What is mental health?

What is mental health?

The World Health Organization defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.

So often in our society, we use the term “mental illness” to mean things like severe Schizophrenia and Schizoaffective Disorder. This is understandable, given that individuals that suffer from disorders like these are often very severely impaired — but this can lead to a troublingly binary way of thinking about mental illness and mental health.

When only extreme cases of mental illness get categorized as such, it can give the impression that everything else constitutes mental health. This is problematic, because it can lead those who are suffering in less extreme ways to blame themselves for their condition. They are led to think of themselves as a failure, rather than as someone who is suffering. This kind of self-criticism is problematic primarily because it presents a formidable obstacle — making it more difficult for the individual to overcome their mental illness. The point here is that we need a new way of thinking about what mental health (and mental illness) look like.

For most individuals, there is no simple “yes” or “no” answer to the question “am I mentally healthy?”. This is because mental health is a continuum, not a binary category. It is multifaceted and complex, made up of multiple interrelated continua. In this respect, it is actually very similar to physical health — and seeing it as such may be part of what is necessary, for many individuals, in order to attain it.

Navigating Medical Care with Iatrophobia

Navigating Medical Care with Iatrophobia

Iatrophobia is a psychological condition where someone has a strong and persistent fear of doctors that interferes with their life. Those who struggle with this condition are at great risk of illness and early death because they often fail to seek the appropriate preventative care and early medical interventions that play a crucial role in disease onset and progression.

Navigating the medical system while struggling with iatrophobia is profoundly challenging. Nothing about this condition is easy. However, there are some guidelines that can be useful to those struggling with iatrophobia and to their loved ones. The most important is to not give up hope. A phobia is not a permanent disability. Evidence-based therapies such as CBT have a very high success rate in treating phobias, with upwards of 90% of people who receive CBT eventually achieving full remission.

Someone reached out to us recently to ask if we knew of a primary care physician specializing in iatrophobia. Unfortunately, we have never heard of an internal medicine doc who specializes in iatrophobia, though we would love to connect with one and refer our patients to them. In our experience, only psychological care (i.e., therapy) is likely to get that specialized, and even then the focus is likely to be on something suitably broad (such as "anxiety disorders").

However, there is a continuum of MDs and DOs with respect to how compassionate, educated, and comfortable they are regarding psychological/psychiatric issues such as phobias. Some of them are great (compassionate toward, educated about, comfortable with, etc. etc.) while others are not (apt to criticize, clueless about, uncomfortable talking about, etc. etc.). 

Strategies for finding a good primary care doctor:

1) You could read reviews (most docs have online reviews at this point).

2) You could ask your friends, family, coworkers, etc. about their primary care docs (whether they like them, what they're like to interact with, etc.).

3) You could shop around (go to a bunch of first primary care appointments with different docs until you find one that feels like a good fit (this would be wonderfully therapeutic for someone with iatrophobia so I highly recommend it).

Other things you should definitely consider:

A) Getting in to see a therapist that specializes in cognitive-behavioral-therapy (CBT) for phobias. Exposure therapy (the type of CBT used for phobias) sounds scary, but it really is the best option for most patients. You can read this article to learn a bit more about why psychologists treat phobias this way.

B) Getting in to see a psychiatrist. They can prescribe you something (e.g., SSRIs or Beta Blockers) that will help lower your fear response so that you're actually able to make an appointment and start seeing someone in primary care. You can read this article to learn a bit more about your psychiatric care options.

If you'd like to get on our waitlist to see a therapist (for the type of treatment described in the above article), you can sign up here.

Therapists Discuss COVID-19 Anxiety

Therapists Discuss Covid-19 Anxiety & Stress Management

Note: This is part of an interview that Jennifer Yeh and Blake Thompson gave for local reporter Julie Muhlstein.

Q1) Do you believe the stay-home and social distancing measures may have an unintended consequence of also raising people's anxiety (OCD, panic or agoraphobia) once they do begin to go out and resume more normal activities? 

BT: Yes. Especially when it comes to Agoraphobia. For many clients, managing agoraphobia means engaging in the ongoing work of challenging themselves to be out in public.  Without exposure, it's not uncommon for them to have a relapse (i.e., for their sensitivity to these triggers to increase again).

