Resources and Articles

Anxious Times and Anxious Behavior

By Christopher Okiishi, M.D. & Ian Kerns, LMFT

In spite of the fact that I have been working with clients on anxiety management for years, I have not, until a month ago worked with clients addressing the anxiety caused by a life-threatening pandemic.  Over this month, I learned from my work with clients many things to help avoid cascading anxiety and panic. Some of the most useful include:

1. Acknowledging that most everybody is scared.

This pandemic has people worrying about the worst:  will they will fall ill? Lose loved ones? Lose their incomes and savings?  Lose homes or even their lives? How can we respond to these fears, both as individuals and as a community?

The truth is:  you’re supposed to be scared sometimes. You should probably be somewhat scared right now–fear is built into us in order to keep us safe.  Even if steps are taken to resolve the threat, anxiety can continue as our brain and body attempt to keep us safe and give us messages to remain vigilant to threats. 

It is important to understand that this anxiety response is part of being alive and being human.  Sharing with others our fears and worries can be reassuring that we are not alone in our anxieties—and we can learn from listening to each other ways to cope and overcome anxious thoughts.  

2. Recognizing that it is really hard not to be able to leave the house.

The term “stir-crazy” is a bit more biting after several days in the house.  Even as the weather improves and there are safe ways to be outside and still maintain social distance, people are feeling the lack of connection with others.

This isolation is really hard, especially when we can easily see people making unwise or unsafe choices.  We can go negative in our thoughts and project ideas and judgments on others, even when, ultimately, their behavior is out of our control. 

This sense of isolation is borne out of a need to be near other humans. It’s important to remember that your feelings of “stir-craziness” are an offshoot of our need for connection to society and community. Though it is an uncomfortable feeling, we can welcome that feeling as the thing that will ultimately bring us all back together when it is safe.

This is a time to focus on what IS in our control.  There have never been greater means of communication available to us than there are today.  Phone calls, video chats, group virtual meet-ups, and online games and activities are plentiful and rewarding.  Some may take some effort to learn how to use them, but the results can be literally life-saving. Talking with friends about positive experiences and ideas, even just a couple of times a week, has been shown to greatly improve a person’s chances of managing anxiety and avoiding despair.  

It is also crucial to maintain a regular routine.  Sleep and wake times, meal times, work, exercise, and relaxation times—when there is less structure in our lives, it is easy to let go of routine and get ourselves into unhealthy patterns.  While it is important to have some variety and novelty in life, a key to maintaining good mental health is a good, regular routine.  

3. Remembering that fear can color feelings and lead to some very odd behavior.

Many of us experience an inordinate level of fear about almost any perceived threat in our lives right now. This fear can be expressed via hoarding, aggression, or even making dangerous choices.

Compulsion and planning are very different things.  Anxiety exists primarily to drive us to take action. When we have a lot of motivating anxiety and very little we can actually do or control, we may engage in some odd and even counterproductive behavior. It’s almost like we have too much anxious energy which compels us to do things that are not rational.  

Some people bought a bunch of toilet paper. I bought a whole bunch of canned black beans. (I mean a bunch of canned beans.) This was an attempt on my part to control the situation in a way that would reduce my anxiety. Some of the things that we do are logical and effective and some are not. Some rational people have done some very irrational things because of anxiety/control cycles.

How do we avoid buying too many beans? I suggest you make a list of things you feel compelled to do.  Then, identify whether the actions you want to take attack the primary threat or are they motivated by other, less rational anxieties.

I now realize that buying beans was an attempt to avoid consequences from a prolonged pandemic.  When I really break that down, starvation is highly unlikely for a lot of reasons. My anxiety caused me to go down a negative thought path, which led me to attempt to appease my anxiety with an action that made me feel some control over an undesired outcome.

When people make these lists, they gain some control over their behavior but, more importantly, they tend to gain a more mindful understanding of what their anxiety is and the relationship between anxiety and behavior.

I also encourage clients to focus on the things they can control, such as consistent and effective social distancing, handwashing, and helping others by calling people more frequently and setting a strong example of socially responsible behavior. 

When we break it down explicitly and focus on those things that we actually need to do to stay safe, we are able to make better decisions to directly reduce our anxiety.



There Is Hope: Suicide Ideation in Times of Crisis

“It is hopelessness even more than pain that crushes the soul.”

-William Styron

In my 35 years on Earth I’ve heard the term “unprecedented” used only a handful of times to describe global events. I don’t know about you, but as I write this tucked away in my basement where I’ve been working from for the last two months, I’m pretty darn sick of the word “unprecedented”.

As all of us are now experiencing the culmination of a global pandemic, an incredibly painful economic reality and the challenge of stay at home orders. We find ourselves faced with one of the most unique circumstances ever: Government mandated social distancing.

