Tag Archives: covid-19

What I Learned

I was recently interviewed for a piece on mental health for VerywellMind about things I have learned from the pandemic.

The question was:
As both one who is living through this and helping others live through this, what are the lessons that most come to mind for you?

Seven things I learned from the Pandemic
1. There was no ‘Normal.’
We say, I wish we could return to normal, I miss the old days. When will things go back?
The old days weren’t so great. We have seen businesses go under, people who were barely getting by already go over the precipice, huge upticks in mental health and substance abuse problems, how separated and isolated people feel, and how difficult it is to ask for and receive support. I believe The greatest lesson of these times is the absolute necessity for a paradigm shift. The concept of a paradigm shift, originally based in physics, refers to a major change in the worldview, concepts, and practices of how something works or is accomplished. Recently, people have sometimes referred to it in employment terms as the Pivot.  Why return to a supposed normal that never worked, completely fell apart under duress, neglected the vulnerable, and is certainly not equipped to address any future challenges?

2. Nothing is more important than connection.
People have deeply hungered for love, touch, intimacy, and affection during these difficult times. It is an essential part of being human. Those who felt most isolated suffered the most challenges to their mental health. I recently wrote a piece about loneliness as a marker of danger to mental and physical health. A recent study equated deep-rooted loneliness as the equivalent of smoking chronically, with regard to the impact on longevity and wellness.

It’s literally a killer.

3. Mindfulness matters.
Groundhog Day happens. Over and over again, I have heard people say they have lost track of time. ’It feels like it’s going by so slowly, and yet so quickly’. Each day can feel the same. Learning mindfulness strategies anchors our perception of reality. We cannot live in a blur, and it’s very easy to succumb to that. Before we know it, it’s September 2021. Also see this helpful post on a mindfulness practice.

4. Pain cannot be avoided.
We can numb our feelings of fear, resentment, anxiety, grief, and terrifying uncertainty. They are still there. How to cope without being overwhelmed requires numerous strategies. I was sent a photograph from a recent trash recycling day in DC, where house after house was lined up with dozens of empty bottles; liquor, wine, beer, soft drinks. Our pain is honorable and a marker of experience. It’s not going to go away just because we want to anesthetize.

5. Looking after your health is absolutely essential.
Health care that is consistent in the middle of chaos is one of the hardest things to do. When you’re just trying to juggle bills, care for children and family, deal with virtual learning, work from home, metabolize constant health alerts and daily fears, confront financial hardship and job changes, and combat isolation and ennui, survival needs take over. Self-care often goes on the back burner. And yet, it is the absolute foundation.

6. It takes community.
In previous work, I have referred to the pandemic as the ultimate #compassionproject. In short, thinking about ourselves and our immediate circle has never worked, is not working now, and will not work in the future. Only if we pull together with our amazing range of strengths, talents, skills, and vulnerabilities, are we going to make it through.

7. Creativity can thrive under fire
I have seen innovation, creativity, flexing, and hustle like never before. In line with number six, above, I have seen projects large and small making the world a better place. Resolve, Love, and Hardwork are unbeatable.

Love and Boundaries: Coping With the Holidays

The holidays are upon us, which usually means family and friends.

Either way, in the current state of the world you’re bound to have someone in your life who is just not taking the virus (and the precautions to slow the spread of it) seriously. And while you might feel like you have to avoid them or cut them out of your life until the pandemic is over, there are a few things you can try before resorting to more extreme measures.

Since this is a problem all too many of us (myself included) are dealing with, I was recently asked by the Virginia Psychological Association to give advice on how to manage this stressful dynamic. What should you do, when people around you are not taking the virus seriously? Please also see my article on cognitive dissonance which discusses why it’s hard for many people to change their mind. 