JY: Yes.  Anxiety is associated with the overestimation of danger, and the underestimation of our ability to cope with a potential threat.  The stay-home and social distancing measures send messages that there is increased risk ‘out there, among other people’.  This is both truly unfortunate for humans as social beings, and also an unavoidable reality of fighting a global pandemic.  It follows that re-emerging from quarantining can heighten anxiety - it involves facing the uncertainty of the world, with its visual reminders that we are still very much in the middle of a pandemic (i.e, masked community members, copious hand sanitizer bottles and gloves, plexiglass partitions, and 6 feet spacing markers on the sidewalk).

Q2) Are there some tips you could share for people who may be feeling especially anxious about going into public places, or even back to work? 

BT: Make decisions about what types of risks you're willing to take before you leave home. It can be inordinately stressful to have to make decisions about risk on the fly. Being clear with yourself about what you are and are not comfortable with ahead of time (and communicating those boundaries to friends and family members) has the power to make your life much less stressful when you venture out into the world. This is more difficult when it comes to work, as many workers don't have the ability to make decisions about which risks they take at work, but to the extent that you are able this can also be a useful strategy for work.

JY:  Blake, I really like your response here, especially communicating boundaries so important.  This can be tough to do, but helpful.

I’d say, first, imagine yourself ahead of time going into public places – see if you can picture these scenarios as vividly as possible.  Consider what possible problematic situations could arise, and how you would handle those effectively. This is what we’d call the “DBT Cope Ahead” strategy.

Second, if possible, give yourself time to break down your re-entry process into steps.  

- Start with situations that are more contained (like a walk in your neighborhood).  As you get your bearings with being out and about, build up from there to different destinations and/or activities where you could be around more people (like getting take-out from a favorite restaurant, or visiting a park).

- Set an intention to leave the home at least once a day, and continue to increase the frequency and length of these outings.

Third, Get social support in this process (even if your companion is masked-up and 6 feet away). Navigating pandemic life alongside someone you trust can help with recalibrating to the ‘new normal’.

Fourth, Give yourself and others as much compassion as possible in this potentially awkward and uncomfortable process.  If you find compassion and judgement of yourself and/or others wearing thin, see if you can speak with a supportive person.

Q3) Could you comment on the notion that while anxieties may typically be based on fears that are unfounded, with COVID-19 the fear is based on reality, the possibility of contracting the disease?

BT: Most theories that we operate from in clinical psychology focus on intra-psychic issues. Covid is definitely an extra-psychic issue. So a lot folks in clinical psychology are thinking about this less in terms of 'curing an irrational fear' and more in terms of 'stress management'. Keep in mind, we don't want people to be fearless, that wouldn't be helpful in this situation (this could result in potential harm to you or others you interact with). But stress is dangerous as well, if only on a different time-scale. Stress causes cancer, it causes cardiovascular disease, it causes insomnia, it leads to substance abuse problems, it can lead to marital problems... it can lead to suicide. We need to take stress management very seriously. Luckily, you don't have to believe that you're 100% safe in order to manage your stress. Even hostage negotiators and fighter pilots can learn to manage their stress, it just takes the proper training - you have to learn the right tools.

JY: First off, great points about the problems with stress and stress-management, but I don’t think this conceptualization of anxieties outside of COVID-19 being based on unfounded fears is particularly useful.  Many of the things that people have anxiety about aren’t always that irrational – rather the level of preoccupation with the fear has become so much more functionally impairing and misery-making than is useful or productive.  I find it more helpful to consider COVID-19 anxiety similarly to other anxieties – the goal is ultimately to boost the signal-to-noise of actual dangers to perceived dangers.  With things we fear (including contracting COVID-19), less preoccupation with the background noise of improbable risks mentally frees us up to attend effectively to the higher probability risk factors – while also leaving space for moments of joy, connection, and calm.

Q4) Is there something especially troubling about a risk that is invisible -- we can't know who might be spreading the disease, so we begin to fear everyone we encounter? 

BT) For many people, yes. Invisibility means more uncertainty and uncertainty is a huge component of anxiety for so many people.