Social connectedness is one of the most important aspects of the human condition. During times of crisis we come together, not apart. Time spent with friends and family is immensely important to our well-being, heck, even time spent with co-workers has its benefits. Physical proximity to our supports matters, it matters a lot.

For those of us with a history of mental health struggles (and without), this “unprecedented” crisis has presented very unique challenges to our well-being: uncertainty, fear, and a sense of hopelessness. Most humans alive have never experienced such a global phenomenon, and few of us are well equipped emotionally to handle such catastrophe. The daily loss of life, the 24-hour news cycle with its constant focus on the pandemic, and a massive economic crisis. Parents may be struggling to juggle working from home and caring for their children. Good news is awfully hard to come by.

The psychologist and suicidologist Edwin Schneidman coined the term “psychological pain” to describe “how much you hurt as a human being. It is mental suffering; mental torment”.

All of us hurt right now.

During times of stress, it is not uncommon to experience thoughts of suicide, these thoughts can range from fleeting “I wonder what life would be like if I were not here” to more intrusive and direct “I want to die”.

Suicide is not inevitable and the vast majority of individuals who experience suicidal thoughts or behaviors go on to live healthy and full lives. It can be hard in the moment to think positively about the future. During this time where many of us have already felt financial impacts or experienced increased depression, the possibility of experiencing suicidal ideation or behavior increases. The psychological pain some of us may experience throughout this crisis is likely to be deep and difficult to cope with.

Support is available, help is out there.

1 – Call the National Suicide Prevention Lifeline (1-800-273-8255) to immediately speak with a counselor (24/7/365). If you are thinking about suicide, are worried about someone else, or would like emotional support, the Lifeline network is available. Calls are confidential and you can call on behalf of someone else. Lifeline counselors are trained to provide support, guidance and referral information for individuals struggling with suicide ideation or behavior or for general mental health crisis.

2 – Mobile Crisis Outreach: If you live in the following counties (Linn, Johnson, Jones, Buchanan, Bremer, Benton, Dubuque, Delaware, Cedar, Jackson, Scott, Clinton, Iowa or Muscatine) you can call the Iowa Helpline (855-581-8111) to receive free telehealth services from a mobile crisis counselor. These services are confidential and available 24/7/365. These counselors are located in Iowa and will connect with you via telehealth to provide screening, immediate intervention and guidance, as well as 24 hour and 7 day follow-up.

There are several warning signs that can help you determine if you or a loved one is at risk for suicide, especially if the behavior is new, has increased, or seems related to a painful event, loss or change. These warning signs include:

· Talking about wanting to die or to kill themselves

· Looking for a way to kill themselves, like purchasing a firearm

· Talking about feeling hopeless or having no reason to live

· Talking about feeling trapped or in unbearable pain

· Talking about being a burden to others

· Withdrawing or isolating themselves

· Extreme mood swings

· Sleeping too much or too little

3 – Social distancing does not mean social isolation. While we can’t be physically with many of our friends and family, we should still make an effort to connect with them. If there is someone you’ve worried about in the past, a friend or family member with a history of depression, now is an important time to reach out and see how they are doing.

4 – Take care of what you can. I’ve noticed with many of the clients I work with (and myself) that as social distancing and stay at home orders have been in place for nearly two months now, sleep habits and routines have started to change. I find myself staying up later and sleeping in later. Sleep and mental health go hand in hand. It’s hard to feel good when we are not sleeping, or if our sleep cycles are significantly disrupted. Depression can drive us to want to sleep away the days. This is also something to be avoided and tends to compound our feelings of loneliness.

5 – Connect with your mental health providers. Now more than ever it is important that we focus on our mental well-being. Despite changes in service delivery from in-person to online, it remains important that we continue (or start) to connect with our mental health providers for support. If you find yourself struggling, call to see if you can bump up your appointment. Let your provider know that you’ve had thoughts of suicide so you can work collaboratively on treatment and support.

6 – Know that you matter. Individuals who experience thoughts of suicide and/or depression will often report that they feel or think their lives don’t matter. As Kevin Hines, the motivational speaker and suicide prevention advocate says “You matter to people you haven’t even met yet”. Treatment for suicide ideation and behavior is very effective. You are worth it. The vast majority of people who experience suicide ideation go on to live healthy and fulfilling lives.

“Look well into thyself; there is a source of strength which will always spring up if thou wilt always look.”

-Marcus Aurelius, The Meditations


Drew Martel (LISW, CADC) is the Director of Crisis Services at Foundation 2 in Cedar Rapids, as well as a provider of individual therapy at Meadowlark Psychiatric Services in North Liberty.