SOME of us are working extra hard during the 2019 coronavirus disease (COVID-19) pandemic, while others are in self-isolation or quarantine. And we all have patients who are in isolation. We’ve put together some advice for ourselves and our patients.

We all respond differently to isolation at home. Whether you’re an introvert and relish the opportunity to stay in or an extrovert who dreads the idea of confinement, isolation poses a challenge for us all, especially over extended periods.

This is not surprising as humans are fundamentally social creatures. In these times, when a haven can quickly turn into a prison, it’s important to think ahead about implementing a variety of strategies to keep us stimulated, relaxed and connected with others (ie, healthy). We can look to research done to support the work of Mars researchers, Antarctic expeditioners and submariners – who spend weeks to years in isolated and confined environments – for insight into tried and tested coping methods. While it is a well studied phenomenon, forethought and preparation are key elements to successfully overcoming the struggle of isolation in any context. Ultimately, remember: if you’re finding it harder than usual to cope with what’s going on around you, this is a normal reaction to an abnormal environment.

This list is designed so that, as time goes on, you can keep coming back to try new ideas or revisit methods you haven’t used for a while, to make isolation an easier and a potentially transformative experience.

Self-care: if you take care of yourself, you’re prepared to weather the storm

  • Sleep, diet and exercise routines stabilise your brain’s circadian rhythm, reduce low moods and build energy and motivation towards tasks that make you feel good.
  • Use YouTube to do a yoga or gym workout in your lounge room at a regular time. If permitted, go for a brisk walk or run around the block.
  • Eat the healthiest food you can get and try to have some diversity in your meals.
  • Sleep is the best measure of stress; read up and act on sleep hygiene; negative changes in your sleeping pattern such as wake-ups or day/night switching can be warning signs to use more self-care strategies or get in contact with someone for help.
  • Meditation is powerful; try out apps such as Headspace, Calm, Smiling Mind or InsightTimer on your phone to start learning.

Social contact: we all need time with others

  • We are social creatures: video call your family and friends regularly; have regular group chats via webcam; walk them around your house, show them what you’re doing; texting is good, but seeing faces is better.
  • Need social activities? Use the internet. Play multiplayer games, online board games with family, watch a season of a TV series together episode by episode while texting or using a webcam to share the experience. Games are more mentally stimulating than movies as they are an interactive experience.
  • Join online communities even for the short term. Facebook, reddit, Meetup – there is a community for everything you could possibly have an interest in. Google searching “subreddit” is a great start.

If you’re isolated with others, be extra considerate of each other. Even partners, kids and best friends. We all need breaks from each other and tempers can get short, especially when we’re stressed and stuck together 24/7. Be compassionate, talk out conflicts and have time apart, even if it’s just doing activities in separate rooms. Being stuck together can be as hard as being isolated, even for married couples and astronauts (we all struggle with this); it’s completely normal. Part of managing this is also recognising and asserting your own needs, as well as making a space for others to do the same. This allows everyone to have an understanding of the expectations of one another and be less likely to inadvertently annoy those around us (or be annoyed by them.)

Positive distraction: spend your time doing things you enjoy to give that time meaning

Researchers have consistently shown that when an activity is perceived as meaningful it has powerful positive effects on our mood and wellbeing.

  • Use passive media to relax (TV shows, books) and active media to keep yourself stimulated.
  • Looking for something with a bit more positivity than watching the news? TED Talks are a great way to see humanity’s ability to better itself and overcome obstacles.
  • Learn a new skill. With YouTube, Coursera and the rest of the internet, it’s easy and doesn’t need to cost you anything.
  • Journaling can be really helpful to give this once in a lifetime experience meaning for you. It can also provide an interesting point to reflect on in the future once this situation has passed. Giving experiences meaning can turn challenges into self-improvement.
  • Online games aren’t just for kids. There are phone apps such as Words with friends or Chess with friends which let you share a game with a friend from afar. Play a whole game or a move per day. Steam also has many electronic board games for download. Never really played computer games? Stardew Valley is a great place to start for positive mental health gaming. Or if you want to avoid computers use your webcam to play a card game, boardgame or charades.
  • Do those longstanding jobs you’ve put off. Have you been wanting to sort out that mess in the garage for years? Or is this the chance to finally write that article? Feeling productive is very protective for your mood at the end of the day. Try writing a “to do” list and tick things off along the way for that extra sense of satisfaction. (Tip: Make sure there is an “easy win” each day to keep the motivation up if some of the tasks are going to take longer to get done).

Put it all together. Don’t invest in just one of these strategies. Pick several activities for your day. Use passive media for breaks. Inject online social contact in the middle. Keep a vague routine (mainly sleeping/eating/exercising) but mix it up to keep life interesting. Don’t let your routine become so fixed that it becomes stale.

Minimise static environments: bring change into your environment

  • Make your environment reflect how you want to feel, rather than how you do feel.
  • Is it too quiet? Leave music on and experiment with new types of music. Miss the sounds of people? Turn on the TV or radio instead and leave it on in the background. Try not to only watch the news though.
  • Spend time in a garden or on a balcony. Fix it up, add a vegetable patch or flowers. Even an indoor house plant has benefits. Green scenery improves your mood and cognition so spend as much time outside as you’re able to. Returned astronauts comment on how much they missed the simple sensation of wind. There is increasing research about the value of nature.
  • Sight, smell, taste, touch … try to find new inputs for each of your senses.

Keep your environment feeling new in some way. Just moving the furniture around, reorganising shelves, changing the temperature or switching art around on the walls can help battle the sameness, which takes a toll when you’re cooped up for long periods.

