Managing Psychological Distress during COVID-19:

Perhaps you are experiencing some fear, panic, stress, or anxiety; or you are still learning to adjust to working from home, and spending a lot of time with your family members (with screaming children and toddlers running around with school closure…), know that you are not alone! These difficulties that you are experiencing are actually normal and natural.

In other words, it is okay for you to not feel okay now.

COVID-19 truly caught us by surprise and we are still running around trying to figure it out. It’s not something we can control or change; we don’t know how long it’s here to stay; we don’t know when a vaccine is going to be created; we cannot change government measures that are introduced to protect us… There are many of these situations that we don’t have any control over, and we naturally feel helpless and desperately want to have some sense of control.

We might benefit applying priciples of the Acceptance and Commitment Therapy (ACT) in our lives:

Ψ Accept things that are not within our control

To do this, we first have to learn the difference between pain and suffering.

Pain is inevitable. As long as you are a living being, whether you are a person or an animal, you will experience varying degrees of pain. We’re not just talking about physical pain here, it also includes psychological pain. For example, if you have recently experienced a loss of a loved one, or a job, or a relationship, there’s a lot of emotional pain involved. Again, it would be a really natural and normal experience given the context. What about suffering? Suffering often compounds the experience of pain. But many of us don’t know that suffering is actually optional. A lot of times, we tend to take on this optional suffering without consciously knowing it. We experience suffering when we refuse to accept, or when we resist or struggle against the situations that we are in.

Let’s look at the current COVID-19 situation and see how it relates to pain and suffering:

Ψ Pain: It’s painful to have to learn to adjust to working from home. Some of us may have quite uncomfortable workspaces at home or have to adjust to the pain of managing young kids on top of juggling the expectations of work. That is painful but that is also inevitable.

Ψ Suffering: We experience suffering when we say things like, “Oh how long is this going to last?”, “I can’t believe this is happening.”, “Why should this happen?”, “Isn’t there another way?”, “I wish this wouldn’t happen.”, “This virus is taking too long, when is it going to end?” or any kind of resistance or struggle to accept the situation and the changes that come with it.

While we may not be able to completely eliminate the pain associated with the experience, we might have a better chance to eliminate the suffering that we experience by learning to accept the situation as what it is—it is not permanent; it will come and it will go.

Ψ Commit to making changes that are more consistent with our values

Another way to manage the current situation is to ask ourselves: “What values are important to me?”, “Who do I want to be as a person?” , or “What kind of values do I want to inculcate in my kids?”

Say, for example, patience is an important value to you. Perhaps this would be a good opportunity to practise a little bit of patience when you’re managing the situation at home. So if it gets stressful—having a meeting, your child running and screaming in the background—you can maybe take a step back, breathe, calmly explain to your child that you need to work and will get back to him/her in 30 minutes. You get the idea.

“F.A.C.E C.O.V.I.D” (adapted from Dr Russ Harris)

F - Focus on what’s within your control

Remember when we talked about how pain is inevitable, and suffering is optional? They apply in this situation. (Spoilet alert: they are going to appear again and again!)

What this means is, we essentially eliminate our suffering when we focus what’s within our control. For example, while we cannot control how long COVID-19 is going to be here for, our travel plans at the moment, we can actually focus on things that we can be doing during our circuit breaker. Things like, the kind activities that we can do at home, the healthy boudaries we can set between working and spending time with our family, whether we want to do some baking or gardening or even taking a walk.

What about things that not within our control? We move on to the next alphabet, A, where we learn to acknowledge.

A - Acknowledging and accepting our thoughts and feelings

This involves acknowledging and accepting our thoughts and feelings with openness, curiosity, kindness and compassion. Let’s take the current circuit breaker as an example. It’s been going on for about two weeks now, and most of us may be experiencing feelings of frustration, anger and stress. You might even have thoughts about how this is quite unfair, that you have to be confined at home even though you’re healthy and not likely to infect anyone by just going out for some air.

This next experiential exercise may help us to better accept all these feelings that we struggle with:

Ψ Find a quiet space where you can be by yourself, and not be disturbed, for about two minutes.
Ψ Allow yourself to experience all this anger, bring all of this anger up that you’ve been bottling in the last week. Allow yourself to experience this anger pulsating through your body, your veins enlarged, your fists are clenching, you’re frowning, your muscles are tense, you’re angry and you can feel that anger coursing through your veins. Bring up all the thoughts about how this may be unjustified, this is not fair, you’re not happy with the current arrangement, you want to go to things that you want to do.
Ψ Just sit with this feelings, physical sensations and thoughts and just observe them with a bit of curiosity and kindness. Allow yourself to actually make space for them and sit with them for one, two minutes or so. Allow yourself to observe these feelings of anger come up and go down. So,it’s a bit like a wave, ebbing through, coming up and going down. And once you allow it to come down, remind yourself that you’re exercising your right not to go out, your decision not to go out is done in service of a greater good. You’re doing that because you’re limiting the spread of the virus and you’re playing your partin contributing and stopping the virus. So, remind yourself that this is done in service of kindness and see if you can allow that anger to come and go.

C - Coming back into our body

We often overlook that our physical body and our emotional and mental body, our mental mind, are actually quite deeply and intricately connected. A gross simplification would be as such:

How we feel -> Body reacts to how we feel -> Reinforces how we feel -> [and so on and so forth]

So, if you're feeling stressed, you might then experience some tightness in your shoulders or maybe at any part of your body, or you might end up frowning or clenching. These are normal physical sensations associated with stress. And when you are exhibiting these physical symptoms, you also send message back to your brain that, “Hey, I’m stressed, prepare for fight or flight! We have to either react to the situation or we have to run away.”

Coming back to the body means recognising what our body is experiencing so that we can short circuit the experience and try to just stay in the present moment with our emotions. What that might look like in terms of a COVID-19 example would be things like, paying attention to the temperature of the water when you're washing your hands, or how your hands feel like when you're lathering the soap against your palms. So, you are coming back to the present experience and you are also coming back to your bodily sensations.

E - Engaging with our present moment

While “C” focuses on our bodily sensations, “E”is more about our behaviors, thoughts, feelings. Taking the same example of our mind drifting off, that would involve acknowledging that you have drifted off. Rather than a critical self-blaming approach, such as “Oh, how could I have drifted off? This is really bad”, or “I feel guilty”, that usually increases our suffering, we can take a more compassionate approach, like “Oh, I realized that I have drifted off, that's really okay, but let's see if I can gently come back to the present moment of what I'm thinking or what I'm actually doing” as it would actually reduce the suffering that we experience.

C - Committed Action

Or, thinking about what effective actions we can do within the limits of boundary. For example, what can we do effectively by staying at home during the Circuit Breaker period? Can we engage ourselves in a hobby that we enjoy, or perhaps watch a free musical or what' others that are readily available online now? Or perhaps we can commit to catching up with friends and family members? These are a few examples of what committed actions can be.

O - Open up

Opening up involves opening up to difficult feelings that we experience and making space for them. Consider when you’re in an aeroplane (something which we are now missing at the moment), we’re often advised to put on the oxygen mark for ourselves before rendering help to others in the even of crisis. In the same vein, we are now experiencing a crisis on a global scale, and we now need to learn to look after ourselves and put on our oxygen mask before we can help others. We’ll need to think about how we can best look after ourselves.

Self-compassion comes to mind. If your friend is going through something difficult, you might be inclined to say, “This has been really difficult for you.” You may try to be encouraging to say, “This moment will pass.” and/ or “We can do this together.”. What about doing so for yourself? Is there a way that we can practice a little more self-compassion to help us get thought this difficult time? Perhaps you could try using this approach on yourself as well. Similarly, opening up means making space for all these difficult emotions that we are experiencing and trying to practice that self-kindness and self-compassion to get us through something that is so difficult at the moment.

V - Values

What kind of person you want to be? What do you stand for? What is important to you?

If kindness is important to you, perhaps this is the time you can practise a bit of kindness on yourself and people around you. Maybe you could say something kind to someone who’s experiencing distress, do something kind for a family member who is struggling at home, or even practise a bit of self-kindness on yourself if you’re struggling? If you value friendships and relationships, this might be a time when you get creative to connect with your loved ones even though you might not be able to meet up.

