Mental Health an Emerging Crisis of COVID Pandemic
Americans are reporting high levels of emotional distress from the coronavirus pandemic -- levels that some experts warn may lead to a national mental health crisis.
“Our society is definitely in a collective state of trauma,” said Jonathan Porteus, PhD, a licensed clinical psychologist who oversees the crisis and suicide hotline in Sacramento, CA. Unlike posttraumatic stress disorder, which surfaces after a trauma has ended, the country is only starting to grapple with the pandemic’s psychological fallout, he said.
“We do see an emerging potential crisis,” said Karestan Koenen, PhD, a professor of psychiatric epidemiology at Harvard’s T.H. Chan School of Public Health, during an online forum this week.
Another recent report, released Friday from the Well Being Trust, said the pandemic could lead to 75,000 additional “deaths of despair” from drug and alcohol misuse and suicide due to unemployment, social isolation, and fears about the virus.
A recent poll of more than 3,100 WebMD readers found that 26% said they felt a sense of trauma from COVID-19.
Koenen, who has studied other major disasters, sees problematic differences this time, including how long-lasting the pandemic may become and how it has affected the whole world.
“We know that social support is so important to buffer the effects of disasters, to help pull people out of disasters, and here, we see that because of physical distancing … we’re sort of robbed of some of that social support, so that’s extra-challenging.
“In terms of this specific situation, we’re really treading new ground.”
Mental Health’s First Responders
At the nation’s crisis and suicide hotlines, counselors are seeing the first waves of emotional distress. Callers have flooded the phone lines to talk about health fears, job losses, relationship strains, and lonely days spent in isolation.
Calls to the Sacramento crisis line increased 40% from February to March, according to Porteus, the CEO of WellSpace Health, which operates the hotline. In a year-to-year comparison, April’s call volume was 58% greater than in April 2019, he said.
Lauren Ochs, MA, a counselor who takes crisis calls in St. Louis, MO, has also talked to many more people since the pandemic started, averaging 25-35 calls during her 8-hour shifts, she said. “About 80% to 85% at least mention COVID. That might not be their primary problem, but some way, somehow, they’re affected by it.”
Calls also have risen significantly at the San Diego Access and Crisis Line in California, said Program Manager Heather Aston.
“We’ve seen an increase in more anxiety-driven calls,” Aston said. Some people are worried about COVID-like symptoms. “They want to know where can they go to get safely tested.” Others are concerned about family members. One woman called for advice on how to help a sister who had stopped eating and drinking and was having paranoid thoughts about COVID-19, Aston said.
In a recent opinion piece published in the Journal of the American Medical Association, Sandro Galea, MD, MPH, DrPH, a professor at the Boston University School of Public Health, warned of an upcoming wave of mental disorders because of coronavirus.
He noted that “large-scale disasters, whether traumatic (the World Trade Center attacks or mass shootings), natural (hurricanes), or environmental (Deepwater Horizon oil spill), are almost always accompanied by increases in depression, posttraumatic stress disorder (PTSD), substance use disorder, a broad range of other mental and behavioral disorders, domestic violence, and child abuse."
The COVID-19 pandemic would likely produce a similar “overflow of mental illness,” he said.
He cited examples:
The mental health effects can happen immediately and last over time, he wrote.
The pandemic also comes at a time when people already struggled to get mental health care, often due to cost, lack of access, and a shortage of providers. As people who had been getting help before stay-at-home orders found their care interrupted, some providers have begun to offer telehealth services.
Charles Jones, the CEO of MDLive, a large telehealth provider, told MedCity News that his company has seen increased demand for behavioral health services from patients who are stressed out about health or work issues. Cigna, one of the largest providers of mental health services, launched a toll-free, 24-hour help line for the public to speak to behavioral health specialists.
From isolation to anxiety to excess drinking, coronavirus has touched almost every area of life, said Lan Nguyen, a suicide and crisis services program manager for the hotline in Santa Clara County in Northern California.
For many callers, community shutdowns have bred a deep sense of isolation, he said. “People complain that they are stuck in the house all day. They don’t know what to do.”
On the home front, relationships can be strained, Porteus said. “Families are kind of a tinderbox, especially in confined areas.” Children may now face a greater risk of abuse, especially since they can no longer find respite at school. “There are a lot of family dynamics that are not healthy, and now kids have to be in them full-time,” he said.