JY: I agree! The invisibility is problematic because it goes hand-in-hand with great uncertainty and this coronavirus pandemic is particularly insidious in that it has presented us with the perfect storm of uncertainty.  For example, the COVID-19 virus has an idiosyncratic process of infection - it has a long incubation period and there is the potential for pre-symptomatic people to unknowingly shed the virus. 

BT: Exactly! These obscurities combine with the novelty of having yet to fully understand the nature of what we are contending with and how to effectively get a handle on it, especially in ways that balance unintended economic and social harms. 

JY: We can add to that things like long waiting periods to be tested and to find out those results. These factors add layer upon layer of uncertainty - and all that uncertainty can pile on to an already stressful situation.

Q5) Anything else you'd like to share?

BT: This is all related also to why so many people, on the other side of the spectrum, act like there's nothing to worry about. They overcompensate for their fears by pretending there's nothing to be afraid of. They pretend so hard, they often fool themselves. If you find that you're afraid of getting sick and dying, or of a loved one getting sick and dying, in the middle of a pandemic, that's not irrational of you and it isn't a weakness - what it means is that you're not in denial. Acknowledging dangers and taking appropriate steps to protect yourself and others - this is a rational and emotionally mature response. Acknowledging that you're stressed and afraid and taking steps to work through these feelings so they don't grind you down - this is a rational and emotionally mature response. Pretending there's nothing to be afraid of and pretending that you aren't afraid - these are emotionally immature responses to a global pandemic.

Shame and Anti-Racism Work

Seattle Therapist Discusses Shame and Anti-Racism Work

A guest post by Tina Alvarado, LMFT

ABSTRACT

We, as White people, need to work on building up our shame resilience as a way to continue to engage in dismantling White Supremacy. The lives of Black, Indigenous, and People of Color (BIPOC) depend on it. It is normal and okay to have hard feelings come up as you confront the White Supremacy you have internalized. Follow the steps explained below to increase your tolerance of these uncomfortable feelings so that you can remain steadfast in your anti-racism work.

INTRODUCTION

As a White Latina and a psychotherapist, I see one of my roles in anti-racism work as supporting other White and White-passing people in exploring their racial identity, privilege, and the role they play in systems of oppression. 

I have noticed a lot of the same themes come up in therapy sessions over the past two weeks as my White clients are responding to a new-found urgency to explore their Whiteness. The purpose of this post is to gather them in one place and share them here in the hopes that it will help other White and White-passing people in their process. 

Below, you will find seven steps that White people can take to help them prevent shame from getting in the way of their anti-racism work. Let this be a starting-off point for conversation and action. I, myself, am excited to engage with others around it as I continue to do my own work.

Dear White People

I want to address something that often gets in the way of our work when it comes to confronting and addressing the ways that we have internalized, participated in, and contributed to White Supremacy: SHAME. Specifically, to use a term coined by Dr. Brene Brown, low shame resilience. 

It is common to experience shame when we are confronting something we have done that contradicts our values or calls attention to a blind spot that we have had. Having a low shame resilience means having a hard time moving through experiences of shame. You are likely get stuck or immobilized by it. Sometimes we approach shame like it's the boogey monster: don’t talk about it, don't think about it, avoid it at all costs and maybe it'll go away. Sometimes we get stuck in a shame spiral and can't seem to find our way out.

Shame does not have to be so scary

In fact, it is partly this response to shame that makes it feel so bad. The action urge associated with shame is hiding, it causes us to isolate and move away. Shame, just like any other emotional state, exists for a reason. It has been evolutionarily effective. We are communal people and as such want to avoid anything that disconnects us from our community. Historically, to be disconnected from our people meant that we would not survive (think about the animal that gets separated from the pack and is vulnerable to prey). 

Present-day, that is not our reality. For the most part, especially if you are white/cis/able-bodied/straight, to be separated from your group is not a threat to survival. The emotional toll of being separated from relationship and connection does have a detrimental effect on our mental and emotional well-being, but that is a topic for another time. The need to be connected is still biologically hard-wired into us. We still feel shame. 

The function of shame is to tell us when we have done something that violates our own values or our community's values. However, shame becomes a problem when it starts to control us. We can easily get fixated on how to avoid it. This fixation can send us into a shame spiral or keep us stuck. 

