COVID-19 Chapter 6: Mental Health

say that we like to fight fear with facts. But there is still so much about this virus and this pandemic that we don't know about, and we don't know how it's going to go. We don't have a roadmap for this. And thinking about our personal risk, or our risk to others, or the risk to our families or our friends, or the economic outcomes, I mean, all of this can send us swirling down the rabbit hole of stress and anxiety and bad dreams and or lack of sleep.

That's not exactly a helpful thing. No, and so we wanted to bring on a couple of amazing people who can share with us coping strategies or good practices to try to get a handle on our stress and anxiety and to help us think about where it's coming from.

this is stuff that we don't know anything about. We go into anxiety spirals just like everyone else very easily. So this was really really personally useful and hopefully it'll be useful for listeners as well.

mental health needs.

of clinical experiences ranging from clients I see through our University Psychology graduate clinic, our training clinic, as well as external practice sites around the Seattle area.

hard to navigate and prepare for. Now, there does seem to be a bit of a new normal that's being established here with you know, pretty much everybody is working remotely at this point except for kind of those essential

businesses and services. There's a lot of social distancing going on, self quarantining going on, and I think becoming increasingly clear, at least to me, My general assumption is that we're in this for a longer hold than I initially expected, on the scale of months as opposed to days or weeks, And so I think at this point the main challenge for me is just trying to kind of embrace this new normal and figure out, you know, how do I want to structure my day so that I can retain

some semblance of normalcy and build some new routines into my life, and how can I kind of make the changes that I need to be making to ensure that I can keep up my work, my personal wellbeing, social connections, all those sorts of things.

just that inherent uncertainty that's going on. So broadly speaking, I think we're seeing kind of an increase in some negative mental health outcomes and as well as a decrease in some positive aspects of mental health. So what I mean by that is, on the negative side, we're seeing increases in stress and anxiety on a pretty broad scale that are being driven by actual health and socioeconomic threats to ourselves, our loved ones, in our communities that COVID

nineteen presents. I think that stress and anxiety has really been compounded by that sense of uncertainty and that sense of helplessness that often comes along with this. We know from a long history of research in animals and mammals and humans that uncertainty and unpredictability and uncontrollability really tend to drive these fear and anxiety reactions and kind of exacerbate them. So I think we're seeing those reactions really

amp up. I think we're also just seeing difficulties that come along with balancing competing demands from work, family, personal responsibilities, your social needs. You know, there are families who have kids who are home from school because the school systems are closed, while the parents are trying to work remotely

at the same time. Probably have households where some parents are maybe getting sick and also trying to care for their children at the same time, and that just really increases the overall stress and level of demand across the board. Some other key things I think we're seeing are kind of the sense of detachment from our social connections, from our social lives in general. That comes along with this

effort to practice social distancing and self quarantining. So we're spending more time in isolation or maybe solely with members of our household, or maybe seeing some disruptions and social activities and social connections. We're seeing kind of big life events be disrupted, so weddings having to be canceled, their mood, vacation's rescheduled, you know, maybe visits that we're skilled to family members who live in a different area, those are being put on hold, and so I think what comes

along with that. In addition to the kind of increase in anxiety and stress that I've talked about, there's also we're kind of losing access to some of these sources of positivity and reward that we ordinarily have that make our lives enjoyable. We're seeing our hobbies be interrupted. We're seeing disruption to the things that we find fun and that we like to do, and some of the reactions we can see from this can be you know, sadness

and response to some of those losses. Might even see some depressed mood as some of those activities have to be canceled or postponed indefinitely. And as we kind of decrease our activity overall and lose access to some of those positive things in our lives, we might be seeing some decreased motivation in general, as well as antiedonia or kind of a loss of an ability to experience positive feelings.

uncertainty is particularly challenging to tolerate. So you know, we can see, we can imagine that this might be impacting them kind of even more. And another piece of it also is that a lot of our work with individuals with anxiety disorders focuses on challenging sort of overly negative

or catastrophic thoughts. So these thoughts might be that we focus a lot on might be things like the world is completely dangerous, or something terrible is going to happen to me or my family if I don't take extreme precautions, for example. And so a lot of our work, like I said, in psychotherapy, we focus on challenging these beliefs through various evidence based techniques to help individuals develop more

balanced or realistic thoughts. And so you can imagine that the current COVID nineteen situation is making some of those catastrophic beliefs a little bit harder or more difficult to

