Coping with COVID-19: Managing Mental Health, Anxiety, and Depression During the Pandemic by Living Your Values

by Suraji Wagage, PhD, JD

The global coronavirus pandemic has altered the way we live, adding a layer of uncertainty to our lives and increasing feelings of worry, anxiety, and depression. COVID-19 has begun to occupy nearly every headline and news story. Gathering places—gyms, bars, restaurants, workplaces—are being shuttered, and health experts discourage leaving the home for non-essential reasons and coming into close contact with other people. You or someone you know may have lost their job, and financial worries may be mounting. Within this new reality, you may find yourself, like many others, feeling increasingly anxious, disoriented, depressed, and adrift. Human beings rely on regular social contact to thrive and find stability in daily routines. Prolonged isolation negatively affects mood, increasing anxiety and sadness.

With the coronavirus spreading, new routines and new ways of living must be developed. You may find yourself wondering how to deal with these changes and how to continue living a rich, rewarding life under the restrictions that the pandemic has placed on us all. As so much around us changes, you may be thinking about your identity without a job or a routine that helps to define you. You may be feeling isolated or lonely. Cognitive behavioral therapy (CBT) can help to clarify who you are and what matters most to you in order to live a valued, rewarding life, which is vitally important now as we live under certain constraints. You can begin this work today by using this effective strategy to discover and move toward what is most important to you in life.

1. Define your values in the areas most important to you. For each of the following areas, consider your values: directions that you can continue to move in for the rest of your life, as opposed to goals, which are specific and can be accomplished. For example, your values relating to friendship may involve being a thoughtful, honest, and responsible friend who can be relied upon in times of need to lend a helping hand or a listening ear and who expresses caring for others in words and actions (while a goal may be to call a friend who is having a hard time). These values can guide you indefinitely. They are directions rather than an endpoint to be reached. There are no right or wrong answers.

• Family relationships: What kind of family member would you like to be? It may be helpful to think about family members who have made an impact on you and what you appreciated about them. Are these qualities you would like to embody?

• Romantic relationships: How would you like to be as a romantic partner? What is important to you in romantic relationships, and what would your ideal relationship look like? How might you contribute to creating this partnership? Even if you are not currently in a romantic relationship, you can start living these values today.

• Parenthood: Are you a parent? What kind of parent would you like to be? Imagine your child or children describing you. What would you like them to say?

• Friendships and social relationships: What kind of friendships would you like to have, and how can you help to build them? What kind of friend would you like to be? Think of your most important friendships-- how would you describe these friends? What made these friendships special? What does it mean to you to be a good friend?

• Academic/professional life: What is important to you academically or professionally, and how would you like to be in these roles? What kinds of qualities are important to you in this area? Think broadly-- you do not need to have a job or be in school to value qualities like being hardworking, diligent, and reliable and to value learning in all the forms it can take.

• Spirituality: What does it mean to you to be spiritual? How is this area important to you?

• Community: Think about how you would like to contribute to your community, your society, and the world. What does it mean to be a good citizen?

• Recreation/leisure: How do you like to spend your free time, and what is important about how you spend this time?

• Physical health and wellbeing: How is physical health and wellbeing important to you?

2. Prioritize according to the importance of each area and identify areas for growth. Rate how important each area is to you from 0 (not at all important) to 10 (extremely important). Next, rate how consistently you have lived your values in each area in the past week from 0 (not at all) to 10 (completely). For example, if one of your values regarding parenthood is to be an empathetic and forgiving parent while setting firm boundaries for your children, how consistently did you do this over the past week?

Practice self-compassion. No one is perfect, and we are all doing our best. Living consistently with your values is a lifelong practice. When you notice a difference between how important the area is to you and how consistently you have lived your values in that area in the past week (e.g., family relationships are 10/10 in importance but 5/10 in living your values), ask yourself what barriers may be getting in your way.

3. Take steps today to live consistently with your values. For the areas that are most important to you, consider some action steps that can be taken immediately to live your values more fully. Think creatively about how you can continue to live your values under the current constraints of the coronavirus pandemic. For example, can you sit down for a meal with family or friends through a video call? Can you call to check in with a loved one you haven’t spoken with recently? If you are accustomed to going to the gym, can you try exercising at home using online videos as a guide? Can you talk to others about how they have been impacted? Can you take a free online course, or bake cookies, or take up a new hobby? Can you make a small donation for medical supplies? You can live your values as fully now as you could before the COVID-19 pandemic, though your action steps may be modified to fit the current circumstances. Try taking one step per day for the next week, remembering that each step, no matter how small, is a step toward living your values. Living your values can help manage feelings of anxiety and depression and improve overall mental health, but if you are struggling, you may wish to seek the help of a therapist. Click here for more information about the cognitive behavioral treatment of depression and anxiety.

This technique is based on Acceptance and Commitment Therapy, a newer, mindfulness-based form of cognitive behavioral therapy (Hayes, Strosahl, & Wilson, 1999).

You can learn more cognitive behavioral therapy tools in this free online CBT workbook.

Hayes, S. C., Strosahl, K.D., & Wilson, K.G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavioral Change. New York: Guilford.

CBT Treatment for Chronic Depression

Most people who suffer from depression experience depressive symptoms for a limited duration, on average, 20 weeks. This is what is considered acute depression, meaning an episode of depression lasting a discrete period of time. However, some who experience acute depression go on to have symptoms that endure for an extended period, lasting many months or years. This is considered chronic depression. Chronic depression lasts at least six months, in which, more days than not, significant depressive symptoms are present. Research has shown that chronic depression can be more difficult to treat, requiring a longer course of treatment and different interventions than acute depression. Cognitive Behavioral Assessment System of Psychotherapy (CBASP) is the only treatment model developed specifically for people with chronic depression (Shatzberg et al., 2005). It is the subject of the largest study on psychotherapy in history and has shown to be significantly more effective than other treatments for chronic depression. 