I - Identify resources

This refers to all kinds of resources, including your mental health resources, such as psychiatrists, psychologists or counsellors, as well as emergency telephone numbers. In Singapore, you can seek additional support from the National Care Hotline. We also provide additional resources at Annabelle Psychology, such as free telehealth counselling for frontline healthcare workers. Telehealth counselling is also available even if you’re not a healthcare worker. Other resources may include personal resources, such as friends and family. For some people, religion and spirituality can also be important resources and for others, self-help books.

D - Disinfect and distance

This is the time when we really need to start disinfect: washing our hands for at least 20 seconds with soap, not just under running water. Really wash, lather with soap first before rinsing off with water. Disinfect your phone regularly. And, don’t bring your phone to bed without cleaning as it’s actually one of the dirtiest items that you own!

Distance, well, refers to physical and social distancing. You know, keeping that 1 to 1.5 metres distance when you’re out to keep a safe distance between you and the other person.

We hope that you’ll find these strategies helpful in managing your distress during this difficult time. Remember, our services are still available if you need additional help. Find out more from our website and our COVID-19 resource page.

Stay home and safe!

This article is part of our video series, Coping with COVID-19. Check out our other videos:
Ψ COVID-19 and Anxiety
Ψ Managing COVID-19 Stress with Mindfulness
Ψ Managing COVID-19 as a Couple
Ψ Parenting Tips during COVID-19
Ψ Emotional Regulation for Children during COVID-19

COVID-19 and Anxiety:

What causes Anxiety and What can I do?

Credit: Annabelle Psychology (Desmond Soh)

…What if I contract the virus?

…What if I unknowingly infect my loved ones?

…What if I lose my job?

Such worries are common. It is very human response given these unprecedented times. We worry about our perceived lack of control and feel helpless about how uncertain the situation is.

Besides these worries, there are also other common signs of anxiety:
Ψ feeling nervous, irritable, on edge;
Ψ having an impending sense of doom and/ or danger;
Ψ feeling stressed about being stressed
Ψ experiencing increased heart rate, perspiration, muscle tension; and
Ψ difficulties concentrating and sleeping.

For many, the unpleasant feelings and experiences that come with the worries are fleeting, and they are still able to function relatively well in general. For others, however, this anxiety may develop into a disorder. They may become unable to carry on with their daily lives, such as being unable to work, spend time with family and friends, or other activities that they used to do.

Making sense of Anxiety Disorder using BioPsychoSocial Model:

(Biology) (Psychology) (Social)
Genetic predisposition + Unhealthy thinking patterns + Unmanaged, prolonged stress/
to Anxiety Disorder & coping Styles traumatic events/
unsupportive environment

Credit: Annabelle Psychology (Desmond Soh)

So, for example, someone who has a family member with an anxiety disorder, has a history of trumatic experiences, is engaging in unhealthy thinking patterns and coping styles, and is experiencing prolonged exposure to stress with little or no social support will be more likely to develop an anxiety disorder.

Once developed, an anxiety disorder can be maintained through unhelpful, false beliefs, which can present as negative or positive beliefs. Examples of each are:

Ψ Negative false belief:
“worrying is bad/ dangerous/ harmful”
“worrying is uncontrollable and I’ll eventually lose all control”

Ψ Positive false belief:
“worrying motivates me to do things”
“worrying helps me prepare for the worst/ avoid bad things from happening”

Both sets of beliefs can be distressing for someone with an anxiety disorder, possibly contributing to even more worry and anxiety. That said, the above may not apply to everyone as each experience of anxiety can be different. If you, or any of your loved ones, experience the above changes, it may be helpful to seek professional help from qualified persons. Check out our Telehealth service here.

Therapy for Anxiety

Cognitive-Behavioural Therapy (CBT) is currently the most efficacious in the management of anxiety disorders. Principles of CBT is based on the approach that connects our thoughts, behaviours and emotions. In other words, each component (e.g., thought, behaviour or emotion) influences the others, and has the potential of contributing to a cycle of events.

Let’s consider the following example in the context of the current pandemic.

(THOUGHT) (EMOTION) (BEHAVIOUR) (THOUGHT) (EMOTION) (and so on…)
What if I contract — Intense anxiety & fear — Difficulty sleeping — Lack of sleep = — More intense — [vicious cycle]
COVID-19? weaker immune system = anxiety & fear with
more susceptible to COVID-19 intense emotions!

Credit: Annabelle Psychology (Desmond Soh)

There are two commonly used CBT methods:

Ψ Cognitive Therapy

This involves identifying unhelpful patterns of thinking and challenging these thoughts. For example, the above example consists of what we call catastrophic thinking, which is jumping right into the worst conclusions. For this case, therapy can include challenging our thoughts that overestimate risk. Do note that each person’s experience is different, so it’s important to work collaboratively your therapist to address this.

Ψ Exposure and Response Prevention

The behavioural component involves gradual exposure to anxiety-provoking situations, with increasing difficulty. So, let’s say, reading or watching any news about COVID-19 brings you extreme anxiety. Exposure therapy can begin with watching 5 seconds of COVID-related news. Once you do that, the next time it can be increased to 10 seconds, and then 1 minute, and then 5 minutes… and this goes on until you reach a point where you don’t feel as anxious anymore.

When we talk about exposure, it’s also important for us to know about avoidant and safety behaviours. Essentially, safety behaviours are behaviours that make you feel safe. But while they help us feel safe in a short term, they are not so helpful in the long term. Sometimes, they can actually be more detrimental than helpful. These behaviours are suble forms of avoidance that have the potential to keep the anxiety going as they prevent us from learning that anxiety symptoms and not as dangerous as we think they are. Sometimes, they might actually make the situation worse.

Credit: Annabelle Psychology (Desmond Soh)

Consider this example: I am fearful of dogs. Let’s say a dog walks right into this room now. As expected, I would immediately feel some form of anxiety. Perhaps an intense amount of anxiety. I might start to have some of these thoughts, "Oh no, what if the dog comes near me? What if it starts to lick me? Is it going to bite me? Is it going to bark at me? Is it aggressive?" All these thoughts are racing through my head as my anxiety starts to increase.

At this point, I have a choice:
Ψ I could either run out the room, or
Ψ I could just stay.

Let’s say, I go with the first choice—I run out of the room. Immediately, I remove myself from the situation and my anxiety levels would likely drop immediately. Why? Yes, because the dog is no longer around. I’m away from the situation, or the object that is causing me anxiety. So, my anxiety immediately drops and I feel safe. However, this is what we call a safety behaviour.

Now, let’s say the same situation happens, but this time I stay in the room. So, my anxiety will surely increase, it will keep increasing, and it might increase to a point that's even higher than the previous situation because I'm staying where the dog is with me. However, as the anxiety increases, it will eventually peak, then plateau, and eventually drop. What’s happening at the same time as my anxiety increases and decreases, is that I am learning that the dog is not so dangerous and may not bite me. Maybe the dog just wants to sit here. Maybe the dog doesn't event want to pay any attention to me at all, it's just minding it's own business. As this happens over and over and over again, this is what we call a habituation of learnt responses. We are essentially learning a different response, whether behaviourally or emotionally to a situation that triggers anxiety.

The above are simply snippets of what might happen during the course of therapy and also, it highlights how important it is to find a therapist whom you are comfortable with. Together with you, your therapist will work out a management plan that works for you and also tailor it to your needs.

This article is part of our video series, Coping with COVID-19. Check out our other videos:
Ψ Managing Psychological Distress during COVID-19
Ψ Managing COVID-19 Stress with Mindfulness
Ψ Managing COVID-19 as a Couple
Ψ Parenting Tips during COVID-19
Ψ Emotional Regulation for Children during COVID-19

Managing COVID-19 Stress with Mindfulness:

Ways to Incorporate Mindfulness into Daily Life

Everyone's stressed

Lives are disrupted, put on hold. Nobody knows how long the current way of life will last.
People are on high alert, feeling the need to keep up with daily updates related to COVID-19.
We avoid going to public places. And when we do, we are sensitive to every cough and sneeze around us.

Indeed, it is stressful times. But do you know that this stress is natural and in fact, expected, given the state of uncertainty we are in? Stress is our body’s natural response to any potential threat or danger, and there is no greater threat than the COVID-19 pandemic right now.

Prolonged exposure to stress can have negative impact on health. However, we can learn strategies to manage stress and improve our health and well-being. Mindfulness is one helpful coping strategy. In mindfulness practice, we direct our attention to the present and observe any thoughts, feelings and sensations without judgement. Regular mindfulness practice helps us react better in stressful situations.

