The promise and its risk

Maladaptive forms of coping have one thing in common.  They promise a quick change in mood. So, one person, perhaps feeling hemmed in by lockdown, may have turned to alcohol for its disinhibiting properties while another may have been drawn to the hyper-stimulation offered by cocaine or amphetamines. Another, burdened by the boredom of a now-limited daily routine, may have turned to gambling for excitement. Yet others may have sought an emotional boost from online shopping or pornography. The more reliant a person has become on these sources of relief, comfort, reward, arousal, and escape, the greater the risk of deepening problems over the longer term once lockdown has eased.

Into the unknown

It would be wrong to assume that the easing of lockdown would be experienced universally as beneficial.There is a risk that some unhealthy coping behaviours, adopted under lockdown or exacerbated during that period, will worsen in many people as restraint is eased. Any significant change, such as a step into the unknown, is stressful. Not everyone who has developed problems during  lockdown will experience an easy self correction and return to less harmful ways of living once the shackles come off. This is partly because a significant amount of time has passed since pre-COVID normality and poor health habits and coping strategies may well have become ingrained during lockdown.

Coping with freedom

The prisoner who finds it hard to make his or her way in the world once freed has some relevance to the easing of the pandemic lockdown and its predictably repetitive routines. How will people cope with reacquired freedoms, where they can act on impulse, behave more freely and indulge the restored ability to choose? How will other people behave?

Having been deprived of meaningful social contact beyond home for so long, some will feel socially de-skilled and therefore fearful of venturing out. Some may rebound into wild hedonism, making up for lost time. Normality will be continually redefined especially in the early phase of lockdown easing. For many people, still oriented to old assumptions, adjustment will be a source of anxiety as they grapple with uncertainty about the world as it is now. They may then reach reflexively for the familiar effects of mood-altering substances, like alcohol or cannabis or other behaviours with an inherent risk of addiction, like gambling or compulsive viewing of pornography. Problems with eating and food or obsessive exercise may also intensify.

Reset and rebalance

Major transitions in life often have a significant impact. A number of people, unsettled in some way by going into lockdown or by its easing, may benefit from a managed transition to the “new normal”. The security and care to be found in a fully serviced facility, especially one that offers a good range of therapeutic activities, may be helpful.  This option would especially apply to those whose misuse of substances, activities or behaviours had become identifiable disorders with little prospect of remission without professional help. The mind, body and spirit will have been affected by lockdown and perhaps by unhealthy coping responses and then again by the easing of lockdown. Taking time to reset and rebalance with the help of skilled care may prove vital to sustaining health. People can learn or re-learn ways to establish, maintain and enhance all-round wellbeing through practicing healthy coping strategies in a supportive environment . After all, most things improve with practice.

Unhealthy or risky coping

• Alcohol
• Other drugs, including tobacco
• Unhealthy eating
• Gambling
• Pornography
• Shopping
• Excessive time online
• Inactivity and self-absorption
• Isolation
• Overworking

Healthy coping

• Relaxation
• Regular exercise
• Good nutrition
• Sleep hygiene
• Social connection
• Giving to others

Our ability to cope is based on the quantity and quality of our available resources, all-round fitness and degrees of resilience. The strength of these will likely be determined by earlier experiences in life and how those were dealt with — or not dealt with.  We will subsequently have developed coping strategies personal to us. 

As the pandemic and lockdown have starkly illustrated, this is where people’s responses begin to diverge.  Coping strategies are either adaptive (healthy/constructive) or maladaptive (unhealthy/destructive). The fundamental difference is that healthy ones do what is required to resolve  and improve matters while unhealthy ones seek only short-term relief from immediately troubling feelings.  Healthy coping results in successful management and reduction of stress while unhealthy coping exacerbates stress-related harm and underlying problems.

Significant change is a major stressor. Normal assumptions about life and how it works from day to day are uprooted. Experiencing a loss of control, people may feel anxious or depressed. The more sudden and alarming the change, the greater the likelihood of such reactions.  So it has proved; not only with the onset of COVID-19 with its inherent threat to life and livelihoods but also given the main defensive response to the pandemic: the suppression of social activity. 

This helps to explain a widespread increase in unhealthy coping behaviours during lockdown. Among these are: excessive alcohol consumption, increased drug and other substance misuse and the over eating of fatty and sugary foods. Unhealthy responses have also encompassed problem gambling and compulsive behaviours involving gaming, pornography or shopping. Lockdown has provided the ideal conditions for the further development of these problems through the unavailability of healthier stress-reducing outlets and the easy accessibility of such activities online.