Shame is also a problem when we get repeated "false positives.” This is when we feel shameful about something that we do not actually need to feel shameful about. False positives can happen with respect to our sexuality, our sexual orientation, the moments in which we confront racism, and so on. When this happens, we need to ask ourselves what forces are conspiring to generate the false positive. In the previous examples it would be: a sex-negative culture, a hetero-normative culture, a culture of White Supremacy. When we are able to successfully reflect on and identify the sources of these false positives, the shame no longer has to be personal. We can overcome, in certain respects, this experience of ourselves as bad or wrong. We can come to see that our shame is just another emotional state that indicates to us that there is something for us to learn.

When we say that there is no room to center white peoples' feelings in anti-racism work, we do not mean "don't have feelings." Of course, you are going to have feelings. You are coming up against blind spots and re-orienting to all the things that White Supremacy has hidden or distorted in order to maintain power (e.g., most of the history coursework in this country centers White people and White experiences almost exclusively). What we mean is that your feelings should not be taking center stage. Your White experience(s) should not be distracting from the experiences of People of Color. This is about how you impact People of Color, not about how they impact you. 

However, you do need to process your feelings. If you get stuck in your feelings or are unable to let yourself become emotionally transformed by this work, you will be ineffective in creating real change for People of Color. Keep in mind that while we White people are experiencing emotional discomfort when we choose (note: this is privilege) to engage in anti-racism work — BIPOC are losing their lives when we do not.

What do you do if you are struggling with hard feelings as you learn about your role in White Supremacy? You increase your shame resilience.

How to increase shame resilience in anti-racism work:

1. Acknowledge that a hard feeling is coming up.

2. Get curious about this hard feeling. Do you have a name for it? Sometimes it helps to give it a label. Other times naming it is more trouble than it's worth, but you can still describe it.

3. Notice what it feels like in your body when you have this hard feeling or what urges come up for you. For example, do you have the urge to hide or to justify and defend yourself? Noticing this is important because it will help you recognize this hard feeling more quickly in the future. It will also help you practice mindfully responding to your feelings so that you can choose what is the most effective course of action.

4. Ask yourself: what is there for me to learn about this hard feeling? What is it that I already know? How can I connect these things?

5. What is the most effective next step that aligns with my goal of dismantling racist systems and the value I recognize in supporting and centering BIPOC lives and experiences?

6. Do that thing.

7. Be kind to yourself and take a deep breath (we will talk more about kindness below).

At any point in these steps, talk to other White people who are doing anti-racism work and continue doing your research about BIPOC lived experiences. After all, one of the ways shame functions is it keeps us silent and shame THRIVES in silence. This silence really serves White Supremacy because it means the system does not have to change.

Example

Reading an article about the importance of contributing funds to anti-racism advocacy work led by Black folks brought a tightness in my stomach. What is there for me to learn about that response? It feels closely tied to the messages about "protecting your hard earned money" or "pull yourself up" or the capitalist idea that there isn't enough to go around. That's uncomfortable to admit. But I know that those messages are actually untrue and rooted in the systems I am trying to dismantle … so I can say “look, there is my internalized White Supremacy showing up again.” 

My urge is to hoard my money. Yet I am aware that this urge is not aligned with the value I recognize in supporting BIPOC lives and in dismantling the systems that falsely say that their lives are less important than mine. How can I, for the sake of living in accordance with my values, act in opposition to this urge? Considering this question in earnest could lead to a flash of insight and to moral clarity. For example: I realize that what I must do is choose to donate to this organization that works for racial justice and is led by a Black Queer person. I will also pay attention to when I have this feeling again so that I can look for more opportunities to un-learn and re-learn.

A note on being kind to yourself

It is important to be kind to yourself. It is a myth that the only way to motivate ourselves is to bully ourselves or be mean to ourselves. This myth is, as you might have guessed, rooted in a number of different interlocking systems of oppression (another topic for another time). 

It is important to be aware that kindness is different from politeness or nice-ness. Politeness or nice-ness values intention over impact and says: "it's ok, I know you were trying and that is enough." True kindness, on the other hand, is not afraid to name a hard truth and call us up into our own potential to do better. It takes ownership over the impact and seeks growth. True kindness says: "I know you were trying and you missed the mark. That's ok because we are all human and we all make mistakes. It makes sense that you're feeling something hard right now. Let's look at what you need to do to repair (if possible), what there is for you to learn, and what you can do differently next time.”

