COVID-19 Pandemic

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COVID-19 & Mental Health

The changes in rules and regulations imposed by the government in response to COVID-19 (e.g. quarantine & social distancing, school closures and lockdowns) may have resulted in many to feel the stresses of not being able to carry on living as usual – lots of us may be working from home, and some of us may do so whilst also trying to take care of children that are attending school lessons from home.

During such times, it wouldn’t be uncommon for many to feel more anger, fear, frustration, guilt, hopelessness, loneliness, isolation, nervousness, sadness, worry and less happy as a result of the stresses associated with the COVID-19 pandemic, such as:

  • Separation from loved ones
  • Loss of freedom
  • Not knowing enough information about the disease
  • Boredom
  • Not knowing when the pandemic will end
  • Not knowing if you have contracted the virus
  • Fear that you may have spread the virus to others

(Brooks et al., 2020)

    It is important to be mindful of how our mental health may be affected by the increased stress caused by COVID-19. Knowing when to seek help is an essential first step to preventing the escalation of mental health problems.

    If you are unsure whether you are experiencing mental health problems, recognising the signs of a mental health crisis can be a good indicator of when you should seek advise from a mental health professional.

    Signs of a mental health crisis can include, but are not exclusive to, feelings of:

    • Not being able to cope on your own
    • Not being in control of your own situation
    • Increased distress and anxiety
    • Increased depressive and negative thoughts
    • Inability to cope with day-to-day activities
    • Increased thoughts of self-harm and suicide

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    If you are unsure if you need help or what help you might need, please just email us to ask.
    We would be happy to help you.

    How might i be affected?

    Quarantine & Loneliness

    As social animals, we human beings are hardwired to seek social contact. Some people may be able to confidently manage spending long periods alone, whilst others may show signs of sub-clinical or clinical levels of depressed mood and anxiety, or may relapse from previously diagnosed mental health conditions.

    Our latest blog provides useful advise on managing stress related to quarantine.

    Our counselors offer video-counseling if you feel that you would benefit from talking to someone – we are here to help you!

    Grief & Bereavement

    Strict measures of social distancing and quarantine can mean that some of us may be forced to grieve the loss of our loved ones on our own, or for others to miss the opportunity to say good-bye to their loved ones during the final moments; which can lead a person to feel an ambiguous sense of loss as they are no longer able to fill the void created by loss through social interactions (American Psychological Association).

    Knowing the stages of grief can help us make more sense out of the fluctuating range of thoughts and emotions we might experience during bereavement.

    1. Denial – “This can’t be happening”. This is when we do not accept that loss has happened. The thoughts and feelings of loss may be minimised or refused which can prolong the denial process.
    2. Anger – “Why is this happening to me?”. Realisation of a loss can make us feel angry about ourselves or others. We might feel that the situation is unfair and look for chances to place blame. (Learn more about how to manage your anger here)
    3. Bargaining – “I will do anything to change this”. We may try to change or delay the loss, even if it is unrealistic to be effective.
    4. Depression – “What’s the point of carrying on?”. Loss has been recognised and at this point, real. This can make us feel isolated, and we may spend more time crying and grieving.
    5. Acceptance – “It’s going to be OK”. The loss is accepted, and the person is able to make a realistic sense of what has happened. The person is able to emotionally come to terms with the loss.

    There are also different types of grief. Identifying the type of grief one is experiencing can help make sense of why we grieve differently depending on who or what we are grieving about. Here are examples of some, but not all, of the types of grief:

    • Anticipatory grief: Reaction to loss that was anticipated. The grief process begins when the person understands and accepts that they are going to lose a loved one.
    • Complicated grief: Reactions to feelings of loss that are debilitating, which significantly impacts the person’s ability to engage in day-to-day activities. 
    • Chronic grief: Grief that does not subside after a long period of time.
    • Delayed grief: Grief reactions that are not experienced until a long period after the passing of a loved one, or starting the grieving process significantly later than what is considered the norm.
    • Traumatic grief: Normal grief reactions in combination with traumatic experiences. This can be as a result of a loved one dying in a  frightening, horrifying, unexpected, violent and/or traumatic way. Distress is extreme enough to impair daily functioning.

    If you find that you are having difficulties grieving about a loved one, our licensed counselor can help you with your grief process through grief counseling.

    What mental health issues might one encounter?

    "Sub-Clinical" Mental Health Disorders

    In the medical world, sub-clinical diseases refer to individuals who are in the early stages of a disease process, or those at-risk who require careful monitoring and treatment. In the mental health context, sub-clinical mental disorders may refer to individuals who are developing signs of mental disorders.

