Like me, you are probably noticing more and more in recent weeks that emotions, like viruses, seem to be spreading from person to person. Fear and anxiety have risen in the general population in the face of the evolving COVID-19 pandemic, and, perhaps more notably, in the patients I have been seeing in my office.
I often tell my patients that tragedy has a way of pulling off the blinders we wear to protect ourselves from seeing the true dangers in the world around us. Without these blinders, many of us might never leave our homes for fear of any number of mortal dangers. Yet, in order to live in a world full of potential dangers, we use heuristics based on cognitive biases that allow us to feel safer than we are. When the blinders come off, we realize that the world is dangerous, we have little control over our destinies, and, perhaps more importantly, the world and the future are uncertain.
Events such as the COVID-19 pandemic highlight for many of us this grave uncertainty of what the future will look like. Most of us are uncomfortable with uncertainty, and people with anxiety disorders perhaps more so. Anxiety is a necessary emotion system set in place to warn us of true dangers. (I tell my patients that getting rid of anxiety altogether would be dangerous: like sending someone with no pain or heat receptors in their hands in the kitchen to cook.) Anxiety disorders often set our danger sensitivity detectors too high and thus interfere with day-to-day living.
Anxiety disorders highlight a cognitive distortion: that thoughts (eg, worries) or behaviors (eg, control) might lend more certainty to an uncertain situation or world. I have seen in my office this week alone several individuals who do not meet criteria for an anxiety disorder, but who spend their session discussing their fears and worries about COVID-19 as well as how they are changing their lives, with frequent hand washing and social distancing, to try to protect themselves.
This is not necessarily a bad thing, as these precautions have been put in place by the
US Centers for Disease Control and Prevention (CDC) to help people “flatten the curve” of infection. In other words, by reducing rapid transmission of the novel coronavirus we can reduce the peak number of people infected and requiring critical care at any given point in time so that hospitals have can care for everyone. It is important to recognize here that the hope is not the complete arrest of the virus (most experts speculate that the majority of the population will become infected with the virus), but rather the protection of an underprepared healthcare system that does not have enough beds or ventilators for everyone in the country, should we all simultaneously get sick and require critical care.
Educating Our Patients
What I have noticed, however, is that my patients have turned to me for knowledge and assistance with how to approach the COVID-19 pandemic. I am not an epidemiologist, but I find that my patients are not looking for statistics; they are looking for guidance on how to regulate their fears. Without this guidance, even my patients without anxiety disorders have begun to act as if they have obsessive-compulsive disorder (OCD), with frequent obsessive thoughts and compulsions regarding contamination, and my patients with already diagnosed OCD appear to be almost paralyzed by recent fears over COVID-19.
My patients with OCD, especially those who have contamination fears, have in recent days canceled (necessary) appointments, hyperventilated in the (empty) waiting room while wearing gloves and a mask, or even attempted to open doors with their feet so as to avoid a doorknob. Turning to telemedicine (as Medicare and Medicaid relax policies to allow us to reach our patients while still helping to “flatten the curve”) has helped me reach out to my patients most paralyzed by fear, but once I have the telemedicine appointment with them, I find that I need to be strategic about how to approach their fears.
How can we as providers reach those most fearful of contamination in these times when everyone is fearful of contamination? We certainly want everyone to follow CDC and state guidelines regarding social distancing, shelter in place, and quarantines. However, we also want our patients to recognize that the situation is perhaps not as personally dire as they believe it is. We are not trying to prevent infection but rather timing of infection. We are trying to come together as a community of humans to prevent simultaneous mass infection. As it is likely many of us will be infected with this virus, the questions remaining are: When will I get sick? How sick will I become? When I do become sick, if I require critical care, will there be a bed at the hospital for me?