Managing children in isolation

  • If you’re stuck at home with kids, feeling in control is key. Use a soft routine if needed – morning and afternoon activities with break times like they have at school.
  • Move activities into the garden or onto the balcony if you can to change up the sameness.
  • Build a fort! Building materials can be anything, let their imagination guide their design.
  • Art can be indoors or outdoors. Get paints and large cardboard boxes. Let the kids create their own town complete with stores, banks, houses in the lounge room.
  • That same paint can be used to create murals on old bedsheets or tablecloths. Turn the dining table into “art space” for a few hours a day.
  • Challenge them to write a story. Younger kids can draw a picture about their character’s adventure. Then put it all together into a book to remember this time together.
  • Kids love to cook. Teach them how to make something, decorate food with them as well.
  • Family movie time never gets old.
  • There are many kid-friendly online gaming communities (Minecraft, Roblox) for children of all ages. If you are unfamiliar with them, read the parental recommendations or try playing with them to share an engaging virtual experience for all ages. Don’t forget to put in place boundaries and balance with lots of no-screen time.
  • Google search “kids online courses”, “kids educational games” or “printable board games”.
  • Set up an internet party with your children’s friends via webcam. They can show each other their art projects, log into an online game together or play charades. Exploring and playing together online is a great way to elicit a sense of normality.
  • Assisting children with their homework when they’re learning from home can be intimidating and challenging for both children and parents. If possible, set aside time that is study time for the household. It’s difficult for one child to be working on homework while other children are watching movies in the same room. Provide frequent breaks for snacks or just stretching. Remember that children are used to staying on each topic for very limited segments of time in a regular school day. Having to consume both the content and do the homework for a topic in one setting may be too much to handle. Find creative ways to work through content. Bake cookies and use the cookie to illustrate fractions. Free resources like YouTube or Kahn Academy are valuable tools to help feel in control and cover content in different and imaginative ways. Be flexible, and give both you and your children credit for making an extraordinary transition under trying circumstances. Telling them how well they are handling the challenge will go a long way to making them feel this is a team effort and not just another demand for performance.
  • Physical movement is just as important for kids. Ask your kids to join you in your daily yoga session, play a ball game in the garden, or YouTube “kids workout sessions”.
  • If you have a partner at home, try to allocate designated “you time” for each of you to allow space for self-care.

Be kind to yourself – it’s okay if your routine is softer than normal, or there is slightly more screen time, or there are days when the kids (and you) don’t get out of their pyjamas. Set the emotional tone for the household by being flexible, while maintaining appropriate boundaries.

For older members of the family who are not so computer literate

  • Catalogue the resources you have at home which might be put towards your goals and interests. It might be a series of books you would like to read, an instrument you want to learn to play or a garden you want to improve.
  • The internet is so entrenched in modern lives it can be easy to forget it is a skillset which can be learned.
  • Stuck with getting your technology working? Type a question into google such as “how do I use Netflix”.
  • Search terms are how to get the most out of the internet. Other useful searches for Google include:
    • “how do I use search terms in google” (learn how to find resources);
    • “learn how to use the internet” or “improve my computer skills”;
    • “what is streaming media”; and
    • try using variations on those same search terms.
  • YouTube can also be used to learn nearly any skill you might think of; from making a vegetable garden to hanging a picture frame to installing software on your computer. Try the same search term you tried in Google on YouTube.
  • Sit down with them and create a playlist of favorite music they can play on their computer with a single click. Show them how to add songs to the list and where/how to find songs they think of. This will give them a chance to reflect on favorite tunes from their past, search them out (with occasional help) and then enjoy the music associated with favorite memories.

When things go back to normal

It’s tempting to think that once restrictions are relaxed, things will go back exactly the way they were. However, it’s unlikely that this will be the case. The large-scale and prolonged impacts of the COVID-19 crisis will change aspects of the ways we function at an individual, relationship, and societal level. Again, this is not a bad thing, but we need to be ready that things will have changed and in ways we might not have expected.

It may take a while for people to feel comfortable mixing freely again. Or we may find ourselves being overloaded by the increase in noise and activity that have been absent for so long. We may even find that some of the interests that we used to have in common with friends and family have changed.

Don’t be worried by this. We will find a way to negotiate these challenges, and maybe some of the changes will stick – and for the better!

For more information on positive gaming for mental health, visit https://checkpointorg.com

If you find yourself stuck and in a low mood, get moving – have a shower or engage in some physical activity. The tactile stimulation/activation is good for forcing your brain to change gear. Once you’re clean and dressed, or have got back from your workout, look at this list again for a different idea or just get some fresh air out a window, stand outside or go for a walk.

Most of all, be kind to yourself, listen to your body, and when it’s starting to feel dull, static and depressing or there’s too much sameness, do something new – try a new strategy and keep presenting your brain with newness to keep it engaged and happy.

Never forget that help is out there:

Mental Health resources in Australia:

One final point, the research is really clear: through challenge and adversity there is opportunity for growth. This challenge is one that can help us develop new skills, explore new interests, and reconnect with ourselves and our values. It won’t be easy, but it can be transformative.

Good luck to you all out there!

Marc Jurblum is a Psychiatry Registrar at St Vincent’s Hospital Melbourne, Space life science committee member for the Australasian Society of Aerospace Medicine and researcher in clinical applications of Spaceflight Psychology.

Sheryl L. Bishop, PhD is Professor Emeritus and Social Psychologist at the University of Texas Medical Branch at Galveston, Texas, US, and an internationally recognised behavioural researcher in extreme environments.

Kimberley Norris is the Consultant Clinical Psychologist for the Australian Antarctic Division and Associate Professor in the School of Psychological Sciences at the University of Tasmania with interests in human health, wellbeing and performance.

 

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.

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