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March 16, 2020

Addressing Anxiety and Stress During A Pandemic – An Interpersonal Neurobiology Perspective

I have been waiting to write this article; waiting for what I am not completely sure.


Perhaps, waiting until my clients started to reach about the COVID-19 pandemic? Or, waiting until I ‘believed’ that there was something to be concerned about? Or waiting because I didn’t want to overshoot or undershoot my response to what the WHO is now calling: A pandemic.


The word sounds serious. And, with that, it is bound to generate a degree of hypervigilance amongst humans. When you hear the word – pandemic – you pay attention. What are you paying attention to? What are you looking for? What does it mean to you? What does it mean to those around them? The word itself is not harmful, however, the meaning we subscribe to the word can be perceived as a threat to our species.


The brain does this amazing thing (albeit it can be a pain in the ass too), it sends out a signal called neuroception into its environment that picks up bits of information and scans its surroundings for a potential threat(Porges, 2011; Porges & Lewis, 2010). This is happening faster than our neocortex can compute or make sense of. As this process unfolds it is searching for anything that might be ‘out of place’ or displaying a different set of patterns than it is accustomed to. Resulting in the hindbrain (the brain stem and the cerebellum) interpreting the ‘out of pattern’ information as a potential threat to the system/species (Porges, 2011).


Accordingly, when the central nervous system (CNS) – consisting of the skull brain, spinal cord, gut and heart brain – neuroceives risk of a threat it immediately activates the survival response (Porges, 2011). The survival response injects a huge amount of adrenaline into the body, met with cortisol, in an attempt to slow down the impact that adrenaline has on the system. The point of an activated survival system is a. To mobilize the body with a burst of energy in preparation for fighting or running, b. To inform the system of potential threat thus, attempting to keep you out of harm’s way, and c. To collapse the system if need be to ‘feign death’ to ‘prevent death’. All of which sends your body, mind, heart racing in a state of panic. This is known as hypervigilance or hyperarousal. Under which circumstance, you will display the symptoms of anxiety or a variation of such (Siegel, 2020).


Key point: Mammals are not meant to experience long term survival states – i.e., long term stress.


This physiological response may be necessary and may actually save your life. But what happens when it causes dysregulation of the entire system? What happens when it causes dysregulation of a community of people? What happens when it causes global dysregulation? We are currently experiencing a wave of global dysregulation – also known as hysteria. Dysregulation of any system results in chaos and rigidity – whether the system is personal or societal (Siegel, 2020).


I chose to open this article unpacking the survival physiology because it is helpful to use this as a point of view as we approach the current hysteria that we are experiencing both locally and globally. The news is coming in faster than we can digest it. As I am writing this article (March 14, 2020), I opened yet another response to the COVID-19 situation, now in Spain, and the panic in the written voice is palpable. The message: Be warned, it is coming to your hometown. With social media as our primary outlet for communication, we cannot shield ourselves from the incoming stories, both anecdotal and statistical – all of which contribute to the activated survival response that has nowhere to run (literally since we are advised to be homebound).


It was noted in a Lancet article called, The Media is the Message, that the mass hysteria caused by media is of utmost concern and they went on to outline how this could have been prevented (Garrett, 2020). All of which does nothing to the majority of the population who are jacked up on adrenaline with swirling fearful thoughts of the worst-case scenarios and have completely lost their capacity to make an informed, emotionally regulated, decision. During states of chaos and rigidity, the system loses its capacity to think rationally, clearly, and cohesively. Both of these situations pose a threat to one’s mental and emotional stability. Potentially spiraling people into states of panic and behaving erratically and irrationally.


You might find yourself grabbing that extra toilet paper, disinfectant, or in what my husband witnessed, taking more than you would normally take while grocery shopping (all the chicken had been purchased from Costco).  He noted that the air felt eerie – something was amok.


Remember the brain comment at the beginning of the article in which I said that through the process called neuroception, your brain scans for unfamiliar patterns. The behaviour out there on the ‘streets’ or in the grocery stores are being coded as unfamiliar behaviour patterns. And the response? You guessed it – hypervigilance.


Now, if as a species we were actually living in optimal states of health and wellness, we may handle this pandemic without risk of mayhem. Mental health (including emotional health) is measured by the harmonious flow of energy and information between all the differentiated parts of the system (Siegel, 2020). This is called coherence. The catcher is, very few of us are in regular states of coherence and harmony. I would argue that the majority of humans are living in states of chronic survival (i.e., stress response).


