This article is written solely from a therapist’s perspective out of everyday mental health cases encountered during the COVID-19 outbreak. The psychological effects of the pandemic have been far reached and such effects being an increased number of mental health disorders, family conflict, social stigma & discrimination, relationship discords and medical mistrust.
As a Psychotherapist, I have found Cognitive Behaviour Therapy (CBT) to be effective while dealing with these cases. It is a widely practised psychotherapy that helps one become aware of their inaccurate or negative thinking so that they can view challenging situations more clearly and respond to them in an effective manner. They learn skills to change thinking and behaviour in order to achieve lasting improvement in mood and functioning and sense of well-being. Hence, I tried to simplify CBT for common people and non-practitioners, so that they find the much-needed help at this hour. I have articulated the CBT techniques in 5 simple self-help steps that are easy to understand and most importantly easy to practice.
STEP 1: MENTAL READINESS
It is the first step where you set the mental context of challenging your thoughts which are not helpful. In doing so, first, accept your thoughts as they are without judging them. Once you have accepted your thoughts, commit to change them and be persistent in your efforts.
STEP 2: FIGHT THE TEMPTATION TO OVERTHINK
Avoid overthinking as it can confuse you and dissuade you from your commitment to change. The more you overthink, the more excuses you will find to justify your unhelpful thoughts.
STEP 3: HAPPINESS IS NOT THE GOAL
It’s important to understand that happiness is not the goal of CBT. The goal is to replace unhelpful thoughts with helpful ones. It is only with the repeated practice of helpful thoughts that a state of happiness can be achieved.
STEP 4: REFLECTION INSTEAD OF RESOLUTION
This step marks the true beginning of CBT. Here you don’t find a solution, rather reflect upon your thoughts and identify the thinking errors present in your daily thought processes. You can also use a diary to note down these thinking errors as you keep identifying them. Some of the thinking errors in CBT include:
- Overgeneralization: You overgeneralize every information that you receive regarding COVID-19 outbreak. You view the COVID-19 outbreak as a never-ending pattern of defeat. You tell yourself “this situation is never going to improve” or “this is going to get even worse.” The problem with overgeneralising is that you start generalising issues faced by other countries or other people to yourself. You start to overthink that if it happened to them, it can happen to you or your family, without understanding that if you take all the measures of home quarantine as stated under the guidelines, there are least chances that you would end up infecting yourself.
- Mental filter: You develop a mental filter that screens out all the supporting and positive information and choose to focus only on the ones that you believe and them being mostly the negative and unhelpful ones. For example one of my patients had a mental filter: a belief that no matter what only non-vegetarians are responsible for spreading across the COVID-19, and because of this he avoided everyone who was a non-vegetarian, would choose grocery owners and shopkeepers who were vegetarian (which was very hard for him to find) and developed a despise for people who had non-veg. As if this was not enough, he sought a therapist who was a vegetarian as well! Such mental filters result from either over/under-information but not the right information and apart from being unhelpful, mental filters are highly biased perceptions of a situation that lead to stress.
- Discounting the positives: You just don’t count the positive in a situation to be relevant. You think “Where more than one million people have been infected with COVID-19, only two lakhs people have recovered, that’s such a low number and where do I stand a chance?” or you think “The steps that the govt is taking are so inadequate, we need more facilities.” Discounting the positive will only make you lose hope and worry more, not letting you accept what is and leverage your resources.
- Jumping to the conclusion: You derive conclusions without questioning or having proper evidence. The recent COVID-19 conspiracy theory of the sceptics is one such example. Many people are tempted to believe that the communist government of China is trying to cover-up the outbreak and hide the official figures. The fact that the Chinese Government tried to suppress the attempts of the whistle-blowers who tried to warn the public of the pandemic has spread fury among the public. While such assumptions lack evidence, they also encourage unhelpful speculations over which the general public has no control. The result inevitably is growing stress and scepticism.
- Magnification & minimization: You magnify things by blowing them out of proportion and you minimise things by shrinking their value inappropriately. For example, in the current COVID-19 scenario, despite the Indian government’s repeated addresses that there are surplus essentials available and public needn’t panic, most people started hoarding essentials. The thought process behind such hoarding was magnification which tells you “It is the biggest pandemic of the century and you will starve to death if you don’t stock up things now.” There is another scenario where people underestimated the spread and contagion of the COVID-19 and engaged in social gatherings. The thought process behind such minimisation was “I will not get infected as I have an excellent immunity and I am young. Mostly old people are dying. Moreover, God is there to protect me. There is a rarest of chance that I get infected.” Such a thought process leads you nowhere helpful. It keeps you ignorant and sabotages your ability to think rationally.
STEP 5: ACTION BASED ON REFLECTION
This step includes challenging the above thinking errors and to take action using the following CBT techniques to replace the thinking errors with helpful and productive thought processes:
- Identify the thinking error: You need to identify the above-mentioned thinking errors in your daily thinking first before you start working on modifying them. You do this by creating a list of the troublesome thoughts that you are having throughout the day. The troublesome thoughts could be about COVID-19 or changes in lifestyle & emotions due to COVID-19. This will allow you to examine your thoughts and match the thinking errors that are taking place in your thoughts. This exercise is called keeping a daily thought log or thought diary. If you wish you can also use an app or anything digital that’s convenient to record your thinking errors.
