Essential Tremor: Stress Management During the COVID Pandemic

At the time of this writing, we are in the midst of a coronavirus pandemic that has no precedent in our lifetime. Although U.S. safety guidelines and home shelter timelines may vary from one state to another, the Centers for Disease Control (CDC) advise that the best way to prevent getting the COVID-19 disease is to avoid exposure. This also helps contain the spread of the virus, so it benefits not just you, but everyone with whom you have contact.

Here is a summary of CDC’s recommended actions (click on the link for more details):

  • Frequent hand washing with soap and water for 20 seconds. NOTE: Soap has a different antiviral action than sanitizers and is more effective when properly used
  • If soap and water are not available, use a hand sanitizer with at least 60% alcohol
  • Avoid touching mouth, nose and eyes with unwashed hands
  • Cover coughs and sneezes, or cough/sneeze into your elbow or a tissue. Throw tissue away.
  • Stay home as much as possible
  • Keep at least 6 feet away from others. Remember that even people who have NO SYMPTOMS can spread the virus if they are infected.
  • When around others, cover your nose and mouth with a cloth mask
  • Wash and disinfect frequently touched surfaces at home

More stress for those with ET

Essential tremor (ET) is tough enough to live with in normal times. Practicing the above safety measures can add stress to daily life. Stress is not good for ET. Even without a disease threat, people with ET often find that their tremors become more severe when they are anxious, worried, fearful or under stress.

In addition to the COVID health scare, no one is immune to an extraordinary combination of economic, political, social and emotional factors that permeate our awareness. These factors are stressors because they trigger what is called the fight-or-flight response. To take one example, when we are bombarded with alarming media information that’s hard to get away from, we become extra vigilant, frustrated, alone, angry, rebellious, helpless, uncertain, trapped—you name it.

Any time a person has such heightened emotions, the fight-or-flight response releases a surge of chemicals (hormonal messages) and bioelectric information (nerve impulses). This normal physical response is actually a survival mechanism when we are in danger, but the body can’t tell the difference between a life-threatening hurricane and a scary news program. The fight-or-flight response is and “equal opportunity” defense mechanism.

The problem is, when the body is flooded with this response, which takes less than a second to go into high gear, it ramps up the brain’s tremor pathway as well as everything else. Just as the heartbeat and breath rate can become hyper, so can tremors. Those with ET who use medication that helps in calm times may find that the drugs don’t work as well in stressful times. Those who have had deep brain stimulation (DBS) may face unique challenges if they suddenly lack easy to necessary maintenance.

Managing stress

The fight-or-flight response has an instant ON switch, but not an instant OFF switch. Instead, if the stressor goes away, the body gradually returns to its baseline. Sometimes it’s a matter of minutes, but if the stressor was especially acute, it may take longer. Now, it seems that stress is becoming chronic. In the current situation, no one knows how long it will take to bring the virus under control or develop a preventive vaccine. This means the stressors are ever-present, so many people are unknowingly living with a constant fight-or-flight response. However, chronic stress eventually becomes toxic in the body, so it’s important to manage stress as much as possible.

Start by learning the ABCs about what happens in your body, and stress management techniques. We suggest using an authoritative source like the Johns Hopkins Stress Management Overview or the Mayo Clinic’s Stress Basics. From there, if you’re curious about specific techniques like mindful breathing or relaxation practice, you can search further. There is a wealth of instruction online, and many youtube videos that can guide and calm you when you practice breathwork or meditation along with them.

Positive use of home sheltering time

There can be silver linings during home sheltering. Avoid overdosing on TV or radio news. Do two minutes of deep breathing every hour. If you have kids at home full time, include them in deep-breathing breaks—chances are, they are also in stress mode, whether from cabin fever, online learning, social isolation from friends, whatever. Remember that not only can stress be contagious, but stress management is also contagious when kids take their cue from parental serenity.

The pandemic is also an opportunity for many families to connect by using phone/internet video chat services. This is a positive use of screen time, and an alternative to video games, channel surfing, or news addiction, all of which can keep viewers in a hyper state.

There is ample testimony from ET participants in online forums that methods such as mindfulness, breathwork, meditation, etc. are helpful in moderating tremors and calming them down. Use this extraordinary time to discover new ways to manage tremors by managing stress.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Neurosurgery Associates.

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