From the WebMD Archives

July 21, 2020 -- With coronavirus cases surging under California’s reopening plan, Gov. Gavin Newsom recently ordered certain sectors, including bars, indoor dining, theaters, and bowling alleys, to close again. Online, crisis fatigue erupted. Residents vented long-simmering frustrations, casting blame on the governor and on each other.

Half a year into the coronavirus pandemic, mental health experts worry that many Americans have reached a point of becoming emotionally overwhelmed.

Anger, frustration, disappointment, and hopelessness have flared across the nation. In California, people took to social media to express their feelings. Some even pushed for recalling Newsom.

“The dictator continues on his path of destruction,” David Wohl tweeted about the governor.

Others pushed back at perceived scofflaws.

The effort to recall the governor, according to Twitter user Nancy Lee Grahn, “is from the same selfish incredibly stupid bunch who just had to brunch, beach, bar maskless & spread their infected droplets all over the state. You did this & now you’re mad? Tough luck, jerks. The Gov is correct & protecting ur undeserving a--, so stop whining.”

It’s Natural to Feel Anxiety and Grief

It's not only the pandemic. Americans are facing economic distress and racial injustice, too. “Most of us are equipped to manage one crisis or maybe a couple of crises simultaneously,” says Arianna Galligher, associate director of Ohio State University’s Stress, Trauma and Resilience (STAR) Program, which treats people who have psychological trauma. “But when everything is sort of coming to a head all at once, there comes a point where our typical means of coping becomes overwhelmed, and the result is crisis fatigue.”

Coronavirus in Context: A View from Australia on Mental HealthWebMD's Chief Medical Officer, John Whyte, speaks with Kieran Kennedy, MBChB BSc, Doctor, Mental Health Advocate, Writer, and Speaker, about his view from Australia on mental health.684

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JOHN WHYTE: You're watching

Coronavirus in Context.

I'm Dr. John Whyte,

chief medical officer at WebMD.

COVID-19 is a pandemic, meaning

that it's impacting people

all over the world.

And many of my episodes

have focused on what's happening

in the United States.



But today, I want to spend

some time talking about what's

happening in other countries,

specifically Australia.

So I've asked Dr. Kieran

Kennedy, a physician

from Australia, to join me.

Dr. Kennedy, thanks for taking

time.



KIERAN KENNEDY: Yes,

good morning, John.

Thanks so much for having me

and for a bridging the time gap

here.

I'm keeping you up late

over there, maybe.



JOHN WHYTE: Yes, yes.

Let's start off with what's

happening with respect to COVID

in Australia

and your neighbor, New Zealand?



KIERAN KENNEDY: Yeah.

And I think in Australia and New

Zealand, we're a little bit

lucky in a sense in terms

of we're slightly geographically

isolated over here.

And so I think compared

to other areas of the world,

we've really been quite

lucky to not be hit as

hard with COVID-19

as other areas.



But it's still been

a real concern.

And obviously, there's

been significant lock down

and restrictions over here.

But at the moment,

things are looking quite good.

So New Zealand has one

active case

for the whole country.

And Australia has,

as of the last check, 18

patients in hospital that are

positive.



But we're really sort of moving

through completely sort

of flattening the curve

and just monitoring things.

So it's been a wild ride

and a scary time

here, as for the rest

of the world.

But lockdown and restrictions

are really starting to ease,

and so it's an interesting time

where we're sort of coming back

out into the new normal

in a way.



JOHN WHYTE: You and I talked

about prior today--

and you have this interest

in mental health and wellness.

And you brought up this issue

of rebound anxiety.

Not the anxiety of people being

home in lockdown, as many people

are in the United States,

but more so the anxiety

as things start to open up.

And you've seen more of that

than we have here.

Tell us what you mean by that,

and what's going on.



KIERAN KENNEDY: Yeah.

I'm really humbled to sort of be

speaking with you

about this today, John,

because I think this is

something that we're going

to see more

of as the world comes

through the initial crisis

point of the pandemic.

And obviously, mental health

issues during lockdown when

things first really hit

have significantly risen.

So rates of anxiety, low mood,

adjustment-related mental health

disorders have skyrocketed.



But what we're starting to see

here in Australia and New

Zealand now, interestingly, is,

as you say,

a bit of a second wave

or a rebound

on the mental health side

as well.

