By Prof. Huang Yueqin, Chair of RI’s Commission on Health and Function
Professor of the Sixth Hospital/Institute of Mental Health of Peking University

The sudden outbreak of novel coronavirus pneumonia (COVID-19) threatens us like a dreadful monster. As is the case with all other pandemics, the outbreak of COVID-19 makes all people, especially those with different types and degrees of disabilities, fearful and anxious. They fear they themselves and their families might be infected by the virus  and they fear the pandemic will persist. At present, there is a lot of information about the pandemic on the Internet, but sometimes it is hard to tell which is true and which is false.  To prevent and control the pandemic, we have cancelled all kinds of gatherings and stayed  at home, with little contact with the outside and nearly no entertainment, so we sometimes feel lonely and bored. Under such circumstances, some people are likely to be troubled with anxiety, depression, despair, self-accusation, anger and other negative emotions in addition to panic, chest distress, headache, lumbago, leg pain, gastrointestinal reactions,  and even sleep problems such as insomnia and poor sleep. Misled by hearsay, many people went for panic buying of masks, medicines, disinfectants, and even vegetables in supermarkets. On the contrary, some people are blindly optimistic, neglect preventive measures, and disobey precautionary regulations. For the medical staff on  the front line  of the pandemic prevention and control, it is natural that they feel huge psychological pressure as well as anxiety, fear, grievance, guilt, remorse and despair. If we were patients infected by the COVID-19, how would we feel? Fear,  anxiety and despair would  be inevitable. What’s more, if we were discriminated against, we would feel guilty and remorseful. If such negative emotions are not dealt with properly, some patients may get liable to do harm to others. In addition to the pressure faced by all people, persons with disabilities also have their disability-related pains and difficulties.

I.  Causes of Anxiety during the COVID-19 Pandemic

What is it that has caused anxiety among different groups of people after the outbreak of COVID-19? Above all, let’s see what anxiety disorder is. It is a common psychological disorder. If one’s anxiety is not as severe as to require medical treatment, it is merely regarded as an anxiety symptom. As an emotional response, it consists of physiological tension, sympathetic arousal, worry, fear and panic, as well as behavioral avoidance and social function decline. Although anxiety is a normal psychological response to stress, it will grow into anxiety disorder if the duration is  too long and the emotional reaction is  too strong. After the outbreak of the public health emergency, many people, though not having anxiety disorder, have displayed anxiety symptoms. This affects their daily life  and is not conducive to disease prevention and control. What is it that has caused anxiety after the outbreak of the COVID-19 pandemic? The anxiety symptoms are essentially rooted in one’s inability to tolerate uncertainties, i.e. he/she has no  idea about how come the pandemic has broken out, whether he/she is in danger, how to avoid infection, and when the alert will be removed. These psychological reactions are common after the outbreak of infectious diseases. Things as trivial as everyday chores can lead to anxiety symptoms, not to mention the unexpected pandemic. Usually, many factors can generate anxiety. But today, the widespread anxiety is attributable to the same cause: the outbreak of COVID-19. Anxiety is difficult for all people, and the COVID-19 patients with anxiety disorders face even worse conditions.

II.  Self-adjustment of Anxiety

How to address the diverse psychological problems troubling different groups of people after the outbreak of COVID-19? There should be science-based ways to relieve anxiety.

First and foremost, we must have a proper understanding about the things in concern. First, we should have some knowledge about how the infectious disease has become a pandemic. The pandemic becomes what it is due to factors of three aspects: the source of infection (wild animals, patients); the route of infection (via respiratory air droplets or close contact); and the susceptible (including the uninfected who are generally susceptible and the high-risk groups such as  the medical staff in  close contact with the patients,   the elderly, and those with a poor immune system due to fatigue or huge psychological pressure). Besides, natural factors (temperature, humidity) and social factors (emergency measures taken by the government) are also very important. Second, we must obtain knowledge about the COVID-19. As far as we know,  the COVID-19 becomes pandemic  in the same way as other respiratory infectious diseases. Currently, no specific medication or vaccination against COVID-19 has been developed, but the antiviral treatment, symptomatic treatment and supportive therapies have worked in most of the cases. The infection prevention and control measures that the public can take include reducing gatherings, wearing masks, washing hands frequently, ensuring frequent ventilation, good nutrition and enough rest, all of which are helpful to curb the spread of the disease. Under the current circumstances, for medical staff, they can be proud of their special experience during this period of time; for patients, they could take comfort in  the thought that they will become immune to the disease after they get cured; for the quarantined, they can  take this rare opportunity to rest and relax; and for those who are away from home and cannot return, they could take comfort in the thought that it is worth staying away from home for the safety of the whole family. People with a physical or psychosocial disability can join in the whole-of-nation campaign for pandemic prevention and control and do what is good for themselves and others. We should all remember that advantages coexist with disadvantages and so do blessings and misfortunes. Everything has two  sides. When we happen to encounter any disadvantage, we can rest assured that we are on the way to embrace advantages.

