As pandemic toll intensifies, so do stress reactions

UCLA Health’s Dr. Robert Bilder offers ways to ease the growing mental health challenges

Each day arrives with its share of unsettling news: a rising COVID-19 death toll, hospitals overflowing with patients, health care workers pushing themselves to the limit. Newly approved COVID-19 vaccines are offering great hope and a path out of the pandemic, but for most, the vaccine can’t arrive fast enough and the anxiety builds.

We can track the number of cases and deaths, but the pandemic’s mental toll on Americans remains incalculable.

Robert Bilder, PhD, chief of psychology at UCLA’s Semel Institute for Neuroscience and Human Behavior, said it's not unusual for people to be dealing with acute stress reactions and, over time, post-traumatic stress disorder, in response to the pandemic.

"It’s probably a good idea to make sure people don't worry that they're 'going crazy' per se and that they recognize that these are relatively normal reactions," said Dr. Bilder, the Michael E. Tennenbaum Family Distinguished Professor of Psychiatry & Biobehavioral Sciences at the David Geffen School of Medicine at UCLA. "At times like this, many people are experiencing levels of anxiety unlike anything they’ve experienced before."

The signs can include striking physiological symptoms – heart racing, changes in breathing – as a reaction to life-threatening circumstances.

"And then there are other levels of loss that people are experiencing," said Dr. Bilder, who has spent more than 30 years researching the neuropsychological bases of major mental illnesses. "Many are grieving the loss of loved ones. Even more widespread is the loss of social contact. In contrast to our prior lives where human contacts occurred spontaneously every day, now it’s critical that we reach out to others intentionally, and build in the opportunity to be in touch with the people that we know."

Dr. Bilder said there is a dual benefit to that kind of outreach.

Dr. Robert M. Bilder is chief of psychology at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA.

"In part, it helps to shore up your own social network, but in addition, you’re not only supporting others, you also are likely to gain quite a bit out of helping someone else," Dr. Bilder said. "That provides an increase in the level of meaning and purpose to your own life."

Finding a purpose amid the crisis is key.

"Being very explicit about what you find important and valuable and doubling down your efforts on doing that are very important," Dr. Bilder said. "At the same time, it’s important not to put such a great burden on yourself that it’s unrealistic.

"I think a lot of people can go through a time like this and feel bad about themselves because they feel a lack of energy, they feel a lack of motivation, they feel like their attention is waning. They can’t keep up the effort level. This is a normal reaction to the kinds of dislocations and stresses that we all are experiencing."

When interacting with students during the first few months of the pandemic, Dr. Bilder said, he was surprised that quite a few found it hard to keep their schedules together while taking classes remotely.

"I was trying to understand the relationship between the change in physical location and time," Dr. Bilder said. "Because their time is still their own. They could do whatever they want. They could keep the same schedule." Then, he said, he recalled research from the 1970s on what are called Zeitgebers, or “time givers,” in German.

"These Zeitgebers are cues from the physical environment that help us to keep our circadian rhythms intact," Dr. Bilder said. "So that if you take any of us mammals and deprive us of the usual kinds of motion cues and spatial location cues — along with the cues of lightness and darkness — we end up being somewhat confused as to the time — and it actually leads to a dysregulation of our internal biological clocks. Being explicit about keeping your biological clock synchronized and regular is really important."

Dr. Bilder suggests having exercise and other activities programmed through the day, especially outside, in the sunlight, safely distanced from others. He also recommends decreasing exposure to blue/green light, one of the causes of insomnia, at the end of the day. Blue/green light is emitted by smartphones and other common electronic devices.

"It’s quite striking how many people reported following the onset of the pandemic that they were experiencing insomnia," Dr. Bilder said.

Considering that getting appropriate rest is a key protective factor against a COVID-19 infection, Dr. Bilder advises keeping a set sleep schedule.

"When you think about all the good things you might be able to do for your immune system, getting good sleep is one of the key things," he said.

He also recommends against "doom scrolling" the news.

"There is a lot of research about people who are drawn to the news sources," Dr. Bilder said. "The media need to provide the most gripping news they can — and terror grips us more than other, nice things. So it’s pretty clear that it’s probably a good idea to limit your exposure to the news — especially if you feel drawn to it. The last thing you need to be doing is doom scrolling through horrendous news about death and dying. It’s just a traumatizing experience."

How does Dr. Bilder think the pandemic will change society long term?

"To me, it feels like it’s a part of the grand arc of history, and one that I hope pushes us toward a greater sense of community, spirit, and that forges a more collectivist alliance for the greater good; part of the pressure that helps us all realize that we have bigger common enemies than we have bigger differences among us,” he said. “Wouldn’t it be great if we were focused on trying to work together for the greater good against common enemies like climate change, global pandemics, anonymous viruses?"

He believes once stay-at-home orders and distancing requirements are lifted, people will realize how much they've missed interacting with other humans.

"There’s one silver lining to facing such existential threats, that supports us asking, 'What is really important? What are the things and people I value the most?'" he said. "I think a lot of people now probably value more the personal contact and connections they used to take for granted."

Tina Daunt is the author of this article.

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