SUMMARY

If you truly want to work for sustainable change to shift the system so that Black folks and POC are no longer bearing the brunt (READ: DYING), you MUST be willing to build the shame resilience necessary to work through your hard feelings and keep them from immobilizing you. The steps enumerated above are just ONE way of doing it. This will take time. It is not a quick fix, but it is necessary for the marathon of work it will take to dismantle the systems that value White lives over BIPOC lives.

Do not let your shame get in the way of learning and doing better.

ABOUT THE AUTHOR

Tina Alvarado, LMFT is an individual and relationship therapist who provides telehealth services to clients in Seattle and throughout Washington state. As a Mexican-American clinician rooted in systems theory, she specializes in identifying and exploring the practical, relational, and psychological impacts of the systems at play in our lives. With expertise in food/body issues, healing attachment wounds, and increasing emotional intimacy she helps millennial clients develop more satisfying connections with themselves and others.

ADDENDUM

As mentioned above, Brene Brown coined the term “shame resilience” and she has authored a number of excellent books that are relevant to developing shame resilience. Here is a list of the books that Brown has written that touch on shame/shame-resilience (as well as a TED Talk):

- I Thought It Was Just Me: Women Reclaiming Power and Courage in a Culture of Shame (2007)

- Connections: A 12-Session Psychoeducational Shame-Resilience Curriculum (2009)

- The Gifts of Imperfection (2010)

- Men, Women and Worthiness: The Experience of Shame and Power of Being Enough (2012)

- The Power of Vulnerability: Teachings of Authenticity, Connections and Courage (2013)

- Braving the Wilderness: The Quest for True Belonging and the Courage to Stand Alone (2017)

- "Listening to Shame" TED Talk (March 2012)

You can order these titles from any number of black-owned bookstores.

Please Donate:  https://therapyforblackgirls.com/ 

Learn + Support: https://blacklivesmatter.com/  https://www.rachelcargle.com/ 

Therapy for COVID-19 Fear & Isolation

New Online Therapy Group: Coping with Fear and Isolation During COVID-19

During the COVID19 lockdowns, many people found that it was helpful to remind themselves that this was only temporary, that in a matter of weeks or months they would be able to see friends and family again. Sadly, this is not true for everyone. For example, those with chronic illness face far more uncertainty because they are at higher risk of death or serious complications should they contract COVID19. This in turn, puts them at much higher risk of anxiety and depression.

This is why we’ve designed a therapy group specifically for those at higher risk of death or serious complications due to COVID-19, to provide a supportive environment for them to connect with others and to learn evidence based psychological tools to help them cope with the isolation, anxiety, and depression that they are struggling with (you can email sonya@seattleanxiety.com to learn more about this group).

We've also launched a low-fee therapy program aimed at helping those who've lost their jobs due to COVID19 and others who wouldn't normally be able to afford the costs of therapy (you can email kate@seattleanxiety.com to learn more about this program).

Understanding the Impact

In any given year, nearly 18% of people in the United States experience an anxiety disorder.(1)  Taking a physical toll, anxiety and mental health issues often manifest and present themselves as physical ailments, such as headaches, stomachaches and/or cognitive problems (such as difficulty concentrating) and can impact all facets of life.(2)   Those with chronic illness face far greater stressors because they are at higher risk of morbidity or serious complications, should they contract COVID-19.  Coupled with increased isolation while avoiding potential exposure to the Coronavirus, those with chronic illness are at much higher risk of anxiety and depression during this time.  

Common signs of distress include:

• Feelings of numbness, disbelief, anxiety or fear

• Changes in appetite, energy, and activity levels

• Difficulty concentrating

• Difficulty sleeping or nightmares and upsetting thoughts and images

• Physical reactions, such as headaches, body pains, stomach problems, and skin rashes

• Worsening of chronic health problems

• Anger or short-temper

• Increased use of alcohol, tobacco, or other drugs(3)

• Guilt

• Sadness and grief

• Helplessness

• Surrealness

• Increased worry and empathy for others(4)

