations, scary situations, and distress that it causes on the relationships they have with their caregivers and siblings. A lot of what you’d see as far as behavior changes, it’d be kind of irritability, strains on the relationship. You’ll see kids just kind of generally nervous, maybe having those obsessional thoughts, getting fixated on things.
Dr. Jacob Bishop: A big one that I always try to address for kids and adults alike is the effects on sleep. I think sleep’s vital anytime, but especially in a time of stress. That’s often one of the first things that are affected.
Amber Coffey: He also mentioned the uncertainty and everything, and I just want to touch base on that really quick. Because uncertainty, that’s the fear. It’s the fear of the unknown. So we don’t know what’s happening tomorrow. We don’t know what’s happening in a few minutes.
Amber Coffey: So with that being said, what I would suggest really is to focus on what we do have control over. We do have control over how we respond to this. We have control over the social isolation, wash our hands, practicing good hygiene. It’s just things like that that I think would actually help with maintaining the stability that we need so badly right now.
Host: Sure. I’ve also heard a tip of how important it is to maintain a routine, and I could imagine even more so with a child. Would you agree with that?
Dr. Jacob Bishop: 100%. I think there’s a lot of good data that show just for your general mental health, whether we’re talking about depression, anxiety, behavioral issues, that a routine, a loose or fluid routine, is often very helpful to alleviate symptoms in general. I think that’s even compounded at a time like this where we’re getting so much new information, so much of the news sounds, legitimately so, it’s scary and frightening and anxiety-inducing. So keeping your normal routine is important for that normalcy, especially for a kid who’s very likely to be overwhelmed by this flood of information.
Dr. Jacob Bishop: On that note, I think it’s also important that we process that information, all the news, all the updates in moderation. I think moderation is huge for most things, especially now, because it would be very easy to fall into a state of constant worry with all the news that’s out there about COVID.
Host: I’m certain it’s age-appropriate in the way that you talk with your kids, but what tips can you give to someone that’s listening on how to discuss our temporary new reality with children?
Amber Coffey: [crosstalk 00:06:17].
Dr. Jacob Bisho…: It’s good to get ahead of it, I think. Because it is so new, I can’t imagine children trying to process this, because it’s so unique. I mean, completely taken out of their environment of going to school and going to classes and seeing their friends. Now, they’re quote-unquote trapped at home. So I think it’s important to communicate about it just in general.
Dr. Jacob Bishop: Then kind of falling back on our first question, when you do notice some of these signs that they are getting stressed, that they are getting more anxious, having distress, not functioning where they’re used to functioning, it’s important to have that relationship so that they feel free to communicate about it. It may be that the adults have to take the initiative before they even see distress occur to just have them sit down with the family, with the kids occasionally, daily, however often they need it, just to kind of keep them up to date with what’s happening, reassure them. Say we have good measures to prevent the spread of the disease. There are positive numbers popping up from different parts of the world where they have instituted some of these things. So balancing the anxiety-inducing things with some of the good news and some of the precautions they can take. Just being able to communicate that with kids just so they know what to expect, a lot of times helps their anxiety significantly.
Host: See that. So avoiding it would be worse.
Dr. Jacob Bishop: Avoiding it would be worse. Yeah. I mean, we have anxiety disorders, quote-unquote, that are treated in specific therapy, but anxiety a lot of times is a symptom of something deeper. It’s your body sending a smoke signal to some degree of you need to pay attention to this before it blows up into a raging fire.
Amber Coffey: [inaudible 00:00:08:01].
Dr. Jacob Bishop: Yeah, exactly. On that note, a little anxiety is good. It gets you to work. It gets you passing grades in school. It gets you-
Amber Coffey: [crosstalk 00:08:08].
Dr. Jacob Bishop: Yeah, absolutely. When it tips over into that dysfunctional part, that distressing part, that part that makes you constantly worried and keeps you locked in at home, that’s when it becomes an issue. That’s an inherent issue with this current situation, is because we’re being told to stay home. That’s one of the issues that we’re facing now with keeping that moderation, keeping that balance at home, and communicating all this well.
