Psychophysiological effect associated to an event is inseparable with regard to the human’s mental health (Celik 2010; Cannon 1987; Roxo et al. 2011; Laird & Lacasse 2014). The manifestation of psychophysiological phenomenon in relation to an event has been observed during pre-modern era and inspired physician like Avicenna from the influence of the great thinker of Aristotle and Plato. Avicenna or Ibnu-Sina, the Persian-born philosopher and physician from the Greco-Islamic era, has made his standpoint on the clinical importance of pulsology (Celik 2010). In his earlier concepts on pulse patterns, it was found that pulse would rise when he or she is anticipating an event, especially if an event is meaningful and related to him or her. Avicenna documented in dealing with such events, the psychophysiological changes that were observed, i.e. increased pulse from normal pulse. For example, a man who is approaching a house with a lady that he loved, started to experience tachycardia and palpitation. Sphygmology, a study of pulses is based on the contribution by Ibnu-Sina (Zarshenas et al. 2013). It is a relatively simple, practical and inexpensive means, having a significant diagnosis yield (Zarshenas et al. 2013). It has been recognised through the history of medicine, over the centuries, that we have a better understanding on the fundamental concept of coping with stress by observing our own pulses. Using this modest physiological approach, it has contributed to the modern way in dealing with distressed situation-the psychophysiology of biofeedback therapy and instilling the Buddhist teaching of mindfulness. For example in the former, biofeedback is a simple way of overcoming stress. Biofeedback therapy is a method that trains people to enhance their health by regulating certain bodily processes that normally happen involuntarily (Abgrall-Barbry & Consoli 2006). Once we are in a stressful state, our pulse and blood pressure will increase. Meditating, or self-dialogue and telling our brain that, “I am in control and can dictate my pulse from the highest to lowest possible beat,” can be helpful in dealing with our stress level via higher mental function coordination. Indeed, regulation of basic physiological phenomena and psychological input-“calming the mind” has both anatomical and neurophysiological explanation via the reticular activating system and thalamic integration. Understanding a simple way in managing with stress, especially during the difficult and stressful time can be gratifying and rewarding. This is especially true when it comes to inconveniences, hassle and problems due to coronavirus disease 2019 (COVID-19) pandemic, and during the movement control order (MCO).

The coronavirus disease 2019 (COVID-19) pandemic is having a far-reaching effect on all bearings of human’s life (Holmes et al. 2020). It had affected human being globally to everyone, their family, society and the environment. We suffered from anxiety due to the uncertainties-as results of this pandemic, i.e. how long the disease will be going on? There was also worries on the spreading of the disease, i.e. whether this disease will further cause more death, and whether the vaccines production is on time and enough to control this infectious disease. The mental impact of not having a normal life like before -meeting family members and friends, walking on the beach or shopping in the mall can be devastating, especially if it occurs in a longer run. To a certain extent, we are living like in a solitary, or in an isolation which may lead to a sensory deprivation to some peoples. Due to the restriction orders on the physical movement imposed, we are not spared from the vast and enormous repercussion in every sector. Interestingly, beside economic and business turmoil across the globe, this pandemic has profound positive effect on the environment’s ecosystem due to reduce human activity, such as clear water river and clean beaches. On the other side, the restriction on movements and being in seclusion will serve as an ongoing sequelae to the mental well-being and physical health which is testing our “sanity”. The psychological complications that were reported (Holmes et al. 2020) include insomnia, somatic complaints and depression.  For physical health, lack of exercise and physical activities may exacerbate our psychological problems like a vicious cycle. This ‘secondary chaining reaction’ will increase mental-health illness in a vulnerable person. 

In a bigger scope, immediate necessities and longer-term plan of actions for mental-illness prevention, like education, research and early intervention can be strategised. A high-level coordination and collaboration for the specific prevention program priorities are much needed. This will allow early diagnosis and proper intervention over time. Apart from being in an isolation, impaired psychological well-being like insecurity and uncertainties, confusion (due to changes of the routines and roadblocks) and emotional seclusion (repression of emotions in order to reduce frequent contact with family in the pretext to avoid conflict with each other) can be pivotal issues. To aggravate this matter to a more difficult position, problem in the work and communities, like being in low economic class (such on a daily pay-‘no work, no pay’), poor housing (staying in a low cost flat with lack of number of rooms and with a huge number of family members), work and school/nursery closures, insufficient resources for medical and health response (lack of mask and personal protective equipment) will further negatively impact the psychological well-being. 

