Note: This article was originally published on the Center for Chronic Illness website on April 4th, 2020. The Center for Chronic Illness (CCI) is a nonprofit organization based in Seattle, Washington. CCI promotes well-being and decreases isolation for those living with ongoing health challenges through support and education. To learn more, visit the website.
The coronavirus that causes COVID-19 is affecting the entire world right now; however, it’s impact on individuals varies greatly. Everyone is struggling without exception; however, one group that may be experiencing a serious impact is people with chronic illness. Often people with chronic illness are immunosuppressed and fall into the category of “people with underlying health conditions.” Approximately 133 million people live with chronic illness or about 40% of the population, so many people are facing a significant challenge right now.
No one expected coronavirus to happen, just like no one expects a diagnosis of chronic illness. If there is one thing I know about the chronic illness community it is that we are resilient. COVID-19 is definitely affecting people with chronic conditions in a negative way; however, there are ways that we are more prepared for this than anyone else.
Here are some ways that people with chronic illness may be impacted:
1. Health Anxiety.
Those with chronic illness frequently experience anxiety related to our health. Autoimmune and genetic diseases often flare up and get worse depending on numerous factors, so people often live in fear of when that will happen next.
With coronavirus there are even more unknowns, which can cause an uptick in anxiety. COVID-19 is taking a toll on everyone's mental health, but when you are in an at-risk category that anxiety can be even more extreme and difficult.
When someone dies from the coronavirus the news reports that the person was either an older adult or had underlying health conditions. For people with underlying health conditions this creates the feeling that our lives don’t matter as much as people without health conditions.
Throughout this pandemic many chronically ill people have been made to feel marginalized and unimportant due to their illness. This is an echo of the greater marginalization people will chronic illness feel every day.
COVID-19 is finally shining a light onto how many people with chronic illness live their lives every single day. Isolation for the sick is rarely if ever discussed in the national conversation. It may be a good time to bring it into the forefront, now that more people understand how difficult even short-term isolation can be.
Isolation is a common byproduct of chronic conditions. Sometimes people aren’t able to work or have lost friends due to changes in life circumstances. People may be bedridden or have little energy to leave the house. With coronavirus we run the risk of increased isolation due to not being able to have visitors and people taking extra precautions with those who are sick.
Coronavirus is cutting off access to everyone, but even more so for people with chronic illness. People may be fearful of attending their regular appointments due to being exposed at a clinic; perhaps they have a medical emergency related to their illness and feel different access to the emergency room. Even a short trip to the grocery store may feel like a huge risk.
People with chronic illness already know what it is like for our whole worlds to be flipped upside down. Often this happens when we get sick and is an ongoing process. We’re constantly adapting and adjusting to a new normal.
For the first time, some people are discovering what it is like to have something interrupt their life and drastically change what they are able to do. We have been preparing for this for years. We were also likely the early adopters of safety precautions due to being at some level of risk.
6. Body Awareness.
People with chronic illness have increased body awareness. We are aware of every little change in sensation, no matter how subtle. This can be a blessing and a curse during the pandemic, but let’s look at how it can be a blessing.
It’s important to know as early as possible if you have contracted the coronavirus so that you can self-quarantine to prevent others from getting sick. Also, so that you can contact your doctor for any instructions and rest, rest, rest.
7. Survival Skills.
We understand what it is like to be forced to find alternative ways to get things done. Maybe we already know how to buy groceries online, because in the past we’d been too exhausted to shop. Maybe we have a big stash of medical supplies, supplements, and medications, because these are things we need on a regular basis. Maybe we are really good at entertaining ourselves in the house, because we don’t go out as much as others. All these things will be to our benefit the longer we are required to stay at home.
Perspective is the most important factor in how to manage any situation. We cannot change what is happening around us, but we can change our perspective. Years of living with an illness has likely taught us how to cope with things you cannot change. Perhaps you’ve learned to take things one day at time and live in the present moment. Likely you have practiced accepting what is.
This is a trying time for everyone and maybe a time in which we can learn important lessons. There may be some good that comes from this. If anything the greater world may gain a little bit of understanding of what it’s like to live with chronic illness.
"There is a difference between solitude and isolation. One is connected and one isn't. Solitude replenishes, isolation diminishes." - Henry Cloud
Note: This article was originally published on ProHealth on March 24th, 2019.
You’ve probably heard of mindfulness, but did you know it's one of the most useful treatments for depression and anxiety? Mindfulness is not just having a moment right now—it's an ancient practice that's here to stay. It's time for you to learn how mindfulness can improve depression and anxiety symptoms and overall mental health.
Through treating clients in my therapy practice, I've learned that the simplest strategies for coping with depression are often the most effective. Mindfulness is a simple tool that is always available to us. It's about learning how to live in the present moment and practicing non-judgement and acceptance. It costs nothing but time and patience, and the benefits are endless.
