WEBVTT - COVID-19 Chapter 6: Mental Health 0:00:42.880 --> 0:00:43.080 Hi. 0:00:43.320 --> 0:00:46.680 I'm Aaron Welsh and I'm Aaron Allmont Updike, and. 0:00:46.720 --> 0:00:48.640 This is this podcast will kill you? 0:00:49.360 --> 0:00:49.839 Sure is. 0:00:50.600 --> 0:00:54.160 This is an episode that is chapter six of our 0:00:54.440 --> 0:00:58.600 series called Anatomy of a Pandemic, which covers COVID nineteen 0:00:58.640 --> 0:01:02.720 and all the different aspects of disease. It's been about 0:01:02.720 --> 0:01:05.040 a week and a half since COVID nineteen was declared 0:01:05.040 --> 0:01:09.399 a pandemic by the WHO, and since that time, our lives, 0:01:09.680 --> 0:01:15.160 everyone's lives have changed dramatically, some more than others. And 0:01:15.280 --> 0:01:17.920 you know, I think it's our tendency. I can speak 0:01:17.959 --> 0:01:20.440 for both of us, Aaron right for sure when I 0:01:20.480 --> 0:01:23.080 say that we like to fight fear with facts. But 0:01:23.319 --> 0:01:26.080 there is still so much about this virus and this 0:01:26.200 --> 0:01:29.480 pandemic that we don't know about, and we don't know 0:01:29.520 --> 0:01:32.320 how it's going to go. We don't have a roadmap 0:01:32.440 --> 0:01:35.640 for this. And thinking about our personal risk, or our 0:01:35.720 --> 0:01:38.160 risk to others, or the risk to our families or 0:01:38.200 --> 0:01:41.320 our friends, or the economic outcomes, I mean, all of 0:01:41.360 --> 0:01:44.720 this can send us swirling down the rabbit hole of 0:01:44.760 --> 0:01:48.960 stress and anxiety and bad dreams and or lack of sleep. 0:01:49.720 --> 0:01:53.080 That's not exactly a helpful thing. No, and so we 0:01:53.200 --> 0:01:58.480 wanted to bring on a couple of amazing people who 0:01:58.840 --> 0:02:02.480 can share with us coping strategies or good practices to 0:02:02.560 --> 0:02:05.320 try to get a handle on our stress and anxiety 0:02:05.600 --> 0:02:09.359 and to help us think about where it's coming from. 0:02:09.520 --> 0:02:11.840 So for this episode, we were really fortunate to speak 0:02:11.880 --> 0:02:15.800 to Rosemary Walker and Pete Rosenkranz, two graduate students at 0:02:15.840 --> 0:02:20.440 the University of Washington in psychology, to talk to us 0:02:20.440 --> 0:02:23.000 about all of kind of the mental health issues about 0:02:23.360 --> 0:02:26.880 this pandemic. They were really incredible to talk to and 0:02:26.960 --> 0:02:29.959 so we hope that you really enjoyed this episode. I 0:02:30.000 --> 0:02:33.560 think it was one of our favorites to record because 0:02:33.840 --> 0:02:36.640 this is stuff that we don't know anything about. We 0:02:36.639 --> 0:02:41.919 go into anxiety spirals just like everyone else very easily. 0:02:43.720 --> 0:02:47.720 So this was really really personally useful and hopefully it'll 0:02:47.720 --> 0:02:49.680 be useful for listeners as well. 0:02:50.120 --> 0:02:59.880 Yeah. So, but first we do indeed, speaking of coping strategies, 0:03:01.040 --> 0:03:04.680 this is we do not recommend alcohol in any way 0:03:04.800 --> 0:03:10.040 as a coping strategy. No, but because you know branding 0:03:10.080 --> 0:03:13.400 and symmetry, we have to have a quarantini recipe. 0:03:15.080 --> 0:03:16.880 So if you want to make the place sipa rita 0:03:17.040 --> 0:03:19.280 version that'd be a good coping strategy. 0:03:20.000 --> 0:03:23.880 Yeah, it's pretty delicious. Okay, So what is in Quarantiny six? 0:03:24.120 --> 0:03:29.360 Quarantine six is a wine spritzer with pineapple juice and 0:03:29.840 --> 0:03:32.320 some kind of like a nice fruity white wine, like 0:03:32.320 --> 0:03:34.520 a Pinot Grease or something, I don't know, whatever you 0:03:34.560 --> 0:03:35.560 have in your cupboard. 0:03:35.840 --> 0:03:38.800 Yeah, honestly, that's kind of the theme of these quarantinies 0:03:38.840 --> 0:03:41.200 so far, is that, like, you know, this. 0:03:41.120 --> 0:03:44.440 Is what we had. A can of pineapple juice and 0:03:44.520 --> 0:03:48.920 a twist top bottle of wine. Don't knock the twist top, No, 0:03:49.160 --> 0:03:51.840 I love Twisttop. I was actually disappointed in myself that 0:03:51.880 --> 0:03:55.000 I bought multiple bottles and one of them had a cork, 0:03:55.000 --> 0:03:57.240 and I was like, dang, should have gone all twisted. 