challenge for some of our patients. So, you know, having the reality is that risks right now of becoming sick or loved ones becoming sick are higher, and so again we're sort of aware of the fact that for many of our patients they're experiencing kind of even finding it even more difficult to kind of work to challenge those

overly kind of catastrophic beliefs. And then also the kind of there are some specific considerations for individuals experiencing or in psychotherapy for depression because sort of Pete hit on this a little bit, but a lot of the work that we do with our patients with depression is around

scheduling activities because there's a real link. We've seen this kind of consistently, and a lot of our therapies are based on the kind of connection between your activity level and your mood, and so when we're working with individuals experiencing depression, we might spend a lot of time making

kind of an activity schedule to boost their mood. And we know that kind of engaging in activities that our values based tends to have a positive effect on our mood, and it's one of our main ways for targeting depressed mood. So again, sort of like we were all just talking about, you can imagine there might be some particular implications for individuals already experiencing depression to then have it harder to access these activities or to be active because of social distancing.

So we're really working to be proactive and creative to address that with our patients who we're working with to who are experiencing depression.

important for us and also for our patients. So you know, for example, one day, the University of Washington clinic was seeing patients in person, and then we changed the next day to kind of having it optional in person, and then an option to do what we call telehealth or sort of therapy virtually, and then the very next day we changed it to they it had all sessions had

to be moved to telehealth. So I think just you know, being really flexible and creative and in terms of kind of rolling with the updates and sort of the new restrictions, and also balancing kind of the needs of our patients with the need for social distancing and working with our patients to find something that works for them. If we can't meet in person person, not all the clinics in Seattle have the ability to move to telehealth or even

walk to you know. Again, it's sort of a balance between what's best for our patients and also the need to distance ourselves right now. So for example, if patients are particularly at high risk for suicide, a provider might decide that meeting in person is still important or necessary. Patients with social anxiety, it might be a real barrier to get them to meet via telehealth. On the other hand,

telehealth has been around for a long time. Not everybody's trained in it, so some people have had to kind of go through really quick training to be able to provide telehealth. But you know, there's a lot of evidence to suggest that it can be very effective, and yeah, I think that's been a big piece of it is

also just getting that all set up for everybody. And then there's more specific things again to our psychotherapies as we deliver them that need to be adapted if you're going to be doing them via telehealth, So things like, you know, when we're treating patients with anxiety disorders, a lot of the time we actually leave the clinic and go out and do what we call exposure exercises, so things like having our patients approach things that they're afraid

of in order to learn that it's not actually dangerous or that they can tolerate the distress that comes up as they approach that feared situation. And so sometimes we do that in our sessions, and clearly that's more challenging when you're meeting via telehealth, but again there are resources to turn to because telehealth has been rolled out, you know, and becoming used more and more, especially for rural populations

and things like that, over the past few years. So yeah, I would say again, I would just say that flexibility has been really important and sort of trying to meet the needs of our patients as best we can, despite the current events and the limitations that are being put on us, and maybe some of the reasons why it's maybe not best to meet in person.

so unknown is what is going to happen. So could you talk a little bit about some of the coping strategies that we could all use to try and deal with some of the issues that we're facing, like the social isolation, the empathy, fatigue, and all of this anxiety about the future.

So the first place I would start out is just to really emphasize the importance of normalizing and validating some of these negative emotional responses and feelings that are coming up, as you're saying, with the levels of uncertainty that we have, how little we know about how this is going to progress and what kind of what the actual level of threat is, as well as those kind of socioeconomic stressors

that come along with the health risks. You know, stress and anxiety are certainly to be expected here, and it's not a sign, you know, if you're experiencing elevated stress and anxiety right now, it's not a sign that something

is kind of fundamentally wrong with you. Those feelings are are normal given this context, and there might be some comfort in just kind of reminding yourself of that when you notice these feelings coming up in a more intense way than maybe you've been used to in the past, and then to really kind of validate them, like the feelings aren't coming out of nowhere right like there is

an actual threat out there. There is actual kind of bona fide uncertainty and unpredictability out there, and that's what these emotions are really responding to and that's the way they're supposed to function. And so these emotional responses, even though they can be unpleasant, oftentimes they actually have real value to us. Anxiety and worry, again certainly can be unpleasant, but it can also help motivate us to prepare and

protect ourselves and our families. Key thing I would also mention here is while it's important to validate and normalize these feelings and kind of accept them that they're kind of part of our experience for now, given the situation that we're in, I think it's also important to be on the lookout for unhelpful thoughts and unhelpful behaviors. So you can ask yourself, is what I'm going to do or what I'm doing, is this actually useful or helpful

