KEEP calm AND conquer CORONAPHOBIA

We’ve felt safe cocooned at home. Now with lockdown easing, many of us find our anxiety tipping into a full-blown fear of going out. In a timely new book, one of the country’s top mental health experts says . . .

SO YOU are struggling. welcome to the club. we all are. if you are not a bit stressed, you are definitely bucking the trend.

Now we are tentatively coming out of lockdown, it is fine to be feeling on edge, or as though you can’t always cope. For me, this crisis has all the characteristics of a wartime experience, where events feel totally out of an individual’s control and our fundamental feelings of security and optimism about the world are changing daily. it is challenging our emotional resilience to the limit.

Stress levels are especially high as we feel our way into a changed world. we are not alone in this — all over the globe, wherever people are lifting the shutters, getting back to work, meeting friends at a distance (italy, Spain, Germany, New Zealand), anxiety levels are soaring. we worry that if we are not staying at home, we are putting ourselves back in the firing line. The fear of missing out (FOMO) has become the fear of going out (FOGO).

And yet some of us are undoubtedly finding it worse than others. For some, especially women, who suffer from anxiety disorders at roughly twice the rate of men anyway, the jitters you would expect are starting to spiral into full-blown fear.

As a doctor and the author of ten books on mental health, i often think women have a lot to feel anxious about — from demanding, full-time jobs to all the caring responsibilities, household chores and management of other people’s lives they are still expected to take on with a smile. And coronavirus has exacerbated it all.

Surveys over the past few months have shown women suffering greater anxiety levels than men. At the start of the crisis, 49.6 per cent of people in Britain reported significantly elevated anxiety levels — equivalent to more than 25 million people feeling high anxiety, according to the Office for National Statistics.

Mid-lOckdOwN the figures dipped a little as people perhaps felt safer cocooned at home, but still women’s levels of anxiety were 24 per cent higher than men’s. The latest surveys — done at the beginning of May, as we began to focus on ways to lift lockdown — show another rise, with a whopping 65 per cent of people feeling ‘stressed or anxious’.

Many of the signs are physical, and fatigue is a big one. women don’t talk about this enough; instead, they drag themselves from one high-stress role to another, adrenal glands pumping out the fight-or-flight hormone cortisol, and then find they cannot sleep at the end of the day.

if you are chronically tired, it is often because you are anxious. Other persistent low-grade ailments linked to anxiety include nightmares, teeth grinding, irritable bowel syndrome and poor concentration. Try not to focus on these things too much, but to relegate them to the background if you can (see my radio exercise below).

As we edge out of lockdown, i have been inundated with calls at my clinic. As a GP with a special expertise in mental health, i have found that some patients, often women, are genuinely suffering a form of post-traumatic stress disorder, where a normal level of alertness to risk has turned into a disabling hypervigilance.

i call it being in the watchtower. They are up high shining their searchlight backwards and forwards, seeing potential danger everywhere but guarding the entrance to the castle with such eagle-eyes, they are certain no one can get past them to attack — and all the while the enemy is tunnelling underneath. The fact is, you can’t eliminate all risk from life.

No one can achieve absolute control, security, order or perfection. You can never be 100 per cent certain someone close to you will not get ill, and it is when we make impossible demands on ourselves — that you will protect your family absolutely from this virus, for example — that anxiety starts to take hold. we learn to manage our anxiety when we learn to accept that risk.

Other patients with pre-existing anxiety are finding their disorder getting better as the crisis goes on. Perhaps they were worried about a terrible nebulous threat in the future and now it has happened, they can stop worrying. Or else they see a bigger worry in the world than whatever was making them anxious on a personal level, and can relax with a new global perspective on it.

Patients who suffer from general anxiety are constantly filled with a sense of foreboding — they assign a danger to many life situations when no danger is present. But the threat of this virus is different, not because the risks of dying seem high (if you are healthy, they are not), but because of the real and often legitimate stress it is causing in general.

People react differently to stress. Some get angry, others feel as though the world is against them; lots attempt to drink their way through it. if you have lost your job, it’s too easy to catastrophise and assume you will never get another one, you will not be able to pay bills, and you will lose your house. it is at this point you have to remember what i call the priority pyramid. The most important things to us are our own physical and mental health, then the health of our personal relationship and that of our children and wider family, and only after all of those things, our job.

if you treat its loss as a problem to solve and adapt to, and choose not to regard it as a catastrophe, then it will not be catastrophic.

