The mental marathon of COVID-19

CHRIS HATZIS
Eavesdrop on Experts, a podcast about stories of inspiration and insights. It’s where expert types obsess, confess and profess. I’m Chris Hatzis, let’s eavesdrop on experts changing the world - one lecture, one experiment, one interview at a time.

The COVID-19 pandemic has forced many around the globe to stay at home as a measure to reduce community infections. The enforced isolations and lock downs have created a situation where, for a lot of us, time and space are blurred, boundaries of work life and home life have been erased, and our weekly routines are pretty much out the window. It's a whole new world for singles, couples and families. Now, more than ever, we need to draw on our mental health resources to help ourselves and others deal with these new realities.

Dr Grant Blashki is an Associate Professor at the Nossal Institute for Global Health at the University of Melbourne and currently lead clinical advisor at Beyond Blue, the Australian independent non-profit organisation working to address issues associated with anxiety and depression. Dr Grant Blashki sat down for a Zoom chat with Dr Andi Horvath to help us better understand our current mental health situations and to offer expert advice for our mental wellbeing.

ANDI HORVATH
So, Grant, how does this enforced sudden change in the environment, the loss of routine, affect certain people? I'd have to add, I myself find it quite frustrating to have the routines gone. I imagine there's a spectrum of different behaviours, how people respond emotionally and behaviourally.

GRANT BLASHKI
I think that's right. I think many of us, we live with an expectation that pretty much next week is going to be the same as last week, that things are pretty certain, that things are pretty predictable. I think what we've seen with the COVID-19 pandemic is that that bubble of certainty has been popped. Many of us are feeling like we don't control things nearly as much as we thought we did. For other people, I think, at this time - they might have lost their job, a loss of sense of purpose. I think also, a unique thing about this COVID pandemic is it's been a real triple whammy for a lot of people. They're obviously worried about their health, not getting the infection. Secondly, many have lost jobs or are under a lot of financial pressure at the moment. Thirdly, the home life has been drastically transformed. For some people, it might be that they're home on their own. For others, they might find suddenly they're in a very busy household with partners and kids.

This is one of the reasons why at Beyond Blue we've been really encouraging people to be proactive about their mental health. Because it looks like this is a bit of a marathon, and we'll encourage people to think about how can I make sure that I look after my mental health during this time?



ANDI HORVATH

There's a lot of people feeling anxiety. They might feel anxiety for fear of the future, that their industry is going to collapse, they don't know what's coming for 2021 and even how they're going to navigate 2020. Can you talk to us a little bit about anxieties?



GRANT BLASHKI
As human beings, appropriately, we are wired to have what we call the flight or fight response, where our adrenal glands squirt out adrenaline and we get hyper vigilant in response to a stressor. When you think about how we evolved, and the proverbial snake jumped out or tiger jumped out and our system kicks into action ready to run or fight. What we're seeing at the moment, particularly with modern media and the 24-hour news cycle is that a stress button is just being pushed over and over and over again. What tends to be newsworthy are the more catastrophic worst-case scenario outcomes. I think that what we've seen for a lot of people is that they've found this a very stressful time, and what tends to happen with people when they're getting too anxious about these issues is they get into what we call thinking errors or faulty thinking.

They predict the very worst. They have the sensation that this is doomsday, there's going to be no good outcome here. They tend to overestimate their own risks. Yes, this is very serious and we're trying to reduce risk. But people who get overanxious will start to overestimate how much risk there is to them personally. We also can get into that irrational thinking of blaming others wrongly. We've seen a bit of xenophobia and very unreasonable irrational racism and things in Australia and around the world. We also tend to underestimate ourselves. How will I be able to cope in this difficult situation? Most of us have got a bit more resilience than we think. The other issue is, yes, the infection is of course contagious, but so is worry.

We are wired so that if other people look worried that in itself will set us off. When you think about how we evolved, that was smart. If a lion was coming and the other primates in the tribe were looking worried, good idea to run even if you didn't see the tiger. All these ways that we're wired have set us up to really get quite anxious about this sort of pandemic scenario.



ANDI HORVATH

I get it that from an evolutionary point of view, that aids with survival if you have that negative bias, it takes you out of fear. What I've also noticed is I've also shut down a bit. It's almost like there's flight, fight and freeze. I tend to sleep through some of the day. Is that also a normal response?

GRANT BLASHKI
Yeah, look, there's such a wide range of responses. Sometimes we do just have to shut off or back off, particularly if the media is getting too much. When you think of it, your mind isn't designed to be on all the time. It actually gets exhausting. As we get into weeks and months of this, you need ways of functioning. A couple of things that I've suggested, certainly to my patients as a GP, I say, why don't we make an hour in the morning, where you're going to look at all the media, catch up on all the information, and then let's put it away. Maybe take some of the apps off your phone. This isn't information that you need hour by hour.

