April 12, 2020 PCI Centers
We live in a very uncertain time right now given the outbreak of the novel coronavirus, otherwise known as COVID-19. Many people are losing jobs, whereas others are losing loved ones. The pandemic is a source of great suffering for billions of people all over the world. News stories come out every day showing the extent of the spread of the virus as well as research being published by virologists, epidemiologists, and biologists trying to help politicians and medical professionals understand the virus better, and how to manage the spread of the illness. This is why countries all over the world are using “social distancing” and quarantine procedures.
This is a historic time of uncertainty for so many. In addition to the natural fear for our own and our loved ones’ safety, fear for our jobs, and fear for the future in general, we have the added stress of being stuck inside and unsure of the future of our ability to even go outside safely. Given the unprecedented scope of this pandemic, we want to provide some free resources for everyone so that they can cope better during this pandemic. This first article will explain what anxiety is and how to cope with it better. The second article will explain some simple, evidence-based, ideas for managing a quarantine lifestyle more effectively.
What is Anxiety?
The words fear, dread, terror, panic, anxiety, thrill, and many others are often used to describe what clinicians call anxiety, which is the main feature of common mental health disorders such as generalized anxiety disorder, phobias, social anxiety disorder, and so on. Until recently, researchers assumed most people in most parts of the world experienced emotions the same way. Thanks to researchers like Lisa Feldman-Barrett we now know that, for instance, different cultures display anxiety differently in their facial movements and think about anxiety differently. Even though many cultures experience and display anxiety in different ways, or to different degrees of intensity, many if not most people experience the core affective components of anxiety in a very similar way.
Clinicians rely on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition of the American Psychiatric Association (DSM-5; APA, 2013) to understand and conceptualize anxiety disorders. Many of the disorders in the DSM-5 mentioned above reference symptoms of anxiety such as “restlessness or feeling keyed up or on edge,” “being easily fatigued,” “difficulty concentrating or mind going blank,” “muscle tension,” and similar states of mental or physical hyperarousal. As we mentioned above, different cultures might display or subjectively experience anxiety differently. Generally, people will experience some version of “hyperarousal” in their mind or body (affect).
Why do we have anxiety? Well, to the best of our knowledge, we have needed emotions and affects to communicate to ourselves and the world what is going on inside of our minds and bodies. Emotions can be thought of like road signs, they signal what the state of affairs is, and give us some idea of how to act next. If we’re fearful or anxious we might engage in the prototypical “threat” response behaviors: freeze, flight, fight, submit, fright, faint. Each of these responses is adaptive in the sense that they can help us avoid a threat. Let’s say you’re on a safari in Africa because you just want to see the cool animals, sounds fun right? Well, if there’s a cheetah in front of you, you might freeze to assess the circumstances and then maybe run away (flight) to your car wherein they cannot harm you. We need effects like fear or emotions like anxiety in order to prompt us to manage a perceived danger.
Why is perceived bolded and italicized? Well, because we are pretty sophisticated, our brains have evolved to become expert learners. We can learn to fear any number of things that are not innately scary. For instance, we’re not born with a fear of spiders, but we can really easily learn to have fear around them because a few species of spiders are poisonous and can kill humans, and, likely many of our ancestors were killed by bugs. We likely have a “bug could be deadly” sensitivity built into our brains. Also, we have a built hardware system in our brain for categorizing and taking in information from the outside world to see if something is potentially scary or dangerous. Watching movies like Arachnophobia teaches us to perceive spiders as dangerous. So, we can learn to be afraid of things or, said another way, we can perceive non-scary things as scary.
Coping with Anxiety
Right now, amidst the pandemic and quarantine developments, many people are experiencing both natural fear (of dying due to infection) and learned fear (xenophobia against different racial/ethnic groups). It seems like many people are doing their best to cope with their fear/anxiety about the pandemic for the past few weeks. On the other hand, some are reacting automatically to these fears. If you listen to various news commentators or participate in social media you’re likely to see people expressing their fear through humor, anger at officials, confusion, and sharing helpful information. These might be variations on our prototypical threat management responses from earlier on in the article: fight, flight, freeze, faint, fright, or submit. Sharing information might be a “fight” response, whereas gallows humor might be a “submit” response. These are all fine and normal, but they probably do not help with intense anxiety like many of us are feeling nowadays.
