When we are confronted with a new, unknown virus, our fear can get out of hand and we often assume the worst. We give in to our fears. We panic. The uncertainty overwhelms us, exacerbates old fears and fears and creates many new ones.
If this reaction sounds familiar, you were probably alive when HIV, the AIDS-causing virus, caused widespread anxiety and unrest in the 1980s. In fact, the outbreaks of HIV / AIDS and new coronavirus / COVID-19 share much in common: an inadequate government response, the stigma attached to the virus, the disproportionate impact on underrepresented groups, and initial confusion about how the viruses transmit become.
At the beginning of the AIDS crisis, people wrongly assumed that they could get HIV by kissing someone else. Michael Soderstrom, a licensed professional counselor with Houston OCD Counseling in Texas, recalls his own fear when he first heard about HIV and AIDS. He says he didn't want to sit in a public toilet for fear of becoming infected with HIV.
There is no doubt that the COVID-19 pandemic has changed us. The question is to what extent it will change us further. Will we ever shake hands again? Do we wear masks every year during the flu season? Will we learn from the lessons of previous health crises? One thing is already clear: the pandemic is not only changing people's fears and fears, it is also changing the way counselors need to approach treatment.
Fear of contamination and harm to others
What about people who had to fight contamination fears before this pandemic? Have you experienced an increase in symptoms? Soderstrom, a member of the American Counseling Association that treats obsessive-compulsive disorder (OCD) and other anxiety disorders, has found that his clients who fear contamination from blood, semen, or body waste have not gotten worse from quarantining them largely from exposure keeps these "impurities" away. However, he has seen an increase in clients worried about getting sick, sick, or dying, as well as clients with perfectionist tendencies struggling with the fact that COVID-19 is ultimately out of their control. The thought that no matter how carefully they follow safety precautions they could contract the disease frightens them, he says.
The pandemic has even led to a new phobia – coronaphobia, the fear of contracting COVID-19.
People with obsessive-compulsive disorder are also currently at risk of relapse as the isolation, increased stress, and insecurity associated with the pandemic can lead to the depression and general anxiety that causes symptoms associated with obsessive-compulsive disorder, says Soderstrom, a Member of the International OCD Foundation and OCD Texas. He has seen several new clients who had previously dealt with OCD themselves but whose symptoms became unmanageable during the pandemic, so they sought professional help.
To some extent, everyone is concerned about cleaning and disinfecting at the moment. When do these thoughts and behaviors become a problem? Soderstrom asks customers struggling with contamination fears to establish a safety practice based on guidelines from a trusted health organization such as the Centers for Disease Control and Prevention (CDC). It also lets customers record how often they clean surfaces to see if their behavior becomes problematic.
When customers find they are going beyond CDC guidelines and compulsively wash their hands, Soderstrom lets them set rules about when to wash their hands, such as when they should wash their hands. B. after using the toilet or sneezing. He also encourages them to limit themselves to washing with soap and water for 20 seconds. First of all, these customers may feel the need to wash their hands every time they touch the front door as it could be contaminated. Over time, Soderstrom may ask them to simply wash their hands with water after touching the front door. This fulfills their emotional need without the full burden of soap and water. These ground rules are there to anchor people in reality because someone who wants safety can always find a reason to wash or clean, he adds.
Soderstrom has also noted an increase in customers who are concerned about infecting others with the coronavirus. These clients struggle with what is known as "harm-obsessive-compulsive disorder". It's the same people who worry about harming or killing someone with their actions, he explains. To illustrate, these customers might grab a doorknob and think, "I hope I have the COVID-19 virus and will give it to my mother." But then they are quick to reject that thought and obsessively clean the doorknob for fear that they will actually give the virus to their mother.
Over-responsibility is a major problem with obsessive-compulsive disorder, Soderstrom continues. Some customers feel a responsibility for failing to protect others from the coronavirus and so often clean frequently touched surfaces like car door handles before others use them.
With these customers, Soderstrom often uses a responsibility cake exercise. If a customer is concerned about giving the COVID-19 virus to their elderly parents and killing them, they would ask, “How can they get COVID-19 any other way? How often have you been to the store? How many times have other people come to your house? “This exercise helps clients realize that taking full responsibility for the possibility of someone else getting COVID-19 is not realistic,” he explains.
Soderstrom also finds this exercise personally helpful. Whenever he has intrusive thoughts about the possibility of getting COVID-19, he asks himself, “How could I get the virus? If I got the virus, who would be responsible – me, the government, or the people I'm with? "Thinking through these questions helps him realize that even if he did get COVID-19, it wouldn't automatically mean he was irresponsible or a failure. Because there are so many factors involved, he knows he's only the best can do to stay safe. The rest is ultimately beyond his control.
