How do we cope psychologically with COVID-19 by Dr. Sean T. H. Lee

Life plans, careers, and even loved ones. One thing or another, most of us have lost something precious to the Coronavirus disease 2019 (COVID-19) pandemic. As we grapple with the abrupt emergence of a novel, deadly disease and the upheaval of our normal daily lives, it is easy to get overwhelmed by crippling emotions. Anger, frustration, sadness, and even depression are some of the many emotions that we may have been experiencing. These emotions can harm our physical and psychological health, especially when experienced over prolonged periods of time. How then, can we better manage or even transcend these emotions?

We must first understand that emotions such as anger and sadness are part-and-parcel of our psychological coping process, as detailed by the renowned Five Stages of Grief and Loss (Kübler-Ross & Kessler, 2005). Under this model, there are fives stages that characterize how we cope psychologically with losses in our lives: denial, anger, bargaining, depression, and acceptance. The crux to restoring psychological well-being and optimal daily functioning, is to recognize which stage we may be stuck in and understand how we may breed adaptive acceptance.

Stage 1: Denial

From touting COVID-19 to be no different from the common cold, to believing that COVID-19 will somehow disappear during the summer months, denialism has manifested quite evidently throughout the course of the pandemic thus far. Denying the threat, either wholly or in part, cushions the psychological impact of the initial blow. Afterall, a stressor can only hurt me if it exists, right? So, if I turn a blind eye to it, then…

The issue with denial is that, while it may protect your immediate mental wellbeing, it prevents you from doing anything about the threat – since you now truly believe the threat does not exist. As a result, those in denial often disregard health advisories and public health policies (e.g., not wearing masks, disregarding safe distancing measures, etc.). In the long run, as these individuals continue to engage in such behaviors, or worse, convince others around them to adopt the same mentality, it further reinforces their alternate reality of COVID-19 being a miniscule if not a non-existent threat. This poses a real risk to their own physical health and others around them, with a grave potential of jeopardizing public health efforts.

Possible Indicators:

• Disregarding health advisories and public health policies
• Selectively looking out for information that reinforces your belief that the threat of COVID-19 is negligible or not real
• Being unable to consider peer-reviewed scientific evidence and official statements put out by health authorities objectively
• Trying to convince others to adopt your stance and drop their preventive measures

Stage 2: Anger

Anger usually precipitates when reality sets in. This strong outward expression is often a reflection of our inner vulnerability; it provides temporary structure to the nothingness of loss. We start blaming anyone or anything we can for the current situation we are in. In the context of COVID-19, this has manifested in the blaming of certain racial groups, certain countries, local authorities, etc. While this could potentially breed learning and preventing a repeat occurrence, more often than not, it only breeds negativity. This is because such anger is often sheerly an expression rather than a conduit to learning and problem solving. In other words, it is often destructive rather than constructive – breeding negative emotionality among others and sowing social discord.

Possible Indicators:

• Constantly feeling irritable and frustrated
• High frequency of blaming with no resolution intent 
• Being antagonistic or violent towards specific groups of people

Stage 3: Bargaining

Bargaining occurs as we attempt to regain a sense of control. Counterfactual thinking occurs during this stage. Statements such as “if only we had made mask-wearing mandatory sooner” and “what if we had banned travel from day 1” reflect our attempt at bargaining for an alternate reality. We yearn that things would have turned out differently. Mentally playing out such simulations provides a sense of “would have” control over the current painful reality. While this potentially provides valuable opportunity for learning and preventing a repeat occurrence, it is not adaptive to be fixated with the past especially if the threat is still ongoing (i.e., COVID-19), because it hinders one from thinking and planning ahead.

Possible Indicators:

• Constantly making “if only” and “what if” statements about the current situation
• Preoccupied with thinking about what could have been 
• Consistently discussing with others how different policies enacted in the past would have led to a different outcome

Stage 4: Depression

Depression marks the transition of focus from past to present. As we attempt to move on from venting our frustration and yearning for what could have been, a somber realization sets in that we are now stuck living with COVID-19 and nothing we can do will change this fact. While this shift can facilitate acceptance, it can also elicit a sense of learned helplessness. We may also start to place a heavy focus on the current practical implications (e.g., unable to afford rent, unable to visit old-aged parents, etc.), which would further drive our mood down. If left unchecked, it could develop into full-blown clinical depression that severely impairs daily functioning and risks suicidality.

Possible Indicators:

• Constantly feeling that there is nothing you can do to make the situation better
• Experiencing the sensation of being “stuck” with no resolution in sight
• Being overwhelmed by worries and concerns about COVID-19 and its associated practical implications 

Stage 5: Acceptance

When we truly accept reality, that COVID-19 is here to stay for some time and the associated losses that have occurred are but a fact of life, we reach the stage of acceptance. Acceptance does not mean that we are perfectly “ok and fine” with everything that has happened (or is happening). But rather, it represents a future-directed orientation. We recognize that this is how things are now and make adaptive plans for the future given the current constraints.

This shift in focus towards the future is key in breeding acceptance. We may have no control over what has happened (past) and limited control over what is currently happening (present), but we still can exert control over our future trajectory. Being caught up with the less controllable aspects of the issue or, worse, denying the existence of the issue altogether, only sets the stage for more future suffering. Recognizing that what we do now can and will shape our future outcome is the first big step to take in fostering adaptive acceptance.

Always remember that we are all in this together.
Act responsibly.
Comply with health advisories.
Protect yourself and others from COVID-19.
Together, we will walk out of these dark times towards a brighter future.