0:03:57.520 --> 0:04:00.320 I shred about forty percent of the cork works that 0:04:00.400 --> 0:04:01.400 I try to do. 0:04:01.480 --> 0:04:09.240 You really remove learned something new about you today. Let's 0:04:09.240 --> 0:04:11.800 take a quick break and then dive into this episode. 0:04:36.640 --> 0:04:41.400 My name's Rosemary Walker. So I'm a sixth year doctoral 0:04:41.440 --> 0:04:47.760 student at the University of Washington and my lab focuses 0:04:47.800 --> 0:04:50.240 on or Our lab is called the Center for Anxiety 0:04:50.279 --> 0:04:53.640 and Traumatic Stress, and a lot of our work focuses 0:04:53.680 --> 0:04:57.920 on providing psychotherapy to individuals with anxiety disorders and post 0:04:57.920 --> 0:05:02.800 traumatic stress disorder, and I work in various clinics throughout 0:05:02.839 --> 0:05:06.320 the Seattle area, mainly our University clinic, where we provide 0:05:06.320 --> 0:05:10.200 psychotherapy to individuals with kind of a broad spectrum of 0:05:10.240 --> 0:05:11.520 mental health needs. 0:05:12.640 --> 0:05:16.080 My name is Pete Rosencranz. I'm a fourth year doctoral 0:05:16.120 --> 0:05:19.200 student at the University of Washington, also working in the 0:05:19.240 --> 0:05:22.120 Center for Anxiety and Dramatic Stress, which is doctor Lori's 0:05:22.120 --> 0:05:26.760 owner's lab that you dub Similar to Rosie, my research 0:05:26.800 --> 0:05:31.960 interests primarily focused on anxiety and PTSD, particularly on I 0:05:32.120 --> 0:05:34.720 was doing some of the treatment mechanisms and therapeutic change 0:05:34.720 --> 0:05:37.600 processes that are going on in our treatments for these issues, 0:05:38.440 --> 0:05:41.160 and also, similarly to Rosie, kind of do a range 0:05:41.160 --> 0:05:44.560 of clinical experiences ranging from clients I see through our 0:05:44.680 --> 0:05:49.440 University Psychology graduate clinic, our training clinic, as well as 0:05:49.520 --> 0:05:52.039 external practice sites around the Seattle area. 0:05:52.880 --> 0:05:57.240 Awesome, thank you, So, I mean, first, I would love 0:05:57.320 --> 0:05:59.680 to hear how you guys are doing. So you're in 0:05:59.720 --> 0:06:02.760 wah Ohington State, which is one of the states that's 0:06:02.800 --> 0:06:06.200 been hit the hardest by COVID nineteen and so you know, 0:06:06.279 --> 0:06:09.920 you've been experiencing these things and probably thinking about these 0:06:09.920 --> 0:06:13.039 things on a day to day basis much earlier than 0:06:13.120 --> 0:06:14.920 some of the rest of us in the US have. 0:06:15.360 --> 0:06:17.760 So can you just kin, don't know, how are you 0:06:17.800 --> 0:06:18.279 guys doing. 0:06:20.000 --> 0:06:23.520 Yeah, yeah, it's a good question. And I've been getting 0:06:23.520 --> 0:06:25.239 that a lot, you know, I think because it really 0:06:25.640 --> 0:06:28.040 it hit here first, and so it has been i 0:06:28.040 --> 0:06:30.039 think a little bit more present for us for a 0:06:30.040 --> 0:06:32.919 bit longer than other parts of the country. 0:06:34.400 --> 0:06:35.120 And yeah, I. 0:06:35.080 --> 0:06:37.000 Would say I would say it's been a it's been 0:06:37.040 --> 0:06:40.520 a challenging time. Life as we have known it has 0:06:40.600 --> 0:06:43.760 really changed, which is now probably starting to be true 0:06:43.800 --> 0:06:46.679 for most people across the country, across the world really, 0:06:47.680 --> 0:06:49.640 and I think one of the hardest parts has really 0:06:49.680 --> 0:06:52.640 been the uncertainty of it all and a lot of 0:06:52.680 --> 0:06:57.280 adjusting to changes in you know, lifestyle and work and 0:06:57.320 --> 0:07:01.120 things like that, and the social distancing aspect has been 0:07:01.480 --> 0:07:02.440 difficult as well. 0:07:02.680 --> 0:07:03.000 I think. 