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Lobsang Rapgay Ph.D.
Lobsang Rapgay Ph.D.

Coronavirus and Anxiety, Fear, Panic, and Paranoia

How to tell the difference between them.

The coronavirus pandemic has brought the world to its knees. According to an intelligence report from the U.S. Department of Homeland Security, we are where we are in part because the Chinese government concealed when the virus first appeared in Wuhan in early December last year from the rest of the world. Now the world has to deal with the devastating consequences, probably the worst humanity has seen since World War II.

As the tragedy unfolds before our eyes, hidden from all the chaos and upheaval is the increasing psychological costs of anxiety, fear, panic, and paranoia and the exacerbation of existing mental disorders such as trauma, depression, and substance abuse, both on an individual level and in society at large.

During this period when we are held hostage by an invisible enemy, all of us can benefit from knowing when anxiety and fear are adaptive and when they become problems so that we know when to cope with them on our own or when to reach out and seek help.

Unlike fear, anxiety is concern about a future-oriented probable threat, such as worry about getting the virus when you go to the grocery. Such matters are adaptive when you can use the anxiety as motivation to protect yourself and your family by strictly following the recommended guidelines provided by the government. You can deal with the isolation and loneliness by creating and developing a daily, meaningful routine to keep yourself preoccupied.

People who use anxiety adaptively will find a sense of reassurance and control when they realize that 90% of infected patients recover on their own. Many of the patients hospitalized eventually recover.

When you hear extraordinarily distressing and frightening news about the virus, your adaptive anxiety alerts you about your excessive reactivity, catastrophic, obsessive thoughts, and can counter them rapidly before these thoughts become full-blown.

It is essential to remind yourself about the benefits you are deriving from adaptive anxiety. It keeps you vigilant to potential risks and confident about dealing with them. People who can use anxiety adaptively can manage the threat of depression triggered by the state of uncertainty, constant fear, and helplessness during the pandemic.

For people who worry excessively about the virus and engage in catastrophic and obsessive thinking, the consequences can be severe. The anxiety can interfere with their sleep, eating habits, exercising, and their ability to engage in daily home and work-related responsibilities. The concern is now a problem, and if unmanaged, it can lead to severe mental and physical impairment.

Some of the ways to tell that anxiety is becoming problematic include when you become more irritable, restless, disinterested, tired. You may also withdraw from significant others or argue over things that generally don't bother you. If these symptoms are making you depressed, frustrated, and negative, you should reach out and seek help, preferably professional help. As in many physical diseases, the earlier you address the problem, the better off you are in dealing with it effectively.

Unlike anxiety, fear is an instant psycho-physiological response to an imminent threat. Hearing movements in the bushes in a forest instantly activate the fight, flight, or freeze response in preparation for an attack from a charging wild animal.

However, when the imminent threat is novel, unknown, kills hundreds of people all over the world as is the case with the coronavirus, people with anxiety traits and history of aversion to risk are particularly vulnerable to react with intense fear. Research shows that people's risk perception is a critical factor in determining healthy from unhealthy behavior. Novel, unpredictable contagion such as the coronavirus is likely to be experienced as high risk, and thus people tend to engage in excessive health behavior while ignoring other potential hazards. Research also shows that the amygdala processes not only fear but also novelty, and people tend to react more negatively to novel triggers than familiar ones. We see evidence for this in how people respond to the familiar common flu compared to how we are acting to the novel coronavirus.

After the initial psycho-physiological reaction to the deadly coronavirus, a person sustains the fear with a series of catastrophic thoughts. In severe cases of concern, these thoughts activate and animate frightening images associated with the virus infused with past threatening images associated with memories of illness, suffering, and death. The fear makes these images become real and persecute the person to the point that it becomes unbearable. These persecutory images, thoughts, feelings, and the part of self experiencing them are projected externally to others, the government, God, etc. In particular, the death instinct—the biological drive towards disintegration is projected outwards as a means to preserve the life instinct—the drive towards regeneration and vitality. As the news about the virus gets worse and the threat hits closer at home, these objects of the projection now become a source of further persecution leading to depression and trauma.

People try to manage their fear by totally isolating themselves from the outside world, engaging in obsessive cleaning, self-protective behavior, and constant catastrophic thoughts. They tend to seek all sorts of medical help while ignoring necessary healthy behaviors such as eating healthy food, exercising, and maintaining interpersonal relationships. Research shows that such avoidance of threat not only increases fear but makes it more challenging to deal with it.

While inspirational guidance by religious leaders and positive psychologists is helpful, it is vital to deal with the motivating factors underlying the destructive nature of fear. The first step is to develop a mental distance to observe the fear. You can now better face persecutory anxiety, its triggers, and maintaining factors. While you will need professional help with this phase of dealing with the fear, one thing you can do in the meantime is to try your best to reduce the projection of your persecutory fears onto others. If you solely focus on the outside world, you will fail to see how your internal sources of persecutory fear play an equally important role in your suffering and distress.

Both extreme anxiety and fear can lead to panic. Panic is technically a misinterpretation of physiological symptoms as a result of anxiety and fear. Individuals who panic become hypersensitive to benign physiological symptoms such as breathing, coughing, sneezing, and headaches. They instantly misinterpret them as evidence for them having the coronavirus.

To manage your panic, you should get a test to disconfirm your fears. Then remind yourself about how misinterpretation of bodily symptoms can cause panic and immense suffering.

Finally, certain groups of people may exhibit paranoia. Paranoia is a delusional state—patients who develop paranoia about the coronavirus sense and see the virus in certain areas in their environment. In some instances, the paranoia might extend to suspicion about people in the neighborhood as intentionally out to infect them with the virus.

In the days ahead, we as a people and nation will face challenges as never before. The notions that the world is a safe place to live in and that we will see our children grow and thrive have suddenly become very uncertain and unpredictable. Death, which seemed so far away, appears around the corner. Yes, we have science and technology, which have provided and will continue to offer unimaginable blessings to the world. Yet, we are learning that science and technology alone are no match for a pandemic of this magnitude. The greatest lesson we can learn from the pandemic is humility and the recognition that it is the human spirit, resilience, courage, and sacrifice that counts in the final analysis. We are blessed with people on the frontlines and from all walks of life who exemplify these qualities. In the process, they have given all of us hope during this terrible ordeal.

About the Author
Lobsang Rapgay Ph.D.

Lobsang Rapgay, Ph.D., is an assistant adjunct professor and researcher in the Department of Psychiatry at UCLA and studies the behavioral and neural correlates of anxiety.

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