If you've experienced a number of major life events in the past year, including concern about SARS, you may be at increased risk for experiencing significant stress. In addition, some lifestyle and social factors may put you at increased risk. However, many researchers believe that while the amount and type of stressful events we experience is important, how we interpret the meaning of an event is just as important.

While one person may interpret a stressful event, such as major change at work or home as a challenge to be mastered, a second person may view the same event as a hassle, and a third person may view the event as a major obstacle that makes them feel hopeless, helpless or unable to cope at all. The meaning people give to an event can affect their ability to cope. When people feel helpless and hopeless or trapped (depressed) they can have trouble coping with even minor changes and hassles.

How you cope with SARS is determined by what the threat of SARS means to you. So, if SARS means loss of hours at work, or a change in your vacation plans, you may cope differently than someone who fears being exposed to SARS at work, someone who is in quarantine, or someone with SARS.

Your Coping Style

How people perceive stressful situations affects how they tend to cope. For example, people who perceive a life event as a challenge to be overcome tend to cope with "problem-focused" solutions. Others who view a situation as life threatening and uncontrollable tend to feel helpless and hopeless. Strategies that may work very well at one time and place or in a specific situation may not work as well at another.

People tend to cope with stress in a number of different ways including:

self-distraction (work, movies) active coping (doing something about it) denial (refusing to believe it's real) substance use (alcohol, drugs) use of emotional support (understanding) use of other kinds of support (help, advice) withdrawal (giving up) venting (expressing negative feelings)

positive reframing (looking for something good) planning humour acceptance (learning to live with it) religion self-blame (self-criticism)

Coping With Stress

While some times in our lives are more stressful than others, we're always under at least some stress. Some of us cope with stress better than others, but MOST of us can learn to cope better.

We understand that SARS is affecting people in many different ways and that there's no one "right" way to cope. However, no matter what your current situation or how you are currently coping with SARS, the following suggestions may help you to cope better.

1. Seek Information

By seeking more information about SARS and coping with SARS you will enable yourself to cope more effectively. Get the correct information from the experts such as Infectious Disease Researchers, public health hotlines or government websites and follow the experts' advice.

Click here for some helpful websites.

2. Evaluate Your Risk

It is important for members of the general public, patients in hospitals, and health care professionals to try to keep the extent of the danger of SARS in context.

At this time, in Canada, transmission appears to be only through droplet spread or contact with infected surfaces. There is currently no evidence of community transmission in Canada. In other words, you can only be infected with SARS if you are exposed to someone with SARS.

If you have not been in close contact with someone with SARS or suspected of having SARS, you should not be concerned about your possible infection and there are no special precautions you need to take at this time. Click here for more information on Signs & Symptoms.

If you are a health care professional, there are likely appropriate infection control precautions being followed at your workplace. To obtain current and comprehensive information on infection control precautions in your community click here.

3. Seek Social Support

Being alone is stressful for most people. Most people like to be around other people, especially in times of stress. We especially like to be around people who make us feel good. Being around people who care about you and make you feel good will help reduce stress. Who do you know who makes you feel good? How can you spend more time with them? Try to challenge whatever fear you have and spend some time with people you like and who make you feel good. People you can really talk to about your concerns.

If you don't have anyone to talk to or if you feel like you need more support than you are getting, we encourage you to use either our on-line moderated support group for Health Care Professionals or SARS Support Community.

4. Reduce Other Sources of Stress

If you are affected by SARS you may want to consider reducing other sources of stress in your life. If you or a loved one is affected by SARS or if you are working in a health care setting and are feeling extremely stressed out by the SARS situation, try to think of other ways to reduce other stress and obligations in your life, even if it means temporarily putting some of your life "on hold", or perhaps making some decisions that you have been putting off.

5. Exercise

Physical exercise is a very simple and effective way to reduce stress and improve physical health. Exercising three times a week for 20 minutes each time can significantly reduce stress. If you find 20 minutes is too much, start at your own pace and increase it gradually as you can do so comfortably. Going for a walk three times a week is a great start. If you are in quarantine because of SARS, try working out while watching an exercise video, working in your garden, or using your stairs to do "step ups."

