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Preparing for the Holidays During COVID-19

For many people, the holiday season will look different this year. Often, the last few months of the year are busy with parties and visiting family and friends. But due to COVID-19, things like traveling and gathering in large groups may not be possible.

For this edition of "My Westchester" Newsletter, County Executive Latimer has asked the Department of Community Mental Health to share thoughts, ideas and available interventions and assistance for those who are struggling emotionally during these difficult times. This newsletter is dedicated to helping everyone through.

The main the goal of this newsletter is to help people understand how things have changed and to offer ideas and support to help build the resilience to get through this together.

Many people have lost loved ones and will be missing someone's presence during the festivities, and even more have lost their jobs and are dealing with financial stress. Others, like healthcare workers, may be working overtime and unable to take as much time off around the holidays as they usually can. It can be hard to cope with these kinds of changes, especially if certain holidays are the only time you see some of your loved ones.

If you live with a mental health condition, you may have an especially difficult time with the uncertainty and the change of plans this year. Many people with mental health conditions find consistency important in their recovery, especially during times of high stress - like both the pandemic and the holiday season. A sudden shift in tradition may have you feeling an extreme loss of control on top of disappointment.

Change is difficult for most people, especially when you didn't ask for or even expect these changes. But that doesn't mean that the holidays are destined to be a disappointment this year. There are plenty of ways to cope with the tough feelings you're having while still enjoying the holidays:

Identify How You're Feeling.
Figuring out your emotions about the upcoming holidays can make things feel less overwhelming. Most people are feeling a lot of different ways at once right now, which is hard for our brains to process and understand. This year has been a difficult year for many reasons. That means that some of your distress is likely related to things other than the holidays. It is completely normal for you to be feeling a bit more emotional than usual right now. Take some time to sort through your emotions in whatever way is most productive for you - you can journal, talk to a friend, or just spend some quiet time alone thinking. Once you have a better idea of the specific feelings you're experiencing, you can start making plans to cope with them.

Acknowledge What You've Lost.
While the holidays are mainly about thankfulness and celebration, this can also be a really hard time of year, even during normal circumstances. If you're missing a loved one, think of ways to honor them during your festivities. If you've lost a job or had to drop out of school, take the time to recognize the challenges that came with that. Even if you haven't lost anything concrete, we've all lost our sense of normalcy this year - it's okay to grieve that during this time.

Make The Most Of It.
There's no denying that things will be different this year, but holidays don't need to be canceled (or even minimized). There will be some things that you can't do right now, but there are surely some that you can. You can still carve pumpkins, send sweets to your friends and family for Diwali, make your favorite Thanksgiving meal, light the menorah, decorate gingerbread houses, and break out confetti poppers for New Year's Eve. For the things you can't do - brainstorm how to adapt them for COVID times. If you're disappointed about Halloween parties being cancelled, plan a small outdoor gathering, or come up with virtual games to play over Zoom instead. Feeling lonely because you won't get to see your extended family? Round up your cousins to video chat while preparing Thanksgiving dinner.

Practice Gratitude.
Gratitude is a major focus this time of year, and while it may seem harder to find things to appreciate, there is still plenty to be thankful for. Make a conscious effort to regularly identify some things that you're grateful for. It can be something as broad as your health, or something as specific as your favorite song playing on the radio the last time you got in the car. Change is hard, but it isn't always bad. There are still ways to celebrate the season with your loved ones, even if you must give up some of your favorite traditions. Find creative ways to adapt. Or start new traditions - they may even add more meaning to your holiday season.

If you're still finding yourself sad, hopeless, or unable to enjoy the holidays this year, you may be struggling with a mental health condition. It may be helpful to speak to someone at Westchester's Emotional Wellness Line at (914) 995-1900 (Monday-Friday 9am-5pm) or, if you feel you are experiencing a crisis and need immediate professional support, contact Westchester's Crisis Prevention and Response Team at (914) 925-5959 (24/7).

