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A Letter To First Responders During The COVID-19 Crisis

Dear Healthcare Providers,

How are you?

No, are you? I ask, because when the demand for care increases and providers become stretched for time, solutions,

and resources, we are the very last to be asked the simple, yet relevant question, “How are you?”

You likely chose a profession in healthcare because you find meaning in helping others. In my field, mental healthcare, I work closely with my clients to provide guidance and support during challenging and uncertain circumstances,

I've wanted to share with you similar strategies for taking care of yourself during times of fear, threatening circumstances and uncertainty. For this reason, I hope to share some cognitive strategies and exercises that might offer you some relief while you work to combat an invisible enemy, COVID-19. We all feel compelled to help in some way and I hope this might be helpful to you. As you read your way through the following please keep in mind that any new change that we try to implement in our life will only be successful when we are committed to making that change. In other words, ask yourself how much do I need this to help me right now? How important is it that I do this for myself, and perhaps for others in my life. When you make a commitment to the importance of practicing these strategies, they will make a difference in your mental and emotional health!

Latest Evidence: JAMA March 23, 2020

You won't be surprised to learn that a recent study published in JAMA Psychiatry last week (3/23/2020) revealed that among 1257 healthcare providers working along the frontline in, and around, Wuhan, China a significant number reported experiencing symptoms of depression, anxiety, and insomnia. More than 70% of participants reported feeling psychological distress; personal vulnerability; loss of control; isolation; concerns about becoming infected; and spreading the virus to their families

Fear & Anxiety

Fear and anxiety are natural emotional responses that we experience when faced with a direct or perceived threat to our safety and well-being. The survival benefits that fear provides prompts us to take immediate action against a direct threat and anxiety generates worry and unease over what we imagine or perceive as a threat. None-the-less, when faced with ongoing threats (real or imagined) to our safety, we are at greater risk of developing physical, mental and emotional symptoms such as panic, obsessions, compulsions, trauma, and depression.

What is most important, given your line of work in a high paced environment of critical care, fear and anxiety directly interferes with the ability to make critical, split-second decisions. When this automatic response system is triggered the Amygdala switches into overdrive and basically hijacks those regions of our brain that we need to plan, problem solve and strategize.

What Does Anxiety and Fear Look and Feel Like?

  • Your heart beats very fast or the beat feels somewhat irregular

  • Your breathing fluctuates between holding your breathe to breathing fast and irregular

  • Your muscles become tense or weak

  • Your stomach churns and your bowels may feel loose

  • You have difficulty with concentration and focus

  • Your mind become fixates on the threat

  • You feel dizzy or light-headed

  • You have hot and cold sweats


Stress, on the other hand is also a natural response or feeling of not being able to cope with specific demands and circumstances. However, when the body becomes triggered too easily, or there are too many stressors at one time, it can undermine a person’s mental and physical health and become harmful. Stress becomes harmful when a person faces continuous challenges without relief or relaxation between stressors from overworked, and stress-related tension builds. Prolonged activation of the stress response causes wear and tear on the body – both physical and emotional.

How a person reacts to a difficult situation will determine the effects of stress on overall health. Some people can experience several stressors in a row or at once without this leading a severe stress reaction. Others may have a stronger response to a single stressor. An individual who feels as though they do not have enough resources to cope will probably have a stronger reaction that could trigger health problems. Stressors affect individuals in different ways.

On the other hand, Stressful situations can elicit physiological arousal that we typically interpret as negative and uncomfortable. The negative appraisal we place on the stressful situation will likely elicit a negative outcome. When we work to reappraise a stressful event to a more positive one this can lead to a reduction in the discomfort we experience.

When to practice these strategies for the best result:

Strategize and Prepare Prior To Your Shift

Knowing in advance that you will be working in a high-risk environment or facing a threatening situation, it’s important that you take time to mentally strategize and emotionally prepare. Think about those scenarios that are likely to trigger feelings of stress, fear and anxiety. Decide what strategies you will utilize to better manage your thoughts, feelings and emotions. The following methods do take practice but with some commitment on your part, you will learn how to interrupt negative thought patterns, and down-regulate your arousal system.