And I think as we're kind

of coming out of what we've

adjusted to in terms of staying

home, restricting ourselves

socially,

doing all the things we needed

to do to ensure COVID-19

sort of was completely

flattened, as we're sort

of coming back

out into the world

and adjusting to the new normal,

I'm seeing a lot of people

in clinical practice,

but also statistically

over here, we're starting to see

that people are really getting

a bit of a rebound anxiety

around that as well.



So that's going to be something

we're going to have to really

be aware of,

I, think as mental health

professionals and as physicians

when it comes to things getting

much better on the COVID-19

transmission right front.

But actually, as our minds learn

to adjust to what the world is

now like around us

and as we come out of our homes,

in a way.

JOHN WHYTE: Because we had

a new normal of lockdown.

And now, we have

the new, new normal.

And everyone isn't necessarily

ready to go back in to society

and resume some

of those activities.

We also talked

about the differences in the way

men and women

may present in terms of some

of the mental health issues

that you're seeing.

Talk to us about what

those differences are.



KIERAN KENNEDY: Yeah, this

is something that I'm quite

passionate about.

Men's mental health is a really

interesting area to work in

because globally, mental health

is an epidemic, and something

that is really hitting

the charts in terms

of our rates

of chronic disability, our rates

of chronic illness.

But sort of for men

particularly, there is still

such a significant stigma

around opening up

about struggling

with mental health,

seeking professional help

for mental health issues.



And that's reflected in some

of the statistics.

So worldwide, rates of suicide

in young men, for example,

are significant.

And we're still saying

in statistics and studies

that men are presenting for help

with mental health issues

significantly less than women.



Mental illness doesn't

discriminate by sex or gender,

but how it is expressed

and showing

is impacted by those things.

So some of the structures

around masculinity and concepts

of who a modern man needs to be

and how a modern man should act

are still often holding men back

from showing that they're really

struggling.



So I think for men

in particular, they are more

likely to withdraw when they're

experiencing anxiety

and depression.

We know that rights of men using

alcohol or substances to maybe

avoid or cover over struggling

with mental health issues

are higher.



I think for everyone,

it's really important that we

push back on this stigma

around mental health

and needing help

from mental health.

But particularly for men, it's

something that we need to really

call out and say it does not

make you any less of a man.

It's nothing to do

with your masculinity

if you are struggling

at the moment and you need help.



JOHN WHYTE: So we've talked

about the role of psychiatrists

and mental health professionals

in addressing some

of these anxiety,

depression, and other issues

relating to COVID.

But you and I also talked

about other measures that are

important in terms of one's

overall wellness

in terms of sleep and activity

and exercise.

And I don't want to embarrass

you, but you were on the cover

of Men's Health Australia.

Is that right?



KIERAN KENNEDY: That is right.

And hopefully, my cheeks don't

go too rosy with you bringing

that up.



JOHN WHYTE: Tell us what, first

of all, what you do to maintain

mental health and resilience

and what others can do

during these stressful times.



KIERAN KENNEDY: There are

little basics every day

and very practical things we can

put in place to be helping

with our mental health.

One of those is-- and you won't

be surprised at all that I'm

going to say this, John,

but exercise and fitness

is something that we know more

and more can positively impact

our mental health.

So I've been encouraging people

to get some form

of daily activity in every day

and scheduling that in.

And research shows

that for mild anxiety

and depression,

that can be just as effective

as an antidepressant.

So routine and scheduling things

there's a really good

practical tip for people

as well.



Sleep is a biggie, and something

that I'm personally

and professionally pretty

passionate about.

But sleep we know

has a significant impact on how

we're doing mentally.

And it can act

as a helpful factor for if we're

experiencing mental health

struggles at the moment.

But it also acts as a resiliency

and a protective factor

to go to bed at the same time

each night.



And most people should be aiming

for seven to eight hours

of sleep.

Some people will need slightly

more.

Some people slightly less.

But that's a good sort

of grounding to go off.

And I've been talking to people

a lot about some very practical,

basic sleep hygiene tips as

well.



I think particularly

with working from home--

and I'm a bit guilty of this,

too-- we've been slipping

into maybe using the laptop

and phone in the bedroom

and the bed, when really,

our bed should be

in particular just for sleep.

So we need our brain

to associate going to bed

with going to sleep.



Other things-- reducing

the bright lights from screens

and laptops in the hour

before bed.

And also, trying to reduce

caffeine in the second half

of the day.

And that is obviously

through coffee, but also

pre-workout.

Dark chocolate can have

a certain amount of caffeine

in it.



JOHN WHYTE: Now, come on, Dr.

