Coping with life in isolation and confinement during the Covid-19 pandemic

In a bid to slow the spread of the 2019/2020 coronavirus Covid-19, an increasing number of countries have initiated 'lockdown' procedures and now strongly encourage or insist upon extreme forms of social isolation and confinement. At the time of writing, many people are in enforced quarantine for an indefinite time because they are experiencing symptoms of the virus or have been identified as part of an 'at-risk' population. Many thus find themselves isolated and confined, most in their own homes, and a few in other places such as hotels, cruise ships, or quarantine facilities.

A rapid review of the psychological impact of quarantine, published recently in The Lancet, highlighted numerous adverse effects of being quarantined, including emotional disturbance, depression, stress, difficulty sleeping, low mood, irritability and anger (Brooks et al., 2020). Mass social isolation is likely to result in mental health difficulties for a considerable number of people. Brooks and colleagues identified several factors that can mitigate the negative impact of quarantine, including protecting personal liberty and agency, minimising the total length of quarantine, ensuring clear communication and providing essential supplies such as food and medicines.

However, individuals in quarantine may have little control over such mitigators. The length of quarantine, clear communication, and provision of supplies are factors that will, or at least should, be addressed by medical professionals and government leaders, decision-makers, and advisors. To empower individuals to cope with life in isolation and confinement during quarantine, it would be helpful to identify effective strategies that they themselves can take to deal with the psychological demands.

One potential source of evidence is from individuals and groups that choose to go and live and work in isolated, confined, and extreme (ICE) settings (Bartone et al., 2018; Golden et al., 2017; Palinkas, 2003; Sandal et al., 2006). This includes populations such as polar scientists, astronauts, submariners, oil-rig workers, cavers, and expeditioners. Although the physical context is somewhat different to domestic isolation and confinement, the psychosocial demands (stressors) that these populations encounter are likely to be quite similar to the demands that many of us will face over the coming weeks and months (Harrison et al., 1991; Suedfeld, 2018). For instance, we share the need to adapt to unusual conditions, and to cope with a sense of threat, danger and uncertainty. Like ICE populations, a quarantined population will likely experience periods of monotony and boredom, suffer from low mood and motivation, and need to tolerate being in close proximity to a small number of other people, while potentially separated from other friends and family for long periods of time (Barrett & Martin, 2014; Bartone et al., 2017; Leach, 2016; Lugg, 2005; Sandal et al., 2006; Smith & Barrett, 2018).  

Fortunately, studies of how people in extreme environments cope (and often thrive) in isolation and confinement shed light on strategies that we could all use (Leon et al., 1991; 2002; Nicolas et al., 2016; Palinkas, 2000; 2003; Pickett et al., 2019; Sandal et al., 2018; Suedfeld et al., 2009; Van Wijk et al., 2016; Wagstaff & Weston, 2014). In recent years, our research group has studied the strategies used by ICE populations to adapt to extreme stressors, and how those strategies allow individuals and groups to withstand stress and maintain their performance, health, and wellbeing in such settings (Sandal et al., 2018; Smith & Barrett, 2019; Smith et al., 2017, 2018, 2019). Here, we summarise some of our key findings, based on data from multiple projects, including several quantitative studies and more than 50 semi-structured interviews with people who have worked at Antarctic research stations, took part in space simulation experiments, commanded submarines, worked on the International Space Station and been on expeditions to the most isolated and remote regions on Earth. 

Adaptation

Adapting to social isolation and quarantine disrupts a person's normal way of life. This is a major challenge identified by groups that deploy to ICE environments. When transitioning into and out of unusual environments, it normally takes a few days (up to 10 days) for people to adjust to their new situation. Knowing and being aware that this is likely to be the case can be helpful, allowing people to look ahead to a time when things will gradually improve as the conditions become more normalised. A common strategy used by ICE populations to adapt quickly to their new conditions is to establish a routine (Smith et al., 2017; Solcova et al., 2016). This seems to facilitate a sense of control and helps reduce uncertainty by building a consistent structure into each day. 

Threat, danger and uncertainty

The uncertainty of not knowing what lies ahead, especially in times of adversity, can lead to feelings of anxiety and fear. Populations that choose ICE settings similarly feel anxious about their situation. Our research suggests that efforts to reappraise these feelings and search for the positives in the situation are helpful (Smith et al., 2018; 2019). People who have experienced confinement in extremes describe 'detaching' emotionally from the situation and focusing on thinking rationally about the actual risks faced and what can be done to minimise those risks. This focus helps to provide some perspective and reduce feelings of threat. At the same time, people in extreme environments try not to dwell on uncertain threats, and threats they cannot control. 

The scale of the current pandemic might seem overwhelming (adding to our anxiety and fear), and firm information about the future is scarce. People in ICE situations emphasise the importance of staying in the present and not being too distracted by the end point. Instead, they try to break down the task or challenge (in the present case being stuck in isolation) and focus on the most important, achievable, and immediate tasks: what can be done over the next hour, day or week (Smith et al., 2017).    

