Been quite the week here with #CoronaVirusSeattle #COVID19. As Psychology Director in the @UWMedicine #MultipleSclerosis Center, my colleagues have reached out with questions like, “Our patients are really concerned and I just don’t know what to tell them.” Long thread to follow:
I don’t have the magic answer, but I do have some thoughts that can hopefully be helpful for everyone. We have been doing work over the past 5 years on how people cope w/uncertainty and how to help people cope better w/uncertainty. Here are related recommendations:
1. Understand that (a) ⬆️ uncertainty causes ⬆️ distress & (b) uncertainty w/ a threat to one’s wellbeing causes ⬆️⬆️ distress. Therefore, we should anticipate that most everybody is experiencing ⬆️ distress. This is unpleasant, but also expected & normal.
2. We don’t want people to be distressed for long periods of time (it is obviously detrimental), but distress itself is not as impactful as how people *respond to* the distress and the impact of that response on their functioning, quality of life, & wellbeing.
3. We know that people respond to distress in many different ways. Some people try to avoid thinking about it and pretend it is not there. Other people focus endlessly on it. And others reside somewhere in between, learning to co-exist with it.
3a. Avoiding thinking about distress does not work – the problem does not go away and the person risks not doing the things within their control to make the situation better.
3b. Worrying endlessly does not work – if it is an unsolvable problem, worry will not produce a solution. Some find initial comfort in worry because it gives them a sense of control, but ultimately it is wasted energy, ⬆️ distress, and ⬇️ functioning, quality of life, & wellbeing
3c. The 🎯 is in between, where one acknowledges the distress, controls the controllables, and learns to coexist with the distress. This allows people to continue to function at their highest, attain their best quality of life, & live with their greatest sense of wellbeing.
4. Helping our patients move from the ends (avoidance or endless worrying) to the middle of the coping continuum is more important than eliminating the distress (which is impossible anyway!). A few suggestions:
4a. Guide the controlling of the controllables. Things are changing constantly, but it is important to clearly communicate the current recommendations. Being clear, concise, & direct will be a calming force. Directing them to what they can do will ⬆️ their sense of control.
4b. Help them improve their ability to coexist with their distress. Once they have controlled the controllables, guide patients towards doing things that improve their wellbeing (social support, hobbies, exercise, enjoyable activities, good sleep, etc.)...
... and guide them away from things that reduce their wellbeing (worrying, checking the internet endlessly, watching the news endlessly, etc.). Be a partner they can trust, knowing that if they need more help, they can come back for more help later.
The silver lining for our #MultipleSclerosis patients is that many have developed the skills to deal w/this. For patients skilled at managing their MS, this requires a transfer of skills. For those struggling to cope with their MS, this is an opportunity to build their skill.
We have a long way to go and the distress will persist. But I have a lot of confidence in my colleagues, our patients, and our community - we will handle this the best we can.
