Coping with COVID: Best practices for mental health professionals during the pandemic.

By: Rania Awaad, M.D.

“Anxiety is a natural response to trying to manage all the changes to our previous pace of life as a result of this pandemic.”

Who could have imagined that, a few short months into 2020, the world would come to a complete standstill? Businesses have closed down, schools are empty, but some of our homes are possibly more full than they have been in a long time. In addition to the many stressors faced by all people as a result of the quarantine, Muslims have faced additional challenges that are unique to them. As Muslim health care professionals, it is important to understand how to cope with these challenges during these unique times, as well as how to guide those seeking our help. As extensions to the shelter-in-place orders resulted in longer periods of time under quarantine, members of the Muslim community came to the eventual realization that the Holy month of Ramadan was going to be drastically different than anything they had previously experienced. With that realization came trepidation but also an opportunity to experience a more introspective Ramadan without the large crowds and social obligations that usually accompany the holy month.

One of the most common first reactions for many Muslims was to lament the loss of the communal aspects of Ramadan. But as news spread that the COVID-19 virus had afflicted millions and claimed the lives of thousands in the US alone, these reactions were quickly replaced by two other emotions: anxiety and fear. It is important to note that both of these emotions are completely normal reactions given the circumstances. In fact, a healthy dose of anxiety allows us to manage new circumstances brought about by shelter-in-place as we juggle the demands of running a home while working, schooling and entertaining children, all while under quarantine. However, when these emotions go beyond the normal and healthy threshold and reach pathological levels of anxiety and concern, the help of a mental health professional may be required. 

Let us first focus on the emotion of fear. As the days continue to pass by without a widely available treatment or vaccine for the COVID-19 virus, it is impossible to know with certainty the extent of the damage the virus will bring. We do not know the exact number of people that will get sick or lose the battle against COVID-19. We may also find ourselves questioning whether the personal, national or even global measures being taken are enough to protect us. Beyond the fear of the unknown, there is also the fear for our own safety and that of our families and communities. The second emotion that many are experiencing at higher rates than usual is a very palpable sense of anxiety. Anxiety is a natural response to trying to manage all the changes to our previous pace of life as a result of this pandemic. Anxiety also arises from figuring out how to work from home or the loss of a job altogether, as well as figuring out how to homeschool children midyear with no prior experience. Added to this is the anxiety of ensuring that our families, whether extended or part of our immediate households, are being properly cared for and are healthy, especially if they are isolated and away from us due to the quarantine. 

“The closing of the Haram was symbolic of the unprecedented nature of this global crisis, and increased the sense of anxiety and dread amongst Muslims world-wide. “

While the above situation is widely applicable to many, Muslims face additional challenges unique to them. For example, Muslims have been challenged by the lack of access to their places of worship and community gatherings with the closure of the mosques, particularly in the holiest month of the year. Many Muslims are also experiencing a sense of loss by not being able to attend the Friday, Taraweeh and even the daily prayers in congregation. Others are feeling physically and emotionally disconnected from family and friends, elders, Imams, other religious and community leaders, or other places of spiritual gathering and solace. Similarly, the broader Muslim community around the world was heartbroken to see Masjid al-Haram in Mecca empty as never before, meaning that the many who intended to go to umrah or hajj this year, possibly a once in a lifetime experience, will be prevented from making that pilgrimage. For many Muslims, Masjid al-Haram is seen as the house of God, and a welcoming, ever-present place of worship that connects Muslims of all races and social status equally. The closing of the Haram was symbolic of the unprecedented nature of this global crisis, and increased the sense of anxiety and dread amongst Muslims world-wide. 

Also unique to the Muslim population is the cumulative trauma that many in the Muslim community feel. With Islamophobia prevalent across the world, but especially here in the United States, Muslims find it hard to heal when the steady rate of Islamophobic hate crimes leaves Muslims little time to fully recover from the previous incident. While these Islamophobic attacks occur as separate events, Muslims may experience them as related because of the accumulative nature of the trauma. Along with the experience of Islamophobia, specific populations within the Muslim community struggle with other forms of trauma . African American and Black Muslims make up 25-30% of the Muslim population in the Unites States; in addition to the scars left behind by Islamophobic attacks and remarks, these communities are also subject to micro-aggressions and racism of all forms. For all of the above reasons, the typical emotions of fear and anxiety are more intensified and the recovery process prolonged for Muslims.

