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Evo Terra: There's an old proverb. May you live in interesting times. I'm not sure how interesting 2020 was, but I know that it certainly took its toll on many of us and in many different ways. Many of us for the first time ever sought out mental health care, but due to the stigma surrounding mental health care, many did not.

Dr. Kathleen Caffrey, a Clinical Psychologist with Palouse Psychiatry and Behavioral Health joins me today in an effort to find out why. This is The Health Podcast, the show by Pullman Regional Hospital. I'm Evo Terra. So let's approach this head on Dr. Caffrey. Why do you think there is a stigma around seeking help for mental health?

Well

Kathleen "Katie" Caffrey: I think we've come a long way in general, in terms of de-stigmatizing mental health, but I think people still have a tendency to assign meaning to mental health difficulties or to seeking treatment. I think a lot of times people might think, you know, this is something I should be able to handle on my own. I look around and I see everyone else seems to be doing just fine, so I should be able to as well. And if I can't, it means something about my character that I'm weak, or I didn't have enough willpower or just that I've failed in some way.

And because of that, sometimes might look at treatment as sort of a last resort. But I kind of like to look at treatment as more evidence of resourcefulness, and getting out in front of things before they become so overwhelming or unbearable that you're really having a ton of impact on functioning.

And I also think there's, some misconceptions about treatment or expectations about treatment that aren't really accurate and probably contribute to stigma. Some people I think have the sense that treatment just won't be helpful. They might think, I can't imagine a way that treatment will be helpful or, you know, what else is somebody gonna have to offer me after I've tried everything I can think of?

And that's unfortunate. It kind of says, there might be some hopelessness around that. I feel like my problems can't be helped and that sort of low self-efficacy or hopelessness just creates another layer of difficulty coping with mental health challenges, and can keep people from seeking treatment.

I've also heard, people say that they've tried therapy before and they didn't have a good experience. And so they might think, gee, what is it about me or my problems that therapy didn't work for me, and make them sort of reluctant to try again. And I think that makes sense. Sometimes people don't have a very good connection with their therapists.

The intervention didn't seem to be helping. But I would really encourage those people, not to assume that they're the problem or that their problems aren't well suited for therapy, because there can be a lot of reasons why a particular therapist or a particular Intervention doesn't really work for somebody.

So I would encourage people to really not be afraid to vet their therapists, ask for information about how the therapist sees the particular intervention helping that person, that, sort of thing.

Evo Terra: Now speaking of helplessness, 2020. I'm curious, did the challenges we all face during 2020, did those cause more people to seek out mental health support?

Kathleen "Katie" Caffrey: Yeah, I think so. Just anecdotally, I definitely saw, more people seeking out mental health care, more people who were already in therapy with me become more distressed and have sort of additional challenges going on. So I definitely think over the last year there has been, more interest and more need for mental health services.

Evo Terra: Now, previously you talked about the stigma surrounding why it's hard to seek out mental health, but let's be blunt for just a moment here. Can you talk for a moment about some of the reasons why people should think about seeing a mental health profession?

Kathleen "Katie" Caffrey: Yeah, definitely. I mean, you know, essentially anyone who is seeking treatment for a wide range of issues, anxiety, or depression, panic, trauma, and PTSD. Grief and loss, I think is a big one that's coming up now, in the context of the pandemic. Even people who may already be treating mental health concerns with medication. The combination of therapy and medication is often, it can be the most effective for a lot of mainstream disorders.

And all that being said, you don't have to feel like you have to diagnose yourself before you seek out treatment, or you have to know for sure that you have some sort of, mental health disorder, if you're in significant distress or you're noticing functional impact, of difficulties on your day-to-day functioning, treatment is definitely worth looking into and pretty related. I also hear people say a lot, you know, I'm not sure if I need to go to treatment because I have friends or family that I can talk to about my problems. But I would definitely stress that evidence-based psychotherapy is much different than just having someone to talk to, and listen to you or even different from just having someone who offers really good advice like friends and family can do. The, therapy is really, it's a combination of you know, listening and helping you process difficulties, but also evidence-based interventions, which might involve skill building, you know, exposure therapy for anxiety, behavioral activation for depression, lots of specific particular interventions that have been shown to be very effective in treating a wide range of concerns.

Evo Terra: So we certainly would never encourage anybody to go to the Google medical school to diagnose themselves. We know that's bad, however, we're, especially in podcast land, it seems like we're awash with all of these ads and commentary about these various apps that are out there. Apps for mindfulness, apps to meditate, apps to do calm your brain sorts of things like that. What do you think about using those? Not necessarily as a substitute for seeking out help from a professional like yourself, but just in general, are those good things as adjunct therapies?

Kathleen "Katie" Caffrey: Yeah, that's a great question. And I think the key there is kind of what you said about not necessarily as this substitute for therapy. I think, I have experience with, different mindfulness apps, in particular that, can be really a helpful sort of supplement if you're working with a therapist about, learning some more mindfulness skills, apps can be really helpful for continuing the work outside of therapy.

It's important to vet the sources of those apps. I think about, things like Talkspace or apps that are designed to be, more teletherapy or, you know, texting therapy, that sort of thing. In that sort of realm, it's really important to vet the credentials of that sort of, service, because you don't know that you're going to be getting the exact same quality as a, a professional, that you see in a traditional setting, but I definitely think there are lots of apps to help supplement, you know. We talk a lot about, mood charting in treatment for depression, or things like bipolar disorder.

