Over the last few weeks, we have been getting used to a new everyday life. Public life is or was at a standstill. For many, this is a challenge that has both physical and mental consequences. Medicom spoke with psychiatrist and psychotherapist Dr. med. Haisch about crisis management, stress, anxiety, solutions, and the time after the crisis.*
* Editor's note: This interview was conducted in March 2020 during the coronavirus crisis, when Covid measures were being implemented differently across various federal states.
Medicom: In your opinion, what is this current period doing to us all from a psychological and psychosomatic perspective? What different behavioral strategies are we currently seeing in people? Do women handle it differently than men?
Haisch: The current health-policy crisis is accompanied for every individual by a high degree of personal uncertainty and anxiety, but of course also by drastic restrictions on individual freedom. In these times, everyone is worried about themselves and their loved ones and hopes that everyone will get through the crisis unscathed. Often, however, even more serious for the psyche is the feeling of no longer having control over the situation—of being "at the mercy" of events, not knowing what will happen next. A feeling of loss of control arises, a helplessness, and from this typically grows anxiety, depression, or even panic. This is further reinforced by the sometimes very alarmist reporting, especially on social media. Of course, the restrictions on everyday life are just as burdensome; supportive social contacts fall away, and hobbies and sports activities can no longer be pursued as usual, even though they would be important for stress relief.
A feeling of loss of control arises, a helplessness, and from this typically grows anxiety, depression, or even panic.
All of this can significantly increase an individual's "stress level," and the consequences, in addition to physical and mental symptoms, include, for example, increased family conflict and the resulting dissatisfaction. There are indeed typical differences between men and women in psychological processing and the resulting behavioral patterns. Women react more frequently with withdrawal, increased depression, and anxiety. Men tend to react with increased irritability or even aggression. Attempting to cope through increased substance use is also typically more common in men. Thus, while people with pre-existing mental health issues in the areas of anxiety or depression are currently particularly at risk, even otherwise very "stable" people are noticing a significant burden during these times.
Medicom: What exactly does stress do to our body?
Haisch: First, we must distinguish between acute and chronic stress reactions. The body's acute stress reaction is quite useful and ensured the survival of our ancestors. For example, in dangerous situations, the autonomic/vegetative nervous system is activated within a very short time so that we can act with a "fight-or-flight response" and thus react appropriately. Specifically, the sudden increase in adrenaline (acute stress hormone) ensures that the body is provided with increased energy reserves, so we are more alert and efficient. As soon as the "danger" has passed, the adrenaline level drops again and the body can return to its "normal state."
The current situation with ongoing health and often economic worries unfortunately falls into the realm of chronic stress reactions.
However, if a chronic stress reaction occurs due to prolonged exposure to a so-called "stressor" (e.g., ongoing professional or private conflicts, health worries, etc.), the tables turn, and the body's otherwise sensible reaction can become a danger point. The current situation with ongoing health and often economic worries unfortunately falls into the realm of chronic stress reactions. This can lead to emotional, cognitive, and physical symptoms and changes due to a long-term elevated cortisol level in the body.
Medicom: And what could be the resulting health consequences?
Haisch: On an emotional level, the mood changes mentioned above can occur; one feels increasingly down, exhausted, drained, and irritable—everything suddenly becomes "too much." Unfortunately, it is also very typical to lose interest in things that are actually positive, such as hobbies or social contacts, and to withdraw more and more, brood over things, or worry about the future. On a cognitive-mental level, for example, concentration and attention problems can set in; one forgets things more easily, can no longer remember texts one has read, and everyday things become "tiresome." A feeling of "being beside oneself" or a perceived "tunnel vision," especially regarding problem areas, is also typical.
Susceptibility to infection typically increases in a state of chronic stress; one is ill more often and recovers less well.
On a physical level, the most noticeable symptoms often arise, for example, increased exhaustion, constant fatigue, and limited performance, alongside sleep disorders, inner restlessness, teeth grinding, and headaches and back pain.
Susceptibility to infection typically increases in a state of chronic stress; one is ill more often and recovers less well. Also common are changes in blood pressure, usually an increase without a somatic cause, racing heart and respiratory problems, feelings of pressure in the chest, dizziness, ear noises and tinnitus, digestive problems, tremors or constant "tingling" on the skin, increased skin complaints, etc.
Of course, most of these symptoms can also have a purely physical cause, which should definitely always be ruled out first before diagnosing a state of chronic stress. Overall, the picture can be aptly described with the term "empty battery" that just won't charge properly anymore.
