Author: tciminero

Most of us have learned that whenever threats occur, we all have a biologically built-in stress reaction that is commonly referred to as the “fight-or-flight” response. We instinctually try to escape the threat or attack it. With the coronavirus (COVID-19) we cannot do either. This reaction, which includes a host of physical, emotional, and mental effects, has protective survival value in short-term threats, but unfortunately fight-or-flight reactions can do damage to our body and mind under chronic threats like the current pandemic. As such, we all have to be proactive in buffering ourselves from these detrimental effects over the months to come in order to maintain our resilience.

First, we have to understand how normal our stress reactions are before we can begin to short circuit any damage. All of us have two powerful emotional needs that are being challenged at this time. We all need a sense of predictability in our life so we know what to expect. Without this we get anxious or fearful and even irritable and angry (fight-or-flight). We also need a sense of control which is blocked in many ways by the current restrictions, which are necessary in combating a pandemic. If we lose that feeling of control, we can eventually start feeling helpless or even depressed. So, anxiety and depressed feelings are normal under these circumstances, but some of the steps listed below are aimed at buffering yourself from these reactions over time.

HERE ARE SOME RECOMMENDATIONS TO HELP GET THROUGH THE WEEKS TO COME

1) First, recognize that in this situation you are having normal reactions to an abnormal event, and that you do not have to stay in a state of denial to get through this. Maintain your self-awareness and if you see yourself getting physically distressed, anxious, or depressed, look at it as a signal that it’s time to do something to feel better. Maintaining awareness will serve as a reminder to do some of the remaining steps.

2) Do something to diffuse some of the physical tension that builds with chronic stress. Take a minute or two to take slow deep breaths throughout the day. If you do any type of mindful meditation or yoga, practice those as well. If you would like someone to talk you through a relaxation or mindful meditation exercise to decrease your tension, you can visit our Audio Relaxation Methods page for some easy 5-minute audio exercises. Going for a walk, a bike ride, or using a video exercise program can all decrease your physical tension. These physical steps also help re-build your sense of control.

(See Dr. Sameet Kumar’s concise summary of some key initial steps on YouTube at youtube.com/channel/UCWQgrHMC7jSKhvFWHsEOSTw)

3) Being quarantined or sheltering in place is necessary to minimize your health risk and to avoid spreading the virus outside your home. However, this is a major disruption of your daily routines and it can add to your stress. To help cope with these changes, which could last for many weeks, try to build in a new structure to your day. This might provide opportunities to use the extra time saved from not having a daily commute so you can do other things at home with family or remotely with friends.

4) Much of the media is understandably focused on the COVID-19 threat, and we might find ourselves spending too much time watching news reports that are available 24/7. In these times we want to be informed, which is crucial, but too much news coverage can be detrimental. Try not to get addicted to the news reports but do stay informed within healthy limits. Many psychologists would recommend no more than 30-60 minutes per day.

5) Be proactive in your daily activities. This means take control of the things you can change and accept the things that are beyond your control. It might sound silly, but washing your hands, sanitizing your environment, and keeping social distances are all proactive and healthy physically as well as psychologically. If you have a specific problem and you can resolve it, take active steps to correct it. If your refrigerator is getting empty and you do not want to go to the grocery store, use one of the delivery services. If you are working from home and have young children there, try to work out a schedule with family members to share child-care time. This can help you compartmentalize work and child-care duties. If you cannot solve a practical problem on your own, talk to trusted friends who can not only listen and provide moral support, but might also see some options you did not see. Staying connected on various social media platforms can be helpful as well. Keep in mind that proactive coping styles improve your immune system.

6) Our stress can be very noticeable to others, including our children. It is important to communicate with children as long as it is age appropriate. School age children of all ages know that this is a unique situation because they are not going to school. Parents will need to help them balance their home studies with their need to have structure and fun in their daily routines. This will be a challenge for them and you, so try to set some steps in place early on so they know what to expect. This will be more complicated for teens and young adults living at home. They might want to be out socializing with their friends, which you might not want them to do because their friends could be carriers of the virus. Depending on the health status of everyone living in your house, as well as your own anxiety about the health risks you can tolerate, you will need to get agreement from all older children as to what is necessary until the health risks are well under control in your community.