6. Diet

What we eat affects how stressed we are. In times of stress, people tend to crave foods that aren't really that good for them, such as potato chips and fast food. If you eat better, you will feel better. Keep any change you make simple and don't try to change everything in your diet at once. Start out by trying to eat more fruits and vegetables and drink more water. Try to cut back on salty, fatty, sweet, and greasy food. Try to eat more fresh food and less fast food.

7. Sleep

A lack of sleep or sleeping too much can affect the level of stress and anxiety we experience. If you are having trouble sleeping try the following:

1. Try to get on a sleep schedule. Go to bed at a regular time each night and get up at a regular time in the morning. Try to not stay up late watching TV and try not to sleep during the day.
2. Try to make the room you sleep in as quiet as possible. Consider earplugs or a sleep mask.
3. Use your bed only for sleeping. Don't live in your bed. If you spend too much time lounging in bed, watching TV, drinking coffee, or eating, your body will learn that your bed is not place for sleeping.
4. If you can't sleep after half an hour in bed don't stay in bed trying to sleep. Get up and do some quiet activity. For example, get out of bed and read a book for half an hour and then try going back to bed. If you still cannot sleep, get up and do something quiet once again.
5. Try to keep your bedroom at a comfortable temperature - not too cool and not too hot.
6. Try to get some exercise very day. You'll feel better and sleep will come much quicker.
7. Try not to exercise or work hard in the late evening. It could make you feel "wired."
8. Don't drink anything with caffeine or alcohol for 4 hours before you go to bed.
9. If you are not sleeping at night, avoid naps during the day.
10. Use relaxation techniques (see below) to help you to relax at bed time.

(Reproduced with permission from The Panic Center)

8. Relaxation and Meditation

There are many ways to practice relaxation. Some people enjoy listening to music or walking the dog. There are also more formal ways to relax including meditation, mindfulness meditation, yoga, and Tai Chi. Many people find these techniques extremely helpful for managing stress.

9. Challenge Your Worries and Anxious Thoughts

When people are stressed, they often experience anxious thoughts such as "I can't do it," "I am going to die," "I am trapped", "I have no choice", "How will I survive?", "I am going to get sick." When we are feeling stressed or anxious, such thoughts seem to be "true." However, often if we can get some distance from our thoughts we can challenge them.

The first step to challenging your worries is to start to notice what you are thinking when you are feeling anxious or stressed. Write the thoughts down and then ask each one of the thoughts the following questions. When you ask these questions, think of yourself as a lawyer or judge asking your worries and anxious thoughts some tough questions. Don't go easy on them - they haven't been easy on you!

1. Is it true?
2. How do I know that it is true?
3. Is it 100% true? (something that is 75% or even 99% true is not 100% true)
4. What is the evidence for the thought?
5. What is the evidence against that thought?
6. Has it ever happened before?
7. What has happened before?
8. What is different now?
9. If it were true, how bad would it really be?
10. If the worst thing happened, what would be so bad about that?

In addition, you might try listing the pros and cons of worrying. What are the good things about worrying? What is not so good? What does your extra worrying get you? Does worrying for twice as long help twice as much?

(Adapted with permission from The Panic Center)

10. Reduce or Eliminate Caffeine, Smoking and Drinking

One way to reduce stress is to reduce your alcohol and caffeine intake. For example, if you are drinking lots of coffee or getting lots of caffeine from other sources (tea, chocolate, cola, diet cola) consider cutting down your consumption of those foods and beverages. Try switching to decaffeinated coffee, tea, or colas. If you are drinking a lot of caffeine, don't try to quit "cold turkey." Try reducing your caffeine intake more slowly. For example, try ordering half caffeinated and half decaffeinated coffee in your cup or drinking one less cup of coffee each day until you have reduced your consumption to where you want to be.

It is important not to increase drinking above the recommended guidelines for those who can drink safely. I.e. (no more than 9 standard drinks per week for women and 14 for men and no more than 2 at any given time. It is also important to recognize your risk and not to start drinking and or smoking as a means to cope. Smoking does not protect against developing SARS. In fact, smoking increases the risk of pneumonia.

11. Apply Problem Solving Techniques

If you are experiencing stress, you may be thinking about making changes in your life to reduce it. It may be helpful to spend some time thinking about what positive changes you want to make in your life, changes that will reduce stress and improve your health. Ask yourself what things you can control and what you cannot. Focus your energy on things you can control.