And there are really helpful apps, to do that electronically. So, yeah, I think there's great, supplements to traditional therapy that can be helpful.

Evo Terra: You brought up the pandemic earlier. And for many of us like myself, that means we're working from home now. And you'd think that would make life less stressful for us only it's not, I can attest to that. So why might people like myself who are sitting here at home wondering why they're so stressed? When and why we might seek out counseling? Can you help me with that?

Kathleen "Katie" Caffrey: Yeah, I think, I've had the experience I transitioned to working from home at the beginning of the pandemic. And I thought, oh, this is so great. I can just, be in my pajamas most of the time, that sort of thing, but there really are added stressors. If you're working with technology like you weren't working with technology before, if, there's sort of a learning curve in adjusting your job to working from home, that can be a challenge.

Also, you know, I have a dog, my dog would drink water very loudly every time I had to meet with a patient so integrating your work environment into your home environment is hard. And I think a lot of us, if we were used to working, in an environment with other people, we sort of miss the social connection.

It's quite different talking to somebody over zoom all the time. or, any sort of, video chat system versus being in person and in passing each other in the hallway or sitting and having a cup of coffee, that sort of thing. So I think if you're feeling some amount of distress that's normal, that's really normative.

Like you said, we're all probably feeling some stress if we've had to work from home. But I think if you're finding yourself very isolated, if you find yourself, really unmotivated, that functional impact where you're noticing that your distress is impacting your ability to do your job well, or to function in some way, that's sort of your sign that it might be time to seek out some help.

Evo Terra: Let's switch gears for a moment. Staying right into anxiety, but this time in the time of COVID-19, which we all find ourselves in, some people feel anxious about the fact that we all have to wear a mask, which is a very good idea. We all need to wear a mask, but still, especially if we're essential workers. Nurses, doctors, even, you know, people who work in restaurants, people who drive Uber and other forms of transportation are essential workers are forced to be in these rather restrictive and it can't be fun to wear a mask all day long. Any tips that you have for those folks?

Kathleen "Katie" Caffrey: Yeah, definitely. I think, and probably if you asked the essential workers who have been wearing masks since, early in the start of the pandemic; they're likely the ones who are adjusted to it. It's like anything that's a little bit uncomfortable at first, with repeated exposure, we will get used to it.

So I would I guess that people who continue to have a lot of distress around wearing masks are probably those who have worn it inconsistently or who remove it every time they experience some discomfort. It makes sense that we want to do that. Like every time my nose itches, I, want to go and itch my nose.

But that kind of keeps me from adjusting to, wearing the mask and getting through it. And some things I hear, that people sometimes have difficulty breathing where they feel like, the mask kind of impedes their breathing. And I think it's important, to just breathe normally and at a comfortable pace. Don't try to like overcompensate or artificially speed up or slow down your breathing, don't necessarily try to take much deeper or shallower breaths.

Your breath will go back to normal eventually as long as you don't, try to artificially change it. And for most people, expectations and interpretation of sensations, like if you have the thought, I can't breathe in this mask, I'm trapped in here. 'I'm never going to be able to calm my breath down. Those sorts of thoughts are going to lead to anxiety and lead to increased heart rate and maybe a little bit of extra trouble breathing. So reminding yourself, instead of thinking, I can't breathe in this mask right now, reminding yourself, like my breathing will go back to normal.

I'm not in any danger. It is going to be okay. That sort of thing can really help you return back to baseline comfortable breathing. Besides that one, there are some annoying things about wearing masks. Glasses might fog up. You might get skin irritation or even acne, face itching like I mentioned, it also impedes some of our social connection with other people. We can't see each other smiling. We have - we can't pick up on nonverbal cues as well, with facial expressions. And I think all of those are really, they can be really frustrating. And I think sometimes it's important to think about kind of core values and reminding ourselves why it's important to wear the mask in spite of those consequences.

So when we start to feel fatigued by wearing the mask, reminding ourselves, maybe, we want to protect ourselves from getting sick or our family from getting sick. But even if you're not particularly concerned about getting sick yourself, maybe you do want to do your part to protect other people who might be more vulnerable or even to just help model for other people, the new normal. And we talked about stigma around mental health. There can be stigma around mask wearing sometimes I think, and the more people who do it in places where we wouldn't normally do it, like therapy or the grocery store or restaurants, the more that other people will feel comfortable doing it too. And, the more, people who are ambivalent about it, will go ahead and make the decision to do it.

Evo Terra: Right. Peer pressure in the best possible way.

Dr. Caffrey, thank you for all of your great practical advice today.

Kathleen "Katie" Caffrey: Thanks so much.

Evo Terra: That's Dr. Kathleen Caffrey, a Clinical Psychologist with Palouse Psychiatry and Behavioral Health. For more information, visit www.pullmanregional.org. And thank you for listening to this episode of The Health Podcast, the show by Pullman Regional Hospital. I am Evo Terra. If you found this episode helpful, please share it on your social channels and be sure to check out our entire library of past episodes, which you can find@pullmanregional.org.