COVID-19 has been disruptive and anxiety-provoking for most people in the United States and the rest of the industrialized world. Many kids’ schools have moved to online classes, important events have been canceled, and many people are now working at home (or working less hours). More and more places have banned large public gatherings and have closed restaurants, non-essential businesses and stores. In San Francisco, people have been told they should only leave their homes to go to the pharmacy or grocery store. There is uncertainty about what will happen, and free-floating anxiety from the death rate and our federal government’s sluggish response, compared to other countries who are managing this crisis. 

But it’s even more disruptive and anxiety-provoking for individuals with persistent mild Traumatic Brain Injuries (mTBIs) and other brain injuries. There’s the curve ball of the unexpected disruption to our daily routine.  There also are the added cognitive demands of remembering the things we need to do (and not do) in order to try to avoid catching COVID-19. There is the decreased social contact from self-isolation, closed businesses, canceled gatherings, and paused services from caregivers.  There is also the planning that goes into limiting our disease exposure and managing the resources that we do have.

Understandably, it is a real challenge not to feel swept away by the anxiety, immobility, and indecisiveness of the moment. It can be tempting to give in to despair and a sense of helplessness. 

So, what can we do? 

I’m not talking about best practices to avoid getting COVID-19. If you want to read about this— which I recommend— see here, here and here (the last article is easier to access on a computer than on a SmartPhone or tablet).

What I am talking about is how can individuals with mTBIs and other brain injuries take care of themselves (non-medically) during this (extended) time of uncertainty. Below are 11 tips to do that. 

1. Seek out reputable medical information. Although there is some conflicting medical information out there, the medical experts from Yale University and the World Health Organization, for example, mostly appear to be putting out reliable information. 

2. That said, take breaks from the Internet and the news. Pay attention to your own limits. Cues that you have reached your limits might be either that you start to feel like your circuits are overloaded, you feel like you’re going into overdrive, or you start to feel really anxious. Figure out how much time it took for you to get there or how many things you read and/or watched. Then set your limit to be about 50-66% of that. Adjust these limits up or down until you find the right balance.

3. Make out a daily schedule for yourself and stick to it. Designate regular times when you get dressed, eat, go to bed, and engage in various activities. You don’t have to achieve military precision. But by creating this normalcy and regularity, you will reduce anxiety and depression, and feel more in control. For individuals with brain injuries, routines and schedules are your allies.

4. Lower your anxiety. Use the techniques that help you cope with anxiety in the rest of your life to deal with your anxiety about the things you can’t control. Write yourself a portable reminder that is visible to you throughout the day to use these techniques. Or try this exercise: make a list of the things that you can control in this situation, and a list of the things that you can’t. (Personally, I like to use a sheet of paper with a line drawn vertically down the middle to do this.) Take the things that you can’t control, close your eyes and then imagine putting them all into a helium-filled balloon, opening a window and letting the ballon go. For the things that you can control, though, see Tips #10 & 11.

5. Actively engage in activities that relax you. Do the (non-substance) things that make you relax, feel peace, or otherwise feel OK in the world. Maybe that’s taking a bath, reading books, drawing, journaling, taking walks, listening to music, or something else. Make sure you’re doing this at least once a day, if not more. If you meditate, do it once a day. If you don’t meditate but want to try it out, there are some good apps, such as Calm or Headspace, which are worth checking out. 

6. Make sure to do something that makes you feel creative and joyful— even if it’s a little thing. That can range anywhere from painting to making goofy videos to spending time around children to rearranging a room— or to anything else that feels creative to you. This will help you re-inspire and reinvigorate yourself. It will help you feel alive and like you have a sense of purpose. Think of the videos of Italians singing together: part of what made these so powerful, in my opinion, was the sense of shared inspiration, the joy, and the affirmation of life in such a stressful situation.

7. Develop a mantra to remind yourself that, most likely, you will be OK and get through all this. (My favorite is “I can get through this.“) Write it down and refer back to it later. Read or repeat this to yourself at various points in the day, especially if you feel anxious, depressed, powerless, or hopeless. 

8. Cultivate your relationships and friendships, virtually. Tell people in your life at least one thing you appreciate about them and express gratitude to them twice a day. (Remember to explain what that thing you appreciate means to you). Arrange video calls and phone contact with friends and family who don’t live with you. This not only will help you feel less isolated and more connected to others, it also will help you experience positive emotions and the endorphins that these release.

9. Make space for exercise and being out in the sunshine— even if there are practical limits on your movement and how close you can get to people. It will help prevent you from feeling cooped up, and you’ll get the physical benefits from being out in the sunshine (e.g., Vitamin D, Melatonin, etc.).

10. Take small actions on small things you can control in your life. Pick one thing that you could change that would make a real, tangible positive difference for you. Maybe it’s something as minor as starting to use that pill box you bought 3 months ago to better keep track of your medications. Maybe it’s doing the dishes right after each meal, so they don’t pile up on you. Maybe it’s cleaning up one room (or one section of a room) in your living space. Or maybe it’s writing every day for 20 minutes. Making a small change can give you a sense of control in at least some part of your life, even when other things feel out of control— and that helps to reduce anxiety and build confidence. Once you have made one change, try making another change the following week. Try to make a small change every week or two.

11. Think of yourself as the hero of your own story, a hero who may be flawed, yes, but still somebody who is admirable. What are the qualities of that person? How do they respond to this COVID-19 situation? (If you have trouble figuring that out, think of a character from a movie, show or book whom you admire. How would that character handle the situation? What ways of handling it would you admire and wish to take on for yourself?) Then ask yourself: what are some ways I could do that starting today?

COVID-19 is beyond the experience of most people alive today. There is no user manual that provides us a guaranteed way to handle all of this. That uncertainty is, of course, scary and stressful— and to some extent, we are all going to have to muddle through as best as we can. Taking care of yourself will help give you the strength, energy and mental space to do so. You might even be able to create some changes to your life that will help you feel less anxious and reconnected to who you are and what matters to you. 

May you stay healthy and take care of yourself during these uncertain times.