0:07:03.040 --> 0:07:06.240 On the other hand, we've heard this a lot this 0:07:06.320 --> 0:07:10.760 week across patients and friends in Seattle, but the sun 0:07:10.880 --> 0:07:13.160 came out this past week, which I think we have 0:07:13.240 --> 0:07:16.920 been especially thankful for. I also would say there's been 0:07:17.000 --> 0:07:21.680 a feeling of you know, shared humanity and community and 0:07:21.720 --> 0:07:24.520 a lot of creativity being sparked too. 0:07:24.840 --> 0:07:26.120 In the past few weeks. 0:07:25.960 --> 0:07:30.600 That I've really seen from you know, breweries and restaurants 0:07:30.640 --> 0:07:34.640 offering kind of curbside deliveries that they you know, hand 0:07:34.680 --> 0:07:38.760 to on a pole into your car, to you know, 0:07:38.960 --> 0:07:44.400 organizations gathering people to babysit for medical professionals, or writing 0:07:44.480 --> 0:07:48.480 letters to individuals who are quarantined, or organizing dance parties 0:07:48.480 --> 0:07:51.440 in the street, things like that. So it's been it's 0:07:51.440 --> 0:07:53.920 a difficult time. The uncertainty is hard, and I also 0:07:54.000 --> 0:07:56.680 think there's been it's been uplifting to see the community 0:07:56.720 --> 0:07:57.400 coming together. 0:07:58.360 --> 0:08:01.000 Yeah, I would, I would really echo pretty much everything 0:08:01.000 --> 0:08:05.160 that Rosie is saying. The uncertainty has definitely been a 0:08:05.160 --> 0:08:09.280 major challenge. I also think it's especially early on when 0:08:09.280 --> 0:08:12.000 we were seeing some of those first cases emerge here, 0:08:12.600 --> 0:08:14.760 it really wasn't clear what we should be expecting and 0:08:14.840 --> 0:08:18.080 exactly what we needed to be doing, and kind of 0:08:18.080 --> 0:08:20.720 just what the future in the near term was going 0:08:20.760 --> 0:08:22.360 to look like, and that was just kind of really 0:08:22.360 --> 0:08:27.239 hard to navigate and prepare for. Now, there does seem 0:08:27.240 --> 0:08:29.560 to be a bit of a new normal that's being 0:08:29.640 --> 0:08:33.120 established here with you know, pretty much everybody is working 0:08:33.360 --> 0:08:36.319 remotely at this point except for kind of those essential 0:08:36.400 --> 0:08:41.440 businesses and services. There's a lot of social distancing going on, 0:08:41.559 --> 0:08:45.679 self quarantining going on, and I think becoming increasingly clear, 0:08:45.720 --> 0:08:47.839 at least to me, My general assumption is that we're 0:08:48.400 --> 0:08:50.960 in this for a longer hold than I initially expected, 0:08:51.960 --> 0:08:55.080 on the scale of months as opposed to days or weeks, 0:08:55.720 --> 0:08:58.320 And so I think at this point the main challenge 0:08:58.320 --> 0:09:01.240 for me is just trying to kind of embrace this 0:09:01.280 --> 0:09:03.760 new normal and figure out, you know, how do I 0:09:03.760 --> 0:09:07.840 want to structure my day so that I can retain 0:09:07.920 --> 0:09:10.920 some semblance of normalcy and build some new routines into 0:09:10.920 --> 0:09:12.839 my life, and how can I kind of make the 0:09:12.960 --> 0:09:14.800 changes that I need to be making to ensure that 0:09:14.840 --> 0:09:18.640 I can keep up my work, my personal wellbeing, social connections, 0:09:18.840 --> 0:09:19.920 all those sorts of things. 0:09:20.880 --> 0:09:27.079 Yeah, So the impacts of this disease we're seeing is 0:09:27.520 --> 0:09:32.240 they're super diverse, of course, and much broader than just 0:09:32.880 --> 0:09:36.800 the impact on people's health. And none of us have 0:09:36.880 --> 0:09:40.760 really ever experienced something like this before, especially not on 0:09:40.800 --> 0:09:43.440 this scale. So what are we seeing in terms of 0:09:43.440 --> 0:09:45.040 some of the mental health outcomes. 