Psychological stress: coping with the pandemic and quarantine

17 April 2020

Top behavioural neuroscientist Professor Nick Rawlins has a warning for us all: spending hours and hours online to glean information about the coronavirus pandemic is potentially harmful to mental health.

Rawlins, a Professor in the Psychology Department at Chinese University of Hong Kong (CUHK) and Professor Emeritus of Behavioural Neuroscience at Oxford University, said earlier research into the psychological impact of the 2003 SARS epidemic on hospital employees in Beijing had found that a person’s level of knowledge and awareness of a disaster influenced how they perceived the potential risk.

The results of that research, conducted by a Chinese and US team and published in The Canadian Journal of Psychiatry in 2009, could be extrapolated to the COVID-19 pandemic.

“I think there’s a good argument we should not be obsessively trawling the internet. Some of the data on the after-effect on people who have gone through the SARS epidemic [suggests] one of the things that seems to have been associated with bad long-term outcomes is spending a lot of time on the internet,” he said.

Rawlins, also Master of Morningside College at CUHK, said the study found that while spending considerable time on the internet increased the risk, time spent watching television did not. It even reduced the risk – probably because distractions at such times are good for us.

The post-SARS survey of 549 randomly selected employees of a Beijing hospital was carried out in 2006, three years after the main outbreak took place. About 10 per cent of respondents had experienced post-traumatic stress (PTS) since the outbreak, with those who had been quarantined, worked in high-risk locations, or whose friends or relatives had contracted SARS two to three times more likely to have PTS symptoms. Symptom levels were significantly positively associated with their risk-perception.

The team also found PTS levels were reduced if the person had an altruistic view of why they were doing such work – a finding with lessons for the COVID-19 pandemic, Rawlins said.

Such a selfless acceptance of risk protected well against long-term consequences, he noted. Giving a point to what people were doing made it easier to cope; and this could be compared to self-isolation. “If you feel it is a contribution to others, that may help with the long-term outcomes,” he said.

In addition, substantial amounts of pre-existing data have indicated that humans prefer known risk to uncertainty. “It is sometimes better to know what is happening even if sometimes what you have just discovered is what you are most frightened of.”

Rawlins said it was obviously rational for those who saw their livelihood being blown away by COVID-19 to worry. “I think it is almost inevitable that the concerns about the economic effects would have a long-lasting effect on a number of people.”

Steps to better mental health by Nick Rawlins

1) Be proactive in helping to improve your mood. Activities ranging from psychological exercises to physical exercise can help. 2) Humans particularly dislike uncertainty, preferring clear answers even if they aren’t the ones we were hoping for. Understanding more about the science of COVID-19 can help. 3) Viruses can be contagious but so can fears. Try to minimise the risk that you might generate and spread anxieties. Media awareness really matters, not just in what you read but also in what you write. 4) You can almost certainly help others, and they can help you, by being considerate and understanding. Both giving and receiving feel good. So, choose to be kind.

However, if people in quarantine because of exposure to the virus were given positive feedback – for example, halfway through telling them they had carried half the risk – this could help reduce their anxiety and make it more bearable. “There is a lesson there for authorities.”

Rawlins drew attention to a review of the psychological impact of quarantine and how to reduce it, published in The Lancet in February 2020. The King’s College London review team found that quarantine was often associated with long-lasting negative psychological effects. Providing adequate supplies and giving people as much information as possible were among strategies to mitigate them.

Uncertainty about when supplies would resume was an important factor, he said. “There are a lot of things that worry people if they are in isolation of any sort, and one is, ‘how am I going to get the next bit of what I need?’.”

It was completely rational to be anxious about what was going on, Rawlins explained. But the anxiety itself could become highly destructive so it was important to avoid allowing it to become worse – by getting into a spin, for example. “Learning how to manipulate your own anxiety levels will help you get through all this.”

Ironically, given the online potential for over-provision of information, part of what we can do is maintain social interactions electronically. However, Rawlins had one additional piece of advice: “Not passing on, explicitly or implicitly, anxiogenic rumours is important,” he said.