Mental health & COVID: 6 tips for personal care this winter

The days are shorter. The nights are longer. That cold chill is back.

Time is moving on, even when so many of us remain confined to our homes with the outside world seemingly at a standstill and entering our lives in small doses: Trips to the grocery store. Doctor’s appointments. Take out food pick-ups.

For many Americans, the return of winter can be a difficult time even when not in the throes of a global health crisis.

An estimated 10 million people across the country live with seasonal affective disorder, or SAD, with mood changes brought on by the shift out of those long summer and fall days (although some feel the effects of SAD at other times of the year as well.) Anxiety disorders are also incredibly common among adults in the United States — approximately 40 million people have one — not to mention those living with depression.

It can all be a lot to digest during the colder months of a “normal” year, when snowy weather, loss of sunlight, and frosty air can impact routines, never mind the ongoing COVID-19 pandemic, mental health experts, say.

“Around the holidays, there’s so much social pressure to have the perfect family and the perfect situation,” Dr. Stella Lopez, a health psychologist at UMass Memorial Medical Center in Worcester, tells Boston.com. “… And then you add isolation and family members who are sick, I think that’s another piece of this. It’s not just the isolation, but also feeling helpless when family members or loved ones are sick and not being able to do much for them.”

With coronavirus cases and deaths mounting amid a so-called second surge and only the beginnings of a vaccine rollout taking shape, our quarantine-led, isolated lifestyle will likely have to endure for at least several more months. The combination of wintertime’s depressive hold and pandemic-related restrictions and stress could levy a concerning toll on mental health, according to Dr. Anthony Sossong, associate medical director for behavioral health at Harvard Pilgrim Health Care.

“This is an incredibly stressful time for everyone, and the overlap between COVID-19 and winter is a particular worry,” Sossong says. “People have been making dramatic changes to the kinds of routines and things they do in order to maintain wellness. And you know, when we can make changes as humans, we’re resilient people. But over time, it really does cause a lot, you know, [of] long term stress that I think has really become palpable.”

But all is not lost.

“The more we can do to maintain our own emotional well being and help support each other, the better we’ll all do,” Sossong says.

With that in mind, here are six tips for maintaining your mental health, especially this winter, as advised by local experts:

Break the cycle: Get active (and creative).

Depression feeds on itself, Lopez says. Physical fatigue sets in and the lack of interest and motivation one can feel builds from there.

“Breaking that cycle and trying to start with small, incremental things that you can add onto your schedule — like going for a walk…making sure that you are getting enough sleep — [are] very important,” Lopez says.

Even with restrictions and closings at gyms and indoor recreational and fitness centers, the internet provides a wealth of resources to help get you moving. Lopez directs patients to search for videos on YouTube, especially for yoga, which she says is a good way to gradually get into a physical routine.

“You know yoga is all about that mind/body connection, and so it helps to kind of ease into building muscle strength, too, but also feeling good about moving and having something to look forward to,” she says.

Once you have your video, make a plan. Set time aside to watch it and follow along. Think ahead of time about what to wear and where you’re going to unfurl that yoga mat. All of this is helpful “to prevent barriers from popping up as you’re trying to start a new behavior,” Lopez says.

Maintain a routine and make sure you give yourself the right amount of sleep.

Getting a good night of rest is crucial — especially the right amount.

“There is such a thing as over sleeping, which can also create some problems,” Lopez says. “And so getting on a regular schedule is very helpful. Having a predictable time when you wake up and a predictable time when you go to sleep, and exercise somewhere in-between, and not exercising within two hours of when you’re trying to wind down” are important.

The average adult typically needs between six and eight hours of sleep, though individual needs can vary, according to Sossong.

To keep track of some of these behaviors, Sossong offers a helpful mnemonic device with the acronym: BRAIN.

  • Be present: “Be present, identifying and acknowledging the feelings and anxiety and thoughts and really recognizing that it’s normal, to feel angry and frustrated and upset and worried (are important). And really just check in with those.”
  • Routines: “Things like sleep, meals, exercise, and hygiene can help combat feelings of depression and anxiety and listlessness.”
  • Attitude: “Anger, anxiety, apathy are to be expected [during the pandemic]. And I think we all have to accept that this isn’t going to end tomorrow, no matter how much we all want it to — acknowledge those thoughts and feelings. And cultivate a practice of conscious appreciation, because it’s very easy to see the things that are frustrating and not going well and sometimes harder to identify the things that actually are quite beautiful.”
  • Inputs: “It’s very clear that limiting the amount of media consumed is really, really important — identifying and limiting other inputs that could increase your negative feelings, really identifying those things that for you are the biggest triggers. And for some people that might be texts from family or friends or watching news or social media, but really getting a sense of what those inputs are and how they affect you.”
  • Networks: “Nurturing those social networks and relationships. … As we sort of rollback some of the things that we were able to start doing here in Massachusetts, really recognizing again that social distance is physical distancing. The social element of that doesn’t have to go away and really shouldn’t. We’re social creatures and we need to maintain the social connectedness.”

