Different Anxiety Responses to the Coronavirus Pandemic

How are you coping with your anxiety about the coronavirus?

Posted Mar 12, 2020

Anxiety about the spreading coronavirus pandemic is widespread, but for people with affect dysregulation, controlling their anxiety can be overwhelming. Dysregulation is the inability to manage the intensity and duration of negative emotions such as fear, sadness, or anger. Allan Schore says that affect dysregulation is the result of insecure attachment and the two major ways that people try to regulate themselves when they suffer from insecure attachment is by over-regulating their affect (i.e. avoidance strategy) or under-regulation (anxiety strategy).1

 Macau Photo Agency/Unsplash
Source: Macau Photo Agency/Unsplash

Coronavirus is rapidly becoming the main subject in psychotherapy sessions requiring psychotherapists to regulate their own anxiety at the same time that they help their patients do so—especially those with affect dysregulation. Having recently returned from Sydney on February 26, I was unnerved by the fact that the Japan Airlines lounge was not serving food; the staff in the lounge walked around spraying disinfectant; and the flight attendants all wore face masks. More than half the people on the flight were wearing masks as well. My anxiety about the virus increased exponentially.

Over the weekend, before I returned to work, South Korea reported its highest daily number of confirmed cases yet, 813, bringing the country's total to 3,150 with 17 deaths. Iran also reported the number of its cases had jumped 388 cases to 593 in 24 hours, with the death toll reaching 43.  

On my first day back to my office, March 3rd, Italy announced travel bans as the death toll in the country reached 77, equaling the total deaths in Iran. My first patient, Rosalind, asked me about my vacation and then turned to her anxiety about the coronavirus. She said she had ordered a carton of Lysol and Clorox wipes; she took her shoes off and washed her hands upon entering her house. Her son had a doctor’s appointment at a hospital and she wasn’t sure if she should cancel it. It was important to help her separate out her internal anxiety from the external reality because she suffers from affect dysregulation and needs help regulating her anxiety.

“I understand why you are concerned. There is a danger of the coronavirus spreading and it makes sense to wash your hands frequently and use Clorox wipes. But I think it’s important to try to separate the reality of the virus and your internal anxiety.”

In contrast to Rosalind, another patient, Sally, over-regulates her affect and uses avoidance and denial. She told me she visited her mother in a nursing home over the weekend just before the nursing home closed its doors to visitors. She said it with a laugh showing no indication that she might have endangered herself.

Another patient, Patricia, like Sally, over-regulates her emotions. Although she was travelling extensively in Asia in January and has asthma, she says she’s not concerned about the coronavirus. She’s confident that washing her hands a lot will protect her.

In conclusion, the coronavirus pandemic will be increasingly stressful as it spreads and more people become ill and/or die. This presents a particular problem for people who are not only physically vulnerable, but also psychologically vulnerable. Some of them will refuse to protect themselves in a misguided attempt to control their fears and some will get increasingly phobic and isolate themselves in an attempt to ward off anxiety. As psychotherapists, the best we can do is control our own anxiety and help our patients live with theirs.


[1] Schore, Allan, (2003). Affect Dysregulation and Disorders of the Self. New York: W. W. Norton & Company.