This guest blog post was written by Dr. Frank Del Rio, Psy.D., LPC, CART to staff members of group homes and caretakers of those with disabilities. We hope this information and advice is a resource to caretakers of those with anxiety, I/DD & autism during the unknowns of COVID-19.
Coronavirus is scary for all of us. For clients with autism, an I/DD diagnosis or extreme anxiety, it can be even worse as they may have a limited understanding of what is going on but watch everyone around them change up routines and all social conventions we teach them, which leads to confusion (and often behaviors). Stores and school closures and health threats are downright paralyzing for some of them. Here are some tips for talking to your client about COVID-19, navigating the next few weeks together, and living with the constant hum of uncertainty they are going through.
The last week has felt like one long news ticker — spiraling coverage of the novel coronavirus (COVID-19), compounded by a steady stream of school closures and event cancellations, video of toilet-paper battles in Costco, and one Presidential address after the other. With so much new, bad information coming to light each hour and so many questions left unanswered, families are feeling on edge — and with good reason.
We are suddenly tasked with the challenge of explaining coronavirus in a way that is factual and serious, yet not overly dire. Our clients may have questions about death rates, travel risks, and contagions. You must respect the client’s need for information and reassurance, while also weighing how the daily news may cause his or her anxiety to spike. And you need to do all of this while managing your own mental health.
You may not agree with everything I state in this message and that is OK. Keep in mind my goal in this tip is to try and reduce the extreme anxiety our most vulnerable clients are going through right now.
#1. Focus on the facts, understand the fear
What can help us to manage anxiety is understanding the concept of intolerance of uncertainty. Intolerance of uncertainly can drive worry and anxiety up the wall. It means that when something is uncertain, we tend to see it as dangerous, unsafe, or overwhelming. We can react with fear and avoidance or with frantic efforts to prepare for the unknown (go to a store right now and try to find hand sanitizer or toilet paper for example).
In times like these, the question is not how to eradicate uncertainty, but rather how to learn to sit with uncertainty and not overreact. Can we learn to tolerate uncertainty a bit more? Can we imagine that while risks are present, things can be OK even if uncertain, and trust that we will be able to handle whatever comes our way?”
As much as possible, focus on the facts as we know them right now. Don’t try to predict the future or share Doom’s Day scenarios with your clients. Projections aren’t helpful when no one knows for certain what’s ahead, and trying to guess may cause anxiety to run rampant. At the same time, understand that we are living in uncertain times and that will, naturally, cause justified worry.
In the end, it is important for us to acknowledge to ourselves and our clients that anxiety, worry and, fear may be present; accept these feelings with compassion, and also learn to step back (at least a bit) from these fearful reactions. Focus on hope more than fear.
#2. Acknowledge and manage your own anxiety.
“Clients often look to staff to understand if they should fear something. Clients are very good at picking up staff’s emotional energy, so it is really important to manage your own fear and anxiety and not amplify your client’s fears. This is even more important for clients who have an anxious temperament or have significant worry about something. Of course, this is easier said than done, especially when a realistic fear like coronavirus is around. I invite staff to check in with their own feelings and if they notice a lot of tension or stress, to do something to bring that down. That can mean relaxing body tension by softening the face and jaw muscles, dropping the shoulders a bit, and taking a few deeper breaths. When we do this, our voice and actions are often less tense and we are more aligned when we ask our clients not to worry too much.”
#3. Bow out or be quiet when your anxiety spikes.
Many of our clients take their cues from us on how worried to be by the tone, pace, pitch, and volume of our voices. If you sense your own anxiety rising or you notice yourself stuffing a million rolls of toilet paper into a closet, try (and I know this is hard) to take a deep breath and bring your own heart rate down. Over the last few days, when my anxiety was heightened, I tried to take frequent walks, forcing myself to hear the birds and feel the ground under my feet. Mindfulness comes in handy at this point also.
#4. Start with a question. Follow with facts.
Ask gently (don’t yell or over question) how your client is doing. Let them tell you if they are worried or scared or have questions about COVID-19. If they do, have a well-informed discussion. Go to the CDC website (or another trusted source) and show them what the scientists are saying. Help them to understand that there are experts working on things as we speak. Try to discourage them from buying into social media posts, rumors or over-done media outlets.
Note: Fueling many people’s anxiety is the spread of misinformation on social media and through unsanctioned videos on YouTube. Experts say the best source of information is the Centers for Disease Control and Prevention (CDC). The CDC has a webpage dedicated to Covid-19. Texas’ Department of Health is another source of information you can trust.
#5. Limit news exposure.
