Coronavirus (COVID-19) and the mental health of cancer patients

Authors: Dr. Vanja Putarek, MA in Psychology; Antonija Vrdoljak, MA in Psychology

COVID-19 has spread across Croatia over the past month and its effects on various aspects of our lives and society in general are already being felt. In addition, in addition to the direct threat to physical health, this emergency situation also has negative consequences for mental health. Uncertainty, changes in routine, social isolation are just some of the sources of problems for our mental health. Among the vulnerable groups to contracting this virus are oncology patients, for whom it is therefore very important to preserve their mental health in order to cope with this situation as easily and effectively as possible, and thus try to avoid further endangering their immune system.

Among the key difficulties related to mental health in the midst of the pandemic are various worries about the COVID-19 virus, such as worries about one's own health and life, as well as the health and lives of loved ones. Worries, as one of the aspects of anxiety, are experienced by each of us almost daily and more or less successfully cope with them, but in the current emergency situation, worries can be very intense, disruptive and disturbing. They often involve a question that begins with the words “What if…?”. This question is difficult or even impossible to answer, and the answers we come up with are just our predictions that give us a false sense of security and control and can temporarily calm us down. However, one “what if” question leads to another, then a third, a tenth, and so on, which ultimately does not calm us down, but rather upsets us. Sometimes we think that worrying will protect us and prepare us for possible future problems. Sometimes we may even think that things will go badly if we do not worry, and therefore irrationally conclude that worrying is okay and that it is best for us to anticipate the worst-case scenarios. So, with worrying, we try to bring a sense of security and control into situations in which no security and control can be guaranteed.

Therefore, in order to cope with worries, it is important to first notice which worries come to our mind and write them down. For each of these worries, we can see how productive and how unproductive it is. Productive worries are those that we can actually influence; e.g. we can influence how we organize our day, what we will do, that we will follow the instructions of experts related to COVID-19. Unproductive worries are those that we cannot influence; e.g. what will happen if this situation continues, what if my parents get sick. For unproductive worries, it would be useful to write them down once a day on paper or a computer, and not just think about them. We need to set aside a certain time interval, for example 20 minutes a day, to write down these worries and think about them. Let's set aside some time in the day that will be the same for us every day and during which we will worry about the various things that bother us. When worries come to mind during the day, let's remember that at that moment it is not the time to "worry" and write down the worries, that we will do it when our scheduled 20 minutes come. For example, when we are studying and worries come to mind, let's remember that it is not the time to "worry" and that we will return to these worries later.

When the anxiety that overwhelms us is intense, we can also apply relaxation techniques, such as abdominal (deep, “from the belly”) breathing. Breathing supplies the body with oxygen (when inhaling) and removes carbon dioxide from the body (when exhaling). When thinking about illness, we may feel increased anxiety and breathe rapidly and shallowly (with the upper part of the body, “from the chest”). Rapid and shallow breathing can lead to an imbalance in the level of oxygen and carbon dioxide. Abdominal breathing leads to a balance of oxygen and carbon dioxide levels, slowing the heart rate and making the person feel more relaxed. In addition, during abdominal breathing we concentrate on breathing properly so that we do not have time to think about the sources of worries. Abdominal breathing is performed as follows: a person inhales deeply through the nose for four seconds, then holds the air for two seconds and exhales for six seconds. It is important to relax the jaw (do not clench your teeth tightly), to make the exhalations last longer than the inhalations, and, if possible, to sit down and make yourself as comfortable as possible. To make it easier to follow the breathing "from the belly", we can place one hand on the belly and the other on the chest. Another relaxation technique that can be used to reduce anxiety is to visualize (imagine) a scene in which the person feels calm, relaxed and comfortable (e.g. a person can imagine a sunset on the beach during the summer, with the sound of the sea and the shimmering of the sun's rays on the gentle waves). It is important to imagine the scene in as much detail as possible and to try to concentrate on as many different parts of the scene as possible.

In situations of severe anxiety, when visualization may be difficult, a grounding technique is useful - for example, using our five senses. The person should name five things they see around them, four things they can touch, three sounds they can hear, two smells they can smell and one taste. In this way, we stay in the present moment and distract ourselves from worries when they become excessively intense and overwhelming.

All of these techniques are easy to use, we can use them anywhere and in any situation, and we can use one of them or a combination of different ones. They are not a substitute for therapy, but they can greatly facilitate the handling of worries and increase control over our emotions.

In addition, in order to reduce the likelihood of worries occurring, it is important to eliminate sources of these worries, such as information from the media. It is recommended to be exposed to the news twice a day, for example in the morning and evening. Frequent exposure will not increase our readiness to deal with this situation, and information does not actually change as often as it seems to us, so we will not miss anything important. The consequence of frequent exposure to the news is an increase in the level of negative thoughts and worries.

In conclusion, it is important that in this extraordinary situation we try to introduce a routine, think and deal with things over which we have control, and try to learn how to deal with stress and anxiety.

Continue reading: I have cancer - what do I need a psychologist for?

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