The same goes for victims of domestic violence, according to Porteus. “People can’t get out of their homes, so they’re more enmeshed with the perpetrators than ever before.”
The St. Louis hotline has heard from many struggling health care workers and others, Ochs said. “I recently talked with an eighth-grade teacher who was in a lot of emotional distress about the school year ending early,” Ochs said. “I don’t think any teacher was really prepared for the school year to just stop.” Not only was he grieving the abrupt loss of his students, but he had little chance to say good-bye. “He was a teacher in a high-poverty area, so it’s hard to reach out to [his students]. It’s hard to Zoom with them, it’s hard to make contact with them.”
Those who have lost jobs or been furloughed have called about financial worries, according to Nguyen.
Besides the financial impact, losing a job can be emotionally devastating, Porteus said. “Our identity is really hit and sometimes, it feels catastrophic. Many of the people who are calling don’t know who they’ve become. They’ve lost what they feel is everything, and they’ve also lost their social context.”
Recently, the San Diego hotline helped one older man who had called in about losing his job as a chef, Aston said. “He had roughly $20 in his checking account and he was suicidal.”
Intense stressors like job loss and fears for one’s life and health can contribute to substance abuse. The Sacramento hotline also has gotten more calls from people struggling with alcohol or substance problems, Porteus said. Overall, alcohol sales have gone up nationwide, and now, some restaurants will deliver alcohol with takeout food orders.
“One thing [counselors] are noticing, especially with older adults, is ‘Yeah, I’m drinking. Why not? I’m not going anywhere. I don’t have to drive. I don’t have all the normal constraints while I’m around people,’” Porteus said.
At a time when coronavirus efforts have battered many state budgets, it could be difficult to fund future mental health services. But some experts are looking ahead.
In his JAMA article, Galea wrote: “Scaling up treatment in the midst of crisis will take creative thinking.” He suggested training lay people to provide psychological first aid, as well as “helping teach the lay public to check in with one another and provide support. Even small signs that someone cares could make a difference in the early stages of social isolation.”
He also advocated for more telemedicine mental health visits.
In its report, the Well Being Trust urged policy makers to consider three areas to combat mental health issues:
“If the country continues to ignore the collateral damage -- specifically our nation’s mental health -- we will not come out of this stronger,” said Benjamin F. Miller, PsyD, chief strategy officer at Well Being Trust.
Even if an epidemic of mental illness is looming, counselors say that people are resilient and can strive to protect their emotional well-being.
Experts offered these tips:
When people are in crisis, he said, it’s helpful to go online to learn about “distress tolerance” skills, which involve accepting that some problems are beyond one’s control. Instead of becoming mired in feelings of unfairness and anger, people can learn healthier ways of thinking and coping when they can’t escape painful situations.
For those who have lost jobs, he suggests looking up interest inventories -- questionnaires that ask you to rate your enjoyment and interest in a wide variety of activities -- to explore career options. “You can figure out the kinds of things that you’re good at and start getting a sense of what your next steps might be."
Taking constructive steps can help to counteract a downward spiral, he said.
“People look at the pandemic and they tend to be drawn to the negative. If we can help shift people to look at the positive, it really helps because we know that neurons that fire together wire together,” Aston said. “We’re going to be able to see the positive more quickly.”
Shared from WebMD
Katherine Kam wrote this story while participating in the USC Center for Health Journalism‘s 2020 California Fellowship.
WebMD Health News Reviewed by Michael W. Smith, MD on May 08, 2020
Acceptance & Mindfulness
Take a moment to think of the last difficult situation you were in.
Did you say statements like “this isn’t fair”, “it should not be this way”, or “why me”?
What emotions did you have during this time?
Now think about the statements above. What emotions do you feel when you think of these?
Perhaps frustration, anger, sadness, or feelings of being stuck. Wishing things were not the way there were creates a lot of difficult emotions. Our mind often travels to the past of what was and then spirals to future anxiety of what is to be. We begin to ping-pong from the past to future and lose touch with the present.
When we push back against reality, we are choosing not to accept the present moment. When we do not accept the present moment, we create more pain.
Leaning into Acceptance…
No one wants to experience pain.
If you take a look at our society…we tend to avoid pain at all costs. One way to avoid it is to wish the present situation was not happening.