Yes, it is Ok to feel sad. we have lost our normality. we will probably have to cancel the summer holiday. we are fretting

about the quality of our homeschooling. But do not fall into the trap of thinking you are uniquely sad or the only one ‘failing’ at the ‘new normal’.

Ditch the Instagram account if it is making you feel inadequate compared to others. The fact that you did not write a novel during lockdown but did eat your bodyweight in banana bread has no bearing at all on what sort of person you are. You can rate your abilities as a maths teacher but you can never be rated as a human being. The good news? You can always beat anxiety. It is perfectly common to feel you are broken or changed for ever by a difficult experience, or that you will never get over it.

I want to reassure you that it is always possible to put yourself back together again, and I have seen it happen many times with patients in my own medical practice. As a society, we do not teach our children or ourselves about how to treat emotional distress, and yet there are so many simple strategies and techniques. No matter how hard your life seems to have become, hostilities will end, peace and calm will be restored, and you will once again feel normal, even if it is in a world forever reshaped by this ghastly virus.

So to help you manage your Fogo anxiety, try the following.

AVOID DR GOOGLE AT ALL COSTS

The internet is full of nonsensical medical ‘data’ that will just increase your anxiety levels. If you are spending every waking minute reading about the virus online, you are bound to start losing touch with the reality of your everyday life.

We tend to search the environment around us for evidence that our irrational beliefs are true, and that very much includes the internet. Stop seeking constant reassurance. No one can give you 100 per cent certainty on anything.

DON’T REACH FOR THAT SECOND GLASS

AvoID alcohol and other substances as a means of controlling your anxiety levels — they don’t help. Instead, overhaul your diet and ensure you eat properly, even if you are not hungry.

TUNE INTO THE RADIO EXERCISE

STop trying to control those low-grade physical symptoms, such as muscle tension, a knotted stomach or constant sighing, so common in general anxiety.

Try the radio exercise instead. Sit down with a book in your hand and the radio on. First, concentrate for five minutes on the radio; turn it up loud and listen carefully so you hear and understand everything.

Now, turn to your book and for five minutes concentrate hard on that. The radio should fade away into the background as you read because your brain can only focus on one thing at a time.

That’s what you want these low-level physical symptoms to become — background noise you hardly notice. Stop trying to fight them. Accept them and get on with everyday life.

FLIP A COIN TO MAKE DECISIONS

ThIS exercise challenges the idea you can achieve 100 per cent control over threats you perceive in a post-lockdown world.

Make a list of activities you enjoy doing — a particular walk, watching a series on Netflix, reading, cooking, yoga, golf, online shopping. For a four-week period, you will choose which activity you do, or do not do, by the toss of a coin.

If you are watching a box set, you must toss a coin before starting each episode. heads, you can watch it, and tails, you miss it.

You and your partner are going for a picnic; both get ready and then toss the coin. heads, you can go. Tails, you must cancel. ouch! And so on, until you have gone through every item on the list. If you can let go of your need for control and embrace a bit of uncertainty in your everyday routines, it becomes easier to accept it in bigger matters.

REVEL IN THE MESS IN YOUR LIFE

RAISe your tolerance for disorder. Ask your partner to mess up a room in your house that you like tidy, and allow yourself to live with the mess for 24 hours. For some people, this exercise is even more distressing than the coin exercise, but it’s teaching a good lesson — you are not a failure if you cannot 100 per cent control your environment.

DON’T STRESS OVER SPILT MILK

Be AWARe when you are catastrophising. Challenge your tendency to do it and try the spilt milk exercise.

visualise what a glass of spilt milk would look like. If you are a catastrophist, you may visualise a puddle of milk on the table or floor. In practice, however, only a tiny amount or a drop of milk may have been spilt.

When we examine our spiralling beliefs, we quickly realise that most of our catastrophising has no basis in fact. Carry a notebook for three months and write down when you find yourself catastrophising about something, and then later, on paper, challenge your catastrophic conclusions.

By performing this exercise, our rational brain begins to overrule our emotional brain and we find our anxiety reducing.