or affect for me right now? One of the key things that we talk about is distinguishing between helpful and unhelpful worry. So most people are probably worrying a lot right now, to the extent that that worry and anxiety actually leads to active problem solving and adaptive coping strategies. That worry is actually useful and it can be helpful to kind of lean into that and act on the

urges that come along with it. However, worry can also be taken to an extreme, and worry can kind of it can go beyond actually helping us take constructive action, and it can start to become more just self perpetuating. So I would say that worry that leads to rumination or the sense of spinning, or generally just to more anxiety and more worry without producing concrete helpful behaviors, that's not going to be so helpful. So when we notice that kind of worry coming up, it can be helpful

to engage in some strategies to limit it. That might be, you know, limiting your new user media consumption so you don't necessarily want to be spending all day kind of scanning the news, especially if you're not actually gaining any new or more useful information than you had before. You

might just be perpetuating that anxiety or making it worse. Similarly, I think when you are seeing out information, you want to make sure that you're actually seeking out reputable, trust trustworthy information so that you can actually act in the appropriate way. Might be just kind of distracting yourself if need be, uh, you know, preferably with something enjoyable like a book or a show or a movie, or maybe

you know, video chatting with a friend. But certainly distraction can be a useful tool when we find ourselves hooked

in this kind of cycle of unhelpful worry. And also mentioned it's probably helpful to be aware of some of the psychological effects that increased stress, fear, and anxiety have on our psychological system, so we know that when we're when we have elevated fear and anxiety, it changes how our attention functions can develop an increased attentional bias to threat, where we are kind of quicker to pick out all the things that appear scary and threatening in our environment,

and we may be gloss over or dismiss things in our environment that maybe would be run counter to that fear, and that can lead to an escalation of fear and anxiety as well. The last thing I would say is fear has a tendency to overgeneralize, meaning that if there's something in particular that we're afraid of, like a virus or coming into contact with the virus, oftentimes that fear kind of spreads out to things that seem related to it.

But that actually are something completely different. And as an example of this, I might think of, you know, fear and anxiety motivated people to go out and buy, say like enough food to have for a couple of weeks in case we can't go to the grocery store. I also saw some people going out and you know, maybe getting some things that didn't necessarily make logical sense and

connection to this particular outbreak. So for instance, like going and buying up down the gawlln of the gallons of drinking a bottled water when you know our tap water is perfectly safe to drink here, and you know that maybe how we prepare for like an earthquake or another type of natural disaster where where that type of infrastructure might be threatened but isn't necessarily something that's going to

be disrupted from this type of outbreak. Yet that fear can kind of push us to engage in kind of those more general actions. So I think just kind of being aware of that can be helpful to see when those tendencies are getting kicked in by the fear. Yeah.

for a lot of people. People vary. There's a lot of variability and how well people tolerate uncertainty, and like I mentioned before, individuals with anxiety disorders tend to find it even more challenging usually, And so I think in this time, an important first step can be to simply acknowledge how this is a time where there is quite a bit of uncertainty, uncertainty about how long this is going to last, about what this will mean for work

and our financial situations, and uncertainty about you know, potential infection of us or our families. And instead of kind of trying to spin on spin and spin and spin and look for certainty, there can be some relief in trying to sort of just accept the uncertainty for now and tolerate it. Think about other times that you've tolerated uncertainty and how you did that, and with that acceptance,

like I said, there can be some relief. And it's also okay to accept the discomfort that comes with the uncertainty, and to notice that it's you know, you don't like it, or that you know what makes you feel anxious in your body, And so that I think can be a really helpful first step is to sort of give up problem solving, give up trying to find answers, and really kind of notice and acknowledge and accept the uncertainty of

the moment right now. Another helpful piece here can be that there's significant evidence to show that people overestimate how badly they will be affected by future negative events and underestimate how well they will cope with and adjust to

difficult situations. So along with the acceptance of the uncertainty, it also can be sort of helpful to remind yourself of that and remind yourself that it's very likely that whatever comes your way in the next few months, getting sick, losing a job, any of those things, it's very likely that you will find a way to get through it, even if right now you can't imagine that you possibly

would be able to. I think another really helpful thing in these moments is I hear a lot from friends, patients, family that kind of thought of I can't imagine how I would possibly get through this, another few weeks of this, another few months of this, and sort of one of the things that makes it the most difficult is the idea that it might last for a while, kind of

this disruption to our life as we know it. And I think this is where we can bring in some of our mindfulness techniques and staying in the present moment can really help. So focusing on what can you do in this exact moment and kind of acknowledging that really all you have to do is get through this moment, and that can really feel a lot easier than thinking about getting through months of this and we really don't

know right again, there's that uncertainty. We don't know. We could see change tomorrow or it could be a few months, and so really all you have to do is stay tied to the present moment and get through the present moment.

