January 29, 2021 • 12 mins
Today Dr. Saltz answers questions with actionable advice about managing anxiety and uncertainty during the pandemic.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Are you feeling more
anxious these days? You have plenty of company, and that's
what I will be answering questions about today. Anxiety In
the time of COVID, the pandemic has caused many people
to experience a rise in their anxiety levels. Life has
(00:49):
become more stressful and less certain across the board, and
chronic stress, combined with deep uncertainty often spells I anxiety.
The American Psychiatric Association has noted a new pandemic of
mental health issues, and one of the most common diagnoses
are anxiety disorders. Most people might not currently have an
(01:12):
anxiety disorder, but they are struggling with anxiety and it's
taking a toll on their day to day life. So
let's get to it and see how can I help.
Here's question one, doctor Saltz, my anxiety has increased tremendously
during the pandemic. What are some simple practices for changes
(01:37):
things that I can do to manage it? Actually, there
are a lot of things that I would call coping
tools that can help you to manage day to day
anxiety if you only insert a few of them, and
you should pick based on which ones are most appealing
to you during your day. So first, I would say,
(01:59):
and probably in some ways the most valuable is some
form of aerobic exercise for thirty minutes, three or four
times per week. And I say probably the most useful
because there is a lot of data, numerous studies that
support decreased stress, decreased anxiety, and improved mood with aerobic exercise.
(02:22):
And you really can choose whatever exercise you like as
long as it's getting your heart rate up well above
your resting pace. So that could be running, it could
be using some sort of machine in your home. It
could be doing calisthenics. It could be doing a group
zoom class or zoomba. It could be dancing. It really
actually doesn't matter what the movement is as long as
(02:44):
it's vigorous and therefore aerobic Aside from that, there are
a lot of different coping tools that take five to
ten minutes a day. One is taste deep breathing. This
is where you breathe in to a slow count of
five and you breathe out to a slow count of seven.
(03:06):
The longer exhale than inhale. And it's important that when
I say deep breathing, I mean abdominal breathing. So you
want to put your hand over your upper abdomen and
have that part of your lower chest upper abdomen rise
and fall with your breath. When you have an exhale
(03:28):
that lasts longer than your inhale, you tend to slow
your heart rate because it's on the exhale that heart
rate slows. And when you slow your heart rate, you
actually physiologically relax your body, and when you relax your body,
you relax your mind. It actually does take some practice,
but you can practice paste deep breathing for five minutes
(03:50):
in the morning and five minutes in the evening to
help you relax. Another technique which you can actually at
some point even add to the first one of breathing.
It's called progressive muscle relaxation. You can do this on
your own if you prefer it. It's basically squeezing each
individual muscle group two, account of five, holding it very
(04:11):
tight during that count of five, contracting all the muscles
and then releasing them. You start with your feet, you
move to your legs, to your arms, to your torso,
your shoulders, your neck, your head, and even your face,
scrunching those muscles as tight as you can and holding
for a count of five and then releasing. When you're
(04:34):
done with your body, your muscles have been relaxed, and again,
in physiologically relaxing your body, you relax your mind. Many
people find the practice of some form of meditation to
be extremely helpful in stress reduction and anxiety management. Mindful meditation,
transcendental meditation, there are many forms of meditation. Meditation is
(04:57):
a practice that does take some skill building, takes time
to learn, and you can start with something as simple
as an app or you can actually contract with somebody
to teach you meditation and do that via zoom. But
many more people are reaching out these days to some
sort of meditative technique. Social support also does help reduce
(05:20):
your anxiety, so simply making it your point to talk
to a friend or two every day for a few minutes,
talk about how you're feeling, talk about what's going on,
talk about what you might be able to look forward
to doing together at some point. Just having that social
support and repartee is actually helpful for reducing stress and anxiety.
(05:44):
And then, last, but definitely not least, is gratitude practice.