Ψ Working from Home

We are familiar with the challenges by now—lack of physical space, loss of personal space, changes in relationship with family members, blurring of boundaries between work and personal life, lower productivity that' may be accompanied by overcompensatory behaviours…

“You are not working from home, you are at home during a crisis trying to work” -source unknown

Using the principles of mindfulness, we can establish a new routine to better adapt to the measures:

Ψ Now that we don’t have to travel to work, we can repurpose this time for mindfulness practice (e.g., mindful breathing or stretching) so that we can start our day with intention and purpose.

Ψ Start and end work on time to maintain a boundary between your work and personal lives. If possible, have a designated area in the house for work to improve your focus.

Ψ Take regular breaks during the day to breathe. You can make it a daily schedule by setting the alarm for breaks, during which you can practise mindful breathing, have a quiet time, or just sit silently with your pet.

Ψ Spending Quality Time with Family

It can be stressful to have everyone at home—people trying to do their stuff, fighting for space and tension can run very high. This period of prolonged stress can affect our relationship with our family members.

Is it possible for us to improve our relationship and spend some quality time together with our family members during this difficult period? Here are some suggestions:

Ψ Structure, structure, structure! Again, it helps to have structure. Just like how personal routines are helpful, a routine for the family can also help establish some form of structure to the day, as a family. Knowing very clearly how the day looks like for every one in the family helps each member to respect the other persons’ time and space. For example, if you were to use the table in the living room for work from 9-11am, then your partner will need to use another area in the house. You will also have an understanding of where common areas will be for breaks or other leisure activities.

Ψ Scheduled breaks: You can also set a scheduled time for everyone in the family to gather and practise mindfulness. For example, having a 3-minute silent period for mindful breathing, or just to sit and observe your thoughts.

Ψ Mindful walk: You may also adopt a mindful walk in the morning or evening as a family. During this time, you can also silently observe the sights and sounds around, or observe your thoughts and bodily sensations without judgement. This can be a period for the family to be in tune individually and as a family.

With the above suggestions, many people do find them helpful in promoting a sense of calm as a family, which would definitely be a welcome during this period. It is also important that we learn to enjoy spending time together and appreciating one another’s presence to help us feel better and more in control.

Ψ Going Out/ Leaving the House

And as you can imagine, it can be quite stressful to go out nowadays. One reason is due to the fact that we have significantly lower degrees of control over our environment when we are outside as compared to when we are at home—there’s a lot of variabilities involved. For example, there are other people involved, and we don’t know who these people are, we don’t know where they’ve been to, what they’ve done and so on. These unknowns create quite a bit of stress for us.

How can we use mindfulness to manage this stress? Here are some suggestions:

Ψ Connect & acknowledge: If you are outside and you find that you’re becoming stressed, what you can do is to connect with yourself for that moment—be aware of any thoughts, feelings and/ or bodily sensations you may be experiencing. For example, you may be thinking, “Oh, I feel scared. I don’t want to be outside.” Acknowledge the worry of being outside and the feeling of being scared. Remind yourself that this is a difficult period for everyone: other people also find it challenging and being scared is a normal human response. It is not wrong for you to have this thought or have this feeling or be experiencing this stress.

Ψ Sensory awareness: You can also pay attention to your senses. For example, noticing five things you can see, four things you can hear, three things you can touch, two things you can smell and one thing that you can taste. Doing so allows us to focus on, and connect with the present moment, which helps redirect from the stories that our minds tend to hook us with.

Simple Mindfulness Practices for Home Practice:

Ψ Mindful Breathing: Maintain your usual breathing without being overly conscious about each breath. Bring your attention to each inhalation and exhalation through your nose. As you continue to watch your breath, remind yourself that each breath grounds you in the present moment.

Ψ Stretching: Stand tall and observe your breathing. Pay attention to any area in your body with tension or ache. Begin to stretch and hold each stretch for about 15 seconds while breathing deeply. Try to involve all the parts of your body from head to toe.

Ψ Mindful walk: Set aside 5-10 minutes of your time. Walk at a natural pace. As you walk, notice how your body feels. Look at your feet and focus on the sensation on them as you take each step. Redirect your attention back to your feet if you get distracted by your thoughts or other stimuli. Next, turn your attention to your sight and take in what you see in your surrounding. Repeat the same with what you smell, hear, touch and taste. Each time you find yourself distracted, simply return your attention to whatever you’re focusing on, with openness and curiosity.

Ψ Sensory awareness: Direct your attention to your five senses. Pay attention to five things you can see; four things you can hear; three things you can touch; two things you can smell; and one thing you can taste.

Remember, it is a difficult time for everyone. So try to be more compassionate with yourself and know that you are doing what you can to adapt. Stay home and safe!

This article is part of our video series, Coping with COVID-19. Check out our other videos:
Ψ Managing Psychological Distress during COVID-19
Ψ COVID-19 and Anxiety
Ψ Managing COVID-19 as a Couple
Ψ Parenting Tips during COVID-19
Ψ Emotional Regulation for Children during COVID-19

Managing Grief and Loss during COVID-19

This is a very strange, very bizarre time for all of us—trying to make sense of how things have become the way they are now, while still trying to adapt to the ever-changing, ever-evolving situation. It’s likely that a variety of feelings may be triggered within us, one of which is grief.

What is Grief?

Credit: Annabelle Psychology (Dr Yeow May Tan)

Grief is a complex emotional experience. It’s usually a collection of feelings evoked by a significant loss or losses. Grief can come in many forms. Sometimes we don’t even know what these feelings are. We don’t even know how we feel, let alone being able to name or identify them. Grief can also manifest in a physical sense of discomfort, tension, exhaustion, a nagging sense of feeling unsettled, and so on.

We can make sense of grief using the Kübler-Ross model, which identified five stages of the grieving process:

Ψ Denial
Ψ Anger
Ψ Despair
Ψ Bargaining
Ψ Acceptance

It’s important to note that grieving is not just limited to these five stages; the stages don’t have to come in order; and we don’t necessarily have to experience all of them.

Grief and Loss during COVID-19

When we think about grief, it is usually within the context of bereavement, when we lose people who are close to us. But we do also experience grief relating to something that’s still hapenning, which we what is happening now with the grief we experience related to the COVID-19 pandemic. This is a living loss that is ongoing without any clear-cut end date, as well as the anticipatory grief of mourning what we have yet to lose with the pandemic is far from being over.

With the social distancing and stay-at-home measures, we experience a variety of losses in our lives—a loss in normalcy in our daily routine and structure. We’re not able to go to work or go to school; we can’t even go out for exercise. We experience the loss in income with business closures, reduced working hours, reduced working shifts… Then there’s the loss in physical connectedness and social interactions with our family and friends. We’ve lost our sense of freedom. We also lose our sense of safety as we are fighting a virus that has no face.

Dealing with the virus spread is already hard enough, but most of us are also being cut off from our usual support networks, especially for people who are living on their own, being isolated can intensify feelings of loneliness. But on the other hand, for those of us who are isolated together with our family, this can serve as a source of support, but it can also magnify friction or tension being in such constant, close proximity.

While it is highly important that we adapt to these changes, we also need to keep in mind that change entails loss. Sometimes, the losses that we experience may not be clear; they are quite ambiguous. Attachment doesn't just refer to attachment to other persons like our family our friends our partner etc. We can also develop strong attachments to our possessions, certain objects certain items that we keep, certain places, even strong attachments to our previous routines. This pandemic again has also forced us to face the loss of these attachments.

This is how the grieving process during COVID-19 might look like in the context of the Kübler-Ross model:

Ψ Denial:“The virus is out there. It’s very far away, it’s not going to affect me, it’s not going to reach me.”
Ψ Anger: “This is ridiculous. My freedom has beentaken away from me. I can’t meet my friends. I can’t do anything that I want.”
Ψ Despair: “I’m already losing my business income, I’m already falling behind my schoolwork. So, why bother trying anyway?”
Ψ Bargaining: “This is going to be over soon.I’ll just have to stay safe forone month, and things will definitely go back to normal.”—it’s as if we are trading our freedom for now, for things to definitely go back to normal in the future.
Ψ Acceptance: “Okay, this is really happening. I’m going to have to do something about this.I’m going to have to deal with it.” With acceptance, the reality of the situation sinks in and it’s only then that we can more effectively manage the pandemic.

