Stanford is currently in Stage 2 of the restart process. Only essential workers, authorized researchers and laboratory support personnel and those with permission to be on campus to prepare the campus for restart should be on campus at this time. All work that can be done from home should continue to be done remotely.

Mental Health + Wellbeing

Introduction

For all of us the past few months have demanded a process of adaptation characterized by an urgent response to an acute stressor, the COVID-19 pandemic. This stressor has affected people in a wide array of ways, ranging from individuals who are facing increases in work demands or decreases, individuals who are now balancing increased child or elder care, affecting individual’s ability to engage in beloved recreational activities, and altering our options around social or religious engagement. This has demanded from us the recruitment of support systems for ourselves, our families and communities, and the establishment of a new routine. As the pandemic continues and associated stressors have developed, we now face how to develop new skills and restore old ones to transition into new stages, such as our phased recovery to university operations.

It is expected that individuals are experiencing stress, or uncomfortable emotions accompanied with physiological and behavioral changes, as we navigate what is an uncertain time for many of us. Stress also can be helpful, but only up to an optimal point, after that it can negatively impact our health, performance and level of distress. Resilience is the process of adapting well in the face of adversity or significant sources of stress.  Experiences like anxiety, sadness, and grief are normal reactions to an acute stressor, like a pandemic. Our goal is to give you tools to move toward resilience and to help you cope with these normal reactions.

Individuals may find themselves worrying, either in productive or nonproductive ways – Worries are cognitive processes. Helpful worries can motivate us to take action (e.g.; protecting ourselves and others, gaining empowerment through knowledge, making rational decisions, problem solving). Unhelpful worries tend to paralyze us or escalate anxiety.  The more we concentrate on our wellbeing, the better able we are to fight the potential negative outcomes of stress and anxiety.

Below are some suggestions on how to be equipped to manage the phased recovery while managing current stressors.

Getting Ready: Envision, Prepare, Engage

ENVISION

When we return to work, things will look different. For instance, we need to be prepared for how we would react to seeing colleagues and friends maintaining distance and wearing PPE. We need to be prepared for our reaction, and our responses to this new environment.

We also need to recognize that the new routine we have established while being sheltered-in-place may be disrupted when we transition our work. We may have concerns about leaving family members behind or young children at schools or child care. We may also have concerns on how to avoid contracting the virus while we are returning to work. We also may not be able to predict how our work environment will change, and it may be difficult to tolerate uncertainty.

PREPARE

One way to foster resilience in the transition back to work is to prepare our support system. Know what family members and friends to contact when needed. Social support can take many forms including emotional support, physical assistance, providing advice, or just providing social connections. Generate some ideas on what types of social support you think you might need and who you can rely on among your support systems for those types of assistance.

Identify which coping mechanisms have helped you in the past and practice them in case they need to be reinstated. Some people may benefit from relaxation, others from increased activity. We can all benefit from exercise and practicing positive thoughts to fight our nagging negative ones.

In addition, you may feel strong emotional reactions as you return to work and are reminded of how things have changed, or of current stressors. If you or a family member are experiencing signs of anxiety and/or depression, identify these and seek support. If needed, make sure that appointments with your therapist and/or primary care physician are scheduled to help with the transition back to work.

The Veterans’ Administration has developed a useful application; COVID-19 Coach App, which has several useful coping skills for a variety of COVID-19 related Stressors. The App is free and available to everyone. There are other internet resources available through the International Society for Traumatic Stress Studies (https://istss.org/public-resources/covid-19-resources#For-Anyone). Having some of these resources or toolkits on hand can be helpful in managing the transition back to work.

A number of internet resources are available from the American Academy of Child and Adolescent Psychiatry (AACAP.org; see Facts for Families) and the National Child Traumatic Stress Network (NCTSN.org) for children. Although it is normal for children to worry, if stress is affecting their functioning and level of distress, consider consulting with your family practitioner.

ENGAGE

We all need to create our story, our narrative of living through these times. When we do this we store our memories with words, rather than emotions with no context. Share with others, and it can also be sustained to let others share this with you. Let your support system know that the lines of communication are open. At the same time, it is ok to set limits and to take care of your own emotional health when you need a break. Remember that physical distancing does not mean social disconnection, remain connected, and engage through a phone call, letters, and new technology.

In the transition back to work it can be difficult to maintain balance, especially with changing work and life demands. We will better be able to manage those demands if we model self-care through healthy behaviors. For example, by having a healthy diet, good sleep hygiene, not abusing alcohol, tobacco or other drugs, and exercising physically and mentally.

Mindfulness is another potential antidote to stress. Mindfulness is the practice of being present and aware of the present moment in a non-judgemental manner. The Stanford Early Life Stress and Resilience Program (elsrp.stanford.edu) has a number of mindfulness exercises for both adults and children. Our partners at Pure Edge, Inc. (pureedgeinc.org) have a number of exercises named “brain brakes” that engage adults and youth in yoga and mindfulness practices. Yoga is one way to practice mindfulness both mentally and physically.