SOME OTHER QUICK REMINDERS

• In your daily structure, do positive self-care activities like taking a long shower, eating a meal with your family, wearing comfy cloths at home if you are sheltering in place.
• Keep busy, especially if you have some fun activities to fill in your schedule. If you are bored, do some de-cluttering so your environment looks better every day.
• As indicated above, limit TV news coverage about the pandemic to less than an hour per day. In line with this, avoid movies like Contagion or any other depressing movies, which easily could increase your stress. If you are going to watch TV, look for light fare so you can have a little reprieve from stress for a while.
• Look for old or new enjoyable things to do like playing board games, taking care of your pets, or engaging in an old hobby.
• Check in by phone or online with family and friends, especially if you have not talked to them recently, to see how they are doing. This is likely to be helpful to them as well as you.
• It cannot be emphasized that it will help your resilience if you practice some daily mindful meditation or relaxation methods each day as well as using your focused breathing exercises throughout the day.

If the stress is too high or you are prone to anxiety or depression, we encourage you to take extra self-care steps. Check out other information on our website. If you have an EAP (Employee Assistance Program) at work, definitely consider this as an option to get professional help since EAPs often provide free counseling services.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

One of the goals of this blog is to discuss psychological principles that will help improve your resilience, an important personal strength, that we all possess at some level. There have also been several iconic examples of the power and importance of resilience in overcoming extreme adversity in recent years. Here I wanted to address some various topics related to improving resilience.

Resilience can be thought of as the ability to buffer yourself both mentally and physically from a variety of stressful life events and circumstances with your own personal attitudes, beliefs, and skills as well as the various interpersonal resources you have such as family and friends.

Some resilience is probably biologically based whereas other resilience strengths are developed throughout life in the skills, beliefs, and values that are learned. Resilience is needed not only to cope with serious life events (even traumatic experiences), but also the ordinary challenges we face on a regular basis. In essence, resilience can be thought of an essential life skill that helps minimize our vulnerability to stressful demands and also helps us maintain persistence in meeting our goals and priorities throughout life. Resilience, once developed, is there regardless of whatever type of challenges occur in the future.

Some authors relate resilience in successful adults to factors such as positive relationships with others, contentment in lifetime roles (for example, as a mother, father, or coworker), and a general feeling of optimism. Resilience is needed whether or not you have experienced great adversity/trauma since we all encounter some degree of stress and challenge in everyday life. Building resilience is protective at other times in life when we are challenged beyond normal limits.

THE NATURE OF RESILIENCE

Resilience is not an all-or-none characteristic, but comes in many degrees of competence. Because there are so many factors that influence our resilience, we have to separate some factors that we do not have any control over in our lives and other factors over which we do have some control. Some of the biggest factors over which we have no control are the qualities, personalities, and behavior of the adults in our early lives. For example, research on children and adults consistently finds that children who have had nurturing parents or other adult figures in their life (including grandparents, coaches, teachers, spiritual leaders, etc.) will have more resilience just due to the behavior of these other people throughout life. The main point here is that children have no control over whether their parent(s) or others will be nurturing, negligent, or even abusive.

Other factors which are not under a child or adolescent’s control that can influence resilience can include things such as financial stability at home, structure and support from immediate and extended family members, and good opportunities for success in school, sports, or other activities. Fortunately, even if we were not lucky enough to be in a nurturing and supportive childhood environment, this does not mean that we will not be able to develop resilience in other ways.

Research cited by Dr. Donald Meichenbaum, one of the most respected authorities on this topic, has described in various works that 50-65% of children with severe childhood neglect and negativity eventually do become resilient adults.

ARE THERE LIMITS TO RESILIENCE?

• • There are many well-known cases of resilience in recent years and probably thousands that never receive any notoriety. One well known example is the story of the young girl Malala Yousafzai, a Pakistani teen and activist for female education, who survived a traumatic injury when shot in the head by Taliban extremists. She survived after extensive medical treatment to became an international icon of resilience and continued her work on making education available to girls and women. She became the youngest recipient of the Nobel Peace Prize in 2014.

• • Another well-known example of resilience is entertainer Trevor Noah who was born to inter-racial parents in South Africa where this was against the law at that time. Trevor literally had to be “hidden” in various situations to be protected legally. He also survived severe bullying by his classmates as a child. Later, as a young man Trevor became a successful stand-up comedian, and he eventually was chosen to be the host of the Daily Show on Comedy Central.

• • Alonzo “Zo” Mourning, a favorite star of the Miami Heat basketball team, published his book aptly titled Resilience. Here he summarized his struggle as a child to challenge his biological parents in court in order to live with a foster family where he was fortunate to have a loving motherly figure in his life. There he succeeded in both school and sports. He received his college degree where he was a standout basketball player which led to the NBA. Later, as a professional basketball player he faced another major life challenge. He had a life-threatening illness that could only be treated with a kidney transplant from which he not only survived but thrived. Zo was part of the 2006 NBA Championship Team with the Miami Heat and he was eventually inducted into the Basketball Hall of Fame in 2014.