The other thing that I suggest to people is if you're at home, good to try and stay in a routine as best you can. Even if you're not working, get up, get dressed. I recommend that people do a calendar, like a schedule for the week and the day. What time I'm going to get up, what time I'm going to have lunch, what time I'm going to do a bit of exercise, what time I'm going to go to bed.

I recommend switch off the technology by 10:30, 11:00. It's very stimulating to your mind. In general, try and be awake during the day, try and get sunlight on your face so that you're keeping your normal body clock going. Usually, you don't have to worry about these things. But I think because this is going to go for months, we really want people to be very proactive about getting into a nice rhythm going, okay, this is very different, but I can do this. The other thing I'd like to mention is that we talked before about thinking errors. But it's very good to think in what we call more realistic or healthier ways of thinking. It's not Pollyanna, it's not, don't worry about it. But if we actually look at the facts and say, okay, this is really bad, we'd prefer that the COVID-19 virus didn't come along. But we also know that through history there have been pandemics that have come and gone.

It's very likely with our great scientists that we're going to get vaccines and better treatments and hopefully that's sooner than later. We know that if we follow the government recommendations, which Australians have been doing really well that we'll be able to flatten the curve. As I said before, I think that many of us are a lot more resilient than we think. It's useful to look at history, I think, and look at how our ancestors got through world wars and big depressions and all sorts of things. There's another side to this, but I think to the extent that we can stay rational and focussed on the realistic outcomes, that's going to help people get through this time.

ANDI HORVATH
When we're calm, we can always make better decisions. Can you help us mitigate negative emotions like fear, anger and irritability when they take over our functioning? How do we move through the fear to learning, acceptance of the situation, and even growth in this scenario?

GRANT BLASHKI
Yeah, look, I think there's a combination of things that we can do, and we know from the evidence about the sorts of things that help people feel calmer. For a start, I think routine is really useful. Setting a calendar up for the week, what time you're going to wake up, what time you're going to go to bed. I tend to, with my patients as a GP, say, schedule in each day one pleasurable activity. Something that you like doing, going for a walk, if you can, it depends on your isolation situation. Or reading a book or watching your favourite show, and one achievement activity. That might be enrolling in an online course you've been wanting to do or fixing up your CV or cleaning that cupboard that you've been ignoring. So, each day, have one pleasure activity, one activity that gives you a sense of achievement.

I think the next thing to do is to try and keep up some exercise. At the moment, we have to be a little bit creative about that. That might be looking at YouTube videos of gym instructors. If you can get outside and you're able to, then that's an option as well. Sleep is really important. We know that trying to keep a normal sleep rhythm helps people feel better as well. I recommend that during the day, as I said, get up, get into a routine. Try and get some sun on your face. Work out what time you're going to go to bed and switch off the tech an hour before. Watch out for stimulants like caffeine, cigarettes. Lay off some of that. If you're waking up worrying in the night, one of the things a lot of my patients find helpful is you put a pen and paper next to the bed and if you wake up in the middle of the night worrying about things, scribble them down on the pad. You say to yourself, I'm going to deal with that in the morning. There's a bunch of things there.

But I think more generally, the self-talk, that little voice that we have in our mind chatting away, especially when we're feeling very anxious, you can really examine, what's that saying to you? Look if it's realistic or fair. The sorts of things you can say to yourself is, this is really bad at the moment, but it is going to pass. We have every belief that we're going to have our scientists identify vaccines and better treatments, hopefully sooner than later. In the meantime, I can take sensible steps as recommended by the government recommendations to reduce risk. The other thing to remind yourself is most of us are a lot more resilient than we realise. It's useful to reflect back historically and look at how some of our ancestors got through big crises, First and Second World War, the Great Depression and things like that.

Curate your media. If you're getting swept up in endless social media, put it away or take it off your phone, and just have a break from it. There's lots of things we can do to try and keep ourselves calm, and Beyond Blue is really keen that people are proactive about their mental health because this is a real marathon. It's going to be months and we need an approach to make sure that we look after ourselves.

ANDI HORVATH

One of the interesting things we've observed in society is a spectrum from panic buying to amazing community spirit. Let's talk about panic buying first, what's that about?



GRANT BLASHKI
Well, as we talked about, anxiety is quite contagious. If we see that other people are all buying toilet paper or all buying Ventolin inhalers, there's a very primitive part of ourselves that thinks, oh my gosh, I should be doing that as well. I think it gives us some sense of control when things feel so out of control at the moment. I think it's a very primitive instinct of ours to try and hoard things and to prepare ourselves for this threat. We've seen that happen. Unfortunately, some of that panic buying becomes its own self-fulfilling prophecy because if people buy lots of toilet paper, yep, it's going to run out for others at the shop.