When it comes to evidence-based coping skills that are a little more effective at helping manage anxiety/fear we have some pretty solid options:
Progressive Muscle Relaxation
If you would like to learn more about these skills see the links below. Please use them as needed.
Diaphragmatic Breathing Demonstration: https://www.youtube.com/watch?v=UB3tSaiEbNY
Progressive Muscle Relaxation: https://www.youtube.com/watch?v=ClqPtWzozXs
Mindfulness Meditation: https://www.youtube.com/watch?v=ZToicYcHIOU
These tools alone can be helpful in reducing your fear. The problem, however, for many is that the tools might not be enough. For others, there might be underlying issues that make implementing these coping skills difficult. If you find yourself struggling to cope please feel free to reach out to us anytime at 747-222-7464 or at https://www.pcicenters.com/
Appel, J., & Kim-Appel, D. (2009). Mindfulness: Implications for substance abuse and addiction. International Journal of Mental Health and Addiction, 7(4), 506-512.
Aritzeta, A., Soroa, G., Balluerka, N., Muela, A., Gorostiaga, A., & Aliri, J. (2017). Reducing anxiety and improving academic performance through a biofeedback relaxation training program. Applied Psychophysiology and Biofeedback, 42(3), 193-202.
Auty, K. M., Cope, A., & Liebling, A. (2017). A systematic review and meta-analysis of yoga and mindfulness meditation in prison: Effects on psychological well-being and behavioural functioning. International Journal of Offender Therapy and Comparative Criminology, 61(6), 689-710.
Bandelow, B., Reitt, M., Röver, C., Michaelis, S., Görlich, Y., & Wedekind, D. (2015). Efficacy of treatments for anxiety disorders: a meta-analysis. International Clinical Psychopharmacology, 30(4), 183-192.
Bernardi, N. F., Bordino, M., & Bernardi, L. (2015). Disentangling the role of breathing in the cardiovascular response to meditation. Brain, Behavior, and Immunity, 49, e47.
Black, D. S. (2014). Mindfulness-based interventions: an antidote to suffering in the context of substance use, misuse, and addiction. Substance Use & Misuse, 49(5), 487-491.
Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., … Marlatt, A. (2009). Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Pilot Efficacy Trial. Substance Abuse, 30(4), 295–305. http://doi.org/10.1080/08897070903250084
Bowen, S., Chawla, N., & Marlatt, G.A. (2010). Mindfulness based relapse prevention for addictive behaviors: A clinician’s guide. New York, NY: The Guilford Press.
Bowen, S., & Kurz, A. S. (2012). Between-Session Practice and Therapeutic Alliance as Predictors of Mindfulness After Mindfulness-Based Relapse Prevention. Journal of Clinical Psychology, 68(3), 236–245. http://doi.org/10.1002/jclp.20855
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., … & Larimer, M. E. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA psychiatry, 71(5), 547-556.
Bowen, S., Witkiewitz, K., Dillworth, T. M., Chawla, N., Simpson, T. L., Ostafin, B. D., . . . Marlatt, G. A. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343-347.
Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C., Johnson, H. E., Deleone, C. M., … Rounsaville, B. J. (2011). Mindfulness Training for smoking cessation: results from a randomized controlled trial. Drug and Alcohol Dependence, 119(1-2), 72–80. http://doi.org/10.1016/j.drugalcdep.2011.05.027
Brewer, J. A., Bowen, S., Smith, J. T., Marlatt, G. A., & Potenza, M. N. (2010). Mindfulness-Based Treatments for Co-Occurring Depression and Substance Use Disorders: What Can We Learn from the Brain? Addiction (Abingdon, England), 105(10), 1698–1706. http://doi.org/10.1111/j.1360-0443.2009.02890.x
Brewer, J. A., Sinha, R., Chen, J. A., Michalsen, R. N., Babuscio, T. A., Nich, C., … Rounsaville, B. J. (2009). Mindfulness Training and Stress Reactivity in Substance Abuse: Results from A Randomized, Controlled Stage I Pilot Study. Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse, 30(4), 306–317. http://doi.org/10.1080/08897070903250241
Buric, I., Farias, M., Jong, J., Mee, C., & Brazil, I.A. (2017). What is the molecular signature of mind–body interventions? A systematic review of gene expression changes induced by meditation and related practices. Frontiers in Immunology, https://doi.org/10.3389/fimmu.2017.00670
Chen, Y. F., Huang, X. Y., Chien, C. H., & Cheng, J. F. (2017). The effectiveness of diaphragmatic breathing relaxation training for reducing anxiety. Perspectives in Psychiatric Care, 53(4), 329-336.
