The Depression and Anxiety Experts

How to De-Catastrophize Your Anxiety

Anxiety serves a purpose: to motivate us to deal with potential threats.

If you are realistically worried about coronavirus and are problem-solving effectively, you are coping well. Keep going! Research shows that moderate amounts of anxiety helps us address potential threats such as illness.

If you are paralyzed by corona-anxiety, not sleeping, functioning poorly and perpetually worried, then you need assistance. Try adding the de-catastrophizing tool to your toolbox. It’s a way to manage medical uncertainty.

Ask yourself:

What is the best-case scenario?

What is the most-likely scenario?

What is the worst-case scenario?

If the worst case scenario comes true, what is my plan of action, even if it means dealing with an ICU admission or death and dying?

Let’s examine these three potential coronavirus outcomes in greater detail.

In the best-case scenario you are never infected or if you are, it is an asymptomatic infection.

In the most likely scenario, if you contract the virus, the most likely outcome, extrapolated from the Chinese Center for Disease Control and Prevention data, is that 81% will have mild disease (no or mild pneumonia) and 14% will have severe disease (shortness of breath, low oxygen saturation or more than 50% of their lungs infected, based on imaging).

In the worst-case scenario, 5% will have “critical disease”, which involves hospitalization and isolation. It can mean an Intensive Care Unit admission and being put on a breathing machine temporarily if you need assistance to breathe.

The case fatality rate was 2.3% in the Chinese cohort. All of these came from the “critical disease” group. So, the worst-case scenario is an ICU admission with mechanical ventilation and possible death.

Psychologically, to cope with the worst-case scenario, ask yourself, what is my plan of action? Will I get through an ICU admission? Have others been admitted to an ICU and put on a breathing machine and survived? Yes. In fact, coronavirus aside, about 80% of critically ill patients admitted to ICUs are in fact discharged. ICUs do excellent jobs of treating patients.

In the worst of worse scenarios, you also need to ask yourself, if I am facing death and dying, what do I need to do in order to cope? How did other family members approach death and dying before me? How did they cope and what went well and what could be improved?  If I die, how can I best support my family and ensure their survival?

So the worst case-scenario, does not sanitize the possibility of death and dying but rather invites us to consider it as a possibility. Discussing the risk of death does not increase the likelihood of it occurring.

What improves the odds: Remember that excellent health care, such as we have, produces better outcomes. New York is not rural China. Additionallly, new antiviral medications or vaccines can completely change the picture. Consider how the AIDS epidemic was turned around by the invention of antiretroviral medications. Staying healthy is a good thing too. Keeping your lungs as pristine as possible will help. If you are a smoker, now is a good time to stop. Nicotine replacement therapy is very helpful and avoids you experiencing withdrawal. Ditto for smoking cannabis, which is not good for your lungs.

Maintaining your exercise through potential isolation and gym closures will be challenging. Nevertheless, peak health improves your chances of overcoming disease. You don’t have to train for a marathon. Seven minutes a day will get your diaphragm working and open up your air passages. And yes, there is an app for a seven minute workout and it’s called Seven!

Other coronavirus uncertainties: How your life will be disrupted in terms of work, finances, school, access to food, toilet paper, respiratory masks and so forth, can also be assessed with the de-catastrophizing tool. Ask the three de-catastrophizing questions concerning these challenges too. Write them down on a piece of paper. It’s a helpful addition to the de-catastrophizing tool. Research shows that writing things down helps psychological processing.

Final word: The idea of the de-catastrophizing tool, is to develop a plan of action that covers all your bases. If you can plan for the best, most likely and worst-case scenarios, then, psychologically, you are doing well. Panic is replaced by realistic optimism.

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