Credit: Annabelle Psychology (Dr Yeow May Tan)

Some people often say that they don't know how to grieve, and this may be because we don't have the words or the language to articulately describe our suffering. moreover, grieving tends to be an unpleasant experience.

What might be useful is to recognise that grieving is actually natural and that it is okay for us to develop certain responses and reactions emotionally over what we are losing during this period of time. Maybe, if we begin by identifying and putting names to our experienced losses, we can start to become more consciously aware of what these losses are and what they mean to usm which can help us to be more able to cope with them. For example, it is devastating to lose a job or to receive a pay cut but it's not just the job itself that you are losing or the money you're receiving that you are losing. It is also about what or how these affect our sense of self and how we view ourselves. Say, you might be the breadwinner of the family and not being able to provide like you used to in the past, could negatively impact on the way you see your capacity in in fulfilling family roles. Studies have shown that our self-esteem and our self-identity can be strongly tied to our job.

Conversely, you might realise that because of this whole crisis situation, you're putting in more hours at your work, say, if you are a health care worker, frontline healthcare workers, crisis responders. While you're putting in more hours at work, it also means that you are losing more personal time for yourself, or for your family. Again, it's about reflecting on how this may impact on your role in other aspects of your life, and what that means to you.

The experience of grief is transient. It's not permanent. Even when we are in the middle of it. People who cope well, they tend to move in and out of those states and it's completely fine to allow yourself to be distracted at times, to be entertained, to laugh and to be amused but not at the expense of recognising and acknowledging your feelings about what you've lost. Most of us have never been through anything like this in our lives, but we have been through other challenges, other transitions that haven't been easy. Whether it's a divorce or breakup, having to change jobs, relocating to another country. These transitions haven't been easy and if we think about those things that we've been through those changes that we had to make think about how you managed those changes. Reflect on what have helped you to cope in those times and tap on those things.Lastly, it is to keep in mind the transitory nature of this period because the crisis will end one day.

In such times, it is beneficial for us to allow whatever feelings we experience to just arise, to sit with them and to make sense of them. We are individuals unique in our own way, and we do have different ways of processing and dealing with this situation.

So, it’s perfectly reasonable if you’re feeling upset, frustrated, angry, guilty, scared and so on. But it’s equally, if not more important,for us to be kind to ourselves because in such times where we have little control, we focus on what we can, and we work with what we have. One of the comforts I take is that we are all in this together, and knowing that as we have always done so historically, that we will be able to get through this in time.

Grieving The Unseen Losses in Daily Life

Besides struggling with our own personal losses, we are also exposed to and overwhelmed by the wider losses nationally and globally.

Credit: Annabelle Psychology (Dr Yeow May Tan)

While we adjust and get used to the changes brought about by this pandemic, sometimes we might not even be consciously aware or realise how the changes or more subtle aspects of our daily life can impact us. For example, when you’re attending a business meeting with colleagues, or a class with your classmates, or simply connecting socially with friends and family members digitally via Zoom, WhatsApp, facebook video, etc., partings and goodbyes may be abrupt and sudden at the end of each session. There is no standing up from a chair, walking out of a room, closing thedoor behind you, for some a farewell embrace, hugs, handshakes, etc. The person who leaves simply dissipates, disappears into thin air.We may not even realise how much more energy we are expending because of the need to focus and pay attention so as to compensate for the lack of visual cues outside the small video box.

Often, we talk about grief as an emotional experience, but in fact, grief can manifest physiologically as physical discomfort, exhaustion, tension, etc. It can impact on our physical health.

With the isolative measures in place and the adjustments you have to make in your lifestyle, you may notice changes in your sleep and appetite. It is not uncommon to feel tired and lethargic due to the intensity of stress and emotions, and possibly the lack of regular exercise regime. While this may increase your need for sleep, you may experience shallow or disrupted sleep. Other changes associated with grief include forgetfulness and difficulties concentrating/focusing, as well as reduced interest in some activities you normally enjoy.

It is important to pay attention to your body and look out for any behavioural changes within yourself. Our minds can sometimes trick us into believing we are okay, but our body never lies.

Because we are all facing such a novel situation, we are working through things we have never experienced before. Perhaps some of us are not used to working from home or sitting for exams/tests where there are plenty distractions, having to share your work space with other family members including your children playing at the background, having to report to our bosses/managers on what we will do every hour, etc.

Novel situations are unfamiliar and they present challenges, but they can also put things in perspectives and open our eyes to parts of others you don’t get to see but more importantly, new situations can open our eyes to parts of the self we might not know or be privy to if we weren’t in this situation. We can learn about areas where we thrive and we can learn about what stresses us, what our triggers are. We need to attend to our own losses and take care of ourselves while practising to be kind and compassionate to ourselves.

Research has shown that once a crisis passes, most people are usually able to bounce back and carry on with their lives. Inevitably, however, some of us may be chronically impacted and require support in the long term. If you need help, you can contact the National Care Hotline for additional support. You can also check out our Telehealth counselling.

This article is part of our video series, Coping with COVID-19. Check out our other videos:
Ψ Managing Psychological Distress during COVID-19
Ψ COVID-19 and Anxiety
Ψ Managing COVID-19 Stress with Mindfulness
Ψ Managing COVID-19 as a Couple
Ψ Parenting Tips during COVID-19
Ψ Emotional Regulation for Children during COVID-19

Navigating COVID-19 as a Couple:

Tips to Survive and Thrive!

It’s hard.

Routines and roles have changed. There’s one, or sometimes two, adult figures working from home. The children are at home doing home-based learning. We have lost our freedom. We are more sensitive, more emotionally vulnerable. All couples seem to be struggling

With so many uncertainties, it may help to take the time to have a serious conversation with your partner. Plan ahead and troubleshoot potential problems that you may face as a family and as a couple, and you might be more prepared to face the challenges together and even emerge stronger in the process.

Here are some suggestions for a fruitful conversation with your partner:

Ψ Setting a convenient time for the conversation.
Be sure to specify the duration so that you both can be free from any distraction and/ or interruption. Both parties should be motivated and ready to be engaged.

Ψ Having writing materials.
Such as a notebook and a pen, to note what you’ve decided during the process.

Ψ Being open to share fears and vulnerabilities.
For example, a wife may say to her husband, “I’m feeling really overwhelmed about looking about our toddler, knowing that we need to be quiet so that we don’t disturb our daughter who’s studying. And you’re also working from home and having meetings… I’m starting to feel lonely now that I can’t go for my yoga classes. I also miss my friends…” Notice how she openly shares about her difficulties in an objective manner so that her husband may better understand the situation.

Ψ Listening with empathy.
Summarise your partner’s concerns to check your understanding of what’s shared. Taking the example above, the husband may respond with, “you’re overwhelmed and this is really hard for you. Is that right?”

Ψ Taking turns to share difficulties.
Treat each other as equal partners and respect the other party’s position and difficulties.

Ψ Addressing the problem.
Adopt a “us against the problem” mentality to band together support each other in facing the challenges. This would include sharing personal needs and requesting for relevant support. Again, taking the previous example, the wife may request for an hour of personal time every morning. She may take this time to do yoga practice on her own, or reconnect with her friends, while her husband helps with the children during this time.

Ψ Re-assessing and updating the situation.
Set aside some time every week to update each other on the changes. What do you need from each other in the coming week? The key is to be flexible as nobody knows what’s going to happen one week from now.

Remember, it’s a challenging period now so be compassionate with yourselves!

Handling Criticisms as a Couple

We’ve all had it growing up, be it from our parents, grandparents, or teachers. Everybody thinks it’s very important to let us know what we do wrong, when we do wrong. While this might have worked while we were kids (perhaps, to a certain degree), we have internalised the way to address problems in such a way that criticising become the way we address problems in life. And unfortunately, our loved ones are often those whom we tend to criticise the most.

What we want to do is instead of criticising—which is attacking the person, we want to attack the problem.

Criticism comes in many shapes and colours. A mild form typically involves telling someone what they did wrong. In a more severe form, it actually amounts to sarcasm, mocking or laughing at the other person, and even taking a position of superiority. This can be done through words, such as “Oh, how come you never did that?” or “Oh, you always do that!”. It can also be demonstrated through our body language, such as eye rolling or shrugging. These are things we do not want to repeat anymore from now on.

