How to Deal with Heightened Anxiety During COVID-19

A Q&A with experts in pain medicine and mental health.

Individuals living with chronic pain and illness may be feeling the additional burden of the COVID-19 pandemic on their mental health. PPM checked in with editorial advisor Michael Clark, MD, MPH, MBA, and Rachel Noble, MS, LPC, of the INOVA Health System to see what they advise. Dr. Clark also serves as the vice chair of clinical affairs in the Department of Psychiatry and Behavioral Sciences and as director of Chronic Pain Treatment Programs at the Johns Hopkins School of Medicine. Ms. Noble is a therapist and leads the women's behavioral program at INOVA.

Below are a few common questions that people with chronic pain or illness may be asking, and the responses from Dr. Clark and Ms. Noble.

Q: I live with chronic pain, so feelings of anxiety, depression, and even catastrophizing are not new to me. But since COVID-19 emerged, I feel like I’m crawling out of my skin. Not only are my emotions in full swing, but my pain levels are worse. What is going on?

A: Anxiety levels are high across the world right now, so, you’re not alone. But, unfortunately, when you live in chronic pain, that worry can heighten both your physical and emotional discomfort.

Physically: Pain and mood run on the same neuro pathways – the central nervous system (CNS). So, it’s common that when something flairs your anxiety, your pain will spike too. Or, conversely, if your mood is low, that can increase your pain as well.  

EmotionallyWhen you live in chronic pain, your feelings can be more intense too. Your CNS is distorted – amplified –even a light touch can be painful. That can be true of your emotions too, so even small fears can feel massive.

The good news is that mood-stabilizing medications can help reduce both your anxiety and pain levels. So, talk with a psychiatrist about medications that may help.

Created with Canva.A visual look at the recommendations herein, from Dr. Clark and Ms. Noble.


Q: I am on a strict medication regimen and I do not drink alcohol. What are some ways I can take a mental break and help to get my pain in check?

A: Excellent question! Here are a few suggestions:

  • Breathing exercises provide a great way to escape while also calming both your mind and body.  
  • Virtual reality goggles and programs have been shown to greatly decrease pain while providing an escape, without leaving your sofa!
  • Listen to and talk with others - ask about their lives;  it’ll give you a break from yours.
  • Look through old photographs. This activity can help in two big ways, by pulling us out of the “here and now” and reminding us that all moments in life are temporary.
  • Give partner massages: If you live with a partner, consider giving each other mini massages to ease muscle tension once or twice a week.
  • Explore online options: COVID-19 has forced many people to find ways to take mental breaks without leaving their homes, so look for positive possibilities on the internet – they are popping up like daisies!

Q: I’ve heard I can have a virtual (audio/video) doctor visit with my psychiatrist. Is this a good idea? How can it help?

A: It’s a great idea! Many healthcare systems have been slowly moving toward telemedicine, but the current coronavirus pandemic has accelerated this transition. Video sessions with your doctor can provide valuable face-to-face time so that they can make a full assessment, which is needed to accurately diagnose and best help you as the individual. Some other ways telemedicine can help to keep your chronic pain in check:

  • Reduce germ exposure: A telehealth visit can eliminate your exposure to germs outside of your home, especially those that can be in medical offices.
  • Avoid pain flares: Those with chronic pain know that traveling, even short distances, can stir a pain flare. By communicating with your provider from home, you can avoid this trigger.
  • Maintain your medication regimen: It is possible to receive prescription medications without leaving your home. Find out  if your medications can be delivered by your pharmacy or a third-party service.
  • Follow-ups: Engage in timely follow-ups with your provider when you need to connect.

Q: Due to my pain condition, I am not very mobile. As a result, I am somewhat used to “social distancing” but I am feeling more isolated than ever. With limited mobility and a small social network, how can I break free from this mindset?

A: This forced social distancing has been challenging, even for introverts. It’s one thing to choose to be alone, but when you feel like you must, when socializing options have been stripped away, it’s upsetting. The best way to combat this discomfort is to take control. Here are a few ways we are advising patients to do so:

  • Connect with your people: Reach-out to your small, yet consistent support group. Schedule regular calls, video chats, or virtual game nights/movie-watching nights with them. If you are religious, find out if your place of worship is offering online streaming sessions or small group get-togethers.
  • Find new people: The internet is booming with creative approaches to connectedness. Search and find new friends! Online support groups are also available.
  • Cherish music: Fill your environment with uplifting songs. Share positive playlists with your friends.
  • Share meals virtually: Enjoy dinner together using technologies like Zoom. You can invite a crowd!
  • Rediscover your front porch: Many people are rediscovering their front porch or front steps as a means of feeling part of the community. Sitting outside for even a short time provides an opportunity to get some fresh air while chatting with your neighbors (while keeping a safe distance).
  • Join a book club: Many book clubs have transitioned to virtual platforms. Find one that works for you.
  • Try online learning: Now may be the perfect opportunity to learn a new skill, such as a foreign language or instrument. Distance learning is available through many community colleges and virtual classroom communities. Some use art to cope with pain as well.

Q: What home-based therapies can I easily do? For instance, do you recommend meditation, music therapy, relaxation, or home-based CBT or ACT practices?

A: Yes, yes, and yes! Home-based therapies offer excellent options for people who can’t get out, for whatever reason. Envision these self-care possibilities laid out on a smorgasbord before you. Try them out, find the ones that are the right fit, and enjoy! And, tell your psychiatrist about the benefits you discover. They’ll be excited to hear all about it!

More on mindfulness and psychotherapy for pain.





Updated on: 07/15/20
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