Set boundaries.
Remember that setting boundaries is essential for your mental and physical well-being. You can set boundaries around everything from what you will talk about and engage with, to what you are willing to physically do with someone who is not taking things seriously. Setting a boundary with family members and loved ones may feel uncomfortable at first but it is a healthy way to let others know what they can expect from you. When you let friends and family members know your expectations, it’s likely they will feel confused or even upset or angry at first. But it’s important to communicate your needs and expectations in a way that is respectful but firm.

If you don’t want to spend time around people who don’t wear masks in public, tell that person that you really value them in your life and want to spend time with them, but in order to continue doing that you either need them to wear a mask or you’ll only connect with them over Zoom or FaceTime call if they won’t. Or, if you live with family members who aren’t wearing masks in public, tell them you will keep your distance from them (to the extent you can) while you are both at home.

You can only control yourself, you can’t control others, so establishing those boundaries helps to protect your mental health and reduce your stress. You don’t have to take responsibility for educating family members on safety measures, and you can take that energy and time and use it for self-care activities such as exercise, breath work, meditation, sleep, walking outdoors.

Try to avoid getting angry or using critical language when you bring up concerns. I have one patient who has told me that when he sees people without a mask, he becomes enraged. He, and his parents, with whom he resides, have underlying vulnerable health issues, and the apparent selfishness of others not wearing a mask makes him incredibly angry. Unfortunately, people don’t listen to you when you’re angry. Leave out the criticism in your conversations.

In sum, it’s not your responsibility to educate your family members, friends, significant others, or roommates on safety measures. But if you do want to share information with them or discuss safety measures, you can do so in a way that communicates your concern without criticism.

When speaking with a loved family member about concerns such as COVID, it is always best to start from a place of love and support. Ask what you can do to help instead of criticize. When was the last time you felt like doing something someone asked if it was delivered in a tone that was condescending or negative?

It’s much better to say, may I buy you a cute mask, instead of: You’re going to die or kill someone, if you don’t wear a mask. I personally have several really pretty masks that have been made for me by clients who are talented, in addition to my regular PPE.

It’s also helpful to use “I” statements when communicating with friends and family, so they understand where you are coming from. For instance, saying – Hey, I am worried about your health, and so I don’t want to potentially expose you to the virus if I come over, or “Hey, I’d love to come to your baby shower or wedding, but I don’t want to take the risk that I might get you or someone else sick.

Remember, that some people are resistant to change. So know when it’s time to stop pushing them. It isn’t your job to preach to others about what they should be doing; you can only control what you are doing. With that in mind, if you still are not comfortable with how your family or friends are dealing with things, you can respectfully decline to spend time with them physically until things are better.

It IS your duty to protect yourself and your health and well-being. Let them know what you are and aren’t comfortable with, and if that’s a Zoom call instead of an in-person dinner party, tell them. If they really respect you and want to spend time with you, they will do what it takes to see you, even if it’s not IRL.
I’m heading to a zoom baby shower for my niece tomorrow, please be safe.

Happy Thanksgiving week.

Cognitive Dissonance and Mental Health

Cognitive Dissonance is the motivational mechanism that underlies the reluctance to admit mistakes or accept scientific findings even when those findings can save our lives. The cognitive dissonance theory, most strongly developed by social psychologist Leon Festinger, states that many people are deeply unwilling to change their minds. Similarly, many find it impossible to admit to or apologize for inappropriate behavior.

This dynamic is playing out during the pandemic among the many people who refuse to wear masks or practice social distancing. Cognitive dissonance causes feelings of unease and tension, and people attempt to relieve this discomfort or anxiety in different ways. Examples include “explaining things away” or rejecting new information that conflicts with their existing beliefs.

When the facts clash with preexisting convictions, some people would sooner jeopardize their health and everyone else’s than accept new information or admit to being wrong. This clearly manifests itself in the echo chamber of social media and the comment sections, I’m right, you’re wrong, it is someone else’s fault, vaccines are a government hoax, and so forth.

