April 3, 2024 — When the COVID-19 pandemic hit 4 years ago, Jenn Kearney felt extra thankful for her years of therapy.
The 34-year-old digital communications manager from Boston said her 11 years of doing therapy — specifically cognitive behavioral therapy, or CBT – prior to the pandemic had given her skills and “ways to cope and adapt that not only benefited me, but the people around me,” she said.
“I had spent a lot of time working with my therapist on, specifically, managing my anxiety through unexpected incidents,” she said.
That was especially useful when her husband contracted COVID at the end of April 2020.
“I was able to use what I knew about my anxiety to loosen its grip on my thoughts and judgment, to prepare myself in case I contracted it as well,” she said, noting that using affirmations like “This will all work out” helped her, especially when she tested positive for the virus a few days later.
“I was able to recognize when my thought pattern was turning into ‘what ifs.’ I used what I had been working on with my therapist — making a conscious effort to reflect on what I was thankful for,” like the fact neither she nor her husband required hospital stays, no one else in their family was sick, and the couple “had the ability to rest and look after each other.” That mindset kept Kearney’s anxiety in check.
It’s no surprise that the COVID-19 pandemic caused worldwide emotional upheaval. A report from the World Health Organization found that anxiety and depression increased globally by a staggering 25% during its first year. But a new study found that people diagnosed with anxiety who received two widely available forms of therapy experienced less stress than others during the pandemic, even during the toughest days of lockdown.
Researchers at McLean Hospital/Harvard Medical School followed 764 outpatients with moderate anxiety. These patients had received one of two treatments: cognitive-behavioral therapy (CBT) or dialectical behavioral therapy (DBT). CBT is a form of talk therapy that emphasizes the power one’s thoughts can have on their feelings. DBT helps patients identify thought patterns that may cause distress.
The patients were organized into four groups: those who began treatment before Dec. 31, 2019; those who began treatment between Jan. 1, 2020, and March 31, 2020; those who began treatment between April 1, 2020, and Dec. 31, 2020; and those who began treatment from Jan. 1, 2021, onward. (The WHO declared COVID-19 a pandemic on March 11, 2020.)
The researchers expected to find that the stressors caused by peak points during lockdown — specifically from March 2020 to July 2020 — would cause worsening of these patients’ anxiety.
Rather, they found that patients who started CBT or DBT prior to the start of the pandemic had decreased symptoms of anxiety. The researchers found that CBT and DBT gave these patients served as a protective effect. This means patients demonstrated fewer symptoms related to anxiety than many people who never had anxiety at all but who were feeling the stress of lockdown.
What’s more, CBT or DBT started at any time can help many people build the same resilience so that major world events or personal upheaval will not cause them to experience worsening of their mental health, the researchers said.
“I was surprised by how robust the intervention was,” said lead study author David H. Rosmarin, PhD, a clinical psychologist at McLean Hospital in Belmont, MA, and associate professor of psychology at Harvard Medical School in Cambridge. “Yet with CBT and DBT, we really teach people not to be afraid of anxiety. Anxiety will not kill you, even though it feels like death to some patients. We’ve been conditioned to fear anxiety, but what we really need to do is to increase our tolerance of uncertainty.”
As the patients in the study progressed through treatment, they began to demonstrate this resilience.
“Patients felt more prepared tolerating COVID-related anxiety as they became comfortable being less prepared,” said Henry J. Eff, PsyD, supervising psychologist at the Center for Anxiety in Brooklyn, NY, where patients in the study were seen. “Those who experienced higher levels of anxiety prior to the pandemic, but who were taught CBT and DBT skills, felt better equipped to manage, and more importantly, tolerate, COVID’s uncertainty.”
Read on to better understand anxiety and how this groundbreaking research can be used preventatively to improve quality of life during unexpected times of crisis but also in in everyday life.
What are the symptoms of anxiety?
Signs of anxiety typically include nervousness, tension, restlessness, a fast heartbeat, and breathing faster. Sweating, shaking, fatigue, having a hard time concentrating, digestive issues, and trouble sleeping may also be symptoms. You can read more about anxiety here.
How does CBT help manage anxiety?
In a nutshell, CBT can help build your “toolbox” for when feelings of anxiety hit.
CBT helps change the ways a patient thinks that are not helpful. By recognizing that your thoughts affect your actions, you gain a sense of control and can make choices that help you respond better to the stresses in your life that make you anxious.
CBT also helps you build emotional strength because it helps you face and overcome challenges.
“CBT is like going to the gym for your emotions,” Rosemarin said.
How does DBT help manage anxiety?
DBT, on the other hand, focuses on acceptance to bring a sense of control to those experiencing powerful feelings.
“DBT can help us manage the intense emotions we experience with anxiety,” said Eff. For example, during the pandemic, “We worked with patients on accepting the realities of COVID: isolation, worry for our loved ones, and complete disarray of normal activity. Accepting this unfortunate situation enables better coping and reduces suffering.”
Can Anxiety Sometimes Be Positive?
The energy that anxiety produces can be used as a powerful motivator — a great tool to push you toward accomplishing whatever you want.
“It can feel counterintuitive to push through anxiety and feel your feelings. We think of anxiety as something we need to get rid of, but anxiety can be a catalyst to things like change,” Rosemarin said. “Anxiety can be utilized; it can be used as a tool.”
The key is to manage the amount of anxiety you feel.
“You typically don’t turn the dial of a stove all the way up or your food will burn,” explained Eff. “However, turn it off completely, and your food won’t cook. There are times where the burner — or your anxiety [in this case] — is higher, and that’s OK. Once we can begin to recognize and label our various levels of anxiety, we can better manage it and learn how to use it to our advantage.”
Most people experience some level of anxiety, Rosemarin said. “We don’t want to ignore or suppress it.”
Is CBT or DBT right for you?
If you experience symptoms of anxiety, see your doctor, who can evaluate your overall health. If you’re diagnosed with anxiety, a psychologist can determine whether CBT or DBT can benefit you and get you ready to handle unexpected life events.
As for Kearney, the skills she has gained through therapy have helped her in all aspects of her life, not just during the pandemic.
“I’m a better parent, partner, friend, sibling, daughter, and colleague,” she said. “I’ve learned invaluable communication and coping skills as well as a better understanding of my mind, how it works, and how I can use my unique ways of thinking to my advantage.”
