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Epidemiology for public health
Istituto Superiore di Sanitŕ

 

Epidemiology for public health - ISS

COVID-19: coping with stress at home and in the family

In an emergency like the current COVID-19 pandemic, our fear of the new and unexpected situation and its potential impact on our health and that of our family, combined with the need for social isolation, causes an inevitable feeling of loss of control, thus triggering stress reactions. Obtaining clear information and following recommendations, however, can help us regain control of our lives, increasing our capacity to respond in a positive way and reducing the anxiety and distress caused by uncertainty in a rapidly-evolving situation.

 

On 6 March 2020, the World Health Organization (WHO) issued some recommendations to help people cope with stress during the COVID-19 global health emergency, which were summarized by two infographics. The information below expands on those documents to describe healthy behaviours to manage stress and mitigate anxiety, and is intended for people who are currently confined in their homes, especially parents of children aged 0 to 3 years.

 

How can we prevent fear from turning into distress?

When faced with danger, fear is our friend: without fear, the human species would have probably become extinct, overwhelmed by danger. Excessive fear, however, makes us vulnerable. Following the advice that we are given is a way to acknowledge the role of fear without being overpowered by it. Sadness, distress and even panic are understandable emotional responses, but they arise from  unrealistic assessments. We often experience catastrophic thoughts when we are at our most vulnerable, such as during periods of inactivity or at night. We can see them as “lies” created by our brain, which our reason cannot always overcome. When a threat is visible, we are instinctively inclined to run away from it: the further we go, the less fear we feel. In this case, however, the threat is invisible and fleeing is impossible because we would not know where to go. All we can do is push the threat as far away from us as possible. But how? Engaging in those virtuous behaviours that we are reminded of every day: staying at home as much as possible, maintaining a safe distance from others, washing our hands frequently without fear of overdoing it, limiting physical contact also within our families. The more we adopt these behaviours, the more protected and reassured and less anxious we will feel.

 

We are what we think. Our emotional responses, and thus our feeling well or unwell, also depend on our perceptions and imagination. Therefore, it is easy to understand that, in order to feel well, we should redirect our thoughts towards things that give us pleasure, and keep our mind distracted engaging in activities that we enjoy: reading, chatting, cooking, caring for our plants or pets, making video calls to friends and relatives.

 

Beware of autosuggestion

When we are in a state of alert, and maybe also of sensory deprivation due to boredom or lack of ideas, we may be more prone to exaggerate our normal feelings and have disproportionate and inappropriate responses. The difficulty is in understanding if we are overreacting. Then, we should try and ask ourselves what we would think if that feeling or behaviour were expressed by a member of our family (wife, husband, child). This “redirection” usually allows us to take a more objective and rational position. From this position, we can think about what we could do to successfully reassure our loved one. This could also help us find a way to reassure ourselves and reduce our levels of anxiety.

 

I must stay at home. What can I do to pass the time?

We may have to stay at home, but we can still access the world outside, talking to whoever we want, reading and watching what we like, and even shopping in virtual stores. In other words, using all the numerous options made available by our technology. Alternatively, we can take the opportunity to rediscover the pleasures of family life, go about our daily routines at a slower and more enjoyable pace, share activities, and dust off old games from a time when we relied less on technology.

 

If we are lucky enough to have a garden or a balcony with plants, gardening or redesigning that space can be quite relaxing. If not, we can use a windowsill to grow herbs for cooking. Caring for our pets can also be helpful: a relationship with an animal is often as rewarding as our relationships with other human beings. Finally, engaging in physical activity also at home is important to preserve our physical and mental health.

 

Tips for mums and dads with infants and small children

“By taking care of your physical and mental well-being, you are also caring for your child”

During this period of forced isolation, also mothers and fathers with infants or very young children have been asked to change their lifestyles and stay at home with their little ones. We should make the most of this time to enjoy the company of our loved ones in our new and unusual lives.

 

This period could also lay bare our vulnerabilities, and many fears and anxieties that are common among new mothers and fathers may emerge in an excessive and uncontrolled way. We may be feeling sad, stressed or confused, or we might think that we are unable to protect our little ones. Here are some tips for mums and dads with infants:

  • Play some relaxing music, sit your child on your belly and try breathing slowly while cuddling them: this will help you both relax
  • Take long and relaxing showers and practise breathing exercises, especially in the evening before going to bed
  • Close your eyes and allow yourself a five-minute mental holiday to a place of your choice
  • If possible, spend some time outdoors with your child
  • When changing their nappy, take the opportunity to give your child a soothing massage
  • Don’t worry about not finding stimulating activities for your child: what they enjoy the most is your company
  • Try and carve out some space for yourself when your child is sleeping: read a good book, look after yourself, try to sleep or at least rest
  • Take care of your appearance: dress well, spend some time putting on your make-up
  • Listen to good music
  • Dance with your child in your arms
  • Try to maintain a healthy diet, which includes natural and fresh food
  • Don’t neglect your needs: your child is important, but you come first. If you are not well, your little one could also be affected and you could feel worse
  • Play recordings of natural sounds, and listen to them when settling your child to sleep
  • Don’t feel guilty if you experience a sense of inadequacy: negative thoughts can be changed and will not prevent you from being a good mum or dad
  • Allow your partner some private time with your child
  • If you have worries, set aside a specific time in your day to deal with them: fifteen minutes while the child is sleeping. Making notes of them may help.
  • Remember that this emergency situation is temporary
  • Practise reality-based thinking
  • Don’t interpret any physical symptom as the sign of a more serious illness
  • Observe your child to monitor their progress.

Here are some tips for mums and dads with children aged 1 to 3 years:

  • Establish regular daily routines
  • If your child is crawling or has started walking, promote these highly rewarding activities
  • If possible, spend some time outdoors with your child
  • Alternate dynamic activities (like pillow fights, floor exercises, dancing together) with more relaxing ones (drawing, playing with building blocks, reading fairy tales), and moments when you will simply encourage their independence
  • Bake cookies or cakes with your child, or let them help you with other simple tasks
  • Observe your child trying to identify their favourite activities
  • Talk to your child frequently, teaching them new words
  • Involve your partner in activities with the child
  • Make phone or video calls to relatives and friends.

If you still feel sad and discouraged, and think that you need help, don’t hesitate to contact your doctor and paediatrician.

 

 

Publication date: 7 April, 2020

Authors: Francesca Cirulli, Fiorino Mirabella, Gabriella Palumbo, Laura Camoni, Alessandra Berry, Sonia Brescianini, Emanuela Medda, Barbara Collacchi, Marta Borgi, Nadia Francia, Centro di riferimento per le scienze comportamentali e la salute mentale - ISS