2020 is one for the history books. Years from now, children will be learning about all that took place this year. Since March, much of our time has focused on COVID-19 and how to deal with its repercussions. Most North Americans had to pivot on a dime when it became clear that this was indeed a severe pandemic. So much stress. So much anxiety. So much uncertainty.
 
And now those in the U.S. are on the brink of an election. One that is also riddled with uncertainty, even with a long history of elections to draw on. This one is different. People are more polarized politically than before. In 2016, those who wanted a different outcome were devastated. It became a tension point for an array of relationships. Spouses, siblings, friends, co-workers became overwhelmed by the impact of this election. Emotions ran high, dividing friends and family members in an unprecedented way. Many unfriended their social media connections over it. Some considered calling off their weddings. 
 
As a marriage and family therapist, I witness the anxious thoughts around this election, holding space for the uncertainty and likely delay as ballots tally past election day.  Most of my clients feel like it is "hard to breathe right now." One person describes feeling like "a balloon where someone is slowly releasing the air." Self-care has sunk to a level that feels out of reach for so many.  And yet, it is more important than ever to engage in healthy habits. The duality of a pandemic and a major election has raised us to a new level of "OMG." 
 
One kind of certainty, wherever your politics fall, is that only one party can win the presidential election, and those results will be unwelcome by many. The initial reaction will most certainly resemble that of fight, flight, or freeze. In fact, many declare they will move out of the country should their party lose. It is not that simple. Uprooting one's life is complicated, costly, and can have unforeseen consequences that are not as "wonderful" as one can imagine.  
 
Whatever the outcome of the election, we must find healthy ways to manage our feelings around it. Remember, we are still in a pandemic that has already raised our anxiety and cortisol levels to new levels. The election's uncertainty will linger past November 3rd as the country and world-at-large wait on the edge of our seats for final results in the various elections. On top of that, the tensions of COVID continue to hang in the air. Couple the election with a pandemic where the numbers are still growing, and your outcome is anxiety and depression, an understandable response to feeling a lack of control. 
 
It is hard to sit with the discomfort of anxiety and depression. You may feel on edge most days and have trouble sleeping. How will you handle the outcome if your candidate loses? It may be unimaginable to think of four years with an undesirable candidate.  This year alone has taken such a toll on us. We have changed how we live, work, socialize, and function in our communities. Individually, each of these is enough. However, when they all converge, we are facing significant mental health concerns. 
 
Now more than ever, we must pay attention to our stress, managing what we can, and letting go of what is out of our reach. Reminding ourselves of the stages of grief can be helpful. The powerlessness felt when we lose someone near, and dear to us is similar to other losses. At some point, we move to acceptance but not without experiencing denial, anger, bargaining, and depression first. If we try to skip these stages, we become stuck and, in turn, lose out on the simple day-to-day life moments that can give us joy. In any kind of loss, acceptance doesn't mean we are no longer grieving; it means we have come to accept that things can never exactly be as they once were, and we can re-engage in life more fully. 
 
We can enact certain behaviors to manage our anticipatory grief around uncertainty in the pending and post-election period, along with our COVID concerns. Here are some tips for managing pre- and post-election stress during the pandemic.

1. Set Reasonable Expectations  
Make sure that you are setting reasonable expectations for yourself as well as others. If you know that someone in your life differs from you on political lines, don't expect a different outcome. Set your expectations to a level that allows you to manage your anxious feelings. For example, if your loved one is unabashedly open about his/her/their political beliefs, do not expect anything but just that. In such situations, I tell my clients to "zero out your expectations." 

2. Set and Maintain Boundaries    
Establishing boundaries with others is the key to emotional balance. When you set a limit, you let others know what you can or cannot handle emotionally. Keep in mind that you are not asking someone for permission; you are clearly stating what you need to feel safe. Concerning political beliefs, be sure to pay attention to how you feel about participating in anything that feels triggering. If, for example, you have a friend or family member who historically disregards your boundary, you can say “no” to situations that he/she/they are attending.

