The COVID-19 pandemic has raised concern among mental health care professionals worldwide in regards to how containment protocols, increasing death rates, and further social isolation procedures may negatively affect our mental health. A wave of new mental health disorders may indeed be on the way, especially as COVID-19 cases increase and our global economic downturn deepens. Research on how COVID-19 negatively affects our mental well-being is still somewhat preliminary, which makes it hard to determine whether the pandemic will in fact increase our rate of clinical diagnoses, such as anxiety or depression.
However, it is important to note that the longer people experience sustained levels of psychological distress, the more likely they are to present with diagnoses that would benefit from treatment. Resilience to high degrees of chronic stress and feelings of isolation may develop, yet can potentially transform into more lasting conditions, such as chronic stress or even chronic pain. As we continue to psychologically navigate the effects of this pandemic, it is becoming important to consider what treatments, practices, and interventions that may aid in optimizing our well-being and sustaining our resiliency to psychological stressors during this turbulent time.
An American health survey published in the journal JAMA led by Dr. Emma E. McGinty found that among a nationally representative sample of 1,468 adults, 14% of people had high levels of psychological distress, compared with an average of 4% during the pre-COVID era; researchers also found little difference in respondents’ feelings of loneliness, compared to averages before the pandemic.
It is known from previous pandemics and viral spreads that public health crises effect the mental health, safety, and well-being of both individuals and communities. These effects can lead to psychiatric conditions, unhealthy behaviors (for example, excessive substance use), and noncompliance with public health directives. Early-stage research indicates that emotional distress and increased psychiatric illness associated with the COVID-19 pandemic has stemmed from uncertain prognoses of those effected, testing and treatment resource shortages, financial losses, and conflicting messages from health care authorities. As a part of the pandemic response, both health care providers as well as the public have an important role in addressing these emotional outcomes.
After crises, people can in fact become resilient and find new psycho-affective strengths. However, those who may be more susceptible than others to the psychosocial effects of pandemics (such as the elderly and people with preexisting medical conditions) may become susceptible to a plethora of mental health conditions such as trauma, depression, or anxiety. Health care providers are also particularly vulnerable to psychological distress due to longer working hours caring for the infected and ongoing involvement in emotionally demanding decisions which can all lead to burnout.
Home-confinement directives have led to stress, depression, irritability, insomnia, anger, and frustration — all of which have shown to persist well after quarantine procedures are lifted. Even though health care workers and affected individuals are motivated to comply with quarantine regulations in order to reduce risk of infecting others, emotional distress can cause some to consider violating these orders. Health care providers who typically treat COVID-19 cases have little to no mental health training and therefore cannot provide the required care needed to appropriately provide suggestions for stress management and coping to patients, such as structured daily activates and maintaining routines.
A perspective article published in The New England Journal of Medicine by Dr. Betty Pfefferbaum and Dr. Carol S. North describes how the mental health and emergency management communities should work together “ … to identify, develop, and disseminate evidence-based resources related to disaster mental health, mental health triage and referral … as well as bereavement care.” It was concluded that mental health care for patients and health care professionals directly affected by the COVID-19 epidemic has been largely under-addressed.
Dr. Richard A. Friedman, a psychiatrist and contributing opinion writer for The New York Times, published an opinion article, in which he suggests that we shouldn’t pathologize normal unpleasant emotions during the pandemic. Friedman questions the conclusion that the pandemic is causing dramatically increased rates of clinical depression and anxiety which he claims to be mostly based from a handful of mental health surveys. Self-report data is notoriously poor at predicting whether people actually meet diagnostic criteria for mental illness which is strictly based on clinical observations. Common feelings people experience during these times include boredom and listlessness and use the word “depressed” loosely to describe myriad negative mental states, such as anxiety, restlessness, frustration, and suppressed anger.
In this respect, feelings, such as boredom, are normal emotional reactions that shouldn’t be conflated with serious mental illness conditions like depression, even though it should still be addressed. It is important not to pathologize normal negative affect yet we must be careful not to belittle the serious negative effects of low-grade stress, anxiety, unhappiness, and boredom — such conditions may in fact develop into something much more serious over time and impede on the immediate functioning of emotional regulatory skills.
