The Coronavirus lockdown has touched all of our lives in one way or another. As a therapist, I have had to get used to a new way of working using video consultations. I can’t say it has been easy. I miss the vividness of seeing someone’s emotional expression when looking directly at their face. Whenever anyone is missing anything, the feeling that they are experiencing is akin to grief: a complicated emotion. We think of it as sadness.

"The less obvious loss for those in therapy may be the loss of hope. Therapy is about understanding our pasts in order to have a better future, a future which is often about engaging with the world. However, the future now seems unknown and uncertain".

However, at times it can feel like anxiety. C.S. Lewis said “No one ever told me that grief felt so like fear. I am not afraid but sensation is like being afraid. The same fluttering in the stomach, the same restlessness, the yawning".

The loss of hope

We are missing the thing we have lost. The most obvious losses at this time will be the death of loved ones. The less obvious loss for those in therapy may be the loss of hope. Therapy is about understanding our pasts in order to have a better future, a future which is often about engaging with the world. However, the future now seems unknown and uncertain. At times like this it can be helpful to look at the Grief Cycle of Elizabeth Kübler Ross.

The stages in the cycle are denial, anger, bargaining, depression, and acceptance. Everyone I have spoken to seems in any one of those stages. There is the denial of the loss, the anger at having a future opportunity taken away, bargaining as we try to think of what we could have done to avert this crisis. The most difficult stage to achieve is acceptance. What makes it hard as we move towards acceptance is the fact that there appears to be no clear end point. The anxiety that this can leave within us like - the fear that C.S. Lewis mentions - is exhausting.

Managing "pandemic fatigue"

Researchers reference the work of Hannah Smith who coined the term “pandemic fatigue” to describe this exhaustion. She said that the term may be helpful in describing the general disorientation that we all seem to be experiencing from not knowing which day it is, to having our routines upset.

If we were to manage this anxiety that leads to this exhaustion more effectively, we could use the Cognitive Behavioural Therapy technique of the “worry hour” which involves setting aside 60 minutes in order to focus “purely” on whatever is preoccupying us. Outside of this time we need to focus on any activity from using Zoom to gardening which does not involve worry.

The rationale here is not to get rid of worry but to establish control over something which feels uncontrollable. The discipline of ring-fencing time can help us establish this. In doing so it can help reach the equilibrium described in the Serenity Prayer: "Grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference".

Being able to accept the humble activities that we can control within the constraints of our lives at this moment in time can help us make peace with the uncertainty of the lockdown.

 

Michael O'Sullivan is a Cognitive Behavioural Therapist working in the Derbyshire Healthcare NHS Foundation Trust. Purchase his book 'A Practical Guide for Working with Depression: A cognitive behavioural approach for mental health workers' here.