Emotional Well-Being and Coping During Crises

Hands being washed with soap over a sink.
In this section:

These are unprecedented times. We need to work extra hard to manage our emotions well. Expect to have a lot of mixed feelings. Naturally we feel anxiety, and maybe waves of panic, particularly when seeing new headlines. An article by stress scientist and Vice Chair of Adult Psychology Elissa Epel, PhD, outlines the psychology behind the COVID-19 panic response and how we can try to make the best of this situation. Her tips can be found below.

Our anxiety is helping us cope, bond together from a physical distance, and slow the spread of the virus. So our anxiety - while uncomfortable - is a good thing right now, especially if we manage it well. At the same time, we must effortfully prevent panic contagion and create periods when we can be screen-free and calm, engaging our attention in normal daily activities. Seize opportunities to share lightness and humor. Laughter right now is a relief for all of us!

You can also find moments of hope and resilience all around us despite the uncertainty. For example, a project created by UCSF postdoctoral scholar Nouf Al-Rashid shares stories of resilience and hope in response to the pandemic from individuals all over the world.

If you feel in crisis or overwhelmed, it may be helpful for you to make a list of what you can and cannot control right now. In this guide, we suggest radical acceptance of the situations we cannot control, and focus on what we can do.

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Tips for everyone

Limit media to reduce anxiety

When there are stressful social events, we hear about them through the news and social media. By now you have heard this recommendation many times and there is research behind it: Watching or scrolling through the media makes us even more anxious. An excess of news and visual images about a traumatic event can create symptoms of post-traumatic stress disorder and poor health years later, according to research by UC Irvine's Roxy Silver, PhD, and others.

Try to limit media exposure during stressful times to no more than twice a day (e.g., checking for updates in the morning and before dinner) and try to avoid it before bedtime. Take a vow to not forward (and thus propagate) alarming headlines to friends and family.

Get and provide warm, comforting, social support by video, phone, or text

Being connected to other people and feeling supported is one of the strongest forms of stress relief! The science behind social connection is described by UC Berkeley’s Greater Good Science Center.

Maintaining social connections is critical! Taking time to share your feelings and to listen and support others will go a long way. Talking with others who have our best interests at heart makes us feel safe. Use phone, video, text, or email. Fortunately these new highways of social contact are unlimited resources. More than just providing social support about the current crisis, it is a good idea to use these connections to talk about the things you normally would - host your book club online, for example - which can create feelings of connectedness. (See 8 Free Apps to Help You Stay Connected During Coronavirus). Host a dinner using FaceTime or Zoom so you can talk while you eat (and talk about some positive things, not just this crisis). Loving and caring for our pets can be phenomenal stress reduction for us too!

Find ways of expressing kindness, patience, and compassion

Be extra kind to yourself. This is a hard time for everyone. Humans across the world are sharing this experience with you. We are all in this together and we may all emerge with a renewed appreciation for our interconnectedness. Helping others in need is both critical to get through this well, and also creates more purpose to our days and well-being.

If you are having critical thoughts, treat yourself as you would a close friend. Dr. Christiane Wolf leads us through a five-minute self-compassion meditation that can bring relief. You might also try taking a compassion break, another well researched technique for reducing pain.

If you are physically well, there is an important way you can help: The American Red Cross often faces a severe blood shortage. They continue to face shortages in 2021 due to recurring coronavirus outbreaks. Eligible and healthy donors are strongly urged to make an appointment to donate and help ensure that lifesaving blood products are available for patients.

Notice for find ways of experiencing joy in your day

We can experience joy or content, even during stressful times, and they create balance, equanimity, and relief. UC Berkeley’s Greater Good Science Center has an online library of many practices based on experimental research that can quickly create positive emotion. This includes experiencing awe from being in nature, purpose in life, and gratitude for what you have. When you wake up you may feel grumpy, but focusing on one or two things you are grateful for can shift your mood for the day. After experiencing a crisis, it is especially hard but important to notice moments of joy, content, or playfulness, as described in our webinar by Esther Perel and Jack Saul.

Create new routines and keep practicing health behaviors

Routine and ritual are restorative to us. Our brain wants predictable activity so we can relax our vigilant nervous system. Go to bed early and go outside each day to be active. (More information about sleep and activity is available below.) Remember that our activities, thoughts, and mood are closely linked. If you want to change your mood, change your activities and/or your thoughts.

