HOLISTIC APPROACH IN DEALING WITH MENTAL STRESS DURING COVID-19 PANDEMIC: A REVIEW

This review article is based on the holistic methods which can be helpful in maintaining mental stress caused by different reasons like lockdown, economic conditions, stress due to social distancing, stress due to lack of work, family disputes due to lockdown, no work and to protect physical health etc.An emotional turmoil is there in the mind of lots of people because of the current unavoidable circumstances created due to pandemic COVID 19.A much-needed approach in improving mental health is required for unavoidable circumstances like epidemics,violence etc.Holistic approach is beneficial because medicines for mental disorders have side effects like addiction.The World Health Organization (WHO) defines holistic health as:Viewing man in his totality within a wide ecological spectrum, and emphasizing the view that ill health or disease is brought about by an imbalance, or disequilibrium, of man in his total ecological system and not only by the causative agent and pathogenic evolution.

In 2005, while addressing 46 th Directing Council meeting of PAN American Health Organization (PAHO) in Washington, the then WHO Director General Dr Lee Jong-wook had warned the world about an influenza pandemic and exhorted all countries to prepare accordingly. WHO had asked countries to implement national pandemic control plans, have well-developed communications strategy as well emphasized on a large-scale international collaboration for the drug and vaccine development. Over all these years, many countries were preparing themselves scientifically, medically and financially. What missing from this checklist were the psychological and social aspects for dealing with the consequences of the pandemic?
The WHO itself in its constitution defines health as, "Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity." In spite of considering mental health as an integral part of the overall health which is determined by a range of socioeconomic, biological and environmental factors; mental health care during and post pandemic failed to secure an important place in the checklist of pandemic preparations. One of the biggest concerns which came across while dealing with the mental health issue is the mentality across organizations that mental health is a personal problem and individuals have to find a way out of it (Sivris& Leka, 2015).
A study for the year 2017 estimated that 792 million people i.e. about one in ten people lived with a mental health disorder. These numbers are definitely appalling but what makes the situation worse is the revelation made in the 973 same study that mental health disorders remain widely under-reported (Ritchie and Roser, 2020). This was the situation for mental health before the spread of this global catastrophic COVID-19 pandemic when most of the world population was leading their lives in a manner which could be considered "normal" in many ways. These were the estimated numbers before lingering uncertainty overtook the world. Indeed, there were natural disasters, ongoing wars, rising tensions, political conflicts, economic slowdown, terrorist attacks in many parts of the world but none of them had affected the world in such a large scale as this COVID-19 pandemic. Global pandemics have been reported for many hundreds of years. In the last century, pandemics occurred in 1918 (H1N1, the Spanish flu),1957 (H2N2, the Asian flu) and 1968 (H3N2, the Hong Kong flu) which means the last pandemic that the world had witnessed of such a large scale was more than half a century ago. Since then a lot has changed in the world. From the means of transportation, communication, trade to the way we shop, eat etc., all has changed. While advancements in medicine and technology is surely helping us to keep the death toll as low as possible; 24/7 real time news, constant social media use etc. are taking a definite toll on mental health.
The vulnerable to mental health problems are not limited to only the patients, their close ones and front liners; anyone can get affected as the majority of world population is now under severe lockdown dealing with various personal freedom being curbed, social isolation, economic losses, family separation, domestic violence etc. A pandemic does not only bring disease, suffering and death for the victims but also stress, fear, depression, panic and grief for the whole mankind. It is not unusual to experience different and strong feelings such as anxiety, depression, stress, and other negative feelings during and after an adverse event. Coping with these feelings and getting help at the right time can save millions of people from the worse. These emotions can be temporary and not all the people experiencing them need to take the medical drugs. Drugs should be used only when absolutely necessary and only when prescribedby a physician. Indiscriminate and prolonged use of psychoactive drugs is not at all recommended. Certain drugs, such as tranquilizers, have major side effects and can lead to addiction (Benjamin and Chidi, 2014).
Holistic treatment and medicines are often discarded as unscientific but there has been quite a growing number of scientific and observational evidences regarding the benefits of these holistic approaches in improving psychological health of human beings. In 1977, Jonas Salk, the famous American virologist and medical researcher who discovered the polio vaccine supported the holistic approaches and said, "We are entering into a new Epoch in which holistic medicine will be the dominant model" (Huff, 1977 as cited in Prescott and Logan, 2018). In this article such approaches are presented and discussed which have been proven in the past to help with mental health.