Thus, we have adapted to dysregulation being a normal state of being. However, what happens when something external to us hits the system and is neuroceived as a potential threat to an already weakened system? The results: An increased risk of shifting into chaotic unstable states. This is definitely problematic for those who were already having a difficult time managing modern stress and staying within their window of tolerance. The window of tolerance, generally speaking, is one’s ability to tolerate stress (or dysregulation) without tipping into chaos and rigidity (Siegel, 2020).


Let’s add another layer of complexity to this already complex situation we find ourselves in today. I have been mostly focusing on the physiological impact of heightened stress and perceived threat of survival. We need to also consider the way in which the mind is perceiving the event. You see, both the event itself and the reaction, including the internalized response, to the event must be taken into consideration. The reaction is the physiological symptomology I described above, which informs potential behaviour. The response is coupled with what we are telling ourselves about what is happening.


Most of our attention is externalized at this time. And, this is also a by-product of the survival system. The system is gearing you up to stay externally focused; on watch, so to speak. In times of crisis, it is not instinctive to turn attention inwards (or even close the eyes). The threat could be right around the corner. However, we are dealing with something that we cannot ‘see’ with the naked eye. We know that ‘something’ is out there, but when will it show up? When will it be in our bodies, our community, our schools, our hospitals? So, we stand eyes open gazing at our phones, computers, tablets, waiting. All of which feeds the vicious cycle I am speaking about – survival activation and chaotic systems of rigidity.


What happens if you turn your attention away from what is happening ‘out there’ and drop into what is happening ‘inside’ of your body, mind, and heart?


Humans constantly internalize because we have a neocortex, thus, we tell ourselves something about everything. Most often, we are not aware of what we are telling ourselves about the situation at hand. And this lack of awareness contributes to the panic, fear, dysregulation that one might be experiencing. However, paying attention to what is happening internally, is equally important as to what is happening externally.


Excavating what you are hearing yourself say about the pandemic is a critical step towards regaining composure and calming a dysregulated system. Your system wants to get you to safety and out of harm’s way. And it doesn’t differentiate between what is a real threat or a perceived threat. I am not suggesting that the pandemic we are in is not a real threat; it is real because it is happening. However, the threat of literal death is statistically low in comparison to SARS at this point (Schulte, 2020).  The kicker is, we have very little control to do much about it.


It is therefore helpful to pay attention to what one can do to feel a sense of control such as: wash your hands, clean your house, limit social contact, stay home if you are sick, slow down and breath, connect to nature, feed your body nourishing foods, drink plenty of water, call your health authorities or take a self-assessment online, limit toxins, move your body, continue to create, and acknowledge the value of health with gratitude.


When in states of anxiety the mind hooks on the worst-case scenario and focuses on the potential fear, this is called negative biasing. Hence, educating yourself with legitimate information coming from trusted sources is part of your responsibility – eg. STAT news or the Lancet – to question irrational fears. Coming up against the potential threat of death, mass sickness, economic collapse, and ‘normal’ everyday things shifting is indeed destabilizing. This is not to be avoided through denial or trite commentary regarding the ‘stupidity’ of humans or ‘global cleansing’. We absolutely need to be validated in our fear, acknowledging that what is unfolding is destabilizing to the entire planet and be supported in calming compassionate ways.


Since collectively all ‘eyes’ are on deck (i.e., phones) it is wise to take a look at the implications that the pandemic is having on individual and collective mental health, and what we can do about it. One key ingredient that fosters a healthy coherent system – enhancing decision making, managing stress better, behaving rationally, increasing empathy and compassion, keeping the fabric of the social species intact – is the skill of awareness (Baldini, Parker, Nelson, & Siegel, 2014; Siegel, 2020).


This is not some new-age rhetoric; it is founded in health sciences. Mindfulness – the practice of bringing one’s attention internally to pay attention with awareness to what arises, notice, and remain unattached – is touted as the ‘medicine’ that fosters integration, regulates emotions, strengthens the window of tolerance, enhances the immune system, and opens one’s capacity to lean in rather than constrict during times of stress (Baldini et al., 2014; Siegel, 2020). If we want to deal with the rising rates of anxiety, potentially resulting in catastrophic behaviours (which I might add could become a secondary pandemic), we need to seriously look at ways to cultivate a practice of inner investigation and increase accessibility to the phone and/or text counselling during times of societal panic.


Initially, I considered ending the article at this point. However, after engaging with some colleagues and friends (a few hours after I wrote the first draft) it was brought to my attention that I need to speak about ways to calm an activated nervous system.


