December 1st, 2014

Epidemics: psychologists urge vigilance

Mary Beth Kilinski, Psy.D., a private practitioner in Cranston, R.I. thinks people in this geographic area may not perceive Ebola as a near-enough threat.

Government officials attired in hazmat suits; dead bodies under blankets; hospital personnel wearing facemasks, gowns and head coverings – images like these have flashed across the front pages of newspapers and television screens across the country since word of the devastating Ebola epidemic in West Africa broke. Once the illness arrived in the United States, news stories became personal for some individuals. But psychologists urge watchfulness, rather than panic, when it comes to the possibility of an extensive outbreak.

An Oct. 14 poll conducted by the Kaiser Family Foundation reports that 73 percent of Americans believe that Ebola will be limited to a small number of cases in this country, while 22 percent anticipate a more widespread outbreak. In spite of these statistics, certain segments of the population harbor fears of contracting the illness.

Carol R. Hevia, Psy.D., clinical psychologist in the Obsessive Compulsive Disorder Institute at McLean Hospital, treats patients who carry an OCD diagnosis. While most of her clients have not yet expressed concern over Ebola, she explains that some of them become anxious about any illness and require a somewhat “counter-intuitive” approach.

“People without OCD can look at managing stress and will hear your reassurances. But for someone with OCD, the more you reassure them, the more anxious they get. Their brains function differently,” she says. “They overreact and think they are at more risk than they actually are.”

Furthermore, patients with OCD operate under the rubric of “What if?” These individuals see possibility in every situation, regardless of probability, Hevia adds. “People with OCD are driving for one hundred percent certainty.”
Regardless of the trigger, interventions for those with OCD include exposure and response prevention, says Hevia. “We need to remove what they do to lower anxiety. Rituals artificially reduce worry and become reinforcing.”

For Mary Beth Kilinski, Psy.D., private practitioner in Cranston, R.I. who treats adolescents and adults with anxiety, restoring balance in perspective is the key to reducing symptoms. She notes that anxiety can be an average and expected response to everyday stressors, but deciding when something crosses over into a disorder involves measuring the subjective levels of distress a person experiences, as anxiety occurs along a continuum.

Typically anxiety is a response to the perception of threat to physical or emotional well-being. Kilinski says, “What triggers one person to experience anxiety does not necessarily trigger another.” In terms of Ebola, she reports she has not heard clients speaking much on the topic as a trigger and thinks people in this geographic area may not perceive Ebola as a near-enough threat. “If they do feel significant anxiety about the outbreak, they likely have a history with another experience of feeling helpless and the Ebola outbreak is a trigger for them.”

To reduce anxiety, regardless of trigger, Kilinski recommends a balanced diet, restorative sleep and adequate exercise as a first line of defense. Adding cognitive behavioral therapy helps to target cognitive distortions and restructure and rebalance thoughts. “Thought filters can create and maintain anxiety symptoms,” Kilinski says. “When [clients] recognize the relationship between thoughts and anxiety, they realize there may be another way to look at the situation.”

In addition to CBT, Kilinski primarily offers clients psychodynamic therapy, formulating anxiety as an emotion secondary to other painful emotions such as anger or sadness. “By asking clients to identify and experience primary painful emotions in the context of the therapeutic relationship, the anxiety no longer needs to act as a protective barrier and can subside,” she says.

Individuals who have been victims of violence may re-experience a past trauma when watching news of Ebola cases, says Barbara Hamm, Psy.D., clinical psychologist and director of Cambridge Health Alliance’s Victims of Violence Program.

When it comes to concerns over Ebola, Hamm says that acknowledging the individual’s fearfulness is important. But, she adds, it’s also important to explain that government agencies are trying to address the issue by working on creating an antidote and developing treatment protocols. She reports that people with a history of victimization feel that no one listens to them, that their views are irrational and minimized.

“When you listen, acknowledge and give information, people tend to settle down. If not, something else is underneath their fears. You have to get to the stressor that is real in their life,” Hamm says.

Media coverage plays such a critical role in fueling fear and anxiety, according to Hamm. “They have a different agenda, that is, to increase viewership. They get people rattled by repeating visual images ad nauseam. This creates a hypnotic trance. It’s not about news, it’s about ratings,” she says. “People need to know it’s okay not to watch. Re-exposure could lead to re-traumatization. You should pace your viewing and know that you can control the information.”

Anxious people are easily agitated by scary things, mistakenly equating them with being in danger, according to Dawn Huebner, Ph.D., private practitioner in Exeter, N.H. and author of “What to Do When You Worry Too Much.” “Anxious people have a lower tolerance for doubt, so any possibility of contracting Ebola is cause for major concern. If it could happen, it will happen,” she says.

Huebner treats patients 12 years and younger and cautions that children are perceptive to parents’ feelings and fears and take their cues from them. Fear occurs on an explicit level, as well as at a subtle level, she notes. To alleviate these fears, parents should gauge what children know and correct any misconceptions. “Give basic information calmly. Acknowledge that Ebola is a serious disease that makes people very, very sick. If your child already knows people can die from Ebola, acknowledge that, too,” she says, but point out that few people in this country have contracted the disease.

Huebner emphasizes that being afraid is not the same as being in danger. “We need to listen to the facts rather than our fears. Shifting away from fear messages and toward concrete steps people can take to help those affected would help,” she says, adding that having a positive role to play can make both children and adults feel better. “Families might decide to make a charitable donation to a non-profit, send caring thoughts out into the universe, pray or find some other way to help.”

By Phyllis Hanlon

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