You mentioned the other thing, which is about the potential for growth. We do know from various traumas around the world, the recent bushfires in Australia, that there is a phenomena, where a traumatic time can bring out the very best elements of people and a lot of community kindness. I think that an event like this reminds us all that we're all human, we're all quite fragile. There's, I think, a real re-evaluation about our sense of connection and what's meaningful to us. If there's a silver lining here, it is that it can bring out some community compassion for each other, and let's hope that this brings out the best sides of Australians during this pandemic.

ANDI HORVATH
Yes, I'm all for community spirit. It actually gives me hope in humanity when I see extraordinary, incredible selflessness and humour shared with neighbourhoods and wonderful things that we can find on YouTube that lift our spirits. I want to turn our attention to individual isolation. Some of us are by ourselves and we are social creatures. Living by yourself does have an effect on the brain and body. For some people, it feels like corporal punishment, solitary confinement. Others, it's welcome solitude. Let's talk about being alone and perhaps it's really loneliness.

GRANT BLASHKI
Yeah, that's right. I think, first of all, there's sort of two separate things here. There's isolation and we know that that is a risk factor for mental health problems. But I guess loneliness is slightly different, because loneliness is that subjective feeling that you're not getting as much human connection as you want or need. We also know that loneliness is a risk factor for depression and anxiety, and actually for a number of physical conditions as well. It's quite common in the community, it seems, even though we've got all this wonderful electronic connection, that there are a lot of lonely people. I've seen some figures back in 2018, a Swinburne study, that showed up to one in four Australians feel lonely, and that 30 per cent don't feel that they've really got a group of friends that they can rely on. That seems about right in terms of what I see in general practice.

So, at this time, I think the first thing to say is if you know friends or family or neighbours who you know are going to be lonely, go that extra yard at the moment. Just drop them a message, check in on them, make sure they're feeling okay. Because it's a pretty tough time if you're on your own. If you are on your own and you're trying to increase connections, there's a number of things you can do. Reach out to friends that you've got, and you can be up front with them. You can say, look, this is a pretty unusual time. It would be great if we could just catch up once a week, maybe on the phone or on a video chat. Make it a regular arrangement so that weeks don't go by without catching up with people. Fill in quite a few people during your week. Try and reach out to a few connected, it might be family members or people, even if they're not living nearby - that you can connect in with.

At Beyond Blue, we have a forum that's dedicated to people getting through the COVID pandemic. This is a moderated forum. It's a big chat group, and we get more than one million people on the Beyond Blue forum. The COVID discussion stream has had 40,000 views already. Lots of people talking about, this is how I'm coping, this is what I do. I'm doing crosswords or I went out and got a pet. Or I've got into this hobby lately, I'm doing online cards. Whatever it is, but I think take that active step so that you're not just caught up there on your own and that you're reaching out, connecting with other people.

ANDI HORVATH
Of course, the other end of the spectrum is those who have been forced into households with large numbers of people or couples who perhaps didn't see each other as often. Many parents are juggling kids at home, they're juggling online meetings. Many types of distractions, it's a little bit like the pressure of Christmas time. What's your advice for those family dynamics or even couple dynamics?



GRANT BLASHKI
Yes, many people have found themselves suddenly in a bit of a pressure cooker at home. They've got money worries, partner perhaps working from home, not working or lost job perhaps, children at home. This is something that at Beyond Blue, we've been very mindful of and as well to be honest, concerns about rises in domestic violence. If you are with a partner who is a very difficult person, but suddenly you're with them 24/7 that makes it that much harder. We really encourage people who are at risk to reach out. There's a number of support lines for people are worried about domestic violence, 1-800-RESPECT, for example. But I think more generally, if you're in a household, it's a time where we've all got to try and be our best selves, a bit more tolerant with each other, a bit more patient, and I think being up-front about setting some ground rules.

So, giving each other enough space, giving each other room if you're working, and trying to have a balance as well between work life and home life. If your place allows it, I think it's good to set up a separate room or a separate corner of a room that's going to be your workplace. I also think there's prompts that you can do, like getting dressed as if you are going to work and going into work mode for the day. Then sort of coming home and getting changed. Some of that routine stuff. I think for kids, a huge challenge - and different for different ages. Toddlers, teenage kids, older kids, there's obviously different issues. But some general principles are be honest about what's going on. The kids are watching what's happening. Remind them that the science tells us that the young people and the kids are mostly safe. Try and get them to focus their energies on something productive, whether that's schoolwork now. That's a huge change for them, going on.