Second, accepting reality is a great way to relieve anxiety. Since the  circumstances are hard to change and the pandemic has happened, we can do nothing but accept the reality  that the city must be put on a lockdown and people must be quarantined. For frontline medical staff, it is inspiring to recall the oath made when they were medical students. From the first day of studying medicine, they are determined to work hard for human health, and it is time to put their professional expertise into use. For patients, they should “take things as  they come” and cooperate with medical staff to  get cured and recover   as soon as possible. For those quarantined after contact with confirmed or suspected cases, they must accept the situation as a cost of pandemic prevention and control. For community residents with no contact with the infected patients, though it is a little uncomfortable to wear masks and stay indoors, prevention and control participated by all people as thus can curb the spread of the pandemic. For those with disabilities or mental disorders, as  they have to stay indoors to  avoid contacting the virus, their routine might  be disrupted, and they have to adjust their daily life and work. However, they must take medicine as prescribed as usual. We  should learn to  live with all of the anxieties caused  by the pandemic. Some people feel anxious for various reasons. Anxiety is not wholly terrible, since moderate anxiety can push one to give his/her best performance and fulfill greater potential; if completely free of anxiety, one may disregard perfection and become mediocre.

Third, expression of one’s feelings helps to reduce physical discomfort. One’s feelings can be expressed to oneself, unbosomed to others, and communicated to the environment  by doing physical exercises, such as strolling and climbing a  mountain. Or  the  feelings  can be sublimated, i.e. to turn grief into strength and to dry the tears before starting anew. When anxiety cannot be properly expressed, it will cause all kinds of physical discomforts. It is even more so in the case of people with physical disabilities. When people are too anxious to eat or too angry to sleep, it is anxiety causing bodily consequences.

Fourth, to vent one’s negative feelings helps. Having changed our cognition and accepted the reality, we should express our feelings in a proper way. Persons with disabilities are suggested to use appropriate ways to express themselves. They can share their unpleasant thoughts with suitable listeners, telling their families, friends, classmates and colleagues about their worries. If they want to cry, they can just go ahead and have a good cry. It is advisable to do things without harming others or damaging the surroundings. It is important to have a sense of humor, learn to joke and have a good laugh to relieve the tension, as “laughter will gain one ten years of life”.

Fifth, emotional transfer also helps. When anxiety is intolerable, it  is  advisable to  take  a vacation, read novels, watch TV, do housework, decorate the room, or go to the park, playground and outskirts that few people visit to do physical exercises. Do not glue yourself to the mobile phone or the TV all day long, but shift your attention from the COVID-19 to cheerful things. The approach to achieve emotional transfer differs from person to person, and persons with disabilities, as others, should do things they find suitable to their conditions and pleasant to them.

Sixth, to give something up helps to relieve anxiety. At this stage of pandemic prevention and control, many plans cannot be delivered as scheduled. When you think of the tasks that were or wouldn’t be completed by the deadline, you will be very anxious. Then you should take comfort in the thought that I’m worse off than some but better off than many, adjust the objectives, and put the unfulfilled on hold. When you justify the postponement and don’t blame yourself, you’ll feel much relaxed. For persons with disabilities, they should do things within their capabilities; if  the original plan cannot be  fulfilled, it  is  not a mistake to give it up.

III.  To Seek Professional Help

If all the above suggestions fail to work, and you are troubled with anxiety, worry,  fear and panic all the time, it is necessary to  turn to  mental health professionals. We  can go  for psychological consultation and guidance, read guides on the pandemic prevention and control, and seek psychotherapy. For patients with mental disorders, if they feel that their emotion is beyond control and has a serious impact on their daily life, they must go  see a mental health doctor. Most important of  all, regardless of  your identity and role in the fight against the pandemic, once you are  caught by  anxiety that cannot be  relieved  by yourself and affects your daily life and work, you should attach great importance to    it. Deal with it under professional guidance, and don’t try to solve it in a desperate and irrational way. With no science-based methods in place, the best time of medical treatment might be missed. It will not only fail to eliminate anxiety, but also will cause unexpected side effects to your physical and  mental health. Special attention should be  paid to  the physical and mental health of persons with disabilities; in case of any emergency, professional help should be sought.

The damage caused by the pandemic to the whole society is grave. The deaths and disabilities incurred by the pandemic are evident, while pains and losses caused by psychological problems cannot be directly estimated; and the aftereffects of resource consumption caused by overreaction will gradually appear. In order to prevent and control the pandemic, the state has taken various measures. Moreover, the whole society has been mobilized to turn anxiety into strength, and the whole-of-nation approach in pandemic prevention and treatment can defeat the novel coronavirus. We firmly believe that the pandemic will get under control and people’s health will be guaranteed. Maintaining physical and mental health will always be the lasting goal of all people, including persons with disabilities.

Author: Prof. Huang Yueqin is director of the Division of Social Psychiatry and Behavioral Medicine of Institute of Mental Health, the Sixth Hospital of Peking University. She is Vice Chair of China Disabled Persons’ Federation and Chair of Commission on Health and Function of Rehabilitation International. She works as President of Chinese Mental Health Journal and President of Society of Crisis Intervention of Chinese Association of Mental Health. She is fellow of American Psychiatric Association and fellow of World Academy of Arts and Science.

As a professor of Peking University and honorary professor of the University of Hong Kong, she is principal investigator in a series of research projects and international collaborations on mental health. She has published 329 papers, including 168 first-author and correspondent-author papers, and is editor-in-chief of seven books.