By Greta Hirsch, PhD This is a great time of uncertainty, which is creating anxiety in all of us. Never in our lifetimes have we lived through a time in which people in every country throughout the world are facing the same invisible enemy and creating feelings of danger globally. One tiny microscopic virus has brought us to our knees and has eliminated all borders or differences among us. We are humbled by our humanity in knowing that we are all facing the same danger no matter where we live or what our roles are in our daily lives. To begin with, we have to recognize that anxiety is a normal, rational, adaptive reaction to a threat or perceived threat. We all have a fight or flight response, which can include:

• Increased heart rate
• Increase blood pressure
• Increased muscle tension
• Dilated pupils
• Dizziness
• Shortness of breath and tingling in the arms and legs.

In addition to these physical responses, one can develop catastrophic thinking, including excessive worry or unwanted intrusive thoughts. People with or without mental health issues can have worry and intrusive thoughts. These become clinical if they are marked by a loss of function and so much distress that you cannot go on with your daily responsibilities or focus on anything beyond your fears. Although every one of us is struggling with the uncertainties that come with the COVID-19 pandemic, up to 30% of the population is biologically predisposed to respond with greater distress, including hypersensitivity to bodily sensations and catastrophic thinking. If you are among those for whom uncertainty is more intolerable, you may need to consult with a cognitive behavioral psychologist who can help you. A therapist can help you learn to tolerate your anxiety, decrease any shame you might be feeling about your anxiety, and help you to understand that it is not your fault. If someone sneezes nearby, the average person may think “I might get infected”, but the thought can come and go without a strong physical response. For a person with health anxiety, these thoughts come with a wave of physical responses. The catastrophic thinking can begin to snowball and the great discomfort can lead to a desire to engage in some behavior to minimize the discomfort. This can include excessive handwashing, googling diseases incessantly, or repeatedly calling your doctor. It can also involve constant scanning of your body for further ‘symptoms’. I recommend that you focus on what you can control. Remember that 80 percent of the population can recover at home, and of the 20 percent that requires medical intervention less than 5 percent are in the ICU. Create structure to your day, decrease your news consumption, and give yourself a limit (once or twice a day) of how often you are seeking information about COVID-19. To get reliable information, limit your searches to the CDC, World Health Organization or National Institute of Health websites. As much as possible stay in the moment and focus on things you can do for now. These things can include:

• exercise
• listening to music
• writing a gratitude list
• engaging in acts of kindness
• sharing humor with others

The goal is to redirect your attention to something other than your anxious thoughts. Remind yourself that you may be going through a moment of suffering, and that suffering is part of life. Find a meaningful purpose to your day. This time can bring out the best in us by asking how we can help. We can focus on a renewal of “we” rather than the “I”. Physically we are pulled apart, but for now social media can keep us in touch. Reach out to someone who is alone. Before this our attention has disaggregated us as a culture, but this crisis can mentally and emotionally reunite us. All the countries in the world now face the same danger. Physical isolation does not need to mean emotional or moral isolation. Sometimes out of our most difficult times can come our greatest growth. We will get through this. Please remember we feel better when we are altruistic and make others’ lives better. Hopefully from this comes a stronger sense of identification and empathy for others. It reminds us that we are all equal and hopefully creates greater humility in all of us.