Mental Health America


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Handling the Holidays During COVID19
Tips & Resources to Supporting Child and Caregiver Mental Health and Wellness

This year families are celebrating the winter holidays very differently. This can be stressful and disappointing as well as an opportunity to explore new traditions.

TIPS FOR SUPPORTING CHILDREN
* Talk It Out: It is important to discuss with children what the plans are for the holidays, what changes should they expect and what are some things that are staying the same? Predictability is key to helping children to manage anxiety.

* Acknowledge Disappointment: It is okay for our kids to feel sad, or upset about changes to their holiday plans - don't we all?! It is important to acknowledge how they feel about the holidays and help them to put words to their sadness, frustration, or worry.

* Traditions: Maintain family holiday traditions when possible - even if they are tweaked a bit this year. You may not be with Grandma this year, but you can ask her for her cookie recipe and send her a batch! This is also an opportunity to explore some NEW holiday traditions (Zoom celebrations, sending care packages, drive by visits/holiday light peeping, working on a shared project etc...).

* Give Kids Voice & Choice: Giving children and teens choices helps them to have a sense of control. Let them help to come up with new quarantine-approved traditions and activities that they can look forward to this season.

TIPS FOR PARENTS & CAREGIVERS
It is just as important for parents and caregivers to manage our own disappointment about this holiday season. Children take cues from their parents. If you maintain a positive, festive and calm demeanor, your kids will pick up on that and do the same:

* Allow yourself to feel sad, worried or angry. Model using positive self-talk. For example, "Since we don't have to travel, we get extra time to relax and play at home."
* Do something to nurture yourself.
* Adjust your expectations.
* Look at the big picture - remember that helping children overcome disappointment helps them build resiliency.

TOOLS & RESOURCES
There are a number of children's books that can be great tools for talking to your children about the pandemic. Below are a few recommendations - the children's and/or teen librarian at your local library is also a great resource!

Penelope and Jack, Together Apart
By Uncle Inkwell, Professor Stork, Illustrations by Elena Kochetova

Why Did the Whole World Stop?: Talking With Kids About COVID-19
By Heather Black

Sheroes of COVID-19: Women Leading in the Crisis
By Rehmah Kasule, Priya Shah, Edited by Amy Meginnes, Drew Edwards, Illustrations by Nandi L. Fernandez

Technology is another great tool for getting children and adults of all ages engaged in mental health and wellness! Below are some recommendations for free apps for all ages:

Breathe, Think, Do with Sesame
Link: https://itunes.apple.com/us/app/breathe-think-do-with-sesame/id721853597?mt=8
Age Range: 2-5 years old

Smiling Mind
Link: https://itunes.apple.com/us/app/smiling-mind/id560442518?mt=8
Age Range: 7-18 years old

Cosmic Kids Yoga
Link: https://itunes.apple.com/us/app/cosmic-kids/id1401503306?mt=8
Age Range: 3-10 years old

Calm
Link: https://itunes.apple.com/us/app/calm-meditation-to-relax-focus-sleep-better/id571800810?mt=8
Age Range: 4 years old - Adults

Mindshift
Link: https://itunes.apple.com/us/app/mindshift-cbt-anxiety-canada/id634684825?mt=8
Age Range: 12+ years old


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10 Mindfulness Practices

Practice helps us to become more aware of where our attention is, and helps us to deliberately choose changing the focus of our attention, over and over again.

1. When you first wake up in the morning: before you get out of bed, bring your attention to your breathing. Observe five mindful breaths.

2. Notice changes in your posture. Be aware of how your body and mind feel when you move from lying down to sitting, to standing, to walking. Notice each time you make a transition from one posture to the next.

3. Use any sound as the bell of mindfulness. Whenever you hear a phone ring, a bird sing, a train pass by, laughter, a car horn, the wind, the sound of a door closing-really listen and be present and awake.