Host: Sure. Well, it’s understandable to have an adult conversation, to be intentional, to have that separate from the kids and away from their ears. Because right now, the adults in the home are dealing with, I can’t imagine, the anxiety of a loved one contracting this disease, furloughs, layoffs, bills, the just pressure overall of homeschooling and being all under one roof. What tips would you give for a relationship right now for the adults in the home?
Amber Coffey: It’s very similar to what Dr. Bishop had mentioned with the kiddos as far as open communication. We want to be honest within a home and transparent as much as possible. Unfortunately, we can’t read each other’s minds, so we really have to go by what is verbalized, what is discussed, how we’re feeling today, how to go about it that way.
Amber Coffey: I will say, it is also very essential right now to practice some self-care. Pouring some energy and sometime into ourselves will actually help strengthen a relationship as well. Well, as you mentioned, a lot of people have financial burdens. We are getting laid off from work, the bills continue to come in. So with that said, you do want to make sure that we still remember that we have a purpose. We are more than our careers. We’re more than our jobs. We’re a human first, and we just want to take some time for ourselves and practice some self-care, [inaudible 00:10:08] meditate in the morning, taking a warm bath. Just have some free time, even if it’s 10 minutes or something like that just in order to get our thoughts together.
Host: Sure. I like what you first offered, Amber, just to be intentional to recognize that your emotions could change, not daily, frequently, to be able to articulate that to your partner.
Amber Coffey: Yeah, absolutely.
Host: If quarantine becomes too much to handle the stress and the anxiety, how can I cope, and what can I do to reassure children? If I feel like I am just at a breaking point, what advice would you give?
Dr. Jacob Bishop: I think practicing some of the things Amber mentioned about the self-care is very important, using this opportunity to focus on some things that either you’ve been intending to do or things you feel like you needed to do for yourself or at home. Kind of reframing the situation away from, “I’m trapped at home,” to, “I have this opportunity to do some things at home I’ve been needing to take care of.”
Dr. Jacob Bishop: I think one of the complications, one of the issues with anxiety, is it makes us look at every situation as doom and gloom. It makes us see the worst in every possibility when anxiety becomes distressing. It’s important that we reframe, we look at the situation, and try to find a silver lining and say, “This offers us some opportunities to stay close and to communicate and to practice self-care and do some things that we’ve intended to do, but maybe we’ve been too busy to do.”
Amber Coffey: [crosstalk 00:11:35].
Dr. Jacob Bishop: As well as good communication, I think, it goes a long way. Now, you can do all that stuff, all that good things, all that prep work, and things still kind of spiral and get, like you said, too much to handle. At that point, that’s when you want to look for red flags of anxiety, where you’re looking at is somebody consistently behaving in a way that’s not normal for them? Are you worried about their safety? Are they turning to alcohol or something else too much, more than often, or some change in that? Some kind of change in their function consistently, that’s when you really want to be able to step in and communicate with that person, encourage them, and consider reaching out to somebody like Amber and our therapists here at Baptist, or me as one of the psychiatrists here.
Dr. Jacob Bishop: Because I think with anxiety, it’s easy to get in bad habits. Like Amber mentioned, it’s a self-protective kind of phenomenon. You experience something that makes you uncomfortable, you act accordingly, and it takes the anxiety away. So you’re going to keep doing that. A lot of times that’s how we make bad habits, which is what spirals into these red flags and these really tough situations. Taking measures to address the anxiety early on, communicating, taking care of yourself, and others, and sometimes that means taking a little time apart, which is tough to do in the same house.
Amber Coffey: [crosstalk 00:13:11].
Dr. Jacob Bishop: Yeah, exactly. Exactly. If you’ve got one door, you can make it happen.
Host: Absolutely.
Dr. Jacob Bishop: Until it gets to the point where you’re worried about somebody, and then you want to take the steps to have them come talk to somebody like us.
Amber Coffey: I just really liked what Dr. Bishop had said pretty much about flipping the switch and changing your perspective and looking on it as an opportunity.