During the ongoing COVID-19 pandemic, participants in Seattle Anxiety Specialists’ recent community survey reported a significant increase in stress, anxiety and worry.  Primary points of concern comprised the health and safety of themselves, followed by that of their family and friends.  Financial concerns were also prominently noted, with 35% reporting their employment situation had been negatively impacted by the pandemic. Overall, 45% reported their quality of life has been significantly impacted during this time.(5)

While anxiety disorders are highly treatable, on average, only one-third of those suffering from anxiety receive treatment.(6)  Of the SAS study participants who indicated their quality of life has been negatively impacted during the pandemic, only 20% reported seeking therapy, with those in high-risk groups less-likely attending therapy.(7)

In the UK, psychiatrists are warning of a potential “tsunami of mental illness” from problems during the pandemic lockdown due to isolation and fears of getting sick and of hospitals.  Professor Wendy Burn, President of the Royal College of Psychiatrists, noted that they are already seeing the devastating impact of the pandemic on mental health, with more people in crisis.  A recent survey of 1,300 mental-health doctors from across the UK found that 43% have seen a rise in urgent cases, with 45% reporting routine appointments have decreased.  With anxiety levels rising and the fear of getting sick hindering patients’ likelihood of seeking therapeutic assistance, many are dealing with increased suffering to the point that they seek help only when they are in absolute crisis and their suffering has reached a point of being unbearable.(8)  By attending therapy sessions while anxiety levels are more manageable, patients can more-easily alleviate their symptoms before peaking at absolute crisis levels.  

Telehealth sessions offer people in isolation the opportunity to connect with others and feel like they’re not alone in their struggles with anxiety, forming supportive bridges with others.  Telepsychology has existed for over 20 years and has been utilized via phone, webcam, email and text messaging platforms.  Smartphones have increased availability of assistance, with people now able to engage in telehealth sessions anywhere they have a phone or Wi-Fi signal.  Lindsay Henderson, PsyD, assistant director of psychological services at a Boston-based telehealth company, has found that online platforms “normalize mental health care, especially among generations who are so accustomed to interacting with people using technology.”  Henderson noted that teletherapy eliminates so many barriers and is a “huge draw for consumers, many of whom are seeking therapy for the first time in their lives.”  Research studies have found videoconferencing telehealth sessions to be equivalent in efficacy as in-person care.  Further, teletherapy can be used as a more-comfortable stepping stone for patients who are new, and perhaps hesitant or nervous, to therapy or counseling.(9)  

Our new group

Seattle Anxiety Specialists’ therapist, Sonya Jendoubi, is well-versed in leading anxiety-based group-therapy sessions.  She will be hosting a new group-therapy option at SAS, starting in June: Coping with Fear and Isolation During COVID-19.  This group offers a supportive environment for individuals, particularly those who are immunocompromised and at higher risk of morbidity or serious complications due to COVID-19, to learn evidence-based psychological tools to help them cope with the isolation, anxiety and depression with which they are struggling.  Sonya intends the group will, “Learn skills of acceptance, resiliency and managing uncertainty during high levels of isolation.  My hope is that participants will learn from and with one another.”

Meeting weekly on Monday mornings, Sonya’s “Coping with Fear and Isolation During COVID-19” group-therapy will be online, welcoming patients with rolling admission.  Since SAS research has found that traditional therapy may be too financially restrictive during the COVID-19 pandemic, group-therapy is particularly beneficial during this time, as sessions cost half of a one-on-one session with most insurance companies offering substantial out-of-network reimbursements – lowering your out-of-pocket expenses, exponentially.  Further, while traditional one-on-one sessions last 60 minutes at SAS (or 45-50 minutes at many other therapy offices), our group therapy sessions will run for 90 minutes each week, ensuring everyone in the group benefits from and gains the most possible during these therapeutic workshops. 

If you are 18 or older and would like to attend Sonya’s group sessions, please register here.  

