Dealing with ongoing stress

By Catherine Robertson Souter
March 30th, 2022
Bullis Jacqueline
Jacqueline Bullis, Ph.D, assistant neuroscientist for the Division of Depression and Anxiety Disorders at McLean Hospital

How psychologists can help patients and themselves

Remember the week everything shut down? As we approach the two-year anniversary of the designation of COVID-19 as a global pandemic, there are still so many unknowns, things to worry about. Is the Omicron variant fading away? Will another variant rise to take its place?

As we have normalized the adjustments we’ve made in our daily lives — wearing masks, avoiding physical contact, reducing travel, etc.– many of us have also normalized the heightened levels of distress we feel.

An undercurrent of anxiety runs beneath everything we do, from visiting with elderly parents to deciding whether to attend an indoor function to making health decisions for our families.

In February 2021, the Kaiser Family Foundation published a report that found that 40 percent of adults in the U.S. had experienced symptoms of anxiety or depression since the start of the pandemic, up about 10 percent from the previous year.

“We need to learn to tolerate that anxiety in a way that is new for us. Be explicit when talking to clients about what avoidance may be reasonable and what might just be increasing anxiety.” -- Jacqueline Bullis, Ph.D, assistant neuroscientist, Division of Depression and Anxiety Disorders, McLean Hospital

“It is really important to address because anxiety and depression combined are potentially the most debilitating mental disorders at a population level,” said David Tolin, Ph.D., ABPP, director of the Anxiety Disorders Center and of the Center for Cognitive Behavioral Therapy at the Institute of Living in Hartford. “At an individual level, schizophrenia is more debilitating but the sheer numbers of people experiencing anxiety and depression means there is an awful lot of impairment out there.”

After the past two years, even those who may not have presented with symptoms of depression and anxiety should be screened.

“We have been living with unprecedented levels of anxiety and fear for two years,” said Jacqueline Bullis, Ph.D, assistant neuroscientist for the Division of Depression and Anxiety Disorders at McLean Hospital. “Everyone is more vulnerable.”

So how does a therapist help?

“The process should start before we get to therapy,” said Tolin. “Anxiety and depression are not always screened in primary care settings which is a shame because they are the gatekeepers to all forms of health care.”

That said, the gold standard of treatment for anxiety and depression, Tolin added, is cognitive behavioral therapy (CBT).

“I do think it is important for all psychologists to have a working understanding of CBT,” he said. “The evidence base is so great that it really is incumbent on psychologists to learn the best available treatments. But if a therapist does not have time or does not want to learn CBT, they can refer a client on to someone who can provide the patient the care they need.”

Of course, it can be tricky for therapists to use some CBT tools during a pandemic.

“During therapy, we focus identifying patterns of avoidance and encouraging patients to face those situations,” said Bullis. “That is complicated with COVID because we are told to avoid certain situations to stay safe.”

Shifting guidelines around best practices for avoiding infection have not helped, from whether to wear masks to the best types of masks to wear, and can lead to greater anxiety and cause people to want to shut down completely rather than expose themselves or their families.

“We need to learn to tolerate that anxiety in a way that is new for us,” said Bullis. “Be explicit when talking to clients about what avoidance may be reasonable and what might just be increasing anxiety.”

Help clients to assess the “worst case scenarios,” she added, to have them understand that most likely they will not end up in the hospital or die (if vaccinated, of course!) It is also important to have compassion for oneself if an undesired outcome does occur.

“Instead of beating myself up, I will say that I made the best choice at the time where I worked to align my decisions with my values,” she said.

News fatigue and doomsday scrolling can add to the distress, Bullis added. Work with patients to assess how much research is necessary for making smart decisions versus just getting into a negative spiral.

“After you watch the news or you read Twitter feed or Facebook,” she said, “how are you feeling? Does it make you feel connected to humanity because you see that others are struggling in similar ways or do you feel more lonely and anxious?”

Of course, therapists must be able to take their own medicine and, like with that airline oxygen mask, practice self-care before helping others. Burnout among professionals is real and we still do not know how long before we return to “normal,” if that ever happens. Taking time to get outside, getting plenty of sleep, eating well and exercising are all key for those providing the care as well.

“Make sure you are doing things you need to do,” said Bullis. “It may be easier said than done, but we need to keep trying. This is a really tough time.”

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