That means basically finding a very concrete method of experiencing
any gratitude that you can. I know it's a difficult time,
but all do actually feel grateful for certain things in
our lives, even as difficult as they are. And when
(06:06):
you bring the awareness of that gratitude to the front
of your mind, there have been a number of studies
again that have shown it tends to improve mood and
decrease levels of stress and anxiety. So that could be
as simple as at the end of the day writing
down three things for which you feel grateful, and those
things could be as small as a wonderful cup of
(06:29):
coffee you enjoyed to something bigger that's going on with
you or with your family. So the practice of gratitude
is also very helpful. There are actually even more techniques,
but the point is that injecting just a few coping
tools into your day can make a big difference in
terms of managing your anxiety going forward. How can I
(06:53):
help with Dr Gail Salts will be back after the
short break, and here's question number two, Hi, Doctor Salt.
Sometimes when it comes to thinking about the future and
(07:13):
its uncertainty, my thoughts spiral out of control. What is
the best way to approach the future in the COVID era?
Should I be making plans or should I just focus
on the here and now? Uncertainty drives obsessing in those
that are prone to it. What does that mean that
the very state of being uncertain makes you have thoughts
(07:38):
that go around and around and around about all kinds
of things. When you ask yourself a question about the
future and you actually can't know the answer, and I
think that, frankly, right now, many of us can't know
the answer to a lot of future questions. Your tendency
is to keep trying different possible answers in your mind
(08:00):
and trying on different scenarios and then feeling distressed at
those ideas or scenarios with an upsetting outcome. So learning
to tolerate uncertainty is something that actually we all have
to do now. And in addition, it's really a good
life skill to have in general, because sooner or later
(08:21):
there are things that come up in life that are
going to be uncertain, even one day when this pandemic
is over. When you imagine a future possibility, rather than
treating each possibility like it's a reality and a problem
that you have to solve, you want to answer this
possibility in your mind with the statement to yourself, hey,
(08:44):
it's uncertain next, meaning you're not going to answer it.
You're going to identify that it's an uncertainty that you
actually can't really know the answer to, and you're going
to tag it as such, and then you're going to
say to yourself, I recognize that, but I'm not going
to answer it so next. Allowing this uncertainty to go
(09:10):
unanswered is actually what allows the amount of questioning or
the obsessing about uncertainty to diminish. That might seem kind
of strange or hard to understand, but really all obsessing
increases as long as we keep answering the obsession because
(09:32):
every time we answer, we have a moment of relief. Ah,
that's the answer, and that relief provides the positive feedback
that keeps our brains asking the question again, it's really
positive reinforcement. And by not answering those questions, those worries,
those obsessions, essentially we provide no positive feedback, and without
(09:56):
positive feedback, that train of thought in our brain just dissipates.
So this is actually the better way to handle uncertainty
right now, there are some things that you can answer,
like what should I make for dinner tomorrow? That that
one you could actually come up with an answer for.
But the answer to when are we going to be
(10:18):
able to get together with this relative? And the uncertainty
of you know, when exactly you or someone you love
is going to be able to get a vaccine at
this moment in time may not be answerable. So when
something is unanswerable, you want to say, hey, that's uncertain Next,
(10:43):
I hope that was helpful. Here are some thoughts that
I hope will stay with you when you're feeling anxious. Remember,
some anxiety is actually a good thing. It's your mind's
danger signal that there is something you need to attend
to in order to be safe, a problem solved. In fact,
actually there's an optimal amount of stress at which we
(11:05):
perform better than when we're not stressed at all. For example,
take sports, or take testing, taking a job task. When
we have some stress, we actually turn out to be
better performers. There's a window of optimal anxiety and stress,
(11:26):
but too much anxiety, as many people are experiencing now
can decrease performance and mood, and it can even if
it goes on too long, become debilitated. So adding some
coping mechanisms into your day to day life can decrease
anxiety levels before they rise too much. Just small tweaks
(11:47):
in your lifestyles, such just exercise, breathing, decreasing your alcohol intake,
talking with friends, these things can all make big differences
in your stress level. Of course, if you find anxieties
with you all day, if it makes it hard to
work and is interfering with your relationships, consider talking to
(12:08):
a therapist. There are numerous types of psychotherapies that even
short term, just a few sessions can greatly diminish anxiety
from a true anxiety disorder, and of course, for people
who are severely suffering, medication can make a huge difference
as well. Do you have a problem I can help with?
