Most of us are feeling the effects of COVID-19. We might be working remotely from home or working on-site and worrying about the risk of exposure. We might be overwhelmed with information about the virus and concerned about paying bills and other financial difficulties. We might have lost jobs or know someone who has COVID-19.
And we don’t know how long the pandemic will last.
All of this uncertainty can cause a tremendous amount of stress and anxiety, so it is imperative that we care for our mental health during this time, said Dr. John Burkhardt, a psychologist at University Medical Center. He said there are mental health care exercises people can do that can help them cope.
As we see a return to social activities and people getting together, how can people deal with the mental strain of being safe?
“This pandemic has caused a lot of uncertainty and ambiguity, and that drives our anxieties and our fears,” Burkhardt said. He said when working with patients, he talks with them about their plans and their concerns, and about hygiene and other safety behaviors to practice during COVID-19. “By providing these anchoring behaviors, they feel at least they have some control over a situation that we all know is not completely in control as of yet. It lets them know, ‘Here’s what I’m going to do, and here’s how I’m going to go about my business.’ And if something happens, then we can talk about a backup plan.”
Are there exercises you can do for mental health?
Mindfulness is an exercise you can do, “and it’s about an awareness and being in the present,” Burkhardt said. Other exercises include deep breathing and progressive muscle relaxation. “Even good old-fashioned exercise is good for your mental health because it gives you a chance not to think about it (COVID-19), at least for a while.”
What is progressive muscle relaxation and how would you do that?
Burkhardt said he typically uses a script and serves as a guide while the patient listens and responds. He starts with the feet and moves up through the body, although you can start at different areas. Or it can be simpler, such as clenching your fists and holding for a count of five and then letting go or clenching your toes for a count of five and then wiggling them and letting them go. He recalled a patient who suffered from anxiety, and when she got anxious, she scrunched her toes. “If you think about it, you’re tightening your muscles and it’s carrying all the way up from your feet and into your body. It’s adding to that anxiety. So, for her, when she got in those moments, she had to make sure to wiggle her toes.”
Can progressive muscle relations be helpful with sleep? When someone is anxious, I imagine trying to fall asleep can be a problem.
Actually, Burkhardt encourages patients to practice progressive muscle relaxation in the morning, as a way to get focused for the day. He recommends that when people wake up, they should to sit in a chair, preferably one with arms where they can rest their arms and hands, place their feet on the floor, set a timer for a minute or two and close their eyes and breathe. “Pay attention to your breathing and don’t worry about anything else or any thoughts you have. You’re just watching everything float away, down a stream. You’ll notice tension that you have, but it’s also relaxing. And, just like anything else, if you do it every day, you get really good at it and it becomes very beneficial,” he said. Burkhardt said if you practice this only when you’re under stress or duress it can be effective “but not to the same level because it’s a skill you have to practice.”
It’s almost like muscle exercise, where you get muscle memory, but this time the muscle is in your head.
“Exactly,” Burkhardt said. “The more you do it, the more you let go of your thoughts and just focus more and more on your breathing and how your body is feeling, it becomes so much easier.” And then that one or two minutes you initially set doesn’t feel long enough, he said.
During this time, people might be feeling guilt – because they didn’t get sick but maybe they knew somebody who got sick, or they are working and know people who aren’t working and having difficulty financially. How do you address that?
“A lot of the time what happens is their guilt is not that I’m well and you’re sick; it’s more like, I want to go see you and I can’t. So, we talk about that. If you don’t have the option of seeing that person, what other things can you do?” Burkhardt said. He suggested calling the person on the phone or talking to them via FaceTime. If that person is in the hospital, send a note or card with someone who is allowed to see them at the hospital. “If you’re religious minded, could you pray for that person? Could you ask your church membership to pray for that person?” Burkhardt said. He said all of these methods seem to be effective.
What about the feeling of isolation? How do you help patients cope with that?