3. Practice Self-Care   
While self-care may look different than in the past, it is essential to emotional well-being. With so much anxiety in the air, you may find it hard to keep up with the practice of self-care. Start with self-compassion. These are unprecedented and difficult times. A few self-care items that can improve your mood include drinking enough water, going for a walk, listening to your energy needs – don't overdo it right now. If you need to rest, take a nap, or aim to be in bed at a reasonable hour. Rest and proper hydration are essential to survival. If you can do more, do it. Self-care is about knowing what you need at various times in your life. It may look different during trying times. 

4. “Name it to Tame it”  
In the therapy room, I often tell clients they need to "name it to tame it."  This technique helps with learning assertive communication. By externalizing our concerns, we provide an opportunity for discussion. In the case of heated political issues, it helps to respectfully state concerns. If things get too complicated, use your boundaries to let someone know the conversation no longer feels emotionally safe.

5. Reframe Stress by Looking for an Opportunity    
The stress of so much uncertainty can be consuming while also providing a chance to be creative and learn something new. One way to cope with anxious feelings is through healthy distractions. For some, that can be cleaning, cooking, running, or painting. Whatever it is, make sure it is something that will bring positivity to your life.

6. Don't Consume Media Junk Food   
We know that a healthy diet is good for us, and sometimes we eat the cake or cookie anyway. That is ok, as long as it isn't your everyday habit. The same is true for your media diet. Compulsively checking your phone or allowing yourself to get pulled into social media posts is not a healthy media diet. Checking the polls every 10 minutes will not change the outcome. Take breaks from your phone or computer and make sure you are reading from reputable sources. 
 
Finally, if your feelings are overwhelming you and disrupt your life, reach out to a mental health professional, such as a marriage and family therapist, for support.  Whatever your beliefs and preferences, we need to connect with others who can validate our concerns without judgment.

For those of us fortunate enough to have work during the COVID-19 pandemic, we must balance gratitude with uncertainty. We are living through history in the making, and the massive sudden pivot to working from home can be overwhelming, particularly for those without prior remote experience.  

Everyone's transition to a remote work schedule will be different. For those who already work from home, the change will be more or less seamless. However, for many, this transition has been abrupt and mind-boggling. Work-life balance has become more daunting than ever before, as it all takes place from your home. Each of us will have a unique challenge to navigate. For a working couple that lives in a studio apartment, for example, it will be more complicated than for those whose space provides more privacy.  
 
There are so many considerations when it comes to navigating all of this "in place." Marriage and family therapists (MFTs) lead from the premise that nothing happens in a vacuum. All of life's demands still exist as you work from home. We are all coping with pre-existing stress on top of the uncertainty that comes with a pandemic. High anxiety about job security is a factor that keeps many of us from setting clear boundaries between our work and personal life. The geographical line vanished overnight, and most of us are scrambling and overextending ourselves to keep from engaging in catastrophic thinking. 
 
As MFTs, we know that setting and maintaining clear boundaries are vital to protecting our mental health. In our field, we talk about boundaries as enmeshed, rigid, or clear, and transparency is the goal. Think of them as your safe zone. Boundaries are about asserting your emotional need for protection. They are not about asking for permission but instead are about letting others know what you can handle. And, as we shelter, work, and play in place, your limits will be challenged. It is okay to be precise about what you can and cannot handle. Others are unable to adjust their expectations and behaviors if they are uncertain about what you need. 
 
Here are some tips for setting boundaries while working remotely during the COVID-19 pandemic: 
 
Hold Yourself Accountable: Setting clear boundaries is up to you. You are responsible for your own needs. It is not always easy to assert your needs, and even more so if you are worried and anxious about job security. However, you are doing yourself and others a disservice by ignoring your needs. Now is the time to use your oxygen mask first, and by doing so, you will be more available to those around you, even from a distance. 
 
Communicate Clearly: Take advantage of the technologies available to you at this time. With so many ways to communicate, we need to make sure we are setting reasonable expectations with our co-workers and clients. It is okay to let your boss know that you are overwhelmed. We all are!  
 
