Nearly seven million people in the United States have been infected with COVID-19 in the past six months. But that’s not the full extent of the virus’ terrible toll—there have also been crushing repercussions on the country’s collective mental health.

Over 40 percent of Americans reported struggling with their mental health since the start of the pandemic, according to a new study from the Centers for Disease Control and Prevention (CDC). 31 percent of respondents reported that they’ve been experiencing anxiety or depression symptoms, and 13 percent stated they’d increased substance use to cope with stress or emotions. Separately, one meta-analysis of COVID-19 studies found that people may experience symptoms of anxiety, trauma, panic attacks, psychosis, and suicidal thoughts in the wake of the pandemic.

The anxiety-ridden reality of a pandemic

At the root of this psychological reckoning: the utter lack of control that most of us are experiencing in our day-to-day. “The sense of uncertainty is very concerning,” says Jill Sonnenklar, Ph.D., a senior psychologist in the Division of Developmental and Behavioral Pediatrics at Northwell Health in New Hyde Park, New York. “People do better when they have routine and structure.”

The reason: “Uncertainty leads to a heightened sense of anxiety,” explains Bella Grossman, Ph.D., a clinical psychologist at the Katz Institute for Women’s Health, Northwell Health in New Hyde Park, New York. The percentage of Americans reporting symptoms of anxiety disorder this year increased about threefold compared to last year, according to the CDC.

Chronic exposure to stress can cause issues ranging from disrupted sleep to heart disease.

Increased levels of anxiety can weaken the immune system, upping your risk of contracting the virus. It also puts your body in a constant state of “fight or flight,” anticipating danger at any moment, says Sonnenklar. That kind of chronic exposure to stress can cause issues ranging from disrupted sleep to heart disease.

Women are especially prone to crippling anxiety right now, as they often shoulder the challenges of working from home, taking care of children, and handling the bulk of household duties, says Grossman. “It was a hard balancing act pre-COVID, but now—especially with virtual schooling—it’s an impossible task,” she says. “So many women are trying to give 100 percent to every area of their life, and there’s just no way to do that.”

The bad-news blues

For those overwhelmed with juggling so much responsibility (or just the relentless onslaught of scary news), there is a danger of slipping into depression. The percentage of people reporting symptoms of depression increased about fourfold this year, the CDC found.

This isn’t unexpected: After the SARS pandemic in 2003, researchers found that being in quarantine was associated with higher rates of depression; the longer lockdown lasted, the greater the symptoms were. “Isolation is a big piece of what leads people to feel more depressed,” says Grossman. The fact that more than one-third of adults aged 45 and older felt lonely before the epidemic, according to a report from the National Academies of Sciences, Engineering, and Medicine (NASEM), doesn’t help.

Self-care is so crucial, even when you feel like burrowing under your comforter for the rest of 2020.

But it’s not just older adults who feel isolated; it’s single people living alone, it’s new moms without a support network, it’s caregivers in charge of grandparents or other relatives, and it’s kids whose parents have opted to homeschool them, who miss their friends.

Kids are especially vulnerable to this kind of upheaval, which is why it’s so important for parents to try maintaining a positive attitude. “Kids are looking at their parents as a model for how they should respond to what’s going on in the world,” says Sonnenklar. “If you’re falling apart, they’re going to fall apart, too.”

Better ways to cope during COVID-19

That’s why making time for self-care is so crucial, even when you feel like canceling your internet connection and burrowing under your comforter for the remainder of 2020. Sonnenklar likens it to the safety instructions before takeoff on an airplane: Always put your oxygen mask on before you help someone else with theirs. “If you’re not taking care of yourself, how are you supposed to take care of the people around you?” she says.

Stress management looks different for everyone: Some people self-soothe with a hot bath, and others prefer a grueling workout. But there are tried-and-true mindfulness skills Sonnenklar recommends everyone cultivate, especially now, to combat anxiety, depression, and stress:

  • Deep breathing: This is an easy one. Just put one hand on your chest and one on your stomach and practice breathing low and slow, watching your hand move away from your body and back toward your body. Do this ten times.
  • Progressive muscle relaxation: This is all about tensing up and releasing that stress; imagine being a rigid piece of raw spaghetti as you tense your muscles for five seconds. Then, relax your muscles and release the tension, as you imagine the spaghetti is now cooked. Repeat as needed.
  • Thought stopping: Replacing unwanted thoughts with better ones is the name of the game here. Close your eyes and picture yourself in your happy place. Think about what it smells like, how it makes you feel, and take in the scene’s visual details. Transport your mind to this location anytime a stressful situation arises.
  • Self statements: Saying things like “I got this!” or “It’s not that bad” to yourself can make you feel better or just help you get through tough moments. Think of it as a mini pep talk that you give yourself.

“The thing about all of these skills is that you need to practice,” adds Sonnenklar. “When you’re stressed, you can’t expect to just pull something out of the hat and say OK, this is going to reduce my stress. You have to practice these at times when you’re not stressed so that when you are, you can pull them out of the toolbox.”

    Most importantly, give yourself a little grace. “Be flexible and remember that, in terms of trying to balance everything, you’re doing the best you can,” says Grossman. “This is an impossible situation, but we are all very resilient, and we will get through this eventually.”