The Other Looming Crisis: How Covid-19 is Impacting Our Mental Health
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Some of my patients with OCD diagnoses are doing really well—almost better than my own family members or friends who haven’t had any kind of cognitive training with regards to leaning into anxiety and uncertainty—because of their learned ability to embrace uncertainty.
Ashley Annestedt, Licensed Clinical Social Worker (LCSW) & Expert in OCD and Tourette Syndrome
On top of the obvious risks that the coronavirus pandemic poses to physical health, it also presents a more latent threat to mental health. For anyone, the combination of fear of contracting the virus, worries about the future, and the disruption to daily routines is enough to bring on anxiety and depression.
But for people with pre-existing mental disorders, the fear and uncertainty that comes with living during a pandemic can turn their already challenging reality into a living nightmare. We know this not only from anecdotal accounts but also from studies on previous epidemics like SARS and MERS, which caused people with certain mental illnesses to be more prone to relapses, defaulting on medications, stress, poor self-care, and suicidality.
Ashley Annestedt, a licensed clinical social worker (LCSW) who specializes in OCD, Tourette’s, and related neurobehavioral disorders, shared how her patients have been faring during the pandemic.
“When it comes to OCD, those who had previous fears of contamination and health-related issues are struggling with increased symptoms as a result of the pandemic,” she said.
The media’s constant repetition of the importance of hygienic measures pushes a button that triggers many sufferers to fall into repetitive behaviors, like obsessive cleaning and handwashing. In normal circumstances, trying to resist compulsions can be extremely difficult for sufferers, but when authority figures and the news media are promoting safe practices that are incidentally obsessive-compulsive, it can be near impossible.
“These days, it can be difficult to tell which of my panic attacks are ‘reasonable’ and which ones are just an extension of my OCD,” a reporter for healthline.com wrote in a personal account of his experience over the past few months.
Among people with Tourette syndrome, which affects about 0.5 percent of people, rising stress and anxiety caused by the pandemic may have increased the urge to express their tics. Some become so overwhelmed with these compulsions that they have trouble going about their daily routines and completing daily tasks.
An ABC News Australia article features two personal accounts from people with the syndrome. One boy named Remi said he has been obsessively washing his hands, jumping, spinning in circles, and repeatedly touching objects. Tics can also include involuntary coughing, clearing one’s throat, repeating phrases, pulling hair, or touching objects repeatedly.
“I started to stress out so much more—the tics, anxiety, it all just built up,” Remi said. “It is so overwhelming. If someone says, ‘Don’t touch that,’ I would have to touch it. You have to let it out and once you let it out, it’s like satisfaction: you have to keep on doing it and it doesn’t stop.”
“Especially for those with coughing and sniffing tics, as you can imagine, they are unfortunately faced with, for lack of a better word, the ignorance of others, who shame them for being out in public for ‘being sick’ when they’re not sick at all. It’s just their tic,” Annestedt added.
Like Remi, 21-year-old Hayley Elford said she was “very afraid” of involuntarily coughing or touching a frontline worker and being fined thousands of dollars. She also has a tic that compels her to lick objects, which has made her apprehensive to go outside.
The stress and anxiety that the pandemic has brought on may also aggravate attention-deficit hyperactivity disorder (ADHD), bipolar disorder, borderline personality disorder, and a number of other mental conditions. Reducing stress as much as possible is key for keeping symptoms at bay almost across the board.
Meet the Expert: Ashley Annestedt, LCSW
Ashley Annestedt discovered her interests in international mental health, anxiety, and OCD during an experience working in a rural village in East Africa, after she completed her undergraduate studies at the University of Memphis. She then pursued her graduate degree in clinical social work from the University of Tennessee, where she was a national LEND fellow (Leadership & Education in Neurodevelopmental Disabilities) and received specific training in cognitive behavioral therapy for anxiety and related disorders.
Prior to entering full-time private practice, she was a faculty member at the University of Tennessee, where she trained medical residents in evidence-based care for pediatric anxiety, parent training, and other topics. She’s now based in Mexico, where she treats patients from six different states as well as countries around the world.