Relationship and separation anxiety
In the coming months, Rocio Morris, a licensed mental health advisor and assistant clinical director at Bougainvilla House in Fort Lauderdale, Florida believes the number of counselors' relationship problems will increase. She has already noticed that more of her clients come to therapy because of family attachment and communication issues. For example, one of Morris' clients has an equivalent relationship with her mother, and the mother's fear of the pandemic affects her in turn. The mother is constantly worried about the family getting infected with the virus, which only serves to heighten the daughter's fear.
Additionally, some Morris customers have identity crises from being isolated and trying to figure out who they are when they don't have normal support networks. One client in particular actively deals with her sexual orientation, but she does so alone in a house with an unsupportive mother and two young siblings. Prior to the pandemic, this client would have found support through school activities or hanging out with friends who had similar experiences. Now she feels trapped and all alone in her house.
To complicate matters, the client has a history of self-harm. Morris, an ACA member who specializes in working with teenagers and adults struggling with anxiety, depression, behavioral problems, and life transitions, works to cultivate the client's inner strengths to support them during this challenging time support. For example, because the client is artistic, Morris encouraged her to use expressive coping techniques. When the client feels the urge to harm herself, she paints that part of her body instead.
Morris, owner of the private practice Reimagine Life Counseling Services, believes that these types of relationship problems are likely to increase. Once the pandemic-related restrictions are lifted, some people will be anxious to leave the house or be separated from certain family members, while others will spend months grappling with the result of being stuck in a toxic environment, she says.
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Soderstrom believes counselors can see an increase in clients panicking for leaving the house and staying away from family members because they are more bonded during the pandemic. "It's like part of us hasn't been trained [during the pandemic] and is getting out of shape," he says. “We have to do this part of ourselves again to be our full selves. … We have to experience fear anew. We have to relive doubt. We need to… relive emotional isolation outside the home. "
Soderstrom knows how much isolation can influence a person's social anxiety. A few years ago he had an extroverted client who lived abroad with his father for a long time. For the most part, the customer remained isolated in his apartment because he did not speak the local language. When he returned to the US, he visited Soderstrom because he was socially afraid to reconnect with his friends. Taking extended breaks from social activities had affected his self-confidence and made it easier for him to dodge his friends, which only increased his anxiety, Soderstrom says.
With Soderstrom's help, this client overcame his fear, but Soderstrom fears that more people will struggle with social anxiety and panic disorders as soon as the need for physical distancing is finally over, as they too were isolated for longer periods of time. He predicts that some people will find social situations, such as going to the mall or being around large groups of people, that will trigger first.
“Because this [pandemic] is such an individual experience for everyone, people will emerge from it or get on with others [experiences]such as losing someone or experiencing trauma in the home. Morris is watching. These differences will affect how people learn to interact with each other again, she adds.
Countering fear, not avoiding it
Clients frequently visit Andrea Batton, a licensed clinical advisor and clinical director at the Maryland Anxiety Center, asking them to "get rid of their anxiety." Of course, nobody wants to be anxious or anxious all the time, but the goal of treatment isn't to completely eradicate those feelings, she says. Batton, an ACA member who specializes in the treatment of anxiety and obsessive-compulsive disorder, explains to clients the adaptability of these emotions, including informing them about our environment and helping them survive. The whole point of counseling is to learn how to respond more helpfully to those emotions, she says.
Soderstrom also advises his customers not to ignore these thoughts and feelings but to be curious about them. Too often, he says, customers try to run away from these thoughts. “We try to control thoughts by either getting rid of the trigger or avoiding the trigger,” he explains. His goal is to get clients to embrace their emotions by holding onto the thought and focusing their energy back into their body or on another thought that they value more.
So when an adult child is having lunch with his father and is irrationally afraid of having the COVID-19 virus and has only given it to his father by hugging, they can pause and acknowledge this intrusive thought one that feels true but is not true. You can ground yourself by shrugging your shoulders, reminding yourself of the small likelihood of giving your father the virus, and returning your attention to what you will be discussing over lunch.
"The art of realignment gives us ultimate strength," says Soderstrom. "It is moving on or refocusing on something that we value or that is important, that teaches us to devalue whatever the [intrusive] thought was rather than avoid it."
