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Instituting Change https://www.instituteforchronicpain.org Tue, 31 Jan 2023 09:39:11 +0000 Joomla! - Open Source Content Management en-gb Stress and Boredom during COVID-19 https://www.instituteforchronicpain.org/blog/item/220-stress-and-boredom-during-covid-19 https://www.instituteforchronicpain.org/blog/item/220-stress-and-boredom-during-covid-19

Living among the COVID-19 pandemic, with its loss of life and livelihood, and our need to maintain physical distancing to protect ourselves and our communities, we face the dual burdens of stress and boredom. It’s a difficult combination because persistent stress leads to lack of focus and feeling scattered. This distractibility leads to aimlessness and inactivity, which further leads to boredom. In boredom, we have nothing to distract attention away from all the stressors in our lives. Thus, stress can lead to boredom and boredom leads back to stress.

The stress response

The COVID-19 pandemic presents dangers that many of us have never before experienced. Until now, it’s been easy when hearing about Photo by Gift Habeshaw courtesy of Unsplashepidemics or potential epidemics on the news to cast it off and think, ‘Oh, that’ll never happen here.’ However, it is now happening here. It is happening most everywhere, given the worldwide dimensions of the COVID-19 pandemic. Even when communities come to control an outbreak, it comes back when those same communities loosen restrictions and open up. It’s hard to identify any society or country for which it hasn't resurged after a community comes to control the initial surge and loosens up the restrictions. As such, we’ve come to experience a low level dread that it’s only a matter of time before COVID-19 comes for us, if we haven’t had it already. Thus, the potential for serious illness and death to ourselves, our family and friends, and our wider communities heightens our awareness and places us in a persistent state of alarm.

Potential or actual job loss and financial stress that has accompanied the COVID-19 pandemic also raises our guard. Economies across the globe
are experiencing significant recessions, even to the point of some economists wondering about another great depression (Lacurci, 2020) with unemployment levels at about 20%. Job- and financial-related insecurities have thus put life as we know it in danger.

The human response to danger is called the stress response. We evolved this capacity to respond to danger because it helped our ancestors to survive acute threats to life and limb, such as being attacked by predators larger than ourselves.

From the microscopic to the macroscopic, the stress response involves cognitive, emotional, systemic, behavioral and social responses to threat or danger. All of these different aspects of the stress response occur largely simultaneously, interacting with each other. So, in the presence of danger:

  • cognitively, we recognize it as dangerous or threatening, vigilantly focus our attention on it, and begin problem-solving for it; we also tend to learn quickly in these instances and will be able to remember it into the future
  • emotionally, we are in a heightened state of alarm, having fear-based or aggressive feelings and sensations, such as tension, guardedness, gut reactions, rapid heart rate, increased blood pressure, increased perspiration, and flushed
  • systemically, three bodily systems of the nervous system, hormonal system, and immune system work together to produce adrenaline, norepinephrine, and cortisol, leading to the above-described high-energy arousal and an inflammatory response which will have an initial beneficial role in healing from injury or illness
  • behaviorally, we tend to aggressively take on the threat and fight it, or flee and avoid the threat
  • socially, we tend to join together with others along some common lines of us against the threat; we also tend to offer help and tend to the needs of others

All of these aspects of the stress response interact with each other and lead to increased odds of survival when threatened.

We might imagine our distant ancestors in this heightened state of arousal and alarm, fleeing to climb the highest tree if alone in the jungle and caught off guard by a threatening animal, or banding together if in a group to fight a common threat. From the microscopic to the macroscopic, the stress response aids in our survival.

The stress response is like a sprinter, not a marathon runner

The stress response tends to work best when the danger is a distinct event, with a beginning, middle and an end. When zebras get chased by lions, their stress response provides them with a heightened burst of attention, arousal and alarm, leading them to be able to evade the lion by running away at great speeds. Once successfully free from danger, everything about the zebras calm down and they go about eating, resting and socializing in whatever ways zebras do. In this way, the danger and the resultant stress response have beginning and end points.