These are extraordinary stories of well-known individuals who overcame major adverse childhood experiences. Most of us are also familiar with others who are symbols of resilience as adult survivors such a Senator John McCain’s recovery after years being tortured as a POW and Nelson Mandela who became President of South Africa after spending 27 years in prison for his anti-apartheid efforts. Resilience does not eliminate all of the negative effects and grief after traumatic events, but it does provide short and long term buffers that help in the psychological healing process.

The reason these dramatic stories are mentioned is not that we all need to demonstrate such phenomenal feats of recovery to be successful in life with our level of resilience. However, each of us will have our own non-traumatic stressors, problems, and challenges in life that cannot be avoided. Our goal is to develop resilience in meeting these “normal” challenges such that we can help insure growth in our own personal stories of success. Normal challenges provide the true opportunities to develop and enhance our resilience to be better prepared should we encounter more significant life events.

WHAT CAN BE DONE TO ENHANCE RESILIENCE?

There are a number of coping skills, life style patterns, and psychological attitudes that will improve your resilience regardless of what your current level might be. Unlike some factors discussed above, these are within your control if you are motivated to improve your resilience and overall ability to cope with life’s demands. These skills include basics like:

• improved self-awareness,
• the ability to regulate your physical and emotional distress,
• how to think rationally when faced with various stressful events, and
• how to be proactive and creative in your problem solving.

In addition, improvements in your self-confidence, self-esteem, expressions of gratitude, and assertiveness can all improve resilience in various ways.

In summary, in spite of your early experiences, working on resilience can enhance several aspects of your life and provide a healthy protective buffer from everyday stress as well as from any major and challenging life events that could occur. Although we cannot be perfectly resilient to all of life stressors, we can be better prepared if we improve our skills now before any major events hit us. The iCope books attempt to teach the core skills to enhance resilience in various ways. Be patient and persistent in learning these skills since the payoff can be quite important throughout life. Our hope is that by changing what is within your control and accepting other things in life that you cannot change from the past or present, you will achieve a number of positive outcomes that adults with high resilience share.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.

When stress gets out of control it can lead to a “panic attack.” These can be frightening experiences, especially when it happens for the first time. These are unforgettable experiences because there is a very heightened physiological reaction with considerable anxiety and sometimes even a fear of death while in a panic state. It is not unusual for someone with a first time panic attack to end up in the emergency room of a hospital because these can feel like a heart attack.

If you have ever had a panic or anxiety attack, we do have some good news: these can be treated successfully with a variety of techniques depending on the severity of the problem. Fortunately, for most people who have ever had a panic attack, these are infrequent episodes that are not likely to cause any major social or medical problems. A combination of the skills taught in the iCope books and possibly medications for those who have had several panic attacks will provide a successful approach to preventing and managing these intense experiences.

If you have had one or more panic attacks that ended up with a visit to an emergency room, it would be wise to get a medication evaluation from your family physician or a psychiatrist. There are some medications that can be quite helpful. One approach is to use a mild tranquilizer on what is called an “as needed basis.” In these instances, you only take the medication when you feel that a panic attack is pending. Even if you rarely need the medication, having it readily available provides a sense of security even if you never have to take the pills. A second approach with medication is to regularly use one of the anti-depressant medications that help keep the neurotransmitter serotonin at the right level, which tends to have a calming effect over time. This seems to help decrease panic attacks, especially if the person has generally high levels of emotional arousal. In some cases, your doctor might prescribe both types of medication.

The strategies that we will discuss in more detail below are the ones that go along with the iCope methods. These are the specific steps to use when you are trying to prevent or short-circuit a panic attack. However, if you take some of the preventive steps to increase your resilience to stress in general, this will help minimize any vulnerability to panic attacks. As you will see below, relaxation skills, rational self-talk, and proactive problem solving will all be helpful in controlling panic.

KEEP THE PANIC IN PERSPECTIVE

From a psychological perspective, it helps to remind yourself that even though these attacks can be very scary, they do not mean you are in a life and death situation. As indicated above, when someone has their first panic attack and does not understand what is happening, they often go to their doctor or an emergency room as a safe guard. If you have done this, and your doctors have reassured you that you are having a panic attack and not a major medical problem, then you will be better prepared to keep any future panic attacks in perspective.