While not intentional, physical distancing guidelines encourage many people to avoid the stimuli that create their fears or anxieties, and this can have a serious impact on their overall progress, says Batton, a member of the International OCD Foundation and a Board member for OCD Mid-Atlantic. For example, some school-age children struggled to go to school before the pandemic because they wanted to avoid situations that might trigger worries about a panic attack or a particular phobia, such as fear of vomiting. Virtual classes – which have become common during the pandemic – are used to reinforce avoidant behavior.
"Avoidance is compulsive behavior that reinforces the idea that there is a danger in school," says Batton. Therefore, she wants these students to return to face-to-face teaching full time. The same goes for clients who want to avoid work or other attitudes that trigger anxiety, phobias, or obsessive-compulsive disorder or anxiety.
Consultants need to work with their clients to come up with plans on how to return to these rooms once it is deemed safe, Batton continues. "We don't want fears, worries and fears to limit your life," she says. "We want you to live in accordance with your life goals [and] not [with] what fear tells you or what your fears tell you not to do."
Reevaluate negative thoughts
When people are triggered, their minds automatically shift to worst-case scenarios, says Batton, a member of the Anxiety and Depression Association of America. When clients struggle with worst-case scenarios or all-or-nothing thinking, also known as "thought traps," counselors can help them by teaching them how to respond more rationally to their thoughts, she continues .
Cognitive reassessment is not about "looking on the good side" or trying to be positive, notes Batton. Instead, counselors should help clients consider other possible explanations and see what else is going on. For example, if a student has problems in a virtual class, they might start thinking, "I won't pass the class." Everyone else understands the material. I'm stupid. "These thoughts will only make the student more anxious about the class, making them fearful of doing homework or even avoiding going back to class, thereby reinforcing those less rational thoughts, she explains .
Batton's goal is instead to teach the student to take a step back and consider what else might apply to the situation. Perhaps the other students are confused as well. Maybe the lessons are difficult. The student may not get an A in class, but they will still pass. After challenging the negative belief, the student can engage in more adaptable and helpful behaviors, such as For example, start a study group or talk to the teacher about how to improve in class.
This cognitive reassessment technique helps clients change the way they respond to intrusive thoughts over time. "When you have more rational thoughts, you will feel more neutral. You won't feel as anxious. You won't feel discouraged … or afraid," explains Batton. These neutral emotions and rational thoughts lead to more productive behaviors, which in turn lead to more rational behaviors Fire thoughts.
Morris says many of their customers are falling into thought traps regarding the pandemic. She often relies on thoughtful exercises to help them loosen up and move forward. If a client is afraid to leave their home because they may catch the COVID-19 virus, she will help them identify the trigger and stop the negative thought before a physical reaction occurs. She asks the client, "What's one little thing you can do to feel more in control?" Perhaps instead of locking themselves in their home, they could put on a mask and take a gentle stroll around their neighborhood.
Morris also shows customers some common misconceptions such as negative labeling (e.g., “I'm stupid”), blowing up (e.g., “This pandemic will never end. I will live) forever alone. ") And self-blame (e.g.," My neighbor has COVID-19. I probably gave it to them. "). She then asks them to identify which ones they are experiencing. This helps initiate the conversation and individualize the coping skills the client will need to respond to those thoughts, she adds.
Soderstrom helps his clients to engage in logical rather than emotional thinking by asking Socratic questions. For a customer who worries they haven't cleaned the doorknob well enough and may be responsible for their family getting the COVID-19 virus, Soderstrom would simply ask, "Would you bet $ 10,000 if a scientist came and…" wipe the doorknob? would the virus find? What is the evidence for this thought? What would you say to your friend if they're in a similar situation? "
He also asks customers to create a thought record that consists of seven columns: situation / trigger, feelings, unhelpful thoughts / images, facts that support this thought, facts that question this thought , an alternative (more balanced)) perspective and the result. This activity anchors customers and pulls them away from black and white thinking, he says.
Rethink exposure therapy
As Batton points out, exposure therapy is the backbone of clinical treatment for anxiety and obsessive-compulsive disorder and related disorders. However, not all exposures are possible during a pandemic. Asking a client with social anxiety to go to a big party is bad therapy right now, Batton jokes.
For this reason, consultants have to get creative with their exposure ideas. For example, Batton uses a HIPAA compatible version of Zoom and Bluetooth to “ride” with their customers with driving phobias. That way, she can still see the customers' expressions, e.g. B. a clenched jaw while training them during exposure. When she has a client engaged in compulsive bathroom rituals, she sets a timer and virtually watches them brush their teeth to limit how long they engage in this behavior. Batton also helps clients with emetophobia (fear of vomiting) by making false vomiting noises together during the virtual session, sharing their screen to view photos of vomit, and video clips of other people throwing up.