4. Throughout the day: take a few moments to bring your attention to your breathing. Observe five mindful breaths.

5. Whenever you eat or drink something, take a minute and breathe. Look at your food and realize that the food was connected to something that nourished its growth. Can you see the sunlight, the rain, the earth, the farmer, the trucker in your food? Pay attention as you eat, consciously consuming this food for your physical health. Bring awareness to seeing your food, smelling your food, tasting your food, chewing your food, and swallowing your food.

6. Notice your body while you walk or stand. Take a moment to notice your posture. Pay attention to the contact of the ground under your feet. Feel the air on your face, arms, and legs as you walk. Are you rushing? Are you feeling impatient?

7. Bring awareness to listening and talking. Can you listen without agreeing or disagreeing, liking or disliking, or planning what you will say when it is your turn? When talking, can you just say what you need to say without overstating or understating? Can you notice how your mind and body feel?

8. Be aware of any points of tightness in your body throughout the day. See if you can breathe into them and, as you exhale, let go of excess tension. Is there tension stored anywhere in your body-your neck, shoulders, stomach, jaw, or lower back? If possible, stretch or do yoga.

9. Bring mindfulness to each activity. Focus attention on daily activities such as brushing your teeth, washing up, brushing your hair, putting on your shoes, doing your job.

10. Before you go to sleep at night: take a few minutes and bring your attention to your breathing. Observe five mindful breaths.

Source: http://www.mindful.org/11-steps-toward-daily-mindfulness/?mc_cid=e802ce5b41&mc_eid=1cb32eff54

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Stress and Anxiety

Anxiety is a product of stress and involves the experience of worrying. Periodic anxiety is an expected part of life. In fact, it's healthy to experience anxiety from time to time. Feeling mildly anxious before a job interview helps us prepare and remain alert. However, anxiety can be experienced with increased intensity and impair our daily functioning, whether it be how we relate to loved ones, perform at work, or simply move through activities of daily living.

Anxiety prepares us for perceived or real danger, and stress is the response. Our brain reacts by sending a stress response throughout our body. We become more alert, our breathing, heart rate and blood pressure increases, digestion slows down, and muscles tense in preparation for a fight-or-flight response. Some stress responses are short-term and provide a minor impact, while others are severe and are emotionally painful. Although stress has become an important response, prolonged stress and anxiety can cause something called traumatic stress.

Experiencing a national disaster such as the Coronavirus pandemic has caused a major disruption to daily living. Furthermore, it is likely to intensify existing feelings of stress and anxiety and spur the onset of new ones. This disaster is unique in that it is not a one-time event. It is ongoing. The pandemic has caused day-to-day changes in how we experience life. For some, this has meant losing their job, wearing a mask when leaving home, habitual handwashing and sanitizing, not being able to visit their friends and family...and even losing a loved one to the virus or related medical complications. Not everyone has the same response to the same traumatic event. Our genetic makeup, previous experiences, coping abilities, and support system have a tremendous influence over how we may experience such an event. Common signs and symptoms of anxiety, according to the National Alliance on Mental Illness, include:

Emotional symptoms:
* Feelings of apprehension or dread
* Feeling tense or jumpy
* Restlessness or irritability
* Anticipating the worst and being watchful for signs of danger

Physical symptoms:
* Pounding or racing heart and shortness of breath
* Sweating, tremors and twitches
* Headaches, fatigue and insomnia
* Upset stomach, frequent urination or diarrhea

Common signs and symptoms of traumatic stress:
* Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares.
* Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
* Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.


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There is hope. Support, utilizing familiar coping skills and developing new ones, and treatment when required can ease these painful experiences. The National Alliance of Mental Illness (NAMI) provides an excellent strategy named the Window of Tolerance (WoT) concept. The WoT concept acknowledges that there is a limited capacity to process or expose yourself to the difficult information around the trauma. Typically, this capacity is limited immediately after the traumatic event(s), which leads to numbness, panic, dissociation, intrusive thoughts, and simply feeling overwhelmed. Read more on how to expand your WoT and start feeling better.