Eat well

Good nutrition helps our mood. Stress makes us seek comfort foods, and in turn high carbs and sugars impact our mood. Many population-based studies show that a Mediterranean diet has been linked to better mental health and stress resilience, whereas a junk food western diet is linked to depression and anxiety. Try to fill your home with fresh produce, frozen vegetables, and whole foods when possible. Several new books written by nutrition scientists describe how diets can be used to improve depression, anxiety, and PTSD, such as The Better Brain or Brain Changer.

The pandemic led to weight gain for many, especially for those already struggling with weight. Working at home can lead to more snacking and mindless overeating. UCSF’s Dr. Ashley Mason provides tips for resisting compulsive overeating in our mini video series. Mindful eating, meditations, and intuitive eating may also help with compulsive eating.

If you or a family member is struggling with an eating disorder, please see the toolkit of resources provided by the UCSF Eating Disorders Program.

Work well enough from home

Working from home can have its own challenges, especially in a small home with children. Don't expect to have the same type of productivity as usual. We are all distracted and needing to cope with a different daily life now, while helping others. Reduce your goals for typical work that is not urgent, if possible. Here are some recommendations on how to stay focused and productive during work hours:

Dealing with isolation and quarantine

The psychological stress of sheltering in place when living alone or being in quarantine once infected can be severe. Here are some resources:


Coping with acute stress

Our thoughts shape our physiological stress responses

Acute, short-term stress is not necessarily bad, and, in fact, can be good. We can approach stressors with a positive mental view that we can cope well, that we have the resources. We can also view the physical stress response as one that helps us perform better, such as increasing oxygen to the brain. These are both types of “cognitive reappraisal.” UCSF professor Wendy Mendes, PhD, has shown that teaching students a positive way to view acute stress led to better performance on tests.

Be realistic and fact-based. It’s easy to think about the worst outcomes, which are catastrophic, but that creates unnecessary stress arousal and suffering. It can be helpful to think of worst case, and then best case scenarios, and settle on something in between, according to University of Pennsylvania psychologist Martin E.P. Seligman, PhD.

Creating short-term stress in the body, that we recover quickly from, can even be good. It creates a calming effect afterward, stimulating the counter-regulatory stress response. Exercise is one example, especially high intensity interval training like the popular "7-minute workout". A protocol of physical acute stress developed by Dutch extreme athlete Wim Hof has become very popular in many countries. Preliminary studies suggest it is helpful for improving our immune response, and Elissa Epel, PhD, and Wendy Mendes, PhD, are currently studying how it improves autonomic and emotional stress responses and mental health at UCSF. It consists of a carefully guided protocol of hyperventilation and breath retention and cold exposure. Wim Hof is offering the online course free now. If you want to try it, it is important to read his safety tips. One can download the Wim Hof Method app to guide you through the breathing.

The acute effects of deep breathing and cognitive reappraisal are important to use throughout the day. See the breathing techniques described below.

The UCSF Department of Psychiatry and Behavioral Sciences has created videos of strategies you can use immediately to reduce acute stress in the middle of your day. These are often considered trauma-informed strategies. Here are four different strategies for you to try:

Reducing stress arousal through breath practices

Practices that manage stress reactions in the moment are critical, particularly for front line providers. Taking time out during the day, frequently, to self regulate, can be very helpful. Find a breathing technique that works for calming you.

The most basic thing to know is that taking a longer exhale than inhale can help calm your body. Easy techniques include slow diaphragmatic belly breathing (vs. chest breathing), a 2:1 ratio for the exhale (i.e., inhale to the count of 4, exhale to the count of 8); 4-7-8 count breathing, and a common yogic alternate nostril breathing (pranayama). UCSF clinical professor Daphne Miller, MD, has used these techniques to help her and her patients in the hospital or even through Zoom. Elissa Epel, PhD, demonstrates these types of breaking in our mini video series.


    Maintaining good sleep

    This expertise is provided by Aric A. Prather, PhD.

    White bedding

    Sleep is a pillar of health. Getting enough sleep keeps your immune system strong. It is also crucial for helping you mentally cope during this uncertain time. That said, it is completely natural to experience more disturbed sleep while experiencing a crisis - including difficulties falling asleep, staying asleep, or waking earlier than you are used to in the morning. You may also find yourself feeling more fatigued than usual. Below are some tips to help your sleep in this challenging time.