Chiesa, A., & Serretti, A. (2011). Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis. Psychiatry Research, 187(3), 441-453.
Christmann, C. A., Hoffmann, A., & Bleser, G. (2017). Stress Management Apps With Regard to Emotion-Focused Coping and Behavior Change Techniques: A Content Analysis. JMIR mHealth and uHealth, 5(2), e22. http://doi.org/10.2196/mhealth.6471
Colgan, D. D., Christopher, M., Michael, P., & Wahbeh, H. (2016). The body scan and mindful breathing among veterans with PTSD: type of intervention moderates the relationship between changes in mindfulness and post-treatment depression. Mindfulness, 7(2), 372-383.
Daley, D.C. and Marlatt, G.A. (1992) Relapse Prevention: Cognitive and Behavioral Interventions. In: Lowinson, J.H., Ruiz, P., Millman, R.B. and Langrod, J.G., Eds., Substance Abuse: A Comprehensive Textbook, 2nd Edition, Williams & Wilkins, Baltimore, 76-81.
Dambrun, M. (2016). When the dissolution of perceived body boundaries elicits happiness: The effect of selflessness induced by a body scan meditation. Consciousness and Cognition, 46, 89-98.
Davis, J. M., Fleming, M. F., Bonus, K. A., & Baker, T. B. (2007). A pilot study on mindfulness based stress reduction for smokers. BMC Complementary and Alternative Medicine, 7, 2. http://doi.org/10.1186/1472-6882-7-2
Eberth, J., & Sedlmeier, P. (2012). The effects of mindfulness meditation: a meta-analysis. Mindfulness, 3(3), 174-189.
Firth, J., Torous, J., Nicholas, J., Carney, R., Rosenbaum, S., & Sarris, J. (2017). Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 218, 15-22.
Fischer, D., Messner, M., & Pollatos, O. (2017). Improvement of Interoceptive Processes after an 8-Week Body Scan Intervention. Frontiers in Human Neuroscience, 11, 452. https://doi.org/10.3389/fnhum.2017.00452
Fjorback, L. O., Arendt, M., Ørnbøl, E., Fink, P., & Walach, H. (2011). Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy–a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102-119.
Frank, D. L., Khorshid, L., Kiffer, J. F., Moravec, C. S., & McKee, M. G. (2010). Biofeedback in medicine: who, when, why and how? Mental Health in Family Medicine, 7(2), 85–91.
Fredrickson, B. L., Boulton, A. J., Firestine, A. M., Van Cappellen, P., Algoe, S. B., Brantley, M. M., … & Salzberg, S. (2017). Positive Emotion Correlates of Meditation Practice: a Comparison of Mindfulness Meditation and Loving-Kindness Meditation. Mindfulness, 8(6), 1623-1633.
Garland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010). Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial. Journal of Psychoactive Drugs, 42(2), 177–192.
Garland, E., & Roberts-Lewis, A. (2013). Differential Roles of Thought Suppression and Dispositional Mindfulness in Posttraumatic Stress Symptoms and Craving. Addictive Behaviors, 38(2), 1555–1562. http://doi.org/10.1016/j.addbeh.2012.02.004
Ghadse, A. M., Ranjan, L. K., & Gupta, P. R. (2019). Biofeedback as an adjunct to conventional stress management and relaxation techniques in substance abuse disorders: A randomized controlled interventional study. The Indian Journal of Occupational Therapy, 51(1), 26.