Depression and Mindfulness
Depression can be defined as a manifestation of living in past regrets, whereas, anxiety is a fear of future events. Either way, you are not living in the present moment. With depression and anxiety, ruminating thoughts often come along for the ride. When you are focusing on the present moment, you are more likely to be aware of your thoughts—giving you the opportunity to talk back to them. For example, you may say in your head, "Thoughts are just thoughts," or "I'm noticing my thoughts again." Then, you can move forward and not get caught in the rumination spiral.
Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) are two formalized ways to learn mindfulness in a therapeutic setting. MBCT is typically done in individual therapy, and MBSR is an 8-week group commonly found in hospital or therapy office settings. Both have a large body of research backing them up. Many therapists of all backgrounds are starting to incorporate mindfulness into therapy sessions.
If you're not ready to commit to therapy or a group quite yet, consider engaging some of these mindfulness exercises and see what you notice in your daily life:
1. Daily Mindful Practice.
A good place to start when working on mindfulness is by choosing a mundane task per day and trying to remain present while doing it. Brushing your teeth, washing the dishes, or folding laundry are all easy options. As you are doing the task, notice all five senses. If you are brushing your teeth, notice your face looking back at you in the mirror, the sound of birds outside the window, the minty taste of the toothpaste, the smell of the air freshener, and the feel of the toothbrush in your hand.
Once you've practiced a mindful task multiple times, try having a mindful meal. Pay attention to every bite, the taste and smell of the food, and the environment around you. This is a great way to only eat until you are full and not add extra calories because you weren’t paying attention.
Finally, try a mindful walk around your neighborhood. Notice things you haven't noticed before: a patch of daffodils, vibrant graffiti, a dog enjoying a stroll, ivy crawling up a building. Leave your headphones behind and be present with the world around you.
2. Non-judgement & Acceptance
Non-judgement and acceptance are skills to become aware of our thoughts and then productively interact with them. If practiced consistently, these two concepts can significantly reduce suffering.
Simply put, non-judgement is not labeling things "good" or "bad." To use a common symptom of depression as an example, consider insomnia. Our first inclination would be to label insomnia as "bad." However, if we adjust our thoughts to label insomnia as "is" or "present" without a qualifier, we may still have nights without restful sleep, but we are not adding to our suffering by thinking about how bad it is that we have sleepless nights. Over time, you will start catching yourself using qualifiers. The non-judgemental qualifier I use in my own practice of non-judgement is, "interesting."
Acceptance is seeing things just as they are, not as you believe it should be or wish it were. Accepting the present moment, even if there is pain, allows us to give up resistance and become aligned with life. Part of acceptance is noticing your intrusive thoughts, accepting they are there, and then observing them as they pass. To practice acceptance, you must come back to it over and over again.
Meditation has a profound effect on the nervous system that researchers have studied for years, but starting or maintaining a meditation practice can be difficult. Some of the fear comes from the expectation of sitting in silence with your thoughts for a long period of time. People with depression often have uncomfortable thoughts and don’t want to be alone with them, which is a valid concern.
Instead of sitting in silence, I encourage my clients to start slowly and use guided meditations. For example, start with 1 minute a day for a week and then increase to 2 minutes a day for a week. You can find thousands of guided meditations of all lengths on the Insight Timer app. Working up in this way will ease you into the practice of depression and mindfulness, and you will be more likely to stick with it. Your goal should be to work up to 10 minutes a day, which is about how long you need for your body to get into a relaxed state.
Experiment with different times of the day. For me, if I don't meditate first thing in the morning, I tend not to go back to it. Others find meditation helps them decompress after work or relax before going to bed. Find a place in your home that has pleasant surroundings and is quiet. For parents, consider meditating while your children are asleep, or as an alternative, you may even meditate with your children and help them to develop this healthy habit.
Mindfulness isn't a one-time thing, it's a way of life. The sooner you start using these practices as part of your depression treatment, the sooner you will see the impact on your mental health. All moments spent in the present are an opportunity to focus directly on the gifts that are right in front of you—gifts that depression may otherwise rob you of.
"Life gives you plenty of time to do whatever you want to do if you stay in the present moment." - Deepak Chopra
Note: This article was originally published on ProHealth on February 17th, 2019.
Believe it or not, what you put in your mouth affects your mood. The better your diet, the less likely you are to develop depression. If you are already diagnosed with depression, what you eat can either increase or decrease your symptoms.
Therapists and other mental health workers are starting to emphasize the importance of a healthy lifestyle for people with mental illness, but preparing healthy food from scratch can be like climbing a mountain for people with depression. Eating healthy is more about increasing the good food rather than cutting out the bad. To avoid feeling overwhelmed, try focusing on small changes, like adding in more of these 5 nourishing foods and reducing foods that don’t support your recovery.