What does it mean to attack the problem? Perhaps this could be better illustrated through an example using something that often comes up in most relationships—spending money:

Scenario 1
You say to your partner, “You are so irresponsible, look at how much money you spent again! When are you going to learn? I’m sick of this!”

Your partner’s likely response…
Ψ …become defensive and respond with, “Well, you know, lifestyle here in Singapore is really expensive, we have to do this!”; or
Ψ …counterattack and respond with, “You are talking? How about your last trip when you booked a first class ticket?”; or
Ψ …accept and respond with, “Well yeah, I’m just not good at anything.” And become, basically, grumpy.

Scenario 2
You say to your partner, “I’m worried about the amount of money we are spending monthly at the moment. How about we sit down together and make some plan moving forward, so that we can save for that college fund for the kids that we discussed.”

Your partner’s likely response…
Ψ …be much more likely to be willing to engage in a conversation that leads somewhere good for both parties.

As we can see from the above, Scenario 2 involves a positive engagement in which both parties “attack” the problem, and not each other. This form of engagement is much more helpful as it not only addresses the problem that affects both parties, it also preserves the relationship.

Practical Tips to Improve Your Relationship

Ψ Engage in little things, often and every day:
Show your partner that you are thinking about him/ her through small gestures, such as a little kiss or cuddle, or surprising him/ her with a cup of tea or coffee, or getting him/ her a glass of water when you think that your partner may be thirsty. These actions carry the message that you are thinking of your partner, you are there for your partner and that your partner is important to you.

Ψ Check in, listen and validate:
Make sure that you check in with your partner every day, and be patient and listen to them without interrupting or trying to problem solve. Being a good listener is important as it encourage our partner to be more willing to share. It’s also helpful to ask open-ended questions, such as, "What is important to you in all this?"; "What would you like to happen looking forward?" Then, we can show understanding and validate. Validating doesn’t mean simply agreeing with your what partner says, but more of showing our partner that we understand the issue from their perspective. If our partner is upset with someone, it’s also important for us to take the side of our partner as much as we can to let them know that they are supported. Me

Ψ Nurture a culture of appreciation:
We want to show our partner that we really care for them and appreciate them, and we can do so by verbalising our thoughts. How many times have you found yourself thinking about how lovely your partner’s eyes are, or how intelligent your partner is, without letting them know what you think? No, we don't say these things because we feel like we already did, or we even expect that our partners already know what we think. Well, just make sure you say them again, it doesn’t hurt to do so. Simple things like, "Honey, I love what a good father you are."; "Honey, you are such a fantastic cook. I just love your dish", go a long way to show our partner that we love and appreciate them.

There are also gender-specific recommendations based on extensive research by Dr John Gottman over the past 7 years:

Men appreciate partners who accept some responsibility for the difficulties experienced in the relationship.

What this means
When sharing what your male partner is lacking in, also consider your role in contributing to the situation. For example, owning to the fact that you haven’t been as involved with a particular task or chore, on top of pointing out the mistakes he has made in that particular task or chore. This typically results in happier partners who are more motivated to work on the relationship.

Women want partners to accept influence over the relationship.

What this means
Acknowledging your female partner’s request with a simple “yes, dear” makes a big difference to how she feels in the relationship. Similarly, recognising that certain things are important to her from the way she repeatedly mention them, goes a long way to showing her that you appreciate her, and value what’s important to her. If you notice that she’s been talking about finding a time to meet with the neighbours, why not arrange for a meal with them? Women want to feel that their partners are as invested in the relationship as they are, and accepting the influence you have in the relationship shows that. It also has a reciprocal effect—you accept influence, she accepts more influence, and so on. The more it happens, the happier you both are in the relationship.

This article is part of our video series, Coping with COVID-19. Check out our other videos:
Ψ Managing Psychological Distress during COVID-19
Ψ COVID-19 and Anxiety
Ψ Managing COVID-19 Stress with Mindfulness
Ψ Parenting Tips during COVID-19
Ψ Emotional Regulation for Children during COVID-19

Virtual Dating during the Circuit Breaker

For people in a romantic relationship, the current Circuit Breaker can be a testing period as physical dates are no longer possible with the social distancing measures. However, it doesn’t necessarily mean that all intimate interactions should come to a complete halt.

While physical interactions may be limited, technology can serve as a potential avenue for people to connect with their partners on an emotional level through virtual dating—the practice of spending intimate time with one’s romantic partner over the internet. It’s been shown that technologically-mediated communication, such as the use of video conferencing platforms, increases relationship stability in couples when physical presence is not possible.

That being said, virtual dating can also present a slew of challenges. After all, it has always been a lesser-used mode of dating before the advent of the pandemic. Historically, couples who are unable to meet in person, such as those engaged in a long-distance relationship, do experience some problems maintaining their relationships, including a sense of uncertainty about future reunions, relationship insecurity, and having unrealistic expectations of the relationship.

Thus, couples may indeed have to put in a little bit more thought into their time together so as to keep the spark of the relationship alive during this period of prolonged physical distancing. Below are some ways for couples to create intimacy and nourish their love through virtual dating.

For the Foodies: Share a Virtual Meal Together

Ψ If you look past the occasional awkwardness of having your partner watch you eat through your webcam, a virtual dinner date can actually be a refreshing experience. With the ubiquity of food delivery services, it is ever more convenient to order in a meal and dine in with your partner over video chat.

Ψ If you’re both up to it, you can even cook your meals before eating together. Simply decide on a dish together, choose a recipe together and let loose your culinary skills together via video chat.

Ψ You can also use this period to look forward to having a meal together at your favourite restaurant to motivate each other to remain hopeful and positive.

For the Gamers: Play an Online Game Together

Ψ Consider challenging your partner to an online game. Not a fan of mainstream titles like Animal Crossing? Fret not, you can also find a number of simple games and puzzles on the internet, such as Sudoku, Scrabble, Trivia quizzes, and crossword puzzles. If you are not the competitive type, working collaboratively on a game or puzzle is also an excellent way to increase the chemistry between you and your partner.

For the Lovebirds: Proclaim Your Love Unabashedly

Ψ For the more openly affectionate couples, consider showering each other with compliments and gifts during the Circuit Breaker period. Let your partner know what you like about them, and do not be afraid to throw in some flirtatious remarks from time to time. Be expressive in your language and get creative with your praises.

Ψ If you are in the mood for it, you may also choose to send some gifts to your partner through the post. Surprise them with a boutique of flowers or a love letter in the mail. You may even make it your weekly routine to exchange gifts with each other, with a different theme for each week.

For the Artistically Inclined: Tune in to Your Favourite Concerts or Get Creative Yourselves

Ψ If you and your partner have an appreciation for music, consider watching a virtual concert together. You can easily find a wide array of music concerts or even musical performances on YouTube by keying in the relevant search terms. You can also find a list of some of the live streams & virtual concerts to watch during the coronavirus crisis here: https://www.billboard.com/articles/columns/pop/9335531/coronavirus-quarantine-music-events-online-streams

Ψ Consider getting creative and make some art yourselves! Serenade each other in virtual karaoke sessions over video calls, or make some crafts using whatever art supplies you can gather at home. Work on your handicraft while you chat with your partner, and show them your artwork at the end of the session.

For the Kinaesthetically-Oriented: Get Moving and Grooving

Ψ Invite your partner to a dance-off! It doesn’t matter if either of you can’t dance, we could all use a good laugh during this time of global crisis. Pick your poison from the array of viral dance moves online and learn them together on video calls before showing off your grooves in an ultimate showdown.

Ψ If you are just not feeling it or would instead prefer something less strenuous, you may also bring your partner on a virtual tour of your house. Assume the role of a tour guide and take your partner through every nook and cranny in your room, kitchen, and toilet. Take this opportunity to share your secret interests and hobbies with your partner, be it your cabinet’s worth of manga collection or a jigsaw puzzle in progress.

Until the day when the whole thing blows over and the circuit breaker measures are lifted, couples may have to face the unfortunate reality of continuing with virtual dates. While dating at a distance may not be the ideal way for couples to build and maintain a long-term romantic relationship, it might just provide an unexpected spark in the relationship before physical dates finally resume in the near future.

Home but Not Alone:

The Impact of COVID-19 on Social Connection

The Covid-19 pandemic triggered various guidelines in the recent months, culminating in a strong social distancing measure — in Singapore, termed the “Circuit Breaker” period — in a bid to contain the virus. Schools have closed, with home-based learning for students across levels and institutions. Businesses, with the exception of those providing essential services, have ceased operations and employees are ordered to work from home. The nation comes to a near-standstill for a month.

