CBT Tips for Coronavirus Anxiety

CBT Tips for Coronavirus AnxietyDuring trying times, varying levels of anxiety are inevitable. In fact, experiencing anxiety can even be viewed as an evolutionary-based and adaptive response intended to help individuals survive environmental threats to the self, safety, or resources. In this post, I will provide information about anxiety disorders and offer recommendations for managing anxiety during this public health crisis. At Interface Consulting and Psychological Services, we are trained doctoral psychologists actively applying Cognitive Behavioral Therapy (CBT) for children, teens, and adults. However, please note that although we are psychologists, our recommendations in this post are not intended to be viewed as commensurate to seeking mental health treatment. If you are experiencing anxiety symptoms for a prolonged period of time, please seek treatment from a mental health provider, such as a licensed psychologist.

Anxiety is defined as an emotional response encompassing worried thoughts, physiological responses, and tension in the body (Kazdin, 2000; https://www.apa.org/topics/anxiety/). Brain imaging research has found that anxiety is likely to occur in response to uncertain threats. Alternatively, fear occurs in response to defined threats (Rigoli et al., 2015; https://www.sciencedirect.com/science/article/pii/S0304394015302639). Anxiety becomes a mental disorder once symptoms reach excessive levels of frequency, intensity, and duration, subsequently leading to behavioral disturbances. Behavioral disturbances include impairments in occupational, interpersonal, academic, and adaptive functioning that are notable to the individual and/or others. The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition is the most recent diagnostic manual in the psychological field. It is the most commonly used diagnostic manual by psychologists and other mental health providers. The DSM-5 denotes the following anxiety disorders: Separation Anxiety Disorder, Selective Mutism, Specific Phobia,  Social Anxiety Disorder, Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Substance/Medication-Induced Anxiety Disorder, and Anxiety Disorder Due To Another Medical Condition.

Anxiety Disorders in general have high prevalence rates with an estimated lifetime prevalence rate of 30% among U.S. adults (APA, 2017; https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders). Specific Phobias and Social Anxiety Disorder have the highest prevalence rates (7-9% lifetime prevalence rate among U.S. adults). Panic Disorder, Agoraphobia, and Generalized Anxiety Disorder follow at a 2-3% lifetime prevalence rates among U.S. adults. Separation Anxiety Disorder has an estimated prevalence rate of 1-2% among U.S. adults (APA, 2017). It is imperative that individuals seek a professional opinion in order to be diagnosed with any mental disorder. Mental health providers are specialists in this area, and therefore, it recommended that if an individual is experiencing any anxiety-related symptoms with impairments in functioning, that they seek a mental health provider’s professional opinion to receive an evaluation and treatment recommendations.

If you are experiencing some anxiety in the current context, there are effective and research-based strategies you can engage in to reduce the negative impact of anxiety. First, reassess perceived threats in your environment. Second, reassess perceptions of your emotional responses to those threats. Third, do not engage in avoidance of anxiety symptoms or triggers. And fourth, avoid seeking excessive knowledge about the Coronavirus if you are doing so to reassure yourself. I will review these strategies in more detail below.


1.Reassess Perceived Threats-Especially Ones About Undefined Future Events

This means that you should seek to evaluate if what you believe to be a threat is actually a threat. When individuals experience anxiety, cognitive biases will often lead to seeking evidence that a threat exists even if it is a poorly defined threat, as brain imaging research has indicated. So, it is important to recognize that these cognitive biases exist and alter reality. Distant threats that are poorly defined (e.g.,”My workplace may close and then I do not know where I will work or perhaps even live”) should be challenged. I recommend gently challenging yourself to recognize the bias in your thinking and redirecting yourself to the present moment.

2.Reassess Perceptions of Your Emotional Responses

Anxiety symptoms can be very discomforting, and for some individuals, they may even feel alarming and threatening. However, the more emotional responses and symptoms are catastrophized (i.e., viewed as the worst thing that can happen), the worse they usually become in terms of intensity and duration. If a person were to experience panic, such as an impending sense of doom, feeling the walls were closing in, sweating excessively, and chest pain, the instinctual response may be to perceive these symptoms as dangerous. Instead, however, I recommend bringing full attention to those sensations with complete awareness of what they feel like in the body. The symptoms do not have to be perceived as pleasant, but I do encourage the symptoms to be tolerated and not suppressed. Indeed, they are tolerable sensations and emotions. Over time, they will become increasingly tolerable and feel less threatening.

3.Do Not Engage in General Emotional Avoidance or Anxiety Avoidance

This item is related to the previous strategy. But this recommendation refers to the importance of not avoiding feeling anxiety or possible triggers of anxiety in general. From a Cognitive Behavioral Therapy perspective, the more we seek to avoid triggers of symptoms or actual symptoms, the higher the likelihood of strengthening the conditioned anxiety response to particular stimuli. For example, let’s say you experience anxiety in response to walking near a hospital or clinic. If you avoid walking by a hospital or clinic, you will feel more anxiety when you walk near a hospital or clinic in the future because you have not extinguished that response over time. So, rather than avoiding feeling any anxiety or triggers of anxiety, allow yourself to face those triggers and experience the emotions that may come as discussed above.

4.Avoid Seeking Excessive Knowledge

Knowledge can be a source of empowerment and clarity. While we have the opportunity to acquire knowledge that can facilitate effective decision-making, the vast and limitless availability of knowledge also presents unique challenges. First and foremost, I caution you to judiciously select media pieces that have at least some evidence-based components. Additionally, try to ask yourself “Why am I seeking this information?” If the answer is “To make myself feel better right now because I’m worried or depressed,” then this means you are seeking knowledge to reassure yourself. Research has found that during past epidemics (e.g., Zika virus epidemic), individuals’ mental health was negatively impacted when they sought information to reassure themselves (see the research study here: https://link.springer.com/article/10.1007/s10880-017-9514-y