Kennedy.

Don't take away

the dark chocolate.



KIERAN KENNEDY: We'll let

that one slide.



JOHN WHYTE: All right, we'll

let that one slide if it's just

a little square.

Now, are you hopeful that if we

institute some of these measures

for resilience

that we can end the growing

epidemic of mental health issues

that we're in the middle of?



KIERAN KENNEDY: I am hopeful.

And I think just taking

these type of acknowledgments

on board

in terms of actually needing

to actively think about

out thinking

and feel what we're feeling

right now as being most

important--

I am really hopeful we can stem

things.



Another really sort of promising

and inspiring thing,

particularly here in Australia

and New Zealand, has been seeing

the acknowledgment

of mental health being on par

with our physical health

right now.

And so there's been campaigns

in terms of making people more

aware of what they're

mental health is doing right

now,

and specific COVID-19-related

avenues for people to get

support if they're experiencing

anxiety, low mood,

struggles

with their mental health

as we move through the pandemic

and now as we're coming out

of it into the new normal

as well.



JOHN WHYTE: We started off

by talking about how Australia

and New Zealand have been

able to flatten the curve.

And in the last couple

of minutes, what other tips do

you have for the folks

in the United States

to flatten the curve,

as Australia and New Zealand has

done?



KIERAN KENNEDY: There's really

been a community sense over here

of people really getting

on board with social distancing

recommendations and things.

And something I'm quite

passionate about as well

is directing people maybe away

from some of the misinformation

and myths that are floating

around on social media

and online and encouraging

people to, I guess,

look at what their local area

or state is recommending

in terms of social distancing

restrictions,

and really just

adhering to those as a way

to look after not just

ourselves, but everyone,

and get us flattening

this curve,

and hopefully at the same time,

looking after our mental health,

too.



JOHN WHYTE: And Doctor Kennedy,

I want to thank you for taking

time today to share

your insights.



KIERAN KENNEDY: Thank you so

much, John.

It's been an absolute pleasure.



JOHN WHYTE: And thank you

for watching Coronavirus

in Context.

John Whyte, MD, MPH. Chief Medical Officer, WebMD, Kieran Kennedy, MBChB BSc, Doctor, Mental Health Advocate, Writer, and Speaker/delivery/aws/82/77/8277433c-19d0-3e5f-be98-94dcdeba88a1/Kennedy_062420b_,4500k,2500k,1000k,750k,400k,.mp407/01/2020 11:49:0000Kennedy 1800x1200/webmd/consumer_assets/site_images/article_thumbnails/video/covid19-images/Kennedy 1800x1200.jpg091e9c5e81f4f8b4

While crisis fatigue is not an official diagnosis, its effects are real. People can feel so overwhelmed that they’re unsure of how to move forward, she says.

When people have crisis fatigue, it’s natural for them to feel a mixture of exhaustion, rage, disgust, despair, desperation, hypervigilance, anxiety, and grief, according to Galligher.

As the crises have worn on, not only have tempers frayed, but many people feel less energetic and motivated, says Karestan Koenen, PhD, a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health.

“In the beginning [of the pandemic], people were scheduling Zoom dates, Zoom parties, Zoom gaming nights,” she says. But she’s noticed more stress and burnout, including among workers who are sheltering in place and perhaps raising children, too. “We’re privileged if we can work at home,” Koenen says. “But if we work at home, there’s no division anymore between home and work.”

Being unemployed is even more dire. As various parts of the country have reopened, some employees have been able to go back to work cutting hair, waiting tables, and selling movie tickets. But even with attempts to restore parts of our previous life, many people remain sad and disappointed that things haven’t gotten better, Koenen says. “In places where things are reopening some, it’s not the same. They realize it’s going to be a long haul.”

Some people appear to have given up trying. In early July, Jennifer Morse, MD, a public health official in Michigan, told the news organization Bridge that she’s seeing a new complication: COVID fatigue. She has spotted more crowds and fewer masks, as has Peter Gulick, DO, an infectious disease expert in Lansing, MI. “It’s like they’re tired of it, they don’t care,” he said. “It’s, ‘Doggone it, I’m not going to eat my spinach anymore.’”

A Different Type of Threat

Despite crisis fatigue, the threat remains real and pervasive. As a psychiatric epidemiologist, Koenen studies the mental health fallout of disasters. This crisis is different from disasters such as a hurricane or terrorist attack. With those events, “It’s very severe initially, and then there’s sort of a linear improvement” as affected communities recover, she says.

