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Managing Mental Health in the Times of Pandemic

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  • Overview

    As the COVID-19 pandemic continues to spread across our nation and the world, more and more patients are experiencing anxiety and depression. Joining Dr. John Russell to explain how we can console our patients—all while maintaining our own mental health along the way—is Dr. Diane Custer.

    Published April 8, 2020

  • Read the Article

    Managing Mental Health in the Times of Pandemic

    Dr. Russell:

    Coming to you from the ReachMD studios, this is COVID-19: On the Frontlines. I’m your host, Dr. John Russell. Today, we will be discussing mental health in the times of pandemic. I’m joined today by Dr. Diane Custer, Chair of Psychiatry at Abington-Jefferson Health.

    So, Diane, during this very scary time, how do we talk with our patients who have underlying anxiety and depression and not make those worse, but not trivialize what’s going on in the world?

    Dr. Custer:

    Well, I think the first thing we need to do is acknowledge and validate their fears, saying things like I can see that you’re feeling angry, afraid, anxious, or sad in this situation, and that it’s understandable and I’m here to help, is a nice way to break the ice and acknowledge what’s right in front of you.

    So, after that, you can focus on things that patients have control over coupled with the most current facts about what to expect from the virus, and how we’re responding to it. It’s important to normalize the expectation that the facts are evolving and will change as we learn more about the virus.

    The fact that the advice changes means that we’re improving and that our knowledge and our response to the virus is improving as well. Some things to advise them is to pick a few trusted sites, like the CDC and spend 20 minutes twice a day reading the updates and getting important news. Otherwise, turn off social media and the news as it relates to COVID. Share the best evidence-based practices for patients that they can use as they go through their day to minimize their risk and maximize their mental and immune health.

    Things like, cover your cough, wash your hands after toileting, touching surfaces, or blowing your nose. Avoid touching your face, your eyes, your nose, and your mouth. Advise them to keep a routine as close to normal as possible.

    Try to get up, bathe, dress, eat, exercise, and go to bed at roughly the same time every day. This will reinforce circadian rhythms, which promote stable mood and sleep. Get adequate sleep to promote immune function. Exercise according to your doctor’s permission given any health conditions. Things like walking, simple stretching, yoga, and other exercise all reduce anxiety and depression, promote good sleep, and maintain good immune function.

    One point about exercise, it’s important not to raise your basal body temperature after 5 pm by doing things like strenuous exercise, hot baths, or hot showers, as this will just send the message to your brain that it’s time to be awake and make it more difficult to fall asleep.

    Eat nutritious foods that promote stable blood sugar, stable mood, and good immune function. Remind your patients about the coping skills that they already now and have loaded into their mental health toolbox. Offer them new coping skills. 

    Help them to practice mindfulness by instructing them to make it a point to

    • (a) notice when they’re beginning to feel a specific symptom of anxiety or depression,
    • (b) deploy a specific plan to address that symptom by doing things like avoiding the things that they already know will make their symptoms worse and acting things that they already know makes their symptom better.

    Reaching out to trusted others to request assistance with things like healthy distractions, conversation, exercise, movies, with factual information, with therapy.

    Those trusted others can provide all these things that will help deal with anxiety and depression.

    Dr. Russell:

    As leaders, ranging from anywhere from leaders in an office to leaders of a whole health system, how do we work with our staffs to reduce their worries?

    Dr. Custer:

    We regularly and predictably update our staff with the current best practices for managing their workday and their home life based on the latest information from trusted resources about the virus. Leaders make themselves available to their staffs, to solicit questions about how the staff, their family and friends are doing. About what information, equipment, or supplies they need to feel better about carrying out their duties at work or at home.

    We acknowledge for them the challenges that they have and they face and the concrete steps that we are taking in order to deal with today’s urgent issues, as well as plan ahead and meet future challenges.

    We offer information about coping with stress and resources available to assist them in coping with this stress.

    We offer resources for all types of assistance so that staff can help their patients, their family, and their friends deal with food and shelter insecurities, stigma, mental health resources, and substance use disorder treatment.

    Dr. Russell:

    You do a lot of work with healthcare workers. So, how do you and I deal with this ourselves? Is watching T.V. news a good thing or a bad thing for us.

    Dr. Custer:

    The first thing we remind healthcare workers of is the fact that they need to take care of themselves. Talking with colleagues reduces isolation, provides new ideas about problem solving in our work and in our personal lives. During time off from work, we encourage distraction and healthy disassociation, which are fabulous coping skills. Conversations about things other than the virus remind us that this pandemic will eventually pass and that there are people and issues in our lives that require our attention and give us pleasure, hope, and meaning.

