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Manage Yourself During the Pandemic


Don't forget to remember yourself during the COVID-19 pandemic.
 
By Jennifer Kirby, senior editor

Consider these 10 action steps to keep yourself mentally strong
 
            By the time of this writing (late-April), you’ve, no doubt, set up a system to operate your practice remotely; created signage for your physical practice and your practice website regarding modified office hours; discussed changes with your employees; called vendors and got your banking in order; among other small business management items, as a result of the COVID-19 pandemic. Have you managed yourself, though?
            “When we’re in a place of threat, our bodies and brains send signals we feel as anxiety,” explains Catherine Lanteri, M.D., a psychiatrist at Lanteri Coaching and Communication (www.lantericoaching.com), in Lexington, Mass., and a member of the Academy of Organizational and Occupational Psychiatry (www.aoop.org). “Right now, we are all feeling anxious because the COVID-19 pandemic threat is on multiple levels; be it our personal safety, the safety of those we love, the safety of employees and the safety of our livelihood. In the midst of this, we need to remember to take care of ourselves.” 
            With this in mind, Dr. Lanteri and her mental health colleagues provide specific action steps private-optometry practice owners can take to manage and take care of themselves during this unprecedented time. 
 
1List Your Concerns
            
It can be helpful to list your concerns regarding COVID-19, so you can watch for any catastrophic thinking or exaggerated thoughts, offers Dr. Lanteri.
            “During a crisis, our thinking can become black and white. Listing your concerns can help you watch for this. Check your list against reality. Break concerns down to a granular level, and focus on what you can control right now. Then make a plan and carry it out,” she explains.
            In the case of optometry, O.D.s can’t control state-wide “stay-at-home” orders, but they can control messaging to patients about openings for emergent care and telehealth visits.
            Seeing the reality of the situation, vs. one’s fears about it, helps to prevent a person’s anxiety from driving a negative behavior, adds Paul S. Hammer, M.D., staff psychiatrist at Island Hospital, in Anacortes, Wash., and a member of the Academy of Organizational and Occupational Psychiatry. This practice also can aid the person in seeing that the situation is not as bad as it seems — and is temporary.
 
2. Tap Into Past Strengths
            Think about one or more times when you overcame a past crisis or challenge, focusing on what allowed you to surmount it, suggests Dr. Lanteri. Doing so enables you to tap into the abilities you already have. 
            “Look at the strengths you’ve used to overcome past challenges and ask yourself, ‘how can I use them to meet today’s challenges?’” she explains.
            For private-practice optometrists, it may make sense to think back to how they overcame the financial crisis of 2008.
 
3. Keep in Touch With Staff and Patients
            Try to reach out, via email or phone, to staff and patients regularly to let them know of your intentions during this time and what you are doing, recommends Dr. Hammer.
            “Let staff know, for example, that you applied for a Payment Protection Program loan, and let patients know, for example, that you are still available to provide eye care,” he explains. “Maintaining such connections will not only help you to feel less anxious, they will also be reassuring to staff and patients during this difficult and isolating time.”
            Nick Thomarios, DO, MBA, FAPA, who is a Medical Director at Molina Healthcare, a psychiatric consultant and current president of the Academy of Organizational and Occupational Psychiatry, suggests not sending difficult emails to staff (layoffs) or patients (delayed frame orders) immediately after you write them, so you can go back with a less emotional head and make sure what you’re conveying has the right tone and message.

4. Talk to an Objective Listener
            Dr. Lanteri recommends talking to people in addition to optometrists about fears regarding COVID-19 and the practice, as such contacts won’t “feed” into your anxieties.
            “An objective listener can help you look at the situation using an analytical vs. an emotional thought process,” she explains. “We know that anxiety gets in the way for making sound decisions and also limits our ability to accurately see the future. Maybe this person is your spouse, a best friend from college or a neighbor.”

5Reframe the Situation
             Try to focus on the positive aspects of the COVID-19 pandemic, suggests Dr. Hammer.
            “If you have children, for example, you now have the opportunity to play board games with them,” he offers. “If there’s a project around the house you’ve wanted to get done, or even practice administration stuff (e.g. accounts receivable, frame inventory, etc.), you may now be able to do these things.”
            Dr. Thomarios adds that you could also use this time to host an event with colleagues, via one of the many video platforms, where you bounce ideas off of each other regarding different aspects of practice; for example, making telehealth visits work.