- Examine the evidence: This technique requires you to detach yourself emotionally from the upsetting event or the troublesome thoughts in order to examine the evidence or facts more objectively. A thorough examination of facts allows you to identify the basis for your unhelpful thoughts. For example, thoughts such as “I might get infected by COVID-19” and “what if something happens to my family,” are fears, not facts. Instead, try to question your fears by asking these counter questions based on facts “how many people I know or in touch with, have COVID-19?” or “How many infected people are my family members exposed to?” or “What is the percentage of spread across my locality and where do I stand a chance of getting infected?” or “What are the chances that I would get infected if I stay home and take all the necessary precautions?” Segregating facts from fears can help you determine which are likely to be a component of a thinking error (the fears) and therefore need your focus and efforts to change.
- Experimental technique: With this technique, you can test whether your irrational thoughts or fears have any basis? For example, experiment with your fears by giving yourself targets. Observe yourself for the next one week and take all precautions to protect yourself from the COVID-19. If you remain virus-free for the next 1 week, you have pretty good reasons to believe that taking all the precautions, you can remain virus-free for the following week as well. Take one week at a time and build on your belief. You can do similar experiments in other fearful situations as well.
- Thinking in shades of grey: Often, we get into polarized thinking i.e. thinking in terms of ‘black and white’, because our mind does not want to make the effort of thinking and analysing, hence it uses cognitive shortcuts to simplify processing of stimuli either into Black or White. Although this kind of thinking helps make quick decisions but often leads to an erroneous thinking pattern which is not in sync with the facts. For example, if I ask the question, “What happens to people who get infected with COVID-19?” majority would reply “They may die of the infection.” This kind of spontaneous thinking, without evaluating things, is called back and white thinking. What about the grey zone? There is a chance they may survive or fight the infection for some time and recover. This pretty much depends upon their age and immunity and may be the kind of care they receive. This kind of thinking is called thinking in shades of grey where you consider the middle zone which is not completely disastrous nor completely safe. Thinking in shades of grey involves rating a fearful situation on a scale of 0 through 100. In reality, the situation may not be 0 or 100 but somewhere in between, which is the grey zone.
- The survey method: Similar to the experimental method, the survey method is focused on asking others, in a similar situation, about their experiences to determine how irrational our thoughts might be. Using this method, a person seeks the opinions of trusted others to verify whether their thoughts and attitudes are realistic. For example, you are not sure whether to order essentials online or go out yourself and get them. Both of them carry the risk of infection. What do you do? Not go out and Starve? The survey method asks you to call and speak to some of your friends or family and understand how they are managing. Remember it is always a good idea to ask more than two people. If you end up asking just one person and if that one is as fearful as you are, you will end up amplifying your fear.
- Re-attribution: This technique of CBT will help you if you are blaming yourself for any unpredictable thing that happened to you or your family during the COVID-19 outbreak. For example, one of my patients got into an episode of depression after she couldn’t attend her father’s funeral who happened to pass away from a cardiac arrest during the pandemic. She was constantly blaming herself for not being around her father when he was undergoing his routine health check-ups. Whereas, in reality, her father was fore-warned by the doctor about his health condition and which he hid from his family and did not take necessary treatments. When she used the Reattribution technique, she realised it was the father’s responsibility to inform family members about his condition and not hide. She also realised that it was not possible for her to travel during lockdown to attend her father’s funeral and also the fact that she was not responsible for the lockdown. Reattribution technique involves assigning responsibility accordingly, where you’re not trying to deflect blame, but ensure you’re not blaming yourself entirely for something that wasn’t your fault altogether.
- Cost-benefit analysis: This technique involves listing the advantages and disadvantages of particular feelings, thoughts, and behaviours. A cost-benefit analysis will help to figure out what a person is gaining from holding onto the unhelpful thinking. For example, many people at this time have unhelpful angry thoughts like “China is conspiring to bring down the economy of the world” or “Tablighi Jamaat is responsible for an increased number of COVID-19 positive cases in India.” The Cost-Benefit analysis technique helps you ask important questions like “how will this thought help me?” “how will it hurt me?”, or “how do these thoughts help me in the difficulties that I am facing now?” by listing the advantages and disadvantages of holding on to these thoughts. If you find that the disadvantages of believing these thoughts outweigh the advantages, you’ll find it easier to talk back and challenge the irrational thought and replace with a more helpful one like “maybe I don’t have all the details about china except what media is trying to portray” or “maybe Tablighi Jamaat is not the only people responsible for the increased number of COVID-19 positive cases in India”.
Remember power by nature declines. The power of COVID-19 is in its uncertainty and unidentified remedy. This power too shall decline one day with the discovery of COVID-19 vaccine. Eventually, everything will resume to normalcy and things that scared once, won’t anymore!
If you feel stressed or something is weighing on your mind, take the time out for yourself and seek professional help from therapists near you. Download the MFine app and consult top psychotherapists from your city.