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Maintaining Mental Health Hygiene During a Pandemic

Joshua D. Rosenblat, MD, MSc, FRCPC (Psychiatry) – March 19, 2020

The coronavirus (COVID-19) pandemic has led to profound changes in social and occupational practices requiring most people to socially isolate. Symptoms of anxiety and depression may increase with the required social distancing practices. Individuals who are already struggling with their mental health are at greater risk of experiencing worsening symptoms of anxiety and depression. Principles of cognitive behavioral therapy (CBT), behavioral activation (BA), interpersonal therapy (IPT) and mindfulness may be applied to maintain “mental health hygiene” to reduce mental health symptoms. The following 8 tips were written for individuals already struggling with depression and anxiety, however, may also be helpful for people with no previous mental health diagnoses. Many of these recommendations may seem obvious; nevertheless, mindfully applying these common-sense strategies may still be beneficial. Applying these strategies on a daily basis would likely have the greatest benefits to your mental health.

1. “MAPS” – Mastery, Altruism, Pleasure, Silence. On a daily basis, schedule in at least one activity for each of the four MAPS categories (e.g., scheduling in at least 4 activities per day). An activity of mastery is anything that allows you to feel a sense of accomplishment in completing a task. The activity may be small or large, such as making a sandwich, cleaning your room, sweeping the front porch or completing a task for work/school. Acknowledging the completion of the task can help bring a sense of purpose and accomplishment versus feeling that every day was wasted with nothing to show for it. An activity of altruism is doing something good for another person. This may also be small or large, such as giving a call to a loved one that is feeling isolated or picking up an extra package of toilet paper for a neighbor (you can always leave it at the door and not make physical contact). Activities of pleasure are also essential. When depressed, you may anticipate that these activities will not be enjoyable, but doing things that used to be enjoyable is still important as “faking it” can eventually lead to actually enjoying it. Having a period of silence on a daily basis is important to allow your brain to settle and be mindful in the moment. For many people, while at home you might have the television, radio or music on all day, but this constant background noise decreases your ability to experience the anti-anxiety effects of being silent and mindful in the moment. Constant noise and stimulation, increases adrenaline levels as your “fight or flight” response is activated. Daily periods of silence may allow your brain and body to decrease your adrenaline levels, activating your parasympathetic nervous system allowing you to “rest and digest.”

2. Healthy Diet – During periods of social isolation, it is tempting to preferentially consume “easy foods” such as takeout and junk foods. Processed foods high in carbohydrates and fat can directly worsen your mental health as your insulin levels rapidly fluctuate, directly effecting your brain function. Ensuring adequate consumption of fruits, vegetables and healthy proteins may give your brain the nutrients it needs to stay well during these difficult times. Cooking at least one meal a day may be helpful, rather than only consuming pre-prepared and takeout foods. Cooking may also serve as a mastery and pleasure activity to help accomplish your MAPS activities for the day.

3. Daily Physical Activity – As most gyms and recreational centers are closed, and your usual daily physical activities are not occurring, a sedentary lifestyle may easily take over, which can quickly worsen symptoms of depression and anxiety. If you are not quarantined, current recommendations still allow for you to leave your home and perform activities that have adequate social distancing. For example, current recommendations prevent group fitness classes, however, going for a brisk walk, run or bike ride still allows for ample social distancing in our currently empty sidewalks and roads. YouTube also has hundreds of free videos demonstrating at-home workouts that may be performed with zero equipment required. Everyone’s capability to perform physical activity will vary, but ensuring some daily vigorous activity, even a brisk walk around the block, may be helpful. Studies suggest that 30-60 minutes of vigorous physical activity at least 4 times per week has significant antidepressant effects. You might not be able to do the full 30 minutes right away, but starting with 5 minutes can still be helpful. If you are spending a lot of time sitting on the couch, setting a timer to get up to walk around and stretch every 20-30 minutes can help prevent “couch brain-fog” and backpain that may develop from prolonged immobilization.

4. Daily Socializing – Social distancing does not mean that socializing must stop all together. If you had plans to meet up with friends or family, try to keep those plans, but shift the “location” to a virtual meet up, using one of the many videoconference applications now available. If you do not have internet at home, a phone call is a good alternative. However, do not solely use social media and texting as your only form

5. Limiting Media Consumption - Many people may have the news playing constantly to get the most recent updates, or may be spending hours a day on social media reading everyone’s thoughts and reactions to the pandemic. This over-saturation in pandemic-related information may have damaging effects to your mental health. Staying informed is important during these constantly evolving times, but limiting pandemic-related media consumption to under an hour per day would allow for sufficient updates while not “overdosing” on pandemic-related news. It is important to appreciate that if you have a mental health condition, you are more vulnerable to having worsening anxiety and depression in reaction to the news. Everyone is affected, but having the self-compassion to recognize that you have a vulnerable brain is important to allow you to assert your needs to turn off or walk away from constant streaming of news updates in a household where this might be the preference of others.

6. A Time-Limited Experience – With depression and anxiety, there is a tendency for the brain to catastrophize and assume that the current experience is a never-ending way of life. You may logically know that the pandemic will eventually end and normal life will resume, but a depressed brain may trick your emotions into thinking otherwise. Reminding yourself daily that this is a time-limited experience may help to reduce these catastrophic thought patterns.

7. Maintaining a Schedule & Routine – As many people are now working from home, normal schedules and routines may quickly slip as you consider sleeping in, taking naps and working into the evenings. However, maintaining routines and structure may help prevent a snowball effect of insomnia, fatigue and cognitive difficulties when changing your routines day to day. A written schedule detailing your plan for when you will be working, relaxing and sleeping may be beneficial. Particularly with sleep, if you take naps during the day, the hours you spend napping your brain will ‘subtract’ from the time you need to sleep at night. For example, if you usually sleep 8 hours per night but took a 2-hour nap during the day, you will likely struggle to sleep (even if you feel tired) as your brain thinks you now only need 6 hours of sleep. Having a bad night sleep will lead to feeling tired the next day and being tempted to take more naps which will further perpetuate the pattern of insomnia and fatigue. A consolidated 8 hours of sleep at night allows for restorative slow-wave sleep, whereas interrupted sleep with day time napping has the opposite effect, preventing adequate quantity and quality of sleep to feel refreshed the next day. Similarly, it is important to maintain a work schedule where you have some hours in the evening that you are relaxing, versus working from home intermittently throughout the day and evening since you are not “clocking in and out” as you usually would. Having at least a couple hours of relaxation in the evening (e.g., ‘work free’ time) before going to bed is essential. Working late into the evening can lead to insomnia, especially when using computer screens that tell your brain it is time to wake up and prevents your brain from switching over to ‘sleep mode.’

8. Mental Health Crisis Planning – During these difficult times, you may experience worsening of your depression and anxiety. At times, this may even lead to suicidal thoughts. You might feel guilty to reach out for help or go to hospital because you feel that you do not want to burden the medical system that is currently strained while dealing with this pandemic. Going to an emergency room will likely have longer wait times, however, if you are not safe to be on your own, coming to the hospital for an assessment of your mental health is still an available option. You should not feel guilty for taking resources, or a hospital bed, from people who have respiratory illnesses as mental health units are separate from internal medicine wards. This means that the hospital will not be admitting patients with respiratory illnesses to the mental health units regardless of you coming for help or not, so do not let this guilt dictate your decision making to come to hospital for assessment. If you feel unsafe and need help, come get the help you need. The emergency room is still open 24/7 to help you in your time of crisis. Alternatively, most crisis lines and websites are still open which you can call for support at any time:

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