Set Your Hours and Maintain a Routine: When possible, manage your time as you would when going to the office. For mental health professionals, like MFTs, this means keeping a similar schedule to the one you do in the absence of the current pandemic. For other professionals, try to mirror the schedule you kept before the quarantine. And if space allows, create a designated area to work in your home. 
 
Protect You Space: Having work overtake your home can feel bad—not because you don't like what you do but because it infringes on what usually is your personal space. Be sure to keep some part of your day sacrosanct for your own time. 
 
Take Breaks:  Just as you would do pre-pandemic, permit yourself to take breaks during the workday. Pushing yourself to be "on" all the time will only lead to additional exhaustion. Take time to eat, hydrate, and stretch. 
 
Be Kind to Yourself and Set Reasonable Expectations: Lead from kindness; no one has done this before. It is a new time, and the rules are unclear. No one expects you to be perfect. Do what you can and let yourself rest when you need to. Keep your expectations of yourself and others within reason. We are all adjusting! 
 
These are trying times for all of us. If you need additional support during the COVID-19 pandemic, please reach out to a mental health professional in your area. Telehealth services are available across the US and Canda. You can find support through the following sources: via the AAMFT therapist locator (AAMFT Therapist Locator),PsychologyToday(www.psychologytoday.com),GoodTherapy(www.goodtherapy.com).

By now, most, if not all, of us are practicing social distancing until further notice. For those with kids, they are homeschooling while trying to balance remote work schedules. For others that may be alone or have no kids or family nearby, or have been temporarily laid off of work, this time is especially challenging.
 
We must all do our part to help reduce the spread of COVID-19. Social distancing functions as a means of harm reduction by allowing time for tests and vaccine production. It is vital and requires effort. The timeframe on this remains unknown, and long periods of loneliness and worry can increase stress, anxiety, and depression. 
 
Social distancing, while crucial, asks us to suppress our evolutionary hard-wiring for connection. Nicholas Christakis, a social scientist and a public health specialist at Yale University, told Science. "Pandemics are an especially demanding test…because we are not just trying to protect people we know, but also people we do not know or even, possibly, care about." (bigthink.com) And yet social distancing will be a way of life for several weeks, if not longer. It is a test of enormous proportions, and we all need to help each other as much as possible from a distance.
 
Breathe…we can do this! Before hitting the panic button, try to think of the opportunities that still exist at this time for creativity, care (self and others), and compassion. We are fortunate to have more ways to reach people remotely than at any other time in history. We have tablets, laptops, and phones that function as mini-computers. We can use these platforms to support people outside of our social restriction circle. 
 
A helpful way to reframe social distancing may be to focus on social solidarity. It is a chance to reflect and expand our circle of moral concern. We are in a time of transformation, shifting away from an I-centric approach to one of collective effort and care. We are all in this together, and maintaining our emotional well-being matters. 
 
For Marriage and family therapists, social distancing is part of a systemic response to managing the spread of COVID-19. The discordant nature of it is such that we are helping the more extensive system, our community at large, by intentionally conducting life via isolation. But to repeat…we can do this! 
 
Here are some survival tips for managing life during this time: 

• Don't Panic: With so many sources of media, it can be hard to weed out unfoundedly pessimistic news. To fend off panic, one must prioritize reason and realism. One way to do this is to make sure you are obtaining information from reputable sources. Some good sites for this include the CDC's coronavirus page, your local health department's website, and the Johns Hopkins Center for Health Security. Other reputable news sources include New York Times Conavirus (free access during the outbreak). Do remember to set limits on how much news you consume each day. It is not helpful to keep checking; in fact, the more you do this, the more likely you are to make snap judgments based on how easily information comes to mind.

 

• Re-create Your Daily Routine: The sudden move to remote working and homeschooling has thrown routines off-kilter. For most of us, this can create additional stress and anxiety. Thankfully, we can retrofit our pre-distancing habits to our new social distancing way of being. If you are working remotely, try to follow a similar routine as you did when going to the office. Get up at your usual time, engage in healthy activities of daily living, and carve out a designated space to work. If homeschooling, set up a schedule that resembles what your kids have been doing throughout the school year. You can modify it, however, as you feel fit. For example, you can develop a schedule that incorporates routine and reward. Follow an hour of reading or math with a snack and an educational show. There is no specific right way to do this, but having a routine will make life a bit easier for everyone. 

