Nobody likes being inside on a beautiful sunny day; but lately, as we’re sure you’ve noticed, some state governments – as well as some other countries- have been mandating people to do so. For some, this situation offers a welcome break from work, more time with their families, and other holiday-esque perks. For others, however, this curb on social interaction is proving to be a significant catalyst for mental health concerns. 

The US Census Bureau has reported more than 42% of people experiencing symptoms of anxiety or depression – an increase from only 11% the previous year. These are staggering numbers, and researchers are working to investigate the causes and impacts of COVID-related stressors. They fear that this observed deterioration in mental health is likely to continue for some time after the pandemic has subsided. Clinical psychologists from Harvard Medical School in Boston have expressed their concerns regarding the unlikeliness of mental health statistics returning to baseline levels at any point in the near future (Abbott, 2021). 

It seems that there is a mental health pandemic nested inside the broader COVID pandemic, and counsellors and mental health professionals are on the frontlines of what seems to be an uphill battle. There is hope, however. For generations, we have been refining strategies and techniques for dealing with acute and chronic anxiety/depression, and now it is a matter of adapting these practices to the digital landscape, and rolling them out en masse so-as-to reach the enormous number of people who need them. Our mental health practices are, in a sense, a vaccination against the perils associated with having to process such a chaotic period in human history, in tandem with the fallout of unprecedented levels of social isolation.

This article proposes a number of strategies that counsellors can use to engage with those affected negatively by lockdowns, as well as certain thoughts and insights that might prove helpful when trying to stay grounded and reasonably stable during these tough times.

What first? The Three Pillars of Health

When a client comes to you with symptoms reflective of anxiety and depression, no matter the circumstances it can be a valuable first step to ensure they are engaging in high quality sleep, good food, and regular exercise. These three pillars of health are often determinants of how one experiences and responds to the world. If a client is not in a position to self-regulate these three pillars of health, it can have a negative impact on their mental wellbeing.

High quality sleep

For individuals with self-reported low quality of life, sleep is often the first and last casualty. A lack of quality sleep can result in a cascade of negative physical and mental health outcomes leading to anxiety, depression, and even physical illness (Greenberg et al. 2001). The ability to self-regulate one’s sleeping pattern depends on the promotion of efficient biological rhythms such as circadian rhythms, which help us maintain equilibrium by harmonising the bodies internal physiological states with the day and night cycle (Brooks, 2013). There are many disorders that originate from poor circadian rhythm regulation, and they may be caused by abnormal activity in an individual’s brain areas responsible for anticipation (anterior cingulate cortex), body temperature control (posterior hypothalamus), and sleep drive (thalamus – or hypoglossal nerve – centre). These brain areas are known as the “circadian pacemakers”, and disruptions in their activity can cause an imbalance in mood, motivation, and energy levels (Adelstein et al. 2008). Remedying sleep issues will assist the body in maintaining a healthy hormonal balance, thus resulting in greater chances to experience positive moods. Counsellors can encourage clients to engage in high quality sleep behaviours such as maintaining a regular bed time, maintaining a consistent wake-up time, avoiding napping during the day (unless necessary), and avoiding excessive caffeine or alcohol intake prior to bedtime. There is a robust catalog of sleep hygiene practices that can be prescribed to clients to assist them in this area.

Good nutrition

A healthy diet has been acknowledged to be an effective intervention for the treatment of anxiety and depression (Chen et al. 2016; Heaney et al. 2013). Counsellors can encourage clients to adopt healthy dietary habits such as regular meal-times, approximately three meals per day, avoiding excessive carbs, sugar, and sodium intake, avoiding caffeine and alcoholic drinks early in the day or within three hours of bedtime, and maintaining a balanced intake of fruits, vegetables, whole grains, nuts/seeds, etc. Generally, a diet high in good fats, protein, and high in anti-inflammatory properties will allow one’s body to respond as effectively as it can to stressors. It is important to address nutrition early on in counselling sessions to ensure the client is operating at a good baseline physiological level.