What do you wan to be doing differently a year from now? Where do you want you life to be? What are some doable goals that you can work towards? What do you want and how are you going to get it?

There are a number of steps you can take to start identifying and solving problems in your life that cause you stress. Think of something that causes you stress and do the following:

1. Identify the problem. What do you want?
2. Discuss the problem with someone you trust. What do they think?
3. Try to get a different perspective. What would somebody say who was looking at your problem from the outside? What advice would you have for a friend who came to you with the same problem?
4. List all of the options you have for dealing with the problem.
5. What are the pros and cons of each option? If none of the options is "great", which one is the "best"?
6. Set some goals. How are you going to get what you want?
7. Decide on a step-by-step plan that will help you to reach your goals

In developing a step-by-step plan to solve a problem, ask yourself:

1. What small changes in your behaviour would make a difference?
2. What small changes in your behaviour would you like to try first?
3. What small changes in your behaviour do you think you can make right now?
4. What things would you like to be doing differently a year from now?
5. If you made a small change in your behaviour, how would your life be different?
6. If you made a small change in your behaviour would you feel that you were on your way to a better life?
7. How would you know you were "on your way" to achieving your goals?

(Reproduced with permission from The Panic Center)

12. Apply Time Management Techniques

Try to use simple time management techniques. Set up your priorities and schedule all activities including leisure. Try to do things that are important to you. Try to focus on some urgent matters and some not so urgent issues. For example, do something you have been putting off. Pick one thing that you have been putting off for days and weeks and do it right now. Notice how taking care of one small thing that has been making you feel stressed, anxious, or guilty can make you feel a bit better. Consider making a list of those kinds of chores and do one a day or one a week. If you find that you are constantly ruminating and worrying all day, tell yourself that you will reserve a time to worry and examine these thoughts but for now you will focus on the task at hand. With practice, you can effectively contain these worries.

13. Take Frequent Short Breaks

If your work or schedule allows it, take several 5-minute breaks each day to stand up, stretch or go for a short walk. Get outside if you can. A little fresh air can work wonders. If you are in quarantine or in a work place that makes it difficult to get outside, try to distract yourself with a video game, listening to music, solving a crossword puzzle, playing a card game like patience, etc. Sharing your feelings with others during break time may also be helpful.

14. Practice Letting Go and Being in the Moment

Practice letting go of negative emotions such as anger by making a decision not to let your anger to waste your time thought and energy. Some people find anger management courses useful.

At other times you might want to try to accept negative feelings, such as worry, by allowing yourself to accept your worries as "just thoughts" that come and go. You might try thinking of your worries as leaves on a stream that you can watch as they appear into view and then move out of site, one thought replaced by another. This kind of exercise can be helpful for people who spend a lot of time trying to avoid their worries.

15. Do Something Nice for Yourself One of the best things you can do to reduce stress is to do something nice for yourself! There are no rules here! Simply set aside some time at least once a week to do something you really like to do. It could be anything. Some people like a walk in the park. Others like a warm relaxing bath or listening to music, or gardening, or reading a book. How can you treat yourself to something simple that you enjoy doing? If you give yourself some time to recharge and replenish you will be better able to cope with stress.

What to Do if You Feel You Cannot Cope

For many people with concerns about SARS, information, social support and the application of coping techniques may be enough to help significantly reduce their distress and anxiety. However, other people may need more help.

If you feel that you are not coping well, or if you are experiencing significant symptoms of anxiety and depression, you may need to seek additional professional help. You may be struggling with SARS-related stress. Alternatively, you may be having difficulty with SARS-related stress because there are a lot of other things going on in your life. If you or someone that you know is really struggling with symptoms of stress, anxiety, or depression over an extended period of time, such as a week or two, you should consider seeing a regulated health professional to discuss your concerns. These professionals include your family physician, nurses, psychologists and social workers.

Before you visit a health care professional you may want to take a few minutes to complete The Anxiety Test. The Anxiety Test is a survey that asks you a series of questions about a number of different anxiety symptoms and other problems that often go along anxiety. These questions are based on questions that doctors often ask when their patients think they have an anxiety problem. Most of the questions have "yes" or "no" answers.

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