Burkhardt said when patients talk about isolation, “depression becomes this really big term that comes up.” A way to cope with that, he said, is by maintaining a daily routine. Burkhardt said there has been research done that focused on Italians in lockdown when that country was facing the brunt of COVID-19. What researchers found was that boredom was the emotion most often reported. “We’re all thinking it is depression and sadness because that’s what we hear. But they found that boredom was the first and one of the most reported emotions people were having.” Burkhardt said boredom can also be a sign of depression, “if you have it long enough and you start accumulating other symptoms. So, here you have this benign symptom, boredom, but if you’re experiencing it day after day, now you have depression, so you always need to have a routine, to help break that up.” He said as human beings, we are social. “Being connected and being in society is part of being a human being. We hear a lot now about social connectedness, whether it’s calling, texting, emailing, FaceTime or Zooming. People use Facebook and Instagram and all kinds of ways to connect with people. I think the study of boredom is an interested connected piece because I think that’s what happens to a lot of folks.”
When do things get past the ability to adapt? What’s the point when someone should say, ‘I really should call for help?’
“Symptoms always have a way of sneaking up,” Burkhardt said. He said people should be aware if they are having difficulty functioning in big areas of their lives, and that will depend on age. It can be school, work, home and their personal lives. “They start struggling in one area, and that’s not too bad. Then they’re struggling in two areas and you’re seeing more symptoms. When you get to three areas, you’re obviously seeing more symptoms. If you backtrack over things, you start to understand the timeline.” Burkhardt said a key symptom he looks for is when it becomes hard for people to do things they used to like to do and that they enjoyed. “If you’re not interested, or you’re too tired, and that wasn’t an issue before, those are the things you start to take notice of. The hardest thing for people is that symptoms don’t just happen all at once. If feels like they do by the time they come to see the doctor, but it’s small progressions of things that happen.”
For people working remotely from home now, how can they manage screen time and turn off work because it’s always there and emails are always coming?
“What we’re inherently talking about is how can I recreate my old normal workday to what I have now,” Burkhardt said. “First, you have to think about what the day looks like. What time do you start? You want to take lunch like you normally would. And then at the end of the day you leave your work.” He said some people might miss commuting and that time to themselves. If that’s the case, he encourages people to simulate a commute. “If you need that time, you could get into your car, drive to work, and then turn around and drive home and walk into your house as if you are home from work. Or you could walk around the block. Another important thing to do at the end of the day is to close the door to your home office; you’re done for the day.” He said there have been more articles these days about Zoom fatigue, and people should be aware of that when scheduling work meetings and avoid scheduling meetings back-to-back. “When I’m seeing someone in clinic, I get up from my desk, walk to the waiting room and we walk back to my office. It’s only a few minutes, but I got up and I moved around a little bit. Just giving yourself a chance to stretch becomes really important, especially because you can sit in Zoom meetings for six or eight hours without moving, because you’re just clicking in. So, having some time set in in between meetings is helpful, even if it’s just a couple minutes to get up and move.”
One of the thing psychologists and psychiatrists are using more is telehealth and telemedicine. How does a patient prepare for a telehealth visit?
Burkhardt said patients should: select a communication mode, such as Zoom, FaceTime or phone; chose a comfortable place where they can have privacy while they talk and that has a strong internet signal; and, if there are certain things the patient wants to talk about, he or she can have a list. He said he’s had patients who have talked from their cars, or a park. “I’ve even had someone out in the middle of a lake, paddling a boat,” he said. “What you’re looking for is a place of privacy, where you can’t be overheard and where you are comfortable. It’s no different than if you showed up at University Medical Center and you’re in my office.”
Do you think telemedicine is the future of psychology?
“I hope it’s at least a bigger part than it has been,” Burkhardt said. “I have folks that don’t mind zooming, but lately it’s been more like, ‘When am I going to be able to come back in and see you?’ But for folks who can’t drive here (to UMC) or who maybe don’t have transportation or are in rural areas, it would that be great to keep telemedicine around for them because we could reach so many more people.”
Have you seen any resistance to telemedicine visits?
Burkhardt said he hasn’t. He said patients are accepting of telemedicine visits and after a couple of sessions are comfortable with it. “People are wonderfully adaptive. It’s what makes this so great.” He said ironically, he has noticed that some of his younger patients prefer to talk by phone. “You would assume that with video such a normal part of their lives, they would use FaceTime. But I just talk to them on the phone. And some of my older patients, all they want to do is Zoom. It’s not what you would think would happen.”