0:09:45.720 --> 0:09:47.679 Yeah, So I can start out talking just kind of 0:09:47.760 --> 0:09:50.600 generally about what we're seeing broadly speaking in terms of 0:09:50.600 --> 0:09:54.480 mental health outcomes. And I think you're really you're hitting 0:09:54.480 --> 0:09:55.680 the nail on the head there when you say that 0:09:55.720 --> 0:09:58.000 this is an unprecedented situation, because I think in a 0:09:58.080 --> 0:10:00.920 lot of ways that defines are action right now. It's 0:10:00.960 --> 0:10:04.920 just that inherent uncertainty that's going on. So broadly speaking, 0:10:04.960 --> 0:10:07.640 I think we're seeing kind of an increase in some 0:10:08.120 --> 0:10:11.280 negative mental health outcomes and as well as a decrease 0:10:11.320 --> 0:10:14.960 in some positive aspects of mental health. So what I 0:10:15.000 --> 0:10:17.120 mean by that is, on the negative side, we're seeing 0:10:17.440 --> 0:10:20.800 increases in stress and anxiety on a pretty broad scale 0:10:21.080 --> 0:10:25.120 that are being driven by actual health and socioeconomic threats 0:10:25.160 --> 0:10:28.720 to ourselves, our loved ones, in our communities that COVID 0:10:28.800 --> 0:10:32.240 nineteen presents. I think that stress and anxiety has really 0:10:32.280 --> 0:10:37.200 been compounded by that sense of uncertainty and that sense 0:10:37.200 --> 0:10:40.600 of helplessness that often comes along with this. We know 0:10:40.760 --> 0:10:44.480 from a long history of research in animals and mammals 0:10:44.480 --> 0:10:50.360 and humans that uncertainty and unpredictability and uncontrollability really tend 0:10:50.400 --> 0:10:53.120 to drive these fear and anxiety reactions and kind of 0:10:53.120 --> 0:10:56.800 exacerbate them. So I think we're seeing those reactions really 0:10:56.840 --> 0:11:01.120 amp up. I think we're also just seeing difficulties that 0:11:01.160 --> 0:11:07.160 come along with balancing competing demands from work, family, personal responsibilities, 0:11:07.200 --> 0:11:09.840 your social needs. You know, there are families who have 0:11:10.000 --> 0:11:12.240 kids who are home from school because the school systems 0:11:12.280 --> 0:11:15.600 are closed, while the parents are trying to work remotely 0:11:15.640 --> 0:11:18.440 at the same time. Probably have households where some parents 0:11:18.480 --> 0:11:20.800 are maybe getting sick and also trying to care for 0:11:21.200 --> 0:11:23.640 their children at the same time, and that just really 0:11:23.640 --> 0:11:27.360 increases the overall stress and level of demand across the board. 0:11:28.440 --> 0:11:32.199 Some other key things I think we're seeing are kind 0:11:32.240 --> 0:11:35.520 of the sense of detachment from our social connections, from 0:11:35.520 --> 0:11:38.200 our social lives in general. That comes along with this 0:11:38.280 --> 0:11:42.520 effort to practice social distancing and self quarantining. So we're 0:11:42.520 --> 0:11:45.959 spending more time in isolation or maybe solely with members 0:11:46.000 --> 0:11:49.320 of our household, or maybe seeing some disruptions and social 0:11:49.360 --> 0:11:53.520 activities and social connections. We're seeing kind of big life 0:11:53.559 --> 0:11:56.480 events be disrupted, so weddings having to be canceled, their mood, 0:11:56.600 --> 0:12:00.400 vacation's rescheduled, you know, maybe visits that we're skilled to 0:12:00.480 --> 0:12:02.640 family members who live in a different area, those are 0:12:02.679 --> 0:12:05.000 being put on hold, and so I think what comes 0:12:05.000 --> 0:12:07.040 along with that. In addition to the kind of increase 0:12:07.080 --> 0:12:09.240 in anxiety and stress that I've talked about, there's also 0:12:09.480 --> 0:12:11.679 we're kind of losing access to some of these sources 0:12:11.679 --> 0:12:14.920 of positivity and reward that we ordinarily have that make 0:12:14.920 --> 0:12:18.520 our lives enjoyable. We're seeing our hobbies be interrupted. We're 0:12:18.520 --> 0:12:21.440 seeing disruption to the things that we find fun and 0:12:21.440 --> 0:12:23.840 that we like to do, and some of the reactions 0:12:23.840 --> 0:12:25.800 we can see from this can be you know, sadness 0:12:25.800 --> 0:12:28.320 and response to some of those losses. Might even see 0:12:28.320 --> 0:12:31.000 some depressed mood as some of those activities have to 0:12:31.080 --> 0:12:35.400 be canceled or postponed indefinitely. And as we kind of 0:12:35.440 --> 0:12:38.480 decrease our activity overall and lose access to some of 0:12:38.520 --> 0:12:41.160 those positive things in our lives, we might be seeing 0:12:41.200 --> 0:12:45.040 some decreased motivation in general, as well as antiedonia or 0:12:45.120 --> 0:12:48.800 kind of a loss of an ability to experience positive feelings. 