The message is simple — stay at home.

Economic and social implications have been fervently discussed. But many have overlooked the psychologica costs that are becoming increasingly apparent since the outbreak. One of which are the psychological impacts of social disconnection, or loss of social connection.

Human beings are social creatures. We thrive on social connection and support; we become distressed when we are isolated. With the safe distancing measures, many experience a keen sense of being alone — away from extended families, friends, colleagues, and other supportive others. We are not even allowed to stand or sit too close to others when we are out. All these go against who we are, contributing to additional stress and coping difficulties during this trying time. Many find themselves feeling increasingly lonely, irritable, on edge, and have difficulties focusing on their work and responsibilities. While we do not yet understand the impact of these short-term measures on our health, prolonged isolation and loneliness have been associated with poor health outcomes.

While we may have to continue to stay at home and limit our social contact for some time yet, there are ways for us to reduce the effects of social isolation by reframing our perspectives of the situation and doing what we can, within the limits of our homes:

Ψ Stay aware: Acknowledge the difficulties that you are experiencing and know that it is natural to feel differently during this challenging time.

Ψ Stay connected: Connect with sources of support, such as family members, friends, and colleagues, through virtual means like phone and video calls to let them know that you care. You may also take this opportunity to reconnect with people you have lost touch with, and let them know that they matter to you.

Ψ Stay healthy: Maintain a healthy lifestyle, such as exercising regularly, eating a balanced diet, and getting sufficient rest.

Ψ Stay informed: Keep up with updates on the pandemic through reputable sources of information to reclaim a sense of agency. Be mindful of the time spent on the news, such as limiting the frequency and duration of time spent reading.

Ψ Stay grateful: List three things that you are grateful for every day despite the changes in daily living to promote positive mood and well-being.

Ψ Stay hopeful: Note down the things that you look forward to doing after this period to remind yourself of that there is life beyond the pandemic.

COVID-19: Potential Impact on our Foreign Domestic Workers

Imagine that you’re overseas. You’ve been away from your family for some time, and while you miss them, you also look forward to peers whom you meet every week. You consider these people your family and you enjoy spending time with them. Suddenly, you’re told that you can no longer meet them. In fact, you can no longer go out. You have to stay in the house that you’re employed to work in, serving the people who employ you. You know about the COVID-19 pandemic and you’re worried. But you have no one to talk to. Your friends also have to stay at home and can only respond to your messages during pockets of free time between chores. You heard that people are losing jobs, and your employers are worried about their jobs. Is this why they seem to be more on edge? If they lose their job, will you also lose yours? What do you do? What can you do?

By now, most people would be familiar with the challenges and stress involved with working from home, such as lack of physical space for work, lack of personal space and boundary with every member of the family present (and in need of space for work), and being disconnected from important sources of support like extended family, friends, and co-workers. However, what many have failed to consider is the challenges faced by a unique group of people in Singapore who are equally, if not more affected, by the current social distancing measures—our foreign domestic workers (FDW).

Right around two weeks before the Circuit Breaker measures were proposed, our FDWs were advised by the Ministry of Manpower (MOM) to stay at home on their rest days to help contain the virus. Now that the Circuit Breaker measures are firmly in place, FDWs are prohibited from spending their rest days outside.

How are our FDWs coping with the current measures? Perhaps we can consider some potential implications the current way of life is for them:

Reduced down time:

With the prospect of going out on rest days removed, how are our FDWs letting their hair down at home? Or, are they now able to do that? Certainty, there are reports of FDWs working on their rest days now that they are at home. Some are even not compensated despite mutually-agreed terms and conditions. These FDWs may be too afraid to stand up for their rights for fear of offending their employers, or even termination. It can also be difficult for them to distinguish between daily responsibility or additional chores that they should be paid for. Some of these FDWs have simply chosen to forgo their rest day altogether and get remunerated accordingly. It leaves to wonder the possible impact of having little or no downtime on our FDWs, especially when they must also be feeling the stress and anxiety rising from COVID-19, as we all do.

Increased work load:

With home-based learning and telecommuting, every member of the family is likely now at home, all day, every day. Inevitably, this translates into additional chores, duties and responsibilities for the FDWs. And not to mention stronger emphasis on cleaning and sanitising. And tending to the children. And going out to get essential items.

Reduced social connection:

Like any other human being, FDWs thrive with appropriate social connection and support. More so because they are all alone in a foreign land. And more so now than ever, in this uncertain time. Let’s say some FDWs are worried about the impact of COVID-19 on their country, or their family. How many FDWs would share their worries and difficulties, freely, honestly and without any fear of judgement or repercussions, with their employers? Likely a small number, and this is by no fault of the employer.

Increased supervision and pressure:

FDWs may also feel the pressure to work harder than necessary under the constant supervision of their employers. On top of bumping into people with so many confined in one common space.

It is likely that our FDWs experience a lot more stress and difficulties than the above. Given the unique nature of their employment, the changes brought about by the safe distancing measures would undoubtedly place them at a higher risk of burnout than before. It is thus important for employers to be aware of these challenges that our FDWs face, and start to be more mindful their mental health and well-being:

Ψ Remind yourself that all of us are affected by the same pandemic in different ways. Recognise that your FDW is also facing challenges and also needs time to adapt to these changes.

Ψ Communicate daily duties and lay out expectations clearly. Allow for regular breaks and sufficient rest.

Ψ Discuss alternate arrangement for rest day. Respect your FDW’s views on the matter and work out a mutually-agreed plan that caters to both parties.

Ψ Identify signs of burnout, such as lethargy, lack of motivation, impaired concentration and memory.

This is a difficult time for everyone involved, and no one is spared. Let’s take this opportunity to exercise compassion for people around us, and support one another as much as we can.

Parenting during COVID-19:

Tips to Survive and Thrive!

With school closure, telecommuting and other social distancing measures, many family members are spending more time together under the same roof. Faced with fewer outlets for socialising and recreation, we can be more reactive to one another, with the potential of eroding the quality of our relationships over time.

Below are 3 areas that may be helpful for parents to better cope during this prolonged period of social distancing:

Ψ Establishing a Daily Routine for Your Child

Having a routine for structured activities, such as home-based learning and free time, helps children regain a sense of control and security. Whenever possible, include your children in planning for each day and they can add in their favourite activities.

A good routine will also include the details, such as specific activity and duration for each activity. An example of a routine may look something like this:

Kevin’s Evening Schedule
6.30pm - Shower
7.00pm - Dinner
7.30pm - Spelling or Mathematics
8.30pm - Play
9.00pm - Reading
9.30pm - Bedtime

Ψ Resources: Support Your Child and Bond!

The current situation makes it possible to structure parent-child bonding activities to spend some quality time together. As recommended by the Centre on the Social and Emotional Foundations for Early Learning of the Vanderbilt University, there are 5 elements to parent-child bonding activities that you can consider when planning for parent-child activities:

Ψ Incorporate your child’s interest. For example, you can consider mosaic art, painting or crafts if your child likes visual art.

Ψ Spend quality time with your child. This would be a good time for one-to-one speical time, so put away your mobile phone or other work materials!

Ψ Assist and teach your child in a positive manner.

Ψ Follow your child’s lead, such as listening to their ideas.

Ψ Provide praise and encouragement and acknowledge your child’s effort.

Below are some suggested activities to kickstart your bonding time:

Ψ I Spy: A classic game that helps children develop observational skills. Find a fixed object that everyone can see and say, “I spy with my little eye there is … blue, that looks like a tree!” Then give a clue as to what the object is.

Ψ Sing-along: Sing songs and rhymes with lots of movements like ‘itsy-bitsy spider’, ‘wheels on the bus’, ‘head shoulders knees and toes’ and ‘if you’re happy’.

Ψ Monkey See, Monkey Do: Do actions with your arms and hands and challenge your child to mimic after you. You can create a series of actions like patting head, cheeks and your lap and so on. Alternatively, do actions with repetitions and get your child to count along. The roles can be reversed with you, as a parent, imitating your child.

