Transcription:

Bill Klaproth (Host):   This Pullman Regional Hospital podcast on COVID-19 recorded on April 10, 2020. The coronavirus pandemic, while not effecting all physically certainly is effecting us all mentally. So how can you manage your mental health during the coronavirus pandemic? Let’s find out with Dr. Chad Sanders, a clinical neuropsychologist at Palouse Psychiatry and behavioral health. Dr. Sanders, thanks for your time. So when it comes to living through a pandemic like we’re doing now, what is our biggest mental health concern and how would we recognize the symptoms?

Chad Sanders Ph.D. (Guest):   Obviously the major one’s anxiety. It’s different for everybody. Some of the common kind of core symptoms would be things like the classic hallmark features—excessive worry, rumination. Then you can also have other symptoms—problems with concentration, sleep disturbance, muscle tension, joint pain, headaches, GI issues. It’s kind of variable. We’ve all experienced stress. The difference is the context obviously. So there's a lot of factors that can contribute to it uniquely to a pandemic and a stay-at-home proclamation.

Host:   So these feelings of stress and anxiety, these are all normal to have, especially during times like these. Is that right?

Dr. Sanders:   Yeah normative for sure. It’s the extent to which it impacts you that makes it where it becomes concerning the more intense it is.

Host:   Can you explain the term demoralization and how that applies?

Dr. Sanders:   Demoralization, which is, it’s more distinct than classic depression. Demoralization is kind of—It can be kind like burnout but it’s also just kind the being demoralized about the current context in which you're in. So when you're stuck at home, you're not able to get out and do things with friends that you're used to. Most people can reach a certain point where they're going to be demoralized and they're going to lose motivation and feel down. So just like with stress, to a certain extent, it’s normative.

Host:   So that’s a really good way to describe the anxiety that a lot of people may be feeling is demoralized. So if someone is feeling demoralized, what are some tips to help manage their mental health at a time when we are abiding the stay-at-home order?

Dr. Sanders:   Yeah. I'm just going to rattle off, I suppose, a lot of the ones that most people are talking about already is the top down stress mood management techniques, diaphragmatic breathing, mindfulness, progressive muscle relaxation, guided imagery. Cognitive diffusion is one I personally and as a clinician really value. It’s this whole bag of cognitive techniques that kind of fostered diffusion from thinking. So it’s not about ignoring your thoughts or trying to block them out or white knuckle, but it’s about disengaging from your thoughts. The one that I—and I talk about this a lot with patients—that I think is really valuable is called paradoxical intention. What it’s about is it gets at the idea that when people actively resist something stressful what you resist persist. So this feeds into lots of things like panic buying, for example. Which on a side note, don’t do it. Panic buying is through—I mean operant conditioning, negative reinforcement. You panic buy, you reduce stress, and you thereby just reinforce the stress. And all of us don’t have toilet paper because of it so that’s not good.

Paradoxical intention is about opposite action. In fact, let’s use the panic buying example. So if you're going to the store and you're feeling really anxious, you're not sure what’s coming. There's the uncertainty and you're like, “Well, I think I do need to get like four crates of toilet paper.” Don’t do that. Instead, expose yourself to the stress of only buying enough that you would normally get. That might seem stressful, but by doing that you habituate to the stress because there’s going to be more toilet paper next week. We are not in that kind of a situation. So you avoid reinforcing the stress too. So paradoxical intention is like that. It also amps it up. I'm not going to go in too much detail, but if people want to look into it I cannot highly recommend it enough.

Host:   So paradoxical intention is disengaging from your thoughts. So instead of giving into your irrational negative thoughts, you take the opposite action. Is that when you use this? We lean into the anxiety.

Dr. Sanders: This is for the secondary stressors like panic buying, substance use. Other things were the anxiety is not well founded. There is a risk of getting COVID right now. So that anxiety is not irrational. So leaning into things is when the anxiety serves a purpose that actually isn’t functional, like buying all the noodles at Safeway. That doesn’t serve a purpose. So paradoxical intention is for the anxiety that doesn’t serve a purpose right now.  

Host:   So for someone struggling with anxiety, what are the warning signs that we need to look out for that would tell us someone would need medical attention or medical help with their anxiety?

Dr. Sanders:   Clinically there's this concept of the three D’s in diagnose is dysfunction, distress, and deviance. It’s not a true requirement, but it’s a guide for diagnosing things. So a person has to meet all three D’s to really be considered in the clinical arena. So if a given behavior or a symptom or feature, etcetera, is causing distress, that’s one. But it would also need to be deviant meaning that most people don’t experience or it’s not the norm and then dysfunction. So distress right now, that’s not enough for it to be considered clinically significant. Most people are having some degree of stress whether it’s financial, isolation, anger, uncertainty, all that stuff. The big one that is going to be a hallmark or a good signal for people to seek out services is probably dysfunction. If you’re not sleeping, if you're not eating, if you're having significant problems with concentration, muscle tension, feelings of depression, hopelessness that you feel like you don’t have control over, suicidal ideation. The things that are going to impair your ability to function and complete your basic ADLs or actives of daily living.

Host:   Okay. So distress, deviance, and dysfunction. When it gets to dysfunction, that’s when you need to watch out. So if you're extremely dysfunctional through this it may be time to seek medical attention. Then as we wrap up Dr. Sanders, is there anything else you want to talk about when it comes to mental health during these crazy times?

Dr. Sanders:   There's also another thing I specifically want to talk about when you ask that question because it doesn’t get enough attention is substance use. People talk about substance use. It’s getting some attention, but usually what I've seen anecdotally is the stories about how the alcohol industry is flourishing and alcohol delivery sales are up. That’s not so great. Drinking alcohol, smoking cannabis. Those things—when they're legal of course—in moderation, that’s not what we’re talking about. In this situation, so people being stuck at home, your home environment, it’s really important for people to think critically about increasing how much substance use they're doing. The main reason—not just the basic health reasons—is operant conditioning.

Let’s just say that we’re going to be at home for the next four to eight weeks. If you increase your substance use in your home environment during that time, you're going to start conditioning your environment to be associated with social use. So your chair, your room, where you sit. Same thing with smokers. Smokers throughout the decades have known that when it comes time to quit, you’ve got to get away from where you usually sit because it triggers you to want to smoke. So by increasing substance use to cope with demoralization and boredom and that kind of stuff now, it’s not a good idea because when this blows over and everybody kind of emerges from the cave—When you go home, your environment is going to cue you to maybe want to drink. That can make it hard to get back to what was your normal routine before. So that’s something that’s important to remember. It’s a hard thing to extinguish. Part of my job working with people is stimulus control. It’s about shifting the environment when you're trying to do some kind of cessation whether it’s tobacco or something else. So it’s just something to think critically about for people that doesn’t really get discussed enough I don’t think.

Host:   No, that’s a really good point. That does seem to get overlooked when we’re talking about mental health during this pandemic. So thanks for bringing it up and thank you so much for your time. This has really been informative. Thanks again Dr. Sanders.

Dr. Sanders:   It was my pleasure. Thanks Bill. I appreciate it.

Host:   That’s Dr. Chad Sanders. To learn more, visit pullmanregional.org. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the health podcast from Pullman Regional. I'm Bill Klaproth. Thanks for listening.