Coping with the nuances of contradictory ideas or experiences is mentally stressful. It requires energy and effort to sit with seemingly opposite things that are non binary. Festinger, in his research, argued that some people would inevitably resolve dissonance by blindly believing whatever they wanted to believe.

Although it’s difficult, changing our minds is not impossible and nor should it be. We need to accept that science and data is fluid. As is life. Mental flexibility is painful, and dealing with uncertainty even more so.
The end result is dissonance, but the actual problem is uncertainty and the stress it causes; we crave certainty because it feels safe. Rarely have we as a society been in a time of such uncertainty, and in times of uncertainty our survival instinct drives us to crave certainty.

Regardless of inherent beliefs, it is important to recognize dissonance and recognize that we need to continue to work on flexibility. In short, we need to cultivate curiosity and accept that something we thought to be true might have been right at the time, but wrong now. Don’t try to explain away problems or reject new information; rather, accept that uncertainty exists and understand that we are in uncharted territory.

As we head toward the fall and into the winter season, I am consistently hearing from my patients and local businesses that uncertainty is their biggest challenge. This manifests itself with individuals as well, and data from mental health providers shows an increase in both substance abuse and clinical depression/suicidal ideation. Most mental and medical health providers are at capacity with a 30-40% increase from last year and with long wait times to get an appointment.

It takes great courage to recognize that it is not COVID, it is not mask ordinances or future vaccines, and it is not government or international conspiracies that are our greatest challenge; rather, it is the inherent anxiety and stress that uncertainty causes. Admitting we are wrong requires some mental flexibility, which involves living with dissonance for a while rather than jumping immediately to conclusions.

COVID-19 and Neuropsychology

My practice in my company offices includes very strict protocols, including daily housekeeping services, using Covid approved cleaning products. I use two full office suites, so that cleaning can be happening in between every single patient. I have created a large garden with seating areas and beautiful flowers so that anyone who accompanies a patient can be seated outdoors, if they choose. I own copious amounts of hand sanitizer. We have been blessed with beautiful weather here in the Washington DC area, and often I meet outdoors with my patients. I have masks, bottled water service, and I wear PPE while working.

On COVID-19 infection and mental and cognitive health: In addition to mood disorders, common symptoms include fatigue, headaches, memory loss and problems with attention. There may be a number of reasons for these brain changes, including inflammation and cerebrovascular events (describes a syndrome caused by disruption of blood supply to the brain).

Research suggests that the virus may gain access to the brain via the forebrain’s olfactory bulb, which is important for the processing of smell. Loss of smell, as well known, is a symptom in many patients with COVID-19.

As part of the system responsible for your sense of smell, the olfactory bulb sends information about smell to be further processed in other brain regions including the amygdala, orbitofrontal cortex and the hippocampus, all which play a major role in emotion, learning and memory.

As well as having extensive connections to other brain regions, the olfactory bulb is rich in the chemical dopamine, which is important for pleasure, taste, intimacy, motivation and action. It may be that COVID-19 alters the levels of dopamine and other chemicals, such as serotonin and acetylcholine, in the brain, but we can’t say for sure yet. All these chemicals are known to be involved in attention, learning, memory and mood. It doesn’t matter if people get sick and supposedly recover. We know empirically that both HIV and Lyme disease have a strong effect on the brain and functioning. The effects of COVID may also be very long lasting, based on emerging neuropsychological research.

Photo, Washington, DC Arboretum, 2019.
(statistics, courtesy of the Lancet medical journal and Embolden Psychology). 

Mental health and Corona

Prior to the COVID-19 pandemic, nearly one in five of U.S. adults (47 million) reported having a mental illness in the past year, and over 11 million had a serious mental illness, which frequently results in functional impairment and limits life activities. Please remember that these are only the reported numbers, because many people do not seek help or endorse symptoms.