References

1. “Understand the Facts” Anxiety and Depression Association of America (2020) https://adaa.org/understanding-anxiety

2. “Coronavirus Disease 2019 (COVID-19): Stress & Coping” Centers for Disease Control and Prevention (2020)  https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html#risk 

3. “Emergency Preparedness and Response: Taking Care of Your Emotional Health” Centers for Disease Control and Prevention (2020)  https://emergency.cdc.gov/coping/selfcare.asp 

4. “Impact of Covid-19 on Stress in the Seattle Community” Seattle Anxiety Specialists (2020) https://seattleanxiety.com/blog

5. Ibid.

6. “Understand the Facts”

7. “Impact of Covid-19 on Stress in the Seattle Community”

8. “Psychiatrists Fear ‘Tsunami’ of Mental Illness After Lockdown” BBC (2020) https://www.bbc.com/news/health-52676981

9. “A Growing Wave of Online Therapy” American Psychological Association (2017) https://www.apa.org/monitor/2017/02/online-therapy

COVID19 and Stress in The Seattle Community

Impact of COVID-19 on Stress in the Seattle Community

Jennifer M. Ghahari, Ph.D. and Blake Thompson, LMHC

Seattle Anxiety Specialists, PLLC

This article is a summary of the survey research we’ve conducted on the impacts of the COVID-19 pandemic on the stress of the Seattle Community. Based on responses from well over a thousand adults in the area, it focuses on certain psychological impacts of the pandemic and will be of particular relevance to Psychologists, Psychiatrists, and others working in Mental Health as they work to respond to the growing therapy and counseling needs of the community.

The article is optimized for mobile. If you’re reading on a P.C., you can click here to download a pdf version.

INTRODUCTION

The Novel Coronavirus pandemic has led to unprecedented dismay regarding physical and mental health as well as economic crises.  Washington state, the first in the country to become impacted by COVID-19, has been most-greatly impacted in Seattle, King County.  Seattle Anxiety Specialists, PLLC, (SAS) has developed and conducted exploratory empirical research to examine the psychological consequences of the pandemic on residents of Seattle and surrounding areas.  By understanding how residents have been most-impacted by the Coronavirus pandemic, therapists and researchers at SAS will seek to develop and offer community-wide support programs, mental health resources and further efforts to lessen and ease psychological trauma caused by the COVID-19 virus.

BACKGROUND: COVID-19 IN WASHINGTON STATE

On January 21, 2020 the Centers for Disease Control and Prevention (CDC) and the Washington State Department of Health announced the first case of COVID-19 in Washington state.1  Due to the ease of transmission of the virus and risk of severe complications (including death), Washington Governor Jay Inslee issued a “Stay Home, Stay Healthy” order on March 23rd in an attempt to stop the spread of the virus.2  Within a mere three months of COVID-19 appearing in Washington, as of April 20th, all 50 states have reported cases of the virus to the CDC.3

“Coronavirus disease 19” (also called SARS-CoV-2, and abbreviated “COVID-19”) is a pandemic respiratory disease that is currently spreading from person-to-person across the globe.  Coronaviruses are a large family of viruses that are common in people and different species of mammals (including: camels, cattle, cats and bats.)  Rarely, animal coronaviruses can infect people and then spread between people (such as with MERS-CoV, SARS-CoV and now SARS-CoV-2).4  Due to there being little to no pre-existing immunity against COVID-19 worldwide, this pandemic has spread quickly and sustainably across the globe.  Thus, on March 11, the COVID-19 outbreak was characterized by the World Health Organization (WHO) as a pandemic.5

Pandemics begin with an investigation phase, followed by recognition, initiation and acceleration phases.  The peak occurs at the end of the acceleration phase, followed by the deceleration phase (in which there is a decrease in cases.)6  While it’s expected that the COVID-19 epidemic may hit its peak in in Washington state during May, increases would continue should the “stay at home orders” cease too quickly.  Initial modeling suggested a possible high that forecasted more than 1,600 deaths at the peak of the virus in the state.  At the beginning of April, new models calculated by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington's School of Medicine, suggested the state could reach the total projected COVID-19 deaths as early as mid-May and the number of projected deaths would drop significantly in Washington - but added that assessment would be contingent on extended social distancing in the state.  Dr. Chris Murray, Director for IHME said the new data shows that social distancing and stay at home orders have been working to reduce the spread of COVID-19 in Washington, particularly in King and Snohomish Counties.7   Projections have been last updated by IHME as of May 12th, estimating Washington’s total deaths as of August 4th could be as high as nearly 1,200 persons. 8  