The same would be true if two territorial stray cats bumped into each other. They’d be apt to fight until one of them gets the upper hand and the other flees. The whole event wouldn’t last for hours, let alone days or months. Rather, it would be a matter of minutes, with largely distinct beginning and end points. Upon getting away and the fight resolving, both cats would calm down and go about their daily cat-like affairs.

At the time when the stress response was evolving, our human ancestors would have faced similar types of threats. It was dangerous back then, to be sure, but the dangers would come and then go. As such, the stress response adapted to be highly effective against distinct threats with a beginning and an end, measured in minutes, not days or months or years.

We can thus think of the stress response as a sprinter, coming out of the gait with a burst of attention, arousal and alarm, and effectively managing an event that’ll be over in a matter of minutes.

However, sprinters don’t tend to be good marathon runners.

Our current dangers associated with COVID-19 have no immediate end in sight.

The COVID-19 pandemic presents us with dangers to life and livelihood for each of us individually and for those with whom we join in these common threats. Just as it is supposed to be, our stress responses are kicking in to keep us safe. These dangers lead us to engage in the following:

  • cognitively, they capture our attention and we engage in persistent problem-solving; as a result we might find ourselves watching our news feeds often, looking up do-it-yourself face masks or other COVID-related tasks
  • emotionally, they lead us to be in a heightened state of alarm, with varying levels of anxiety and irritability, muscle tension and agitation
  • systemically, our nervous, hormonal, and immune systems are working together to produce adrenaline, norepinephrine, and cortisol, leading to arousal and a widespread inflammatory response
  • behaviorally, the dangers lead us to physically distance from each other, wear masks, shelter-in-place or engage in ways to respond to the pandemic through the institutions of healthcare, government, business and non-profits
  • socially, lead us to engage in acts of compassion towards one another in our united fight against the virus; we may also tend to splinter into competing groups that differ on how best to respond to the pandemic and thus come to fight against each other

Based on what we know about how the stress response functions, these aspects are predictable and in fact describe the actual aspects of our individual and communal lives.

Notice too that some of these aspects of the stress response are leading to unhelpful responses when they continue indefinitely.

The stress response initially heightens our focus and attention on the danger, but over time they become impaired. The heightened attention of the stress response is like a sprinter being asked to run a marathon after the runner has already left the starting line in a full-blown sprint. The sprinter just can’t keep it going. Similarly, our initial heightened focus on danger becomes exhausted when asked to maintain it over time and as a result we become attentionally sloppy. Our attention spills out over anything and everything, and we become distractible.

Distractibility leads to aimlessness. Tasks and goals for the day are thwarted by other demands and they all become in partial states of completion. Photo by Christopher Ott Courtesy of UnsplashBy the end of the day, it can seem like nothing got done and yet you’re exhausted.

Aimlessness is fatiguing. A persistent state of arousal associated with the stress response takes a lot of energy to maintain. It’s like an engine idling at too high of a rate. It uses up all the gas without ever really going anywhere. Similarly, when the stress response remains engaged for too long, the resultant distractibility and aimlessness is exhausting.

Sleep can become an avoidance strategy. While it may initially prove helpful, sleep as an avoidance strategy can outlive its usefulness, just as the attentional aspects of the stress response are outliving their usefulness. Avoidance sleep is rarely refreshing when done on a repetitive basis.

This odd combination of distractible over-activity coupled with pockets of inactivity and rest leads to a persistent boredom. It can feel like you have too much to do and not enough to do at the same time. In addition to sleep, other avoidance strategies such as binge watching TV or stress eating can provide temporary relief but they lose their luster in time. As a result, we come to have a vague sense of futility through our days called boredom.

In this boredom, we have little to hold our attention but for the threats associated with COVID-19 and a tanking economy.

The stress response thus leads to boredom and boredom leads back to stress in this age of COVID-19.

References

Lacurci, G. (2020, July 21). A second great depression? Unemployment crisis hits big cities hard. CNBC. 

https://www.cnbc.com/2020/07/21/some-big-cities-are-hitting-great-depression-unemployment-levels.html

Date of publication: July 27, 2020

Date of last modification: July 27, 2020

About the author: Dr. Murray J. McAllister is the publisher and editor at the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported and to make that empirically-supported pain management more publicly acessible. To achieve these ends, the ICP provides scientifically accurate information on pain that is approachable to patients and their families.