Art therapy
The growing interest over the past few decades and increasing positive results have made arts in health a major field of practice and research. In fact, art in health has now taken the shape of art therapy.
It was around 1930s-40s when psychologists realized that self-expression through non-verbal method such as painting, dancing, making music etc. could be beneficial for the mentally ill people, but still the use of arts was limited for therapeutic means. It was only in 1990s when art therapy really gained momentum (Malchiodi,2005).
One of the most elaborated and significant literatures related to the topic of art in health is produced by Staricoff (2004). In this work the author compiled 385 relevant studies and the concluded that there has been strong evidence of positive influence of the arts and humanities in the field of healthcare. The findings of the study highlight the crucial importance of the arts and humanities in:inducing positive physiological and psychological changes in clinical outcomes ; reducing drug consumption ; shortening length of stay in hospital ; increasing job satisfaction ; promoting better doctor-patient relationship; improving mental healthcare ; developing health practitioners" empathy across gender and cultural diversity.
Depending on the condition of the patient art therapy can be used as an alternative therapy or as a supplemental therapy. Art therapy had shown potential in improving posttraumatic stress and traumatic memories through stimulating the patient"s senses, thereby facilitating revelation and self-discovery (Malchiodi, 2005) Foa et al. (2010) listed some elements which are common in most art therapy techniques such as resilience enhancement and stress/anxiety management skills, cognitive restructuring and realizing testimony and destigmatization. In fact, International Society for Traumatic Stress Studies also recommends creative art therapies (Foa et al. 2010) 974 Expressive arts therapy is an effective form of treatment around the world for trauma survivors (van der Kolk, 2014). In a study conducted on the sex traffic survivors and their advocates to determine the effectiveness of art therapy, it was revealed that survivors and advocates both responded favourably to art therapy techniques. The sex trafficked survivors when taking part in art therapy showed increased connection, hope, strength, confidence, resilience, and self-worth at the same time there was a decrease in their shame and despair.
The study suggested that with the right help and therapeutic resources considerable growth and restoration is possible for overcoming traumatic experiences. Connecting inner feelings and experiences with something tangible provides an outlet of expression. Art therapy, in combination with other necessary supportive services, creates an environment of empowerment where survivors can recapture the power from within that was stolen or lost for a time. Kometiani and Farmer (2019) Music Therapy "Where words fail, music speaks."-Hans Christian Andersen Music has been one of the most popular means used for relaxing and as mood elevator since ages. Over the past few decades there has been a significant growth in exploring music as a therapy for various health problems which has been on rise since the positive outcomes of many studies.
Based on the significant outcomes of their study Knight and Richards (2001) concluded that music has the potential to be used as a powerful anxiolytic treatment. Increase in subjective anxiety, heart rate, and systolic blood pressure can be prevented by using a music treatment in their experiment.

Therapeutic Humour
Humour has been an integral part of human life and over the recent years its therapeutic use has gained a lot of interest worldwide. Association for Applied and Therapeutic Humor (AATH) founded in the year 1987 was deals with understanding and application of humor and laughter for their positive benefits.
Humour has been shown to reduce anxiety and negative responses to stress (Cann et al., 1999).
It was found by Szabo (2003) that 20-minutes of watching a humorous video could induced almost the same positive psychological changes as were induced by 20-minute bout of aerobic exercise. In fact, humor was found to perform better than exercise in lowering anxiety.
A study conducted to examine the impact of a humour therapy workshop on physical and mental health of elderly people found the humour workshop had significantly lower follow-up levels of anxiety and depression and improved general well-being for those who participated. (Ganz & Jacobs, 2014)

Meditation
The world was amazed to know the miraculous role meditation had played in keeping the football team of 12 boys and their coach astonishingly calm while they were trapped in an underground cave in Thailand for over two weeks (Massola 2019). According to a Stanford expert Leah Weiss, meditation which is a kind of mental training, played a key role in keeping the group alive. She further explained that how meditation can increase the problem-solving capacities of the brain in such adverse situations by gaining control over cognitive resources that would otherwise be hijacked by the threat. She also added that meditation improves focus and compassion. (Mejia 2008) The effects of meditation, specifically Transcendental Meditation (TM), on college students' experience of stress, anxiety, depression, and perfectionistic thoughts was investigated and gave the result showing a significant decline on all variables. Engagement in compassion meditation is found to have potential to reduce stress-induced immune and behavioral responses (Pace et al. 2009). Doug et al. (2008) also reported that meditation-based stress-management practices reduce stress and enhance forgiveness among college undergraduates Practice of meditation is found to produce a relaxation response even in the young adult subjects who had never practiced meditation before. It was observed that if meditation is practiced before the stressful event, it may reduce 975 the adverse effects of stress without withdrawing the beneficial effect of stress, namely, improved memory scores. (Mohan et al. 2011) Innes et al. (2012) found that a simple meditation program had the potential to reduce perceived stress and blood pressure, and improve certain domains of sleep, mood, and memory in adults with mild cognitive impairment or early stage Alzheimer's disease and their caregivers. Hence, by providing psychological, cognitive, and physiological benefits, meditation could be an inexpensive and effective intervention for the well-being of such population.

Conclusion:-
The world today, is experiencing a unprecedent situation and this has affected us on every level and hence to overcome this situation we should adopt some measures for both individual and collective recovery. The holistic approaches discussed in this review can be easily integrate into the daily lives of the people where the first post traumatic recovery begins for most of the people. We suggest that mental health treatments should not be limited to only psychoactive drugs but there is a need to systematically incorporate holistic approaches which have been backed by some scientific evidence to get the benefit across individual and community levels.