(12:31):
If so, email me at how can I help? At
Seneca women dot com. All senders remain anonymous and listen
every Friday to how can I help with me? Doctor
Gail Salts
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Are you feeling more
anxious these days? You have plenty of company, and that's
what I will be answering questions about today. Anxiety In
the time of COVID, the pandemic has caused many people
to experience a rise in their anxiety levels. Life has
(00:49):
become more stressful and less certain across the board, and
chronic stress, combined with deep uncertainty often spells I anxiety.
The American Psychiatric Association has noted a new pandemic of
mental health issues, and one of the most common diagnoses
are anxiety disorders. Most people might not currently have an
(01:12):
anxiety disorder, but they are struggling with anxiety and it's
taking a toll on their day to day life. So
let's get to it and see how can I help.
Here's question one, doctor Saltz, my anxiety has increased tremendously
during the pandemic. What are some simple practices for changes
(01:37):
things that I can do to manage it? Actually, there
are a lot of things that I would call coping
tools that can help you to manage day to day
anxiety if you only insert a few of them, and
you should pick based on which ones are most appealing
to you during your day. So first, I would say,
(01:59):
and probably in some ways the most valuable is some
form of aerobic exercise for thirty minutes, three or four
times per week. And I say probably the most useful
because there is a lot of data, numerous studies that
support decreased stress, decreased anxiety, and improved mood with aerobic exercise.
(02:22):
And you really can choose whatever exercise you like as
long as it's getting your heart rate up well above
your resting pace. So that could be running, it could
be using some sort of machine in your home. It
could be doing calisthenics. It could be doing a group
zoom class or zoomba. It could be dancing. It really
actually doesn't matter what the movement is as long as
(02:44):
it's vigorous and therefore aerobic Aside from that, there are
a lot of different coping tools that take five to
ten minutes a day. One is taste deep breathing. This
is where you breathe in to a slow count of
five and you breathe out to a slow count of seven.
(03:06):
The longer exhale than inhale. And it's important that when
I say deep breathing, I mean abdominal breathing. So you
want to put your hand over your upper abdomen and
have that part of your lower chest upper abdomen rise
and fall with your breath. When you have an exhale
(03:28):
that lasts longer than your inhale, you tend to slow
your heart rate because it's on the exhale that heart
rate slows. And when you slow your heart rate, you
actually physiologically relax your body, and when you relax your body,
you relax your mind. It actually does take some practice,
but you can practice paste deep breathing for five minutes
(03:50):
in the morning and five minutes in the evening to
help you relax. Another technique which you can actually at
some point even add to the first one of breathing.
It's called progressive muscle relaxation. You can do this on
your own if you prefer it. It's basically squeezing each
individual muscle group two, account of five, holding it very
(04:11):
tight during that count of five, contracting all the muscles
and then releasing them. You start with your feet, you
move to your legs, to your arms, to your torso,
your shoulders, your neck, your head, and even your face,
scrunching those muscles as tight as you can and holding
for a count of five and then releasing. When you're
(04:34):
done with your body, your muscles have been relaxed, and again,
in physiologically relaxing your body, you relax your mind. Many
people find the practice of some form of meditation to
be extremely helpful in stress reduction and anxiety management. Mindful meditation,
transcendental meditation, there are many forms of meditation. Meditation is
(04:57):
a practice that does take some skill building, takes time
to learn, and you can start with something as simple
as an app or you can actually contract with somebody
to teach you meditation and do that via zoom. But
many more people are reaching out these days to some
sort of meditative technique. Social support also does help reduce
(05:20):
your anxiety, so simply making it your point to talk
to a friend or two every day for a few minutes,
talk about how you're feeling, talk about what's going on,
talk about what you might be able to look forward
to doing together at some point. Just having that social
support and repartee is actually helpful for reducing stress and anxiety.
(05:44):
And then, last, but definitely not least, is gratitude practice.