Monotony and boredom

As isolation and quarantine measures continue, monotony and boredom will likely set in. Many of the people we have interviewed have talked about challenges associated with repetition, lack of variety and sensory deprivation. Resource-rich populations have access to a wide range of internet-enabled entertainment and sources of distraction, from streaming media and podcasts to video meetings and gaming platforms. People may even have access to virtual reality headsets that allow a degree of escapism. This can obviously help fill time and provide stimulation. However, variety is important, and it might also be helpful to engage in other creative pursuits and hobbies that can be done on your own away from screens (and especially away from social media). From the earliest days of Polar exploration, people in ICE contexts have learned the value of making their own entertainment in extreme environments. Sources of distraction for Ernest Shackleton's crew on his 1908 Antarctic expedition included a wind-up gramophone and books that they read aloud to each other. They also put on theatrical performances and passed time engaging in rambling theoretical arguments, such as why the wind blew in particular directions (Roberts, 2013; see also Philpott, 2013). Modern day expedition-goers similarly tell us they read books, listen to music, play card games, and cook food as good ways of filling time. Where possible, building exercise into a routine is also an effective way of counteracting feelings of monotony and boredom and reducing feelings of stress.    

In true conditions of sensory deprivation, with little external stimulation and limited access to outside resources, shifting focus internally and using techniques such as self-talk, visualisation or breathing practices and meditation can be helpful. These techniques can be used to create a sense of personal control when other aspects of the environment cannot be changed. 

Low mood and motivation

It is almost inevitable that at some point during isolation and quarantine people will experience feelings of low mood and a lack of motivation. This is also not unusual for people living in ICE conditions. Knowing that it is perfectly normal for mood and motivation to ebb and flow and that there will be some good days and some bad days can be comforting. Ways of coping with low mood and motivation in ICE conditions include acknowledging progress and focusing on small achievements to help foster a sense of competence.

This strategy is also valuable for reinforcing self-efficacy: the sense that one is able to cope with the demands faced (Kjaergaard et al., 2015; Leon et al., 2011). These little wins could be celebrated amongst a trusted social support network, which might be the people you are isolated with or with others through social media networks. A common technique used to maintain morale and motivation in ICE settings is having celebratory meals (Barrett & Martin, 2014; Solcova et al., 2016). Celebrations could be the achievement of a milestone, or a festive event (a birthday, for instance) and they help foster a sense of camaraderie and togetherness. Modern technology could allow people to 'share' these meals with others via video link.

Having or finding a sense of purpose is likely to be helpful during the isolation and quarantine period. Individuals in ICE settings often talk about completing projects, taking online courses and learning new skills as a way of staying motivated and providing focus (Botella et al., 2016; Kanas, 2015). Those who can work from home may find this a valuable source of focus and goal-directed pursuits during quarantine. Otherwise, finding a passion project to which to dedicate time may help those in isolation keep their spirits up. 

Keeping a journal during periods of confinement has a long history, and many people we have interviewed talk about journaling during ICE experiences as a way of processing their thoughts, including frustrations and worries, offering a cathartic route to express their feelings (as well as filling the time). Keeping a regular log – on paper, online, or by video – can help people process their experience and create a sense of order in what can otherwise feel like a chaotic time (Pennebaker, 1997. 

The paradox of social proximity and separation

Being in isolated and confined settings and in close proximity with the same people for long periods of time can be stressful. People who have experienced ICE settings emphasise of the importance of being tolerant of others, and being tolerable oneself (Barrett & Martin, 2014). To reduce the likelihood of conflict and arguments occurring in what may already be a difficult time, self-restraint is likely to be needed (Corneliussen et al., 2017; Wagstaff & Weston, 2014). One way that this can helped is by identifying an area of personal space, a place where someone can retreat to in times of frustration. Expedition teams often also talk about developing team norms that mean if a person you are living and working closely with is doing something irritating, it is okay to have an open and honest conversation about why and resolve the problem before it leads to further tension and potential arguments (Smith et al., 2017). Establishing such ground rules may be helpful to make a quarantine period as comfortable as possible. 

Being separated from friends and family during isolation and quarantine may be difficult. Messaging and video calling platforms allow connections to be maintained even across many thousands of miles. Although such contact with others can be powerful and foster social connection, it can sometimes have negative impacts. Our work with ICE populations indicates that outside communication needs to carefully considered to make sure it is beneficial to the individual and group receiving it. This might require some expectation management and letting people know, for example, when it is most convenient video call. Call content can also have an impact upon mood and morale and it useful to think about what sort of topics you would and would not like to discuss (Devonport et al., 2011). The same goes for the content you see and post on social media sites and in instant messaging. Using mute options can often be helpful to control what is seen and when.  

Conclusion

The strategies we have identified are based on research with people living and working in isolated and confined extreme environments, but they may be of value to those facing social isolation measures during the pandemic. Of course, domestic quarantine has other challenges: having to occupy children, for instance, and dealing with financial hardship. These issues will likely require their own creative solutions. Hopefully, though, the ideas and approaches mentioned above can be useful in managing some of the psychological and social demands that are likely to be faced in the weeks and months ahead.  

- Dr Nathan Smith, PhD is a Research Fellow in Psychology, Security and Trust at the University of Manchester. His research focuses on the psychology of performance and health under conditions of extreme stress. See also 'From underworlds to outerworlds'.

- Professor Emma Barrett, PhD, CPsychol is a Professor in Psychology, Security and Trust at the University of Manchester. One of her research interests is humans in extreme environments and in 2014 she co-authored the book Extreme: Why some people thrive at the limits. 

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