Interview with Fabian Cardell: anxiety problems in the COVID crisis

We talked to psychologist Fabián Cardell about the problems related to anxiety in the COVID crisis.

The way we manage anxiety is one of the psychological aspects most sensitive to the crises that occur around us. Radical changes in the economy, culture or social dynamics can affect us greatly, and even more so if these transformations are clearly for the worse.

In the case of the coronavirus crisis, all the ingredients are in place to trigger anxiety problems. To better understand the logic behind them, we interviewed an expert on the subject: psychologist Fabian Cardell.

Fabian Cardell: understanding the anxiety problems triggered by the pandemic

Fabián Cardell Muñoz is a psychologist specialized in clinical psychology and based in Pozuelo de Alarcón, Madrid. He also works as a teacher of psychologists in training, and he divulges about topics related to behavioral science to make them more accessible to the general public.

In this interview he gives us his perspective, as a mental health expert, on the effects of the coronavirus crisis on citizens' management of anxiety.

As a psychologist, in these months have you noticed changes in the type of problems for which people seek help?

The current situation is extremely demanding for the psychological resources of most of the population. Living with uncertainty is sometimes a very difficult mission. We don't know if we can infect ourselves or our families. We do not know when we will be confined again. We do not know if our jobs will be affected. We don't even know if I will be able to go to work or study tomorrow.

In addition, we have been exposed to situations that are very difficult to assimilate in a short time. Some of them very abnormal. We have experienced near-deaths (without being able to say goodbye to our loved ones), social isolation, work stress (in the case of healthcare workers and state security forces and corps, for example)....

All these circumstances have had emotional and psychological consequences, which are reflected in mental health consultations in our country and the rest of the world.

In our center we have noticed an increase in family-related problems, mainly couple problems and emotional problems in adolescents.

We have also seen an increase in anxiety-related problems: agoraphobia, health anxiety, worries about the future.

It is also noteworthy the increase we have noticed in the relapses of people who already had some psychological disorder or problem. I believe that the aforementioned variables are the perfect breeding ground for people with previous pathology to have seen their symptoms increase.

Which population groups do you think are most vulnerable to anxiety problems in this new situation of the COVID-19 crisis?

We already know that the elderly population is the most vulnerable to direct contact with the virus. However, the opposite is true if we talk about anxiety, depression or Post Traumatic Stress Disorder. Our elders are the least vulnerable to these types of problems.

Studies show that the young population (18-39 years old) is the one that has had the worst experience. The data show that they have suffered more anxiety, depression and somatic symptoms than other population groups.

If we talk about professions, those who have suffered the most have been the health and state security forces and bodies, as well as people working in the transport sector. They have endured a heavy workload and have sometimes been overwhelmed by the circumstances.

In our center we are specialized in the treatment of anxiety and we are aware of these difficulties. To help in these times of crisis we are offering: Free first aid to health care providers, Special prices for large families and also to unemployed people.

Can cases of Obsessive-Compulsive Disorder and phobias be intensified by concerns about hygiene and prevention of contagion?

Agoraphobia and Obsessive Compulsive Disorder are anxiety disorders. Any stressful situation can affect these pathologies, increasing their symptoms.

The person who is suffering from these problems has probably noticed that he/she has increased the time he/she dedicates to his/her cleaning rituals and has increased his/her avoidances (not going to certain streets, not being in contact with certain people, avoiding certain time slots,...).

These behaviors that may reduce his anxiety in the short term and give him a certain sense of control, in the medium and long term are increasing his obsessions, his fears and therefore maintaining the problem.

What I would recommend is that if you have noticed that these behaviors have increased and are affecting your quality of life or the quality of your relationships, you should contact an anxiety disorder specialist for advice.

Many times, the most severe problems come not through the anxiety itself but through the behaviors that people adopt to alleviate that discomfort. Do you think that the pandemic situation leads many people to try to combat anxiety by consuming addictive substances?

Indeed, for many people the way to manage the discomfort is through addictive behaviors, both consuming some substances such as alcohol, cocaine, cannabis,... and increasing certain behaviors that can become addictive such as: online gambling, video games, social networks...

The trap of these forms of emotional management is that some relief or well-being is achieved in the short term (due to the dopamine that my brain secretes), but in the long term I add discomfort and more problems to my life, my family and social relationships worsen, my academic or work performance decreases and above all, I lose my skills to manage my emotions in a healthy way.

Addiction (alcohol consumption, cocaine, technology,...) ends up being my only way to feel good. It seems that this pattern is repeating itself and increasing a lot these days, as a result of the moment we are living in.

As for the consequences of the social isolation to which many people have to submit themselves, which do you think are more related to stress and anxiety?

Social isolation leads in most cases to a decrease in activity. We have less contact with our friends (except by video calls), our sporting activity decreases (gyms are closed) and consequently, we destructure our day to day life.

In addition, also very important, being alone at home increases the attention we pay to our problems, difficulties, dangers, etc... This favors the increase of anxiety and depressive problems.

When we repeatedly look at the same problem, without taking action, it tends to feel bigger, unmanageable, disabling. This has very negative emotional consequences. We will assess these consequences when planning our intervention.

What can be done from the psychological point of view to respond to these anxiety problems caused by the coronavirus crisis?

We started this interview talking about the fact that we have no control over what is going to happen, we do not know if we will become infected, if we will continue working... but what we do have control over, what we can choose, is what happens in us, what we think, feel or do. We decide the way in which we face this situation. This is going to be decisive in how we are going to live this crisis.

All the techniques we use in the center are based on scientific evidence, they have demonstrated their effectiveness in multiple patients who were experiencing similar problems.

The first thing we must understand is that anxiety is a normal and necessary emotion in potentially dangerous situations, thanks to this emotion we have been able to evolve as a species because in times of threat we have been able to prepare ourselves to flee or fight (before a predator for example). The problem arises when this anxiety becomes very intense (for example with panic attacks), very frequent (every time I go out in the street) or lasts a long time (I spend weeks in tension).

The first step to begin to redirect my emotions is to identify my internal discourse. It will be essential to know what I am saying to myself when I get anxious. For example: "I am going to catch it and I will end up infecting my family, I will lose my job,...". We must learn to have a more realistic discourse, based on the present and on realistic data. Mark Twain said: "I have lived through many terrible things in my life, most of which never really happened".

Always putting the focus on the most negative and dangerous aspects of reality is only going to stress and distress us. Isn't it true that every time I take a curve with the car at a certain speed I am not thinking, constantly, about the possibility of crashing? That would affect my stability and my driving. Similarly, it is important to focus on the aspects of our life that we do have control over. For example, we can focus on our personal challenges, our sports routine, our friendships, our family.

In therapy we accompany this process so that the person is able to address the circumstances of his or her life in the healthiest way possible. And thus achieve greater peace of mind and quality of life.