This guest post comes from Dr. Eva Ash, a clinical psychologist and AIP Certified Coach who works with clients on everything from psychotherapy and behavior change, to women’s issues and AIP. Today on the blog, Dr. Ash is sharing some important insight about the impact of the pandemic on our stress levels, particularly as members of the AIP community, and what we can do to manage this new kind of chronic stress. These insights have been gained first-hand over the last two years of Dr. Ash’s work supporting clients through the pandemic.
It’s 2022 and we’re still in a pandemic?! Let’s talk about managing our stress.
As a clinical psychologist and an Autoimmune Protocol (AIP) coach, a common concern I hear is, “How much longer am I going to have to live like there’s a pandemic going on?” I’m finding that it’s very common to have grown weary of wearing our masks, limiting our close contacts, and weighing the risks when we try to decide which activities to pursue and which to avoid. So many people want to know when life will go back to “normal.” And the truth is we really don’t know.
Things have gotten better since we celebrated last New Year’s Day – vaccines and boosters are out, and drugs to treat Covid-19 are on the horizon. But it’s clear that in general we have paid a price for living through the pandemic. The American Psychological Association’s survey of U.S. adults in February 2021 revealed that, since the start of the pandemic, many have had undesired weight changes, sleep disturbance, and increased alcohol use (APA.org).
In this article, I’m going to explore the (sometimes imperceptible) ways the pandemic has impacted our health, particularly as members of the autoimmune community, and share suggestions for how we can move forward and manage these impacts in the most healthful, productive way.
Stress: A Big Trigger for Autoimmunity
After years of research, as well as the anecdotal experiences many of us have had in managing our autoimmune (AI) conditions, we know that decreasing stress and increasing social connections are important parts of healing from AI illness. The AIP clearly teaches that it is not only increasing nutrient density and decreasing inflammatory foods that helps us to heal, but managing lifestyle factors such as stress, sleep, exercise, connection with others, and time in nature.
Researchers have been looking at the links between stress and AI for years. For example, one study shows that traumatic stress in childhood (being abused, witnessing violence, growing up in substance abusing households) puts us at risk of hospitalization for AI disease in adulthood (Dube).
Why would chronic childhood stress increase our risk for AI? A recent review exploring research into stress and immune function found that, in short, stress and depression lead to increases in stress hormones like cortisol, increases in inflammation, and decreases in immune function. From this we can say for sure that, along with risk factors such as genetics, infections and viruses, and nutrient insufficiency, stress is certainly part of the development of AI.
So perhaps for some of us, managing the stress of the pandemic has come naturally because we’ve taken seriously our need to manage stress even earlier than March of 2020. But it’s also possible that the pandemic was just one stress too many for some of us. Or perhaps we managed the stress of the pandemic well in its early days but have become less able to manage it as the pandemic has dragged on.
A New Kind of Pandemic Stress in 2022: Chronic
The pandemic was stressful in March of 2020 because there was so much uncertainty. We didn’t know how we would manage the changes we were told to make: working or schooling from home, wearing masks, keeping our distance from others. But many of us figured we could do anything it took for a short time. When I called my clients to tell them I was moving everyone to telehealth, I had two who insisted that they would just wait for me to return to the office. Neither they nor I thought it would be eighteen months before I returned to my office.
But no matter how well we managed the stress of the pandemic when it began, now the stress has become chronic. Therefore, the research discussed above that links chronic stress to AI becomes relevant.
An analogy that helped many of my clients by the summer of 2020 was that we had to start thinking about managing this pandemic as a marathon rather than as a sprint. We can’t just put our heads down and power through a stressor if it lasts months or years. We need to actively develop strategies to manage chronic stress. Or perhaps redouble our stress management efforts.
Sources of Chronic Stress During a Pandemic
The stress of the pandemic has been different for different people. For some it was more stressful at the beginning because so much was unknown: was it going to spread? Was someone close to us going to get sick or die? Should we wear masks, or should we save those masks for healthcare professionals? Is it safe to go to the grocery store?
Then, isolation became a big stressor. For people who live alone the advice to stay in their homes and limit their interactions with others may have been devastating. Those of us in the AI community may have been particularly stumped since increasing social connection is often part of our healing strategy.
Being quarantined in close quarters with others is stressful, too. Balancing our jobs at home with helping our children navigate online school is a big challenge. And as a therapist who sees many couples, I know that the pandemic has highlighted for some couples that they really don’t get along and can’t see a way to stay together for the long term.
But for some the pandemic is more stressful now that we are back to school, the office, or out in public, even if we are vaccinated. So many unknowns can surface: how long will our vaccines remain effective? Will strict quarantines return? Will others judge us (or feel pressured to join us) if we keep wearing our mask after mask mandates are lifted?
For some of us, a significant part of the stress of the pandemic has been the constant and sometimes conflicting news cycle. Even the most media savvy among us may have become glued to our constantly buzzing news alerts or our omnipresent televisions. It can be easy to forget that media outlets need to make money, and attention-grabbing headlines sell. But a constant drip of fearful sounding headlines is clearly not good for our stress levels.
Finally, the pandemic has meant lots of losses to lots of people, and the grief can be overwhelming at times. Some of us lost loved ones, but even if we didn’t, the death toll numbers are staggering. But there are subtler losses as well: losing freedom to come and go as we please, not being with our colleagues at work or school, missing family get-togethers and holidays, and many more.