The food itself is only partially responsible for mental wellbeing, however; it is also the mere act of preparing and eating food that yields significant psychological benefits (Weng et al. 2004). There is something innately gratifying for human beings about expending effort in order to gain a reward, so the process of preparing a meal – as opposed to ordering takeaway – could invoke feelings of reward or alleviate feelings of stress (Heaney et al. 2013).  Counsellors can help their clients understand that there are many components of eating habits that are beneficial for mental health; we can help our clients incorporate these into their lifestyles, thus fostering a greater sense of control in these unpredictable global times.

Regular exercise

It has been said that if there were a pill developed that offered people the same benefits and healing properties that exercise offers, it would be the most valuable pharmaceutical to ever be developed. Exercise is one of the most effective measures of self-care for improving overall mental health; it has been shown to reduce depression, anxiety, fatigue, irritability, stress – and the list goes on (National Center for Biotechnology Information, 2003). Counsellors might discuss with their clients the best types of exercise routines depending on their goals. If they are interested in weight loss or strength gains then a more intense approach is necessary than if they are simply looking for an endorphin boost, in which case a more relaxed regime would be adequate. Regardless of whether it is aerobic activity, stretching, yoga, or muscle strengthening activities, counsellors can encourage clients to engage in regular physical activity so as to improve mood and promote psychosocial outcomes. 

Exercise activates an innate mechanism which makes us feel good about ourselves. This is understood scientifically, but in more personal terms it can be summed up thusly: if you are moving around, you are probably doing something important, so you should feel good about yourself. As animals in the wild, we would only expend energy (run, lift, jump, and climb) when we were trying to achieve a worthwhile goal, so it makes sense that emulating these behaviours would have positive effects on our self-esteem and mood. When exercising, as far as our physical body is concerned, we seem to be doing something of value that will result in the attainment of something desired; we are able to harness that process and trigger the positive effects that come along with it. Outlining the primacy and simplicity of this mechanism to clients could motivate them to start a regular exercise routine.

Alright, what else?

Okay, we’ve covered the three main pillars for health and mental wellbeing. These will provide clients with a solid foundation from which to enact further interventions. They still, however, have the problems of social isolation, little-to-no time outdoors, and possible financial hardship.

Social isolation

Social isolation can be a major factor affecting mental health for clients. The comfort found in the companionship of friends and family provides an opportunity for emotional support and social gratification. Too much time spent alone could lead to feelings of anxiety, depression, or discomfort with one’s own sense of self. Take steps to ensure that your client has routine opportunities to interact with others. Group activities are really beneficial, such as book clubs, film discussion circles, hobbyist communities, and many have adapted their operations to online formats, giving those in lockdown the opportunity to continue engaging with like-minded people. Not experiencing social interactions sends messages to the body and mind that you are not connected to a network of people; this is a fundamental determinant of our mental state because – in a similar anthropological vein to exercise making us feel useful – a mammal without a tribe is not of much utility to anybody and is not under any protection from others. It can be helpful to conceptualise our basic needs in this type of logical manner. 

Time spent outdoors

Another factor to focus on with clients is time spent outdoors. It’s no secret that sitting down indoors for 8 hours a day is not great for our mental health. Ensure your client gets to enjoy the fresh air and well-being that comes from time in nature. If your client is in lockdown, or doesn’t live near an area that allows exposure to the natural environment, then encourage them to spend time in natural light during the day where possible – perhaps by a window, on a patio, or in a backyard. This simple habit will help regulate one’s circadian rhythm and also provide vitamin D; a lack of vitamin D has a big impact on our health.  Vitamin D is important for our mood and mental health – among other things – because without enough of it your body may not be able to regulate the expression of neurotransmitters involved in mood regulation (Kesby et al. 2017); this could lead to depression or anxiety.

