Early in the pandemic, Dr. Deborah Birx, the Coronavirus Response Coordinator for the White House Coronavirus Task Force, reminded the public of the critical importance of individual and collective human behaviors to change the course of the COVID-19 pandemic. She said,

“It’s communities that will do this. There’s no magic bullet. There’s no magic vaccine or therapy. It’s just behaviors. Each of our behaviors translating into something that changes the course of this viral pandemic over the next 30 days.”

The pandemic continues to profoundly change our “normal” lives many months later. The good news is that we appear to be coming off of the devastating third wave of the pandemic. Further, vaccinations are proceeding at a decent pace – more than 2 million per day.

Recently, the CDC announced guidelines for fully vaccinated individuals that begin to normalize their lives. For instance, it’s now ok for them to gather in very small groups with others who are also vaccinated. (Read the full recommendations here).

However, we are not home-free yet. Some experts predict that early reopenings with full relaxation of public health measures in many states could be followed by a fourth wave. This once again reminds us of the importance of human behavior in combatting the pandemic. Despite tireless, ongoing efforts, until we reach levels of vaccination that approach herd immunity, we are still at risk of relapse.

There has been some good news on the therapy front. Clinicians have gotten much better at treating hospitalized COVID patients leading to a drop in the death rate. Further, there are a number of new drugs that significantly alter the course of the illness. The bad news is that the continued global pandemic has resulted in the spread of many new strains of the virus. Some are more infectious and some more virulent. We still don’t know for sure how effective existing vaccines will be in halting transmission of the virus.

So, for now, we continue to depend on human behavior to contain the spread of the virus.¹ And, according to experts, we will do so for the coming months (or longer) until most of the population is fully vaccinated.

The challenge of depending on human behavior to combat the COVID-19 pandemic

The challenge of employing human behavior to combat a crisis of this magnitude is that behavior is often unreliable and unsustainable. We’ve already seen this play out in some areas of the country where people are agitating for freedom from the public health mandates of masking and distancing. Because of these challenges, and the fact that a medical solution is still somewhere in the future, many are asking, “how do we move forward?”

A good place to start is to gain a deeper understanding of why people act the way they do during times of immense stress and uncertainty. Behavioral science can help inform our country of the next steps we need to take to enact real, meaningful change in our country’s overall response to the coronavirus.

In this piece, we’ll explain how stress can influence our behavior. And, we will share actionable insights that can be used to inform both our individual and collective responses to the coronavirus pandemic.

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The impact of stress on thinking and decision-making

In times of crisis, most of us are exposed to increases in both acute (in-the-moment) and chronic (consistent over time) stress. Stress² can impact us in a variety of different ways, including how we process and perceive information in the world around us.

As a function of evolution, we’re wired to preferentially notice, process, and remember emotional information³ over non-emotional information. For example, many of us can vividly remember that embarrassing moment from middle school. However, we might be hard-pressed to recall what we had for breakfast three days ago.

Stress has many physiological and psychological effects.⁴ One is the heightening of our awareness of negative, rather than positive information.

Again, this is an evolutionary response. Humans become stressed because there is a threat in our environment. Heightened awareness of negative information increases our chances of identifying and dealing with the source of our stress.   

There is a large amount of emotionally negative stimuli related to the COVID-19 pandemic

Today, we are seeing, hearing, and experiencing a large amount of negative and fear-inducing information. And, we are more likely to retain that negative information, and have it be top of mind.

That chronic exposure to emotionally-negative stimuli can lead to increased stress. It can also provoke neurobiological changes that predispose us to be more likely to notice other negative stimuli.

One classic example is the phenomenon of many experiences after breaking up with a romantic partner. To them, it seems like every song they hear on the radio is about breaking up or falling out of love.

While this is helpful for survival in some cases (being hyper-aware of animal noises while walking in the woods at night, for example), it can be very cognitively taxing for us in situations like the one we are in right now.