    It is likely that people may experience some or all sub-clinical symptoms of mental disorders due to the high stress resulting from the COVID-19 pandemic. The following are examples of common mental disorders and their symptoms:


    Experiences of depressed mood, loss of interest and enjoyment, and reduced energy and increased fatigue. Other symptoms include:

    • Being less active
    • Reduced concentration and attention
    • Reduced self-esteem and self-confidence
    • Ideas of guilt and unworthiness
    • Bleak and pessimistic views of the future
    • Ideas or acts of self-harm or suicide
    • Disturbed sleep
    • Lower appetite

    Generalised Anxiety Disorder (GAD)

    Characterized by excessive and globalized worries (worries which pertain to many areas of the person’s life). Symptoms of GAD may include:

    • Difficulty sleeping
    • Difficulty with appetite
    • Increased irritability
    • Difficulty concentrating
    • Self-criticism
    • Physical symptoms such as headaches or muscle tension
    • Feeling on edge or as if something bad is going to happen

    Obsessive-Compulsive Disorder (OCD)

    The presence of obsessions (recurrent and persistent thoughts, urges or impulses), compulsions (repetitive behaviours), or both. OCD symptoms are:

    • Time-consuming
    • Cause significant distress to the individual
    • Causes significant distress or impairment to the individual’s social, occupational, or other important areas of functioning

    e.g. repetitive hand-washing and/or cleaning rituals beyond what is seemed necessary and aimed at reducing anxious feelings.

    Illness Anxiety Disorder (Hypochondriasis)

    Characterised by the preoccupation with the idea that one is or may become ill. Symptoms include:

    • Lack of somatic symptoms (or mild somatic symptoms)
    • If there is a medical symptom present, the anxiety is out of proportion to reality
    • Hyper-vigilance about one’s health
    • Frequently monitoring signs for illness (e.g. checking temperature multiple times a day)
    • Avoidance of medical care/treatment for fear and anxiety of what one imagines will be found

    Specific Phobia

    An intense and irrational fear towards a specific object or a situation. Encountering the feared object/situation can cause:

    • Feelings of imminent danger or doom
    • Feeling a need to escape
    • Physical sensations such as heart palpitations, sweating, trembling, shortness of breath, being choked, chest pain, abdominal pain, tingling sensations, and chills or hot flushes
    • Feeling faint, dizzy or lightheaded
    • Fear of losing control or “going crazy”
    • Fear of dying

    e.g. phobia of germs, needles or hospitals.

    Relapse of Mental Disorders

    Some who were formerly diagnosed and treated for their mental disorder may experience a lapse of mental illness which can feel like a temporary return of old habits. Lapses are a normal human reaction, and can be initiated by high stress, low mood, tiredness, or ill health.

    Others may experience a complete relapse, whereby unhelpful patterns of thoughts and/or behaviors may be engaged in, similar to those before treatment or remission.

    Although lapses and relapses can be frustrating, it is possible to learn how to notice and prevent lapses and relapses from occurring.

    Counseling can assist the process of prevention and recovery from relapse.

    What to do for treatment?

    Evidence-Based Treatment Recommendations

    Evidence-based means that the treatment or practice has been recognised as an effective method by peer-reviewed scientific experiments. The National Institute of Health and Care Excellence (NICE) guidelines state that evidence-based treatments are based on “the best available evidence” and informs “how healthcare and other professionals should care for people with specific conditions.” Guidelines follow a stepped-care model “to organise the provision of services and to help people, their families, carers and practitioners to choose the most effective interventions.

    The goal of an evidence based treatment is to deliver the highest quality treatment options recommended and available, and to increase responsibility from the service providers, whilst also ensuring that patients have the right to involvement in discussions with health professionals in order to make informed decisions about the course of their treatment.

    Evidence-based interventions typically follow a biopsychosocial approach. This means that treatments are designed to consider and address the biological, psychological, and social factors related to the mental health problem.

    Below are adaptations of recommended evidence-based treatment practices provided by The National Institute for Health and Care Excellence (NICE) for adults on mental disorders previously mentioned:

    Effective treatment of depression is optimised by identifying the degree of depression. Depression can be categorised as “sub-threshold clinical impression”, “mild”, “moderate” or “severe” so that patients can receive the right level of treatment. An accurate psychiatric and/or psychological assessment is used to help identify the level of depression.

