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Robin Kish (Host): If you're feeling stressed, anxious, or drained, you're certainly not alone. COVID has taken a devastating toll. Many have lost loved ones, their health and their jobs. We've been isolated and unsure about what lies ahead. Add to that political polarization among friends and family and concerns over Russia's war with Ukraine. It's no wonder each day can feel overwhelming. So what can we do? Today, we speak with a Licensed Psychologist about coping and connecting on this edition of Here For Your Health. Welcome to the Healthcare District of Palm Beach County's podcast Here For Your Health. I'm your host Robin Kish. Our guest today is Licensed Psychologist Dr. Adriana Lequerica Ziemba.

Dr. Ziemba is the Behavioral Health Integration Manager with the Healthcare District of Palm Beach County's CL Brumback Primary Care Clinics. Thanks for being here, Dr. Ziemba.

Adriana Lequerica Ziemba, PsyD (Guest): Thank you. It's good to be here.

Host: Dr. Ziemba in your practice you care for adult clinic patients in south Florida. What types of fears and feelings are they sharing with you?

Dr. Ziemba: Well, many are grieving over personal losses, the loss of time, and really the loss of being connected to others.

Host: So those are pretty significant feelings of loss. Dr. Ziemba, are we traumatized as a society? And if so, what are the physical and mental effects?

Dr. Ziemba: So the past two years have been filled with high, high stress. And for some, it has been traumatizing. The most recent Stress in America Survey, which is commissioned by the American Psychological Association, did note that 63% of adults find that they are forever changed due to the COVID-19 pandemic. Stress affects our health, not just our physical health, but also our mental health. It does increase things like adrenaline in the short term, which can feel like restless energy. It can affect your sleep quality. It can lead to those feelings of just feeling quite drained throughout the day. If the stress is quite long-lasting, as it has been for most of us, you can start developing poor health habits, which then can further impact our health. Things like less physical activity, an increase in alcohol use. And then of course, disruptive sleep patterns, which can affect our driving later on, or can just affect the way we function throughout our day. I will say this, however, there's some good news. We can learn how to manage stress with adaptive coping skills. So really just fancy word for really knowing how to destress and not only for your mind, but also for your body.

Host: Dr. Ziemba, what are some tools you recommend to cope with the horrors and fears of war or the grief and loss caused by the pandemic?

Dr. Ziemba: Yeah. So starting with grief because it's something that we have been addressing quite often in the clinics. I often describe grief like the ocean. Some days the ocean is calm and it's sunny outside, and other days here come the waves and here comes that storm. And really allowing ourselves to feel your emotion, both when it's sunny and stormy outside and allowing the sadness and the happiness and knowing that we all grieve differently. There is no one right way to grieve. One of the things I often recommend specifically to patients is honoring, if you lost a person, honoring that person through actions, through a shared event. So a great example is if mom or dad passed away during this time, or grandparents, somebody, you know, who's close to you and let's say they loved golf, right?

We live in south Florida. Lots of people love being outdoors, love golf. Well maybe a good way of honoring their memory, is to put together a golf scramble, a golf event, doing something that keeps their memory alive and keeps you connected to those happy memories. That's one way of grieving that can be very helpful and quite powerful.

And then really talking to your loved ones, to friends, to families, keeping those memories alive. When it comes to grief, there is no timeline. That's the other part we think we should be done after a certain time. There's no timeline. Like I said, sometimes that ocean's going to be really sunny. And then maybe a year from now, something will remind you of your loved one. And the ocean's a little bit stormy that day, but that's okay. The sunshine will come back.

Robin Kish (Host): So those are good suggestions I mean I, I'm sure there are other ways to release stress and anxiety that you may have just day to day.

Dr. Ziemba: Absolutely. Yeah. So relieving stress and anxiety day to day can come in the form of allowing yourself to have moments of happiness, listening to music, or doing something you really enjoy, listening to a book on audio, if that's easier for you or reading a book. There's lots of ways that we can destress in those moments. Going back to the grieving part and you had mentioned also the horrors of war and the things that are going on in the world right now. Something that I really remind folks is, and I've been doing this since the beginning of the pandemic as well, while we definitely encourage everybody to stay informed and watch the news, also limit the amount of time you're spending on news watching, or reading or listening, because we can end up maybe consuming too much of that information. It can increase the stress in the moment. From afar, especially when you had mentioned the war that is ongoing currently.