And then I think a last piece that kind of ties back to some of the challenges people are facing is a lot of us have lost access to things that give us meaning in life, and so how are we not going to fall into hopelessness and helplessness if we've lost contact with those things that give us meaning and how can we make meaning out of our life still given the current circumstances, one thing that we really encourage people to do is try to spend some time

thinking about what your values are. So values are personally important, principles that are kind of you as an individual, find intrinsically rewarding, and these vary across individuals. Can be things like creativity, learning, compassion, gratitude, social justice. All of those

are our values. And in this time it's a really good time to get in contact with those values and think about what can bring these into your life despite the fact that maybe your homebound, or you aren't able to go to work, or you aren't able to spend time with friends, if that's your value, and people have gotten really creative with this, you know, and I think that there's lots of ideas online you can look up, but first it takes figuring out what your values are

and then finding ways to get creative to bring them into your life. Right, So, for example, if compassion is a value of yours, can you find a way to bring in four different ways that you get in touch with that value each day? So maybe that's you know, asking a neighbor who you know if you can grocery shop for them, or write letters to people who are quarantined, or make drawings if you have kids at home, your help your have your kids make drawings and send them

to family members or loved ones. Lots of different creative ideas, and one thing, it can be kind of difficult to actually think of these things when you are when you are feeling low or you are feeling anxious, because we know that sort of our mood impacts how we think.

So a really good idea is to actually have you think about these ideas for this and generate a list, and so that in times when you are maybe your mood has kind of tanked a little bit, you can kind of access this list and force yourself to kind of engage in one of these activities which then we know can have a positive impact in your mood, and schedule them ahead of time, so even if in the moment you don't feel like doing them, it's a part of your kind of planning, a part of your day

that you've planned, and kind of do what you can to force yourself to go through with these activities or these ideas that you've had because again, we know that that can have a positive impact on your mood.

and you know, not accessible, so it's very private. And then a lot of the time, again there might be little adaptations, but the therapy sessions look largely like therapy sessions look in person. You can you can see the person through the screen, you know. The therapy sessions usually actually end up feeling I think, very very familiar and similar to when they're in person. You know, there's things we help people set up, you know, a private place

so that they feel like they are have privacy. I think that can be a really key component of it. If there's family members or kids around, we might ask that they step outside or something like that. But it largely looks very similar to therapy in person, but you're just communicating through the computer.

throughout these events that are ongoing. So I would kind of just I would reiterate that plug for at least giving telehealth a try if it's an option to you, and you know, even if it's let's say you're already in therapy but for one reason or another, telehealth is not an option for you, you might consider still just reaching out to your therapist and seeing if you can kind of actively make a proactive coping plan together with your therapist for how to navigate that term period until

you're able to resume treatment, and that's probably something that's

best done in consultation with someone's individual therapist. Similarly, if you've been in treatment, just kind of remembering what you have learned so far, and you know, rather than approaching this as taking a hiatus from your treatment, to approach it as maybe an opportunity to practice and live with the skills that you've been learning so far, so not to give up on those efforts, so you can practice that self compassion even if you know you might struggle

to use the skills that you've learned effectively when you're outside of therapy at context, and that's okay, And so being compassionate with yourself if you know as you're trying to do that, but really trying to keep up practicing

those things that you've been learning. And then more broadly, I think if you haven't been in treatment, it's probably worth just being on the lookout for really some longer term patterns of mood or emotional behavioral sturbances, particularly when they get to the point where they're really starting to interfere with your daily activities or your general well being. In that case, it might be a sign that it

might be worth reaching out for some professional help. And I think that kind of resources are being developed on an ongoing basis in terms of where to find telehealth opportunities. But in general, individuals, insurance companies definitely generally have kind of a directory of providers that are who are in network psychology today. You can also have several find of

therapist tools. I'm not sure if you know telehealth option has been built into that search tool he yet, And there's some other resources out there where you can kind of search for therapists to explore if telehealth is an option.

good sleep hygiene, and sleep is so important. You know, it has a cascading effect on mood and anxiety definitely, and anything we can do to kind of buffer against those right now is going to be important. And so you know, doing things like going to bed at the same time and waking up at the same time, and you know, limiting screen time before going to bed, things

like that can make a really huge difference. Right now, taking a bubble bath, if you find that relaxing, Anything that you can think of to build into your life right now that can just boost up your resilience and buffer against issues with mood and anxiety is going to be really important for everybody.

