People have about 60,000 thoughts per day of which more than 90% are automatic, i.e. generated by our brain by associating an external stimulus (for example any daily situation in the hospital), with a memory record (it could be the memory of a death of a patient, the image of a relative).
As these thoughts are automatic, we have no control over them. What we do have control over is whether we pay attention to them or not. A thought only does harm if we fix our attention on it. Consequently, the way to prevent them from harming us is to direct our attention (and we do have power over this) to something else. There are several techniques that we can use to “let the thought pass”, some based on the alert systems that have priority in our brain and others that use the saturation of our processing systems.
- Diverting attention to other senses: to sounds (for example, paying attention to any surrounding sound, colleagues, sick people, the floor elevator…), to sight (looking for yellow objects, or round objects, or wooden objects…). As far as pain signals are concerned, we can recommend to put a rubber band on the wrist, and to give ourselves a “rubber band” when the annoying thought appears. Immediately our attention will go to our wrist and the thought will pass.
- Saturate our reasoning capacity: for example with series of linked words (road-novel-latino-girlfriend-trip…), or with numerical exercises (counting from 100 backwards in threes 100-97-94-91-88…). we will occupy “our working memory” and there will be no room for nagging thought.
Why do I blame myself if I am doing as much as I can to help COVID-19 patients?
Emotions appear only if an external stimulus (a lion) or an internal stimulus (a thought) sets them in motion. Guilt is always associated with a thought linked to the past. When we review any negative situation that occurred in the hospital, if we look for the cause in others, anger appears, if we attribute the cause to ourselves, guilt appears. We know that you have a lot of pressure and responsibility, but it is important to remind yourself that you are doing the best you can with the means at your disposal, don’t overdo it, you are doing fine!
How can I fix the reluctance I have for everything since this pandemic started?
The key is to establish routines and maintain activation by performing rewarding tasks. Listlessness is as if we installed a sign over our head saying “I don’t feel like it”. If we put a “like” before it, “I don’t feel like it, I don’t do anything”, we will fall into the downward slope of a depressed mood. However, if with an effort of will we put a “although” before it. “Even though I don’t feel like it, I’m going to call my friend Maria”, we will be able to put our mood in a positive frame of mind by obtaining the reinforcement of a pleasant conversation.
What can I do to get rid of my constant fear of contagion?
We all share that fear, especially those of you on the front lines in hospitals and health care facilities. Fear is good like all emotions, and it will help you to be alert and aware of not neglecting your protective measures, from putting on your PPE properly, to paying attention to your every move to avoid mistakes. The bad thing about the virus is that a mistake, a single oversight can lead to contagion. The most dangerous thing, in my opinion, is that, accustomed as you are to the daily situation in the hospital, there is a relaxation in the permanent attention needed. The only measure against fear (here there is a very real stimulus that triggers it) is protection and permanent vigilance.
How can I get back to a restful sleep?
It is normal that in situations of stress and low mood, sleep suffers. Studies have been published this week indicating that in general the confined population is sleeping worse, with an increase in vivid dreams having been identified.
To counteract this deterioration, it is advisable to maximize sleep hygiene measures and in the event that the lack of sleep is intense, go to your doctor so that he can prescribe a remedy. Sleep is “the psychologist’s thermometer”, we can all have a bad night, but several bad nights in a row require that we pay attention to it.
How can I cope with my distress at the possibility of infecting my loved ones or whoever is close to me?
Worry is characterized by the presence of emotionally active (“hot”) thoughts, triggered by a spiral of increasing physiological activation (palpitations, dizziness, sweating, choking and shortness of breath, nausea, shivering, trembling…) that are beyond the person’s voluntary control. Being worried is a common response to many life circumstances. We all have a need for control, and natural uncertainty, in many aspects of our lives that we do not control, generates a healthy and adaptive worry.
At the core of the anxiety experience is the feeling of uncontrollability and unpredictability of potentially dangerous stimuli. Worry is the result of a failed attempt to predict future negative consequences, under the assumption that “worrying” will allow control or better preparation to cope with the feared event. Consequently, worrying progressively becomes “the strategy” of coping since others, such as the effective capacity to solve the problem (when they are in our circle of influence), or the coping capacity (when it comes to situations on which we cannot act) are never put to the test.
We recall here the famous circles of Covey (1975) the area of influence and area of concern. Each of us has a wide range of worries: health, children, work problems, public debt, nuclear war…. We can separate these from the things we have no mental or emotional commitment to, creating a “circle of worry”. When we review the things that are within our circle of concern it becomes clear that some of them we have no real control over, and, with respect to others, we can do something. We can identify the concerns in the latter group by circumscribing them within a smaller “circle of influence”.
Worry is activated as a coping strategy, preventing the analysis and/or appraisal of emotionally active problems and the emotional consequences (e.g. instability) that would result from this analysis or from the possibility of facing the solution. This process is maintained because, on the one hand, it prevents us from this emotional exposure, and on the other hand, because we feel that being worried is an active approach to the solution of the problem. This is not so, because worry is thought and not action, and it blocks the proactive approach towards the solution of our problems.
In the case at hand, worry should help us, within our “area of influence with our ability to solve problems”, to take reasonable protective measures to prevent contagion to our loved ones. But as we said above, this pandemic has an uncontrollable and unpredictable part (like so many things in our lives), which places it outside our area of influence where our capacity for acceptance, if someone is infected, will be put to the test.