The impact of chronic stress on decision-making

Chronic stress impacts our decision-making. In fact, even in “normal” circumstances, much of our behavior, including buying, is driven by a balance between two motivations:

• The desire to regulate how we feel right now
• The need to regulate ourselves from doing something impulsive.

Those two cognitive “needs” operate more or less in balance with one another. This balance is disrupted by negative emotions, such as: 

• stress
• fear
• uncertainty

Under those conditions, our desire to make ourselves feel better gets amplified. And, we put much less effort into controlling our impulses. That is why many of us went out and stocked up on toilet paper and other essentials when the pandemic first began. We did it even though we knew we didn’t necessarily need it or could have saved it for someone else.

The importance of human behavior in our response to the COVID-19 pandemic

With a deeper understanding of how stress impacts human behavior, we can start to make informed decisions about the most effective ways to move forward.

There are steps we can take both individually and collectively that can enact meaningful change and help change the course of the coronavirus pandemic for the better.

Individual behaviors

Individually, we can work to reduce our negative exposure and protect ourselves from becoming overly stressed by:

• Physical activity

Physical activity,⁵ even around the home, can mitigate the production of stress hormones like cortisol. It also reduces anxiety-like symptoms. Physical activity also promotes oxygenated blood flow to the brain. This can both reduce cognitive load and promote long-term brain health.

• Social support

Social interaction⁶ provides myriad mental health benefits. Even virtual interactions, via webcam or even text-based communication, promote the release of oxytocin. Oxytocin⁷ is a reproductive hormone that can increase feelings of bonding and closeness. It also drives prosocial behaviors.

Although these responses are mitigated for virtual, rather than in-person, interactions, maintaining social relationships has obvious benefits over social isolation.

• Emotion regulation

Effortful regulation of our emotions⁸ can be challenging. But it is very effective for our well-being. We may be tempted to turn off the news, close our laptop, and avoid as much negative information as possible. However, this strategy of emotion suppression – ignoring or pushing away our negative thoughts and feelings – only delays (and, sometimes, amplifies) negative emotional states.

• Reappraisal

Reappraisal⁹ is a method of thinking critically and re-framing the negative information we are exposed to and reframing how it relates to us. This way of thinking is much more beneficial to our long-term emotional health. Further, it can have protective effects when we encounter new, negative stimuli. Reappraisal often takes cognitive effort, but the long-term effects are worth it.

Related Content:  Natural Remedies That Support Positive Mental Health

Strategies we implement to help the collective

• Highlight and communicate the positives when possible

As a society, we choose to focus on and highlight the positives as much as possible. We do this both for our emotional health and also for effectiveness in our communication.

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Emotionally, there is a lot to feel negatively about right now. Many of us have lost loved ones, our livelihoods, and social relationships. Those things, of course, are incredibly difficult to deal with.

Acknowledging those negative stressors is important. However, ruminating¹⁰ on them is harmful to ourselves and to others around us. 

• Try to not highlight negative information

Highlighting negative information is a less-effective communication strategy. For example, there has been ample research over the last three decades on anti-smoking PSAs.¹¹It shows that a focus on the negative health outcomes of smoking are often ineffective at promoting smoking cessation.

This is because our default response is to shut out that information. We think, “This can’t happen to me” or “I don’t want to see that.” In some cases, those PSAs¹² may actually prime smoking behavior¹³ because they cue smokers to think about nicotine.

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More effective messaging focuses on the positive consequences of behavior change:

• • • Leading a long and healthy life
    • protecting your loved ones, and so on.

Whether you are a manager, a health official, or even a parent, understand that negative information can get peoples’ attention. However positive information can be more effective at promoting behavioral change.

• Mentalize on behalf of others

We are all the main characters in our own story. However, getting through a crisis is a collective and social experience.

It can be difficult to be vigilant to the needs of others. But, putting in the effort to do so is critically important.

Try not to become frustrated or hurt if your partner wants to take a few hours to read a book quietly. Or jump to conclusions about work ethic if a team member needs to take an afternoon off to decompress.

Do something, even if it is small, like reminding yourself, “That’s what they need to do for themselves right now.”