Goessl, V. C., Curtiss, J. E., & Hofmann, S. G. (2017). The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychological Medicine, 47(15), 2578-2586.
Golding, K., Fife-Schaw, C., & Kneebone, I. (2017). Twelve month follow-up on a randomised controlled trial of relaxation training for post-stroke anxiety. Clinical Rehabilitation, 31(9), 1164-1167.
Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., … & Ranasinghe, P. D. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357-368.
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1-12.
Houlihan, S. D., & Brewer, J. A. (2016). The emerging science of mindfulness as a treatment for addiction. In Mindfulness and Buddhist-derived approaches in mental health and addiction (pp. 191-210). Springer, Cham.
Irving, J. A., Dobkin, P. L., & Park, J. (2009). Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR). Complementary Therapies in Clinical Practice, 15(2), 61-66.
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11-21.
Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Dell Publishing, a division of Bantam Doubleday Dell Pub. Group.
Kabat‐Zinn, J. (2003). Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice, 10(2), 144-156.
Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041-1056
Khanna, S., & Greeson, J. M. (2013). A Narrative Review of Yoga and Mindfulness as Complementary Therapies for Addiction. Complementary Therapies in Medicine, 21(3), 244–252. http://doi.org/10.1016/j.ctim.2013.01.008
Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519-528.
Kim, H., & Newman, M. G. (2019). The paradox of relaxation training: Relaxation induced anxiety and mediation effects of negative contrast sensitivity in generalized anxiety disorder and major depressive disorder. Journal of Affective Disorders, 259, 271-278.
Laneri, D., Schuster, V., Dietsche, B., Jansen, A., Ott, U., & Sommer, J. (2015). Effects of long-term mindfulness meditation on brain’s white matter microstructure and its aging. Frontiers in Aging Neuroscience, 7, 254. http://doi.org/10.3389/fnagi.2015.00254
Lehrer, P.M. & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work? Frontiers in Psychology, 5, 756 https://doi.org/10.3389/fpsyg.2014.00756
Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., … Li, Y.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Frontiers in Psychology, 8, 874. http://doi.org/10.3389/fpsyg.2017.00874
Manzoni, G. M., Pagnini, F., Castelnuovo, G., & Molinari, E. (2008). Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC psychiatry, 8(1), 41.
Marcus, M. T., & Zgierska, A. (2009). Mindfulness-Based Therapies for Substance Use Disorders: Part 1 (Editorial). Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse, 30(4), 263. http://doi.org/10.1080/08897070903250027
McNeece, Carl Aaron, Diana M. DiNitto, and Carl Aaron McNeece. Chemical dependency: A systems approach. Boston, MA, London: Pearson/Allyn and Bacon, 2005.
Murphy, J. G., Dennhardt, A. A., Martens, M. P., Borsari, B., Witkiewitz, K., & Meshesha, L. Z. (2019). A randomized clinical trial evaluating the efficacy of a brief alcohol intervention supplemented with a substance-free activity session or relaxation training. Journal of Consulting and Clinical Psychology, 87(7), 657.
Pace, T. W., Negi, L. T., Adame, D. D., Cole, S. P., Sivilli, T. I., Brown, T. D., … & Raison, C. L. (2009). Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology, 34(1), 87-98
Rainforth, M. V., Schneider, R. H., Nidich, S. I., Gaylord-King, C., Salerno, J. W., & Anderson, J. W. (2007). Stress Reduction Programs in Patients with Elevated Blood Pressure: A Systematic Review and Meta-analysis. Current Hypertension Reports, 9(6), 520–528.
Rogojanski, J., Vettese ,L.C., Antony, M.M. (2011). Coping with cigarette cravings: Comparison of suppression versus mindfulness-based strategies. Mindfulness, 2(1), 14–26.
Rosenkranz, M.A., Davidson, R.J., MacCoon, D.G., Sheridan, J.F., Kalin, N.H., Lutz, A. (2013). A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation. Brain, Behavior, and Immunity, 27, 174-184. DOI: 10.1016/j.bbi.2012.10.013
Segal, Z., Teasdale, J., Williams, M. (2002). Mindfulness-Based Cognitive Therapy for Depression. New York: Guilford Press.
