As therapists, we recently find ourselves in our own real-life experiments, hearing echoes of the things we have been asking our clients to do for themselves, and now more than ever, we need to make sure we are also walking the talk.  We are into week four of social distancing (really physical distancing), and in complying with government recommendations, most therapists (and all four of us) are offering online or teletherapy, in place of in-person sessions. Teletherapy is emerging as the new normal (perhaps long overdue).

In light of this, we’d like to address some recent trends we’ve noticed might impede our mental wellness during this COVID-19 containment period, and provide our practical guidance.

Our top five tips and trends include:

1. Privacy: Finding creative spaces for privacy, for online therapy and for when you simply need space.
2. Structure: The importance of creating structure for yourself during uncertain times.
3. Responsibility: Helping your non-compliant loved ones accept the importance of self-isolation, and check in on healthy boundaries.
4. Flexibility: How to ‘roll with the punches’ by increasing cognitive flexibility.
5. Regulation: Recognizing how fear and other emotions show up in our behaviour and what we can do to help ourselves deal and heal.

1.  Finding Privacy

Privacy for therapy

When you imagine ‘therapy’, chances are you envision a cozy, quiet, office with a live therapist. A private space, where you could safely talk about whatever experience you need to unpack, or whomever, you needed to talk about.

In week three of sheltering at home, hanging out non-stop with our family members, therapy may feel like a more urgent need, but more difficult to achieve.  Online therapy might take a bit more preparation, but don’t let the initial challenge of looking for private space get in the way of getting the support you need. Some ideas for finding privacy are:

• Talk to your family about taking a call and needing privacy.
• Pick a quiet room (even a closet, or the bathroom will do!).
• Carpeting can help buffer noise.
• Put a noise machine or radio on outside of the room, or download a white noise audio file on another device.
• Put a towel or pillow at the base of your door.
• Wear earbuds or headphones, so your therapist’s voice is for your ears only.
• If there’s a specific sensitive subject, you can create ‘code words’ to use with your therapist.
• Go in your car, park at a park, or in a spot with publicly accessible wi-fi (your therapist should be providing the secure platform to access).
• Looking for free wi-fi? If your own driveway doesn’t work, try the parking lots of your local coffee shop, fast food restaurant, Rogers or Bell store, or other public wi-fi spot (we find generally, Starbucks works best).
• Don’t be afraid to ask your therapist about your specific needs or concerns – we’re learning new tips and tricks every day as well to help meet your needs. As an essential service we can also explore an option for face-to-face sessions if extremely necessary.

I just need alone time!

Some of us are just looking for privacy for ourselves, especially if you already worked from home and were used to a quiet house, are an introvert, or are just simply losing your marbles (which is totally understandable). Try:

• Setting pre-specified “quiet time” in closed rooms (see section below on Creating Structure),
• Take a bath (lock the door!),
• Sit on balcony, or get going on some yard work,
• Go for a walk/run,
• Talk to each other about the overall noise in the house at different times of day.

2.  Creating Structure

During uncertain times, when there isn’t a great deal of order externally, we can create structure internally, at home, which can help buffer the stress caused by uncertainty.  Some of us have this skill from our jobs, and the rest of us suddenly have to create it.  Here are some strategies for creating structure:

Focus on your values

Keeping your values in mind as you navigate your new normal is something we’re all figuring out how to do. Your values are things that light you up, when you feel you are being true to yourself.  If you align with those five to ten values regularly (like connection, family, patience, creativity, loyalty), you’ll feel less stuck. We need to give ourselves permission to create our own daily structure based on our individual values.

Some ways to do this include:

1. Look at what sort of activities you’d be doing normally, and identify which of your values line up:
1. Sports: exercise, fitness, social
2. Visiting: family, friends, relationships
3. Writing: creativity, art, alone time
2. Once you have a list of things you value, see if you can come up with new ‘physically distanced’ ways of fulfilling these values:
1. Sports: going for a run or walk outside; doing a home workout video (with friends on video chat).
2. Visiting: video chatting with friends and family daily; going for a physically distant walk with a friend.
3. Writing: find quiet time and place each day for yourself to write; find inspiration in what’s going on around you.
3. Structure your day in a way that incorporates all of these things that are important to you. Write out a daily schedule, with specific time blocks for all of the activities that keep you feeling healthy.

