Anxiety, IBD and the Pandemic: What to do?!
This article was written on March 24, 2020. Further developments in what we know about the coronavirus are continuously emerging.
There is a great deal of worry in our world right now. There seems to be a spectrum of those who believe “this will all be over soon” and those who have been sheltering in place for weeks. If you are someone with inflammatory bowel disease (IBD), some of these concerns over personal hygiene and your health are not unfamiliar. However, when the entire nation is attempting to “flatten the curve” you may be feeling the effects of uncertainty.
Briefly, let me introduce myself. I am a clinical health psychologist who specializes in working with patients with gastrointestinal problems. I see many patients with IBD and other bowel conditions in my outpatient behavioral health program at the University of Michigan.
In light of the current COVID-19 pandemic, I have transitioned all of my patient appointments to virtual visits as of last week. It is critical during this time of uncertainty for people to have access to their mental health care! A common theme of our appointments has been exploring emotions related to this pandemic and providing some actionable strategies to cope.
Why is it important for someone with Crohn's or UC to manage stress and anxiety?
Research shows that approximately 21% of people with IBD have symptoms of anxiety.1 Additionally, it has recently been found that anxiety can lead to worse outcomes in IBD.2 Therefore, having strategies to manage anxiety is an important part of IBD care.
It is often thoughts that drive worry and anxiety and it can be very difficult to control those thoughts when the world around you feels extra scary. Behaviors are more controllable and can be a great place to start when you begin to feel the effects of stress and anxiety.
There are aspects of your health within your control
Focus on recommendations from reputable sources:
- Continue to take your medication. Many people with IBD have had concerns over the use of their medications. However, current recommendations from IOIBD are to remain on medications as it is important to keep inflammation under control. Talk with your doctor if you have specific questions!
- Respect social distancing and sheltering in place. This will help to reduce your risk of exposure to illness. Travel and social gatherings will be rescheduled. On the bright side, it allows us to have things to look forward to in the future.3
- Practice good hygiene. It cannot be stressed enough, wash your hands properly and avoid touching your face. Take shoes off outside your home. Air high-five your friend from at least 6 feet away instead of shaking hands or hugging.
- Practice self-care and stress management. It is important to manage stressors that are in your control. Make sure you have a plan for medications, nutritious foods and cleaning supplies. If grocery shopping causes stress, talk with a loved one or friend who may be able to do your shopping for you.4
Your IBD may be in remission or quite well-controlled according to your doctor, but with stress, you may notice some GI distress. Many people with IBD can have overlapping IBS. You can learn more about managing IBS and stress here.
Be mindful of the moment you are in
Mindfulness is about be present in the moment. That can be a good moment (laughing with a loved one or enjoying a warm bath) or a less comfortable moment (you’ve just turned on the TV and the latest numbers of those who have died from COVID-19 are broadcast over the screen). During the more difficult times of your life it is easy to begin to negatively forecast into the future (i.e. “My immune system is compromised. What if I get sick? What if one of my loved ones gets sick?”).
Practice these steps to manage uncomfortable emotions
- Acknowledge and validate your emotions. “Oh hello anxiety. I feel my heart beating fast. I am worried about my health.”
- Return to your body through a grounding exercise. Begin to slow your breathing and focus on the air coming in through your nose and exhaling out of your mouth. Relax the muscle of your jaw and face. Place relaxed hands palms down on your lap, stomach or at your sides. Pull your shoulders down away from your ears. Plant your feet firmly on the ground and remind yourself, “I am safe right now”.
- Engage in your present moment activity and determine if you need to change your behavior. If you were on social media or watching TV and found yourself feeling anxious, it is time to turn away from those activities. Limiting screen time right now is important. If you were talking with a friend or loved one and began to feel these emotions, talk to them about it. Connecting with others remains important and we are all going to have moments where some comforting words from someone else will lift spirits.
Rely on the coping skills you already have!
Many people with IBD have had to make changes in their plans or avoided certain situations because of their health, long before this pandemic. Be kind to your feelings and trust your gut instincts. Stress can take a physical toll on the body so allow yourself extra time for rest and relaxation. Engage in exercise as your body permits. Ask friends and family for support when you need it. Remember that your medical team should be your primary source when it comes to medical decision making.
Remember that emotional health is just as important as physical health
Should you find yourself in need of additional support to manage your mood, seek out mental health care! Many providers (therapist locators: psychologytoday.com or RomeGIPsych.org) are shifting to virtual visits recognizing the importance of access to quality mental health care during this time. Be well!
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