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Without the luxury of sheltering at home, essential workers are experiencing unprecedented levels of stress and anxiety, according to mental health experts.

"We're in the battlefield," said Paul DiCarlo, co-owner of Jimmy's Food Store, a small Italian grocery in Dallas. "You're just trying to get the customers in and out quickly."

Nearly half of all American adults say the COVID-19 pandemic is hurting their mental health, according to a recent . But those numbers could be much higher for bus drivers, bank tellers and other critical workers, said Alison Holman, a psychologist and nurse.

"This virus is a major chronic stressor for all levels of essential workers. It can make every day seem like a year, and weeks seem like a decade," said Holman, an associate professor at the University of California, Irvine. She researches trauma-related mental health problems.

"There's a lot of free-floating anxiety because of this ambiguous invisible threat. We're unsure what's coming next, and that's terrifying for people."

Earlier this month, the Centers for Disease Control and Prevention issued new guidance for how essential, or critical, workers can return to work after being exposed to a suspected or confirmed case of COVID-19. For example, essential workers must have their temperature taken before starting work.

DiCarlo said he's taken steps to ease anxiety among employees and customers, like suspending the store's popular sandwich-making service, which was creating crowds.

At home, he took the additional action of cutting back on alcohol after work.

"The fear of getting the virus is a big deal in my brain. I'm diabetic, so I've got to keep that blood sugar down, and cutting down on drinking helps me sleep better, too," said DiCarlo, 61.

In addition to getting enough sleep, Holman said essential workers can help reduce anxiety by eating a healthy diet and exercising regularly. She also suggests deep breathing as soon as the worrying starts.

"Try 4-7-8 breathing," she said. "Get in a comfortable position, breath in through your nose for a count of four, hold it for seven counts, and exhale through your mouth for eight counts. Then do it four times in a row."

While we all continue to practice social distancing, essential workers should also practice "news distancing," she said.

"Research has shown that negative cycle of distress, media, distress and more media is not good for you," she said. "Limit exposure to one or two fact-based sources of media once or twice a day. You don't need to inundate yourself with the media 18,000 times a day."

Some essential workers can dial back their anxiety by talking about what they're going through with friends and family members.

While most of the pandemic is beyond our control, essential workers can lessen stress by focusing on what they can control – following guidelines, such as regular hand-washing, to protect themselves and minimize risk, limiting exposure to media coverage, and voicing concerns to public officials, Holman said. Workers also can discuss concerns with their employers.

"They can demand, for example, that they have protective equipment. Call whoever's in charge of policymaking. That's your right. It's something that's in your control," she said.

Wearing face masks also might help lower anxiety. DiCarlo said he noticed his fellow workers and customers seemed less stressed after store workers began regularly wearing masks. "It just seems to help everyone's comfort level," he said.

Essential workers also might be able to reduce acute anxiety by focusing on positive aspects of their jobs, Holman said.

"Look for a silver lining," she said. "Some people might find strength and meaning in their commitment to helping people, which can buoy them against the negative impact COVID-19 is having."

And, of course, people who aren't essential workers can help out.

For starters, wash your hands, follow social distancing rules and take other precautions recommended by the CDC, including wearing masks in public.

"It's so frustrating when people don't understand how serious this really is," said Coco Balalau, a Dallas emergency room nurse.

To de-stress after work, she makes surgical caps for fellow health care workers. "I can't be idle. If I stop and think about it, it gets too overwhelming."

She can predict the exact moment each morning when her work-related anxiety will kick into high gear.

"There's a spot on the highway exit ramp, right before I get to work – that's where the tears start."

During times like that, it helps to acknowledge the anxiety and then gently let it go, she said.

"For me, it's important to be mindful. I pause and say, 'They need you. You're good at what you do … you got this.'"

Editor's note: Because of the rapidly evolving events surrounding the coronavirus, the facts and advice presented in this story may have changed since publication. Visit Heart.org for the latest coverage, and check with the Centers for Disease Control and Prevention and local health officials for the most recent guidance.

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