Another potential antidote to stress is noticing your own dialogue with yourself. Are you being kind and encouraging or harsh and unforgiving? Are the beliefs accurate? Look for thoughts that are more fair and balanced. When we replace extreme, rigid, or inaccurate thoughts it is another way to decrease painful emotions.

If you have children at home encourage them to be active and to express their opinion and feelings about the current situation through such means as art, music, writing, or any other healthy venue.

Embrace Your Resilience and Adaptation

Resilience is a physics term. It means the coil springs back to its original position. We want to respond to change by returning to our baseline state.  Resilience is not absolute; some days we may feel more resilient in some areas, and not others. It also waxes and wanes; some days we feel more resilient, other days we just do not.  It is important to note that most of us will do well even when having to face a number of challenges.

In addition to resilience, it is also important to develop a parallel skill; adaptation. In adaptation, one returns to a different state of function, not where we were originally, but one in which we thrive within the new environment. In order to adapt well we need to use coping tools, such as self-care, and developing an approaching style, rather than an avoidant one. In other words, it is ok to talk and seek care when needed.

The quarantine, shelter-in-place and restrictive ordinances we are experiencing are an opportunity to embrace the value of citizenship. We are all being asked to be responsive together for the benefit of our world. Together with our families, friends, colleagues and neighbors we are responding to an important call. We may be asked to return to these more restrictive practices if necessary.

Managing Grief

When one loses an important attachment; either a relationship or something that was valued in our lives (e.g.; previous abilities, freedom) one grieves that loss. The process of grief is also a process of adaptation. This adaptation to the loss may require approaches that differ from other traumas. When dealing with grief, it is helpful to understand that there is no right way or wrong way to grieve, and people’s experiences of grief vary widely. For those who have experienced losses, it can be particularly difficult right now as many of our typical ways of grieving have been interrupted. It can be helpful to identify achievable rituals that can be implemented now, as well as ways to engage social support around the loss. It may be necessary to think about ways to engage these rituals and supports in virtual space or in new adaptive and creative ways. It is also important to recognize that grief is not a linear process, and the feelings may wax and wane. Under resources we provide information on how to learn about dealing with grief and support systems that currently exist to help us manage grief.

Conclusion

Every family is different. One needs to identify those strengths within ourselves that will help us battle negative thoughts and attitudes. Each family structure is unique, and depending on your family composition your approach may vary. You do not need to be perfect, and you do not need to do it alone. Remember, it takes a village.

Resources

Stanford Department of Psychiatry and Behavioral Sciences – COVID-19 resources webpage- https://med.stanford.edu/psychiatry/covid19.html

Stanford Early Life Stress and Resilience Program (ELSRP) – COVID-19 resources webpage- http://elsrp.stanford.edu/

Kara: Grief Support for Children, Teens, Families & Adults- https://kara-grief.org/

ISTSS – International Society for Traumatic Stress Studies- https://istss.org/home

AACAP – American Academy of Child & Adolescent Psychiatry- https://www.aacap.org/

Veterans Administration Mobile Apps (COVID-Coach and other self-help apps)- https://mobile.va.gov/appstore/veterans

Daily Guided Meditation

Stanford ELSRP in partnership with Pure Edge, Inc. hosts a live daily 30 min guided meditation conducted by Dr. John Rettger and Anne Contreras.

Talking to Young People about COVID-19

This webinar reflects on the anxieties that children and transition-aged youth are likely to be experiencing during the pandemic and how to address them.

Webinar from Stanford’s Department of Psychiatry and Behavioral Sciences

Worry, Stress and Anxiety: How to Manage it

A presentation on coping, staying healthy, and benefiting from life’s challenges.

Child and Adolescent Trauma

Brief Description: Interview that addresses stress and trauma in children

Stanford’s Podcast: What Makes Up Your Mind

Talking to Kids about COVID-19

Presentation on discussion strategies on how to talk to kids and teens about COVID-19

Stanford’s SCOPE 10K Podcast

Heart, Mind & Body: Understanding Grief and Adaptation to COVID Loss

Webinar addressing a model for understanding grief and adaptation to loss, discuss the unique challenges to adaptation posed by a COVID-19 loss and ways to promote adaptation.

Stress and Anxiety: Coping Staying Healthy and Building Resilience in College Students (English and Spanish)

Discussion on the neuroscience of stress and coping strategies specifically related to college students during the Covid-19 pandemic.

Discusión de neurociencia del estrés, de los problemas específicos por la situación de Covid-19 de los estudiantes universitarios y se proporcionarán estrategias de calma para afrontarlo.

https://vimeo.com/412449092

Stress and Anxiety: First- Responder Series (In Spanish; English in production, soon available at elsrp.stanford.edu)

Autocuidado y Manejo Del Estrés Para Profesionales De Primera Respuesta al COVID-19.

5/18/2020 – Módulo 1: Introducción y estrés

5/19/2020 – Módulo 2: Neurociencia del estrés y Claves traumáticas

5/20/2020 – Módulo 3: Estrategias de manejo del estrés: cognitivas y emocionales

5/21/2020 – Módulo 4: Autocuidados

Register here: https://us02web.zoom.us/webinar/register/WN_YkG5xkv-QBa6DQd23Bhb8w