It just so happens that as I write, my sense is that everything is peaking (at least here in Canada). We just got notice that schools and daycares are closing. My high school children are worried about diplomas, missing class time, not graduation, and worried about social isolation. My clients are cancelling appointments or reaching out via text. Non-essential businesses are being asked to either close or limit contact with customers. The malls have shut down. My husband is trying to make a decision about going into work tomorrow and is feeling like he is standing on the edge, holding his breath, waiting to be told about the ‘next big thing’ that he cannot predict. To boot, I have been at home sick for a week (self-assessment tool indicated it is not COVID-19 but having second and third thoughts within the span of a day). So yes, it feels like everything is peaking and this is within ONE household. Dropping into the possibility that every household on the planet is experiencing something similar is indeed a cry for some form of emotional regulation. The irony is that we need each other during times of crisis, yet we are being asked to isolate.

How do you calm an activated nervous system? What is essential?

It is important to note that we are a social species and we rely on one another to help regulate our systems (Siegel, 2020). This is called: Co-regulation. Thus, when one of the members of your community/family/tribe/work is in an activated stress response, the quickest way to calm the system is to be met by someone with whom you trust, that is holding a coherent calm centered grounded state of being. As much as this may be a contradiction today, or perhaps a paradox, soothing touch helps to regulate one’s nervous system; hence why a hug a day can keep the doctor away. NOTE: I am not suggesting you go against National regulation at this time; please follow National recommendations. I am merely noting another dilemma we find ourselves in. 


I do not have the bandwidth to go into all the hormonal juices that get released when we are received with the calm loving presence of another, but let’s just say that they are life-promoting and immune-boosting. Humans require these four foundational needs that foster healthy attachment, ultimately resulting in strengthening one’s tolerance to stress (Siegel, 2020). They are known as the 4 S’s: Safety, Security, Seen, Sooth.


If at this moment you are not feeling secure within your environment due to the pandemic, and perhaps you feel that your safety is at risk (health security) you can lean on the other two S’s to help calm the activated nervous system. As well you can foster inner safety and security through the practice of mindfulness.


Let’s take a brief look at ways one can be seen and soothed during times of instability and insecurity:


  • To engage in genuine conversations with people you trust
  • To have your feelings be validated (not dismissed or belittled)
  • To be acknowledged
  • To receive the soothing comfort of the voice of a loved one
  • To breathe together or with your pet
  • To walk in nature (and cry in nature)
  • To take a long warm bath
  • To listen deeply to another with curiosity
  • To open in empathy and compassion to one’s experience (everyone will be experiencing this time differently)
  • To practice bi-lateral tapping
  • To listen to binaural sound beats
  • To dance and move your body
  • To speak your fears, out loud, and have someone reflect them back to you
  • To laugh
  • To practice grounding techniques
  • To breathe deeply and notice your body
  • To scan your immediate environment with your eyes, in all direction, and tell your brain that at this moment you are safe (if indeed you are not in immediate harm’s way)
  • To practice yoga
  • To call the people you love
  • To call health links or your mental health distress line if needed
  • To access phone therapy or text therapy
  • To always come back to the body and the breath – in…this…moment


I know that this list may seem stale in comparison to the magnitude of the global disruption we are facing and the felt sensation you may currently be experiencing. However, they are real tangible ways in which you can begin to work with your activated nervous system to bring a sense of calmness during the storm. Even droplets of calm offer nourishment. There is a saying that I love (and I do not remember who said it) but it goes something like this: The strongest coherent nervous system in the room creates a resonance that emanates into the environment and impacts the frequency of other nervous systems, attuning them to the coherent frequency. Thus, one coherent nervous system can impact the entire group helping to soothe their dysregulation.


Bottom line: We need each other during times of deep stress to help regulate our activated nervous systems.



Baldini, L. L., Parker, S. C., Nelson, B. W., & Siegel, D. J. (2014). The clinician as neuroarchitect: The importance of mindfulness and presence in clinical practice. Clinical Social Work Journal,42(3).

Decety, J., & Lamm, C. (2013). Empathy versus Personal Distress: Recent Evidence from Social Neuroscience. In The Social Neuroscience of Empathy.

Garrett, L. (2020). COVID-19: the medium is the message. Lancet (London, England), 2019(20), 19–20.

Porges, S. W. (2011). The polyvagal theory. The National Institute for the Clinical Application of Behavioral Medicine.

Porges, S. W., & Lewis, G. F. (2010). The polyvagal hypothesis: Common mechanisms mediating autonomic regulation, vocalizations and listening. In Handbook of Behavioral Neuroscience(Vol. 19).

Schulte, D. (2020). Overreaction may be bigger threat to public health than the novel coronavirus. Retrieved March 16, 2020, from

Siegel, D. (2020). The Mindsight Approach to Wellbeing: A Comprehensive Course in Interpersonal Neurobiology. Mindsight Institute.






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