Finances 

Finally, financial hardship could be a factor contributing to mental health issues for your client. If they are feeling stress about how they will afford their next meal or pay rent, this could justifiably be causing them worry and anxiety. This is not a problem for which there is a simple solution; it will require time and assistance from relevant professionals, but counsellors can offer advice and coaching throughout these times. A general rule of thumb for people struggling with finances is to review one’s spending habits to figure out where changes should be made. Try making a budget, and sticking to it. Look for additional sources of income through side hustles, or ask friends or family for help. It can be hard to accept help from someone else – but often they are glad that you asked!

A step by step process to recommend to clients could follow along these lines:

  1. Make a list of your expenses   
  2. Limit unnecessary expenditure on luxuries 
  3. Find alternative sources of income
  4. Find ways to save money on necessities 
  5. Pay your debt off as soon as possible 
  6. Create a rainy-day fund to allow for unexpected expenses

The client should be aware that these changes will help with their life situation, but will also have positive effects on their mental health. Cognitive distortions can worsen people’s financial situations, and negative thoughts about their abilities to change things can make them more likely to stick with old habits. We all have a tendency to blame ourselves for things that go wrong, and this can intensify these thoughts of inadequacies, thus creating a vicious cycle of neuroticism. Recognise this loop and try to break it. Take control. By making small adjustments at a time, many small victories will come from the efforts.

So basically…

Unsurprisingly, it’s not easy to have the world seemingly fall apart around you. The rising numbers in mental health statistics are indicative of people’s difficulties in adapting to this strange new situation. Fortunately, hope is not lost. Counsellors, among other mental health professionals, are able to offer guidance and advice to their clients regarding holistic sustainable habits that bolster their ability to handle life’s stressors. If a client can develop good sleep, eating, and exercise habits, then they will be more likely to be able to gain some control over their social life, outdoor exposure, and finances. It’s a long road to recovery, and a bumpy one at that; we just have to keep going. 

References

  1. A. A. H. Abbott, “”What is the role of each gender in the COVID pandemic?”,” Office of Communications and Public Liaison, Office of the Vice Provost for Student Affairs, Harvard University, August 4, 2020.
  2. Adelstein, R. M., et al. (2008). “Circadian Rhythms in Mental Health”. “CNS Spectr”. 13 (8): 607-616. doi:10.1111/j.1755-5949.2008.00068.x
  3. Brooks, A. J. (2013). “The Neuroscience of Healthy Sleep”. Bantam Books. ISBN 9780062126037. Retrieved from OCLC WorldCat Library website.
  4. Chen, C.-T., et al.. (2016). “Dehydration Impairs Brain-Derived Neurotropic Factor Secretion in Young Men”. “Nutrition”. 32 (6): 791–796. doi:10.1016/j.nut.2016.02.002.
  5. Greenberg, R. T., et al. (2001). “Sleep Deprivation and Depressive Symptoms in the Elderly”. “American Journal of Clinical Geriatrics”. 13 (4): 203–211. doi:10.1097/00001508-200102000-00001.
  6. Heaney, C., & Wyse, B.. (2013). “Sleep in General Medicine”. In Pocket Companion to Medicine , P. Little, J. Lewis, & N. Phillips (Eds.). Pp. 121–160. Oxford: Wiley-Blackwell . ISBN 978-1-118-77178-0. Retrieved from OCLC WorldCat Library website: https://www.worldcat.org/oclc/882446055.
  7. Kesby J.P., Turner K.M., Alexander S., Eyles D.W., McGrath J.J., Burne T.H.J. (2017). “Developmental vitamin D deficiency alters multiple neurotransmitter systems in the neonatal rat brain.” Int J Dev Neurosci.
  8. National Center for Biotechnology Information (2003). “Nucleic Acids Research”. Volume 31, Issue 1
  9. Weng, W.-Y., et al.. (2004). “The Relationship between Breakfast, Mood and Academic Performance in High School Students”. “Asia Pacific Journal of Clinical Nutrition”. 13 (4): 397–403. doi:10.1046/j.1440-6047.2004.00267.