0:12:49.840 --> 0:12:51.600 I was just going to add a little bit more, 0:12:52.320 --> 0:12:54.440 you know, I echo, I would echo everything Pize says, 0:12:54.440 --> 0:12:57.040 but I would also add a couple unique considerations for 0:12:57.080 --> 0:13:00.600 the clinical populations we work with. So we work particularly 0:13:00.640 --> 0:13:04.720 a lot with individuals with experiencing mood and anxiety disorders, 0:13:05.320 --> 0:13:09.520 and you know, for individuals with anxiety in particular, one 0:13:09.559 --> 0:13:12.560 thing we know is that uncertainty tends to be most 0:13:12.559 --> 0:13:16.520 people don't love uncertainty, but for individuals with anxiety disorders, 0:13:16.600 --> 0:13:21.920 uncertainty is particularly challenging to tolerate. So you know, we 0:13:21.920 --> 0:13:24.760 can see, we can imagine that this might be impacting 0:13:24.800 --> 0:13:28.280 them kind of even more. And another piece of it 0:13:28.360 --> 0:13:31.199 also is that a lot of our work with individuals 0:13:31.200 --> 0:13:36.320 with anxiety disorders focuses on challenging sort of overly negative 0:13:36.400 --> 0:13:39.960 or catastrophic thoughts. So these thoughts might be that we 0:13:40.040 --> 0:13:42.120 focus a lot on might be things like the world 0:13:42.320 --> 0:13:46.319 is completely dangerous, or something terrible is going to happen 0:13:46.360 --> 0:13:49.679 to me or my family if I don't take extreme precautions, 0:13:49.760 --> 0:13:53.200 for example. And so a lot of our work, like 0:13:53.240 --> 0:13:57.760 I said, in psychotherapy, we focus on challenging these beliefs 0:13:57.800 --> 0:14:03.000 through various evidence based techniques to help individuals develop more 0:14:03.520 --> 0:14:07.600 balanced or realistic thoughts. And so you can imagine that 0:14:07.640 --> 0:14:11.560 the current COVID nineteen situation is making some of those 0:14:11.600 --> 0:14:15.080 catastrophic beliefs a little bit harder or more difficult to 0:14:15.160 --> 0:14:19.000 challenge for some of our patients. So, you know, having 0:14:19.520 --> 0:14:23.320 the reality is that risks right now of becoming sick 0:14:23.440 --> 0:14:27.920 or loved ones becoming sick are higher, and so again 0:14:28.000 --> 0:14:30.120 we're sort of aware of the fact that for many 0:14:30.160 --> 0:14:33.440 of our patients they're experiencing kind of even finding it 0:14:33.480 --> 0:14:36.720 even more difficult to kind of work to challenge those 0:14:36.800 --> 0:14:41.480 overly kind of catastrophic beliefs. And then also the kind 0:14:41.480 --> 0:14:46.480 of there are some specific considerations for individuals experiencing or 0:14:46.520 --> 0:14:50.560 in psychotherapy for depression because sort of Pete hit on 0:14:50.560 --> 0:14:52.120 this a little bit, but a lot of the work 0:14:52.160 --> 0:14:54.680 that we do with our patients with depression is around 0:14:56.040 --> 0:15:00.880 scheduling activities because there's a real link. We've seen this 0:15:00.960 --> 0:15:04.480 kind of consistently, and a lot of our therapies are 0:15:04.520 --> 0:15:07.880 based on the kind of connection between your activity level 0:15:08.360 --> 0:15:12.920 and your mood, and so when we're working with individuals 0:15:12.920 --> 0:15:16.360 experiencing depression, we might spend a lot of time making 0:15:17.200 --> 0:15:20.760 kind of an activity schedule to boost their mood. And 0:15:20.800 --> 0:15:24.000 we know that kind of engaging in activities that our 0:15:24.080 --> 0:15:26.920 values based tends to have a positive effect on our mood, 0:15:26.920 --> 0:15:30.040 and it's one of our main ways for targeting depressed mood. 0:15:30.600 --> 0:15:33.280 So again, sort of like we were all just talking about, 0:15:33.480 --> 0:15:36.080 you can imagine there might be some particular implications for 0:15:36.160 --> 0:15:39.480 individuals already experiencing depression to then have it harder to 0:15:39.600 --> 0:15:44.720 access these activities or to be active because of social distancing. 