    Dr. Russell:

    So, Dr. Custer, any tips on dealing with social media through all this? Certainly, we get home and a lot of us in our spare time are looking at how people are reacting to this on social media. How do we deal with that?

    Dr. Custer:

    Using social media to reduce social isolation and connect with trusted people who treat us well and provide calming interaction makes a lot of sense. Using social media to help our family and friends feel connected and informed makes sense as well. Avoid exposing yourself to unvetted, hysterical, or stigmatizing sources of information, as these will only promote anger and fear; two emotions that we try to manage in this pandemic. Using social media for sharing kindhearted humor and silliness is a great idea. Laughter is a great medicine.

    Dr. Russell:

    And our best health tip for a lot of folks right now is socially isolating. So if we’re socially isolating people, how do we recommend people still feel connected with – with other human beings so they don’t develop loneliness or other issues.

    Dr. Custer:

    Going outside is a great idea. With some mindfulness, you can maintain six feet of social distance and still do a variety of things, like walking around the neighborhood, gardening, cleaning up your property, working on your car, and shooting hoops to name a few. In warm, sunny weather, try sitting outside and reading.

    Listening to the sounds of nature has a definite calming effect. Noticing the feeling of the sun, the wind, or the rain on your skin can help you reconnect with nature.

    Take advantage of the positive aspects of technology. Use phoning, texting, FaceTime, Skype, and WhatsApp to maintain your connection with people.

    1. Ask friends and family about how they are doing.
    2. Ask for help with your own challenges.
    3. Offer to help them in safe ways.
    4. Share ideas about how to solve problems or cope with stress.
    5. Host a virtual book club, movie club, or chess match with a friend or a family member.
    6. Reminisce about fun times and make plans for future get-togethers that you can deploy once the pandemic has past.

    Dr. Russell:

    So you and I were physicians during 9/11 and this seems very, kind of, reminiscent of this. Are you seeing some parallels to what we experienced after 9/11?

    Dr. Custer:

    It definitely does. In fact, trauma informed approaches are very important at this time because people who’ve been through any kind of trauma, including 9/11, can have those kind of feelings reactivated and to begin to experience symptoms of those traumatic reactions. 

    Dr. Russell:
    Thank you so much for being with me today.

    Dr. Custer:
    Thank you. My pleasure.

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Details
Presenters
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  • Overview

    As the COVID-19 pandemic continues to spread across our nation and the world, more and more patients are experiencing anxiety and depression. Joining Dr. John Russell to explain how we can console our patients—all while maintaining our own mental health along the way—is Dr. Diane Custer.

    Published April 8, 2020

  • Read the Article

    Managing Mental Health in the Times of Pandemic

    Dr. Russell:

    Coming to you from the ReachMD studios, this is COVID-19: On the Frontlines. I’m your host, Dr. John Russell. Today, we will be discussing mental health in the times of pandemic. I’m joined today by Dr. Diane Custer, Chair of Psychiatry at Abington-Jefferson Health.

    So, Diane, during this very scary time, how do we talk with our patients who have underlying anxiety and depression and not make those worse, but not trivialize what’s going on in the world?

    Dr. Custer:

    Well, I think the first thing we need to do is acknowledge and validate their fears, saying things like I can see that you’re feeling angry, afraid, anxious, or sad in this situation, and that it’s understandable and I’m here to help, is a nice way to break the ice and acknowledge what’s right in front of you.

    So, after that, you can focus on things that patients have control over coupled with the most current facts about what to expect from the virus, and how we’re responding to it. It’s important to normalize the expectation that the facts are evolving and will change as we learn more about the virus.

    The fact that the advice changes means that we’re improving and that our knowledge and our response to the virus is improving as well. Some things to advise them is to pick a few trusted sites, like the CDC and spend 20 minutes twice a day reading the updates and getting important news. Otherwise, turn off social media and the news as it relates to COVID. Share the best evidence-based practices for patients that they can use as they go through their day to minimize their risk and maximize their mental and immune health.

    Things like, cover your cough, wash your hands after toileting, touching surfaces, or blowing your nose. Avoid touching your face, your eyes, your nose, and your mouth. Advise them to keep a routine as close to normal as possible.

    Try to get up, bathe, dress, eat, exercise, and go to bed at roughly the same time every day. This will reinforce circadian rhythms, which promote stable mood and sleep. Get adequate sleep to promote immune function. Exercise according to your doctor’s permission given any health conditions. Things like walking, simple stretching, yoga, and other exercise all reduce anxiety and depression, promote good sleep, and maintain good immune function.

