To avoid overwhelming the U.S. health-care system by spreading the coronavirus to vulnerable groups, public officials around the country have asked people to practice social distancing — avoiding large crowds and close contact with others.

President Donald Trump has called for Americans to avoid gatherings of more than 10 people, and the Centers for Disease Control and Prevention has recommended that no events with 50 people or more take place for the next eight weeks. In the region, Pennsylvania Gov. Tom Wolf and New Jersey Gov. Phil Murphy ordered all nonessential businesses closed, including such places as movie theaters and malls, and limiting restaurants and bars to takeout and delivery only.

“Right now, it’s OK to not be OK,” said Val Arkoosh, chair of the Montgomery County Board of Commissioners, during a news conference earlier this week. “This is a very unusual and unprecedented situation that we find ourselves in, and it’s changing every single day, and it’s perfectly normal to feel unsettled.”

Social distancing is not easy for many to cope with, but it can be particularly difficult for people already struggling with mental health issues, according to health experts. Research from the 2002 SARS pandemic — a different kind of coronavirus — showed that quarantine can result in considerable psychological stress in the form of depressive symptoms and PTSD. Other research has shown that chronic social isolation increases the risk of mortality by 29%.

But there are ways for people to mitigate the stress through focusing on things they like to do and establishing a sense of control over their environments and schedules, therapists say.

“What makes people feel safe and secure are things like having a place to live, get food for themselves and their families, and being able to go outside and socialize with people,” said Angelique Porter, a social worker and psychotherapist at a community behavioral health center in University City. “This has never happened at this scale before, so there’s a lot of fear and uncertainty. And that sense of being cut off from other people can increase your depression, anxiety and stress levels.”

Thea Gallagher, director of the outpatient clinic at the Center for the Treatment and Study of Anxiety in the Perelman School of Medicine at the University of Pennsylvania, said that previous research has shown that for people with depression, their mental state gets worse during self-isolation because it’s easier for them to believe negative self-talk. With anxiety, she said, that isolation can lead to taking in too much stressful information at once because there are no external distractions.

“People get bombarded with really scary information, and the more that that happens, the more people feel anxiety and fear,” said Gallagher, also an assistant professor at Penn. “Focusing on other things is very hard right now.”

Exercise, art, and a sense of routine

To protect mental health while self-quarantining, Porter has encouraged clients to get as much physical exercise of any kind as possible, such as taking quiet walks around their block or doing online workouts with YouTube videos. She also pointed to meditation and mindfulness activities offered by apps as a way to lower stress.

“You can also distract yourself with an art activity, like coloring, painting, drawing, listening to music, or playing music if you play,” Porter said. “Those distractions have been proven through research to reduce stress, which in turn can boost your immune system.”

Gallagher encouraged people to create some level of routine by writing down what they’re going to do on an hourly block or picking up a project that will make them feel better. That way, people will have something to look forward to, she said.

“If you approach this like, ‘What are some things I can do to help myself feel a sense of control?,’ it helps you lean into the fact that this is happening,” Gallagher said. “What’s happening is a big change for a lot of people that came quickly. We thrive in our routines, and we like knowing what’s coming next and having a sense of how our day looks.”

She also encouraged people to keep up their social connections remotely through FaceTime or text messaging, and avoid “mindless scrolling through social media,” which can cause increased panic and anxiety. Gallagher said that if people find themselves doing that, they should try to limit the amount of time they spend on those sites. And if people notice that information about the virus on the news is becoming repetitive, they should take a break and do something else.

“If you know one of your friends is vulnerable to mental health stuff, reach out to them” she said. “Call them, set up FaceTimes, watch Netflix with them. Call a friend you’ve wanted to talk to but haven’t in a while, and share positive and encouraging tips, or what has worked for you.”

This applies to people who may struggle with reaching out for support due to mental health issues, said Gallagher.

“Even if you feel like no one cares, push yourself to connect with other people,” she said. “Recognize that a lot of thoughts about not mattering to others are lies, challenge some of your beliefs by thinking about what you would tell a best friend who is struggling during this time to do. You would tell them that they matter, and to reach out.”