Remember, bad news is compelling and drives viewership. It drives up ratings, which in turn brings in more advertising dollars. Seeing images of people wearing masks in hospital wards and hearing coronavirus news reports all day long can increase distress in anyone, but especially in those predisposed to anxiety already. Experts say it’s a good idea to decrease your viewing time. If necessary, read news reports discretely on your phone away from your clients. We are not trying to avoid clients getting information but trying to make sure we do not unnecessarily put them into extreme anxiety.
#6. Don’t over-share.
Clients may have questions about germs and sickness and, in some case, even death. But unless they ask you directly, try to minimize conversation on the topic of illness. The best thing you can do is reassure them that legions of responsible people are working hard to keep everyone safe and healthy. You can also point out that the reason so many gatherings are being canceled is that experts say that being at home is the safest place to be. Hearing that home is the safest, healthiest place to be is the most reassuring message your client can hear. If your client is taking medication for anxiety and feeling more anxious, however, don’t hesitate to share your concerns with your psychiatrist or prescribing physician.
#7. Maintain a routine.
Many of our clients thrive on routine. Sustained disruption in their routine can be extremely upsetting for them. To offset this sudden and enormous change of schedule, try to put in place a reliable daily home routine. Wake at the same time each day; carve out blocks of time for activities, exercise, and entertainment; and remember that regularity is calming and reassuring.
#8. Expect non-verbal signs of anxiety.
In some clients, anxiety often manifests as behavior that is extra clingy, weepy, aggressive or irritable. Keeping diet and sleep routines as normal as possible will give clients a sense of security. Extra attention will go a long way toward making an anxious client feel better.
#9. Try to play — and laugh.
Break out board games, build a house of cards, bake cookies, or take a walk. Show clients that there’s an upside to all the cancellations. If a much-anticipated event or spring break is canceled, try to reschedule it for a later date so that everyone has something to look forward to.
It is hard sometimes, but try to find the humor in things. Joke about how all of our hands are rough and raw from hand washing and find some great smelling hand cream to use. Joke about the reams of toilet paper, massive long lines at the stores, and empty shelves of goods. Try to find some humor in these things that seem so out of the ordinary. While this may strike some people as inappropriate, remember the goal is to lessen the anxiety experienced by our most vulnerable clients.
#10. Remind your clients of the altruistic purpose of self-quarantining.
Oftentimes when clients understand the higher purpose of things, they can do some ‘meaning-making,’ which allows them to feel some control over their conditions. For example, some may say, ‘We have to stay home now so that we don’t pass on the virus to others. We are going to be OK. If we stay home, we can make sure that ______ stays healthy too…”
Coronavirus Basics
Of course, I would be remiss if I didn’t remind everyone of the coronavirus basics:
If you have symptoms, reach out to your doctor.
For specific questions regarding individual health, contact your physician. Congestion, fever, and breathing difficulty should be brought to the attention of a healthcare provider. Understand however, that the flu is still a bigger concern than the coronavirus. Be proactive in seeking treatment but keep things in perspective.
Teach and utilize proper hand-washing techniques.
Regular and frequent hand washing is the number one way to kill the spread of germs. The CDC recommends washing hands with soap and water for at least 20 seconds (two rounds of the “Happy Birthday” song or saying the alphabet twice). If soap and water aren’t available hand sanitizer that contains at least 60 percent alcohol is an acceptable substitute. Help your clients remember to wash hands before and after eating, after touching garbage, after using the toilet, and especially after blowing their nose.
Practice good, basic hygiene. Avoid touching your face with your hands.
Demonstrate to clients (or children) how to cough or sneeze into a tissue and make tissues readily available throughout the home, especially in bedrooms, bathrooms, and the kitchen. Discourage sharing food and beverages, and remind clients to avoid people who are sneezing or coughing. Handshakes are another no-no right now. Instead, greet people with a wave or challenge your family/friends/clients to make up their own healthy version of a no-contact greeting.
Clean and disinfect your home but don’t overdo it.
Wear disposable gloves when cleaning and disinfecting and discard them after each cleaning. Clean surfaces (counters, frequently touched cabinets, and drawers) with mild soap and water. Disinfect with diluted household bleach or alcohol solutions (follow manufacturer’s instructions.) Vacuum and dust as you normally would. Clean your cell phone as well, according to its manufacturer’s instructions.
Launder with care. If someone in your home is ill, launder their clothing separately and use disposable gloves — designated for this purpose — when handling their clothes, linens, and towels. Explain to clients/children that this is temporary and special treatment during the next few weeks and that things will go back to normal eventually.
Please take care of yourselves, your families and your clients.
Dr. Frank Del Rio, Psy.D., LPC, CART
Psychologist, Certified Authorized Provider
Helen Farabee Centers
Intellectual & Developmental Disability Services