Regardless of how the exposure is done, the goal is to initiate these intrusive thoughts and fears so that clients realize that their worst fear is unlikely to occur. Through this experience they do not “unlearn” fear. Instead, they get "new safety learning" or inhibitory learning (i.e. learning that the dreaded stimuli and their emotional response to them are safe) and get used to the thoughts and uncomfortable feelings, Batton explains. The anxious thoughts lose their power and diminish over time, she adds.
Before the pandemic, Soderstrom rarely went to clients' homes for exposure therapy. Now, with the transition to the health of tele-behavior caused by the pandemic, he regularly enters the customers' homes virtually and works in real time on their phobias and fears. For example, a client fears losing control and accidentally stabbing her grandmother. Previously, as part of the treatment, he asked the client to take a plastic knife and sit next to her grandmother or hug her as a homework assignment. Now he can watch her while she actually does this exposure exercise.
Soderstrom also finds inventive ways to help customers focus on their core fears. For example, he asked customers with social anxiety to call someone on the phone and post new videos on TikTok.
Virtual expositions have actually expanded Soderstrom's treatment options because, as he emphasizes, "so many obsessions / compulsions are made in the house". Therefore, he plans to continue virtual exposure sessions even after returning to face-to-face sessions. He likes that the virtual exposure sessions give him visual, not just written, evidence of the clients' progress.
Batton notes that virtual exposures offer their clients inexpensive treatment options. Before the pandemic, she had to collect a travel fee every time she made a home visit to do exposure work. Due to the pandemic and the health of tele-behavior, home calls have been eliminated, and since exposure therapy is usually practically as effective as it is in person, she plans to resume this practice occasionally after the pandemic-related restrictions have ended.
The consultants' own fears (and hopes)
At the beginning of the pandemic, Soderstrom feared that he would lose contact with his customers. He thought he wasn't as effective as a therapist because of the limitations of physical distancing. But Soderstrom was happy to learn that his fears were unfounded. He just had to adapt his technology and become more vulnerable with his customers.
With the health of tele-behavior, clients may not be able to grasp the counselor's body language, or they may not feel comfortable being vulnerable themselves, Soderstrom says. He finds that being open and honest about the way he feels often leads customers to be more open with him. For example, he recently said to a client, "Sometimes I feel like it's difficult to get treatment right now." This prompted the client to share that he also found therapy difficult. The client had been unable to do their therapeutic homework that week and had even considered dropping out of therapy. Soderstrom assured the customer that they were not alone with this feeling.
Morris believes advisors will need to keep suicide on their radars for the months and years to come. The rate of suicide among teenagers has already risen, and it is reasonable to assume that the loss of jobs, isolation and loss of life as a result of the coronavirus pandemic will only increase that rate, along with suicidal thoughts among both teenagers and teenagers Adults, she says.
Morris emphasizes the importance of advisors making more contact in these times. She recently hosted a webinar for a local high school on the effects of COVID-19 on teenagers and discussed the red flags of suicide as a preventative measure. By providing psychoeducation, she hopes to normalize conversations about suicidal thoughts and prevent future suicides.
Batton's greatest fear for the profession itself is that many consultants decide to deal with customers exclusively for reasons of tele behavior, even after the risk of a pandemic has ended. She admits that returning to face-to-face sessions may not be easy or straightforward for many clinicians, especially if they have had to terminate their office lease. However, she hopes that most counselors will find some way to return to an office in some form. Batton longs to see clients and counselors in person again, partly because face-to-face sessions are beneficial for clients struggling with certain fears and anxieties, such as social phobias, she says.
Morris shares Batton's concern about the possibility of advisors not returning to their offices. She is currently hiring consultants for her clinical office and has found that many of them are still afraid of having face-to-face meetings even after taking proper precautions to wear masks and disinfect between sessions. Morris admits that the entire process was troubling for many clinicians. First, they had to be quick to get their practices online. Now they are being told that with security precautions they can go back to the office. She wonders, "How long will it take for counselors to feel comfortable again in face-to-face meetings?"
Soderstrom says some of his clients are concerned about the possible consequences of continued suffering over the past year due to the pandemic. Others with anxiety and obsessive-compulsive disorder fear that if their situation becomes too difficult, they could implode or become incapacitated in worry. He assures them that people are strong and can adapt to the worst of circumstances – just as they were before.
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Lindsey Phillips is Counseling Today author and UX content strategist. Contact them at [email protected] or through their website at lindseynphillips.com.
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Opinions and statements in articles appearing on CT Online should not be assumed to reflect the opinions of the editors or guidelines of the American Counseling Association.