Be Kind to Yourself

You don’t have to follow the same routine as before. If it makes sense to sleep in an extra hour and it’s not going to negatively affect your day, then sleep in that hour. Allow yourself the time and space to adjust to this new life.

Try Something New

There are lots of changes to absorb, so it makes sense we’re going to also change. The restaurants are closed but you can still have a date night with your partner – you’re going to have to be creative. Try new routines, an activity you’ve never done before (like online therapy!), or do more of something you often don’t have time for. Get out of your comfort zone; after all, we’re all a little uncomfortable right now, aren’t we?

Get on the Same Page

Family meetings might be awkward and new, but they can be crucial at a time like this, where everyone is stuck in the house together, or shared family arrangements are thrown out of whack. Pick a night every week to have a family meeting – get everyone in the house involved. On paper you can chart the week with school, work, dinners, chores, and time for video games and quality family time. If you’ve never done it before, know it will feel awkward and you will receive ALL the eye rolls and “do I have to’s?”.

At the end of the week review it, look at what worked/what didn’t work and re-adjust for the week ahead.

Organize Yourself

For those of us who really value structure, or get carried away doing either not enough work, or too much, making sure you’re organized is important. Make use of to-do lists, alarms and reminders to help you structure your day. Put things in your calendar you wouldn’t normally put in (like standing up, or changing the laundry, looking into your partner’s eyes).  Most importantly, make sure you have balance and boundaries by setting specific working hours, self-care time, and family time. Take breaks during the day as well, even if you have to schedule them.

3.   Pandemic-level Responsibility (feeling over-responsible)

Feeling over-responsible for other people who are not your dependent children can be very tough. With all the stories in the news about which generation is tougher to manage during this pandemic, we had to wonder:  are some of us over-responsible adult children especially triggered right now?

While this experience can affect any generation, in psychology, we sometimes refer to the emotional state of being a ‘parentified child.’  Parentification describes a role reversal, where a child is obliged to act more like the parent should be (but isn’t) to their own parent or sibling. It can happen for various reasons, including parent physical or mental illness, parental alienation in divorce, enmeshed relationships, porous boundaries with parents for example.

Whatever the reasons, the child grows into an adult who feels generally over-responsible for caretaking of their now older or elderly parents, adult siblings and perhaps other people in their life.  This constant boundary crossing into other adults’ lives tends to cause problems for us in the long run.

How do we regulate our anxiety when we don’t have full control over what our parents and other loved ones do?  How can we exercise compassion and understand what we AND they’re going through?

• Some of our loved ones may be afraid and their coping strategy to reduce their anxiety, rather than to face that this is real, is to downplay the crisis.
• Acknowledging their fear response by helping them talk about what’s going on, rather than telling them what to do, may be helpful.
  • Recommend things you can do together virtually like facetime, can help.
  • Recommend a new hobby that doesn’t expose them to risk.
• Most people don’t want to be told what to do, which can be distressing for the over responsible adult child, but we need to manage our own levels of distress first.
• If we can be compassionate, patient (to an extent), and provide the right information, we have a better chance of getting through to our loved ones
• Before you lock your stubborn friend or mother in a basement, remember to BREATHE (see Regulation below)!
• If you’ve been trying to talk to them and your approach isn’t working, switch it up. Appeal to your loved one’s values. If they’re more worried about others than themselves, speak to that.
• Remind them of their responsibility to help protect the health of others, including other loved ones, the elderly, and children, you need their help.
• Hold your boundaries. Our parents often still think of us as children (so what if we act like children sometimes?), and this can translate to them not respecting our adult boundaries. It’s not their job to remember our boundaries folks, it’s our job to remind them.

