The little losses caused by COVID-19 add up. Here's how to deal with them.

Therapists at the FamilyMeans Center for Grief & Loss in St. Paul have been inundated with calls. Many people seeking help are dealing with what psychologist Molly Ruggles describes as "a stacking up of losses without enough time and emotional space to move through those losses before another one comes along."

The arrival of COVID-19 has brought with it layers of losses.

First and foremost, of course, is the rising death toll and the increasing number of people becoming ill. But there are also a wide range of losses unrelated to health, said Ruggles, the center's assistant clinical director, naming several on an ever-growing list.

For people who have lost jobs, there's a loss of financial security and loss of identity, she said. Those working from home can experience increased stress, too, especially if their kids are around. There's also the loss of communities in the workplace, at school, at the gym, with faith organizations, and other groups. Then there's the loss of freedom simply to go places and see people.

Our familiar routines have disappeared, along with the comfort that comes from knowing what to expect.

"This whole pandemic is a trauma and lot of little traumas," she said. "And what that does to us, psychologically, is that it really shatters what people's worldview was before this all happened."

People whose lives were generally predictable, and who felt the world was a comprehensible, benevolent place, have had those beliefs upended.

"For lots of people, that opens up a lot of anxiety and fear and uncertainty and feeling paralyzed on how to cope," Ruggles said.

Virus-related losses have been especially difficult, not only because of how many have stacked up in quick succession, but also that so many of the losses are shrouded in uncertainty.

The latter are what Pauline Boss, a professor emeritus at the University of Minnesota, describes as "ambiguous losses."

Uncertainty, Boss said, leads to what she calls "frozen grief," a place of limbo where the loss is unresolved and the grieving process cannot move forward. These are the most stressful types of losses, she said, noting how doctors often say that patients find it easier to accept a grave prognosis than an uncertain one.

Even clear-cut losses, such as death or lost job, come with more unknowns than usual: What mourning rituals are possible? How long will it take to find a new job? And the abstract losses are myriad, Boss said, ticking off several: not feeling safe; not knowing answers to questions; not trusting our leaders; not knowing if we're going to get the virus or our loved ones are going to get the virus; not knowing if we should wear a mask or not.

Such uncertainty always leads to anxiety, she said, "that feeling of helplessness is absolutely devastating to a population of people who are used to solving problems, so our culture is especially hit hard by this one."

Compared with other types of traumas, such as terrorist attacks or natural disasters, Mary Jo Kreitzer, director of the Center of Spirituality and Healing at the University of Minnesota, noted the pandemic's breadth and depth.

"Everybody on the planet is experiencing loss at some level, and the loss ranges from relatively minor to catastrophic and life-changing," she said. "It's almost as though there's cumulative grief as individuals, and collective grief encompassing the world," she said.

For Minnesotans, Kreitzer noted, much of our grief is anticipatory at this stage of the pandemic, as people worry about losing their jobs, their homes, their savings, their loved ones, or even their own lives.

To better understand how grief and anxiety are intertwined, and get worse if they're suppressed, Kreitzer referenced a metaphor in Claire Bidwell Smith's book "Anxiety: The Missing Stage of Grief," which suggests that turning into the sadness and worry — like a car turning into a skid on an icy road — can help us gain control of the situation and process it.

Grief, Kreitzer noted, is one of the most powerful experiences that we face as humans. There is no right way to grieve. Nor is there a timeline. And there are often many ups and downs.

Kreitzer said she doesn't believe people "get over" a loss, but rather work through it to find a place of acceptance. And though it can be a painful process, experiencing grief can help us find a greater sense of purpose or meaning in our lives.

"There's recognition that life will never be the same. But that doesn't mean it can't be good," she said.

From missing prom to missing a paycheck, losses add up

In addition to the basics — getting enough sleep, exercise, and healthy food; doing activities you enjoy; building in a routine — here's some suggestion for dealing with virus-related losses.

Don't minimize your loss

Recognizing losses, both large and small, can ease the pain and protect your emotional health, said St. Paul psychologist Molly Ruggles. You are allowed to feel upset about canceling a vacation or missing your prom without judging yourself. "When you're comparing your camp getting canceled to someone dying, people can feel shame about those losses or minimize those losses," she said. "But the reality is it's still a loss."

Allow yourself to grieve

Giving yourself time and space to feel emotions such as sadness can happen in a variety of ways, with or without other people. "People can write about it, they can sing about it, they can do art, they can do prayer … they can participate in grief groups," suggested Mary Jo Kreitzer, director of the Center of Spirituality and Healing at the University of Minnesota.

Ruggles recommends paying attention to your feelings. "When you feel that grief coming up, rather than immediately pushing it away or engaging in something else, just take a moment to take a deep breath and exhale and let yourself have that feeling before moving on," she said.

Notice the positive

Develop a gratitude practice, Kreitzer said, suggesting people write down three good things every day and then review the list weekly. "In the midst of despair and horrendous circumstances, there's still kindness and beauty and joy," she said. This difficult time can also reveal new ways of doing things we didn't know were possible. It also can help us understand what's most important in our lives.

Reach out

Even though we are physically distanced, we still need to connect with our support systems, to love and be loved. Ruggles suggests letting your loved ones know you've been thinking about them and, if you know they've experienced a loss, mentioning it specifically. "It's a way of giving the person permission to talk about it and communicating that you care about them," she said. "We can't give a person a hug, but we can communicate feelings of tenderness for them in other ways."

Be flexible

Avoid binary thinking, said Pauline Boss, a professor emeritus at the University of Minnesota. Instead of thinking, "The world will never be good again," shift to "both/and" thinking, such as "This is terrible, yet I can learn something from it." That will help you cultivate resilience. "If you try to remain the same afterward, rigidly holding onto whatever you did before, you are probably not coping as well as the person who is able to be more fluid and flexible," she said.

Control what you can

We can't control how long this is going to last or predict what's going to happen, but we can control our actions and attitude," Kreitzer said. Intentional choices to do something (clean a closet, play music) or not do something (reducing trips outside the home, limiting media consumption) can help. Kreitzer said she has been reminding parents who are concerned about their children's schooling that kids' mental health is more important than academic skills. "How they felt during this time is going to stay with them long after the memory of what they did," she said.

Seek help

It's normal to feel sad, stressed and anxious now. There are abundant resources online, such as the Center for Spirituality and Healing's extensive set of articles and videos and assessment/goal-setting activities. Therapy sessions are now accessible in so many virtual forms — video chatting, phone calls, texting. "It can be so helpful just to feel like you're not in it alone," Ruggles said.