We spoke to Sarita about how COVID-19 lockdown conditions can impact the brain, how stress can impact the body’s ability to fight viruses and why she has been preparing for a global flu pandemic for years.
Sarita, scientifically, what happens to the human brain when it is denied human contact for an extended period of time? Are there any shifts/changes from normal cognitive impulses?
When humans are put into extreme isolation scenarios, for example being put in a deep dark hole with no light exposure, we see significant changes in human functioning, sometimes including auditory and visual hallucinations. People start to lose sense of time and their mental health can deteriorate quite quickly. The social isolation brought about by COVID-19 is less marked than that. I don’t think we are going to see the same responses to isolation that we would in extreme conditions.
However, one of the main ways that the brain benefits from social connection and interaction is a reduction in stress hormones, such as cortisol. Cortisol is incredibly useful if you happen to be being chased by a tiger, for example. It is a glucocorticoid, a natural steroid, which helps to provide glucose to the muscles in order to sustain a ‘fight or flight’ response.
If you’re just sitting in your front room, worrying about catching COVID-19, it’s not very helpful to have the brain trigger that kind of response. The elevation in adrenaline and cortisol isn’t helpful because there’s nothing to fight. Social connection helps to create a social buffer, which reduces that physiological response. Sharing worries with someone can help to lower your physiological response. This then helps the brain reduce the release of cortisol and allows you to feel more calm and relaxed. As such, being able to talk about and share COVID-19 related worries or concerns can help protect your physical and mental health, not just your emotional health.
How does the human brain change when under stress, like the stresses we are experiencing during the COVID-19 pandemic?
Under extreme conditions, the brain undergoes a number of physiological changes. The brain can actually shrink in size if extreme isolation occurs for an extended period. What is interesting is that different people will experience different responses. Some people will cope well whereas others will not cope as effectively.
In extreme isolation we may see a reduction in the awakening cortisol response. This is a response that we elicit every day. In the morning when you leap out of bed, your cortisol level will rise markedly and then it will fall away during the day. That cortisol rises to help motivate you for what’s coming. When people are ‘over-wintering’ (staying indoors, sleeping longer, not travelling or spending time outside), they don’t experience that same cortisol rise. It’s as if the body has given up preparing for the day. This is why it is essential to keep a good routine going and stay motivated.
People that have been in isolation for a long time also tend to have an impaired immune system and we can even see changes in cardiovascular health. This could be because when people feel lonely they show an increase in unhealthy habits that provide comfort, like smoking, drinking and eating more unhealthy foods, while also lacking the motivation to exercise.
It’s important to realise that we don’t 100% know what to expect from the current lockdown situation because this has never ever happened in the whole of human history. The people on whom previous isolation studies have been done have been highly trained individuals in extreme circumstances such as survival situations.
During COVID-19, we’re going to find some people with good support networks who will adapt quite well. For other people, particularly those with progressive neurological conditions (and their carers), it’s going to be more of a challenge.
What impact can stress and isolation have on people living with those progressive cognitive conditions, such as Alzheimer’s and dementia?
With these kinds of conditions, it’s important that care routines are adhered to as much as they can be. It’s also important to understand the difference between being lonely and being isolated. For some people, feelings of loneliness can come when they’re in the middle of a party surrounded by a hundred people. If they’re not feeling a connection with those people, they can subjectively feel lonely. However, others who are used to limited social interaction in their normal lifestyle, may do much better than people who really crave that social interaction.
For people living with Alzheimer’s, we know that social interaction is very useful in helping abate cognitive decline. As such, it’s really important during this time to get people with Alzheimer’s disease and other forms of dementia partaking in activities as much as we can. The loneliness factor is interesting because the UK already has a lot of lonely elderly people. The Coronavirus crisis has shone a spotlight on that. I’m almost hopeful that this crisis will have helped to illuminate the need for social interaction much more than before.
We don’t really know whether there’s going to be a negative impact on people with dementia or with Alzheimer’s as a result of COVID-19 specifically. But the important thing in all of this is to control the stress that isolation or dread can bring about.
When people are feeling very stressed, their cognition can become impaired. When people feel anxious, their brain processing space is taken up by those feelings and there almost isn’t enough room left for other cognition. When you’re worrying about catching COVID-19, that thought can ruminate around your head and impair the processes that would help you break away from those thoughts.
It’s therefore really important to use distraction techniques. Try not to watch the news so much. A good way of avoiding ruminating on the negatives is to reframe your current circumstances in a more positive way. In other words: you’re not ‘stuck at home’, you’re ‘safe at home’. This helps to keep the brain clear and equipped to maintain the most essential cognitive functions.
