Psychologist Dr. Johns answers questions about COVID-19

Monday, March 23, 2020

With the ever-evolving coronavirus disease 2019 (COVID-19), there is much uncertainty for everyone — especially for cancer patients. We turned to Dr. Shelley Johns for advice on how to manage stress. A researcher at the IU Simon Comprehensive Cancer Center and a board-certified clinical health psychologist, Dr. Johns is assistant professor of medicine at IU School of Medicine and a research scientist at Regenstrief Institute. Her research focuses on testing mind-body interventions to reduce cancer-related fatigue and fear of cancer recurrence. She teaches medical students and residents at IU School of Medicine about the importance of psychological care of their patients and leads workshops on campus and in the community on stress management.

Q: First off, what can you tell us about a person’s natural reaction to stress?

A: Stress is the body's natural reaction to any change that requires an adjustment or response. The body responds to these changes physically, mentally and emotionally. One of the first stress symptoms we may notice in response to the COVID-19 pandemic is sleep disturbance. Watching the news or checking social media close to bedtime can interfere with our ability to fall asleep. We may notice other signs of stress such as upset stomach, increased or decreased appetite, rapid heartbeat, fatigue, muscle tension or headaches. We may experience problems with memory, concentration or staying focused. Emotionally, we may feel more anxious, overwhelmed, restless, irritable or sad.

Q: What effects does stress have on a person’s body who is fighting cancer?

A: Chronic stress — from situations that last many weeks or months with no definite end point — can weaken the immune system. Further, the hormones the body produces in response to chronic stress have been linked to cancer growth. COVID-19 is likely to be a chronic stressor for everyone, so we all need to be proactive and establish a self-care plan that can keep us all safe. The need for this is particularly important for individuals with cancer and other serious medical conditions, whose immune systems are already overworked. Fortunately, chronic stress can be managed in ways that can reduce our risk. A psychiatrist, psychologist or social worker can teach you skills to successfully manage your stress. Mindfulness meditation and yoga are proven stress reduction strategies that can be done at home. Getting adequate sleep can also help with stress management and healthy immune function.  

Q: Your research has examined how mindfulness can help adults with cancer and their family caregivers during challenging times. Can you explain mindfulness and how it can be applied during the COVID-19 pandemic?

A: Mindfulness is the human ability to be fully “awake” in our lives — aware of where we are and what we’re doing without getting too reactive or overwhelmed by what’s going on around us. Mindfulness can connect us to our inner wisdom so we can respond to challenges skillfully with greater ease. As we learn more about COVID-19, our thoughts naturally drift to the future, which can increase our anxiety. We worry about our health, risk to our family and friends, whether or not healthcare systems will be prepared to care for coronavirus sufferers, whether or not we can get the food and supplies we need, and the financial impact of COVID-19.

Although we can’t eliminate these understandable worries, pausing for 10 minutes each day to practice mindfulness may increase our sense of well-being as we navigate COVID-19 stress. I have recorded six, 10-minute mindfulness practices, which you can access here. Additional guided mindfulness practices are offered through Mindful.org  and by calling the IU Health Guided Meditation line at (317) 962-6463.

Q: What are some stress management activities that cancer patients can do on their own during this uncertain time?

A: Preferred stress management activities vary by person and are often driven by our energy level and how we’re feeling physically. Any sort of physical activity (e.g., taking a walk, doing a few yoga stretches) can help release tension. Consider replacing news watching with a funny movie to lift your spirits. Listening to music that was popular during happy moments from your life — music that helps you feel truly alive — is often a great stress reducer. Making a list of three specific things you are grateful for each day can be a pleasant reminder that life is about much more than cancer and COVID-19. Seeking support from friends and family — and offering support to anyone in need — can be another stress buster. Such social connections may need to be by phone during this time of social distancing. Consider setting a limit during your calls on how many minutes you will devote to talking about COVID-19. Talking about other life-affirming topics and interests will help “turn down the volume” of your stress.      

Q: Feelings of fear are common among individuals with cancer and now with so many people during this pandemic. What can everyone do to cope with those feelings?

A: Fear is a natural human emotion during uncertain times. Fear will likely be part of our lives until COVID-19 is contained; however, there is much we can do to cultivate resilience in response. My team recently conducted a clinical trial testing three behavioral interventions to support breast cancer survivors in coping adaptively with fear of recurrence. The following skills helped reduce fear and anxiety among our study participants:  

  • Mindfully focusing on the present moment. Unhappiness — including fear — creeps into our awareness when we focus our attention on the unchangeable past or the uncertain future. Practicing mindfulness using these recordings can help.
  • Being compassionate with yourself. Treat yourself with as much kindness as you would treat a friend in need, a distressed child or an injured pet.
  • Letting your values guide your actions. Living intentionally in alignment with your values can ignite meaning and purpose in life even when fear is present. What values do you most cherish at this moment in your life? Do you want to be known for being a loving and attentive family member, a person who embodies wisdom, someone who takes daily action to improve their physical and emotional health?

Q: With today’s technology, it’s easy to get overwhelmed with all of the breaking news notifications about COVID-19. What tips do you have for people, both those with cancer as well as their family and friends, for monitoring the news?

A: Although we need to stay informed, too much media of any kind can undermine mental health, deplete our energy, and be a time waster. To determine the right amount of news viewing for you, consider rating your stress level on a 0-10 scale (0=no stress to 10=extreme stress) BEFORE watching or reading the news. Then, consume 30 minutes of news from your preferred source(s) and re-rate your stress level on the 0-10 scale. If your rating increases by two to three points, 30-minutes of news or less may be all you need for the day. The goal is to stay adequately informed to protect your safety without overdoing it. Filling your day with meaningful and enriching activities may be a more satisfying and healthier choice.   

Q: Anything else that we haven’t touched on?

A: During uncertain times like these, I am reminded of the Serenity Creed, which can be applied to COVID-19: “Grant me the serenity to accept the things I cannot change (stock market fluctuations, America’s new obsession with toilet paper); courage to change the things I can (handwashing, social distancing); and the wisdom to know the difference.”

Let’s all do what we can to maintain our sense of humor as we collaborate in effectively controlling the spread of coronavirus.