Authors: Drs. Dean Colston, Rebecca Fein, and Killian Kleffner
“Humans are, by nature, social animals” - Aristotle
There is a reason psychologists, healthcare and social workers cringe at the term “social distancing.” They argue it's not the best term to use during the COVID-19 pandemic. Why? Social distancing implies not socializing or connecting with others. So, the term "physical distancing" is more appropriate.
We know that loneliness and isolation are byproducts of social distancing. In fact, loneliness is a strong risk factor for high blood pressure, lower immunity, heart disease and cognitive decline. Not having strong relationships increases the risk of dying prematurely by 50%, which is greater than obesity or physical inactivity and roughly damages a person as much as 15 cigarettes a day (APA, 2017; Holt-Lunstad, 2018).
The COVID-19 pandemic has significantly changed our lives over the last six months. Many of us have been feeling a variety of emotions, such as fear, uncertainty, anxiety, insecurity, frustration, helplessness, loneliness, and even depression. Others are struggling to cope with the day-to-day disruptions in their lives. For example, we have seen a surge in unemployment claims and business closures or bankruptcies. School administrators are converting their face-to-face classes to online courses. At the same time, some politicians have once again called for shelter-in-place orders because of the increase of coronavirus cases. As of July 2020, the COVID-19 pandemic is still causing widespread concern, fear, and uncertainty.
McGinty et al. (2020) found that US adults have experienced greater psychological distress in 2020 compared to 2018. The COVID-19 pandemic is not only having a negative impact on individuals' mental health, but it is causing additional challenges for those folks with existing mental health and substance abuse conditions (Panchal et al., 2020). One negative outcome of the pandemic has been an increase in many people feeling lonely and socially isolated in their home. But why is this so challenging for us? Research has revealed that humans are biologically wired for social connection (Goleman, 2006). In other words, our brains are designed to connect with other people. So, it is important for our survival. Goleman added that we can be biological allies for our loved ones during stressful times. In other words, we have the ability to calm and comfort our loved ones, which positively impacts their immune system.
During this pandemic where physical distancing and quarantines are commonplace, social isolation has become a topic of concern because of its detrimental effects on health. Psychologists are highlighting this issue because they understand that social isolation is one of the risk factors for suicide.
Similarly, the public is experiencing increased anxiety levels. A part of this problem is that we are still learning about this new virus. Although we know more about COVID-19 today than a few months ago, we are still discovering many facets of this virus. Yet we still don't have a vaccine. Consequently, people are concerned about their health and their family's well-being.
Another issue is that public health officials and the medical community are routinely correcting misinformation that is circulating about this disease on social media sites. This is causing confusion and distrust among the public. At the same time, many people are stressed about their finances, especially if they were laid off from work due to the COVID-19 pandemic.
Furthermore, behavioral health professionals are warning us about an increase in domestic violence and child abuse cases during this outbreak (Abramson, 2020; Boserup et al., 2020). One of the challenges is that we are encouraged to stay at home unless it is for essential business. Although quarantines and lockdowns are essential to suppressing COVID-19, staying at home for victims of abuse is equally dangerous. Abramson (2020) noted that "violence in the home can also lead to adverse health and mental health outcomes, including a higher risk of chronic disease, depression, post-traumatic stress disorder, and risky sexual and substance use behaviors" (para. 3).
It is not unusual for people to ask if life will ever return to normal again. Many are asking how and whether life should return to what it once was pre-COVID-19. As we ponder these questions, steps should be taken to counter the effects of social isolation, loneliness, anxiety, fear, and depression. By understanding how the brain is functioning under stress and addressing the mental health needs associated with the pandemic, you may minimize the long-term consequences.
Underlying Brain Mechanisms
You’ve probably seen the term “COVID Brain” in the news or while doomscrolling. But what does it really mean? The term is used for people having a hard time making decisions or thinking critically or who are feeling more emotionally fragile than they used to. This “fuzzy” feeling of mental capacity occurs because of real-time changes in brain function.
A particular part of the brain (the prefrontal cortex) is responsible for complex thinking and decision making. This brain area works very efficiently when we have the full scope of information and similar experiences to compare a current situation to. For example, customer loyalty, such as going to the same grocery store (if you still go in person) occurs because it is the easiest decision for your brain to make. Choosing something familiar is easy because you have a lot of information on the store (e.g. you know exactly where to find the cheese you like) and your brain has many instances in long-term memory validating that decision.
This structure, reliable information + past experiences = decision is thrown completely out the window right now.
We don’t have all the information.
Many of us don’t have similar experiences to draw on.
To put it another way: your brain is flooded with new, often unreliable information, constantly. Your back-up system, long-term memory, is devoid of comparable experiences.
“The combination of impaired analytical thinking and heightened external sensitivity creates what can be called "Covid-19 brain"--a fragile, frazzled state that keeps our thoughts simultaneously on edge and unfocused.” - Plassman and Kessler, 2020
In other words, your brain is, quite literally, too tired to function. That’s not all. The constant state of prolonged uncertainty and trauma is also overtaxing the affective brain network.
What does this look like in the brain?
Let me introduce my friends, the neurotransmitters: these cool little things are the chemical communicators of the brain. To oversimplify, they let different parts of the brain know, according to a previous part, whether to do something, not do something, be happy, be sad, laugh. Like a microscopic game of telephone that decides what you do and how you feel.