Symptoms of Chronic Stress
So how do we know if pandemic stress is really starting to get to us? These are some of the symptoms of stress to look out for:
- Feelings of anger or sadness
- Feelings of numbness or frustration
- Feelings of worry or fear
- Difficulty concentrating
- Difficulty motivating ourselves to work/study/play
- Changes in our sleep: sleeping more, less, nightmares
- Changes in our appetites: eating more or less
- Increases in stomachaches and headaches
- Increases in our use of alcohol and recreational drugs
- Worsening of mental health problems
- Physical symptoms such as chest tightness or fatigue
If you have only one or two of these symptoms, you are likely doing a good job managing your stress. But the more of these symptoms you can check off, especially if you also find that the symptoms are significantly interfering with your ability to do your job, maintain your relationships, or stay healthy, the more you might want to consider upping your stress management game.
Effective Ways to Manage Chronic Stress
Classic stress management techniques like the ones below can be very helpful. I usually recommend my clients choose at least one physically oriented strategy (e.g., deep breathing), at least one cognitive strategy (e.g., challenging irrational ideas), and at least one spiritual strategy (e.g., meditation), and practice these at least once a day. A book I often recommend that teaches these strategies and more is The Relaxation and Stress Reduction Workbook by Davis, Eshelman, and McKay. If you prefer an app to a book, my clients have used Breathe2Relax, MyLife, and Headspace with success.
- Deep breathing
- Slow belly breathing
- Progressive muscle relaxation
- Challenge irrational ideas
- Focus only on what you can control
- Listen to calming music
While not usually included in classic stress management technique lists, there are some other things you can do that might be particularly helpful depending on your symptoms. If you feel flighty or untethered when stressed, like you are floating through life without purpose, then grounding exercises such as splashing cold water on your face or digging your heels into the floor can be useful. A resource for more grounding exercises can be found here.
Increasing our social connections is crucial for maintaining our mental health, whether during a pandemic or not. While research is still developing in this area, we know that lack of social support is associated with increased blood pressure, increased cortisol levels, decreased oxytocin levels, and feelings of detachment (Ozbay).
Some simple ways to increase social connection include:
- Checking in on a neighbor you know lives alone
- Volunteering at a local charity
- Starting a neighborhood dog walking group
I did this last one in March 2020, and it has continued to this day. In the early days of the pandemic, it got us outside for fresh air; those who worked from home got some relief from Zoom fatigue and caught up on the news from those who were obsessively reading and listening to it. And we all got some gentle exercise, albeit walking six feet apart.
There are some other stress management techniques that are particularly relevant to Covid stress:
- Making sure you have a routine, even if your usual place of work or school has changed
- Limiting media exposure
- Focusing on one well regarded source for facts and ignoring unreliable or anecdotal sources
- Letting go of what you can’t control (e.g., what others do with their masks and vaccines)
But focusing on the doom and gloom of stress can be part of the problem. Sometimes we cannot do much about the stressors: the pandemic will continue or not; our neighbors may flaunt mask requirements; media outlets will continue to grab audience share by using sensational headlines.
So, if we can’t change the stressors, what can we do? Research tells us that changing our mindset about stress is crucial (Crum). How? By making stress work for us rather than against us.
In short, those researchers recommend taking a three-step approach to stress: acknowledge the stress, welcome the stress, and use the stress to achieve goals or connect with things that matter to us (Leibowitz & Crum). This is all easier to say than to do, but essentially the idea is that by acknowledging stress we can shift from a place of fear to a place of action. Their approach is summarized nicely here.
How to Tell if You Need More Help Managing Your Stress
Perhaps you’ve been working on adjusting your mindset, incorporating stress management techniques, and avoiding sensational media, but you still feel overwhelmed. It might be time for professional help like coaching, psychotherapy, or medication if your symptoms are severe and have been persistent for more than two weeks. For example, if you have difficulty getting out of bed several days a week, or your concentration problems have interfered with work or school to the point others have noticed, or your sleep is disturbed more nights than not.
Places to get help include your primary care physician, your job’s Employee Assistance Plan (EAP), or national clearinghouses such as the National Alliance on Mental Illness, the U.S. Department of Health and Human Services, or the Veteran’s Association. Many U.S. states have also set up more local referral networks. Google “New York Covid resources” for example for the state you live in. Some countries have set up similar resources. Google “Israel Covid mental health resources” for example for the country you live in.
I recently came across a great example of a woman who has adjusted her mindset as she dealt with the pandemic. For inspiration, read this 87-year-old’s strategies for embracing the stress and using it to motivate her to get out and get living. At 87, she says it is time for her to enjoy a full life. And perhaps it’s time for us to enjoy a full life as well. What does that mean for you? Here are a few ideas to get you thinking:
- Book a (refundable) trip
- Make a change in your career
- Learn a new skill like an instrument or a language
- Search the internet for a long-lost friend
- Make a significant relationship change
- Start a meditation practice
- Crum, A.J. et al. (2020). Optimizing stress: An integrated intervention for regulating stress responses. Emotion, 20(1), 120-125.
- Dube, S.R. et al. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71, 2, 243-250.
- Leibowitz, K. & Crum, A. (2020, April 1). In stressful times, make stress work for you. The New York Times.
- Morey, J.N. et al. (2015). Current directions in stress and human immune function. Current Opinion in Psychology, 5:13-17.
- Ozbay, F. et al. (2007). Social support and resilience to stress. Psychiatry. 4(5) 35-40.