Other coping strategies include:
* Limiting media exposure
* Breath slowly and deeply
* Progressive Muscle Relaxation
* Mindfulness activities such as meditation
* Accessing Social Support
* Distractions

Take care of you...
Sometimes slowing down enough to take the time to relax when you are stressed or anxious is difficult.
Changes like what we've experienced during COVID-19 can be stressful.
Take time to relax and calm your mind, body, and heart.
Self-Care isn't' selfish... it's smart.

NYS Project HOPE
Coping with COVID
https://nyprojecthope.org/connect/


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Wired for Resilience: Learning to Activate Your Innate Capacity to feel Safe, Connected, and Regulated.

Over the past 10 months, there has been a lot of focus on the physical effects of COVID-19 on the human body. We've talked far less about the effects on the mind. But this pandemic involves stress at many levels. Under stress, we have an automatic survival response that compels us to fight, escape, or simply shut down and check out. This is hardwired to take charge whenever our brains and bodies feel under threat or imminent danger. Left unchecked, these responses can take over our thoughts and actions, and result in a number of mental health issues such as anxiety, depression, traumatic stress disorders, and stress-related illnesses.

One of the survival response is known as "the Social Engagement System (or SES; Porges, 1994, 2013)." It helps us feel safe, connected and regulated, and has a number of positive effects. First, it synchronizes our breathing with our heart rate, which means that oxygen gets into the blood stream more efficiently. It also balances our immune system, turns off inflammatory responses, and improves digestion and metabolism. Activating the SES has been shown to help those with heart failure, high blood pressure, and inflammatory diseases such as arthritis and asthma.

In terms of emotional wellness, the SES turns off and regulates our stress response system; it makes us both less reactive and less likely to shut down. It also helps us to think more clearly, plan and problem solve. And most importantly, it allows us to relate with each other better, to enjoy each other's company, and to play, laugh and empathize.

So for those of us looking for coping strategies to deal with COVID 19 and related stress, the SES is a good place to start. Learning how to activate the SES in as many different ways and situations as possible will help you feel better in the short term and build resilience in the long term. There are two basic strategies for doing this.

The first involves connectedness with others. The SES responds to signals of safety from others, particularly a welcome tone of voice, intermittent eye contact, and genuine smiles. It also responds to an easy rhythm and flow of conversation, gestures, and ideas. You may have people in your life or even a pet that provides these signals for you and helps you feel at ease. Being aware of safety signals can help you appreciate them when they're present, and make sense of your discomfort when they're not. Being aware and mindful of these signals also means that you can send them to others with greater intentionality, and receive them back as well. It's a win-win for both parties.

This of course is easier said than done, especially during this pandemic. Zoom erodes many of these signals: tinny voice quality, lack of eye contact, and the loss of a natural rhythm and flow of verbal exchanges deprive the SES of important safety information. Apart from Zoom issues, the pandemic has left us with a range of stressors involving real fears and losses, both minor and catastrophic. Finding ways to be socially engaged and present is difficult indeed when our nervous system is being triggered by threats, both real and imagined.

This brings us to the second set of strategies. Whereas the first strategy involved using connectedness with others, the second strategy involves developing connectedness from within. From a neurobiological perspective, this involves teaching the body to send signals of safety to the brain; there are many techniques to help us do this.

The most direct way is through breathing. When we're stressed, we may breathe rapidly and shallowly, or actually stop breathing, only to find ourselves hyperventilating. We may breathe through our mouths and into our upper chest, which inadvertently activate the fight or flight response. Simply being aware of our breathing can help us catch ourselves. Breathing in for a count of four and out for a count of four for a few minutes will start to turn on the SES. If you can allow your breath to naturally slow down to 5-6 breaths per minute, the SES will operate at an optimal state. Doing this for 15-20 minutes a day can generate a sense of overall well-being that lasts well beyond the exercise.

