Among popular topics up for discussion within recovery communities—pre-pandemic—was the co-occurrence of post-traumatic stress disorder (PTSD) or Adverse Childhood Experiences (ACE) with a substance use disorder (SUD). According to the Veteran's Health Administration, PTSD is strongly predictive of relapse in patients with SUD. That alone should capture the attention of those in the recovery community who struggle with PTSD, especially with the associated panic attacks as new or different coping skills can be difficult to ascertain in this unique situation.

In a time where we are all affected by the COVID-19 pandemic and its impact across the globe, everyone is being called to do things many have never experienced before, which can have a rattling effect on the maintenance of recovery as well as mental health. The two are closely and immensely interconnected.

The CDC released an assessment on the Chinese population, due to the unique impact the SARS outbreak had on many of their citizens who are also the first to be hit with the ongoing COVID-19 pandemic. Within their discussion were overwhelmingly high statistics on resurfacing PTSD symptoms and the onset of PTSD in frontline workers, as well as others heavily impacted by public health protocol to isolate, quarantine, and distance.

Underlying Antagonists or Arousal Triggers

Maintenance for freedom from the daily effects of PTSD, which can be all-encompassing in a persons' daily life, is critical for the mental stability and fortitude needed to keep attention on successful recovery practices. The complex relationship of depressive anxiety and panic disorders like PTSD makes ongoing management of SUD difficult. However, by keeping the bar for fear, panic, hyper-vigilance, and over-excitability high, the threshold for panic attacks becomes more difficult to trigger. That's where the solution lies.

For people with panic and anxiety disorders—specifically post-traumatic stress disorder (PTSD)—it can be quite an undertaking to distance, isolate, or quarantine. This can be especially daunting when it seems the whole world is living in fear—fear of the unknown, fear for the lives of others, or just plain fear with no name—because that's how PTSD and anxiety works, thriving off 'mountains out of molehills'. Part of recovery that is especially useful for those who are dual diagnosed is that there are ways to name fears, their effect, and understanding what tools are available to pat down those mountains.

There is a component in many recovery models that address daily maintenance to name our resentments, fears, and triggers, then process what they bring to the forefront for us. Recovery also offers the tools to keep them "right-sized" until we can get connected with outside resources to get a handle on continued maintenance. Trying on new skills, exploring new interests and outlets in new, albeit rightfully unnerving, situations can be a great opportunity to reinvigorate recovery, old and new.

Ways to Tend to Your Mental Health and Recovery

So, here's a handy list of some ideas to try for your mental health & recovery while in isolation, quarantine, or while good old fashioned social distancing.

1. Meditation

YouTube has a gold mine of varied meditations: guided, brain wave meditations, or simply calming music to take a soothing pause.

2. Take a Breather!

Take a break periodically throughout your day to try some simple breathing exercises. Count backward from ten. Focusing on your breath is a simple tactic to draw yourself back into the moment and out of panic or fear. Considering your surroundings and naming things you can see, touch, smell, etc while taking slow, deep breaths is an excellent way to recenter and focus on the present to recharge.

3. Go Outside but Keep Distance From Others

A change of scenery alone, even moving around your own neighborhood, can be a helpful tool in breaking away from a panic attack or the downward spiraling thoughts of overwhelm and hyper-vigilant obsessive patterns that can bring one on.

4. Stay Active

Have old exercise equipment that's been collecting dust? Time to break those out and get your body moving. Many Insta-famous trainers and gyms are posting to their pages and email lists free workouts and routines you can do right from your living room. Pump out some worries and increase the endorphins that can keep panic attacks at a minimum, or outright break you away from one.

5. Video Chat or FaceTime With Others

Don't forget the high-risk folks you know & frontline or 'essential' workers. Chances are, they're carrying around some extra stress and worry right now, too. A valuable tactic we learn in recovery is reaching out and not feeling so alone in big feelings. Many 12 step meetings have moved to Zoom or virtual meetings. Ask your local chapters for that information.

6. Limit News & Social Media

The CDC suggests limiting news and social media intake since it's inundated with updates on the COVID-19 pandemic. Turn it off, unplug, hang with yourself! Chances are, you can turn the volume down on internal chatter and panic if you keep it limited on the devices in your home.

7. Stick to a Schedule, or Don't

Feel like you're falling into the abyss of a schedule-less life and knocked off your routine? Feeling the overwhelming dread of "life is going to eat me" by keeping a schedule? Now's your time to shine! Implement some of these suggestions and create a new schedule. I don't think anyone out there is judging anyone for telling Netflix, "yes, I'm still watching".

8. Dig Into Your Closet

Does the thought of how packed your closet is send you into a tailspin? Time to pull it all out and maybe not Marie Kondo your whole place, but just check in with your space and maybe do some sprucing and spring cleaning.

9. Dig Into Your Mental Closet and Clean it Out, Too

The thing about anxiety & panic disorders, or PTSD is that it can tend to follow you everywhere, at all times. The hypervigilance, constant feelings of fight or flight, and some other associated symptoms leave little bandwidth for tackling whether or not some life plans/goals/concerns are actually things worth mentally working over and over. Have any paper around? Perhaps take this mandated pause as a time to put it all on paper; make those thoughts make sense & give your overworked brain a break. Sometimes seeing it all laid out makes it all the more obvious that yes, having goals is good, not all of them need to be met at the same time, and see where you can trim some fat off the constant nag and worry that can cloud your brain. This one is about spring cleaning your thought process.

10. Check-in with Your Recovery Support Network

Have a sponsor in recovery? Check-in with them, too. Friends? Newcomers? Support group members? Pound the phone all day, if you want. That thing you tell yourself because of anxiety—that they already have enough going on, do you REALLY need to reach out? YES. Yes, you do. Most folks in mental health that cross my path are indeed open for business, just maybe from their couch with doxy.me provider links and are happy to help you sift through all the mental spring cleaning above.

Have Compassion for Yourself and Others

Worth an honorable mention is taking this as an excellent opportunity to give yourself some grace. PTSD is hard. Panic attacks are hard. It's okay to feel the complete and total overwhelm of your own stress, as well as the panic of others. Being a compassionate human being, open to the emotions and concerns of others is a great thing. That being said, don't set up camp and live there if you can't. Take breaks, deep breaths, time to assess compassionately and invest in yourself. Eat well, get sunshine where and when you can and move around.

Perhaps this is an opportunity to shake off those coping skills we always hear about and breathe life back into them and ourselves now that some daily drudgery has been removed. Time for a perspective shift, friends. Time to really work on flexing those muscles of self-care, reflection, and turn our fears into growth opportunities. What we do to care for ourselves, taking each day as it comes and asking where we can apply recovery principles and best practices to look directly at fear, panic, trauma, or whatever haunts us and hold space to process those emotions, then use our recovery principles to challenge our negative thoughts and continued fear is fertile ground for growth.

We are all in this together, one day at a time, to remind each other to give grace and mercy to ourselves and others. We are all in this; no one of us is alone—even in isolation, quarantine, or from a social distance.

Stay safe & stay recovered, friends.