So from afar, it's difficult sometimes to watch all these things. So things that we can do is act kindly, do acts of kindness. Sometimes volunteering, helping others, assisting refugees from effected areas, honestly, sometimes that helping others, even from afar can help us with managing those levels of stress as well.

Host: Dr. Ziemba, is there a different approach when it comes to ways adults can help children and teens deal with their stress and anxiety?

Dr. Ziemba: Yes. You can definitely ask them about that anxiety, about that fear, about their thoughts, actually, that part's very important and listen. Validate that their emotions are real. So, instead of saying you shouldn't be crying or there's no reason to feel this way, really listen to them and validate that emotion, allow them to take their time in expressing their thoughts and their emotion. They may need to quite literally draw to express that emotion. Maybe they can put it to music. They can write it as a poem, as a journal entry for themselves. And then sharing that with you. Allowing your children the space to share their thoughts and emotions is so very important as a way of not only healing, but just the expression of that emotion.

Also encouraging them, of course, back to being kind. Some schools have done some pretty unique things. They have these random acts of kindness boards where a child, a teen can grab a paper from the board that has an act of kindness friend on it. And that's what they do. And doing those acts of kindness can really help a person, a teen, a small child feel better. Especially when they had a lot of fears or anxieties. So maybe that's something that you can also do at home. Maybe fill a jar with some of these acts of kindness and everybody gets to pick one once a week or every few days as a way of managing some of those fears and anxieties and stresses that have been going on.

Host: Great ideas. What are the signs that adults or youngsters should seek professional help from a mental health expert for the way they feel?

Dr. Ziemba: One of the things that is a really big sign or marker is loss of everyday function. So meaning if your child or yourself start struggling with maintaining friendships, showing difficulty with quite literally showing up to work or to school or in completing work. So, if you or your child were pretty on it when it came to completing your work on a day to day basis your chores, the things that you regularly do, and you start finding that it's starting to become a struggle or there's some deadlines that are being missed, or your child is really struggling with finishing homework or giving you a lot of pushback about attending.

That might be a really good sign, to start seeking assistance. In addition, if you or your child start experiencing that low mood, a lot of sadness, lasting for about two weeks and it's something that is happening every day. And of course, most importantly, if at any time there's thoughts of self-harm, wanting to die, thoughts of suicide or actual acts of self-harm that is a time to reach out to your primary care provider, a school counselor, or a mental health professional. I do want to say that there are resources in the community. So, within our county, you can always dial 211. They do have a 24-hour crisis line that you can reach out to, 211 also has a community helpline, so it can help you get connected. If you come to one of our clinics at CL Brumback Primary Care Clinics, we have behavioral health as part of your regular medical appointment. So, that will be a good time to mention some of these things so that the behavioral health consultants, such as myself can come speak to you directly or to your child, so we can figure out a plan to see where we go from there.

Host: So all of those signs that you mentioned, they're signs of some sort of depression, would you say?

Dr. Ziemba: It could be depression, it could be anxiety. Sometimes it's just high stress, and we want to address it before it becomes something much more serious.

Host: One of the impacts of the pandemic as I'm sure you've noticed is that drivers seem to have become more reckless on the roads. In fact, the National Highway Traffic Safety Administration reports that 2021 was the deadliest year for US vehicle crashes in over a decade. Fatalities also increased among motorcyclists, bicyclists and pedestrians. Personally, I see motorists speeding and driving aggressively every week on the highways here in Florida. And it's scary. Dr. Ziemba what's triggering this behavior?

Dr. Ziemba: So it is quite interesting. I am with you. I see that as well. I, myself drive quite a ways to get to our rural location out in the Glades. So I have had the same experience. A theory from the beginning of the pandemic, is that when most folks were at home and the highways were a little bit emptier, right? The roads were a bit emptier, the folks who were on the road were speeding more often and higher speeds generally leads to more accidents, especially more deadly accidents. Speaking to the most recent national crash data, the number of accidents actually went down. However, the fatalities went up. It was found that in 45% of those fatalities, the driver of the vehicle were either not wearing seatbelts, had alcohol impairment, or there was a lot of speeding involved.

Currently, there may be more of a factor of adjusting back to very busy roads, especially down here in south Florida, and then really asking ourselves as drivers to return to safer driving practices. I do suspect that folks who are driving and they're finding they're the quite stressed either in their routes or just on their day to day; maybe they're not being quite present in their driving. They're distracted. Not necessarily by phones, but they might just be distracted by their own level of stress, maybe getting lost in thoughts rather than being present in driving. And that can also lead to some accidents. Right. So, we really want to encourage everybody to be fully present, to be very alert when driving.

