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The coronavirus pandemic has been tough on all of us. According to the Centers for Disease Control and Prevention (CDC), 31% of adults reported struggling with anxiety and depression in late June. In mid-July 53% of adults said their mental health has been negatively impacted from worry and stress brought on from the coronavirus, up from 32% in March, reports the Kaiser Family Foundation. Unfortunately, overwhelming feelings of sadness and loneliness are more commonplace as we spend more time at home—oftentimes, alone.
When stress or anxiety becomes overwhelming, it can be difficult to remember what coping tools to use to manage feelings and ground yourself. According to Dr. Nomi Levy-Carrick, Associate Vice Chair of Ambulatory Services at the Department of Psychiatry at Brigham and Women's Hospital and Assistant Professor of Psychiatry at Harvard Medical School, emotional regulation and executive functioning are closely tied.
"When people are acutely stressed and really anxious, it’s exactly the moment they need their coping tools, but it’s exactly the moment that it’s also really hard to access them, to figure out which ones to use, or even what they are," she explains.
That's why many therapists and psychiatrists recommend keeping a coping toolbox to help deal with these stressful times. Below, you'll find more information on what a coping toolbox is and what you should keep in it so you can properly take action when these emotions do come up.
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What is a coping toolbox?
A coping toolbox is essentially a box filled with items and notes of coping strategies to help oneself calm down and express their emotions in a healthy way.
"I would recommend a coping toolbox for anyone and, particularly in, the context of COVID-19 where we’re seeing increasing rates of depression and anxiety," said Dr. Kathryn D. Boger, the program director of McLean’s Anxiety Mastery Program. "We all could use more tools to be more resilient and decrease our vulnerability."
These coping toolboxes should be created at a time when you're not experiencing high stress and can properly think of effective coping items or strategies. However, an effective toolbox could take some trial and error, warns Dr. Boger. While you might assume something would calm you down, you could find out that it actually further aggravates the situation when the moment comes.
The act of creating the toolbox works with people of all ages, especially children and adolescents, making it a great tool to create with others. It can lead to healthier discussions on managing stress, especially when done with a close friend or family member, says Dr. Levy-Carrick.
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What to put in a coping toolbox
To create a coping toolbox, secure a box (any old shoebox, food container, or something that's easy to store will do) and fill it with thoughtful items that you feel help distract or relax you. Dr. Levy-Carrick recommends filling the box with index cards of reminders such as the funny joke that always makes you laugh, the friend that’s helpful that you can reach out to, or hobbies you might forget to do that you really enjoy.
Although these may seem like obvious relaxers, in the heat of the moment of stress, they are often forgotten. "I had one patient whose index card said 'turn the radio on' because once the music was on it was okay, but it was getting [the music] on that was the challenge," she said.
It's important to note that these strategies for stress relief will vary from person to person, but it should either help you arrive at more balanced emotions or lead to behavioral activation, according to Dr. Luana Marques, Ph.D., a clinical psychologist at Massachusetts General Hospital and President of the Anxiety and Depression Association of America. She recommends creating a note with a quote that gives you hope or a card that says "I need to charge up" or "I need to go for a walk."
"For example, a patient might have a lot of black and white negative thoughts and they might arrive at more balanced thoughts [from the toolbox]," she said. "This is not to replace a negative thought, but imagine yourself saying something like, 'I’m doing the best I can and I’m living through a pandemic.'"
Dr. Boger has her patients put physical items in their coping toolboxes that will help soothe their five senses. "The idea here is that by engaging the five senses, you're helping to ground yourself and be more present in the moment."
Here are some examples of objects to use to engage each sense:
Smells: Choose items that have scents that are pleasing to you. Lavender scented items, a favorite perfume, lotion, candles, vanilla, cinnamon, essential oils, or chocolate.
Sound: Create a playlist of songs that evoke calming or pleasing memories. Be sure to include headphones, chimes, or a rainstick.
Touch: Choose items you can hold or rub in your hands or even on your body that are soothing or calming to you. A smooth rock, silly putty, a stress ball, a massage roller, textured cloth, a fluffy stuffed animal, or a weighted lap blanket.
Taste: Pick items that are pleasing to your taste buds that are nonperishable. Hard candies, butterscotch, gum, or chocolate.
Sight: These are visually appealing items. Photographs of loved ones, pets, or places you've been to in the past (this could be a small photo book), postcards from memorable trips, images of a dream location, a sand garden, coloring books, or mandalas.
When to use a coping toolbox
According to Dr. Boger, there are two approaches to using a coping toolbox: you can reach for it at times when you notice your stress levels are starting to rise or you can reach for it periodically throughout the day for a more proactive approach.
For the latter, Dr. Boger says to think of yourself as a piggy bank with 100 coins in it. Throughout the day, something like spilling your coffee on yourself would remove some of these coins, and during COVID-19 times, coins are much more likely to be removed. By 5 p.m. you could wind up with just two coins left to get you through the rest of the day. But calming yourself down with one of your tools before you feel this extreme stress could be a great way to replenish your coins throughout the day.
While a coping toolbox might be a more personal, private thing for some people, others prefer to keep it somewhere they can see it. Putting the toolbox out in the open can make it easy to find and use when stress or anxiety strikes, says Dr. Levy-Carrick. A coping toolbox doesn't necessarily have to be a physical box, either. Dr. Marques says her patients will often take a picture of their coping strategy or a calming quote and set it as their phone background, so it's a constant reminder. Some strategies could even be listed on a notes app for easy access for these tools, as well.
"The spirit of the box is to have easy access [to these tools] that remind you to take care of your brain," Dr. Marques said. "Any indication that your thinking might be locked, you're feeling black and white, your emotional thermometer goes off, or behaviorally you feel off them, reach for it."
If you are feeling suicidal, thinking about hurting yourself, or are concerned that someone you know may be in danger of hurting himself or herself, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). It is available 24 hours a day, 7 days a week and is staffed by certified crisis response professionals.
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This article originally appeared on Reviewed: How to create a coping toolbox to help with anxiety, according to doctors