What does this all mean? Well, you would want to remind yourself of certain things if you are experiencing a panic attack, or beginning to sense that a possible attack might occur soon. You want to remind yourself that although scary, “there are things I can do to short circuit the panic.” Even if you do experience a panic attack, these are typically short time-limited experiences that often end within 30-60 minutes. Our bodies literally get exhausted and the panic eventually has to stop, even if you do nothing about it. Try to remind yourself that a panic attack will typically be a short-term event.

FOCUS ON YOUR BREATHING TO RELAX

When a panic attack begins, our breathing changes. We start to breath faster and take shorter shallow breaths. This creates a cycle that can lead to hyperventilation where the faster you breathe, the less oxygen you actually get into your body. As soon as you feel stress increasing and begin to fear a pending panic attack, one simple thing to do is to focus on your breathing. Just as described in the iCope books, take a few slow deep breaths and hold them for a while before breathing out slowly. A good pace is 4-5 seconds to breathe in and 4-5 seconds to breathe out. After that, purposely slow your breathing and try to take slow deep breaths until you feel calmer and more in control of your arousal. This will begin to short circuit the production of adrenalin and other stress hormones and allow you to relax. For added practice when you are NOT trying to control a panic attack, try to use the 5-minute mindful meditation exercises, which can also help as a preventive strategy.

TALK CALMLY AND RATIONALLY TO YOURSELF

Actively talk to yourself in order to reassure yourself that you will be okay. If you have had any prior successes with short circuiting panic, this is the time to focus on that previous success. Say positive things like:

I’ve handled these in the past and I can get through this.

I am not in danger and my goal is to just slow down the high arousal.

 Let me focus on slowing my breathing. This is something I can control.

This might take a little time, and even though I hate this, I can manage it.

Avoid any catastrophizing, which exaggerates your panic and will only generate more adrenaline and stress. If you say things like “I’m going to die,” or “this scary feeling will never end,“ you will actually fuel more anxiety. If you happen to have a prescription for a mild anti-anxiety medication, remind yourself that you have this backup “insurance” available. However, whenever possible, try to stop the panic if you can without the medication. This will build your confidence should you ever be in a situation without medications.

MAINTAIN YOUR SENSE OF CONTROL

Psychologically a panic attack is challenging because it makes us feel out of control. The more out of control you feel, the worse the panic will be. In order to combat this, you want to have some ways to remind yourself that you do have some control of physical and emotional arousal. Your first defense will be remembering to change your breathing. If you can change this, you have direct evidence that you have some control of the situation. Your next step is to think about what steps you can take to gain even more control. Think of options you can use to take more control when panic is building. For example, some people find that being active like going for a walk in or around your home, office, or school can actually help you feel better. Simply getting up and going to get a drink of water might be helpful. If you are driving, and if it is safe to pull off the road, do that and focus on your breathing or listen to some music in the car until you feel back in control. The main point here is to generate some proactive problem solving steps and think of behavioral ways that you believe will help restore a sense of control. Then, when you begin to have any signs of panic building, use those steps to give yourself more control of the situation. This will be a much better approach than waiting until you are in a panic attack to do your problem solving at that time.

SUMMARY

When you feel panic building or find yourself in the midst of a panic attack, try to do the following:

1. Keep your physical and emotional reactions in perspective. Remind yourself mentally that you know what to do to manage your panic attacks. Expect that this will be a time limited situation lasting on the average of less than an hour.

2. Take a few slow deep breaths. Remember, a good pace is 4-5 seconds to breathe in and 4-5 seconds to breathe out.

3. Adjust your regular breathing pattern into a pace where you take slow deep breaths rather than rapid shallow breaths.

4. Use positive and rational self-talk about what you are doing to manage the situation. Remind yourself of any prior successes in handling panic and look at this as a practice exercise to get more skilled at short circuiting panic. You will get better with practice.

5. Avoid feeling out of control. Maintain your awareness of all of the things you can do to keep the panic under control. Remember to use your problem solving alternatives like taking a walk, getting a drink of water, talking to a friend, or even taking your medication if needed.

If you continue to have difficulty with panic attacks after trying these strategies and you have not already done so, contact your doctor or a therapist through your health plan or EAP. Most psychologists are familiar with treating panic with various strategies, but they cannot prescribe medications. You can also read the book iCope: Building Resilience Through Stress Management, which can help you learn to manage stress more effectively and indirectly prevent panic.

Tony Ciminero, Ph. D. is an author and clinical psychologist based in South Florida. His consulting firm (Ciminero & Associates, P.A.) provides crisis intervention services world-wide. His most recent book publications include the iCope book series. For additional resources, explore iCopeWithStress.com.