The COVID-19 pandemic and the resulting economic recession have negatively affected many people’s mental health and created new barriers for people already suffering from mental illness and substance use disorders, who were previously substantial in number. In polls conducted in mid-July, 53% of adults in the United States reported that their mental health has been negatively impacted due to worry and stress over the coronavirus. This is significantly higher than the 32% reported in March. Many adults are also reporting specific negative impacts on their mental health and wellbeing, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus. As the pandemic wears on, ongoing and necessary public health measures expose many people to experiencing situations linked to poor mental health outcomes, such as isolation, health worries, evictions, and job loss.

Some takeaways:
A broad body of research links social isolation and loneliness to poor mental health, and data from late March shows that significantly higher shares of people who were sheltering in place (47%) reported negative mental health effects resulting from worry or stress related to coronavirus. In particular, isolation and loneliness during the pandemic may present specific mental health risks for households with adolescents and for older adults. The share of older adults (ages 65 and up) reporting negative mental health impacts has very significantly increased since March. Polling data shows that women with children under the age of 18 are more likely to report major negative mental health impacts than their male counterparts.

Research also shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide. Recent polling data shows that more than half of the people who lost income or employment reported negative mental health impacts from worry or stress over coronavirus; and lower income people reported much higher rates of major negative mental health impacts compared to higher income people.

Poor mental health due to burnout among front-line workers and increased anxiety or mental illness among those with poor physical health are also concerns. Those with mental illness and substance use disorders pre-pandemic, and those newly affected, will likely require mental health and substance use services. The pandemic spotlights both existing and new barriers to accessing mental health and substance use disorder services.

In my practice, many people do not have access to consistent Wi-Fi or Internet service. During this unprecedented time of uncertainty and fear, it is likely that mental health issues and substance use disorders among people with these conditions will be exacerbated.

Embolden remains dedicated to providing access and services for medical professionals and front line personnel. The long-term effects that we are experiencing cannot be minimized.

Executive functioning and COVID-19

Many of you are excellent teachers, and probably didn’t know it. I’m a clinical psychologist of 23 years with a neural science background, and I have worked with children and teens every one of those years. I have literally met and spoken in detail with thousands of children and families. They are MY teachers.

When you show your kids that they, and you, don’t wear masks, don’t social distance, hang out in public places, pick fun over health, and disregard safety of others,  you are teaching LOTS. 

  • Rules don’t apply to you.
  • Impulse control doesn’t matter, do what YOU wanna do.
  • Being uncomfortable, physically or emotionally, is just too hard.
  • Fun before safety.
  • Others don’t matter, it’s about you.
  • You are healthy right now, so why worry. 
  • Emerging research doesn’t matter; it’s changing anyway, so it’s irrelevant.
  • Uncertainty is unbearable.
  • Everyone else is doing it, so why not.

Unfortunately, children with their developing frontal lobes do not apply these rules, which are aspects of executive functioning, to a single situation. They are generalized and integrated at the neuronal level. They are learning, growing beings.

[“But Doctor, Junior will not follow basic household rules. They only think about themselves. And she goes out every weekend and does risky things. It’s so frustrating.”]

Um. 

Obviously, there are many families working hard, and I mean hard, to keep others and themselves safe. I know it’s not easy, I hear from you every day. Big respect. There are also creative solutions. May you all have a healthy summer and fall.

On pandemic and homeschooling

Several of my local school systems as well as private schools in my work in Maryland, Virginia, and Washington DC have made it known that they are going to have a very limited schedule or no in vivo teaching this fall.

I work with many parents and educators. It’s been an incredibly difficult process, since March, to parent, work from home, do home schooling, manage health concerns, and still try to have quality of life and self care.

I have the deepest respect for the challenges involved. But it’s essential to help children feel safe, keep healthy routines, manage their behavior and build resilience.

Here are some tips to help your children feel safe.
– Address children’s fears directly
Children rely on their parents for safety, both physical and emotional. Reassure your children that you are there for them and that your family will get through this together.