Now that we’ve discussed the two most prominent emotions present during the pandemic, the question arises of how to best cope when the end is not yet in sight. We offer five practical coping strategies for adults that are custom-tailored to the Muslim population:

“It is important to modulate that anxiety in oneself in order to model healthy coping skills to those in our care.”

1: Talk and Listen

It is important to communicate how you feel to those whom you trust. Many adults, especially those in caretaker roles, bottle up their emotions in order to be “strong” for others in their care. However, this pandemic is so overwhelming that the end result of bottling up one’s emotions will eventually manifest into unhealthy coping styles. The flip side to talking is listening- especially to those most impacted by the pandemic, such as the elderly. Make sure you are providing opportunities for all of your loved ones to express themselves and feel heard. It is important to note that adults not only model behaviors for children, but also emotions. As the expression goes, “Anxious adults make for anxious children.” Thus, it is important to modulate that anxiety in oneself in order to model healthy coping skills to those in our care. 

Although we are physically isolated from one another due to shelter-in-place rules, we need to remain connected in order to support one another. One way this can be done is via virtual visits with friends and family. This is especially important when thinking of the elderly who may be faced with increased feelings of loneliness and isolation stemming from the loss of community that was once derived from family gatherings and regular attendance at their local mosques. Making the time to virtually connect with elders thereby helping them maintain their sense of belonging can help reduce the negative mental health impact caused by physical isolation. It is imperative that we build virtual support communities to ensure that we all play a part in getting through this pandemic. As we deal with the effects of isolation due to COVID-19, remember that each person deals with tribulations differently. Remember to be flexible and accept each person’s feelings as they are, while avoiding judgement or shaming. Lending a supportive ear is key in the current circumstances. 

2: Moderate Your News Intake

During a global pandemic, it is expected that media outlets and social media platforms will churn out content minute by minute to which we, in turn, will be exposed. In order to maintain a healthy mindset, we should try to reduce our news intake even if it means fasting from news consumption for parts of the day- or even full days- if we find ourselves being negatively affected. Overstimulation from being “plugged in” constantly translates into reduced mental space to deal with our families and the other responsibilities that we are faced with daily. Instead of spending excess time engaged in following news reports, we need to treat this gift of time as a golden opportunity to discuss with children and even other adults sheltering with us some of the key lessons learned from this Pandemic. COVID-19 has certainly brought to light some of the best practices that are already a part of our deen, such as tahara, handwashing, and restrictions against price gouging and other forms of economic abuse. These “mini-halaqas” could even discuss lessons from the seerah related to plague and disease. For example, Prophet Muhammad’s parents, peace be upon him, both died because of fever in Madinah that was known to be contagious and may have been a virus. A review of how Muslims historically dealt with plagues based on their understanding of Prophetic Hadith coupled with the science of their times could make for an interesting discussion as well. 

For those who are fortunate enough, one of the blessings of the current situation is the increased amount of time we have to engage productively with our families. Remember that humans crave human interaction- kids and adults alike will always gravitate towards spending time with each other over electronics. Taking walks as a family while maintaining social distancing with others, gardening together, dusting off and playing puzzles or board games, reading the Quran and praying as a family are all healthy forms of engaging with each other during shelter-in-place. 

3:  Take Time

It is imperative that we take time to recharge daily. Implementing daily and weekly self-care routines into our schedules is important for our mental health, especially for those of us who are caregivers. Working from home is new to many and thus work-life balance will prove to be challenging if proper self-care isn’t implemented. For example, taking breaks regularly throughout the day can help keep the mind engaged. It is also important to make the time to care for our bodies as they are an amanah (responsibility) from Allah, subhanahu wa ta’ala. This includes maintaining healthy eating habits and allowing oneself to develop a healthy sleeping pattern- avoid binge watching Netflix, for example. For individuals who struggle with substance use, it will be imperative that they not use substances to escape from the anxiety brought on by the pandemic. This would be the best time to seek out professional services to help address negative habits instead of falling more deeply into them. 