Although not exclusively, people who entered lockdown with actively maladaptive behaviours will have been at greater risk of self-harm than those who had previously established healthier behaviours and coping strategies. Some will have developed serious problems as underlying issues will have intensified and been compounded by counterproductive coping strategies. Many people will now need professional help.

Removal to a safe, caring environment that is set up to inhibit access to and indulgence in unhealthy behaviours, may now be essential. This option will afford the necessary time and space not only to help understand the nature of the maladaptive responses but will also provide an opportunity to embrace an holistic approach to improving resilience. With expert support healthier coping behaviours can become ingrained.

During a COVID-19 lockdown, parents with school-age children will face the challenge of integrating home schooling into family life, which may prove difficult if working from home at the same time. Families will need to find imaginative ways of keeping children appropriately stimulated mentally and exercised physically.  It is best to place some limit on use of digital devices and instead explore a variety of interests and activities.  Older children, cooped up at a time when they are beginning to separate their identity from that of their parents may find that their moods and reactions increase in intensity.

It is essential for people who may not have lived closely together for years to recognise that life under COVID-19 restrictions will not always be plain sailing.  They will need a shared understanding of how living arrangements are going to work best for all. Everyone being prepared to give and take will go a long way to making the process easier; as will responsibly adopting a patient, considerate and respectful attitude to each other. Historic resentments will need to be kept in check, any “heat” turned down.  Individuals must forego attempts to control or forcefully impose their preferences on others. In this context, the risks of domestic violence, particularly where there is a history, will rise and will inevitably increase with the consumption of alcohol and/or other drugs. Potential victims must have a route to safety pre-planned.  Alcohol consumption should be minimised in any case to avoid inflaming or depressing feelings.

Establishing some sort of daily routine within the household while avoiding too much rigidity to that structure will foster healthy functioning and serve to prevent drift and even chaos. If circumstances allow and without becoming too regimented, it helps to allocate time and space for different purposes such as work, learning, play, recreation, eating, exercise and sleep.  Individuals should be able to spend some time on their own should they wish and if feasible. Setting aside time for check-ins once in a while is recommended to enable individuals to share what is going on with them and for the family to improve its understanding of and support for each other. In the heavy atmosphere surrounding the COVID-19 pandemic, it is easy to focus on the obvious range of negative impacts, but there are distinct positives to be found also. It will pay to identify and build on them.  Families will spend time together they might not otherwise have found, acquire new perspectives, perhaps coming to know and appreciate each other as never before.  An individual and collective resilience may well result.

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It is important for people who are prone to depression to deal proactively with their situation in order to avoid sinking into a kind of paralysis. Given that people with depression tend to experience feelings of hopelessness, the news relating to COVID-19 can increase their despondency. Uncertainty about the future, whether from an individual, family, community or societal perspective will take its toll on morale.  The seemingly endless stream of negative news and information tends only to confirm worst feelings. Enforced isolation and social disconnection will certainly not help matters. Loss in a variety of forms is a factor, whether of social freedom, interests, opportunities, work or of loved ones, whether through distance or death.

There are a number steps that can be taken to prevent the circumstances surrounding COVID-19 from lowering mood even further. It is important to structure the day to provide routine while including a degree of variety. It is not helpful to succumb to drift, so getting up and getting going is even more critical during lockdown. Making plans for the following day and keeping to them will usually help, as will ensuring regularity in times of going to bed and rising. Fitting in exercise, vigorous enough to raise the heart beat and breathing rate, will make a positive difference, not only to physical fitness but also to mood and mental acuity. There are now many examples of people devising imaginative ways to exercise in limited space as a result of lockdown.  Eating healthily, including not overdoing consumption, will play a part, with particular care being taken to keep intake of any junk food to a minimum. Hydration is vital, so drinking water regularly is a must. Alcohol is to be avoided because, while it may provide relief of uncomfortable feelings and temporarily lift mood, it will in the end lead to a depressing of mood and make it more difficult to enjoy restorative sleep.  It also dehydrates.

While isolated — never a good situation for someone who is depressed — it is essential to maintain frequent connection to others in some way.  Fortunately, modern electronic media provide a range of opportunities for both individual connection and the convening of groups, of different kinds. Talking to someone else as openly as possibly during times of depression is therapeutic in itself.  Given the additional toll that the COVID-19 crisis may well take on some people’s mood, it is as well for them to have readily to hand phone numbers of helplines that will provide support in times of acute crisis. It may also prove beneficial to try painting, colouring or drawing if a person has difficulty articulating feelings, before sharing these with others as far as practically possible. It has long been recognised that most depressions are episodic, meaning that they generally improve with the passage of time. Despite the uncertainty surrounding the precise trajectory of COVID-19 pandemic, it will end eventually. In the meantime, the steps outlined above will go some way to helping prevent or alleviate the worst effects of the additional pressure of lockdown on mood.

