We are not wired to tolerate uncertainty – and these are the most uncertain of times. But while increased anxiety is only natural, we can all adopt strategies to control it Emine Saner Emine Saner @eminesaner Sun 22 Mar 2020 14.00 GMT Last modified on Sun 22 Mar 2020 18.50 GMT Shares 1,185 Comments 819 AnxietyCollageForWeb Illustration: Guardian Design Just over a week ago, our world looked very different from how it does today. The shift has been so rapid and frightening, it feels as if the ground beneath us has given way. It is disorienting, as if normal life is just over there, out of reach. I have been through two major bereavements, close together, and this has the same unanchored feeling of grief. The human brain is not wired to tolerate uncertainty, but it is wired to be alert to any threat. So, if you are feeling pandemic panic, it is only natural. Blame your brain. For most of us, life has never felt more uncertain, and uncertainty is, according to a 2016 study by neuroscientists at University College London, an even more stressful state to be in than actually knowing something bad will happen. It may explain – if you’re young-ish and otherwise healthy – why you may be almost hoping to contract Covid-19, just to get out of that will I-won’t I? mental tussle. Those of us who are older or more vulnerable don’t have such a privilege. According to Robert Leahy, the director of the American Institute for Cognitive Therapy and author of The Worry Cure, we are all locked in “an international human trauma, where everybody has a sense that their life, or the lives of people they love, is threatened”. When we are anxious, he says: “We tend to equate uncertainty with the worst outcome. For example, after 9/11, I heard so many people say it’s inevitable that there’s going to be another major attack on New York City, or a nuclear attack by al-Qaida. That never happened. When we’re anxious, we tend to treat the uncertainty as a bad outcome. But uncertainty is neutral – we don’t know what’s going to happen.” We want to be assured the way our world looks when we get up in the morning is the way it will look when we go to bed Prof Daniel Freeman We can look to what has happened in other countries with understandable horror, but we can also hold on to the fact that measures such as testing, social distancing, quarantining and travel restrictions seem to have some effect, and that at some point, there will be potential treatments. None of this is to underplay the seriousness of the pandemic, and the many lives that have already and will be lost. But the point is that at the moment, nobody really knows what is going to happen. Most of us crave stability. “We want predictability,” says Daniel Freeman, a professor of clinical psychology at the University of Oxford. “We want to be assured that the way our world looks when we get up in the morning is the way it will look when we go to bed. And if change occurs, we prefer it to be on our terms.” But sometimes life has other ideas. Advertisement “We have to come to terms with such uncertainty,” he says. After all, we already live with plenty of uncertainty and lack of control, even if it is on a much smaller scale, such as driving a car or being a passenger in one. “We have to accept that no action is 100% risk-free and that we can’t totally control events, no matter how much we try. No matter how much we worry, we can’t know what’s in store for us. And we can’t prevent problems happening just by worrying about them. In the end, it is best to concentrate on what is meaningful in our lives.” As a lifelong catastrophiser, and despite knowing with hindsight that in every instance, my imagined worst-case scenarios didn’t come true, my worry doesn’t feel unwarranted at the moment. The question is: how helpful is it? Not very. “We know that this is a dangerous virus,” says Natasha Page, a therapist and member of the British Association for Counselling and Psychotherapy. “But are we catastrophising about some things? Are we trying to predict what the outcome is going to be? It can be helpful to think about what the best-case scenario could be as well. Anxiety can be a helpful emotion to have – it can help us to keep safe and do the right things – but fixating on the worst outcome is not a healthy thing to do.” (Unless, of course, you’re one of those in charge of stopping the spread.) Coronavirus: the week explained - sign up for our email newsletter Read more Constantly checking the news may feel like a way of asserting control over events, says Freeman, but it can exacerbate anxiety. “Knowledge is power. So make sure you get your information and advice from the very best sources. You’ll also have to keep checking in to make sure your plan fits with the expert advice. There is an obvious temptation to seek out information all the time, but although this may be helpful as you first orientate yourself to what is going on, a moment comes when we need to put limits on it.” Advertisement He advises creating a plan in order to make it easier to deal with anxious thoughts so “we have formed our response and know what to do. A little time worrying isn’t necessarily a problem, as it may alert us to modifications we need to make, but too much time spent worrying skews our thinking. We catastrophise when we worry, leading to less measured responses.” Freeman suggests constraining worry to one or two set periods each day. “When worry comes at other times, just note the thoughts down, then don’t fight them but let them go. Notice the worry, acknowledge it, but don’t let it distract you. Stay as calm as you can, focus on what you’re doing and not what you’re thinking, and watch the worry recede into the distance.” ‘Try to be the person who calms a friend or partner down, and don’t buy everything in the supermarket.’ Facebook Twitter Pinterest ‘Try to be the person who calms a friend or partner down, and don’t buy everything in the supermarket.’ Photograph: Greg Blatchford/REX/Shutterstock With understandable concerns about job security and how you will survive financially, “try to take as much control as you can over the situation,” says Page. “We know there are things being set up in order to help people with mortgage or rent payments, and help for businesses. Get yourself well-informed and think about what you might need to plan for.” If you are reading this piece, chances are you are currently healthy. “Remind yourself that in this moment you are safe and well,” says the therapist Eve Menezes Cunningham. “Anxiety is defined by fears around the future. With a pandemic, no one’s imagining that future is going to be all sunshine and rainbows but at the same time we don’t know how it’s going to pan out.” When we’re anxious, she says, we typically try to control more, but so much is now beyond our control. “We can only control what we are doing – staying at home for the sake of more vulnerable populations, if you’re not already self-isolating because you are part of a more vulnerable population – not stockpiling. Be kind to yourself – anxiety is a normal reaction to have in a really unusual situation.” Advertisement Can you dare to think about the future? What if you had big plans that are now suddenly on hold – going to university, trying for a baby, moving house or changing career? Nobody can tell you what the best decisions for your life are right now, and it might be better to think no further ahead than a day or a week. “Don’t deny reality but remind yourself that this will pass, although we don’t know when,” says Cunningham. “For some people, being at home all of a sudden, there is time and space to think about what we want to do with our lives. A lot of people will be looking for more purpose and meaning. It might not be the best time to make big changes, but thinking about a happy future in which you’re doing work that you love or you have the family you’ve longed for will help. When we’re stressed and creating cortisol, it perpetuates stress.” Too much cortisol also compromises our immune systems. “When we think happy thoughts – imagining the love we’ll have for our future baby or the fulfilment we’ll have in our future career,” she says, “we might not only feel better, but we should also be boosting our immune function.” Be aware that our emotional estimate of risk, says Leahy, “is extremely high. What we tend to do when we’re emotional is think about anecdotes, not probabilities. This is human nature – we’re not evolved to calculate baselines and probabilities. So we think about stories and how they’re related to us personally. The question is: what is the absolute probability that I’m going to die from Covid-19?” He believes someone is more likely to eventually die from cancer or heart disease. In China, which has a population of around 1.5 billion, at the time of writing 3,245 people have been killed by Covid-19 (and, Leahy points out, China has reported no new domestic transmissions). I’m not sure how comforting this is, especially for those of us who are vulnerable – the virus still seems an unknown quantity, and we still don’t know how much havoc it will wreak, how overwhelmed our healthcare system will get, or (if we do get a handle on it) when it will spring back again once the restrictions on our lives are lifted. So it comes back to building tolerance for uncertainty. “There are things you can do to boost your ability to cope in these uncertain times,” says Freeman. “Our lives are becoming much more restricted, so it is absolutely crucial that we have enough activities that we really want to do. Ideally these activities will be meaningful to us and build on our strengths. We need to think about new ways to connect with and support our friends, family and neighbours. In these times, our relationships with others become even more important.” Anxiety is contagious, as a 2014 study by researchers at the Max Planck Institute for Human Cognitive and Brain Sciences in Germany shows. “Empathetic stress” increased as a result of witnessing someone else in distress, whether they were a loved one or a total stranger. When we see worrying on a global scale, it is not surprising that we will be affected. So try to be the person who calms a friend or partner down, and you should both benefit. Don’t buy everything in the supermarket, don’t go out with symptoms, check on your neighbours, help each other out – because kindness is contagious, too.