Oct 22, 2020 COPD and Mental Health During COVID-19
More Tips to Build Resilience at Home
Robert Chang MD and Jacqueline Tosolini RCP
The SARS-CoV-2 pandemic has caused many to experience negative emotions, affecting general health and well-being. For those with chronic illnesses, such as COPD, these emotions are compounded by fears of a severe reaction to the novel coronavirus infection. Daily worries about one’s health can lead to increased anxiety and depression, feelings of isolation and sadness caused by the loss of our usual social support systems, and fear that this may become the “new normal”. It is normal to experience such feelings during uncertain times, but many struggle to keep these emotions from being counterproductive and even overwhelming.
Using resources from the COPD Foundation, the Centers for Disease Control, and from multiple mental health experts, here we outline some ways to help maintain control over our health, increase resilience and deflect the harmful effects of isolation and negative emotions.
Know your numbers and develop an action plan.
Know your numbers. Monitor your baseline (typical) breathing rate, heart rate, and oxygen saturation. Once you know your baseline measures, you can use the “My COPD Action Plan” which provides green, yellow, and red zones to guide self-care.
The Green Zone: I am doing well today.
The Yellow Zone: I am having a bad day or a COPD flareup. Prepare a written plan with your doctor for the yellow zone contingency. This may include the adjustment of medications and the use of antibiotics or steroids. For suspected COVID-19 viral infection, the use of a metered-dose inhaler with short-acting bronchodilators is preferred over the use of a nebulizer to minimize exposing household members to aerosolized virus.
The Red Zone: I need urgent medical care.
Be aware of your mental state
There should also be a plan for the possibility of an exacerbation of mental distress whether it be anxiety, panic, apathy, or depression. These states are often preceded by worry, irritability, or insomnia. Share a description of your feelings with family or close friends. Negative emotions should not be suppressed or denied because they will only become stronger.
Persistent anxiety or depression is treatable by a mental health professional. The triggers for worries can be examined. Negative thoughts can be reframed into more positive alternative thinking. It is not the thoughts themselves that are bad; it’s what one does with them that can cause more suffering.
Do not delay seeking help
Do not hesitate to notify your physician for any exacerbation of mental or physical illness during this pandemic; do not wait more than 24 hours to call if your symptoms continue. Since the early months of 2020, many clinics are utilizing audiovisual technology for a majority of their outpatient office visits, increasing the efficiency and safety of these encounters. Telehealth visits for treatment of mental health problems are effective in treating anxiety or depression while patients remain safely in their homes.
Add structure to your day
Schedule your day so that there is a timetable of tasks to be accomplished. Maintaining structure and routine activities are an important part of coping with stress. Be grateful and express satisfaction (even silently) following the completion of any task, no matter how small.
Don’t stay cooped up
If possible, spend time outdoors each day, enjoying nature and sunshine. Many are worried about leaving the house during the pandemic. But a walk in the sun can be accomplished safely using a mask and social distancing. Out of doors is a well-ventilated area!
Engage in some form of exercise each day. Start off slowly in your home for 2 to 3 minutes, three to four times a day. Aim to increase the times slightly each day. When this is no longer challenging, advance to your backyard, and before long, you will be walking around the block. Exercise using the legs is most important to prevent deconditioning and worsening of shortness of breath. Additionally, upper body exercises can be done easily with the use of resistance bands at home, 2 to 3 times a week. For further information on starting an exercise program, see our basics section. Your physician or local pulmonary rehabilitation program can help develop an individualized program of strengthening, stretching, and aerobic exercise.
Set aside some time each day for meditation or mindfulness. These activities of the mind attempt to engender a sense of well-being and equanimity. Find a quiet location, a comfortable posture, and focus your attention on an object or sensation. Keep an open mental attitude letting distracting thoughts come and go without judgment. You will find that physical signs of stress and anxiety will be diminished. Chair yoga can also lead to clearing of the mind and being one with yourself, all while stretching and gently exercising.
For those with chronic lung disease, breathing techniques can improve oxygenation as well as the sense of well-being and of being in control. During a period of meditation, while seated comfortably with shoulders loosened, taking a slightly deeper inspiration through the nose followed by expiration that is about twice as long can be quite calming. As you breathe in, imagine the flow of energy into your body; as you exhale, blow out all your tensions. Let it go! Another breathing exercise, pursed-lip breathing (as if you are whistling while breathing out) can be used during exertion and exercise to help with the work of breathing.
Learn something new
Explore developing new skills that will build mental strength and provide a sense of purpose. Consider online courses, podcasts, and audiobooks. Use technology to acquire knowledge of activities such as gardening, household projects, or community support.
Regularly schedule some time each week with family or friends using FaceTime, Zoom, or similar technology. Engage with lighthearted conversation and fun and games. Using the internet regularly for social connection may actually improve some relationships going forward, one of the few bright spots of the shutdown forced by the pandemic.
Go to bed and wake up on a consistent schedule, aiming for at least 6-8 hours of sleep each night. Practice good sleep habits by avoiding physical exercise or watching video news before bedtime. Taking a warm bath or shower before bed helps relaxation and to prepare you for a good nights’ sleep.
Make a mental note each day of things for which you are grateful. Remind yourself about something you should be grateful for, such as your home, your family, or your friends. Also, when possible, consider giving help to friends, family, or neighbors. Express gratitude to others including essential workers. These acts of kindness will predictably bring more joy and meaningfulness to your life.