An NCI-designated Comprehensive Cancer Center
May 27, 2020
We are living in the midst of a contagion. Not a day goes by without many of us thinking, or worse, worrying about the novel coronavirus called COVID-19
 
“COVID-19 really challenges our sense of safety and reveals the holes in that protective shield we like to think is around us,” said Jaroslava Salman, M.D., a psychiatrist in the Division of Psychiatry at City of Hope.
Jaroslava Salman Jaroslava Salman, M.D.
“A virus reminds us of our vulnerability as human beings. And that can be very unsettling. We may not think about it, but it impacts us emotionally.”

That emotional impact can give rise to another type of contagion — a side effect of COVID that, for many, may feel just as debilitating: emotional contagion.
 
It occurs when the emotions of a person or persons trigger similar feelings in the people around them. 
 
“We respond to the emotional state of those around us and we have the ability to spread what we're feeling,” said Salman, an assistant clinical professor in the Department of Supportive Care Medicine at City of Hope. 
 
Think about entering a room full of people laughing. The effect on you could be that their mirth is infectious. Just being in close proximity to positive emotions, you may “catch” a case of positive emotional contagion.
 
But for many, what is happening related to COVID-19 likely is the opposite. From inside homes, spilling out into neighborhoods, spreading out to societies and stretching around the globe, the worry, frustration and fear wrought by the novel coronavirus — can be catching.
 
Those feelings of dread and hypervigilance spread — much like a virus — resulting in emotions bouncing between people.

We Respond To Others' Emotions

 
“Those are emotions that have a very strong charge and they're uncomfortable to carry around,” said Salman. “So sometimes that emotional contagion, that bickering or other negative ways of dealing with the virus, is a way for us to channel and let out that frustration, to just let off some steam.”

This emotional cascade can be worse for cancer patients, said Salman, since they are already contending with a heavy emotional load, and possibly trauma, related to their cancer diagnosis and treatment. The emotions around COVID-19, for them, could be looser, easier to trigger.
 
But Salman says there are ways for patients, and others, to blunt the impact of emotional contagion. 
 

Awareness


The first step to stemming the spread of emotional contagion, says Salman, is awareness; knowing that it is actually happening.
 
Being triggered emotionally may be a side effect of the “fight or flight” response to danger deeply wired in the brain; the part that has evolved over millennia, protecting humans from mortal danger like predators.

COVID-19 Makes Us Feel Vulnerable


Salman says awareness allows us to tap into the higher-order regions of the brain that evolved to “talk us out of” acting on our fear.
 
“I think it can be therapeutic to be aware of that connection, to connect the dots, because it allows patients to understand themselves better,” said Salman. “And they'll say, ‘Ah, OK. So it's not that I'm crazy, it's because this is real. This can really happen to us as human beings. That's why I'm reacting this way.’” 
 

Take a Breath, Assess


Once you become aware that you are in the midst of “fight or flight,” the next step is to take a moment and assess the truth of the situation. This allows those higher-order parts of the brain, located in the frontal region (also known as the prefrontal cortex), to gauge the true nature of the situation unfolding.
 
“It is really the frontal lobes of our brain that are able to pause, look at a situation, analyze it and acknowledge, ‘OK, you're feeling more anxious. Let's think about this right now. Why do you think this is happening? And what can we do about it?’” said Salman.

Pause, Process, Decide

 
“It really takes an intentional effort, a conscious effort to have awareness of that; to pause and think about, ‘Why are we talking to each other this way? What is actually happening? Is this really worth bickering over?’” said Salman. 

“Without forcing ourselves to pause and think and take a different perspective, we'll just continue, and everybody will suffer. So we have to be intentional in pausing, processing and deciding, ‘What is the perspective I can take on the situation? Is this the end of the world?’ And most of the time, it isn't.”
 

Take Space


Much like a virus can be contained by maintaining space from others, one strategy for stemming the cycle of emotional contagion is stepping away from emotionally charged situations or environments.
 
That could mean something as simple as taking a series of long, intentional breaths, practicing meditation, even taking a walk.
 
“A half-hour walk may be enough time to just process how you're feeling,” said Salman. “You may think about what you want to say, what you want to do, maybe even rehearse it in your mind and picture yourself, ‘If I were to handle this really with compassion to myself and for those around me, what would that look like?’
 
“Ask yourself and then see what your mind offers, and then you come back and you just say those words and do those behaviors. You may still feel the emotion, but that emotion will not stay there with you. It will go away. It will pass.”

Don't Try To Be Perfect

 

Practice Compassion


When things have calmed and your perspective is changed and more rooted in reality, Salman says the final step for avoiding emotional contagion is to practice compassion toward ourselves and those around us. It can be helpful to be kind and see our collective emotional expression not as a bad thing, she said, but rather a natural reaction to difficult circumstances.

“I think that the compassion lens is powerful as long as we keep it in front of us and are willing to use it as a reference to every situation,” said Salman. “What are your personal values? What is important to you? If you think about that carefully then chances are that you're going to respond in a way that is aligned with that. If your personal values are, ‘I want to treat my family members with respect and kindness,’ then that's a simple reference point.”
 
For help with emotional difficulty spiraling out of COVID-19, visit the Department of Supportive Care Medicine webpage.