That means basically finding a very concrete method of experiencing
any gratitude that you can. I know it's a difficult time,
but all do actually feel grateful for certain things in
our lives, even as difficult as they are. And when
(06:06):
you bring the awareness of that gratitude to the front
of your mind, there have been a number of studies
again that have shown it tends to improve mood and
decrease levels of stress and anxiety. So that could be
as simple as at the end of the day writing
down three things for which you feel grateful, and those
things could be as small as a wonderful cup of
(06:29):
coffee you enjoyed to something bigger that's going on with
you or with your family. So the practice of gratitude
is also very helpful. There are actually even more techniques,
but the point is that injecting just a few coping
tools into your day can make a big difference in
terms of managing your anxiety going forward. How can I
(06:53):
help with Dr Gail Salts will be back after the
short break, and here's question number two, Hi, Doctor Salt.
Sometimes when it comes to thinking about the future and
(07:13):
its uncertainty, my thoughts spiral out of control. What is
the best way to approach the future in the COVID era?
Should I be making plans or should I just focus
on the here and now? Uncertainty drives obsessing in those
that are prone to it. What does that mean that
the very state of being uncertain makes you have thoughts
(07:38):
that go around and around and around about all kinds
of things. When you ask yourself a question about the
future and you actually can't know the answer, and I
think that, frankly, right now, many of us can't know
the answer to a lot of future questions. Your tendency
is to keep trying different possible answers in your mind
(08:00):
and trying on different scenarios and then feeling distressed at
those ideas or scenarios with an upsetting outcome. So learning
to tolerate uncertainty is something that actually we all have
to do now. And in addition, it's really a good
life skill to have in general, because sooner or later
(08:21):
there are things that come up in life that are
going to be uncertain, even one day when this pandemic
is over. When you imagine a future possibility, rather than
treating each possibility like it's a reality and a problem
that you have to solve, you want to answer this
possibility in your mind with the statement to yourself, hey,
(08:44):
it's uncertain next, meaning you're not going to answer it.
You're going to identify that it's an uncertainty that you
actually can't really know the answer to, and you're going
to tag it as such, and then you're going to
say to yourself, I recognize that, but I'm not going
to answer it so next. Allowing this uncertainty to go
(09:10):
unanswered is actually what allows the amount of questioning or
the obsessing about uncertainty to diminish. That might seem kind
of strange or hard to understand, but really all obsessing
increases as long as we keep answering the obsession because
(09:32):
every time we answer, we have a moment of relief. Ah,
that's the answer, and that relief provides the positive feedback
that keeps our brains asking the question again, it's really
positive reinforcement. And by not answering those questions, those worries,
those obsessions, essentially we provide no positive feedback, and without
(09:56):
positive feedback, that train of thought in our brain just dissipates.
So this is actually the better way to handle uncertainty
right now, there are some things that you can answer,
like what should I make for dinner tomorrow? That that
one you could actually come up with an answer for.
But the answer to when are we going to be
(10:18):
able to get together with this relative? And the uncertainty
of you know, when exactly you or someone you love
is going to be able to get a vaccine at
this moment in time may not be answerable. So when
something is unanswerable, you want to say, hey, that's uncertain Next,
(10:43):
I hope that was helpful. Here are some thoughts that
I hope will stay with you when you're feeling anxious. Remember,
some anxiety is actually a good thing. It's your mind's
danger signal that there is something you need to attend
to in order to be safe, a problem solved. In fact,
actually there's an optimal amount of stress at which we
(11:05):
perform better than when we're not stressed at all. For example,
take sports, or take testing, taking a job task. When
we have some stress, we actually turn out to be
better performers. There's a window of optimal anxiety and stress,
(11:26):
but too much anxiety, as many people are experiencing now
can decrease performance and mood, and it can even if
it goes on too long, become debilitated. So adding some
coping mechanisms into your day to day life can decrease
anxiety levels before they rise too much. Just small tweaks
(11:47):
in your lifestyles, such just exercise, breathing, decreasing your alcohol intake,
talking with friends, these things can all make big differences
in your stress level. Of course, if you find anxieties
with you all day, if it makes it hard to
work and is interfering with your relationships, consider talking to
(12:08):
a therapist. There are numerous types of psychotherapies that even
short term, just a few sessions can greatly diminish anxiety
from a true anxiety disorder, and of course, for people
who are severely suffering, medication can make a huge difference
as well. Do you have a problem I can help with?
(12:31):
If so, email me at how can I help? At
Seneca women dot com. All senders remain anonymous and listen
every Friday to how can I help with me? Doctor
Gail Salts
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