But with the coronavirus, there’s no recovery yet, she says. “That’s what’s been different. We’re still in it.” She compares the pandemic to other chronic, severe stressors with no obvious end point -- more similar to long-term conflicts and war, or displacement and refugee camps.

“For most of us, if there’s a clear end in sight, it’s a little easier to gather the necessary energy to cope in the short term. But when a crisis crosses over into more of a chronic crisis, it’s more difficult to tap into those energy reserves,” Galligher says. “A lot of people are starting to ask some of those more existential questions, like ‘What are we going to do, and is this the new normal? How do we proceed as a culture?’”

Moving Forward

Galligher and Koenen, who have counseling backgrounds, offered advice on how to combat the challenges of crisis fatigue.

Spend your energy intentionally

Instead of feeling daunted by so many crises in the world, choose one or two priorities where you want to have an impact, Galligher says. You can use your personal efforts, voice, or money to contribute to a meaningful goal.

For example, some of her colleagues were deeply troubled by the wildfires in Australia during the past year. “They weren’t in a position to head to Australia with fire hoses,” she says. “But they were absolutely in a position to send some extra capital toward wildlife rescue and to support the folks who were on the front lines trying to fight these fires.”

Pursue things that give you joy and hope

No one needs to be reminded that the world is awash in problems. In the midst of the turmoil, “You have to actively decide to find joy,” Koenen says. “Make that an active practice.”

She takes time from her busy schedule to walk outside, pull up a favorite song, or hang out with her son and dog.

Such moments make life worthwhile, Galligher says. Notice the things, big or small, that bring lightness and humor to your day.

Take breaks, take care

Pay attention to when you’re feeling tired and overwhelmed, Galligher says. Allow yourself to take a break from the stress and engage in a healthy, soothing distraction. You’re not being selfish, she says. Taking care of yourself is an act of maintenance and self-preservation.

Koenen agrees. While giving and altruism are valuable in times of trouble, they can come at a cost if we’re not careful. “The needs are so great that it’s easy for the average person, in the interest of being helpful, to burn themselves out.”

Pick your battles wisely

The mask vs. no mask battle rages on, producing some uncomfortable and occasionally violent confrontations. Black Lives Matter protesters have gotten into arguments with those who proclaim that all lives matter.

Right now, many of us are engaging in important conversations with those who disagree with us, Galligher says. You can’t control how others will behave during such exchanges, but you can control your own actions and decide when it’s time to end a discussion that’s going nowhere -- or to not engage in the first place.

Take a break from the news

“We all need to turn off the media at times,” Koenen says. Leaving the TV on in the background all day can increase our sense of crisis fatigue. Instead, take a few hours away from the news and from social media to refresh yourself.

Much of Koenen’s career has focused on trauma, so she’s learned to create boundaries to avoid becoming overwhelmed by her subject matter. For instance, she doesn’t do any studying on trauma before bedtime, she says.

Seek support

We’re already feeling isolated because of shutdown orders, but emotional connection and support can be healing for those who feel overwhelmed. Talk to someone you trust about how stress is affecting you, Galligher says.

Don’t consider your crisis fatigue as something abnormal, she says. Feeling angry and despairing in the face of intense and prolonged stress is a common and understandable reaction.

Remember that we’ll come out on the other side.

While the crises confronting us are vast, we can draw on the personal strengths that have helped us in the past, Koenen says.

“Most people have had times in their lives where things have been really bad and have gone on for a long time -- a family member who’s been sick or had a chronic illness. Thinking about those times and how you got through them would be helpful.”

The country has faced calamities before, “things like the Great Depression, these other large, catastrophic events that went on for many years at a societal level,” she says.

“We have had major crises before, and there’s always another side -- where we’ve come out of that.”

WebMD Health News Medically Reviewed by Michael W. Smith, MD on July 21, 2020

Sources

Arianna Galligher, associate director, Stress, Trauma and Resilience (STAR) Program, Ohio State University.

Karestan Koenen, PhD, professor of psychiatric epidemiology, Harvard’s T.H. Chan School of Public Health.

Twitter: @DavidWohl, July 13, 2020; @NancyLeeGrahn, July 13, 2020.

Bridge: “As coronavirus cases rise, Whitmer halts plans to further reopen Michigan.”

Detroit Free Press: “Defiant gym owners staying open, refuse to obey Whitmer's order.”

Farmington Daily Times: “Gov's order rescinding indoor dining creates blowback.”

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