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Michael Carrese: If your levels of stress and anxiety have increased during the pandemic, you're far from being alone. According to the Kaiser Family Foundation, a majority of Americans say their mental health has been negatively impacted due to worry and stress over the Coronavirus. And as we face a long winter during which the virus will remain a major factor in our lives, this trend is sure to continue. So on today's program, we're going to hear from two experts from the University of Vermont Health Network about recognizing signs of stress and anxiety due to COVID-19 and what you can do about it. We're joined by Aaron Steward, PhD, Chief of Psychology at Champlain Valley Physicians Hospital and co-chair of the Vermont Human Trafficking Task Force. And we also have Dr. Daniel Mitchell with us PhD. He's a Clinical Psychologist at Central Vermont Medical Center. Welcome to you both.

Dr. Steward: Thank you for having us.

Dr. Mitchell: Thank you for having me.

Host: So, I thought we'd start by trying to sort out what's worrisome and what's not worrisome. In other words, everybody's experiencing some level of stress. Obviously our lives have been upended by this for months now. What is sort of normal to experience or feel when you have a kind of a situation where there's heightened stress? You want to go first, Dr. Steward?

Dr. Steward: Sure. The hardest part, I think we've been seeing about COVID-19 is that it's the factor of it's the straw that broke the camel's back and that what's normal is to always have some level of stress. Some level of stress is sometimes good for people. It's the challenge of when stress becomes too much to cope with, and that's internal factors and external factors all compiled on top of one another, that it becomes feeling abnormal for people. And so that's what we're seeing right now is we're seeing a lot of stress fatigue, where people have too much stress to cope with in the way that they've always coped with stress.

Host: So, they need some new techniques which we'll be getting into Dr. Mitchell. What would you add to that?

Dr. Mitchell: I think that's very well said. I would add that it's also a very prolonged stress with no safety period. So when you have stress that goes on for a very long time, such as six to eight months, and then on top of that, there's no ability to feel that the, what we would call maybe a trauma has passed that is not happening. And so that really perpetuates and adds to the already daily stressors that you might have as well.

Host: Right. No end in sight to this. That's a big factor. So maybe I could ask about anxiety versus stress, because there are people who have never experienced anxiety might really not know what the difference is. And when that gets to be a worrisome thing, can you try to break that down a little bit for us, Dr. Steward?

Dr. Steward: Sure. I can try. But what you'll find in my explanation is that anxiety is stress sometimes and stress is anxiety sometimes, they sometimes present in a similar manner and sometimes they feel very differently to people. So my first response to you is that the best way to figure out what is going on for yourself is to check in and also express yourself to somebody else. Sometimes we don't know what we are until we say it to somebody else. So our brains are built to deal with short bursts of stress. And Dr. Mitchell is really on point in talking about the longevity of this stressor and that we were built to run away quickly, flight quickly, deal with very short windows of stress. And that's not what we're experiencing now. And so our bodies are not built and our brains are not built to cope with very long lasting stressors.

So, what people might be looking for when they're trying to check in with themselves is how their body is feeling. And people feel anxiety and stress in all parts of their body, but there's medical responses. There's physical responses, there's emotional responses, and everybody's different in the way that they exhibit stress. So you're looking for tightness in your chest, increased heart rate, sweaty palms. You're also looking for intrusive and racing thoughts that just keep coming back to you, that you can't get rid of any can't quiet. You're looking for stomach aches and headaches, fatigue, tiredness, and also irritability and frustration. So the most important part about stress and anxiety and addressing it is figuring out the ways that we feel so that we can figure out what we want to do about it.

Host: Yeah. That's a lot of great stuff to think about there, Dr. Mitchell, anxiety, symptoms, signs, things to worry about?

Dr. Mitchell: I think she covered everything there. I would also say that there's a functionality piece. So when we have what we would call typical stress, and just a reminder that, you know, some types of stress are very positive. So you have distress versus what's called you stress. You stress is a positive form of stress, but when you start talking about anxiety, your functionality of your ability to do day to day things, be able to concentrate, be able to multi-task. It decreases your functionality. So that sometimes is also a way to be able to discern between stress and anxiety/

Host: And what can happen if you leave this unaddressed? Dr. Mitchell would stick with you for a minute. What's the, like a near-term concern for people who aren't familiar with these feelings don't know what to do with them. What can start to happen?

Dr. Mitchell: If it goes unaddressed either by taking care of yourself, using self-care measures, talking to someone as Dr. Steward has mentioned as a really good way to cope, if you don't cope with it and it sticks around, it can do all sorts of things. And one of the biggest issues is it decreases functionality. And what happens there is as you function less, it perpetuates on your life. So now not only do you have the stressors of coping with worries about the pandemic, for example, but those worries are getting in the way of you being able to take care of your family from moment to moment, for you to be able to not do your job as well at work. And so then you add that stress of ruminating about getting fired, not being able to sleep, not eating well or eating things that are probably less healthy for you because you're trying to cope drinking alcohol, etcetera. So all these things perpetuate upon the problem. And a lot of times what can happen, and this can be a moment to moment thing, or it can last a very long time is going outside of your window of tolerance.

And so that's where you either go into what I would call a shutdown mode or hypo arousal. And that's where you kind of check out, you shut down and you're not able to function at all, but no one might notice that because sometimes when that happens to people, you just, it's very hard to tell that somebody has shut down. Because they're not doing anything they're not responsive. The other direction that can go is hyper arousal. And that often looks like a panic attack or just not being able to function, but do you go in the other direction? And this can go on and on, coming inside and outside of that window of tolerance, and it can have a lot of health effects as well over time. If it's not addressed, it can turn into chronic health problems such as cardiac issues. It can even cause, or, you know, have a correlation with diabetes, COPD, all sorts of health issues can, it can be more prone or vulnerable to those because of ongoing, unmitigated stress.