4.  Flexibility, but the brain kind

Cognitive flexibility refers to our brain’s ability to switch from one train of thought, or way of thinking, to another, in order to adapt to a new situation. An analogy often used is switching between TV channels.  If you are set on only one channel, you can get stuck there, and miss experiencing all that is offered on the other channels. Cognitive inflexibility is something parents might experience with a child who struggles to transition from one activity to the next, or with someone who doesn’t like curveballs being thrown into their days that mess up their schedules or to-do lists.

Perhaps no collective experience like this pandemic has demanded new levels of cognitive flexibility from all of us. We are being required to bend and flex in ways we never knew were possible – whether we like it or not.  It’s possible some of us might be struggling more than others, especially if you are in touch with your extroversion, have had a hard time with change in the past (we all do, some more than the average cat), already deal with having a neurodiverse brain in a neurotypical world, or have had a highly structured job or office environment.

Acceptance and Commitment

We have some tips to ease into cognitive flexibility, adapted from Acceptance and Commitment Therapy (ACT), a version of CBT, focusing on accepting your emotions, and moving forward with your life.

A mental shift of acceptance of your fear: first we must understand our fear!

This may seem counterintuitive, as fear can be perceived as negative. Fear or anxiety comes with unpleasant physical symptoms, and sometimes also a steady stream of ‘what ifs’ and ‘shoulds’. Typically, when faced with something causing these feelings, we try to avoid it.

We can see feelings of fear and scarcity demonstrated in the grocery aisles: carts full of toilet paper, Lysol wipes and hand sanitizer. We are scared. We want to get rid of the yucky feeling, so we do what is efficient in the moment. Spoiler alert: Buying copious amounts of TP is not the long-term solution to feeling better – this is our way of trying to avoid – or get rid of – these feelings of anxiety in the moment.

The fear we feel about COVID-19 is real. While the feeling of fear and anxiety are unpleasant, some level of anxiety is normal and it’s what allows us to continue to be safe, self-isolate, and reduce the risk of spreading the virus.

This is unchartered territory for you – and almost everyone – as we are learning to live through a global pandemic. It’s understandable you may have a heightened sense of worry and you may ‘freak out’ at times – that’s okay!

Remember in those moments that cognitive flexibility is a key factor to learn to live within a new normal. You can do the following to help you accept and feel your emotions, ground yourself, and move forward:

Accept

Practicing radical acceptance helps us understand that our emotions are normal, and accept that they’re going to be there no matter how much we try to avoid (and that, like everything, this too, shall pass).

1. Remind yourself what you’re feeling is normal, and it’s okay to feel this way.
2. Reality is as it is (the facts about the present are the facts, even if you don’t like them).
3. There are limitations on the future for everyone (but only realistic limitations need to be accepted).
4. Everything has a cause (including events and situations causing pain and suffering).
5. Life can be worth living, even with painful events in it

Feel the emotion

Acknowledging and tending to our feelings, even the difficult ones, is what we need to ease the emotional pain.

1. Name the emotion (if we can name it, we can tame it).
2. Acknowledge all emotions are okay, they emote for a reason. If we pay attention to them, we can recognize the clues to help us figure out what we need (usually not more toilet paper).
3. Talking about your emotions with people who can hold them with empathy and support (if you don’t feel like you have access within your limited connections right now, reach out for professional support, online of course).
4. Recognizing we are not alone in our suffering, and being as kind to ourselves as we are to our friends and loved ones, is important. Noticing our shared common humanity is a step towards being more compassionate to ourselves.

5. Regulation

When we speak about self-regulation, we teach that ‘story follows state’ – that is, our body’s signs of stress (heart rate, dry mouth, nervous stomach, jumbled thoughts) inform the story our brain creates about how safe or unsafe we are.  Our society is living in fear right now.  Some of the behaviours discussed (TP hoarding) – include avoidance, denial and numbing (to deal with our unpleasant physiological agitation).  Sometimes distraction is okay – it takes away the emotional strain or pain in the moment. But feelings resurface when we push them down repeatedly.  If we stay disconnected and don’t share our fears with others, our fears also come with consequences adding an extra layer of shame.