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Through the language and tone used, information is often imparted in anxiety provoking ways. It is not always trustworthy while arriving continually from a wide variety of sources. It can be difficult to make sense of it all. An already anxious person may light upon items of news that serve only to confirm their worst fears. They may feel that anything that can go wrong will go wrong and disastrously so.

Fear of being alone without readily available support will be intensified by having to keep the social distance required to limit the spread of COVID-19.  In such circumstances an anxious person may find it even harder to turn off worry and rumination, which can be fruitlessly circular in nature. Adolescents may experience the isolation more intensely, particularly if family dynamics are already problematic. Disconnection from friends and increased worries about the future may exacerbate any emotional volatility.

What helps anxious people to cope at this very difficult time? An overriding principle is to come to an early recognition of the things that are in a person’s control and those that are not.

Taking regular breaks from news and other information surrounding Coronavirus will likely prove a relief. Furthermore, in order to obtain information about COVID-19 and related events that can be trusted, it is best to rely solely on reputable authoritative outlets. Anything that fuels speculation is to be avoided.

It will be beneficial to maintain connection with friends and family through electronic media, wherever possible linking up in ways that allow everyone sight of each other. Sharing positives with colleagues, friends and family, whether individually or in groups, will encourage all concerned. To guard against excessive self-preoccupation it is important to find ways to give emotionally to others. Practicing the calming processes of Mindfulness can be of real benefit.

Evidence is also emerging that colouring and puzzle solving, which are both diverting and absorbing, may decrease anxiety. Other ways to manage anxiety include establishing a routine and setting boundaries in terms of both time and space between activities such as work and relaxation, with time for parenting a factor for many. It will be important to keep busy in a quietly measured and purposeful way where achievable goals are set. Even small achievements can prove rewarding and motivating while raising self-esteem.

Drinking sufficient water and avoiding alcohol and caffeinated drinks will have a part to play, not least because both have an adverse effect on sleep. Finding a way to incorporate fairly energetic exercise, however limited the space available, will also serve to ease anxiety. It is possible to access therapeutic help online where Cognitive Behavioural Therapy would be a preferred option or to participate in support groups. While incorporating an approach to life under COVID-19 restrictions that involves taking one day at a time, it is as well to be reminded that this crisis too will pass.

How people in recovery cope with the strictures imposed to combat the spread of COVID-19 will depend upon various factors: such as how long someone has been in recovery, any other current health issues, as well as the quality of their immediate circumstances.  People suffering additionally with a significant mental health problem, such as depression or anxiety, may struggle more than others. They not only have to contend with the curtailment of normal social activity, including possibly work or education, they will be doing so in the context of a real threat to health and even life.  Those who have been alcohol dependent,  have been or remain smokers, have used opioids or methamphetamines or have an underlying physical condition will be at increased risk.

To a greater or lesser degree, the enforced isolation brought on by COVID-19 will be stressful for everyone. However, people recovering from addiction, particularly in the early stages will be psychologically vulnerable. Social distancing may lead to turning inward, with a loss of motivation and purpose, even paralysis. People may become bored, a propensity that afflicts many addicted people. They may become restless and agitated with sleep patterns disturbed.  They may become distressed if compelled to be locked down with family where any pre-existing strains in relationships may be intensified. The real danger for people in recovery is turning again, as a means of coping, to the substances or behaviours through which their addiction developed, including those facilitated by the internet. With other avenues closed to them, the online world will offer a range of both positive and negative opportunities. 

So what can be done?  The first thing is to avoid drifting into a mindless state.  It is a time to step back and reflect before developing a personal plan that has daily structure with flexibility built in. This should include some activities that are stimulating and others that are relaxing; both rewarding. It should also include health-promoting approaches based on the principles of recovery, especially when dealing with inevitable emotional swings.  “One day at a time” is a useful mantra during the COVID-19 lockdown while anything that smacks of a quick fix should be avoided. Practicing mindfulness will help while avoiding whatever fosters negativity. However limited the space, it is important to organise some way to take exercise that gets the heart and lungs going. It will be a time to discover or rediscover interests, begin or continue learning. It will be important to add in some real fun.Perhaps the most important thing during the social distancing required to prevent the spread of COVID-19 is to stay connected to others, especially to those who understand the realities of addiction and the challenges of recovery.  This is where online communication comes into its own and there is evidence of increasingly imaginative ways for people to communicate one to one or in groups over the internet and so gain vital support.  There will be many positives to be drawn from surviving the experience, among which will be a sense of achievement, increased resilience, self-knowledge and self-esteem.

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