And then if you find yourself with aggressive tendencies, right, getting quite angry on the road, which can happen. I think it happens to all of us. Taking a moment to do some of that deep breathing while you are behind the wheel and remind yourself that you will get to where you need to get to, eventually. Right. So especially where I drive to, we often remind ourselves, take your time. It's okay to get there a few minutes late. Just get there. As long as you got there, alive and safe, that's.

Host: That's the goal. Well, let's switch gears here. No pun intended, and talk about children's social media and mental health. So like adults, youngsters have increased their use of social media during the COVID pandemic. For many, social and online connectedness has been a lifeline to safely communicate, learn, and work. However, studies show excessive screen time has also had negative physical and mental health implications like depression and body image issues, especially for teenage girls. Dr. Ziemba, what are some of your clinical observations?

Dr. Ziemba: Those are excellent points. These things are occurring so much so that in December of last year, so in 2021, the US Surgeon General, Dr. Murthy made an official advisory about youth mental health crisis. Social media and online presence can have a positive impact, right, on a lot of people and help with connectedness. I was among the many who attended a wedding on Twitch, for example, we couldn't be there, good friends were getting married early on in the pandemic. They decided that they were going to do a broadcast. So, it was a wonderful experience. However, it's really how the platforms are being used.

That part is what matters. Is there bullying going on on those platforms? Is there unsolicited messages from adults to children happening on those platforms? What are the safety mechanisms built into those apps to prevent children from viewing or engaging with inappropriate materials? This is where parental and guardian supervision really is so quite important.

With girls in particular, there are more studies that do show that girls and young women identify a pressure to really compare themselves on their looks and their bodies, which can then have this undue weight on their own mental health. I like to remind everybody that what you see on social media is heavily edited. Even TikTok videos can be easily edited. Then we find ourselves comparing to standards, which are not even based in reality. There is a more in-depth talk about this particular subject matter. And I encourage everyone to check out a particular podcast that is also through the American Psychological Association called Speaking of Psychology and looking for Dr. Linda Charmaramin's chat that is specific on how social media is affecting teen mental health.

Host: That's a good resource. What do you recommend parents or guardians do to monitor or address their children's social media use?

Dr. Ziemba: Boundaries. So this is where we started having a boundary talk about the phone or the ability to get online. So, one of the recommendations I've been making for years. And this is something I learned during my fellowship time is in particularly around meal times, not necessarily dinner, but whichever meal time, having the electronics turned off or placed somewhere else. And using that time to talk to your family, to your kids; this is one way of starting to set those boundaries around engagement in social media or being on the phone rather than being present in what you're doing and eating that meal and sharing that time. Another thing that oftentimes, and I, and I will say this kids do not like it when I bring this up in the exam rooms, when their parents or their guardians are there. But it's important to start moving those electronic devices out of your kids' rooms. And in particular at night, when you don't have the ability to supervise, what's actually happening, to check out what social media sites they're on, or who's texting them at midnight. Right. And right now we want to make sure our kids are sleeping well because there's a lot of brain growth and body growth that occurs during sleep.

And being up all night or being up quite late on the phone or on the tablet or on the computer is not terribly healthy for them. So, this is where I say it might be time to get an old school alarm radio, put that back in the room. Having a boundary that the kids or your teens put their cell phones or their tablets or computers somewhere outside of the bedroom to charge overnight.

And then they to get good sleep, hopefully. It does take time. I always remind parents and kids. It is not easy to make this transition. Be patient and kind to yourself. It takes time. However, let's not only protect our children in regards to what their social media views are going on, but also improve their sleep habits. As they get older, they need really good sleep and it's a great time to build good sleep habits.

Host: Those are great suggestions. Dr. Ziemba, after working with patients who are going through pain and navigating this new, normal of life, how do you destress in your personal life?

Dr. Ziemba: it's always good to ask the expert how do you do it? Because we all do it a little bit different. So I, myself am a music outdoors sports person. I will say that right after work I get in my car. And then usually before I even put the car in drive, I take two or three minutes and I do a moment of mindfulness or a moment of gratitude to really settle my mind. Kind of start shaking off the day, especially if it's been a tough one, which definitely occurs. Then I pick good driving music or a good podcast to keep me company and then get on my way. I also love, love to spend time with my family and my dog. And if I get a chance, I love going for hikes, truly just being outside. That's my part of it. I also, make it a point to reach out to friends. And for so long during the pandemic, I wasn't able to make it to the gym like i was doing prior. And so I couldn't meet with my friends for our usual workouts. So, we started doing tandem workouts. They would work out in their house. I work out of my house, but we would do it together. Like we would set a time and date and call each other right before it's like, you ready? Yes. Let's go. And I'll call you afterwards and we'll check in. So, it's a great way of de-stressing and connecting at the same time.