ACT also informs helpful ways we can stay regulated.

Ground Yourself

In times of heightened emotions, it can be difficult not to panic. Grounding can help us get back in touch with the here and now, and focus on what we need in the moment.

1. Use your senses to really focus on where you are in the moment. Focus on your surroundings, what you’re feeling in your body, take a few deep breaths, and remember that you are safe in this moment.
2. Get out in nature and really experience your surroundings (what do you see, smell, hear, feel?).

Move Forward

Once we feel calmer, we can keep moving forward. Shift your focus to the controllables, and engage in activities that are in line with your values.

1. Ask yourself if you’re doing everything you can to help reduce risk for yourself and others?
2. Engage in a pleasurable activity. Share a positive or informative post on social media to help spread happiness, kindness and facts; offer to help a neighbour or loved one; practice self-care by doing something for you.

Finally, remember that this will pass, and like all of the other difficult times in your life you will get through this!

Even being able to consider some of these strategies helps to build the muscle of cognitive flexibility, which is what builds our capacity for resilience and allows us to ‘roll with the punches’. Be patient with yourself, and remember any type of change takes time.

While not everyone experiences this, one trend we have noticed in particular across our practices (which spans the province), in particular increasing is comparative suffering.

Comparative Suffering

Increasingly, fear shows up in our behaviour in minimizing our own suffering by pointing out the “more important” suffering of others. ‘Rank ordering’ our suffering is yet another attempt at dismissing our own painful emotions.

The COVID-19 pandemic has certainly brought this out in many of us. It sounds like this:

“I can’t be afraid for my children who are simply missing school, there are children in the world who don’t have adequate food or positive home lives”

 OR

“Why should I be tired and irritated after a long day of work, there are people who are out of jobs”

OR

“I shouldn’t be worried that I can’t go to my graduation, there are people who have had to cancel weddings”

This tactic of reducing emotional pain doesn’t make our unpleasant feelings go away, it adds another layer to it.  Now in addition to the difficult feelings – like fear and sadness, we also experience the feeling of shame: “I’m bad because I’m feeling sad when other people have it worse than me.”

• Recognizing the importance of empathy for OURSELVES is helpful.  Feelings of empathy are not finite, there is enough to go around.
• Letting go of shame allows us to more fully look outside of ourselves, which allows us to have a deeper sense of empathy for others.
• The clearest way to give support and empathy to others is to attend to your own feelings.

Shame grows when we don’t express how we feel. When we can share our feelings with others, especially feelings of shame, and it is received with empathy, shame cannot survive, and we are free to connect with others in a healthy and supportive way.

Our Closing Thoughts

Noticing our emotional and physiological state are the first steps toward getting a handle on our emotional states. Are you getting easily irritated by the silly things your partner does, like the way he/she chews his food? Or eats her banana? Or having a shorter fuse when you see your children haven’t emptied the dishwasher?  Noticing this behaviour in ourselves is the first step to easing the emotions underneath our behaviours. We start our own regulation by first noticing, second regulating our physiological response and finally following the steps involved in tending to our emotions (see Feel the Emotion above).

It’s a strange time and we’re all going through it together. How we come together to manage both ourselves, AND support our families might require strategies from us that we haven’t used before.  While we all learn new things, figure out our new normal, know support is here for you. No one is meant to go through a pandemic (emotionally) alone, despite ‘social distancing.’ We’re mammals and humans aren’t wired to struggle alone. Reach out for help, go easy on yourself and your loved ones, and reach out for support, sooner rather than later.

Written in collaboration by Peer Supervision Group, OAMHP Members Mindy Bilotta, RP,Christina Crowe, RP, Christina Janiga, RP Jennifer Thomson, RP, otherwise known as The Kind Heart Therapists (and on a rowdier day, The Kind Heart Cult).