People who are wrestling with anxiety and obsessive-compulsive disorders are feeling an even heavier burden in these stress-producing times. Much of the news about coronavirus feeds their already heightened concerns about contamination, being sick or general discomfort when the future is uncertain.
Washing hands, avoiding crowds, and for some with possible exposure – twice daily temperature taking – have become urgent public health recommendations instead of excessive behavior requiring treatment.
Those whose therapy involves touching objects without washing their hands or overcoming an urge to avoid contact with potential germs now are seeing everyone around them washing their hands, stocking up on hand sanitizers and avoiding large gatherings.
Now all Americans are being told to view their surroundings in a way that seems to mimic OCD, said Shala Nicely, who has had the disorder since she was a young child and is now a cognitive behavioral therapist specializing in exposure and response therapy.
Efforts to tame catastrophic thinking may be overwhelmed by a flood of news and warnings that suggest their worst fears are true and that the world is as dangerous as they thought.
An estimated 31.1% of U.S. adults experience an anxiety disorder at some point in their lives, according to the National Institute of Mental Health. Contamination fears – thinking that you are picking up diseases from your surroundings – are the most common form of OCD, a chronic condition in which people have uncontrollable recurring thoughts and behaviors that affects about 1.2% of U.S. adults.
Patients with contamination fears worry they will come into contact with something that will harm them or their loved ones, so they either avoid contact or develop compulsions or rules to control their obsession, such as frequent hand washing.
Advising people to wash their hands as frequently as possible is “the last thing you want someone with OCD contamination issues to do,” said Reid Wilson, director of the Anxiety Disorders Treatment Center in Chapel Hill, N.C.
The Centers for Disease Control and Prevention recommends washing hands not constantly but at specific times, such as after sneezing or coughing and before eating, and the agency offers advice on social distancing and other safety measures.
Wilson and Nicely recently wrote a blog post with Kimberely Quinlan, a therapist in Calabasas, California, to help people with anxiety respond to the epidemic and keep their disorders in check. (The International OCD Foundation also offers information on OCD and sources to treat it.)
Much of their advice focuses on reducing anxiety and balancing accurate recommended health guidelines with treatment goals. They suggest cutting back on checking the news for updates about the virus or travel alerts; giving oneself permission to follow the World Health Organization and CDC guidelines for hand washing; and being kind to oneself without expectations of perfection.
Checking the news constantly tells the brain, “This is something to worry about,” Nicely said. It’s better to establish a limit – once or twice a day for five minutes, for example – and stick to that, she said. The quick-changing nature of the situation may also make a person want to check the news or seek reassurance from others if they have travel plans. Nicely and her co-authors suggest turning to a trusted person who does not have OCD and following that person’s lead.
Quinlan said one of the most common struggles she hears from her patients and her online followers is how to align the CDC and WHO guidelines with reducing their own hypervigilance. Some, for example, might be working on not immediately washing their hands after touching a doorknob or an ATM. Learning to sit with discomfort stirred by that exposure is part of their therapy. The current emphasis on hand washing and social distancing can feel like moving backward in their progress, she said.
The authors suggest using the CDC and WHO guidelines for making decisions. Rules, they say, are “your friends.”
“OCD does not get to make the decision about how long you get to wash your hands. So the exposure really becomes following the CDC and WHO guidelines and not overwashing or listening to the OCD when it says ‘But do you really do it for 20 seconds?’ ” and then living with the uncertainly,Nicely said.
While the CDC and WHO tell people to follow the advice of doctors, people with health anxiety may over-monitor for physical symptoms, search online to try to self-diagnose or doubt the advice given by a doctor and seek out multiple opinions.
Again, asking a trusted friend about how they would handle the situation can help.
“The person with health anxiety could try to emulate the decision-making process being used by the trusted family member to come to a decision about whether another doctor visit is warranted,” Nicely said.
It may be hard for those who do not have anxiety or OCD to understand how the disorders affect people, Nicely said. Often the person looks fine on the outside, and in casual conversation “OCD” is used as a joke or to mean someone is just neat. But the disorder can be debilitating and warrants treatment.
“I felt like I was a hostage with a gun to my temple day and night and a person was whispering in my ear, and I was constantly in a state of fight or flight. That’s what my OCD was telling me,” she said.
She also felt she had a target on her back, feeling that, “If something bad was going to happen, it would happen to me.”
Generalized anxiety disorder, or GAD, involves worry about a variety of activities or events and is characterized by difficulty controlling worry on more days than not for at least six months.
Worry is supposed to be “step one of problem solving,” Wilson said. The problem is when people stay in that step and just “worry, worry, worry.”
The goal is to learn to deal with uncertainly and distress, and instead of pushing away thoughts, the person needs to take control of how to respond to them, he said.
If a person lets their anxiety or OCD get the better of them, it’s helpful to keep a positive mind-set, like a basketball player who misses a point, who looks at the opponent and says, “The next one’s mine,” he said. Having a goal, or reason you want your mind available and not locked in worry, is helpful, he said.
Seven miles south of the Life Care Center of Kirkland, the epicenter of the covid-19 outbreak in Washington state, Gary VanDalfsen treats patients with anxiety and OCD. He has been in private practice as a psychologist for 24 years, but March 5 was the first time he worked from home using a telehealth system to consult with patients remotely because so many had canceled office visits.
“They were concerned about coming into a public place, particularly the folks with contamination concerns,” he said
VanDalfsen evaluated whether the desire to stay home was driven by compulsion or avoidance – coping mechanisms for the disorder patients usually work to overcome – or the latest health advisories that high risk patients should avoid large groups.
“What’s hard right now is that this is an unfolding story so it’s difficult to determine what’s excessive and what’s not,” he said.
Wilson, who has treated anxiety disorders for 35 years, said the AIDS crisis, plane crashes and SARS also have captured the nation’s attention, but the coronavirus is unprecedented in how it stirs anxiety.
“This is the first time in a long time where [an event] has affected the majority of the people I see,” he said. “This is different.”
One patient recently expressed fear that he would bring the virus to his therapy session. He had touched something in the library and then his face and worried he could infect Wilson and kill him. A patient with GAD worried about her daughter and grandchild visiting from overseas. Her concerned was not specific but simmered all day, “cooking in the middle burner of her mind,” Wilson said.
Even without the threat of coronavirus, Wendy Schotland, 47, said flu season is always a hard time for her. She wears gloves when she goes out, signs for a credit card or pushes a grocery cart. Her GAD and fear of germs is exacerbated because she takes immunosuppression medication for an autoimmune disorder.
As a veterinarian who makes house calls, she recently posted a note to clients about postponing visits if anyone is the household – besides the furry friend – is sick. In most ways, however, she is living her life as she always does, with her usual boundaries for exposure.
At this time of year, epidemic or not, she won’t fly.
“Some of us have a lower breaking point than others,” she said.