Looking after mental health in lockdown: Tackling worry and overthinking

Ed Watkins, Professor of Experimental and Applied Clinical Psychology and Director of the Mood Disorders Centre at the University of Exeter Medical School, on mental health and wellbeing during the coronavirus pandemic

The COVID-19 crisis is impacting our mental health. Increased uncertainty, health fears, disruption to normal life, isolation, unemployment, and the loss of loved ones increase worry, anxiety and depression. Surveys in April 2020 found much higher distress, anxiety and depression than previous years. The biggest increase in distress was in 14-24 year olds. This age period is a critical time for the emergence of mental health difficulties. It is a vulnerable time because significant developmental changes occur in young people’s brains, alongside key life transitions, such as becoming independent and first romantic relationships. Social distancing, disruption to education and the shut-down of the hospitality industry all interfere with these transitions and have hit young people hard.

Promoting wellbeing and preventing poor mental health in young adults was already a priority. This has only been increased by COVID-19.

When feeling stressed, talk to yourself as if you are talking to support a good friend, say encouraging and motivating things, point out your progress, successes, and strengths and remind yourself that it is normal to feel anxious and okay to not always feel okay.

The good news is that there are effective ways to promote wellbeing. In an approach developed at the University of Exeter, we found that tackling worry and the tendency to overthink upsetting events can reduce anxiety and depression. In a trial published in the British Journal of Psychiatry, a face-to-face therapy targeting worry and overthinking outperformed antidepressants alone for patients with hard-to-treat depression. In two further trials, we found that an online treatment that targeted worry helped to prevent future clinical depression and anxiety in 15-21 year olds in the Netherlands and in undergraduates across the UK.

We’re building on this work with the ECoWeB study, a €4 million project funded by the European Commission to promote wellbeing in young people. To make helpful strategies accessible and easy to use just when needed, we’ve built a self-help mobile app called MyMoodCoach. Now we’re recruiting young people to benefit from this app, while helping us test different versions to see what works best. We compare self-monitoring alone, which we know can improve management of emotions, versus self-monitoring plus general self-help lessons and tools to cope with stress, versus self-monitoring plus specific strategies personalised to the individual, such as tools to reduce worry.

We already have more than 750 people aged 16-22 signed up. We’re keen that readers share our link www.mymoodcoach.com with young people without a history of depression, who are eligible to sign up. We assess wellbeing and emotions online after one, three, and 12 months so we can learn how wellbeing changes in young people and which strategies are most useful. Users report the app is simple to use and helpful, e.g., “MyMoodCoach really helped me when I was stressed and had nobody to talk to.”

For those who understandably may be worrying more right now, the strategies we found most helpful in our trials can be remembered with the mnemonic: ASK – Active, Specific, Kind.

First, be Active. Physical and mental activity are great for your mental health. Doing activities that you value and enjoy will improve mood and reduce overthinking. Activities you can get absorbed in are particularly helpful, e.g., creative activities like art, music, gardening or cooking, or attending to nature.

Second, be Specific. When people worry, it’s easy to get into general thinking that moves away from the particulars of the situation, for example, wondering “Why me?” or “What if this terrible thing happens?”. This thinking worsens mood and make things seem worse. In contrast, our research finds that thinking in a specific way, focused on the details of a problem and the circumstances in which it occurred keeps things in perspective and helps to solve problems. It helps to slow things down in your mind and ask questions like “How did this happen?”, “How can I start to tackle it?”. Teaching people with depression to think this way reduced their symptoms.

Third, be Kind. When things don’t go to plan, it is easy to slip into self-critical thinking. A good antidote to this is being kind and soothing. When feeling stressed, talk to yourself as if you are talking to support a good friend, say encouraging and motivating things, point out your progress, successes, and strengths and remind yourself that it is normal to feel anxious and okay to not always feel okay. As best you can, use a calm, gentle tone of voice.

In these difficult times, it’s a real priority to find better ways to maintain good mental health for everyone. Our research is one piece in the jigsaw puzzle of working out how to build better mental health across society. We hope it leads to more initiatives, policies and investment to promote mental health.

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