A study published in the journal Psychiatry by Dr. Jacob Meyer and colleagues found that no longer being physically active along with increased screen time following COVID-19-related restrictions are associated with worse current mental health. Physical activity among those who were previously active before the pandemic was reduced by 32.3%; self-isolation or quarantine was strongly associated with higher depressive and anxiety symptoms compared to social distancing.
Dr. Julio Torales and colleagues published a review article published in the International Journal of Social Psychiatry, which concluded that the outbreak is leading to additional health problems, such as stress, anxiety, depressive symptoms, and insomnia on a global scale. Collective concerns in regard to outbreak rates, deaths, and shutdowns influence daily behaviors, economy, prevention strategies, and decision-making from policymakers.
The authors believe that the current focus on the transmission of COVID-19 infection all over the world may be distracting the public’s attention away from acknowledging the psychosocial consequences. They emphasize that emerging mental health issues may evolve into long-lasting health problems and isolation. This conclusion places emphasis on raising the public’s awareness of what psychophysiological interventions can be explored that can mitigate the effects of stress, anxiety, and depression and inform health care professionals how they can be optimally delivered during quarantine times.
Dr. Ravi Philip Rajkumar published a review in the Asian Journal of Psychiatry that emphasizes what has been proposed in other papers in regard to six roles health care professionals can take when addressing mental health within the population at this time: education of the public about the common psychological effects of a pandemic; motivating the public to adopt strategies for disease prevention and health promotion; integrating their services with available health care; teaching problem-solving strategies to cope with the current crisis; empowering patients with COVID-19 and their caregivers; and provision of mental health care to health care workers.
A paper published in The Lancet by Dr. Emily Holmes and colleagues states how digital psychological interventions that are mechanistically based, alongside a better understanding of the buffering effects of social relationships during stressful events, are recommended in the long term.
A multitude of research indicates that in addition to limiting screen-time (especially relevant for home office users), regular physical activity throughout the week, whether it be in the form of weight training or endurance training, such as jogging, can decrease anxiety, depression, and increase self-report goal-oriented behavior, positive outlook, and wakefulness.
But training is not solely body-based but can also be in the form of mental training regimens, such as meditation, breathwork, and yoga. During quarantine times when many fitness centers as well as private mental health clinics can be closed, both guided physical fitness regimen programs as well as mental health professional services can be accessed online via public domain or encrypted telemedicine services.
I have thoroughly investigated the efficacy of yoga for the aging brain, including contemplative practices like meditation, for amplifying neurovisceral integration between the heart and the brain — and the efficacy of remote online-based telemedicine programs for anxiety and depression. If we are to reflect upon these subjects and their relevant findings, efficacy seems to be somewhat reliant on the particular technique, the needs of the individual (user or client), dosage (practice frequency and engagement), as well as means of delivery (the expertise of the interventionist or therapist).
Not all yoga techniques and mindfulness practices are able to sufficiently decrease anxiety and negative affect; certain telemedicine programs lack easy user ability and professional input; and meta-analytic reviews have determined that most smartphone-based meditation apps lack long-term clinical efficacy. This makes it especially important for health care providers during this time to promote and evaluate mental health treatment programs that are not only effective but also effective in their means of delivery. This is especially true for individuals who have prior health conditions and cannot make it to clinics due to quarantine regulations and shutdowns.
Establishing a schedule where time and attention is invested in not only protecting the face and mouth with face masks but also the heart and mind with attentional training, creative thinking, and physical exercise is important during these turbulent times. It is natural for us to feel helplessness, anger, grief, and confusion and to know that they are not always personal but a part of our humanity.
As a specialist in integrative mind-body medicine, I work with my patients and clients in person and digitally to be in touch with their vulnerability, to use awareness to face the anger, confusion, and fear — and to explore these sensations with tenderness. There is a way to meet our degree of isolation, become sensitive to daily bouts of stress, and work through our pains — even when it does not meet the criteria of a clinical diagnosis.
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