    Create a “news-free” wind down

    Before going to bed, it is important to unplug and ready yourself for a restful night. The first thing to do is to say goodbye to all distressing news. We suggest:

    • 1-2 hours prior to bed, unplug from email, news, and anything else that creates a busy mind and begin focusing on creating a calm, relaxing environment. Say goodbye to the news; trust that it will be there in the morning.
    • Turn down the lights and do things that are relaxing. Relaxing activities vary by person, but often include reading, listening to music, or a meditation audio.
    • Avoid alcohol close to bedtime and discontinue caffeine after noon.
       

    Keep a regular sleep schedule

    Maintain a regular wake up time. If possible, also try to get some direct sunlight in the morning. Together, these will help regulate your circadian rhythm.

    Don’t toss and turn in bed

    If you are unable to fall asleep or wake up and can’t fall back to sleep, don’t toss and turn in bed for longer than 15-20 minutes. Get out of bed and do something relaxing until you feel sleepy and then go back to bed.

    Make your bedroom a shrine to sleep

    Be sure to keep your bedroom dark, quiet, and cool.

    Mind your day to protect your night

    What you do during the day can have a big effect on your night. Working from home affords convenience, but also may lead to more sedentary behavior and napping. Napping can eat away at your sleep drive, making it harder to fall asleep at night. Inactivity can similarly lead to lighter sleep and less feelings of restoration in the morning after a night of slumber.

    Good sleep habits for children


    Maintaining physical activity

    Woman and child doing yoga

    Find ways to exercise. More than ever before we know that our physical health affects our mental health, and exercise can reduce stress reactivity and even ameliorate moderate depression. Research shows that getting fresh air and seeing greenery reduces somatic stress in our body and clears our mind.

    Although it may be tough to exercise indoors, engaging in regular physical activity will help reduce your anxiety and stress. The online applications below have guided exercise routines. Each day, more teachers put their classes online. We will highlight good ones here each week.

    Consider that live classes for exercise and meditation give us a group experience which may make us more likely to show up for them.

    • Planet Fitness has a series of free guided workout videos on Youtube.
    • J&J Official 7-Minute Workout is a free workout library containing 22 preset workouts, varying in intensity and duration. Workouts are designed to fit your schedule and range from 7 to 32 minutes in length.
    • Wakeout comes with hundreds of exercises you can do right at your desk, such as yoga, chair exercises, and hand health exercises to stay productive, energized, and healthy.
    • YogaWorks offers around 30 high-quality free classes each day via live streaming and 1300+ on-demand classes that can be viewed any time.
    • Do Yoga With Me and Yoga with Adrienne offer free yoga videos for everyone.
    • Down Dog Yoga has a wide selection of online classes include prenatal yoga, barre, HIIT, meditation, and yoga.
    • Core Power Yoga offers classes online.
    • Zumba offers great workout video packages.
    • A vigorous 30-minute Vinyasa yoga class with master teacher Janet Stone
    • Peloton is offering a 30-day trial of their digital membership, which offers streams of live/recorded group classes from a closed set. (It doesn’t require their bike to access classes on cycling, strength training, yoga, and meditation.)
    • The Workout.Today is a weekly email newsletter with a free workout that you can do at home.
    • UCSF Fitness Center offers a wide variety of live and on-demand workout videos, fitness clinics, and webinars with a virtual membership.
    • Gaia Yoga offers online yoga videos, as well as nutrition coaching like recipes, and can be accessed via a free trial.
    • Obe Fitness memberships offer free trials and include 22 live workouts daily as well as 6000 on-demand classes, including prenatal and postnatal routines and 30-day programs.
       

    Online stress reduction resources

    Different people like different types of stress reduction practices. On this website, we have pointed you to social support, exercise, and sleeping well - all of which build your stress resilience. It also helps tremendously to adopt a daily mind-body practice, like yoga, qi gong, or meditation. Even if it’s only for five or 10 minutes a day, that practice makes a difference. Set a time of day you block out for this on your calendar; if possible, right after waking is a great time for practice. We have highlighted free apps, but there are an abundance of longer practices on the web to do at home for deeper restoration.

    Here are a variety of practices to reduce mental and somatic stress that can be done online. Explore these and see what you love! This is a great time to join a live group online. We will update this section regularly, including live events.

