Rx: Limit Watching the News to 30 Minutes, 3X/Week

July 13, 2020

A 4-step plan to tackle the worries of the day.

From the Editor

Over the past 3 months I have learned a lot from my patients, some of whom I have been treating for 13 years. If I had to take an exam this past March predicting how my various patients would respond to, and be impacted by, the dramatic events we have endured, I surely would have failed. It has been a stark reminder of the complexities underlying each individual’s constitution, resilience, adaptability, and self-awareness as to how they fit in to the universe’s big picture.

My first surprise was how well several of my patients with significant anxiety disorders were coping with the COVID-19 pandemic. A recurring theme for a subset of these patients was their satisfaction and sense of mastery at how well they were coping with the societal disruption and global fears. One patient shared how she was intrigued by how anxious many of her friends and co-workers were. When she was asked how she could remain so calm in the face of all of the uncontrollable stressors the pandemic created, she simply stated that she had been challenged by anxiety all of her life and had developed strategies to cope and reframe her relationship to stressors. She told me she experienced a sense of self-mastery.

Another patient who has suffered from severe obsessive-compulsive disorder, which created a secondary social anxiety and social avoidance, described feeling guilty because she rather enjoyed the empty streets, closed stores, and social distancing. Her anxiety was increased by the thought of our state re-opening.

Another subset of my patients, many with chronic and severe mental illnesses, were unphased by the pandemic’s intrusion; they shared that nothing had really changed for them. Their day-to-day activities were pretty much the same.

One patient, a man in his 50s with a lifelong history of severe social anxiety and chronic depression of variable intensity, reported a significant increase in anxiety as well as the new onset of severe insomnia. The patient lives alone and has been on disability for decades. His meager disability income combined with food stamps and fuel assistance barely allowed him to pay his monthly bills. With great determination and motivation, about 8 months ago he began a part-time job working 10 to 15 hours a week—his first job in decades. With a little extra money every month, he decided to enroll in a basic cable TV plan, which opened access to 24/7 cable news with all of its fury.

He directly connected his increased anxiety and insomnia to his newfound daily exposure to cable news, which inundated him with reports of a country and a world that had become extremely dangerous and violent. His anxiety and fear increased whenever he stepped out of his apartment. He said he would lay in bed at night with frightening images from the day’s news, unable to sleep, and worried about what tomorrow might bring.

Reflecting on his experience, I was reminded of one of my favorite quotes from J. Krishnamurti, a philosopher who was often described as the “guru’s guru.” He repeatedly stated: “Consciousness is its content.” So simple, yet so profound. I read more Krishnamurti during medical school than any other subject, despite his books not being a part of our curriculum. The insights he stirred up in me, along with my experience with Mindfulness Meditation working with Jon Kabat-Zinn, PhD, in the Department of Medicine’s Stress Reduction and Relaxation Program at the University of Massachusetts Medical Center, were the 2 factors that led to my decision to become a psychiatrist.

“Consciousness is its content”—such a simple phrase; yet it contains the roadmap to peace of mind. In retrospect, many forms of psychotherapy are based on this underlying principle. An obvious example is cognitive behavioral therapy, whereby in order to reframe or modify an automatic thought, perception, or judgement, the first step is to recognize the content of the mind’s narrative that has created the experience. In my view, mindfulness practice is an important part of the triad in Dialectical Behavior Therapy for the same reason. Over the years, I have developed a brief exercise that I use myself—and I teach to many of my patients—to disrupt an unskillful cognitive or emotional loop and choose a healthier content for my mind.

The first step is the most challenging, and it is strengthening the ability of my mind to recognize when it is filled with content worth removing or changing. As soon as the recognition occurs, the exercise begins:

1. STOP. I wake myself out of the trance of thought that I am in, often by saying the word stop to myself.

2. BREATHE. I consciously take a slow, deep breath, sending relaxation throughout my mind and body, and clearing the content of my mind.

3. REFLECT. Once grounded in the present moment, I reflect on the mind content that was present and consider options on which I should focus my attention.

4. CHOOSE. I choose what appears to be the healthiest and most appropriate mind content with which to fill my consciousness.

Although simple in concept, it is a very challenging exercise to practice. By repeating this exercise over and over, the brain appears to rewire itself so that the mind moves away from the unhealthy content, and increasingly toward healthier content with all of the associated benefits. To be clear, I am using the terms brain and mind loosely.

Returning to my patient who suddenly had access to cable TV, his mind’s content had become filled with the residue of the Breaking News, which is usually jarring and commonly contains content that is unpleasant and fear-provoking. By limiting exposure to this content—by watching enough to remain informed but limiting the amount to decrease agitation and anxiety and fear—a balance may be established to optimize good mental health. After exploring options with this patient, we developed a plan whereby he would watch cable news for 30 minutes, 3 days per week. No prior authorization was needed.

Inbreath . . . outbreath . . .❒

Dr Miller is Medical Director, Brain Health, Exeter, NH; Editor in Chief, Psychiatric TimesTM; Staff Psychiatrist, Seacoast Mental Health Center, Exeter, NH; Consulting Psychiatrist, Exeter Hospital, Exeter, NH; Consulting Psychiatrist, Insight Meditation Society, Barre, MA.

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