Review of psychological sequelae in quarantined respondents may be enlightening (Holmes et al. 2020).  It revealed numerous emotional effects, including boredom, worries, low-mood, irritability, fear, role-confusion, anger, frustration is associated with confinement, some of which persisted after the quarantine is lifted (Holmes et al. 2020). Specific predisposing factors include greater length of confinement, having insufficient steady supplies of food, obstacle in securing adequate medical care and medications, and resultant of monetary losses and financial independence.  These conundrums add a toll on the pre-existing problems such as poor psychological adjustment. An unhealthy behaviour such as excessive substance use, e.g. vaping (or smoking), or excessively dependence on hypnotics to deal with insomnia, and non-compliance with public health orders such as practicing social distancing and home confinement will push the mental well-being further into negative consequences, like precipitating another new set of mental disorder, i.e. psychosis or melancholic depression.

Opportunities to supervise psychosocial needs and provide support during ‘this period of turmoil’ are being offered by means of telemedicine. In the context of COVID-19, psychosocial assessment and monitoring should consist inquiries regarding COVID-19-related stressors like anxiety, psychosomatic preoccupations, domestic violence and loneliness and secondary adversities (no paid salary and economic loss, for example). By telemedicine, some affected individuals will need referral for formal psychiatric evaluation and care, while others may gain positive benefit from supportive interventions intended to promote wellness and boost coping strategy (such as empathic listening, psychoeducation or supportive therapy). Considering the broadening economic crisis and numerous fears and uncertainties surrounding this virulent disease spread, pessimism, hopelessness and harbouring suicidal ideation may surface. This will require urgent medical attention and consultation, or referral in preview for psychiatric hospitalization.

Understanding the psychological sequelae of COVID-19 pandemic can be viewed in the light of the Elisabeth Kübler-Ross’s theoretical perspective of death and dying (Kübler-Ross & Kessler 2014).  Based on her model of grieving, which was later refined by Elisabeth’s collaborator, Kessler (Kübler-Ross & Kessler 2014) found that another important stage of grief, on the subsequent “loss”-whether it is death, loss of income or falling sick is the ‘meaning’ behind this disadvantages situation. Kübler-Ross pointed that in her Five Stages of Grief, a pattern of adjustment resembling a symbolic loss during COVID-19 pandemic consisting of state of denial, anger, bargaining, depression, and acceptance. Lastly, the meaning on what has happened will add to a complementary of these stages of emotion in reacting to our journey in dealing with COVID-19 pandemic.

As the COVID-19 pandemic has frightening implications for individual and shared common problems of emotional and social functioning, an imperative role in monitoring psychosocial needs and providing psychosocial care to the affected individuals, health care providers, and the public-should be integrated. It should be combined into a general pandemic health care. Having said that, we cannot forget our own responsibility in taking care of our own self and caring for our grief. We are taking accountability of our actions-our emotional wellbeing, cognition and sanity. Instituting a self-remedy in our home like practicing simple technique of biofeedback is beneficial during this difficult time.  Imagine yourself sitting or lying down on sofa, watching your pulse in a quite ambience manner. You feel your pulses rhythming each second and minutes and as your pulse lowering, you can feel the air is entering your lungs and your heart is beating slowly. By thinking of being able to control (and be in control) and bring down your pulse is considered as mindful. Forming a self-dialogue and concentrating with the “current and now” and non-judgmental values on yourself is a self-cure. Monitoring your own pulse and talking to yourself to be “relax, and calm” is gratifying each time passed.  Interestingly, by applying the concept of mindfulness and biofeedback to your own benefits, i.e. integrating the knowledge of the past to today’s coping strategy-we might be able to cope up better in this world.