Let me introduce their partners, the receptors: the neurotransmitters can’t send a message if a receptor isn’t there to receive it. Brain chemicals will just sit in the brain until they are broken down if they don’t attach to a receptor.
Let me introduce my frenemies - the amygdalas: these [relatively] small almond-shaped parts of the brain are part of the system that controls emotion, behavior, motivation, long-term memory, and olfaction (smelling). The amygdalas are responsible for alerting us to danger and stimulating fear before we are consciously aware of any danger. They also strengthen our memories with their associated emotions. Daniel Goleman featured this structure in his 1996 book Emotional Intelligence: Why It Can Matter More Than IQ by coining the term “amygdala hijack” which is a personal, emotional response that is immediate, overwhelming, and disproportionate to the event.
During the prolonged fear, uncertainty and trauma caused by a pandemic, our amygdalas are hijacked, our receptors can die off, and our neurotransmitters change in composition and distribution (Nummenmaa et al., 2020). Reduced activity in brain areas like the prefrontal cortex combined with increased activity in the amygdalas creates a perfect storm of brain function: difficulty with critical thinking and a spotlight focus on negative emotions and events (Janiri et al., 2020). Sound familiar?
One more question. Have you been sleeping poorly? That’s right, the vicious cycle of anxiety and sleep deprivation is also regulated by these brain areas (Ben Simon, Rossi, & Harvey, 2020).
This is not the type of “brainstorm” you want to have. The good news? There are actions you can take to protect yourself and create “neuro-resilience.”
Tools and Strategies from Dr. Rebecca
Many people are practicing mindfulness during this time. If you’re able to get your mind to slow down, this can be a wonderful tool for releasing stress, pressure, anxiety, and other troubling emotions. If you’re not having success with mindfulness, or if you’re like me and like to have a variety of tools and strategies to work with, here are some additional things to consider.
Create a distantly connected plan. Yes, I do realize how ridiculous that sounds. We are living in a time where physical distance requirements create challenges for connecting with others. One way to combat the isolation is to create a plan where you can connect with others, but from a physical distance. This might include use of Zoom to visit with friends/family, or it might include things like thinking about how the pandemic can be used to bring you new friends. Getting engaged with online groups can be difficult for some, but can provide lasting friendships to others.
Go outside. Another thing happening for people, at least in my community, is fear of being outside. My mother, for example, was horrified when I told her that I go out into my backyard without a mask. My backyard isn’t shared, and my family is all the same germ base. However, in circumstances where physical distancing isn’t possible, wearing a mask is definitely advisable (and so is washing your hands, because we know washing one’s hands is the best way to prevent disease in general). Go outside, get some fresh air.
Unplug from the world. This may sound counter intuitive, but I make times in my week where I unplug from everything and everyone, and guess what? I feel much better when I don’t need to think about how disconnected we are. If you create space to connect with yourself, you might learn many new things about yourself and the world. I can pick and choose who and when I connect with, allowing my energy to not drain off so quickly or by people, places, or things that I’m less than interested in.
Services are available now for people to get therapy, doctor visits, and who knows what else via the internet, but the reality is what is getting lost is connection. Human connections are very important at all stages of life. If you’re struggling to connect with people right now, ask yourself if you’re struggling to find people to connect with, or if you’re struggling with how to connect during this time? These are two different struggles and need to be addressed in two different ways. Video conferencing doesn’t offer hugs and is not a substitute for Friday night parties with friends, but it does provide a way to connect with others that provides safety for all.
Abramson, A. (2020, April 8). How COVID-19 may increase domestic violence and child abuse. APA. https://www.apa.org/topics/covid-19/domestic-violence-child-abuse
American Psychological Association. (2017, August 5). So lonely I could die. APA. https://www.apa.org/news/press/releases/2017/08/lonely-die
Ben Simon, E., Rossi, A., & Harvey, A.G. et al. (2020). Overanxious and underslept. Nature Human Behaviour, 4, 100–110. https://doi.org/10.1038/s41562-019-0754-8
Boserup, B., McKenney, M., & Elkbuli, A. (2020). Alarming trends in US domestic violence during the COVID-19 pandemic. The American Journal of Emergency Medicine, S0735-6757(20)30307-7. Advance online publication. https://doi.org/10.1016/j.ajem.2020.04.077
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Holt-Lunstad, J., (2018) The potential public health relevance of social isolation and loneliness: prevalence, epidemiology, and risk factors. Public Policy & Aging Report, 27(4). https://doi.org/10.1093/ppar/prx030
Janiri D, Moser DA, & Doucet GE, et al. (2020). Shared neural phenotypes for mood and anxiety disorders: A meta-analysis of 226 task-related functional imaging studies. JAMA Psychiatry, 77(2):172–179. doi:10.1001/jamapsychiatry.2019.3351
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Nummenmaa, L., Karjalainen, T., & Isojärvi, J. et al. (2020). Lowered endogenous mu-opioid receptor availability in subclinical depression and anxiety. Neuropsychopharmacology. https://doi.org/10.1038/s41386-020-0725-9
Panchal, N., Kamal, R., Orgera, K., Cox, C., Garfield, R., Hamel, L., Muñana, C., & Chidambaram, P. (2020, April 21). The implications of COVID-19 for mental health and substance use. Kaiser Family Foundation. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/
Plassman, H., & Kessler, B. (2020, July 7). Battling ‘Covid-19 Brain.’ INSEAD Knowledge. https://knowledge.insead.edu/blog/insead-blog/battling-covid-19-brain-14626