The irony behind this method of avoidance is that we are actually creating more pain for ourselves.
When we push back on the reality of the present moment…we create more pain.
When we refuse to accept the truth of a situation, we deny the present. When we deny the present, we are disconnected and feel both the pain from the situation AND the pain from wishing it was different.
This not to discount the pain that comes from a difficult situation. Rather, acceptance invites us to acknowledge the truth rather than staying stuck in wishing it was not this way. Failure to accept the present moment as is can cause a greater intensity of emotional pain.
…And How Mindfulness Can Help Us Do This
Mindfulness has become quite the buzz word in our culture along with many different ideas of what the practice is. Jon Kabat-Zinn, Founder of Mindfulness-Based Stress Reduction, provides us this definition:
“The awareness that arises from paying attention, on purpose, in the present moment and non-judgmentally” (Kabat-Zinn, 2015)
Simply put— mindfulness is to experience the present moment fully awake.
This means we are not ruminating in the past nor letting the mind wander to the what ifs of the future. We are fully embracing the present moment for what it is.
Pay attention to where our thoughts wander…are you in the past or future? Or are we fully in the present moment?
What is the story we are telling ourselves? When we begin to live awake in the present moment and accept what is, we can lessen painful experiences.
Acceptance ≠ “I Agree”
Let me confirm that true acceptance DOES NOT mean agreement. It is extremely difficult to accept a situation that is painful AND we can choose to accept the present moment.
True acceptance does not mean agreement. We can both disagree with a circumstance and agree that it is reality.
When painful experiences happen in our life it is human to wish circumstances were different. It is when we lean into full acceptance of the current situation that we arrive to freedom.
While we cannot discount the pain and difficulty a situation may bring us…there is freedom in acknowledging the reality.
It is when we push back at the present moment when circumstances become more painful.
Once we fully acceptance the present moment for what is it we can then navigate the new reality.
Bringing awareness to your thoughts on the situation – what is the story you are telling yourself? Start by noticing your thoughts. When they wander to “this is not fair” or “I can’t deal with this”, acknowledge them nonjudgmentally.
We Have a Choice
It takes a LOT of energy to fight reality. Acceptance can place us in control of our emotions. Acceptance AND mindfulness of the present moment gives us freedom.
Life can guarantee pain. It is our choice how we respond to it.
Acceptance gives us the ability to be mindful in the present moment. When embracing acceptance accompanied by mindfulness of our thoughts and feelings…pain is lessened.
Over the years, the words “trauma” and “Trauma Informed Care” have been used in various settings, including outpatient and inpatient. The sole purpose is to bring attention to the providers of a potential trauma history with the patient/client/family, so that the provider can respond accordingly. Recently, “Trauma Responsive Care” has been added to the mix, but to an outsider it may sound similar, if not the exact same as the other phrases being used. So what is “Trauma Responsive Care” exactly?
Trauma Responsive Care has many components to it, so it’s best to break it down to the basics. This particular certification is offered through Finding Hope Consulting, LLC, which is a local consulting firm that specializes in Trauma Informed and Trauma Responsive trainings for professionals in various fields. The certification series utilizes neuroscience and resilience based interventions to rebuild neuronal networks that have been damaged by trauma and to assist people in healing from their trauma in order to lead resilient lives.
Mary Vicario is a Certified Trauma Specialist and founder of Finding Hope Consulting, LLC. She put together a curriculum that is based upon the ACEs (Adverse Childhood Experiences study) and included research from leading scientists in the field, including Drs. Bessel van der Kolk (author of The Body Keeps the Score), Gabor Mate (author of In the Realm of Hungry Ghosts: Close Encounters with Addiction), Dan Siegel, Louis Cozolino, Pat Ogden, Sandra Bloom, Stephen Porges and others.