Host: And getting healthy.

Dr. Ziemba: Absolutely. Yes.

Host: Now, I've also heard, as you mentioned earlier, breathing techniques are great. You mentioned music, going outdoors and exercising. To a park or hiking. Talking to friends or loved ones to help calm down when life feels uncertain and overwhelming. What are your top tips for coping and connecting?

Dr. Ziemba: I say, start with one healthy habit. Just pick one. There's so many. And we feel like, oh my gosh, I need to do all of them all at the same time. Pick one. If deep relaxation breathing is a thing that works for you, do that one and do it with an intention and start making it a true habit. So, once a day, even if you're not feeling stressed in that moment, use that deep breathing, really connect with your breath, be present in your own body in that moment. And make it a scheduled thing. Maybe at lunch break, I take one or two minutes and that's when I do my deep breathing or like myself right before I get on my drive, that's when I do my mindfulness or gratitude practice. So, start with one healthy habit and then start adding on. You can start adding on those things, like going for a walk or honestly just any type of movement that feels good for your body. Sometimes people let me know there are no safe places for them to go for a walk around their neighborhood or the timing isn't good for them because of their work schedules.

So one of the things you can do is put some music on at home, and dance, dance around the house, that's good movement too. You don't need to have a structured exercise routine to get healthy or to do something that helps with your stress.

Host: And how can you tell when what you're doing to cope is actually working?

Dr. Ziemba: Yeah. You know, that it's working because you're more intentional and less reactive, meaning that you're less likely to snap. A lot of folks tell me, I feel like I'm snapping a lot and that's not me. So oftentimes when we start coping, well, we have this adaptive coping, there's less snapping happening. You're much more intentional. You're able to slow yourself down before you give a response. Other things that remind you that things are working is maybe you start feeling that your shoulders and your neck are not as tense by the end of the day. A lot of folks find that throughout the day, their shoulders basically become their earrings right. They're squeezing them all the way up and all those muscles get tense. When you start working on healthier habits, coping strategies, breathing techniques, maybe your shoulders are a little bit more relaxed by the end of the day, or maybe you're starting to have less headaches because the healthy habit you picked was drinking a little bit more water throughout your day.

A part that really lets me know coping is working is you're allowing yourself to feel your feelings, not just the joy. Definitely letting yourself feel joy, right? Giving yourself permission to be happy and smile, but you also start letting yourself cry and feel sad. Sometimes we just need a good cry and that's okay too. And once you start really being present in your emotion, that's how you know, the coping is working. It's adaptive.

Host: We're not bottling it up anymore. We're letting it out. Whether it's positive or negative, or in between.

Dr. Ziemba: All feelings are welcome. Absolutely. We are human and therefore we come with all the feelings, not just happy, not just sad. Somethings we're frustrated. Sometimes we're angry. That's okay. It's what we do with those feelings that really matter.

Host: Dr. Zeimba, before we wrap up, do you have any final thoughts or advice?

Dr. Ziemba: Yes Above all, be kind to yourself, those words of encouragement and kindness that you give to others so freely; all those words, I need you to start speaking those words to yourself as well, every single day. Making sure you reach out, truly asking for support is strength. Taking care of yourself is a skill and we all need to practice. So practice kindness every day. I also like to leave people with one of my favorite quotes by Dr. Kabat-Zinn. You can't stop the waves, but you can learn how to surf.

Host: And on that note, I thank you, Dr. Ziemba for your time and expertise. Guess we'll all be learning how to surf.

Dr. Ziemba: Thank you for having me. This has been a great chat and I do hope that everybody has a wonderful day.

Host: If you find this podcast helpful, please share it on your social channel and check out our full podcast library for topics of interest to you at healthcaredistrictpodcast.org. Today's podcast is brought to you by the Healthcare District of Palm Beach County. The health care district is a unique safety net healthcare system located in south Florida and provides county residents access to primary care, skilled nursing and hospital care, registered nurses, in nearly all the county's public schools and oversight of the county's trauma system, which includes operating two lifesaving Trauma Hawk, air ambulances. Learn more by visiting hcdpbc.org and our Brumback Clinic's website at brumbackclinics.org.