Ψ Reading together: Use picture books or books with simple sentences of 3 to 5 words. You can make a book, or create one together by getting your child dictate or point out to you. You can also use pictures from magazines or brochures that your child can stick on the books, before writing the stories for them.These books will make great memories later on! Or let’s say your child has an all-time favourite book, you can get them to act the plot out and even create a twist to the story.

What if you have tele-meetings and have to be away from your child? There are also activities to engage your child, such as the following for preschoolers:

Ψ The Shaker: Use a plastic bottle of any size and fill it with any sound makers you may have (e.g., beans, beads, sequins, rice, little knick-knacks or buttons). Cap the bottle tightly or hot glue it to prevent your children from getting to the shaker’s contents.

Ψ Magic Bottle: Fill a bottle half with water and half with corn syrup. Add glitter, sequins, or other tiny sparkling things. The corn syrup slows down the motion of the contents and prevents the glitter from sticking together. You can hot glue the lid onto the bottle so that the little hands don’t spill it. Shake it up and watch the pretty water.

Ψ Hunting for Bottled Treasure: Create a self-contained buried treasure game that your children can play together! You can add a variety or small household objects, such as paperclips, buttons and different coloured toys. Be sure to keep track of how many objects you put in and what they are. Make sure, again, you seal the container tightly so you don’t get the contents spilled on anyone.

Ψ Slimy Goo: Pour corn starch and add water until the goo runs from the spoon. You can also add your desired food colour to it. The goo will feel hard until you try to pick it up—it will run through your fingers as you try to pick it up. Therefore, pack it in an airtight container.

Ψ Doodle Fun: One of the most versatile playthings is a mini whiteboard and some dry erase markers! Alternatively, drawing or sketch pads and crayons will also work. Your children can practise doodling with different coloured markers or letter writing. You can also interact with your child by engaging in fun imaginative doodling together.

Ψ Others: baking, card-making, Lego, mosaic art and painting—dependent on your child’s interest and ability levels.

Ψ Additional Assistance

It is challenging to balance work, childcare and self-care. What happens when your child’s behaviour and needs get out of hand, or you feel too overwhelmed despite the above suggestions?

Good news! To minimise the disruptions to your child’s therapy and progress, Annabelle Psychology Clinic has made adjustments to allow consultations and therapy to continue via Telehealth.

During this period, interventions will focus on strategies that are implementable in bite-sized chunks, covering coping strategies in various forms, such as mini tasks and goals you can do with your child; parenting activities; advice on managing your child’s behaviours; and strengthening the parent-child relationship. We will also cover skills for positive behaviour management and child development, helping you care for your children by forging strong relationships with them.

If observation sessions are required, we may ask that you place your mobile device at a spot where our Educational Psychologist can observe your child’s interactions at home. We will then arrange for private discussions based on the detailed observation. We will also share information relating to child development so that you can implement effective strategies for your child at home. We believe that home is definitely an important setting for effective interventions to take place.

Positive Behaviour Management

Children benefit from consistent management of inappropriate behaviours in a positive yet firm approach:

Ψ Consistent home rules with visuals: These help to remind your children appropriate behaviours that are expected of them. Pro tip: limit to not more than three rules, and use them as consistently as possible!

Ψ Pre-correction strategy: This is a proactive strategy designed to prevent or interrupt predictable problem behaviours from occurring. It also increases the likelihood of appropriate behaviours taking place. For example, you can remind your children of appropriate behaviours expected of them by providing reminders of the home rules.

Ψ Reinforce appropriate behaviours: You can encourage desirable behaviours in children by looking out for displays of such behaviours and providing reinforcements through praise. Pro tip: the praise has to be specific to the behaviour. An example of a behaviour-specific praise could be, “I like how you listen to mommy.”

Ψ Token economy: This is a behaviour modification system which adopts a systemic reinforcement approach to encourage appropriate behaviours in children. The token economy should be tied to the home rules mentioned above. The tokens serve as positive, visual reinforcement which will then encourage them to behave appropriately at home. The token economy can be placed on your children’s table where they will be rewarded with a token when they demonstrate the expected behaviours according to the home rules. Do note that the reward is the token, so there is no need for extrinsic rewards. (Extrinsic rewards, such as stickers and erasers, are not recommended as they tend to create dependence. In general, we aim to promote appropriate behaviours in children through intrinsic motivation, which is when they do certain things for their own sake rather than for any external reward.)

As far as possible, try to avoid corporal punishments, such as hitting your child. Punishment-based systems are not appropriate as they do not help children understand rules or ways to engage in appropriate social behaviour. In fact, when we punish our children, we are actually giving them attention for inappropriate behaviour, which could increase the incidence of the inappropriate behaviour instead. Punishments also shame and humiliate children, contributing to negative parent-child relationship and poor home climate.

Self-Monitoring

Self-monitoring is another strategy that can help children exhibit positive behaviours more independently. It involves teaching children to assess their own behaviors and record the results of their monitoring.

While self-monitoring does not create new skills or knowledge, it is effective in increasing the frequency, intensity, and duration of appropriate behaviors. It can also help you save time spent on monitoring your child’s behaviours. Hence, self-monitoring promotes independence and personal control in children. It is also effective in improving academic engagement and task behaviors, as well as increasing compliance and reducing difficult behaviors. Asking children to reflect on their behaviors can have a powerful impact. Knowing that they have to explain their behaviours (or anything that got in the way of having a wonderful day) often contributes to better decision-making.

Educational Psychologists often use a checklist to help children conduct self-monitoring on their behaviours throughout the day. This checklist is dependent on the child's level of understanding and ability, as the child needs to be able to understand and follow through with it. Such self-monitoring checklists often involve expected behaviours or tasks, and the child is responsible to check or cross off each item after completion. When used correctly, these checklists help to guide behaviours and tasks, while simultaneously increase children’s awareness of their own behaviors and work performance.

Additional Strategies to Manage Inappropriate Behaviours

This section involves specific strategies to target behaviours, such as constantly seeking attention or refusing to do schoolwork. As with the above, we caution against corporal punishment (e.g., hitting). As much as possible, strive to create a positive and encouraging learning environment. Constantly acknowledging your child's efforts has the effect of motivating them to display more appropriate behaviours as well.

Ψ Planned ignoring: Planned ignoring is a technique that requires a conscious effort to ignore certain inappropriate behaviours to prevent reinforcing the unwanted behaviours. It works best with behaviours that are designed to gain your attention.

Tell your child that it is not polite to engage in that particular behaviour.
If the unwanted behaviour persists, ignore it completely. This means no eye contact or speaking to your child, including making comment to other family members about your child.
*Do ensure that your child is safe, and use minimal verbal or physical redirection, if you have to.

Ψ Replacement behaviour: Allowing your child to engage inappropriate replacement behaviours can help them regulate their emotions. For example, your child can ask for more time to cool down when they get too upset. In this case, a timer can be set for five minutes and you can inform your child to continue with his/her task at the end of the five minutes. In addition,it is also helpful to teach your child strategies to express feelings in an appropriate manner.

Ψ “I” message: “I” messages are simple ways for children to communicate in any social situation. This technique allows your child to provide feedback in a safe manner and get the message across about how they feel without sounding as if they are blaming others (you, their teachers, or their peers). The messages avoid put-downs or judgment.

“I” Messages are often used to describe the behaviour, the resultant feeling, and the effect or consequence of the behaviour, or:
I feel [name the feeling] when [describe the behaviour].

For example, “I feel angry when you scold me and call me names. It is hurtful and I don't like it”.

Ψ Assign responsibilities: To further develop your child’s strengths and increase meaningful engagement at home with routines in place you can assign your child with home responsibilities, such as assisting with household chores or washing their own utensils and plates on a daily basis. More opportunities should be provided for your child to practise other essential daily living skills. If they are not keen on household chores, it’s time to get creative. Perhaps involving them in decorating the house using art and craft materials, or having conversations with them on how to improve the decor of the house?

We hope that you’ve found this video series and the strategies helpful. For more information on parenting and interim interventions during COVID-19, you can consider consulting our Educational Psychologist via Telehealth.

Stay home and safe!

This article is part of our video series, Coping with COVID-19. Check out our other videos:
Ψ Managing Psychological Distress during COVID-19
Ψ COVID-19 and Anxiety
Ψ Managing COVID-19 Stress with Mindfulness
Ψ Managing COVID-19 as a Couple
Ψ Emotional Regulation for Children during COVID-19

Emotional Regulation for Children during COVID-19:

Helping Children Survive and Thrive!

