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How might COVID-19 affect people experiencing mental health conditions?

We ask how COVID-19 might affect people experiencing mental health conditions, drawing on a case vignette.

In this, and the following step, we will hear Kevin’s story. We explore some of the key factors in his experience and consider the experiences of other people experiencing mental health conditions.

Let’s start by hearing from Kevin, who you will notice is struggling with restrictions caused by lockdown.

Kevin’s Story

This is an additional video, hosted on YouTube.

Download Transcript of Kevin’s Story (right click or tap/hold and open in new tab)

Thank you for listening to Kevin’s story. Please feel free to comment at the bottom of the page. Let learners know what Kevin’s story brings to mind.

Survival response or mental health condition?

We must recognise that, like Kevin, we are all either current or potential users of mental health services. The usual responses to threat and uncertainty (fight-or-flight) that you have just learned about sit on a continuum with more distressing thoughts, behaviours, and emotional states associated with mental health conditions.

This is particularly true of mild to moderate mental health conditions relating to depression and anxiety, such as panic disorder, a single depressive episode, or generalised anxiety disorder.

Obsessive Compulsive Disorder, for instance, is characterised by ritualistic behaviours or compulsions (e.g. checking or washing) that neutralise the threat of unwanted intrusive images, ideas, or fears. Some of the compulsive behaviours seen in individuals with OCD sit at the extreme end of a continuum of adaptive responses to threat.

Checking and washing, for example, are not random behaviours. They are precisely the responses we have all been told to engage in to prevent the threat of infection, and many patients with an existing diagnosis of OCD were early to react to the calls for increased cleanliness, distancing and avoidance, which are seen as adaptive responses to the crisis. It is important to state, however, that while aspects of this condition can feel relatable, the unique challenges faced by individuals with OCD, and other mental health conditions, do ultimately lead to distinctively distressing experiences. For someone with OCD, thoughts about washing don’t stop once the tap is turned off, so statements such as, “I’m a bit OCD”, are still as unhelpful as ever.

Often it is the intensity of potentially adaptive responses, or our relationship to them, that is distressing, rather than the response itself.

Sadness, anger, and panic are three completely appropriate emotional reactions to the uncertainty and exposure to threat that we are currently experiencing. These are unpleasant states that we may wish to avoid. For some of us, however, they are intensely terrifying states that are embodied reminders of unsafe experiences or memories. This can be for a range of reasons, including previously upsetting or traumatic events.

Many of us have coping strategies to avoid feeling vulnerable. We may ‘keep busy’, or ensure we are always working towards our next goal or achievement. More problematically, we may use drugs and alcohol or avoid intimate relationships.

For people who find certain emotional states difficult, feeling them during this difficult period can bring on that same fear response we have heard about before. Currently, there are fewer opportunities for distraction or avoidance. Thus, some of us have a double threat – an external fear of the virus, but also the internal threat of unfamiliar bodily changes that are signs of the onset of emotional vulnerability.

Pause for thought

In summary, as we all respond to the threat of COVID-19, our adaptive and automatic responses to threats can increase mental distress.

  • People managing emotional difficulties and mental health conditions may face additional challenges and complexity
  • Other people may experience emotions that are harder to cope with or bring back previous negative experiences

“I was right to be afraid” – The pandemic as confirmation of an unsafe world?

We’ve established that mental health conditions can be on a continuum with adaptive responses. Things become more complex when, for individuals with OCD or other mental health conditions, COVID-19 seems to confirm an existing belief or idea about the world – “See, I told you it was unsafe”. We see this in Kevin’s story, and will hear more about this difficulty on the following page when Dr. Jo Stubley discusses trauma.

Psychological therapy often explores these long-held ideas, beliefs, and habits, which may originate as a way of protecting ourselves. Therapy is ideally undertaken sensitively and in a safe and consistent environment. The following sections will touch on current disruptions to mental health services, and next week you will hear more about how to begin thinking therapeutically about individuals like Kevin.

© Maudsley Learning © Tavistock & Portman NHS FT
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COVID-19: Psychological Impact, Wellbeing and Mental Health

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