Is there any evidence that isolation and loneliness can actually impact the way in which the human body fights viruses, and how concerned should we be about this during the current COVID-19 pandemic?
We know from psychoneuroimmunology (the study of the effect of the mind on health and resistance to disease), that there is a link between your physical and your mental health and there is some evidence that extreme isolation can impact negatively on immune function. If you feel mentally depressed or stressed, then your immune system may not work as well, so it’s important to keep your spirits up.
There was a study on dental students in the States where they made a small cut in the students’ soft palates to see how quickly they’re healed. What was interesting about this study is that they repeated it. The first time the students were just coming up to exams, so they were quite stressed. Then the second time they did it was in the summer holidays and they were more relaxed. What they found was that the wounds in the palates healed much more quickly in the summer than it did when they were just coming up to their exams.
Surprisingly, there are studies that have shown that simply watching TV comedy can boost your physical health. We don’t fully know how the mechanisms work that mediate these responses. All we do know is that when people are feeling depressed, certain aspects of the immune system act differently. Natural killer cells that fight viruses don’t seem to be produced as much as when we are feeling sad.
What research is currently being done into the cognitive effects of this level of self-isolation and how the brain reacts to such an upheaval in routine?
Quite a lot of research is starting to materialise, but you’ve got to remember this has been an incredibly fast-moving event. When I’m doing talks about disaster research, I always say that it’s actually very difficult to access people to survey during a disaster because of the many ethical considerations we need to take into account.
If you were looking at an acute incident such as an earthquake, the last thing you would want is a psychologist turning up with a clipboard asking you how you’re feeling. That’s just not an ethical thing to do. In that sense, COVID-19 does provide us with a unique opportunity to start thinking about gathering some learning so that we’re better prepared if this should happen again in the future.
The COVID-19 crisis has followed the pattern of some of the disaster research work that I’ve worked on. One thing that has stood out to me is the amount of people who denied that COVID-19 was a serious problem, and therefore denied taking action. This happens in many different disaster situations. People don’t want to follow government advice; some don’t really understand why they’re being asked to do things.
The classic situation is people refusing to evacuate during say an earthquake or a flooding incident and won’t believe the government messages. We’ve seen that in the response to COVID-19, and particularly among the elderly. The number of people that I’ve heard saying: “If I get it, I get it,” has been particularly frustrating. I’ve certainly had arguments with my parents about how they need to follow the advice to safeguard themselves.
Speaking of self-protection, you have been preparing for a major global disaster for some time. In January this year you went on record saying that you were most concerned about a global flu pandemic. How did you see such an event coming?
When I was doing my PhD 20 years ago, I was studying people in acutely life-threatening situations and how they responded. What came up time and time again was that survivors, the people who did better were those who had prepared. Preparation could come in the form of training or buying equipment or something as easy as storing food. At that point I realised that some preparedness actually increases your level of survival in difficult situations.
I then started reading around all the things that could possibly go wrong. I read up on the flu pandemic of 1918, the SARS outbreaks in 2003, the 2013 Middle Eastern Respiratory Illness and Ebola. I came to the conclusion that these events were major threats that could easily happen again. It was almost as if, because they had taken place in other countries, people in the UK weren’t seeing them as a potential threat and, therefore weren’t preparing properly. That’s why I decided to start prepping myself.
What long-term neurological and emotional effects of self-isolation could we expect to see after COVID-19 lockdown?
The plasticity of the brain is quite remarkable. We know from doing brain scans on people that have been through earthquakes, changes in the physical structure of the brain happen remarkably quickly. Even after two or three weeks, parts of the brain such as the hippocampal areas can change, with one theory suggesting that this can lead to side-effects such as post-traumatic stress disorder (PTSD).
But as well as shrinking those areas, we can also make them grow again. Any negative cognitive changes that we might experience due to COVID-19 do not have to be permanent, they can be repaired. When we come out of isolation and we start to make those social connections again, there is no reason why the plasticity of the brain can’t help us come back to normal functioning.
In that sense, we should view the physical, emotional and neurological effects of this unprecedented situation in a similar way. Yes, things are going to be tough for a while, but we should never lose sight of the fact that, with the right understanding and support in place, we have the capability to recover and get back on our feet once all this is said and done.
Sarita Robinson is Principal Lecturer in Psychology at the University of Central Lancashire and one of the UK’s leading researchers into the neurophysiological effects of stress and isolation. She has conducted extensive studies into loneliness, its effect on the brain and how isolation impacts neurological and cognitive conditions such as Alzheimer’s disease.
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