In remembering to take time for ourselves, we need to also make time to spend with Our Creator, for all our energy and strength comes from Him. For women, this can be the time to make itikaf, spiritual seclusion, at home, while men can do the lesser itikaf called khalwa. These are practices that can be implemented into our daily lives; no specific time frame is prescribed for this practice and even five minutes will suffice. It is even encouraged to pray the five mandatory prayers in a state of itikaf or khalwa even for a short period of time. Teachers of spirituality always remind us that itikaf is like the safety valve on a pressure cooker. As we go on with our daily lives there is a constant build up of stress, anxiety and ‘pressure’, and when we turn to Allah in our state of itikaf, we are letting go and ridding our minds of these ‘pressures’. It would behoove us to take some additional time while on our prayer rugs to ponder and contemplate how a microscopic virus has brought the world to a standstill and all of us to our knees. While in this state of meditative contemplation, we need to remind ourselves that sickness is in fact a purification from Allah, and that “no calamity befalls a Muslim except that Allah removes sins from him/her because of it, even if they were pricked by a thorn”. There are also various ayat or spiritual aphorisms from the holy Quran from which we can derive some comfort and peace of mind. Examples of these ayat include:  لَا يُكَلِّفُ اللَّهُ نَفْسًا إِلَّا وُسْعَهَ, “Allah does not burden a soul beyond that it can bear…” (Qur’an 2:286) and قُلْ لَنْ يُصِيبَنَا إِلَّا مَا كَتَبَ اللَّهُ لَنَا ,“Say: ‘Nothing shall ever happen to us except that Allah has ordained for us…”(9:51). 

“In times like these, it is important to seek help from professionals in the field and to be connected with available mental health resources.”

4) Take Action

For some people, anxiety can be greatly reduced by being action-oriented. Seeking out ways to help those who have been severely impacted by COVID-19 can serve as a form of healing by channeling that anxiety into serving others. By being creative we can develop safe ways to serve and to check in on the most vulnerable in the community, both Muslims and non-Muslims. Examples might include putting together care packages, creating meal trains, or even doing grocery runs for the elderly, immunocompromised, homeless, or those who are living paycheck to paycheck. These activities can also serve as a great teaching opportunity to remind us to be thankful for all that Allah has provided for us. Involving children and teens in our families and communities in these projects can greatly help control the level of anxiety they feel as well. By directly serving others who are more impacted, young people especially can regain a sense of control and reduce the feeling of helplessness.

5) Get Help

It is imperative to recognize that at times the help we need is beyond what we are able to provide for ourselves. It is quite possible that after engaging in everything that has been outlined above, one may still find that his/her level of anxiety and/or fear is still very high. For others, they may suffer from underlying mental health conditions at baseline that have been exacerbated by this pandemic. In times like these, it is important to seek help from professionals in the field and to be connected with available mental health resources. Many mental health providers and clinics, such as the Khalil Center, are now offering web therapy and making access to care more feasible than ever before. For those who may not need professional support but would like to deepen their knowledge and skill set, there are a variety of tutorials and webinars that outline coping mechanisms for dealing with anxiety such as the Khalil Center’s YouTube channel dedicated to COVID-19 response.

Turning to Allah in times of distress and unease will lead us to remember that “No calamity befalls [anyone] except with Allah’s permission. And whoever has faith in Allah, He will [rightly] guide their hearts [through adversity]. And Allah has [perfect] knowledge of all things.” Quran 64:11 

For more information, please visit the Khalil Center and watch Dr. Awaad’s video on I’tikaf with SeekersGuidance here.

About the Author:

Rania Awaad, M.Dis a Clinical Associate Professor of Psychiatry at the Stanford University School of Medicine where she is the Director of the Muslim Mental Health Lab, and Chief of the Diversity Section. Her research and clinical work are focused on the mental health needs of Muslims. Her courses at Stanford range from teaching a pioneering course on Islamic Psychology, instructing medical students and residents on implicit bias and integrating culture and religion into medical care to teaching undergraduate and graduate students the psychology of xenophobia. Her most recent academic publications include an edited volume on “Islamophobia and Psychiatry” (Springer, 2019) and Applying Islamic Principles to Clinical Mental Health Care (Routledge, 2020). She has also produced a toolkit, fact sheet, CME course, and is now editing a clinical textbook on Muslim mental health for the American Psychiatric Association. She is also the Clinical Director of the San Francisco Bay Area branches of the Khalil Center, a spiritual wellness center pioneering the application of traditional Islamic spiritual healing methods to modern clinical psychology. Prior to studying medicine, she pursued classical Islamic studies in Damascus, Syria and holds certifications (ijaza) in Qur’an, Islamic Law and other branches of the Islamic Sciences. Dr. Awaad is a nationally recognized speaker, award-winning teacher, researcher and author in both the Islamic and medical sciences.