0:15:45.480 --> 0:15:48.240 So we're really working to be proactive and creative to 0:15:48.320 --> 0:15:51.760 address that with our patients who we're working with to 0:15:52.280 --> 0:15:53.800 who are experiencing depression. 0:15:54.360 --> 0:15:59.080 Yeah, that is you know, additional challenges. It's very important. 0:15:59.480 --> 0:16:03.640 So you know, you two have unique perspectives in the 0:16:03.680 --> 0:16:05.880 mental health profession. Can you talk about some of the 0:16:05.960 --> 0:16:08.600 challenges that you have faced so far and some of 0:16:08.640 --> 0:16:12.120 the challenges that you think are going to appear in 0:16:12.120 --> 0:16:14.840 the future as this COVID nineteen situation progresses. 0:16:17.280 --> 0:16:20.600 Yeah, yeah, I think, you know, like everybody else right now, 0:16:21.120 --> 0:16:25.960 this is all very novel. We're navigating new water, and 0:16:26.040 --> 0:16:30.560 I think over the past month, flexibility has been incredibly 0:16:30.600 --> 0:16:35.160 important for us and also for our patients. So you know, 0:16:35.280 --> 0:16:38.680 for example, one day, the University of Washington clinic was 0:16:38.720 --> 0:16:41.360 seeing patients in person, and then we changed the next 0:16:41.400 --> 0:16:43.880 day to kind of having it optional in person, and 0:16:43.920 --> 0:16:46.680 then an option to do what we call telehealth or 0:16:46.720 --> 0:16:51.000 sort of therapy virtually, and then the very next day 0:16:51.040 --> 0:16:53.480 we changed it to they it had all sessions had 0:16:53.480 --> 0:16:56.200 to be moved to telehealth. So I think just you know, 0:16:56.320 --> 0:17:00.240 being really flexible and creative and in terms of kind 0:17:00.280 --> 0:17:04.520 of rolling with the updates and sort of the new restrictions, 0:17:04.720 --> 0:17:08.159 and also balancing kind of the needs of our patients 0:17:08.520 --> 0:17:12.399 with the need for social distancing and working with our 0:17:12.440 --> 0:17:15.080 patients to find something that works for them. If we 0:17:15.119 --> 0:17:18.600 can't meet in person person, not all the clinics in 0:17:18.640 --> 0:17:21.280 Seattle have the ability to move to telehealth or even 0:17:21.359 --> 0:17:23.760 walk to you know. Again, it's sort of a balance 0:17:23.840 --> 0:17:27.440 between what's best for our patients and also the need 0:17:27.480 --> 0:17:31.520 to distance ourselves right now. So for example, if patients 0:17:31.560 --> 0:17:34.880 are particularly at high risk for suicide, a provider might 0:17:34.920 --> 0:17:38.640 decide that meeting in person is still important or necessary. 0:17:39.240 --> 0:17:41.880 Patients with social anxiety, it might be a real barrier 0:17:41.960 --> 0:17:45.840 to get them to meet via telehealth. On the other hand, 0:17:45.880 --> 0:17:49.400 telehealth has been around for a long time. Not everybody's 0:17:49.440 --> 0:17:51.400 trained in it, so some people have had to kind 0:17:51.440 --> 0:17:54.320 of go through really quick training to be able to 0:17:54.359 --> 0:17:57.360 provide telehealth. But you know, there's a lot of evidence 0:17:57.400 --> 0:18:00.480 to suggest that it can be very effective, and yeah, 0:18:00.480 --> 0:18:02.200 I think that's been a big piece of it is 0:18:02.200 --> 0:18:05.199 also just getting that all set up for everybody. And 0:18:05.240 --> 0:18:08.800 then there's more specific things again to our psychotherapies as 0:18:08.800 --> 0:18:11.360 we deliver them that need to be adapted if you're 0:18:11.359 --> 0:18:14.919 going to be doing them via telehealth, So things like, 0:18:16.320 --> 0:18:18.800 you know, when we're treating patients with anxiety disorders, a 0:18:18.800 --> 0:18:21.439 lot of the time we actually leave the clinic and 0:18:21.480 --> 0:18:24.199 go out and do what