Lessons Learned From Treating COVID-Related Anxiety

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ANXIETY & STRESS DISORDERS

As a result of the coronavirus pandemic (COVID-19), 2020 was a very challenging year. Concerns about contracting the infection, loss of income/employment, disruption of routines, physical isolation from friends and family, restriction of leisure activities, and school and daycare closures caused significant stress for patients and clinicians. Although the stress may not meet the diagnostic criteria for an anxiety disorder, the symptoms can affect quality of life. Tips for addressing stress and anxiety related to the pandemic can be used for other natural disasters and events (Figure).

Assess your patient’s response to the COVID-19 pandemic. A major concern for many patients is contracting the virus, and sometimes the fears are based on misinformation. Empower your patients by educating them on COVID-19 transmission and epidemiology and dispelling myths. I have patients who are so fearful of getting infected that they do not want to leave their house, go to the grocery store, or conduct any essential activities. When a patient knows how to protect themselves from infection, they will less anxious. Remind them that certain precautions reduce their risk: staying 6 feet apart, wearing a face covering, keeping hands clean at all times, and not touching hands to face. If they follow these rules, they will feel less stress when leaving their homes.

Figure. Steps in Addressing Pandemic-Related Anxiety

Advise patients who are highly anxious to limit screen time and news/media.The media is inundated with information that can increase a patient’s anxiety. Patients should spend the extra time on self-care activities, like taking breaks from work; engaging in physical exercises, meditation, and yoga; spending time with their loved ones; listening to music; watching a good show; or reading a novel. Any activities that helps alleviate stress and gives them pleasure is recommended.

Educate patients about normal responses to stress and trauma. Normal responses can include anxiety, apprehension, disbelief, anger, insomnia, concentration problems, fatigue, and irritability. Increases in pain and other physical symptoms are also common. These stress reactions are usually transient and will likely resolve once patients adapt to the pandemic-related changes. If a patient reports stress response symptoms that do not resolve after a few weeks, or that are severe enough to cause significant distress or interfere with daily functioning, then they should be assessed for the development of adjustment disorder with anxiety, acute stress reaction, or new onset generalized anxiety disorder (GAD).

Assess treatments and adjust accordingly. Patients with underlying anxiety disorders, especially GAD, may experience exacerbation of their anxiety. If their symptoms were previously controlled by medication, consider an adjustment.

Cautiously consider the addition of anti-anxiety medications. Patients may present and ask for medications, like benzodiazepines, but alprazolam or lorazepam should not be prescribed without a thorough assessment. Since PRN benzos can take 30 minutes to an hour to work, PRN dosing is not effective in preventing a panic attack, which usually comes on within 10 minutes. It is preferable to start patients on a selective serotonin reuptake inhibitor. As recurrent panic attacks are often due to an underlying anxiety disorder or depression, it is vital to assess the patient.

Dr Choy is past president of the Orange County Psychiatric Society and a distinguished fellow of the American Psychiatric Association. ❒