• Be Altruistic: Research shows a strong correlation between philanthropic activities and improved health and well-being. While social distancing puts limits on our ability to engage in altruistic behavior, it doesn't eliminate it. One can offer to shop for a neighbor or relative that is elderly or has a compromised immune system. Another way to give is financial. If someone in your community is temporarily laid off, you can offer to drop off groceries or send a gift card to help offset some of the burdens he or she is facing. 

• Be Creative: Being socially restricted may provide an opportunity to engage in creativity. With the time at home, you will likely cook more. Find new recipes or have an in-home bake-off. Other creative outlets include – drawing, puzzles, knitting, crocheting, creating writing. You can find anything on YouTube, so don't be afraid to learn something new while you have time to do so. 

 

• Move it! At this time, we can still go outside for a walk and get fresh air. Take time every day to go for a walk or jog (if preferred) while maintaining a safe distance from others who may be doing the same. Getting fresh air and moving our bodies is one of the best things we can do at any time, and now more than ever. 

 

• Choose to Remain Positive: Social distancing will have taxing moments. Human nature leans into the negative with ease, so staying positive will take some effort. Marriage and family therapists often talk about the positive to negative ratio or “magic ratio” is 5 to 1. This means that for every negative interaction during conflict, a stable and happy marriage has five (or more) positive interactions (gottman.com).

​During this time of social distancing, you will have ups and downs, and that is okay. Make room for the trying moments, and remember they are just that – a moment, not forever. Maintaining an attitude of optimism is more beneficial to your well-being than dwelling on negativity. Try to choose a healthy mindset day by day, and remember you’ve got this!

Managing fear and anxiety at any time is challenging. No one likes uncertainty, and with so many avenues to information, basic levels of stress can skyrocket. Remember that human beings are survivors. Anxiety is activated by the primal part of our brain, signaling us to fight, flight, or freeze. It intends to aid survival, and yet, as it sometimes functions, it leaves us feeling paralyzed, panicked, and riddled with fear. Remember that this is normal, and everyone will feel some level of anxiety and fear right now.
 
Given the seriousness with which we are receiving information about COVID-19 pandemic, it is normal to feel anxious. Facing concerns of the developing covid-19 pandemic, marriage and family therapists, as well as other mental health experts, want to remind those with exacerbated anxiety, fear and depression symptoms some ways to manage their symptoms during this time of uncertainty.

• Honor Your Feelings: You will have anxious thoughts. Hold space for these thoughts as not to avoid, ignore, or suppress them. Give yourself permission to have anxiety as an appropriate response to uncertainty. Manage things in smaller increments of time, reminding yourself what you can and are unable do from minute to minute. This can help keep things in perspective. 

 

• Self-Care Matters: Engaging in self-care is critical right now. A short list of self-care items includes: sleep, balanced nutrition, exercise, hydration, as well as protecting and conserving our emotional energy. When our personal energy drains our ability to keep things in perspective becomes increasingly distorted. 

 

• Maintain Social Support: Stay in touch with your social support system via text, phone, FaceTime, Skype—whatever is available to you. Pay attention to your sleep and nutrition needs. It can be hard to sleep well when we are a bundle of worries. Try to maintain a healthy routine including the things you typically do to support your physical and emotional wellness. And use caution by following current health and safety protocol while doing them.

 

• Check on Others: Helping others when we are worried can be a welcome distraction, as well as an action item to ease anxious feelings. Take time to check in on anyone in your family, friend, or community group that is living alone, or may need additional support during this time.