    One point about exercise, it’s important not to raise your basal body temperature after 5 pm by doing things like strenuous exercise, hot baths, or hot showers, as this will just send the message to your brain that it’s time to be awake and make it more difficult to fall asleep.

    Eat nutritious foods that promote stable blood sugar, stable mood, and good immune function. Remind your patients about the coping skills that they already now and have loaded into their mental health toolbox. Offer them new coping skills. 

    Help them to practice mindfulness by instructing them to make it a point to

    • (a) notice when they’re beginning to feel a specific symptom of anxiety or depression,
    • (b) deploy a specific plan to address that symptom by doing things like avoiding the things that they already know will make their symptoms worse and acting things that they already know makes their symptom better.

    Reaching out to trusted others to request assistance with things like healthy distractions, conversation, exercise, movies, with factual information, with therapy.

    Those trusted others can provide all these things that will help deal with anxiety and depression.

    Dr. Russell:

    As leaders, ranging from anywhere from leaders in an office to leaders of a whole health system, how do we work with our staffs to reduce their worries?

    Dr. Custer:

    We regularly and predictably update our staff with the current best practices for managing their workday and their home life based on the latest information from trusted resources about the virus. Leaders make themselves available to their staffs, to solicit questions about how the staff, their family and friends are doing. About what information, equipment, or supplies they need to feel better about carrying out their duties at work or at home.

    We acknowledge for them the challenges that they have and they face and the concrete steps that we are taking in order to deal with today’s urgent issues, as well as plan ahead and meet future challenges.

    We offer information about coping with stress and resources available to assist them in coping with this stress.

    We offer resources for all types of assistance so that staff can help their patients, their family, and their friends deal with food and shelter insecurities, stigma, mental health resources, and substance use disorder treatment.

    Dr. Russell:

    You do a lot of work with healthcare workers. So, how do you and I deal with this ourselves? Is watching T.V. news a good thing or a bad thing for us.

    Dr. Custer:

    The first thing we remind healthcare workers of is the fact that they need to take care of themselves. Talking with colleagues reduces isolation, provides new ideas about problem solving in our work and in our personal lives. During time off from work, we encourage distraction and healthy disassociation, which are fabulous coping skills. Conversations about things other than the virus remind us that this pandemic will eventually pass and that there are people and issues in our lives that require our attention and give us pleasure, hope, and meaning.

    Dr. Russell:

    So, Dr. Custer, any tips on dealing with social media through all this? Certainly, we get home and a lot of us in our spare time are looking at how people are reacting to this on social media. How do we deal with that?

    Dr. Custer:

    Using social media to reduce social isolation and connect with trusted people who treat us well and provide calming interaction makes a lot of sense. Using social media to help our family and friends feel connected and informed makes sense as well. Avoid exposing yourself to unvetted, hysterical, or stigmatizing sources of information, as these will only promote anger and fear; two emotions that we try to manage in this pandemic. Using social media for sharing kindhearted humor and silliness is a great idea. Laughter is a great medicine.

    Dr. Russell:

    And our best health tip for a lot of folks right now is socially isolating. So if we’re socially isolating people, how do we recommend people still feel connected with – with other human beings so they don’t develop loneliness or other issues.

    Dr. Custer:

    Going outside is a great idea. With some mindfulness, you can maintain six feet of social distance and still do a variety of things, like walking around the neighborhood, gardening, cleaning up your property, working on your car, and shooting hoops to name a few. In warm, sunny weather, try sitting outside and reading.

    Listening to the sounds of nature has a definite calming effect. Noticing the feeling of the sun, the wind, or the rain on your skin can help you reconnect with nature.

    Take advantage of the positive aspects of technology. Use phoning, texting, FaceTime, Skype, and WhatsApp to maintain your connection with people.

    1. Ask friends and family about how they are doing.
    2. Ask for help with your own challenges.
    3. Offer to help them in safe ways.
    4. Share ideas about how to solve problems or cope with stress.
    5. Host a virtual book club, movie club, or chess match with a friend or a family member.
    6. Reminisce about fun times and make plans for future get-togethers that you can deploy once the pandemic has past.

    Dr. Russell:

    So you and I were physicians during 9/11 and this seems very, kind of, reminiscent of this. Are you seeing some parallels to what we experienced after 9/11?

    Dr. Custer:

    It definitely does. In fact, trauma informed approaches are very important at this time because people who’ve been through any kind of trauma, including 9/11, can have those kind of feelings reactivated and to begin to experience symptoms of those traumatic reactions. 

    Dr. Russell:
    Thank you so much for being with me today.

    Dr. Custer:
    Thank you. My pleasure.

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