But also remind them that they're really helping. That their efforts in doing social isolation are really part of protecting the most vulnerable people in the community from this nasty disease. Then they really feel like they're contributing something important. I think also regarding the schoolwork, that's going to be a tricky one, and have realistic expectations. Learning from home, having assignments come via the computer and webcams and things, it's going to be pretty different to the kids being at school. So, don't expect too much, but see what you can do. We're all going to have to be pretty flexible.

ANDI HORVATH

There are about two million Australians experiencing anxiety conditions every year and about one million experiencing depression. Does the COVID environment make these people more vulnerable to relapse or intensification of their conditions?

GRANT BLASHKI
So, I look after many patients with depression and anxiety. Many of them have quite a good routine to their life that they know helps prevent relapse. It might involve sport and socially who they catch up with and how they eat and how they sleep. So, as we've got this very disruptive time, for some people it does put them at risk of relapse. What I've suggested to a lot of my patients is keep your mental health plan going. You can access now your GP and your mental health professionals on telehealth. If you can't get out of the house, contact them, keep up that plan. Also remember that Beyond Blue has a 24-hour phone line and now the new dedicated COVID mental health support service, which there's some terrific material on the website and also the phone line as well. There's information there about looking after your mental health throughout this time.

One thing I'd like to mention is for some people, paradoxically, they're actually managing this crisis pretty well because they've actually got quite a lot of psychological skills they've learned over the years such as routine and managing their thinking. They can actually apply it quite well to this crisis. Yeah, a few different reactions to this pandemic.



ANDI HORVATH

Do you think after this pandemic, there will be a whole new lot of people experiencing anxiety and depression because their industries have collapsed or they're jobless? This could bring about a whole new wave of more mental health conditions. Is that what professionals are expecting?

GRANT BLASHKI
Well, I guess what we've seen, certainly in this acute transition and transformation, we saw a huge jump in the Beyond Blue support service contacts. We saw a 30 per cent jump. As I mentioned, our new COVID mental health service line is now working as well. Certainly, there's a lot of mental health issues that are being precipitated by this event. I think in the longer term, it's yet to see exactly how it's going to play out. But common sense is going to tell us that people have been through a hard time and lost jobs or relationships have fallen apart or anything like that. It's obviously having very lasting impacts on them. But I always do balance that by the fact that this is not the first time in history that humanity has dealt with a really challenging time. Human beings never fail to surprise me with incredible resilience and inventiveness and capacity to adjust to a completely new way of doing things.

We're yet to see how it will play out, but absolutely the challenge, as I see it for us at Beyond Blue, is that people are being proactive about really looking after themselves. In the same way, physically we're saying, keep up your exercise and stay fit, I think mentally as well, be really on the front foot about it. Make sure you're getting into a good routine to look after yourself.

ANDI HORVATH
There's no doubt that your physical health is connected to your mental health, which is connected to what you eat, which is connected to how you sleep, which is connected to how you behave and of course how much sunshine you get. This has all been great advice, thank you. I'm holding a couple of truisms to myself. I'm saying to myself, laughter is the best medicine. I'm saying, a problem shared is a problem halved. I'm saying, no man or woman is an island, and I'm trying to live by that every day. So, reaching out, talking about stuff that concerns us and trying to find something to laugh at. Is that a good plan?

GRANT BLASHKI
I like your plan very much. I think it's very important to keep your sense of humour. At our household, we've started what we call the corona tap out, which means if we're just sick of talking about it, let's just talk about something else for an hour. I think that that's very important. Your idea, no man or woman is an island. How true is that? I think we've just realised how very important our social connection is to all of us.



ANDI HORVATH
Absolutely. Dr. Grant Blashki, thank you for talking to us.

GRANT BLASHKI
Real pleasure.

CHRIS HATZIS
Thank you to Dr Grant Blashki, Associate Professor at the Nossal Institute for Global Health, University of Melbourne, and lead clinical advisor at Beyond Blue. And thanks to our reporter Dr Andi Horvath.

For more information on the Beyond Blue Coronavirus Mental Wellbeing Support Service and online forum, call 1800 512 348 or go to coronavirus.beyondblue.org.au. And if you, a friend or a loved one is experiencing a personal crisis, call Lifeline on 13 11 14 or go to lifeline.org.au.

Eavesdrop on Experts - stories of inspiration and insights - was made possible by the University of Melbourne. This episode was recorded on April 14, 2020. You’ll find a full transcript on the Pursuit website. Production, audio engineering and editing by me, Chris Hatzis. Co-production - Silvi Vann-Wall and Dr Andi Horvath. Eavesdrop on Experts is licensed under Creative Commons, Copyright 2020, The University of Melbourne. If you enjoyed this episode, review us on Apple Podcasts and check out the rest of the Eavesdrop episodes in our archive. I’m Chris Hatzis. Join us again next time for another Eavesdrop on Experts.