Navigating Fear and Anxiety During the Pandemic
The advice that Annestedt gives her patients on managing anxiety is relevant for anyone suffering from mental hardship during this time.
“I’ve always encouraged people to really recognize what they don’t have control over and on the flip side, recognizing where they can take action and where they do have some semblance of control or certainty,” she said. “Some of my patients with OCD diagnoses are doing really well—almost better than my own family members or friends who haven’t had any kind of cognitive training with regards to leaning into anxiety and uncertainty—because of their learned ability to embrace uncertainty.”
One of the big recommendations Annestedt presents to patients is to limit TV and social media time. “You can scroll on the internet for five hours and cycle through it again and again and drive up anxiety—or you can make choices to spend your time based on your values, like immersing yourself in a work project, taking a walk, playing with your kids, and most importantly, being emotionally and socially connected even though we’re physically distant.”
Annestedt said that the words “social distancing” have been damaging for some people with mental disorders.
“It made people feel like not only can I not come in physical proximity of others, but I also have to feel emotionally distant as well. Luckily, that language has changed, especially in the mental health world. The fact that you can stay socially and emotionally connected, even though you can’t see friends and family, is key.”
If Zoom calls don’t appeal, there are other options, like online gaming, watching a movie with a friend with a screen sharing app, joining a virtual book club, or even attending online seminars.
“Even though we’re restricted and can’t take a walk or go to the gym, it’s recognizing, ‘I do have control over this day,’” she said.
Pushing yourself to try new things is helpful, but Annestedt also warned against falling into the trap of setting too high of expectations for ourselves, which can become another source of anxiety in itself.
“A lot of people have internalized this social expectation that since everyone is at home, we have to start all of these side projects, learn a language, or read 15 books,” she said.
“Everybody is just treading water and trying to keep their head above it,” she continued. “It’s important to just kind of pull back from those social expectations if you need to and manage what you can on a daily basis. We’re schooling in a pandemic and parenting in a pandemic. We’re employees in a pandemic and none of that is easy. This idea that we’re going to be immensely productive in a pandemic is a little ridiculous.”
Telehealth: The Saving Grace for People With Less Common Disorders?
Websites like BetterHelp and Talkspace, which serve as a platform for mental health professionals to offer their services online, have been convenient for people with increased anxiety and depression to find help during the pandemic. But people with more specific disorders may have trouble finding a professional that is qualified to help them.
This is especially true in rural states. For example, Annestedt is currently the only OCD specialist licensed in Alaska.
“They have a huge population of people and the fact that I am the one person available to them is absurd,” Annestedt said. “I have a very long waitlist, so it’s disheartening to think you can wait three months to see me or you just cannot get the care that you need and it really shouldn’t be that way.”
Annestedt has been offering her services in live, online video sessions (also known as telehealth) since well before the onset of the pandemic. That’s why she is licensed in Alabama, Alaska, Arkansas, Colorado, Idaho, and Tennessee.
“Even pre-pandemic, there were truly not enough therapists trained to treat specific disorders,” she said. “Now that we’re expecting a second wave, I’m super concerned about there being fewer available with an increasing need.”
Moving Forward: Increasing Counseling License Reciprocity Among States?
The rise of telehealth is making some question the licensing rules for counselors and psychotherapists that prevent them from practicing out of state.
These restrictions were originally put in place to ensure that patients receive care from a qualified professional. But in the digital age—and especially during the pandemic, where lockdowns and stay-in-place orders make physical contact risky—these restrictions mean people are going without care, despite the fact that there are mental health professionals who are willing but unable to help.
Many legislators and regulators are already working on opening legal access to existing and prospective clients. For example, psychologists’ regulatory association is the Association of State and Provincial Psychology Boards (ASPPB). Additionally, social workers are advocating for change through the ASWB and counselors through the AASCB.
“I hate that it’s the pandemic that caused it, but I would love to see our society as a whole and embrace telehealth,” Annestedt said. “If that’s the silver lining to all of this in regards to mental health and some of those restrictions can be lifted, then that would be excellent.”