-Answer questions about the pandemic simply & honestly. Talk with children about any frightening news they hear or see. It is OK to say people are getting sick or passing, but say following rules like hand washing and staying home will help your family stay healthy. Explain to them why they may not be able to see their friends easily in a calm fashion. Making things seem like they are falsely positive it’s not helpful for children, because they will know that there is something wrong

-Recognize your child’s feelings. Calmly say, for example, “I can see that you are upset because you can’t have your friends over.” Guiding questions can help older children and teens work through issues. (“I know it is disappointing not to be able to hang with your friends easily right now. How do you think you can stay in touch with them?”)

-Keep in touch with loved ones, friends, and family. Children may also worry about a grandparent or family member who is living alone or a relative or friend with an increased risk of getting COVID-19. Video chats can help ease their anxiety

-Model how to manage feelings. Dr. Siddique calls this emotion coaching. Just like a coach can help you be a better athlete or student, emotions also require practice, feedback, and implementation.

Talk through how you are managing your own feelings. (“I am worried about Grandma or Auntie, since I can’t go visit her. The best I can do is to check in with her more often by phone. I will put a reminder on my phone to call her in the morning and the afternoon until this outbreak ends.”

-Acknowledge compromises. Yes, working from home is hard. I have to make a lot of adjustments. I know mommy is in the study all the time. It’s like being at the office but now it’s here at home. Sometimes when I’m here in the house, I can’t always talk to you. But we will have our time later.

-Tell your child before you leave the house for work or essential errands. In a calm and reassuring voice, tell them where you are going, how long you will be gone, when you will return, and that you are taking steps to stay safe. More than ever, communication matters.

-Look forward with realistic optimism. Tell them that scientists are working hard to figure out how to help people who get ill, and that things will get better.

-Offer extra hugs and say “I love you” more often. Being affectionate matters.

-Keep healthy routines
During the pandemic, it is more important than ever to maintain bedtime and other routines. They create a sense of order to the day that offers reassurance in a very uncertain time. All children, including teens, benefit from routines that are predictable yet flexible enough to meet individual needs. go to bed within a certain time range and wake up at the same time. Model that unfortunate times do not have to create chaos.

-Structure. With the usual routines thrown off, establish new daily schedules. Break up schoolwork and chores when possible. Older children and teens can help with schedules, but they should follow a general order, such as:
Wake-up routines, getting dressed, breakfast and some active play in the morning, followed by quiet play and snack to transition into schoolwork.
Lunch, chores, exercise, some online social time with friends, and then homework in the afternoon.

-As recommended by Dr. Siddique: Fun, food, and family time before bed.
Chat, play, read, or watch a great show. How you complete the day sets the stage for the next one.

-Avoid any physical punishment. Per pediatric research: Spanking, hitting, and other forms of physical or “corporal” punishment risks injury and isn’t effective in any scientific study. Physical punishment can increase aggression in children over time, fails to teach them to behave or practice self-control, and can even interfere with normal brain development. Corporal punishment may take away a child’s sense of safety and security at home, which are especially needed now. They can also manifest and difficult or unhealthy relationships in the future, because people who love you can hurt you.

-Neuropsychology research: Embolden reminds parents and caregivers never to shake or jerk a child, which could cause permanent injuries and disabilities and even result in death.

-Self care. Caregivers also should be sure to take care of themselves physically: eat healthy, exercise, and get enough sleep. Find ways to decompress and take breaks. If more than one parent is home, take turns watching the children, if possible.

Ten strategies to cope with anxiety about COVID-19

In my upcoming book, Fight/Flight/Flow, I discuss the importance of anxiety. Anxiety is a natural human reaction that involves mind and body. It serves an important basic survival function: Anxiety is an alarm system that is activated whenever a person perceives danger or threat. Anxiety is both in the mind, or cognitive; and in the body, in the form of physical symptoms.

