Abby Guido is dreading the winter. The cold will force her family back into the same kind of lockdown they faced in the early days of the pandemic. “It’s constantly on my mind,” said Ms. Guido, 41, an assistant professor of graphic and interactive design at Temple University.
Ms. Guido’s husband, Chris, has lymphoma, so the family needs to be particularly careful. He’s in remission, but since chemotherapy has weakened his immune system — potentially elevating the risks of Covid-19 — the family stayed in lockdown until the weather grew warmer in late May, allowing safe outdoor activities. At last they could ride bikes with their two children, explore the park and picnic with friends.
Soon this will end. The isolation will return. Ms. Guido recently began taking the antidepressant Lexapro to calm the looming anxiety, “kind of in preparation for the feelings I know will be coming this winter.”
Millions can relate. The summer brought relief for many — outdoor brunches, rambling walks, beers on the stoop — yet in the latest of 2020’s cruel twists, the plunge in temperature may cause a surge in infections and stress.
“This is going to be brutal. I think it’s unprecedented on every scale,” said Kim Gorgens, a professor of psychology at the University of Denver. The stress of heading back indoors does not exist in a vacuum, Dr. Gorgens said, but is part of a bleak mix of concerns — anxiety over the presidential election, economic uncertainty, wildfires, protests over racial inequalities — and that all of this, collectively, is “reaching a kind of fever pitch.”
This is especially true for underprivileged and marginalized communities, where large multigenerational families are often crammed into one home, said Dagmawi Dagnew, a psychologist with the Department of Veterans Affairs and co-founder of a volunteer organization providing mental health resources to the Ethiopian-American community in Philadelphia. “Some of us have the luxury where space is taken for granted,” said Dr. Dagnew, but for low income people, the stress is “related to basic needs” such as ventilation, child care or helping older parents.
And all of us, in every circumstance, are dealing with the cumulative toll of six-plus months of the pandemic. “We’re moving from sprint mode to marathon mode,” said Bethany Teachman, a University of Virginia psychologist specializing in anxiety. She added that since stressors tend to pile up over time, we’ll be “going into winter feeling depleted and exhausted.”
So how can we handle the stress of heading back indoors? What are the best strategies?
Dr. Teachman recommends a three-step approach: Acknowledge, find alternatives and then make a plan. Start by recognizing that it’s OK, and even helpful, for people to “grieve what they have lost,” said Dr. Teachman, “because there are real losses.”
This kind of acceptance is crucial for “emotional regulation,” explained David Rosmarin, the founder of the Center for Anxiety in New York, and an assistant professor of psychiatry at Harvard Medical School. “Accept the fact that it might be a crappy winter. Don’t try to fight it. Let the emotions come. It’s a wave. It crashes over you, and then it passes.”
Once we’ve acknowledged the hardship, “the critical piece is to not stay stuck there,” Dr. Teachman said. “We can recognize that things are hard, without wallowing.” Identify what we have lost (such as socializing), and then find alternatives — maybe online meet-ups, a pod with another family or simply bundling up.
“If you have the opportunity, invest in a really good winter coat,” Dr. Teachman said. “Look into a little heater to put on a patio.”
Planning ahead is important. “Plan now before it gets very cold,” Dr. Teachman said. This is partly for practical reasons — that heater might be on back-order — and partly for psychological ones, as “it’s actually much harder to make and implement plans once you’re already feeling anxious and stressed.” Dr. Dagnew noted that uncertainty is a key reason we feel stress, so “having a plan is the antidote for uncertainty.”
Every therapist emphasized the importance of social connections. “We are social creatures, and we can’t fight the pandemic by socially isolating ourselves,” said Stefan Hofmann, a professor of psychology at Boston University, and the author of “The Anxiety Skills Workbook.” “Very few people are able to weather the storm by sitting in the room and meditating.”
This will likely mean, yes, more of the dreaded Zoom calls. “You might roll your eyes and hate every minute of it,” Dr. Gorgens said, but we should think of it as “taking your medicine.”
Other basics we shouldn’t overlook: eating healthfully, exercising regularly, following routines (to maintain a sense of control), limiting alcohol and especially getting plenty of sleep. “That’s where you’ll get the biggest reward, as sleep is the common denominator across every mental illness,” said Dr. Gorgens. She also recommended that we “limit exposure to the 24-hour, inflammatory, incendiary news cycle, that will only get louder in advance of Nov. 3.” Consider discrete times for news consumption (such as blocks in the morning and evening), as opposed to an IV drip throughout the day.
As we’re nudged back indoors, we’ll be making constant calculations about what is an acceptable level of risk, which varies for each person: Can a friend swing by for a brief indoor visit if you both wear masks? Can you then offer a cup of coffee, which would mean taking off the mask? Is that OK, if you stay six feet apart? And if you decide that’s allowable, can you just let them stay for lunch or to watch the game?
To lower the stress of that never-ending Covid-19 Math, Dr. Teachman suggested having “some kind of system, so it doesn’t feel overwhelming every time.” You might make decisions based on checking the test positivity rate from your local health department or guidance from the Centers for Disease Control and Prevention. Dr. Teachman said she uses the online risk calculator at MicroCovid.org, which uses estimates from Covid-19 studies to help users quantify the risks of various scenarios. (CovidCanIDoIt.com offers a similar tool.)
Also, don’t underestimate the power of a simple phone call, reaching out and asking for help. “It’s really basic, and it’s still very dependable,” said Nicole Davis, clinical director of crisis services at Seattle’s Crisis Connections hotline. Ms. Davis added that crisis call centers (such as the national suicide prevention hotline, at 800-273-8255) are excellent resources for anyone experiencing acute anxiety and that you don’t need an emergency to call.
Finally, Dr. Hofmann suggested that our end game should be to flip adversity into opportunities. “For anybody who wants to be more resilient, this is the magical thing to do,” Dr. Hofmann said. He advised focusing on meaningful projects and connections; in his case, he has spent more time bonding with his 17-year-old son. Maybe it’s a new career goal, new hobby or new creative outlet — there’s at least a bit of truth in those tired memes reminding us that Shakespeare wrote “King Lear” during a plague. Positive mind-sets matter. Goals give purpose.
“We cannot change the pandemic. It is here. We have to accept it,” Dr. Hofmann said. Instead, he advised: “Find where you want to go with your life, and go in this direction.”