6. Go on a News Diet
             If your go-to news channel remains on for a majority of the day, consider picking one or, maybe, two times, maximum, to tune in, recommends Dr. Hammer.
            “The news is creating a lot of added anxiety right now,” he says. “Even the tone and demeanor of the newscasters engender this urgency and feeling of the world is coming to an end. As a result, if you are already anxious, you should avoid getting sucked into that.” 
            Dr. Thomarios suggests it may be wise to limit one’s social media use as well, due to this medium’s ability to amplify anxiety.

7. Structure Your Day
             A busy mind is often a happy mind, notes Dr. Hammer. For this reason, he recommends scheduling your day, particularly if your brain has a tendency to wallow in worry.
            “Get up at the same time you normally would during the work week, get dressed, have a cup of coffee and then plan projects for the morning — maybe clean the gutters — the afternoon — maybe mow the lawn, garden — eat a good, healthy lunch and then go for a walk or participate in some other form of exercise,” he says. “In addition to keeping the mind busy, it helps, mentally, to be able to take charge of something in the midst of things you have no control over.” 
            Dr. Lanteri adds that exercise, be it jumping jacks in your home, long walks around your neighborhood, or something more rigorous, such as running, reduces levels of stress hormones and creates endorphins, which are natural pain killers.
            The Mayo Clinic (https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469) suggests at least 150 minutes a week of moderate aerobic activity (such as brisk walking or swimming) or 75 minutes a week of vigorous aerobic activity (such as running) for most healthy adults. 
            If you are able to work from home, do lunch breaks and wrap up your work at the time you normally would, Dr. Thomarios adds. This prevents getting into a habit of working all the time, which can exacerbate stress. 
 
8. Schedule Wind-Down Time
            Roughly an hour to 45 minutes before you normally go to sleep, perform your normal evening routine of shutting the windows, locking the door — whatever it may be — brush your teeth, get into your pajamas, and read a physical book vs. using a Kindle or viewing any sort of screen, recommends Dr. Hammer.
            “I would also consider writing a list of what you’re worried about in a journal, closing the journal and then saying out loud, ‘I can’t do anything about these things tonight, so I’m not going to think about them tonight,’” he says.
            Dr. Lanteri adds to be mindful of alcohol intake:
            “Alcohol is something that, when used in moderation can be enjoyable and reduce stress. But, alcohol intake can also disrupt sleep and lead to irritability and even depression if you drink in higher amounts,” she cautions.
            If you’re looking for additional methods to help you achieve a good night’s sleep, Dr. Thomarios recommends deep breathing exercises (see: bit.ly/2VfVwci, as an example); Dr. Hammer suggests daily exercise (mentioned above); and Dr. Lanteri recommends the slew of mindfulness and meditation apps that you can download via your digital devices.
 
9. Watch for Depression
            The following are signs of depression, according to the American Psychiatric Association:
            • Feeling sad or having a depressed mood
            • Loss of interest or pleasure in once-enjoyed activities
            • Changes in appetite: weight loss or gain unrelated to dieting
            • Difficulty sleeping or sleeping too much
            • Loss of energy or increased fatigue
            • Increase in purposeless physical activity, such as hand-wringing or pacing or slowed movements and speech, as observed by others
            • Feeling worthless or guilty
            • Difficulty with thinking, concentrating or decision-making
            • Death or suicide thoughts
 
10. Seek Professional Help
            Symptoms of depression for two weeks often prompt a diagnosis of the condition, so you should consider seeking professional help, if this is you, say those interviewed.
            To find such support, Dr. Lanteri recommends reaching out to your primary care provider for the names of psychiatrists or psychologists. She says to ask other caregivers and trusted friends. If those avenues don’t work, she suggests visiting your state’s psychiatric society for recommendations or even looking online. 
            She adds that mental health professionals are working hard during this time to provide telehealth appointments.
 
This Too Shall Pass
            “What we know about trauma from the military and others is that using resilience skills while in the midst of something that is traumatic can have a significant impact on reducing residual injury of trauma,” explains Dr. Lanteri. “Appreciate this is a time of anxiety. Tapping into your strengths, using your mind, body and spirit, can make a big difference in how you experience this pandemic and how you come through it.”  OM

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