How to stay sane when the world’s going mad

Take a deep breath. Now, tell me ... how are you feeling? There are no wrong answers, and no one else needs to know. Give your day a score out of 10 if you can't think of the right words. Even better, write it down. Set a reminder to write down how you're feeling every day. Now you've started a mood diary.

These sorts of techniques are usually reserved for the therapist's chair. But with anxiety rising during the pandemic and many psychologists unwilling to take new clients during lockdown, we need to get people help now, before the stress they're feeling spirals into something worse. A solution might be to teach them how to help themselves-virtually. (Scroll to the bottom to get a list of tips to stay calm during the crisis.)

The stage seems to be set for a global mental health crisis. Nearly half of Americans say the coronavirus crisis is hurting their mental health, according to the Kaiser Family Foundation. Stress levels are even higher than they were during the 2009 recession, a Washington Post poll found.

It's not surprising. So many of the pillars keeping us sane have been toppled: we're confined to our homes, unable to see many of the people we love; money and health worries abound; the news is like a disaster movie; our sleep is disrupted. Not only is the pandemic beyond our control, but there is no clear, identifiable end point. Both those factors are known triggers for anxiety that can spiral into something more serious, such as depression or addiction.

Turn to the apps

But anxiety is treatable and manageable-even when all you have is your smartphone. For many people, their first port of call is a mindfulness and meditation app like Headspace or Calm. For a few dollars a month, these offer guided meditation for beginners, breathing exercises, and tutorials on a range of topics intended to help relieve stress. These apps have only started to be studied in the last several years, but evidence to support their use is emerging. Researchers from Carnegie Mellon University found that regular use of a mindfulness app can help make people feel less stressed. Another CMU study found it can reduce loneliness. A study published in Nature concluded that meditation apps can boost young people's ability to focus and remember. There's little evidence that these apps can be as transformative for mental health as therapy, but they can be enough for some.

Rachel White, a 34-year-old New Yorker who works in tech, credits a meditation app with pulling her back from the brink of a breakdown. I didn't leave my apartment for the first month of lockdown. I constantly heard sirens and was afraid to go outside. It got completely overwhelming. Everything was too much," she says. To cope, she would lie in bed and stare at the ceiling. I knew I had to do stuff, but my brain wouldn't let me," she recalls It was shutting down. That was the catalyst that made me download Calm."

She'd never tried guided meditation or a mental health app before. Without it, she believes, her mental health would have deteriorated further. I've shifted from a general sense of fear and panic to accepting that what's happening is out of my control. I've adapted what I can to improve my own health, and I'm making longer-term changes that will make me better off," she says.

For those who want more fine-grained, quantified detail, there's more complex software such as NeuroFlow and Unmind. These apps monitor people's mood, sleep, stress, and pain levels to help them discern patterns in what helps their mental health-and what hurts it. They then provide personalized lessons to help people better support themselves. Both apps are reporting an increase in demand. However, even NeuroFlow's own CEO, Christopher Molaro, admits it won't be right for everyone. There is no silver bullet for people's mental health. It's such a complex and widespread issue," he says.

Re-train your brain

Some apps have been specifically created for coronavirus-linked anxiety. Covid Coach includes meditation and breathing exercises, tools to track anxiety and moods, and pointers to resources for people who need help with domestic violence, substance abuse, and other issues. It was created by the National Center for PTSD, part of the US Department of Veterans Affairs, but is open and available to all, for free. Another app launched during the pandemic, called Clarity, nudges users to check in and set a score for their mood every day. Like Covid Coach, it includes tailored resources on how to stay well during the stressful times we find ourselves in, sourced from the UK's National Health Service and mental health charity Mind.

Of all the interventions that have been studied for anxiety, cognitive behavioral therapy is the gold standard. It has a more positive long-term impact than taking one of the commonly prescribed medications. Even better, it still delivers benefits when accessed online or through self-teaching. For example, a randomized control trial conducted in 2014 of 114 teenagers diagnosed with anxiety found internet-delivered and in-person CBT equally effective. This is especially good news when you consider the covid-induced shortage of psychotherapy slots.

Bringing CBT to the masses is the idea behind a free six-part online course called Helpers, created by a group of UK psychologists. Helpers aims to equip people with structured ways to discuss grief, loneliness, anxiety, and other difficult emotions with their friends, families, and neighbors. People can form groups with others if they wish, or go through the course on their own. It's based on the principles of clinically proven therapy types like CBT and acceptance and commitment therapy (a form of therapy that helps you to embrace thoughts rather than fight them). It's not the only course out there based on clinical methods-other online resources include The ACT Companion, eCBT, and Woebot.

We need to let people know that these difficulties do not mean they're crazy," says web designer Simon Fox, who had the idea for Helpers.

Even Helpers won't be able to catch everyone, though. It explicitly states that it is not for people who are in severe distress, or having thoughts of harming themselves or others. People who feel they cannot cope should refer themselves to their local mental health service. And, like all these apps and tools, it is not available to people without access to internet-connected devices.

But all these products tap into a tantalizing idea: getting more people to proactively look after their mental health. Fox hopes we might use the pandemic as an opportunity to further destigmatize mental health care and help build up people's resilience. This can be a chance to grow your own toolbox to deal with difficult things," he says. It's not about not feeling things, but it's about adapting and having more mental resources to deal with the demands you're facing."

Of course, mental illness isn't new or unique to coronavirus. And some of our reactions to the pandemic may be nothing to worry about, says psychologist Kiana Azmoodeh. Struggling through this-feeling stressed, anxious, and low-is not in and of itself a diagnosable mental health condition," she says. It's a stressful time, and stress is an appropriate response."

A checklist of things to help with anxiety

• Notice when you are worrying, and be kind and compassionate to yourself. This is a difficult time; it makes sense that you might be more anxious.
• Focus on what's in your control. Work out what is a hypothetical worry (you cannot do anything about it) and what is a real problem (needs a solution now).
• Refocus on the present moment. Focus on your breath, or on using your five senses.
• Engage in activities that you find meaningful and enjoyable. That could include music, walking, reading, baths, household tasks, or calls with friends and family.
• Notice and limit your worry triggers. If the news is making you anxious, limit your consumption.
• Practice gratitude. List the things you were grateful for that day: for example, The sun was shining."
• Keep a routine, and stay mentally and physically active.

(Compiled for us by psychologist Elizabeth Woodward using guidance from the UK's NHS.)