 

• Consume a Healthy Media Diet: Just as you need to pay attention to sleep, nutrition, hydration as ways to manage your health, you must choose a healthy media diet. Seek information from reliable news sources only. Set healthy boundaries for checking in on the latest news to short, defined periods, and refrain from setting related push notifications on your device. In fact, it serves your interest to turn these notifications off. Appropriate information consumption can reduce anxiety and fear, or at the very least, give you a break from ruminating on the current covid-19 climate. Here are some better-established sources when you do turn to the media coverage:

             Johns Hopkins Coronavirus Resource Center
             New York Time Coronavirus
​

• Live Reasonably, Do What you Can: Take the recommended precautions as outlined by Centers For Disease Control & Prevention (COVID-19) and other credible health agencies (see links above). Remain focused on the factors within your control, such as washing hands, covering your mouth during coughs and sneezes, avoiding non-essential travel, and practicing social distancing. 

• Reach Out to a Mental Health Professional:  MFTs and other mental health professionals are still keeping up with their clients. Many have moved to virtual platforms that offer telehealth to clients. If you’re noticing that your symptoms of anxiety (in association with COVID-19 or otherwise) are causing you significant distress or are interfering with your ability to function normally, reach out for formal mental health supports. You can find support through the following sources: via the AAMFT therapist locator(AAMFT Therapist Locator) , psychology today(www.psychologytoday.com), and good therapy(www.goodtherapy.com) 

These are challenging times, and now more than ever, we need to work together in supportive and compassionate ways. From some of the most difficult moments come opportunities to grow. This is a time to redefine our communities in ways that will allow us to feel more connected, despite temporary social distancing. 

While our responses to loss have common features, not all loss is the same nor is all loss recognized in the same way.  For those who struggle with infertility, pregnancy loss, and the unexpected results of genetic testing, grief is layered and complex. It is often unseen or marginalized by others, making the grieving process all the more difficult. Couples who experience these types of losses are mourning multiple events. And clinicians need to be aware of these losses in order to help clients mourn and move toward healing.
 
The disappointments caused by these losses are often overlooked. When we encounter infertility, for example, we tend to think of the couple’s inability to conceive and do not see other hidden pain they experience. Few people recognize the full impact of the sadness that the infertile couple is going through. The loss of a hoped-for future is one of the complex layers felt by the couple experiencing infertility. It can be very difficult to allow oneself to grieve over something that has not come into full existence, as is the case with the dream of having a life with children.
 
Couples who have gone through a pregnancy loss or the unexpected results of genetic testing, suffer the loss of the future in a way that is different from the struggle of those experiencing infertility. Every couple has a vision of their baby and the life they are going to have with him or her. And when that is lost, the pain is crushing while the loss is often mourned in silence.  Grief then turns invisible, unacknowledged even by well-meaning others who respond with such comments as “you can have another” or “it’s not your fault.” Or in such cases as multiples where one twin is lost, people might attempt to console with,  “at least you have one baby.”
 
The number of these experiences is not negligibly small; of course, even if it was, sufferings that are rare are harrowing or isolating in a special way. But most of the invisible losses we have in mind here are common. To take just one type of loss, today as many as 20% of clinically diagnosed pregnancies will end in a miscarriage. Despite this high number, these experiences are not widely announced or shared. Even the tendency of today's social media to share, and even overshare, life events and updates does not usually extend to these kinds of hardships
 
 
What does this mean for our clients who experience invisible losses and are suffering in silence? We need to remember that these clients walk into our office carrying the heartache of days, months and sometimes years of cumulative loss. They are mourning—over and over.  It is our task to witness and help them express the roller coaster of emotions that they are experiencing. Our clients need to feel their way through the losses and over time, fold them into their lives—finding a “new normal” and creating an expanded life narrative.
 
We need to ask ourselves, how comfortable are we giving a name, a story, and a voice to their pain?  If we, ourselves, can get comfortable with and take seriously the losses of our clients, we can then make the gentle inquiries into the invisible and unspoken worlds of infertility, pregnancy loss, and unexpected genetic diagnosis.  Through sharing their heartache with us, with their partners, and with trusted loved ones, our clients will eventually heal and move forward with a “new normal” in place. When we help our clients bring loss out of invisibility and silence, we help them live their lives out of the shadows feeling loved, accepted and supported by those around them. While the human lens toward the world is forever reshaped by a loss, the experience of joy can be recovered and even increased. Their stories have been validated and honored, and they can once again live meaningfully and fully.