Is Returning to Normalcy Causing You Stress?

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JOHN WHYTE: Welcome, everyone. I'm Dr. John Whyte, chief medical officer at WebMD. The lockdown has caused many of us to be anxious, to be stressed. And now that we finally got used to it to some degree and there's talk of reopening in many areas of the country, there is reopening, many folks are feeling stressed and anxious again. So how do we deal with those emotions? How do we recognize those emotions?

So I've asked an expert to join me. I've asked Dr. Mena Mirhom, a psychiatrist at Columbia University, to come back and help give us some tips as to how to manage all of this. Dr. Mirhom, thanks for joining me again. It's nice to see you.

MENA MIRHOM: Thank you so much for having me, Dr. Whyte. Pleasure to be with you as always.

JOHN WHYTE: Well, let's start off with you talk about the first step is doing a self-inventory to find out what your triggers are. Can you walk us through how someone can do that?

MENA MIRHOM: Absolutely. One of the reasons that's important to do is we use some of these umbrella terms such as stress and anxiety, and those things mean a whole lot of different things to different folks. So one of the ways that we want to begin this process is to go full-blown Oprah self-assessment kind of interview for yourself. The reason that we want to do that is depending on what emotions you uncover, you're going to change your whole approach and what would be most beneficial for you.

So for example, some of the questions you want to ask yourself are, “What are the things that may trigger my anxiety?” “What are the things that make me feel uncomfortable?” “What are the settings that may make me feel uncomfortable?” “Is it more of a social dynamic of being in a place with new people, us wearing masks, maybe not wearing masks?” “Do I shake their hand or I do one of these fist bump things or I do the elbow thing?” “Is it more of a social?”

Some patients have told me, “You know, Dr. Mirhom, the worst thing for me is I'm worried about my commute, being in traffic and road rage, and I haven't had to experience that in a long time.” Is it more of an academic in terms of being in classes again for younger folks or students? These things are all very different. So you want to understand that dynamic as well as you want to also ask yourself, “What are the things that make me feel safe?” “Where do I feel more comfortable?” “Where do I feel, this is familiar, this is something I can do again?”

So first we want to begin with asking ourselves these details and take some time. I've had folks even go through the process of writing some of this down. You may surprise yourself with how much there is to know about yourself.

JOHN WHYTE: And writing it down really does have an impact on doing this inventory. You also talk about compassion, self-compassion, being nice to yourself. So let's break that down. What does that mean? We don't want to engage in unhealthy behaviors. Does that mean I can binge on Netflix this evening? What does being nice to yourself really mean, practically speaking?

MENA MIRHOM: Yeah, in a practical sense we often talk about the dialogue that's happening internally in our minds. Sometimes we can catch ourselves saying things to ourselves that we would never say to a friend or even, to be honest, someone that we don't like very well. Saying, oh, how could you be thinking this way? Why are you not like so and so? This person is all psyched and excited about the reopening, and you're timid or you're afraid or you're worried about this and that, you do not trust science. You don't trust this.

So the first thing when we talk about self-compassion is that dialogue of giving yourself a little bit of a break, knowing, hey, this has been a tough year, we've been through a whole lot both financially, health-wise, as a country, as a nation, we've been through it. So begin by saying, “It's OK, this is going to be a gradual process, and I'm going to allow myself to have the patience with myself, not to lose my own patience as I'm dealing with myself.” This doesn't mean, as you mentioned here, it's not about just sit home and watch Netflix all day or things like that.

But as we're beginning to take gradual steps, these micro steps that we've talked about in other sessions, to know that, hey, I may take a step forward, re-evaluate, maybe I'll have to pause for a moment. And I'm not going to have this inner dialogue that is highly critical, super, super critical, of every step I make, knowing that I'm going to give myself a bit of a break as I go through this transition process. This is the example that I've given to some patients, is when you're waking up in the morning and someone just turns on the light all of a sudden, and your eyes physically take time to adjust. This is going to be an adjustment period for us, and we need to be patient with ourselves.

JOHN WHYTE: What's the short-term goal, something like being able to get on public transportation? Or is it something that you say by the end of the month, I want to be able to do this? What are some of those examples?

MENA MIRHOM: Yeah, some of those things can certainly be transportation in terms of what is the method that you're getting around these days. Is it public transport for driving for some folks? I've had some patients who the thought of being behind the wheel because of their significant anxiety is a tough thing -- getting on a highway again and getting on a bridge. So maybe if that is a source of anxiety, going back to our self-inventory, perhaps a short-term goal can be: By next week, I'm going to take a little bit of a longer ride than I did before.

If my social anxiety is more so the issue, so I'm not going to unnecessarily jump into a huge setting, I'm not going to go to a Yankee game, for example, tomorrow. But maybe a short-term goal is: “By next week, I'm going to have coffee with a friend in an outdoor setting and see how I feel; maybe then I'll go out with a few more friends, also in an outdoor setting, and see how that feels as well.” And because, especially, I want to comment on the fact that the social skills that we are regaining here are just that. There are skills that can become rusty, and like riding a bike, but you want to get back on the bike and do some practice.

JOHN WHYTE: You and I have chatted a few times over the past few months. And you have a great line where you said, “John, the story you tell yourself is important.” What does that mean?