What are ACEs and why are they so important? I’m glad you asked! As stated above, ACE stands for “Adverse Childhood Experiences” and laid the groundwork for the links between trauma in childhood and medical conditions, psychiatric problems, addiction, and/or other unsafe behaviors later in life. The study actually happened quite serendipitously; it resulted from a researcher (Vincent Felitti, head of Kaiser Permanente’s Department of Preventive Medicine in San Diego) noticing that about half of the participants in a weight loss program dropped out, despite being successful in losing weight. Upon further investigation, he noticed that a number of the participants also endured childhood sexual abuse. He conducted interviews with participants in this program and was able to uncover more links between childhood abuse and the various outcomes listed above. The results were remarkable. According to the CDC, the questions referred to the experiences that the respondents had during their first 18 years of life. They include emotional abuse, physical abuse, sexual abuse, mother being treated violently, substance abuse in the household, mental illness in the household, divorce/separation of parents, a member of the household being incarcerated, emotional neglect and physical neglect (https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html).
The results of the study found that ACEs are frequent: according to the CDC website, “almost two thirds of the study participants reported at least one ACE and more than one in five reported three or more ACEs.” The research and its findings were officially published in 1998.
The study showed that the more ACEs that someone reported, the higher the risk of having co-occurring medical and psychiatric issues and behavioral problems. Problems such as chronic illnesses (cancer, diabetes), risky behaviors (alcohol and drug abuse), bodily injuries (TBI, fractures, burns), mental health issues (depression, anxiety, suicide, PTSD), maternal health issues (unintended pregnancies, pregnancy complications, fetal death), and infectious diseases (HIV,STDs)are some examples.
ccording to the TRCC handbook, research has identified additional stressors that could play a role in a person’s mental and physical development. These are called Compounding Adverse Toxic Stressors or CATS. These include poverty, war/community violence, witness to or experiencing violence (includes seeing abuse of siblings), bullying, homelessness, early childhood intrusive surgeries and discrimination (Garner et al, 2012). Some additional statistics show the affects of ACES without resilience based experiences to offset them (Vicario, 2019). They include:
Building upon this research and utilizing the need of “felt safety”, we begin to redefine what safety is and how someone can identify it within themselves. We also utilize techniques that assist the client in feeling safe in unpredictable situations, identifying Vagus Nerve responses and calming techniques, education surrounding the Limbic System and its purpose, and rebuilding their lives. This task is no small undertaking, but with validation and support from the appropriate people, healing can be a reality.
If you or someone you know is struggling with the effects of trauma, depression, anxiety or any other related issues, feel free to schedule an appointment with me! I’m happy to utilize TRCC interventions or any other interventions that will assist in ensuring your success.
You’re here because you are curious about EMDR therapy and you want to know what it’s all about. As a therapist, I’ve learned many types of therapy that have positively changed the way I approach my practice, EMDR incorporates all that and so much more. For many years, I heard from respected clinicians about the incredible changes they have seen in their clients engaged in EMDR therapy. The therapy has gained recent momentum in the mental health world, and for good reason. EMDR is empirically validated as effective for helping people deal with trauma. It has also been shown effective with many other disruptive symptoms such as anxiety, depression, panic attacks, and addiction recovery. Think of your painful memories, thoughts, images, like a tangled ball of yarn, often complicated to talk through especially when the strings are intertwined. EMDR therapy can help to untangle the yarn and allow you to process one string at a time, in a safe contained way. EMDR therapy can accelerate the therapeutic process by resolving painful past traumas allowing you to live more fully in the present. And who doesn’t want to live in the present?
Why am I telling you about EMDR?
I was trained by Dr. Stephen Dansiger, a certified EMDR therapist from the Institute of Creative Mindfulness. I experienced a life changing shift when he himself demonstrated the 8 phases of treatment on me. Keep reading and I will tell you more about these 8 phases later. During my experience I felt a relief, something years of talk therapy had not been able to process for a long time. As a clinician, I feel passionate about giving as many people the opportunity to learn about and benefit from this treatment as possible.
But what is EMDR therapy?
EMDR stands for Eye Movement Desensitization and Reprocessing. Don’t worry, it is way less complicated than it sounds. It is a non-drug, non-hypnosis, psychotherapy that combines many positive elements of numerous therapies along with left/right brain stimulation (known as bilateral stimulation), developed by Dr. Francine Shapiro in the 1980’s. EMDR therapy involves a trained therapist waving their fingers from left to right (some therapists use a light bar to achieve this part of the therapy), in a windshield wiper motion, which will trigger the brain to bring up the painful memories in an effort to process them and speed up the healing process. All of this is done in a safe environment with you and your therapist present. You are not alone in the processing of your memories. The therapist will also work to reprocess negative beliefs, images, and feelings and replace them with more positive ones. The outcome is the feeling of resolution and a more peaceful state overall. EMDR therapy has successfully treated millions of people of all ages, has gained notability with veterans of war as a primary treatment modality for Posttraumatic Stress Disorder, but also many types of other traumatic stress and negative symptoms that come along with different experiences.