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joemcallister4@gmail.com (Murray J. McAllister, PsyD) Stress Mon, 27 Jul 2020 14:24:02 +0000
COVID-19 and Chronic Pain: Challenges and Opportunities https://www.instituteforchronicpain.org/blog/item/219-covid-19-and-chronic-pain-challenges-and-opportunities https://www.instituteforchronicpain.org/blog/item/219-covid-19-and-chronic-pain-challenges-and-opportunities

The COVID-19 pandemic continues to impact the world with deaths in the hundreds of thousands and countless more having become ill. To reduce the risk of contagion and death, areas around the world maintain self-quarantining practices and have been doing so now for multiple months.

Sheltering-in-place, or self- quarantining, presents both challenges and opportunities for everyone, including those with persistent, or chronic, pain.

Challenges

While the COVID-19 pandemic presents multiple challenges to everyone, one of the most important of these challenges to those with chronic pain are the potential for vulnerabilities to developing serious complications if becoming ill with COVID-19. The coronavirus, which is the virus that causes COVID-19, leads to a wide range of symptoms for those who become infected. Some people don’t have any symptoms at all. Still others have mild to moderate degrees of symptoms. Still others have critical, life-threatening symptoms. These latter people with COVID-19 tend to become hospitalized and may even die.

The Centers for Disease Control (CDC) keep statistics on cases of COVID-19 worldwide and initially found that those who are most prone to Photo by Allie Smith courtesy of Unsplashdeveloping critical, life-threatening forms of the illness are the elderly and those with certain pre-existing health conditions (April 3, 2020). Health conditions that are present at the time when another, unrelated health condition develops are called comorbid conditions. These conditions are high blood pressure (otherwise known as hypertension), high cholesterol (otherwise known as hyperlipidemia), diabetes, and chronic respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and asthma.

In the United States, the CDC later found that African-Americans also have a greater risk of developing serious, life-threatening illness from COVID-19 (April 14, 2020). Indeed, in some states the majority of those who have died from COVID-19 are African-Americans, even though this group of people only makes up a minority of the population. While the cause(s) for this discrepancy is unknown at present, speculation is that the above-mentioned comorbidities as well as social and economic causes of poor health are the most likely culprits (Yancy, 2020).

It’s noteworthy that chronic pain syndromes are not one of the comorbidities that make people prone to critical, life-threatening progressions of COVID-19. With that said, however, the comorbidities listed above can occur in those with persistent pain. As such, it is important to take the threat of COVID-19 infection seriously for anyone with persistent pain whose health is additionally compromised by conditions such as heart disease, diabetes, COPD or asthma.

To reduce your risk of infection, it is important to follow the common guidelines advocated widely by governmental and healthcare institutions. Most everyone knows of them by now, but they bear repetition.

  • Stay home as much as possible.
  • Engage in distancing at least six feet, or 2 meters, (or more) from others, particularly when in public.
  • Wear a mask when out in public or at home if you’re ill.
  • Wear a mask if you are taking care of someone who is ill with COVID-19.
  • Wash your hands often and for at least 20 seconds with soapy water, or use a hand sanitizer that is made up of at least 60% alcohol.
  • Cover your cough or sneeze with your arm or a tissue.
  • Don’t touch your eyes or face.
  • Wash and disinfect common surfaces.

The CDC has a good webpage with more information here on this topic.

Opportunities

It may also be an opportunity for all of us to do what we can to become as healthy as possible. It’s all too easy for anyone of us to focus on the dangers of the illness, the disruptions of sheltering-in-place, and the economic stresses that are occurring as well. With all these problems, it’s easy to seek comfort in comfort foods, sleeping in late and staying up late, binge-watching TV, web surfing aimlessly for hours, or drinking alcohol (or using other drugs) more than you should. It’s all understandable, of course, so we shouldn’t judge ourselves or others when engaging in these behaviors, but when we do them we end up becoming unhealthier at a time when we need to be as healthy as possible.

Most of us while sheltering-in-place tend to have extra time on our hands and we could use this time to start a healthy behavior that we’ve always known we probably should do, but have never really gotten around to doing. As such, we could spend our extra time on ways to foster our health and overall well-being.