we call exposure exercises, so 0:18:24.359 --> 0:18:28.480 things like having our patients approach things that they're afraid 0:18:28.520 --> 0:18:32.480 of in order to learn that it's not actually dangerous 0:18:32.600 --> 0:18:35.040 or that they can tolerate the distress that comes up 0:18:35.160 --> 0:18:39.320 as they approach that feared situation. And so sometimes we 0:18:39.400 --> 0:18:42.240 do that in our sessions, and clearly that's more challenging 0:18:42.240 --> 0:18:45.440 when you're meeting via telehealth, but again there are resources 0:18:45.480 --> 0:18:50.199 to turn to because telehealth has been rolled out, you know, 0:18:50.240 --> 0:18:53.960 and becoming used more and more, especially for rural populations 0:18:54.000 --> 0:18:57.000 and things like that, over the past few years. So yeah, 0:18:57.040 --> 0:18:59.960 I would say again, I would just say that flexibility 0:19:00.080 --> 0:19:02.800 has been really important and sort of trying to meet 0:19:02.880 --> 0:19:05.560 the needs of our patients as best we can, despite 0:19:05.600 --> 0:19:08.000 the current events and the limitations that are being put 0:19:08.040 --> 0:19:10.760 on us, and maybe some of the reasons why it's 0:19:10.800 --> 0:19:12.879 maybe not best to meet in person. 0:19:14.480 --> 0:19:19.280 Yeah, so we've heard a lot from our listeners, our 0:19:19.320 --> 0:19:22.199 friends and family. You guys brought up a lot of 0:19:22.240 --> 0:19:26.040 the different stressors and anxieties that people have been feeling. 0:19:26.600 --> 0:19:28.880 Aaron and I I can speak for us both right 0:19:28.960 --> 0:19:34.080 erin Oh, Yeah, we've both we've both been really feeling 0:19:34.080 --> 0:19:38.000 this as well too. A lot of the fear, the apprehension, 0:19:38.080 --> 0:19:42.920 the anxiety about all of this uncertainty. Even us even 0:19:42.960 --> 0:19:46.840 though we kind of, you know, know about the fact 0:19:46.880 --> 0:19:50.359 that these sorts of pandemics could potentially happen, it's still 0:19:50.480 --> 0:19:54.280 so unknown is what is going to happen. So could 0:19:54.320 --> 0:19:56.200 you talk a little bit about some of the coping 0:19:56.240 --> 0:19:59.359 strategies that we could all use to try and deal 0:19:59.400 --> 0:20:01.960 with some of the issues that we're facing, like the 0:20:02.040 --> 0:20:06.520 social isolation, the empathy, fatigue, and all of this anxiety 0:20:06.520 --> 0:20:07.320 about the future. 0:20:08.480 --> 0:20:11.560 Yeah, absolutely, I think there's a there's a lot we 0:20:11.600 --> 0:20:13.520 could cover here. So I'm gonna I'm gonna cover some 0:20:13.560 --> 0:20:16.400 things up front, and then Rosie's gonna take over from there. 0:20:17.080 --> 0:20:20.320 So the first place I would start out is just 0:20:20.359 --> 0:20:24.840 to really emphasize the importance of normalizing and validating some 0:20:24.880 --> 0:20:28.280 of these negative emotional responses and feelings that are coming up, 0:20:29.000 --> 0:20:31.200 as you're saying, with the levels of uncertainty that we have, 0:20:32.080 --> 0:20:33.760 how little we know about how this is going to 0:20:33.920 --> 0:20:36.040 progress and what kind of what the actual level of 0:20:36.080 --> 0:20:40.000 threat is, as well as those kind of socioeconomic stressors 0:20:40.000 --> 0:20:42.679 that come along with the health risks. You know, stress 0:20:42.680 --> 0:20:45.920 and anxiety are certainly to be expected here, and it's 0:20:45.960 --> 0:20:48.160 not a sign, you know, if you're experiencing elevated stress 0:20:48.200 --> 0:20:50.840 and anxiety right now, it's not a sign that something 0:20:50.960 --> 0:20:54.160 is kind of fundamentally wrong with you. Those feelings are 0:20:54.200 --> 0:20:56.959 are normal given this context, and there might be some 0:20:57.000 --> 0:20:59.640 comfort in just kind of reminding yourself of that when 0:20:59.640 --> 0:21:01.800 you notice these feelings coming up in a more intense 0:21:01.840 --> 0:21:04.240 way than maybe you've been used to in the past, 0:21:04.840 --> 0:21:07.280 and then to really kind