    Emotional Well-Being During the COVID-19 Crisis for Health Care Providers webinar series: Focus on psychological first aid

    View videos

    We know this is a difficult time for everyone, especially those of you who are serving patients. Please view our webinar series featuring mental health and emotional wellness experts showing how health care providers can reduce personal stress during the COVID-19 outbreak and climate disasters.

    Meditation

    AM live events (times are PDT)

    • 10:00 a.m.–12:00 p.m.: A two-hour meditation seminar from Spirit Rock Meditation center in Marin with Sylvia Boorstein on Wednesdays.
    • Various times: UC San Diego offers several live 20-minute sessions each day on coping, mindfulness, compassion, and anxiety.
       

    PM live events (times are PDT)

    • 12:30–1:00 p.m.: UCSF’s Amy Hepner has weekly meditation sessions on Wednesday via Zoom. (Meeting ID: 514 447 417, or call in at the phone number: (669) 900-6833).
    • 4:00-4:30 p.m.: Free online meditation classes for kids from Mindful Schools on the first Wednesday of the month.
    • 7:15-9:15 p.m.: Monday night meditation group from Spirit Rock Meditation center in Marin with Jack Kornfield and other excellent teachers
    • Various times: The East Bay Meditation Center offers meditation self-care groups online (some specific to POC, LGBT, those with disability, and others).
    • Various times: The Copper Beech Institute offers a variety of live virtual mediations daily, some unguided and some guided.
       

    Online

    Mind-body movement for restoration and relaxation


    Useful wellness and mental health apps

    Articles tell us what to do, but apps help lead us and remind us to practice self-care every day. Below are apps we recommend, and many have been shown to be effective in evidence-based research. These high quality apps have been made available to UCSF, with some also free to the general public.

    The Stress Free UC Study found that Headspace, used daily for just 10 minutes, reduced stress in a meaningful way and the benefits lasted for two months after stopping use. Headspace can be done in the morning or evening, alone or with family, or anytime you need to take a break.

    Please consider trying one of these apps.

    Meditation and relaxation

    • Headspace: Two-week free trial for the general public.
    • Health Minds Program App: Always free. Meditation and mindfulness skills.
    • Calm: Seven-day free trial. A meditation, sleep, and relaxation app.
    • Stop, Breathe & Think: Always free, and for kids too.
    • Insight Timer: Always free. This is not a daily app, but rather a great library where you can search for various types of meditations and lengths by excellent teachers.
    • 10% Happier: Free and paid options available. (Seven days free, then $99 per year.)
    • UCLA Mindful App: Free. Meditation by Diana Winston.
    • Mindfulness Coach: Mindfulness Coach 2.0 was developed to help veterans, service members, and others learn how to practice mindfulness. The app provides a gradual, self-guided training program designed to help you understand and adopt a simple mindfulness practice.
       

    Coping with anxiety and depression

    • Sanvello: A program for reducing stress and treating anxiety and depression that includes a coach or groups.
    • Meru Health: A program for clinical anxiety or depression that uses an app and therapist, and biofeedback monitor is optional. Referral from a health care provider is necessary.
    • Happify: Some free content, including stress reduction and cognitive techniques to address anxiety.
    • MindShift CBT: Free content, including cognitive behavioral therapy strategies to address general worry, social anxiety, and panic.
    • PTSD Coach: Created by VA’s National Center for PTSD and the Department of Defense’s National Center for Telehealth & Technology. This app provides you with education about post-traumatic Stress Disorder (PTSD), information about professional care, a self-assessment for PTSD, opportunities to find support, and tools that can help you manage the stresses of daily life with PTSD.
    • PTSD Family Coach: In conjunction with PTSD Coach, the PTSD Family Coach app is for family members of those living with PTSD. The app provides extensive information about PTSD, how to take care of yourself, how to take care of your relationship with your loved one or with children, and how to help your loved one get the treatment they deserve.
    • Mothers and Babies Online Course: A well-validated, web-based program for depression (available in both English and Spanish) for pregnant women, new mothers, and those who want to support them.
    • COVID Coach: Created for everyone, including veterans and service members, to support self-care and overall mental health during the coronavirus pandemic.
       

    Insomnia

    • CBT-i Coach - Free cognitive behavioral therapy for insomnia, available for iOS and Android.
       

    Additional apps

    If you are interested in finding mental health apps, please consider using PsyberGuide — a helpful non-profit site developed by UCSF alum and UC Irvine professor Stephen Schueller, PhD, that provides expert reviews on mental health apps (both credibility and user experience) and offers solid recommendations.