Another technique for self-regulation from within involves movement. Certain types of movement stimulate nerve receptors throughout the body, which deliver signals of safety to the brain stem. Just like a calm, predictable rhythm and flow of social interactions helps us feel safer and connected, a calm, predictable rhythm and flow of sensory information has a similar effect. QI Gong and Yoga are excellent examples. Many Eastern practices involve gentle shaking. Like an Etch-A-Sketch, gentle shaking for 2-3 minutes can discharge built up residues of chemicals related to stress in your autonomic system.

If you're interested in exploring movement and breathing practices, The Westchester Library System offers several free classes each week in a practice called Breath, Body and Mind (Brown & Gerbarg, 2012). This model is "Evidence Informed," meaning that the techniques have been studied through empirical research and have been determined to be safe for most people. WLS provides them free of charge and taught by experienced individuals who have undergone advanced certification in this model. BBM practices can be considered "neural exercises" that activate the SES and are for everyone who's interested.

In summary, people can learn to shift into these states on their own, even when stressed out. In this way, the SES can be built and strengthened throughout the lifespan. This is the autonomic basis for resilience. Understanding how we're wired and what we can do to maximize our resilience informs and enhances other coping strategies. You will undoubtedly discover many skills that you have already developed in terms of building your resilience. It is hoped that with this knowledge and ideas, you will continue to explore and play with related strategies, and that they will serve you well long after this pandemic has ended.


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Westchester County Services & Supports
Crisis Services

If you need 24-Hour Phone Support:

Substance Abuse and Mental Health Services Administration (SAMHSA)
Disaster Distress Helpline: 1-800-985-5990 (English/Spanish); TTY: 1-800-846-8517

If you need a 24-hour Crisis Text Line:
Text GOT5 to 741741 to Connect with a Crisis Counselor, Free 24/7 support

Suicide Prevention Lifeline:
1-800-273-TALK (8255) for English; 1-888-628-9454 for Spanish

Interpersonal Violence (i.e. Domestic Violence) has been an experience of many New Yorkers through the COVID-19 pandemic due to isolation, distress, and more. Reach out to the NYS Coalition Against Domestic Violence Distress Hotline 1-800-942-6906

Westchester County Crisis Prevention and Response Team
Call: (914) 925-5959
24/7

Talk it out

Life as you knew it and lived it has changed with COVID-19. One important thing to know now is that each person reacts differently and that looking for help to sort out and understand your feelings is a strength, not a weakness.

Contact Westchester County Emotional Wellness Line to speak to a professional who can listen and share some options and resources with you.

Westchester Emotional Wellness Line
Call: 914-995-1900
5 days (9am - 5pm)

Westchester County Department of Community Mental Health Resource Directory
https://dcmhservices.westchestergov.com/DCMHservices/

New York State Project Hope Crisis Counselors understand what you are going through. Talking to them is free, confidential, and anonymous. Talk to someone who is trained, knowledgeable, and never judges. Sometimes it helps to talk with someone you don't know.

NY State Project HOPE Emotional Support Helpline
Call: 1-844-863-9314
7 days (8am-10pm)

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Help at Your Fingertips:
Westchester County's Employee Assistance Program

The Employee Assistance Program (EAP) is a free, voluntary, confidential service that is made available to you, as members of the county workforce, and members of your immediate family.

We are confronting an unprecedented challenge. The COVID-19 pandemic has raised levels of concern, fear and anxiety for individuals as we face concern about ourselves and our loved ones. And at a time when connection and support can lift us, social distancing has forced us to find other ways to get that support.

The EAP remains available to help you find solutions to difficult situations and connect you to services in the community that work with your health plan.

EAP clinicians can help with:
* Family Problems
* Emotional Issues
* Gambling, alcohol or substance abuse
* Legal, credit, housing and any other concerns of daily living

Remember, as the time passes after a traumatic experience people usually start to feel better, especially if they are using good coping practices. Still, this can take longer that we expect, especially if the stress is ongoing and sometimes it is useful to seek out more information or to talk to a trained helper who can provide more support.

Your EAP clinicians can be reached by contacting 914-995-6070. Monday to Friday 9 a.m. to 5 p.m.
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