Amber Coffey: During this time, we could actually practice mindfulness, which is really, really helpful whenever something [inaudible 00:13:39] anxious. All mindfulness means is being aware of your settings, being in the moment, and we don’t worry about tomorrow, we don’t worry about what happened yesterday. We just focus on today.
Amber Coffey: Looking at today, we can also look at what we have going for us. We practice gratitude, and we don’t look at what’s holding us back or what’s going against us right now. Doing those things, even if it’s identifying three grateful things, and you might even want to practice this with your kids in the morning. What’re three things that we’re grateful for today? Start the day off on a positive perspective. Doing so will actually decrease anxiety. What we’ll see is an increase in positive emotions.
Host: Okay. I like that. That’s a really good takeaway for everyone. Regardless of what you’re feeling today to start your day off that way is to change your outlook. Are you available right now to treat patients? Are you seeing anybody through telehealth, or do you have any resources available to pass on to our listeners?
Amber Coffey: We do. We are actually creating some additional access points of care. We are mobilizing additional behavioral health clinics throughout the state. We are actually forming a team right now to get some public service announcements created, have that be through a blog or just educational resources that people can have in their hand, accessible virtually pretty much at any time.
Amber Coffey: Then also with Baptist, they have the MyChart, which is a service. If they get on Baptist Health’s homepage, they could remote access the virtual care through that, or they could download the app and have it on their phone. Fortunately, there is at this time, technology is a really good resource to utilize.
Host: Certainly. One thing I also wanted to ask you is about people with preexisting mental health conditions. Should those listeners change anything about their treatment right now?
Dr. Jacob Bishop: Well, it’s important for every individual. That stresses the importance of having a consistent professional relationship with a provider, whether it be a therapist or a psychiatrist, either or. Because having that relationship, they know what to look for and how you’re feeling, how you’re doing, whether you’re stable, whether med adjustments need to be made, triggers that may lead to some kind of distress or worse. Really for a time like this, I think it’s important to look at mental health through that lens.
Dr. Jacob Bishop: Now, for those who are stable and have had that long term relationship with the provider, it is great to have these telehealth options and the charting and that sort of thing to just keep tabs on them.
Dr. Jacob Bishop: I encourage anyone out there who feels like they’re anxious to the point of distress or feeling that way to reach out, because even if you haven’t been in care before, that’s not going to cause any of us to turn away new patients. We’re here during the time of need, and we want to be available for folks who just need a little bit of extra help with this current climate.
Host: Sure. Would it be helpful if someone journals right now their symptoms so they can make the associations to external factors or things that are going on around them to assist with care?
Amber Coffey: Absolutely.
Dr. Jacob Bishop: Yeah, I think that’d be great. That would give the patient and their provider a lot to process throughout this course.
Dr. Jacob Bishop: One of the thoughts we’ve had recently is we’re in the acute stage now where we’re still experiencing this quarantine for the first time in our lives, all this new information we’re processing. But the social distancing and the isolation and that sort of thing, that presents its own unique set of anxiety.
Dr. Jacob Bishop: But we also need to be looking ahead too, because this entire situation is going to have a pretty significant ripple effect. I encourage folks to really pay it the respect that it deserves, and don’t hesitate to reach out to a counselor, a therapist, a provider even as the quarantine is coming to an end. Because I think this is going to affect people on an emotional, mental, financial, professional level for quite some time. I think there’s no better time to reach out and establish to have that stability and to get the help that’s available to you. I think it’s important that we keep the long game in mind as well.
Host: Yeah, I like that. That’s true. Anything else you guys want to share with me today?
Dr. Jacob Bishop: Appreciate the opportunity. It’s such a unique time and unfortunate in many regards, but good to see everybody rallying and doing what they need to do to protect each other and ourselves. Just encourage folks to keep with it and keep hoping and trying every day, because we’ll eventually beat this. I know it’s hard to see the end now as things are still up in the air. But in the meantime, we’re here and have plenty of options to help you if you’re feeling overwhelmed or anxious or worse. So appreciate the time.
Host: Of course, Dr. Bishop and Amber, thank you so much for your time today.
Dr. Jacob Bishop: Thanks a lot.
Amber Coffey: Thanks.
Host: Of course, have a great one.

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