Another important tip is to eat something with protein, such as nuts, eggs, or lean meat, every three hours or so to keep blood sugars stable. When your blood sugar drops it can mimic a mood swing or panic attack.
5 Foods to Eat:
You may be sick of hearing about how avocados are a superfood, but this is one food that deserves the hype. Our brain is made up of mostly fat and needs healthy fats as building blocks. Avocados are a good source of tryptophan, which we need to make serotonin, otherwise known as the happy chemical. Try adding one to a smoothie for your daily dose of this savory fruit.
Speaking of fats, Omega 3 fatty acids are great for your brain and nervous system. Studies have shown that fish oil supplements can be as effective as antidepressants. It is speculated that Omega 3s reduce brain inflammation and increase serotonin production. If you are a vegetarian or vegan, tofu and walnuts are also high in Omega 3s.
3. Spinach and other dark leafy greens
Dark leafy greens are nature’s perfect food. Their depression fighting properties come from folate. Low levels of folate have been linked to depression, so getting plenty into your diet will help increase those levels. Greens are also a natural source of iron, which carries oxygen to your brain.
Raspberries, blueberries, blackberries, and strawberries are all packed with antioxidants, which help reduce inflammation at the cellular level. In fact, they have more antioxidants than any other fruit. They also contain many brain-healthy vitamins, such as A, C, and E, that are commonly lower in people with depression.
5. Dark Chocolate
Dark chocolate is a health food disguised as a delicious treat, especially when it comes to brain health. Cacao contains phytonutrients which fight and prevent inflammation. These specific phytonutrients also improve circulation, which means more blood to the brain. Milk chocolate doesn't have the same healing power, due to heavy processing and the addition of dairy and sugar (see below). To reap the benefits, it must be high-quality dark chocolate. The higher percentage of cacao the better, so aim for at least 85%.
5 Foods to Avoid:
The brain needs glucose to function but gets plenty from the carbohydrate-heavy Standard American Diet (SAD). The recommended daily dose of sugar is 25g per day for women and 38g for men, which sounds doable until you realize that the average can of soda has about 35-40g of sugar in it. The problem isn’t necessarily sugar, it’s how much sugar we consume. Elevated levels of glucose in the blood impact cognition, memory, and the ability to process emotions.
You’ve probably heard of celiac disease where gluten causes an autoimmune reaction, but you may not be familiar with the more common diagnosis of non-celiac gluten sensitivity. Studies have shown that removing gluten in people with either IBS or non-celiac gluten sensitivity decreases symptoms of depression. Maintaining a gluten-free diet is becoming easier as compliant foods are more accessible at grocery stores and restaurants. It may be worth a try to see if it helps improve your mood.
3. Processed Foods
Processed foods and the brain don’t mix. Studies have shown that people whose diet is high in processed foods are at an increased risk for depression. Processed food is anything you buy already prepared and usually comes in a package, can, or box at the grocery store. Processed foods usually contain excess sugar and other additives, which are all those things you can’t pronounce in the ingredients list. Part of improving mood through diet is being aware of what you are eating, which is challenging with processed foods.
Dairy makes some people sluggish and slow, which is the last thing you need if you have depression. Gluten and dairy are considered the two biggest food culprits for inflammation, possibly due to many people being intolerant to both. It’s believed that a protein in cow’s milk called “casein” is to blame. You may not need to give up dairy entirely. Instead, try swapping cow’s milk to goat or sheep’s milk, cheese, and yogurt.
Caffeine isn't exactly a food, but in some people, it can increase symptoms of depression and anxiety, so limiting your intake is something to consider. Caffeine is linked to increased symptoms of depression. The level of caffeine intake is correlated with the intensity of symptoms in people with mental health issues. In other words, the higher the caffeine intake, the worse the depression.
Furthermore, people with depression frequently report problems with sleep. Caffeine can disrupt sleep. If you are having difficulty sleeping or ruminating thoughts, consider switching to decaf or cutting back to 1-2 cups per day. Be cautious when transitioning away from caffeine. Caffeine withdrawal symptoms can make depression worse, so cut back slowly over a long period of time.
The bottom line is, don't worry if you eat a hamburger or give in to your craving for ice cream. Stress is also a trigger for depression, so don't become too rigid about your eating habits and practice a lot of self-compassion if you can’t resist that side of french fries.
When it comes to depression, anything you can do to ease your symptoms is a positive, especially if it’s as easy as adding in a few more cruciferous vegetables.
"Nothing feels as good as becoming who you were meant to be." - Jenna Scatena
I'm Kerry (She/Her/Hers) and I am a licensed therapist, writer & speaker. This is a positive space focused on how to thrive in any situation and the transformative power of suffering.