Medicom: In your view, is it possible that more people with corresponding pre-existing conditions will need medical care due to psychosomatic stress? For example, can an asthma or heart patient have an attack solely because of fear of an illness like the novel coronavirus? Or is that too far-fetched?
Haisch: That is quite possible. We just have to keep in mind what happens in the body, for example, during a panic attack, i.e., a state of pronounced anxiety. This means a maximum stress state for the body; the symptoms mentioned above occur, such as chest tightness, increased breathing difficulties, etc., even in otherwise healthy people. If the person concerned then also interprets these in a "catastrophizing" way based on their previous experiences and current focus (i.e., every physical symptom is mentally and immediately classified into a "worst-case scenario"), this naturally reinforces the anxiety and, consequently, the physical reaction, leading to a so-called "vicious cycle of anxiety." And in this helplessness and panic, many people naturally turn to the medical care system without there being a real physical emergency. And these cases are definitely occurring more frequently at the present time than in a "normal state."
Medicom: Is there something generally valid that everyone can take to heart and do now to get through this time better, or is there something that one should rather not do now, even if one might mistakenly believe it helps?
Haisch: It is of great relevance to allow a certain feeling of control to arise and to strengthen self-efficacy. This means, on the one hand, that the "flood of information" should be limited—for example, the latest status should only be checked once in the morning and once in the evening from trustworthy and reputable sources (e.g., RKI, WHO), but in the meantime, especially social networks should be "rested" in order to avoid constant negative "sensory overload."
Furthermore, it is very important to shift one's own focus more to the areas that are controllable—despite the difficult times—for example, "how can I shape the day with my family today," "how can I make meaningful use of the time for myself." The feeling of "self-efficacy" should emerge again, i.e., the feeling of being able to shape things oneself and not just having to wait helplessly ("active coping"). This specifically includes strengthening oneself on the various levels of the "bio-psycho-social" resource model. So "what good can I do for my body right now" (biological level), for example, paying attention to a healthy diet, exercise as far as possible, relaxation, etc.
Furthermore, the "social" level should be considered: "How can I maintain my social contacts during this time," how can I use the time with the family, which conversation have I been wanting to have with a friend or partner for a long time, what can I plan with my family for the time "after the crisis"? And last but not least, it is of course very important to strengthen the psychological level, also through concrete measures: "what is good for me mentally," which book have I always wanted to read, which music makes me feel good, which people can help me in this situation? Here, too, it is important to develop a certain "inner sense" of the situation, for example, by re-prioritizing family, strengthening cohesion, or by offering help to neighbors.
And the focus should definitely be on the positively experienced things; this means, in concrete terms, that one should temporarily distance oneself from things or people that further increase anxiety. After all, we must not forget that anxiety and the associated stress reaction in the body further weakens the immune system, which is certainly the least sensible thing in these times. Occupy yourself with future perspectives, plans, and goals that help you to mentally overcome the current "dry spell." This also means, for example, "allowing" yourself to turn to unburdened areas of life alongside all the negative influences, such as watching a funny movie, in order to deliberately redirect the focus to these areas as well.
Medicom: If I notice that I am overwhelmed by the situation and anxieties arise, what can I do? Are there relaxation exercises/therapies/herbal remedies that can be helpful? When do I need to seek medical help?
Haisch: First of all, it is very important to find a certain "valve" for the anxieties—in the best case, to talk about them. Everything that "haunts" the subconscious unspoken usually becomes "bigger" and more threatening. So it is important to seek contact with relatives or friends, preferably those who react level-headedly and less anxiously.
Another possibility for a valve function is to put the anxieties on paper and critically question them; often, this already provides better distance. Here, too, it is helpful to keep one's own resources and resilience factors (see above) in mind and to strengthen them in a targeted manner. Of course, regenerative measures such as yoga, progressive muscle relaxation, autogenic training, meditation, or simply a nice bath with calming music can also be helpful.
Of course, you can also get support through herbal, calming preparations. However, I think expert advice is sensible here, as not every active ingredient suits every person and an individual approach is sensible. If the symptoms really increase into the clinically pathological range or if a corresponding pre-existing condition exists, it can sometimes also be sensible to temporarily adjust psychopharmacological medication, of course only under specialist guidance. In this regard, I would absolutely avoid resorting to preparations that have a potential for dependence, as these only increase anxiety in the long term and have other harmful consequences.