MENA MIRHOM: Absolutely. One of the things that determine our behavior, these are some of the basis for cognitive behavioral therapy, is our thoughts become our actions, our actions become our habits, our habits become our lives. So these track records, or this way that we live our lives, really begin with a story and narrative. Sometimes that narrative is what we're telling ourselves about ourselves. Sometimes that narrative is what we're telling ourselves about the world around us.

For example, the narrative I could be telling myself could be very positive and saying, “I've taken great strides so far,” “I've gotten vaccinated,” maybe, “I've been among the folks who have done that, and I've taken these small steps, and I have guidance around me, and now I'm confident enough to take steps forward.”

Or I could be telling myself a narrative that is more based in fear, more based perhaps in some pseudoscience, more based in negative thinking. And oftentimes, another thing that we say is that you do tend to find what you're looking for. If you're looking for hope, you're going to find it. If you're looking for ways to get discouraged, there's no shortage of that as well.

JOHN WHYTE: I did a short meditation exercise a few weeks ago with Deepak Chopra to talk about how do we address anxiety. But you often talk about the role of breathing, and it may seem simple, we're all breathing. But in many ways, that can impact our mind in terms of our anxiety. So walk us through, you've been quoted as saying, “You have to train like an athlete.” And you talk about these skills. So when it comes to breathing, how should we be aware of our breath?

MENA MIRHOM: It's critically important. And the analogy of either an athlete or a Marine or someone who is highly skilled, even though we're not going into combat -- one of the things that you learn to master is how your breathing impacts your heart rate. One of the things that we see when we get stressed out and we get anxious is your body physically begins to feel like it's under attack. It goes into this fight-or-flight mode as we know here. And when it's reacting to this fight-or-flight reaction, one way that you can control that, you can actually literally slow your heart down, is by the way you breathe.

I'll give you an example. I can get a bit more worked up and a bit more anxious and I can begin to breathe more and more rapidly. And as I'm breathing rapidly, my heart rate rises and my body is sensing now, we're in trouble, things aren’t going well. And we're going to begin to continue to escalate that in terms of whatever catecholamines are being released or hormone changes, versus if I recognize and say, “I'm in a stressful environment, I'm going to pause here for a second, and maybe I'll even close my eyes for a moment.”

I'll take one slow deep breath, be aware of my breath, be aware of the fact that now, I'm going to be working on something actively to change my anxiety level. And I'm not saying it's magical, it'll happen over one breath. But I am saying is it's something it's within our power to actually impact the way we feel physically.

JOHN WHYTE: Now, what about folks that are wondering should they seek professional help. There's a lot one can do with family and friends and colleagues, but what are some of those signs that you may need professional help with a mental health professional?

MENA MIRHOM: Certainly. One of the ground rules here is that we all need a bit of help in one way or another, whatever our social support is. And when we begin to take those steps, it doesn't mean that a professional is going to replace those things, but perhaps can supplement them. If you're, again, on an athletic kick these days, but if you're the greatest athlete in the world, you still need a coach. There isn't an athlete who is just doing it solo.

So I try to walk patients through this little acronym of the four Ds of distress. These are some things that can help make that decision and guide answer that question. One of the Ds, the first D, is duration. If you're trying to do your best with these stress symptoms but they're continuing to be stressful and day in, day out, week in, week out, we're dragging on here duration-wise, that can be one red flag and say, “Maybe I should consider speaking with a counselor or therapist or psychiatrist.”

The second D is depth. What I mean by that is we all will get a little bit anxious or stressed at times, but the depth of that experience, or how much it's going to impact you, for example, could be so deep that it can become a panic attack. A panic attack is this feeling of impending doom. That level of a depth of an experience, 0 to 10 on anxiety scale, another red flag. Say, “Hey, maybe I should think about it.”

A third D is how it impacts duty. So our duty, whether it's school, work, social life. I've had many patients tell me, “I've been trying my best, but no matter what I can do, I still have such difficult stress and anxiety that it makes it hard for me to go to work,” “I'm calling out to work a lot,” “I'm not able to go to school the way I usually would.” It's impacting your function, impacting duty, red flag again. Maybe you speak with a counselor and they say, “Oh, you're totally fine, there's no problem,” but it could be a thought to say, “Maybe I should speak with someone.”

And the last one, is probably the most clear and most important, is danger. If these distressing, stressful situations and feelings are becoming such that you're beginning to have thoughts about harming yourself or maybe life is not worth living, and things feel very dark at that point, and there's a danger element to you in terms of how you're living, that's another important red flag. Seek help faster than you usually would.

JOHN WHYTE: Inch of hurting oneself or hurting others. Well, Dr. Mirhom, I want to thank you again for taking the time to provide these practical tips, recognizing that these are stressful times for everyone. And it's OK not to be OK.

MENA MIRHOM: Absolutely. Thank you so much, Dr. Whyte. Always a pleasure.

JOHN WHYTE: And if you have questions about COVID, drop me a line. You can email them to us at drjohn@webmd.net or post on Twitter, Instagram, or Facebook. Thanks for watching.

This interview originally appeared on WebMD on April 22, 2021

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Is Returning to Normalcy Causing You Stress? - Medscape - Apr 22, 2021.