It can be an effective way to reappraise the situation. And, it helps you put yourself in the shoes of someone else.

Our behaviors are the best weapons to fight COVID-19 right now

As we await the official end of the pandemic, our behaviors remain an important weapon in the fight against coronavirus. Despite its unpredictable nature, especially in times of crisis, we must find ways for human behavior to help, not hurt or hinder, our response to the pandemic.

We must take what we know about human behavior during times of chronic stress, and apply it to how we move forward as individuals and a collective. It will help us shape a response that is better suited for human behavior. One that can, ultimately, change the course of coronavirus.

References:

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1. Stephen M. Kissler, Christine Tedijanto, Edward Goldstein, Yonatan H. Grad, et al Projecting the transmission dynamics of SARS-CoV-2 through the post-pandemic period Science 22 May 2020:Vol. 368, Issue 6493, pp. 860-868 https://doi.org/10.1126/science.abb5793
2. Harvard Health Publishing, Harvard Medical School, Protect your brain from stress, Updated 2/15/21 https://www.health.harvard.edu/mind-and-mood/protect-your-brain-from-stress
3. S Hamann. Cognitive and neural mechanisms of emotional memory. Trends in Cognitive Science 2001 Sep 1;5(9):394-400. https://pubmed.ncbi.nlm.nih.gov/11520704/
4. Elizabeth A. Kensinger, Remembering the Details: Effects of Emotion, Published in final edited form as Emot Rev. 2009; 1(2): 99–113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676782/
5. Eli Carmeli.  Physical Activity Reduces Stress and Anxiety. Journal of Aging Science 2013 https://www.longdom.org/open-access/physical-activity-reduces-stress-and-anxiety-2329-8847.1000e108.pdf
6. Fatih Ozbay, MD, Douglas C. Johnson, PhD, Eleni Dimoulas PhD, et al – Social Support and Resilience to Stress, Psychiatry (Edgmont). 2007 May; 4(5): 35–40.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/
7. Fatih Ozbay, MD, Douglas C. Johnson, PhD, Eleni Dimoulas PhD, et al – Social Support and Resilience to Stress, Psychiatry (Edgmont). 2007 May; 4(5): 35–40.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/
8. James J Gross , Oliver P John – Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. “J Pers Soc Psychol”[jour] – 2003 Aug;85(2):348-62 https://pubmed.ncbi.nlm.nih.gov/12916575/
9. James J Gross , Oliver P John – Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. “J Pers Soc Psychol”[jour] – 2003 Aug;85(2):348-62 https://pubmed.ncbi.nlm.nih.gov/12916575/
10. Costas Papageorgiou, PhD, Adrian Wells, PhD.  An Empirical Test of a Clinical Metacognitive Model of Rumination and Depression.  June 2003  Cognitive Therapy and Research 27(3):261-273  https://www.researchgate.net/publication/227080665_An_Empirical_Test_of_a_Clinical_Metacognitive_Model_of_Rumination_and_Depression 
11. K Goldman , S A Glantz – Evaluation of antismoking advertising campaigns,
    JAMA  1998 Mar 11;279(10):772-7. https://pubmed.ncbi.nlm.nih.gov/9508154/
12. Melanie Wakefield, PhD, Yvonne Terry-McElrath, MSA, Sherry Emery, PhD – Effect of Televised, Tobacco Company–Funded Smoking Prevention Advertising on Youth Smoking-Related Beliefs, Intentions, and Behavior – Am J Public Health, 2006 December; 96(12): 2154–2160.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698148/

13. Joseph Grandpre, PhD, Eusebio M Alvaro, PhD, Michael, Claude Miller, PhD, John R Hall -Adolescent Reactance and Anti-Smoking Campaigns: A Theoretical Approach –  Health Communication  February 2003 15(3):349-66 – https://www.researchgate.net/publication/10723186_Adolescent_Reactance_and_Anti-Smoking_Campaigns_A_Theoretical_Approach 

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Published 6/28/20. Updated by Patricia Salber, MD on 3//9/21.