Host: So obviously we don't want things to get to that point. And Dr. Steward, maybe you can kick off a discussion about some strategies for coping better, some tips and tricks. What do you talk to your patients about who are experiencing these sorts of things?

Dr. Steward: I think people sometimes worry that if they check in and acknowledge, recognize how they're doing have honest conversations with themselves about the way they're feeling that it will get worse. Sometimes people believe that avoidance will help them cope and compartmentalize. The hard part about stress and anxiety is when it grows to a certain point, it becomes impossible to avoid and compartmentalize it. And so we really have to turn around and face it. We really have to look at it and acknowledge and recognize it in order to diminish and decrease it. And that we know from a lot of challenges and stressors is that when we look at them and address them, we can make them better. And so the first thing I say to everybody is even though it's scary, and even though it feels like it's going to make it worse, we have to really get honest and authentic about how we're feeling.

And so, we've been doing a lot of work here at the hospital, trying to talk more about how everybody's doing. Let's find safe people to confide in let's express as a system, and also as individuals, how we are actually doing to prevent it getting worse. And so what I'm talking to people about is how frightening, but also how important it is to evaluate how we're really doing. And many of us have been trained to not do that. Certainly healthcare professionals, certainly emergency responders. And a lot of people in the community have been trained not to express how they're doing in order to push through it. This isn't one of those situations where that's going to work. And so the first thing I would say is a daily, if not hourly, check-ins with yourself. And also how do we find people that we can really talk to about how we're really doing?

Host: Yeah. And I'm sure people, because we're all in the same boat are more than willing to be receptive and listen and help out in that way. Dr. Mitchell, what about some practical things? People go to meditation, there's downtime, there's, there's all sorts of other ways to tackle this. What are some ideas?

Dr. Mitchell: Well, I think that meditation can be challenging when you've kind of crossed that threshold. I always encourage people to have a mindfulness practice, but sometimes you have to work with what you've got. So what I have anecdotally gotten feedback from my patients are things that are more in the moment that you don't have to sit down and carve out time for, because we're all busy with all the practical issues of life that have just been a barrage of new responsibilities that we've had with less resources. So walking, going for a walk, and if you can't go outside because it's two in the morning, or, you know, it's a snow storm or a thunderstorm than just walking around your house and just letting your thoughts and feelings and body sensations be there and just noticing them instead of trying to change them. So walking is probably one of the most reported beneficial coping mechanisms.

So, self-care also, I think, you know, when you're able to talk to a trusted person, I think that's really important. And part of that is that validation you can get from someone makes you feel that you're not alone. But I also think that anxiousness often, I think Dr. Steward mentioned the failure, that you have a lot of troubling thoughts, excessive worry, and what I call rumination, which is where you think about the same thing over and over again. And no matter how hard you try, it just keeps coming back around. And so being able to say some of those thoughts out loud, or put them on paper one way or another, getting those words out in front of you can help you kind of work through and process what it is you're thinking and feeling. And sometimes I think we need to challenge ourselves in terms of how we're framing, how we're thinking about the situation that we're in.

One of the things that there's research now coming out in trauma informed therapy is a control piece that a very common thought pattern for people with the pandemic is that they are not in control. And so what I have found really useful is to help people to put that out there and challenge that. And I'm not in control of some things, but I am in control of me. I can control what I do about what's going on around me that I can't control. So some of those quick mindfulness tools like walking, noticing your breath, taking a few deep breaths, doing what I call a mindful minute, where you take a nice big stretch and a couple of deep breaths. Those are things journaling talking to a friend. And I think that being able to build some sort of a mindfulness practice from there is really helpful, but being honest with yourself on how much time and how much resource do you have to be able to carve that out and just being kind with yourself about also having to take care of all the priorities that you have as well.

Host: So, Dr. Steward, as we wrap up here, some final thoughts, what do you want people to walk away from this conversation knowing?

Dr. Steward: Yeah. Thank you. What I've been talking to people about sometimes they think is silly and I've been talking to people about making sure they're drinking enough liquid, staying hydrated so that they're not getting physiological symptoms. That also stress them out more because people are worried, they're getting COVID-19. And so physical symptoms bring up more anxiety. And so staying hydrated and eating, I've also been talking about breathing. That's something you can do in any moment of time. And nobody knows you're trying to calm yourself down by doing it so inhaling and exhaling and slowing that down, increasing pleasure and joy. And so you balance out some of that anxiety and stressors by trying to search for things that make you feel better. Doing all the things that people might think are silly and weird, but make you feel happier, pleasure, and joy.

And then the last thing that has been working really well for people that they sometimes don't think about it. We have to get better at setting boundaries and setting limits and saying, no, we don't have a lot of reserves and extra. And so we have to sift through all of the things in front of us and figure out what we really want to do and what we really need to do and what will make us feel better. And so getting that muscle going of, I can't do that right now, or I'm not going to be able to do that in the near future, setting boundaries and limits in line with who you want to be and how you want to feel, is the biggest skill that I've been working with people on recently because of the pandemic.

Host:  Well, I'm afraid to say that's all the time we have for today. My thanks to Dr. Erin steward and Daniel Mitchell.  And thank you for joining us today for this conversation with experts from the UVM health network. For more information about COVID-19 visit UVM health.org/coronavirus.