When the body and mind react to danger or threat, a person feels physical sensations of anxiety — things like a faster heartbeat and breathing, insomnia, tense muscles, sweaty palms, a queasy stomach, and trembling hands or legs. These sensations are part of the body’s fight-flight response. The fight response can make us angry and irritable. The flight response can make us avoidant and isolated. These are caused by a rush of adrenaline, cortisol, and other chemicals that prepare the body to make a quick getaway from danger. They can be mild or extreme.

My psychotherapy for anxiety involves what I call the flow response. It’s hunkering in place, but not in a passive way. It’s observing, holding, and waiting. It’s like floating in water. You’re still in it, but you’re not thrashing about.

The fight-flight response happens instantly when a person senses a threat. It takes a few seconds longer for the thinking part of the brain (the prefrontal cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. If the cortex sends the all-clear signal, the fight-flight response is deactivated and the nervous system can start to relax. If the mind reasons that a threat might last, feelings of anxiety might linger, keeping the person alert. Physical sensations such as rapid, shallow breathing; a pounding heart; tense muscles; insomnia; gastrointestinal problems; choking sensation; trembling; and sweaty palms might continue, too. Lastly, anxiety is curvilinear. A little bit of it can motivate us to problem solve and take action. A lot can immobilize and sicken us.

Tips to manage anxiety during these challenging times:

1. Sense of community.
Being there for and with others lessens our solitary load. From virtual exercise classes, virtual classrooms, volunteering, and zoom cocktail hours, feeling connected decreases anxiety. We are social creatures, and separating has been very difficult for many.

2. The spiritual life.
From meditation and yoga, to a peaceful walk in nature, a personal home altar, or faith based activities, these pastimes help reduce our panic and sense of fear.

3. The foundations of self-care.
Keeping to good sleep hygiene habits, nutritious meals, and daily exercise. All three of these are potent medicine.

4. Reflect don’t react.
There are many choices within our control even when we feel out of control. Dr. Victor Frankl, who was incarcerated in a concentration camp and wrote “Man’s Search for Meaning,” stated everything can be taken from a man but one thing, the last of the human freedoms, to choose one’s attitude in any given set of circumstances, to choose one’s own way of being.

5. Place stones across the river.
This is my method that I teach to patients, that consists of piecing together the small moments that make each day meaningful and significant. Speaking with a great friend, playing or cuddling with your companion animal, enjoying the beauty of the spring time, having the perfect cup of coffee, taking a moment to connect with others online, listening to your favorite music. These seemingly insignificant things become a powerful gestalt when they are pieced together, and help make our brains create hopeful pathways.

6. You are not your day.
If you have a day where nothing feels hopeful, or an even an hour of despair, it does not define you. It will pass. Remind yourself of the times that you persevered through catastrophic times. Reboot. You can even make self statement index cards and read them to yourself. Remind yourself that this too shall pass.

7. Disconnect.
Sleep, rest your body, turn off the screens, don’t read the news. We can stay in formed but we can also inundate our brain with information and misinformation.

8. Question.
Not everything you read in the news or the Internet is accurate. Similarly, when we are having anxiety or depression, our brain is a trickster that tells us misinformation. We can learn to refute it.

9. Schedule.
Keep to a routine as much as possible. This should include the aforementioned exercises, meal prep and planning, sleep, work, outdoor time, social media time, and downtime.

10. Breath-work and grounding.
Strategies that I teach individuals with anxiety disorders can be used by anyone, you can take them with you anywhere. Using the power of your breathing, close your eyes, take a deep breath in through your nose, and exhale slowly through your mouth. Repeat. And again. Similarly, you can ground your body by progressive muscle relaxation, this is a series of moments of tightening and releasing your muscles starting at your feet and working all the way up to the top of your head. For example, clench your feet hold for five seconds, and release. Continue to your legs, and so on. There are many guided strategies on the Calm App or HeadSpace, on Apple and android, that can help you practice these methods.

If you feel that anxiety is trying to take over your life, please seek professional support. Embolden offices are now offering free 30 minute sessions to first responders.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.