You’re probably wondering how simple “finger wipers” do all that? Interestingly enough the “finger waving” is key to the therapy. It engages something called bilateral stimulation (right to left eye movement), which repeatedly activates the opposite sides of the brain. This releases emotional experiences that are "trapped" in the nervous system. When this happens it assists the neurophysiological system, the basis of the mind-body connection, to free itself of blockages and begin to heal. In a basic sense, when a person experiences an adverse event, or trauma, the brain cannot process the event as it does normally. The brain instead takes this event and stores it, sort of like “I’ll get to this later”. Unfortunately, the “I’ll get to this later” never quite happens and essentially these adverse feelings, memories, and thoughts become “stuck” in an isolated memory network. They can easily become re-triggered by sound, smell, feelings, and environments that were activated during the traumatic event. EMDR therapy is able to guide the person in a safe, contained environment to “unstick” the memories, reprocess them, and replace them with more positive images. Once this happens,the person can begin to move forward with healing.
Who is the best candidate for EMDR?
EMDR therapy is for children, adolescents, and adults. If you or a loved one has ever experienced panic attacks, complicated grief, dissociative disorders, pain disorders, anxiety, performance anxiety, depression, addictions, phobias, sexual and/or physical abuse, body dysmorphic disorder, and personality disorders.
**It is important to note that a consultation with a EMDR trained therapist is the best way to determine if EMDR is right for you.
EMDR therapy has been designated by the American Psychiatric Association, U.S. Department of Defense, and the International Society for Traumatic Stress Studies, as a highly effective and empirically supported treatment modality for the treatment of Posttraumatic Stress Disorder (PTSD).
What happens in EMDR Therapy sessions?
EMDR therapy has a standardized set of protocols that a therapist will follow. There are 8 phases to the treatment, that are moved through at a varying pace depending on your readiness for the next stage. An EMDR therapist is trained to know appropriate pacing but you can determine whether to continue or stop at anytime. The therapist is there as a guide to help you get the most out of the experience, and at times may gently aide in pushing you through painful moments.
Why bring up painful memories? Isn’t it best to forget them and move on?
By avoiding the painful memory you might continue to experience the lasting effects of the event, through nightmares, stress, anxiety, and panic attacks. By holding onto these memories you stop yourself from moving on. The problem with avoidance, or ignoring these memories, is that it is a temporary relief. For a brief moment it allows you to feel better and put aside the pain, but it doesn’t remove it, and worse, it allows it to keep its power over you and your joy. Often, this painful memory rears its ugly head at times when we are not prepared and leaves us crippled by its effects. EMDR therapy is not just bringing up painful memories, its moving through them in a safe, contained way. It alleviates suffering, and replaces it with positivity.
What happens when I’m done with all 8 phases?
After the 8 phases you will likely continue to process the material for days, weeks, or perhaps even months. You might have new insights, vivid dreams, feel angry or numb with no real answer why. This is because your are finally processing the unpleasant memories you were holding onto for so long. Your therapist will guide you through this process and advise best practices for moving forward. Some people feel a slight buzzing all over their body, similar to the feeling of when they stand up too fast. Don’t worry, this will soon fade. Your right and left hemisphere are stimulated by the finger waving motion and it is only natural that you will feel something afterwards. Often times, after a person has processed one of their target issues they will notice that some of the other target issues, are no longer are troubling them. This is because our memory networks are linked in ways we aren't consciously aware of. Its normal to cry, feel tired, need time to be alone, or feel a little “off” because your body is starting the healing process. Allow it to heal.
So this all sounds like something I might want to try. What do I do now?
I would be more than happy to help you in your journey to healing! You can call our main office at 513.939.0300 and ask the office staff to schedule an appointment with Jennifer Burns for an EMDR session. I am currently taking new clients and would love to meet you.
Where can I find more information on EMDR?
EMDR International Association
The Institute for Creative Mindfulness
U.S. Department of Veterans Affairs: National Center for PTSD