of validate them, like the 0:21:07.320 --> 0:21:09.399 feelings aren't coming out of nowhere right like there is 0:21:09.440 --> 0:21:12.040 an actual threat out there. There is actual kind of 0:21:12.040 --> 0:21:15.159 bona fide uncertainty and unpredictability out there, and that's what 0:21:15.200 --> 0:21:18.080 these emotions are really responding to and that's the way 0:21:18.119 --> 0:21:22.360 they're supposed to function. And so these emotional responses, even 0:21:22.400 --> 0:21:26.080 though they can be unpleasant, oftentimes they actually have real 0:21:26.520 --> 0:21:31.080 value to us. Anxiety and worry, again certainly can be unpleasant, 0:21:31.119 --> 0:21:33.919 but it can also help motivate us to prepare and 0:21:34.080 --> 0:21:38.000 protect ourselves and our families. Key thing I would also 0:21:38.119 --> 0:21:41.080 mention here is while it's important to validate and normalize 0:21:41.080 --> 0:21:43.680 these feelings and kind of accept them that they're kind 0:21:43.680 --> 0:21:46.520 of part of our experience for now, given the situation 0:21:46.640 --> 0:21:49.359 that we're in, I think it's also important to be 0:21:49.400 --> 0:21:54.280 on the lookout for unhelpful thoughts and unhelpful behaviors. So 0:21:54.320 --> 0:21:56.879 you can ask yourself, is what I'm going to do 0:21:57.000 --> 0:21:59.480 or what I'm doing, is this actually useful or helpful 0:21:59.520 --> 0:22:03.080 or affect for me right now? One of the key 0:22:03.080 --> 0:22:06.199 things that we talk about is distinguishing between helpful and 0:22:06.400 --> 0:22:10.160 unhelpful worry. So most people are probably worrying a lot 0:22:10.240 --> 0:22:13.959 right now, to the extent that that worry and anxiety 0:22:14.040 --> 0:22:18.440 actually leads to active problem solving and adaptive coping strategies. 0:22:19.119 --> 0:22:21.919 That worry is actually useful and it can be helpful 0:22:21.960 --> 0:22:24.000 to kind of lean into that and act on the 0:22:24.119 --> 0:22:27.800 urges that come along with it. However, worry can also 0:22:27.880 --> 0:22:30.879 be taken to an extreme, and worry can kind of 0:22:31.200 --> 0:22:33.879 it can go beyond actually helping us take constructive action, 0:22:34.440 --> 0:22:37.360 and it can start to become more just self perpetuating. 0:22:37.800 --> 0:22:40.280 So I would say that worry that leads to rumination 0:22:40.680 --> 0:22:44.400 or the sense of spinning, or generally just to more 0:22:44.440 --> 0:22:49.880 anxiety and more worry without producing concrete helpful behaviors, that's 0:22:49.920 --> 0:22:52.359 not going to be so helpful. So when we notice 0:22:52.400 --> 0:22:54.760 that kind of worry coming up, it can be helpful 0:22:54.760 --> 0:22:58.880 to engage in some strategies to limit it. That might be, 0:22:59.000 --> 0:23:02.159 you know, limiting your new user media consumption so you 0:23:02.440 --> 0:23:04.399 don't necessarily want to be spending all day kind of 0:23:04.440 --> 0:23:07.040 scanning the news, especially if you're not actually gaining any 0:23:07.119 --> 0:23:10.679 new or more useful information than you had before. You 0:23:10.720 --> 0:23:15.159 might just be perpetuating that anxiety or making it worse. Similarly, 0:23:15.240 --> 0:23:16.919 I think when you are seeing out information, you want 0:23:16.960 --> 0:23:19.879 to make sure that you're actually seeking out reputable, trust 0:23:19.920 --> 0:23:23.560 trustworthy information so that you can actually act in the 0:23:23.600 --> 0:23:28.320 appropriate way. Might be just kind of distracting yourself if 0:23:28.400 --> 0:23:31.080 need be, uh, you know, preferably with something enjoyable like 0:23:31.119 --> 0:23:33.080 a book or a show or a movie, or maybe 0:23:33.119 --> 0:23:36.920 you know, video chatting with a friend. But certainly distraction 0:23:37.040 --> 0:23:39.840 can be a useful tool when we find ourselves hooked 0:23:39.920 --> 0:23:44.240 in this kind of cycle of unhelpful worry. And also 0:23:44.280 --> 0:23:47.520 mentioned it's probably helpful to be aware of some of 0:23:47.560 --> 0:23:52.120