In addition, I naturally advise against any "self-medication" through addictive substances such as alcohol, nicotine, or cannabis, as these, if at all, only provide short-term "relief," but the harmful consequences clearly outweigh this.
I think it is important that if you notice the above-mentioned symptoms of chronic stress on yourself, you should seek professional help as early as possible so that these do not become chronic and thus increasingly difficult to treat.
Medicom: How do I explain all this to children, do you have any advice?
Haisch: For children, the role model function of the parents is essentially important; they orient themselves significantly by the reactions of the parents and are thus strongly influenced in their psychological experience. If the parents react with helplessness and anxiety, this will also affect the children; if the parents react calmly and level-headedly, this will also lead to less anxiety development in the children.
It is, especially with older children or adolescents, quite sensible to clearly communicate the seriousness of the situation; it helps little here to want to maintain the image of an "intact world" that, unfortunately, does not exist right now; children would see through this sooner or later anyway as incongruent information. Nevertheless, it is of course very important to only provide the children with the relevant information and to protect them from the flood of anxiety-inducing news, especially on social networks.
It is certainly sensible here to communicate the most important new information once a day (e.g., how long schools are expected to remain closed, etc.) and then to use the rest of the day for other topics and content.
For children, family cohesion is of course particularly important in such times; the joint active shaping of time and mutual support take on an even greater significance in times of crisis. And here, too, forward-looking planning and working out future perspectives for the time after the crisis is necessary and helpful, as the restriction of social contacts and leisure activities can of course also be very painful for children.
Medicom: Due to the restricted freedom of movement, there is certainly more conflict potential in partnerships; how do you assess that, what could help? Not everyone has a house and a garden at their disposal.
That is very true. Due to the circumstances already mentioned above, there are significantly increased couple conflicts during these weeks. It is absolutely necessary here that each of the partners maintains certain personal freedoms, i.e., that each is allowed, figuratively speaking, to "go their own way" and that one then "meets again" regularly and purposefully. Specifically, this means that everyone should allow the other time to occupy themselves with their own resources without reproach or "interference" and that one sets fixed points every day that one shapes together as a couple or as a family, for example, having dinner together and the subsequent game night. That is of course very difficult currently, depending on the spatial circumstances, but it is absolutely necessary to allow oneself the freedom and the "being alone for oneself" at some times of the day, in order to then be able to enjoy the time together more again. Here, too, of course, as already said above, possible anxieties, dissatisfaction, or needs should be voiced as early as possible before they build up too much and then "discharge" in an argument. It is just as helpful to quietly work on common goals and wishes for the "time after," for example, a joint vacation. Common future perspectives are very important, especially in this time.
Medicom: We now have a health crisis, but what comes next; what burdens on our mental life must we then expect? Example: existential anxiety! Is there, for all the uncertainty, a way to mentally prepare for this or to deal better with these future anxieties and existential worries?
Haisch: This is a very large and, in my view, currently completely unforeseeable issue, which naturally causes very real fears and hardships for many people, which certainly cannot be "talked away." Nevertheless, it is helpful, especially with anxiety about the future, to obtain as much information as possible, for example, "What support packages are available?", "When and how can I apply for them?", "Are there perhaps other, new ways for me to maintain my income?", "How can I make preparations during this time for the phase afterwards?" (e.g., "how can I still stay in contact with my customers"). Of course, it is also absolutely necessary to open up to your family about your existing fears and to think about possible solutions together.
Attempting to go through this time as a lone wolf is doomed to failure.
Attempting to go through this time as a lone wolf is doomed to failure. Here, too, it is highly advisable to exchange ideas with colleagues and others who are also affected, and, if necessary, to develop joint concepts. It certainly requires a great deal of creativity and optimism, which makes it all the more important to pool resources, stand together, and support one another. The more you manage not just to passively "wait and see," but to actively shape things, the less threatening your fears of the future will seem.
Thank you very much for the conversation. That was valuable advice!
About the person:
Dr. med. Sarie Ann Haisch is a resident specialist in psychiatry and psychotherapy at the Areion Competence Center in Neu-Ulm, specializing in the treatment of stress-related illnesses. Previously, she worked in various inpatient facilities, e.g., the Ulm University Hospital, the Kilchberg Sanatorium in Switzerland, as well as the Center for Psychiatry in Ravensburg. In addition, she completed training as a business coach at CIP Munich. Beyond her therapeutic work, she offers seminars and workshops for companies. Her key topics include burnout prevention, healthy employee management, and strengthening resilience.
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