Sevinc, G., Hölzel, B. K., Hashmi, J., Greenberg, J., McCallister, A., Treadway, M., … Lazar, S. W. (2018). Common and dissociable neural activity after mindfulness-based stress reduction and relaxation response programs. Psychosomatic Medicine, 80(5), 439–451. http://doi.org/10.1097/PSY.0000000000000590
Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014). Mindfulness as a treatment for behavioural addiction. Journal of Addiction Research & Therapy, 5(1). : http://dx.doi.org/10.4172/2155-6105.1000e122
Stein, L. A. R., Martin, R., Clair-Michaud, M., Lebeau, R., Hurlbut, W., Kahler, C. W., … & Rohsenow, D. (2020). A randomized clinical trial of motivational interviewing plus skills training vs. Relaxation plus education and 12-Steps for substance using incarcerated youth: Effects on alcohol, marijuana and crimes of aggression. Drug and Alcohol Dependence, 207, 107774.
Stetter, F., & Kupper, S. (2002). Autogenic training: A meta-analysis of clinical outcome studies. Applied Psychophysiology and Biofeedback, 27(1), 45-98.
Tang, Y. Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., … & Posner, M. I. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences, 104(43), 17152-17156.
Upton, S. R., & Renshaw, T. L. (2017). Immediate Effects of the Mindful Body Scan Practice on Risk-Taking Behavior. Mindfulness, 1-11. https://doi.org/10.1007/s1267
Ussher, M., Spatz, A., Copland, C., Nicolaou, A., Cargill, A., Amini-Tabrizi, N., & McCracken, L. M. (2014). Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. Journal of Behavioral Medicine, 37(1), 127-134.
Vallejo, Z., & Amaro, H. (2009). Adaptation of mindfulness-based stress reduction program for addiction relapse prevention. The Humanistic Psychologist, 37(2), 192-206.
Varvogli, L., & Darviri, C. (2011). Stress management Techniques: Evidence-based procedures that reduce stress and promote health. Health Science Journal, 5(2), 74-89.
Vilardaga, R., Luoma, J. B., Hayes, S. C., Pistorello, J., Levin, M. E., Hildebrandt, M. J., … Bond, F. (2011). Burnout among the Addiction Counseling Workforce: The Differential Roles of Mindfulness and Values-based Processes and Work-site Factors. Journal of Substance Abuse Treatment, 40(4), 323–335. http://doi.org/10.1016/j.jsat.2010.11.015
Williams, J. M. G., & Kabat-Zinn, J. (2011). Mindfulness: diverse perspectives on its meaning, origins, and multiple applications at the intersection of science and dharma. Contemporary Buddhism, 12(01), 1-18.
Witkiewitz, K., Warner, K., Sully, B., Barricks, A., Stauffer, C., Thompson, B. L., & Luoma, J. B. (2014). Randomized trial comparing mindfulness-based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Substance Use & Misuse, 49(5), 536-546.
Witkiewitz, K., Bowen, S., Douglas, H., & Hsu, S. H. (2013). Mindfulness-Based Relapse Prevention for Substance Craving. Addictive Behaviors, 38(2), 1563–1571. http://doi.org/10.1016/j.addbeh.2012.04.001
Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 211-228.
Wright, R. (2017). Why buddhism is true: The science and philosophy of meditation and enlightenment. London, UK: Simon & Schuster
Wu, J. Q., Appleman, E. R., Salazar, R. D., & Ong, J. C. (2015). Cognitive behavioral therapy for insomnia comorbid with psychiatric and medical conditions: a meta-analysis. JAMA Internal Medicine, 175(9), 1461-1472.
Zgierska, A., Rabago, D., Zuelsdorff, M., Coe, C., Miller, M., & Fleming, M. (2008). Mindfulness Meditation for Alcohol Relapse Prevention: A Feasibility Pilot Study. Journal of Addiction Medicine, 2(3), 165–173. http://doi.org/10.1097/ADM.0b013e31816f8546