Maybe we could work at cooking from scratch more often, looking up some recipes and spending more time in the kitchen. We may come to enjoy cooking when done for pleasure as a pastime. We would also subsequently eat less processed foods and likely more fruits and vegetables. In doing so, we might even lose a bit of weight. In all, we might develop an enjoyable past time that is safe to do because we are also at home, while also eating healthier and possibly even losing some weight.

We could also start a gentle exercise routine.* Initially, it could be something quite modest, without rigor. You could use the motto of 'anything is better than nothing’ and so perhaps it is just walking a circle or two in your house or down to your mailbox and back. With time, you could extend it to walks outside each day or every other day. You could use the same approach if you have access to a treadmill, stationary bike, or other similar equipment. Notice it is gentle, yet something more than just stretching. It’s something that gets your heart rate up. It's a gentle or mild aerobic exercise and it makes us healthier when done over time.

We could get outside more often (while maintaining social distance) and spend time in green spaces.* Many parks remain open. Our grandmothers used to tell us to ‘go outside’ when we were kids because they knew it was good for us and they were right. Being among rocks and trees, with birds and scurrying little critters, and breathing fresh air improves our well-being. This link is a nice article that reviews the science proving that our grandmothers were right all along.

We could also do a stress management technique for a few minutes each day, such as diaphragmatic breathing, progressive muscle relaxation,Photo by Madison Lavern courtesy of Unsplash meditation, yoga, or tai chi. Any of these contemplative practices are ways to develop the skill sets of calming yourself down and focusing your attention. We don’t tend to think of the abilities to calm yourself down and stay focused on things as skills that can be learned, but they are. They are like learning to play a sport or a musical instrument – the more you practice, the better you get at them. Simlarly, a contemplative practice like those listed above take practice to get good at them. With practice, however, you won’t have to resign yourself to being stressed and scattered. Instead, you could get good at becoming calm and focused. These skills sets can positively affect our health and well-being.

Any of these healthy behaviors bring about a greater sense of well-being, but are also apt to reduce factors associated with many of the comorbid conditions listed above that are associated with severity of COVID-19. They help to reduce blood pressure, lower cholesterol, reduce inflammation, lose weight, and lower blood sugars. They may even improve the functioning of the immune system.

Conclusion

Living and staying safe in the time of COVID-19 with its resultant economic uncertainties presents many challenges. It’s normal to be scared in the presence of danger. Sheltering-in-place, or self-quarantining, can also lead to persistent boredom and aimlessness. In response, it is common to seek comfort that temporarily provides relief, but in the end is actually unhealthy.

Now is the time, when we need to be as healthy as we can to fight off potential infection, to take active steps to improve our health. It’s a time to reset our priorities and stop putting off doing those things that we always knew we should do, but haven’t gotten around to it. Now, more than ever, is the time to become as healthy as possible.

*Please always follow the advice of your healthcare providers when starting a gentle exercise routine or going outside. Their recommendations should always supercede the informational content of this site. You may have unique aspects to your health that cannot be represented accurately with general, educational information as found on this site. Please also see Terms and Conditions of Use.

References

Centers for Disease Control (CDC), (April 3, 2020). Retrieved on April 20, 2020, fromhttps://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

Centers for Disease Control (CDC), (April 14, 2020). Retrieved on April 20, 2020, fromhttps://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/

Guan, W., Liang, W., Zhao, Y., et al. (2020). Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. European Respiratory Journal, 55(4), 2000547. doi: 10.1138/139930003.00547-2020

Yancy, C. W. (2020). COVID-19 and African-Americans. JAMA, published online. doi: 10.1001/jama.2020.6548

Date of publication: April 23, 2020

Date of last modification: April 23, 2020

About the author: Dr. Murray J. McAllister is the editor at the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported and to make that empirically-supported pain management more publicly acessible. To achieve these ends, the ICP provides scientifically accurate information on pain that is approachable to patients and their families.

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joemcallister4@gmail.com (Murray J. McAllister, PsyD) News & Recent Events Wed, 22 Apr 2020 18:35:03 +0000