Take time to check in with yourself.

Burnout is real. In a year where having so much extra time on our hands may have left some feeling less-than-productive, experts say checking in with yourself is really what matters.

“That message that they send over the loudspeaker in the plane, secure your own oxygen mask before helping others who require assistance, … I think that’s important,” Sossong says. “I think you have to recognize that you are not going to help other people, you’re not going to be of assistance to other people, if you’re burning out. And it’s really important to check in, make sure that you’re giving yourself time for self care and stress-management activities.”

Sossong points to setting short term goals or things to plan for and look forward to, “especially if they’re social things, even if you can’t do them in person.”

“That can be really helpful,” he says.

Lopez says keeping in mind that the current state of the world is only temporary — that mindfulness — is key.

“We aren’t defined by our productivity,” she says. “That’s not really what it’s about … We’re not expecting to come out of this, you know, out of some kind of hibernation being authors or craftsmen or I don’t know… I think we have to be realistic about it.”

Take time to check in with others.

Zoom calls aren’t only beneficial for work.

According to Lopez, a lack of calls or text messages from a friend or loved one you hear from often can be an indicator something is awry in their life.

“It’s hard right now because some of it is also you want to disconnect for a little bit, and that’s ok,” she says. “But I think one of the things that I would recommend is really normalizing checking in on each other.”

Part of that is making “it ok to not be ok” and vocalizing those feelings with those we care about and care for us, she says.

“We’ll be much better off than just trying to hide it [and] white knuckle through this,” Lopez says.

Know that grieving is normal — even when everything else is not.

Over 316,000 Americans have died as a result of COVID-19 this year —  more than 11,500 people from Massachusetts alone.

Grieving is, of course, a normal and healthy emotional process.

“This loss of friends or loved ones, you know, can be really overwhelming, even without all of the other changes and loss that we’re experiencing…” Sossong says. “So I think that what’s really important is to, again, take stock of how we’re doing, recognizing that a lot of these feelings are perfectly normal parts of the grieving process.”

With funeral restrictions in place aimed at stemming the spread of the virus, many families have been unable to mourn their losses through familiar traditions, or at least to the scale they would have liked to honor their departed.

“Not only that, but also being present for a person while they’re convalescing is so important, you know, to be able to feel active in a helpless situation, and so that part is really challenging,” Lopez says.

Families and friends may feel the temptation to delay observing some sort of formal memorial, she says. But taking the time to honor the memory of someone who has passed “can be really powerful” for processing loss, according to Lopez.

Those feeling that loss this winter should still try to find a safe and creative way to do that.

“I think a lot of times when people have difficulty getting past their grief, it’s mostly out of not being able to process, not being able to accept, not feeling like they have the opportunity to honor that person’s memory,” she says.

When and how to get additional help.

While emotions can be healthy and important to embrace, you should always keep in mind that you are not alone in facing them, especially grief.

“If people are starting to experience sadness or depression that gets to the point that it’s impacting day to day function, or impacting the sort of activities of daily living like sleep and exercise and … even the ability to enjoy things, it really is time to seek some professional help,” Sossong says. “And particularly if people are thinking that life isn’t worth living or thinking about suicide, it’s really time to seek help.”

While mental healthcare demand is high in Massachusetts, Sossong recommends those having difficulty in accessing services to reach out to their healthcare or insurance provider. Harvard Pilgrim, for example, has a 24-7 crisis line dedicated to connecting patients with outpatient providers. Telemedicine has also proven a helpful tool during the pandemic, he notes.

Additionally, the Massachusetts Department of Mental Health offers a 24-hour emergency and crisis support hotline, every day of the year toll-free at 1-877 382-1609. The state website also includes other avenues for seeking help, including several free websites and help lines available to the public.

Those who are contemplating suicide or know of a friend or loved one who is can contact the National Suicide Prevention Lifeline at 1-800 273-8255.

“There are resources available,” Sossong says, “and it’s important to look for those supports.”

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