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COVID-19: Practical cognitive behavioural strategies to manage your mental health

Mental health

We are living in extraordinary times that may be leading to increased feelings of stress, anxiety and fear. These are normal reactions to challenging situations. However, sometimes these feelings can overwhelm us and hit a tipping point where it impacts our ability to function. It can lead us to stop doing the things that we know are good for us, it can lead us into poor habits, and can impact our thoughts in a negative way.

Cognitive behavioural therapy (CBT) is a way of ‘thinking and doing’ that is an evidence-based approach, offering strategies to manage challenging moods and anxieties. Below are some tips to help keep well during this stressful time.

Make a routine for yourself and your family

With many changes in our work and social interactions because of COVID-19 and physical distancing, it is important to create a new daily routine. Having a predictable routine can reduce anxiety and improve focus and productivity. Make sure that you incorporate time for self care including exercise, time for connecting with others (via telephone or social media), and time to do things you enjoy. Consider adding things into your routine that can provide a sense of accomplishment like catching up on work, cleaning out a cupboard, or learning a new skill.

Catch, Check, and Change troublesome thoughts

This exercise can help improve your mood by modifying your thoughts to be more balanced. When you notice you are having strong negative emotions, try to catch the thoughts that are accompanying them. Check the thoughts by taking a step back and making sure you are looking at all of the factors in the situation. It can be helpful to imagine that someone you love is having this thought. Think about what you would say to them, including the pros and cons. Finally, change, or modify the original thought by making it more balanced based on the facts you’ve identified. Here’s an example of how to use this strategy:

Catch the initial thought: I’m not going to be able to cope during this crisis.

Check the thought by looking at the facts: There are real health concerns. I’ve managed with other difficulties in the past (e.g. family illness, job changes). There are supports in place from our community and government to help me get through it.

Change and reframe the initial thought based on the facts: While there are real concerns and this is a challenging time, I have coped with difficulties before and there are supports and strategies I can use to stay healthy, like physical distancing.

Use behavioural strategies: mindfulness, breathing and relaxation

Mindfulness meditation:

Mindfulness is paying attention to thoughts and feelings in a particular way — on purpose, in the present moment, and non-judgmentally. This can lead to increased awareness, decreased negative thinking, decreased ruminations and catastrophizing, which can lead to a different approach to problems, with more choice and different ways of responding.

We can use the breath or bodily sensations as anchors to keep us in the moment. There are different mindfulness meditation practices including body scan, sitting practices, mindful walking and mindful movement.

Some links to begin to explore mindfulness meditation:

  1. Jud Brewer is a psychiatrist and neuroscientist with expertise in mindfulness. This is a brief meditation exercise addressing anxiety around coronavirus.
  2. Ten Percent Happier is offering free access to guided meditations for health care workers. As well there are free meditations for everyone here by world renowned teachers.
  3. Mindfulness during the coronavirus: Harvard professor’s tips to help lower anxiety.

Box breathing:

Imagine breathing around a box. Inhale as you visualize going up one side of the box, then pause as you go across the top of the box, exhale as you imagine travelling down the side, and pause again as you travel along the bottom of the box. As you breathe in gradually to fill your lungs with air, hold for 1-5 seconds, then exhale the air, hold for 1-5 seconds, and repeat. This can be done 7-10 times in a row, focusing on the breath.

Progressive muscle relaxation:

Tense and relax each muscle group starting from your feet and gradually work your way up the body to your face. This exercise has been shown to reduce stress and anxiety, and improve sleep and wellbeing by lowering blood pressure and decreasing muscle tension.

Some links to walk you through the exercise of progressive muscle relaxation:

Practice good sleep habits

Good sleep habits, also known as sleep hygiene, can help improve the way we handle challenging situations. Try to go to sleep around the same time each night and wake up around the same time each morning. Create a relaxing bedtime routine so you can wind down and train your body that it’s time for sleep. While in bed, avoid using things that you associate with being awake such as your phone or watching television. If you find yourself lying in bed and cannot fall asleep after 15-20 minutes, get out of bed and do something low key, such as reading a book. When you feel tired, go back to bed and try again.

Using CBT strategies may take some getting used to but try to be patient with yourself. These tips can be used whenever you’re feeling stress, fear or anxiety and can be practical everyday strategies to help individuals cope and manage their mental health.

If you need help in an emergency please call 911 or visit your local emergency department. If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

About the author

Dr. Joanna Mansfield

Dr. Joanna Mansfield is a psychiatrist at Sunnybrook’s Women’s Mood & Anxiety Clinic, Cognitive Behavioural Therapy Clinic and General Psychiatry Clinic and teaches medical residents in psychiatry at the University of Toronto.