More on the kind of psychological or mental health side, the themes that we've seen emerging in terms of how to kind of best go through this process in terms of outlook for our own and our community members' mental health, is to really embrace this attitude of flexibility, kindness, and creativity.

So you know, again, we're all navigating an unprecedented situation and they're bound to be missteps along the way, trying to take kind of a gracious and flexible attitude to that, maybe watching out for negative assumptions about people's behavior and instead kind of considering that, okay, maybe we're all kind of trying to do our best here navigating an inherently

very difficult situation. We're all kind of trying to figure this out together, and that involves extending kindness and graciousness to yourself and others and kind of just accepting that, you know, we're not going to be perfect through this, and that's okay, We're still going to do our best. I think intentionally practicing empathy can be helpful in those situations.

Really just embracing those creative ways that we can stay connected to the people we care about, and to get creative about how we build in those sources of positivity and reward and things that fulfill our values into our life.

I think this is going to entail having to take a pretty open mind approach to this and being open to some trial and error as we go along, So being willing to maybe try out new, potentially unconventional ways of connecting with other people, whether it's you know, virtual happy hours, or watching a movie together over video chat, maybe playing a board game together or virtually as well as you know, maybe finding new ways to exercise if you can't go to your normal gym, or of having

trouble kind of getting access to the normal ways of the exercise. Maybe it's finding new things that you try out at home or walking around your neighborhood, and maybe those wouldn't have been your first choices up until this point, but it might be worth just taking open minded approach to them and giving them a try to see if

they work for you. I think this emotional support aspect is pretty key, So offering emotional support to others when it's needed or when it's sought out by people you care about, kind of you know, validating those feelings that are coming up, and also seeking out that kind of support when you need it yourself. So if you're you know, seeking someone to kind of process your emotional reactions to things with or to problem solve with, you know, be

proactive about that. Seek someone out who you trust and have that conversation that can be really beneficial for everyone involved. And then I think you know to the extent that we can offer concrete or physical support when it's appropriate to help our communities. So there are some communities who are asking if anybody has you know, extra and ninety five masks at home that they could donate for healthcare workers. Maybe there's philanthropic means in which you can have a

positive impact in your community, those types of things. So being on the lookout for really what is called for by trust, trustworthy, reputable sources, participating in those efforts when you are able to, and you're just kind of doing your part to engage in these new practices that are being encouraged and to kind of kindly encourage others to do so as well, and just acknowledging that, you know, we're finding a new way to live our lives for this time being, and that's a real challenge for all

of us.

out there. So in general, we'd probably recommend making sure that you're consulting trustworthy sources, government websites, professional organizations, as opposed to maybe taking mental health advice from social media or from memes that you see hosted or from non mental health professionals. So there are a lot of those professional organizations out there, some of them that we have come across that have COVID nineteen specific information on there that we liked. One was a DAA dot org. That's

the Anxiety and Depression Association of America. On their if you go to their front page of their website, they have an entire section devoted to helpful advice for dealing with coronavirus anxiety and it's a great resource to consult. Another one would be SAMSA or the Substance Abuse and Mental Health Services Administration, So that's SAMHSA dot gov. Similarly, they have a wealth of COVID nineteen related mental health

information right on their front page. There a good place to consult as well.

So check out that episode of Ologies if you want more detail on that and where to find the links to actually kind of sign up for that if you're a person who's interested in helping in that way.

different aspects of the disease. And so as we learn more, we may revisit aspects of the clinical disease, or the vaccine development, or the epidemiological patterns, but we also want to bring in some other things too, So hopefully we'll bring you episodes on the economic impacts of this, on how this disease or outbreaks like this work in countries that do not have the resources like the United States

and other more wealthy countries have. So keep an ear out for those subscribe to our social medias tpwkise our Twitter, This Podcast will Kill You, Instagram, and we're also on Facebook under this Podcast will Kill You. And we also have a website where we're going to post FAQs and we're going to post updates, and we're going to post new episodes as we have them.