According to the CBASP model, maltreatment and trauma experienced early in life can derail normal psychological development and sometimes result in early-onset chronic depression. Such maltreatment can take many forms, from physical abuse to perceived invalidation. Alternatively, later in life, an out-of-control mood state can also undermine psychological functioning in people with no history of neglect or abuse. Significant life events such as the onset of chronic illness, loss, and divorce can trigger such a mood state and result in lasting feelings of sadness and despair. Research has shown CBASP therapy is one of the few treatments that can effectively treat both early- and late-onset chronic depression.

Through CBASP treatment, people learn to objectively examine their interpersonal behavior's consequences in specific interactions. Through this process, patients learn to become more perceptually connected to their environment, observing where their behavior is working against them and identifying behavior more consistent with their desired outcome. It is this process that, over time, helps people move from persistent feelings of helplessness to an increased sense of mastery and contentment. These gains are accomplished through a technique known as situational analysis.

In situational analysis, one’s attention is repeatedly directed to the effect of one’s behavior on others and the effect of one’s interpersonal behavior on the therapist. Working through the situational analysis over time, the interpersonal trauma the patient brings to treatment is healed by separating those elements of the patient’s past she is projecting onto the present.

CBASP treatment has been shown to be highly effective in people whose depression symptoms do not respond to traditional talk therapy or to antidepressant medication. If you or someone you know is struggling with chronic depression, click for more information about cognitive behavioral treatment of depression. 

Shatzberg, A.F. et al. (2005). Medication or therapy is effective when the other is not. Archives of General Psychiatry, 62, 513-520.

All material provided on this website is for informational purposes only.  Direct consultation of a qualified provider should be sought for any specific questions or problems.  Use of this website in no way constitutes professional service or advice. 

Behavioral Activation to Treat Depression

It is estimated that in 2016, over 16 million adults in the U.S. had a major depressive episode. This represents almost 7% of all adults in the United States. Even more shocking, this number only accounts for a small subset of individuals with depression, as not everyone with clinical depression meets the diagnostic criteria for a major depressive episode. Sadly, most people suffering from depression do not seek treatment despite the development of very effective treatment methods in the last few years. Recent research has demonstrated that cognitive behavioral therapy is the gold standard in treating depression.

Cognitive-behavioral models of depression have long held that depression is the result of an interaction between thoughts, feelings, and behavior (e.g., Beck et al., 1979; Rehm, 1977). Simply put, situations trigger some response of one of these elements, for example, thoughts. The thoughts then cause a chain reaction in which feelings are influenced, which in turn trigger behaviors, often resulting in a kind of emotional snowball with its own momentum. An example of this is someone not being invited to go out after work with the rest of one’s coworkers. This may trigger the thought, “No one likes me.” As a result of this thought, sadness is elicited, causing the person to go straight home and lie in bed. Having only one’s negative thoughts to occupy one’s mind, this cycle becomes stronger and stronger.

The cognitive behavioral approach to therapy is to target the thoughts, the behavior, or both to break the momentum of this system and inspire new emotions, thoughts, and behaviors to arise. Significant evidence suggests that merely increasing rewarding behaviors is a very effective way to treat depression effectively. Behavioral Activation (Martell et al., 2010) is a CBT treatment that has shown significant success in research studies. In fact, Behavioral Activation has been shown to be just as effective as antidepressant medication at reducing depressive symptoms and even more effective than medication at keeping the symptoms from recurring after treatment (Dobson et al., 2008).

The premise of behavioral activation treatment is that once we get into a depressive cycle, we slowly withdraw from activities that are rewarding. People who are depressed often spend too much time in bed, watching TV, avoiding people and beneficial activities. Behavioral activation is about gradually re-introducing rewarding activities back into people’s routines. These activities can either be pleasurable, such as going for a walk or scheduling dinner with a friend, or mastery-oriented, such as painting the bedroom or volunteering at a charity. After a period of consistently engaging in reinforcing activities, mood gradually improves, resulting in less self-defeating thoughts, and the upward mood cycle builds momentum.

The primary way of going about behavioral activation is through activity monitoring and activity scheduling. Keeping a detailed record of behavior during the week, as well as tracking feelings of pleasure and mastery associated with each behavior, serve as a guide to what might be missing from your routine. After tracking this for a few days to a week, the following weeks are spent gradually increasing rewarding behavior into your day by scheduling the new rewarding behaviors. In this way, people can come out of their depressive cycles by replacing them with contentment cycles. Sounds simple, but in practice, it can be quite difficult to engage in any activity when you’re feeling unmotivated.  Consequently, behavioral activation is usually most effective with the help of a trained cognitive-behavioral therapist who knows techniques to aid behavior modification and knows how to avoid potential pitfalls that can derail progress early on. Studies have shown behavioral activation for depression with a CBT therapist can improve symptoms after just the first session, with most people showing significant symptom reduction/remission after as few as 12 sessions.

If you or someone you know is struggling with depression, behavioral activation may be the right treatment for you. For more information on cognitive behavioral therapy and cognitive behavioral treatment of depression, visit Cognitive Behavioral Therapy Los Angeles.

Beck, A.T. et al. (1979). Cognitive Therapy of Depression. New York: Guilford.

Dobson, K.S. et al. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 3, 468-477.

Rehm, L.P. (1977). A self-control model of depression. Behavior Therapy, 8, 787-804.

Martell, C.R., Dimidjian, S, & Herman-Dunn, R. (2010). Behavioral Activation for Depression. New York: Guilford.