Coping with Anxiety, Depression and PTSD in these Extraordinary Times

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Prof. Esti Galili, Director of the Division of Child and Adolescent Psychiatry at the Hadassah Hospital Jerusalem, together with Dr. Claudio Michanie, Head of Child and Adolescent Psychiatry of the CEMIC University Hospital, Buenos Aires, Argentina.

Prof. Galili emphasised that she was not sharing knowledge but rather sharing her experience in this pandemic.

Dr. Michanie expressed the uniqueness of counselling patients when the therapist is also immersed in the trauma of COVID-19. “It’s not as if you are secure and comfortable and you are offering your knowledge to your patients,”. Rather, the therapist shares the anxiety patients are experiencing from COVID-19’s threat to human survival.

Both specialists described the stress of living in lockdown for over 100 days which have creating serious gaps in mental health care, because in-person consultations have not been possible. They and their colleagues have seen a worsening of symptoms in their patients with panic disorders and generalised anxieties, and an increase in psychiatric emergencies. Dr. Michanie also reported that they had witnessed a 40 percent increase in domestic violence against women. Children, he said, are exhibiting more self-harm and attempting suicide more often.

Personal protective equipment provides its own set of problems in allaying the fears of children, who are brought to the Emergency Room. Normally, Prof. Galili explained, a therapist will wear casual clothing when meeting with a child so as not to appear intimidating. With physicians needing to wear masks and face screens in the ER, they appear impersonal and frightening, which makes it difficult to evaluate children and gain their trust.

Inpatient and outpatient mental health care during the pandemic are fraught with their own sets of problems, noted Prof. Galili. The inpatient adolescent unit at Hadassah had to be closed to visitors, adding to the level of stress. The social distancing requirements have forced out-patient group therapy to be conducted with smaller groups, which, Prof Galili said, is not as effective for the teens.

In addition, one-on-one therapy has been curtailed, with therapists working from home. The value of the interpersonal experience of sitting in the same room with a patient cannot be discounted, Prof. Galili explained. “Tele-medicine” use has been boosted. It is a cheaper service, but is not “best medicine”.

While some children are receiving their therapy on Zoom, not all children have access to smartphones. Even if they do, these Zoom calls often take place in a noisy home environment, with other siblings running around. The doctor is also at home, sometimes with family members in view, so a setting for private, intimate therapy is elusive.

Prof. Galili also discussed COVID-19’s huge impact on hospital care workers. The Hadassah staff working in the COVID-19 outbreak units are under tremendous stress. At the end of a shift, they are simply too tired to pick up a phone and ask for help. Her solution was to put on the necessary personal protective gear and join them in their staff room. She then was able to ask the doctors and nurses if they wanted to talk. The staff members were very grateful for this face-to-face therapy, she said, and she was able to help them cope with an extremely stressful environment.

By the same token, Dr. Michanie emphasised that “this is a time to be extremely empathetic toward parents who are overwhelmed by their need to work while their children are home from school and require home-schooling.” Therapists, he recommended, “must help parents lower their expectations, to be less demanding of themselves and their children.”

Prof Galili re-emphasised sleep disorders and increased stress caused by a lack of “screen discipline” (use of mobile phones and tablets) with proper bedtimes and limits to phone use needed.

Prof. Galili cautioned that while we may think that watching the news extensively and absorbing a lot of information will calm us down, “it doesn’t work that way.” To help reduce the level of anxiety, Prof. Galili recommended that people engage in new activities or begin a project. She suggested dancing, listening to music, cooking, painting, knitting, or getting involved politically. The rigidity of stress can be helped with mindfulness and other similar exercises.

“Learning something new,” she said, “opens channels of positivity in your psyche.”

Prof. Galili noted that as humans we have great capacity for hope which is a natural deep-seated belief that we can ultimately survive through any situation and particularly this crisis.

 


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