Self-care is any deliberate activity we do in an effort to meet the needs of our physical, mental, emotional and spiritual well-being. Especially for healthcare providers who spend their working hours caring for others. Self-care reduces stress, replenishes our capacity to provide compassion and empathy and improves the quality of care.

Anxiety + Thoughts = A Vicious Cycle

As previously explained, anxiety and fear work together as part of the brain's fight or flight response system. When faced with a perceived threat, this system goes into overdrive to help us prevent, avoid, or circumvent the negative outcomes that result from circumstances outside of our control.

Anxiety actually changes the way we think, leading us to believe that certain thoughts are real. Just because you have a thought doesn’t mean you have to accept it, believe it, or act on it. You have a choice in determining useful thoughts from those that keep us stuck and get in our way. Most thoughts are just mental chatter.

Learning how to manage anxiety starts by breaking the cycle. When you first notice the anxiety, ask yourself these following questions:

  • What’s happening that might be triggering the anxiety?

  • Is the anxiety a reasonable response given the situation?

  • Is this something I need to pay attention to right now?

As you begin to notice the thoughts that present with the anxiety, consider the following questions:

  • Is this thought useful to me?

  • What is the evidence that this thought is true? What are the facts?

  • Given this thought, what is the worst that could happen?

  • If it did happen, what could I do to cope with it?

  • Am I confusing “possibility” with “certainty”? It's possible, but is it likely?

React versus Respond

In an effort to better understand anxiety, new research shows that anxiety can actually improve our performance if we know how to respond to it. Interestingly, most people are not well versed in responding to anxiety. More often than not, we tend to react rather than respond to anxiety. What's the difference you may ask?

  • React: There's a pandemic. You're in Costco and see people with carts full of toilet paper. You react by buying the last 5 packages of 30-rolls. You now have enough toilet paper for a year.

  • Respond: There's a pandemic. You're in Costco and see people with carts full of toilet paper. You respond by buying 1 package of 30-rolls, leaving the last 4 packages. You realize you can restock as needed.

Managing anxiety is key to responding in a way that aligns with our goal and offers the best outcome. While we can not control others or unexpected situations, we can take steps to avoid reacting during times of stress and uncertainty.

1. Know your anxiety triggers 2. Name the feeling (nervous? frustrated? restless?) 3. Ask yourself why 4. Try to separate emotion from the facts 5. Identify your primary objective or goal 6. Choose steps that align with your objective or goal

Lastly, I will leave you with some final tips on getting through this difficult time...

  • Don't go at it alone

Don’t fool yourself by thinking “I got this”. You need to rely on the support of your colleagues and teammates that you so closely work alongside. Working in an environment of heightened chronic stress over an extended period will take a toll. You can mitigate this by taking the proper steps to ensure you stay physically and mentally healthy. And, keep an eye out for the wellbeing and health of your team members. Looking out for the safety of others will improve your own safety awareness.

  • Be honest about how you feel

You work to save lives, heal illnesses and ailments, but you’re not super-human. Do not deny or minimize the feelings you will experience during this pandemic. Any fear you experience is legitimate and not a sign of weakness. When we dismiss our emotions, we detach from what it means to be human. Take each day, minute by minute, and hour by hour. Be honest about those things outside of your control. When we are honest and accept our human limitations, we put ourselves in a better place to learn, adapt and develop new strategies and solutions for the problems that lie ahead.

  • Take care of you first

As the old saying goes, “Dawn your safety mask first, before you assist those around you.” Serving in a profession where you are primarily responsible for the care of others, there’s little time to care for yourself. You can’t expect to make accurate, split-second treatment protocols unless you yourself are mentally, emotionally and physically healthy. Step away when things get too much, ask for help, slow down, or take a few deep breaths, whatever it takes to get through.

  • Be mindful and self-aware

Have frequent self-check-ins. Be aware of how your focus and concentration may become compromised. Stay mindful of what you need to accomplish ignore any negative thinking patterns. Remember, why you chose your profession – to help others. Train your awareness to become less distracted by automatic thoughts that patterns that are self-defeating.

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