School closure, full home-based learning, staying indoors, not being able to see or play with friends…

It is not only the adults who have to adjust to changes in daily routines and schedules. Children do, too. They also experience stress and difficulties, as well as difficult emotions, such as anger, frustration, sadness, fear and anxiety with all the uncertainties. As many young children may not know how to manage these emotions, they often require support from their caregivers to do so.

It is important for parents, or other caregivers, to know that negative emotions are never wrong. While negative emotions can be expressed in hurtful, or harmful manner, telling a young child not to be angry is not going to help in any way. Instead, we can encourage them to talk about their emotions and model helpful ways to express them. As adult role models, we can be more mindful of how we express our emotions, or talk about the COVID-19 situation, when we interact with others. Whenever possible, we want to model helpful ways of expressing emotions and managing stress and anxiety during this period. Remember: your child is watching you!

Besides, here are some ways to help young children retain a sense of control in this uncertain time:
Ψ Establishing a routine: structures help them know what to expect each day. Examples include regular meal times, bed times, and daily activity list.
Ψ Having sufficient sleep: sleep reduces susceptibility to stress and emotional difficulties.
Ψ Exercising: many children, especially young ones, find it a helpful outlet for difficult emotions.
Ψ Relaxation or coping skills: pleasurable activities, such as listening to music, deep breathing exercises, yoga practices.

Note: If your child is displaying any of the following warning signs such as nightmares, excessive focus on anxieties, aggressive behaviour, regression in behaviour or self-harm, it would be advisable to seek professional help. Find out more about our Telehealth service here.

Now, more than ever, it is important for parents to show up for their children and ensure they feel heard, validated and supported. Despite your best efforts, however, difficult situations may still arise. Children may still feel overwhelmed, they may even experience emotional breakdowns and temper tantrums. Next, we will be looking at how to manage these episodes when they arise.

Parents, remember that it’s equally important to look after yourselves and your mental health. This Circuit Breaker period may cause you to experience mixed feelings. On one hand, you might be grateful for more time at home with your family. On the other hand, you might have experienced situations during which you were stressed, overwhelmed and/or frustrated and you really wish to avoid experiencing them again. Having mixed feelings is okay. Having children at home involves things like managing their emotions, keeping them meaningfully engaged throughout the day, and dealing with their pent-up energy from being cooped up at home all day. All these, on top of our own our own daily responsibilities. Imagine!

As parents, it’s important to really take a step back and think about your own emotional well-being. Am I doing okay? If you're struggling or having any difficulties, please check out some of the other videos that have been put together to help manage the COVID-19 pandemic. You can also find out more about our other services during the Circuit Breaker period, such as the support groups and Telehealth Counselling.

Taking care of your mental health is not selfish to do so and we definitely can’t pour from a cup that is empty!

Managing Emotional Meltdowns or Tantrums

With everything that’s going on, we can sometimes overlook the impact of COVID-19 on our children’s mental health. Compared to adults, children are more susceptible to trauma-related stress, anxiety and depression. Responses may vary, with some children becoming more irritable and others clingy. Certain behaviours like tantrums or meltdowns may also be more common during this period.

What are meltdowns?

Meltdowns occur when children are overwhelmed by negative emotions and they simply don’t know what to do. As you can imagine, it can be distressing for children and frustrating for adults. But rather than seeing tantrums as a complete disaster, we can use them as an opportunity for learning—for us and for our children.

Let’s look at what we can do before, during, and after a temper tantrum:

Before a meltdown:

Ψ Distract your child, or redirect your child’s attention to a less frustrating activity. We know our children quite well and tend to observe big feelings of frustration build up before a meltdown.
Ψ Ask yourself:
“Is there a need that is unmet right now?”,
“Is my child hungry or tired?”,
“Are my expectations clear and realistic?”,
“Am I using language that’s too complicated?”
Ψ Listen to their concerns. Give them the space and opportunity to talk about what’s going on with them at that moment. If they don’t have the words, provide them with the words to describe the feelings that they’re experiencing, and then validate how they’re feeling.
Ψ Give options to let them have a sense of control over the situation. An example could be: “You must be feeling very frustrated right now that you can’t go out and see your friends. Let’s see what we can do to make you feel better. Would you prefer to do a puzzle? Or would you like to draw a picture?

During a meltdown:

What happens when you can’t get there on time and the tantrum can’t be stopped? We know It’s easier said than done, but try to remain calm. Don’t take the tantrums personally—remember, this is not about something that you have done.

Ψ Ensure that their surrounding environment is safe
Ψ Remain calm. There isn’t much to do but to wait for your child to calm down.
Ψ Once your child is calm, praise them and talk to them about their feelings and their experience. Again, provide them with the words if they can’t find them on their own and problem solve for the next time.

After a meltdown: The Calm Down Plan

A Calm Down plan is a list of strategies to soothe your child so that they can regulate intense, negative emotions, such as anger, fear, sadness and anxiety, with guidance. This is particular important for younger children, such as preschoolers, who find it difficult to manage their emotions independently. Essentially, the Calm Down Plan not only helps to reverse the effects of your child’s stress response on his/ her nervous system, it also helps them find a healthy outlet for these big emotions.

The Calm Down Plan requires an active partnership between parents and their children. As each child’s sensory and nervous systems are unique, do expect some trial and error before you come to a tried-and-tested plan. In addition, what works now may change and evolve with time, so it’s okay to make adjustment whenever necessary.

When coming up with a Calm Down Plan for your child, you may consider the following questions helpful:
Ψ Is there a particular place that your child finds calming? Where do they tend to go when they feel upset or frustrated?
Ψ Do they calm down with physical touch or do they shy away from it?
Ψ Do they feel better being around others or being alone?

Below are some strategies that are commonly included in Calm Down Plans:

Ψ Diaphragmic Breathing

Diaphragmic breathing may appear simplistic, but it’s a technique that’s backed by lots of research. It also helps that it’s handy to implement, as you don’t need any special equipment—it can be done anytime, anywhere. Furthermore, it’s also effective for adults, so parents can feel free to add it to your own Calm Down Plan!

Put one hand on your chest, and one hand on your belly. Take a deep breath, breathing in through your nose, and breathing out through your nose. You may find that the hand on your chest is moving more than the hand on your belly—this is very common. A lot of us are chest breathers, so when we become stressed or anxious, our breathing becomes shallow. And we’re not actually activating our diaphragm when we’re breathing in, so we’re actually not getting as much oxygen as we should. To calm the stress response, we want to reverse this process, so we want to activate our diaphragm. This means that the hand on our belly will is move more than the hand on our chest.

For little kids, we can teach them this technique by having them visualising their bellies as big balloons, and imagining their bellies inflating like a big balloon when they breathe in, and the balloon deflating when they breathe out. Repeating this 4 to 5 times has a significant calming effect.

Yet another way to make this exercise fun and relevant for children is to ask them to imagine breathing in the smell of their favourtie food when they breathe in, and to be use their exhale breath to blow out all the candles on their birthday cake.

Ψ Other Techniques and Resources

Besides breathing, other strategies include Mindfulness for children, yoga, getting in touch with nature, sensory plan, making a fortress, asking an adult for a hug, movement and physical activity, listening to music, and of course having children talk about their feelings.

If you would like to find out more information about tailoring an individualised Calm Down Plan for your child, or other parenting support, please refer to our Telehealth service here. Do also check out our resources on COVID-19 and join our support group if you require support during this difficult period.

Being Effective Co-regulators

As parents, it is important to take a step back and engage in self-reflections during this difficult period. When it comes to children’s emotional health and well-being, it really is all about the parents’ ability to function well as a co-regulator—to step in when your child is experiencing overwhelming feelings of frustration; to implement that calm down plan before a tantrum.

When we think about tantrums or emotional meltdowns or whining, we can sometimes be quick to respond with scolding or with discipline. We immediately think our children or their behaviour are wrong, and we need to put a stop to them immediately. Or, we might take it quite personally, thinking that they are intentionally trying to get on our nerves and ruin our days.

Either of the above can be quite dangerous. When we respond with anger and punishment, telling them things like “stop crying” or “don't cry”, we are actually sending the message that feelings are not meant to be felt, or what they're experiencing is wrong. This can be unhelpful, and even harmful, as they might get trapped in a vicious cycle that could be difficult for them to break free from in the future.

Three Steps to Being Effective Co-regulators for Your Child