    Across all depression severity, treatment focuses on addressing anxiety, sleep hygiene, and active monitoring of the patient.

    For persistent sub-threshold depression and mild to moderate depression, a low-intensity psychosocial intervention is recommended. This can include a structured group physical activity programme; Cognitive Behavior Therapy (CBT) based self-help materials recommended by a mental health practitioner; Computerised CBT (CCBT); and group CBT. Read more information about cognitive behavioral therapy here.

    For persistent sub-threshold depression (which does not respond to low-intensity psychosocial interventions), mild to moderate depression, and moderate to severe depression, a combination of medication (prescribed by a psychiatrist) and a 3-4 month high-intensity individual psychological intervention (such as CBT, interpersonal therapy [IPT], or behavioural activation) is recommended.

    However, note that these are recommendations – therefore the patient ultimately makes the informed decision on what type of treatment they wish to receive.

    It is recommended that medications are continued for a least 6 months after remission to reduce the risk of relapse.

    Generalised Anxiety Disorder (GAD)

    For all known and suspected cases of GAD, a psychological assessment, education (about anxiety symptoms and treatment options), and active monitoring of the patient is recommended.

    If education and active monitoring has not improved anxiety symptoms, low-intensity psychological interventions are recommended, which can include:

    • Self-help materials and guidance based on CBT principals recommended by a mental health practitioner
    • Group therapy

    For those who do not improve after low intensity psychological interventions, either medication (prescribed by a psychiatrist) or a 12-15 week high-intensity individual psychological intervention (CBT or Applied Relaxation), or a combination of both treatments are recommended.

    It is recommended that medications are continued for at least 1 year after remission to reduce the risk of relapse.

    Obsessive-Compulsive Disorder (OCD)

    A low-intensity psychosocial intervention is recommended if the adult’s functional impairment is mild. This may include:

    For those who find the low-intensity interventions ineffective or are experiencing severe functional impairment,  NICE recommends a combination of medication (prescribed by a psychiatrist) and intensive individual CBT & ERP. Adults with moderate functional impairment are offered a choice of either medication or CBT (& ERP) first, before a combination of treatments is offered.

    *Exposure response prevention (ERP) is a process in therapy where patients are encouraged to face their fears and let the anxious and obsessive thoughts happen, whilst preventing the patient from “correcting” or “neutralizing” their thoughts through repetitive actions. The aim of ERP is to learn that anxiety will decrease naturally without the need of such “corrective” or “neutralizng” behaviors, and to unlearn the habit associated between anxious feelings and compulsions.

    Hypochondriasis (Somatic Symptom Disorder / Illness Anxiety Disorder)

    Hypochondriasis is one of the most difficult psychiatric disorders to treat. Psychological interventions are usually not first sought out by the patient with Illness Anxiety Disorder as patients usually refer themselves to a medical rather than a mental health professional due to concerns surrounding physical health problems.

    This can potentially lead to a number of expensive and unnecessary diagnostic tests and consultations with multiple physicians, with the hope that one would find the answer to their thoughts and beliefs about their presenting physical symptoms and health problems. However, a combination of Cognitive Behavioral Therapy (CBT) and antidepressant medication is recommended as the intervention approach for this disorder.

    Specific Phobia

    Most people with specific phobias are able to manage their phobia without  treatment by avoiding their feared object or situation. However, treatment may become necessary if the feared stimulus cannot be avoided (e.g. phobia of germs, needles and hospitals).

    The recommended treatment for phobias is Cognitive Behavioral Therapy (CBT) from a counselor. Mindfulness has also been shown to be an effective approach, whereby the aim is for individuals to have a heightened awareness of the present moment of experiences in the body and surroundings.

    CBT and mindfulness may be combined with a gradual exposure to the feared object or situation. The aim of graded exposure is to reduce the anxiety related to the feared object/stimulus through the process of desensitization, and for the patient to regain their control over their phobia.

    Medication may be prescribed by a psychiatrist on a short-term basis, not to treat the phobia, but to diminish the anxiety symptoms related to phobia.

    Where / how can I get help?  Who should I talk to?

    Getting Help - Our Services

    If you feel that your mental health has been significantly affected and/or are in need of help, contact us using the form below. Our team of licensed and experienced counselors will be more than happy to help you, face-to-face or through online video counseling, during these difficult times.

    If you are not sure whether you may be showing signs of a mental disorder, book a psychological evaluation appointment with our psychologist who can make an accurate evaluation of your mental health and guide you to further interventions where necessary.