As the physical coronavirus pandemic continues to spread, an emotional pandemic is following fast in its wake. When the whole world is going to pieces, it’s awfully hard for the human mind—a fragile thing in the best of times—to cope, and more and more, doctors are reporting the spread of despair, worry and depression among their patients, especially those already suffering from some form of anxiety disorder.
Even before COVID-19 hit its shores, the U.S. was a clinically anxious place. According to the National Institute of Mental Health, just over 19% of all American adults will experience at least one anxiety disorder over any 12-month period. The fifth edition of the Diagnostic and Statistical Manual, the mental-health professionals’ bible, lists a dozen different anxiety and related conditions. Not all are likely to be especially affected by the COVID-19 pandemic, but a number are, especially obsessive-compulsive disorder (OCD), generalized anxiety disorder, social anxiety disorder, agoraphobia, acute stress disorder and separation anxiety disorder. Given that many around the world are being told by public health and political officials not to come within six feet of one another, this last one hits especially hard.
It’s too early in the coronavirus plague to know the exact extent to which anxiety disorders are on the rise, mostly because the clinical cases are lost in the much louder noise of the global panic. But anecdotally, at least, doctors are reporting both new anxieties among existing patients, and relapses among former ones. “We are seeing our clients who are prone to anxiety or depression or OCD experiencing more symptoms,” says psychologist Stefanie Sugar, a Manhattan-based practitioner.
“I’m seeing a lot of disappointment among patients,” says Chicago-based psychologist Patrick McGrath, head of clinical services for NOCD, a telemedicine site that provides online treatment with licensed practitioners for people suffering from OCD. “Someone with social anxiety disorder will say, ‘I was in the middle of treatment, I was just getting out and meeting people and this is setting me back.'”
As its name suggests generalized anxiety disorder (GAD) involves a pathological response to everyday challenges like worries over money, work deadlines, and parenting. For people with GAD, those common woes produce disabling pain, and coronavirus is surely having an impact.
“The worry becomes, ‘How do I pay my bills? What if I lose my job? What if I lose my car?'” McGrath says. “Anxiety disorders are based on two words: ‘What if,’ followed by the worst scenario your brain can devise.”
People living with post-traumatic-stress disorder (PTSD) are also feeling the impact of the coronavirus pandemic. PTSD patients live with a sort of chronic angst, and anxiety about one more mortal threat like COVID-19 can be more than they can bear. What’s more, social distancing denies PTSD patients one of their most effective therapeutic strategies: company. Detachment from family, friends, other relationships and previously pleasurable activities are all hallmarks of PTSD, according to the Mayo Clinic.
“Patients with PTSD can be isolated and often arrange for people to come by and check on them,” says McGrath. “Now no one is knocking on the door.”
People with OCD might be the most susceptible to the impact of a viral outbreak. The disorder by definition entails anxiety about germs, disease and social interactions. It’s that much harder to manage when the world tells you that, guess what, now is the time to feel that fear for real.
“The coronavirus situation is an awful recipe for some people,” says Sugar. “A core component of OCD is intolerance of uncertainty. It’s hard to know what news sources to trust, which numbers to trust.”
McGrath’s NOCD site is a leading indicator of the effect this is having. “We are currently treating 200 patients in individual sessions,” he says, “But the site includes a message board and 300 people have signed up a day in just the past few weeks.”
Others telemedicine psychotherapy services like BetterHelp and Talkspace are experiencing similar trends. “Talkspace has definitely seen an uptick in people seeking therapy—for both new and returning patients,” wrote a company spokesperson in an email to TIME. “Since mid-February Talkspace’s user volume is up around 65%.”
The usual strategies for managing anxiety disorders in general and OCD in particular don’t really work in the midst of the pandemic when hand washing and avoiding crowds are two central pillars of controlling the spread of the virus. But one more tool that can be aggressively used even now involves patients writing down their feared scenario, and regularly re-reading what they’ve written. In the case of corona it can seem exceedingly counterintuitive for the GAD patient to write the words, “Yes, I’m about to lose my job and my home” or for the OCD sufferer to write “I indeed contracted the virus from the cashier who gave me change and I’ve fatally infected my grandmother too.” But reading the words several times a day can strip them of their power.
“They’re brutal scripts to write,” says Sugar, “and they’re tremendously effective.”
As the pandemic rages, words like “tremendously effective” are tremendously welcome, no matter what part of the crisis they address. The human mind is not the principal target of the virus, but it can be very much a collateral casualty. Like all of the other such casualties of the crisis—the struggling businesses and the reeling economy and the shuttered schools—it can recover too.
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Write to Jeffrey Kluger at firstname.lastname@example.org