As of April 18th, at the time SAS’ survey was conducted, Washington state’s Department of Health reported a total of 11,790 cases of coronavirus, with 634 confirmed deaths from the virus in the state.  The majority of cases (5,135 or nearly 44%) and deaths (346 or nearly 55%) have occurred in King County, where the populous Seattle is located.  Following King County, those hit with the highest confirmed cases and deaths include: Snohomish (2,101 / 94) and Pierce (1,109 / 32).9  Those at the highest risk for severe illness from COVID-19 include: people 65 years and older; those living in a nursing home or long-term care facility and those of all ages with serious underlying medical conditions.10

Reported by Washington state’s Department of Health, patients aged 60 and older were most-likely to succumb to COVID-19.  While only 35% of confirmed cases were in those aged 60 and older, this cohort comprised 92% of the state’s deaths.  Those under the age of 40 appear to be less affected by COVID-19’s morbidity.11

BACKGROUND: PSYCHOLOGICAL IMPACTS OF THE COVID-19 PANDEMIC

During the COVID-19 outbreak, stress and anxiety levels have increased across the community and particularly for those at higher risk for severe illness and with underlying health conditions.  Older adults as well as those with disabilities are at increased risk for having mental health concerns, such as depression.  Taking a physical toll, mental health issues often manifest and present themselves as physical ailments, such as headaches, stomachaches and/or cognitive problems (such as difficulty concentrating.)  Moreover, doctors are more-likely to miss mental health concerns among those in the increased-risk category as their disability and age tend to be viewed as the primary contributor to presented physical ailments.  Namely, depression can be mistaken as a normal part of aging in older adults.12

Aside from overall stress and anxiety, common psychological reactions to COVID-19 have formed due to a myriad of causes.  Firstly, there is a concern about protecting oneself as well as family and friends.  Further, patients often have a sense of guilt if loved ones assist them with activities of daily living.  Disruptions in regular medical care or community services impact those who were already medically challenged in some regard, dependent on frequent appointments and assistance.  Moreover, feeling socially isolated takes on a psychological toll particularly for those who live alone or are in need of assistance and who are now facing less interactions due to community-wide stay-at-home orders.  Further, those facing increased levels of distress are often those who: have had pre-existing mental health concerns (which began prior to the outbreak); live in lower-income households; have language barriers; and experience stigma because of age, race, ethnicity, disability or perceived likelihood of spreading COVID-19.13

Those coming out of quarantine also tend to face severe stressors, regardless if they may have been exposed to COVID-19 and have not gotten sick.  Emotional reactions to coming out of quarantine may include: having mixed emotions, including relief; stress from the experience of being monitored for signs and symptoms of COVID-19; sadness, anger, and/or frustration because friends of those close to you have fears of contracting the disease from contact with you, although you have been determined not to be contagious; and guilt about not being able to perform normal work or parenting duties during quarantine.14  Forced isolation, coupled with the fear of possibly having the Coronavirus, is particularly daunting and can be a significant stressor and manifest with both mental and physical ailments.  As such, the CDC has cited common signs of distress during this time, including:

• Feelings of numbness, disbelief, anxiety or fear.

• Changes in appetite, energy, and activity levels.

• Difficulty concentrating.

• Difficulty sleeping or nightmares and upsetting thoughts and images.

• Physical reactions, such as headaches, body pains, stomach problems, and skin rashes.

• Worsening of chronic health problems.

• Anger or short-temper.

• Increased use of alcohol, tobacco, or other drugs.15

BACKGROUND: FINANCIAL INSECURITY AND UNEMPLOYMENT

Approximately 10% of workers have lost their jobs mid-March to mid-April, due to the economic effects of the COVID-19 pandemic.16  With over 10 million people currently seeking jobless benefits17,  this is one of the largest and fastest incidence of job losses on record in the United States.18  Washington state has been hit particularly hard by the Coronavirus, with nearly 1 million weekly claims filed, as of April 26th.  Washington’s Employment Security Department reported receiving 20,000 calls a day19, utilizing extended resources available such as using evening hours and Sundays to process claims.20

A myriad of workers has been affected by the Coronavirus.  According to an analysis conducted by the Institute for Women’s Policy Research, about 60% of job losses were experienced by women.21 The IWPR report added that women lost jobs in four sectors, while employment for men rose, within: educational and health services; financial services; construction; and information.  However, men lost more jobs than women in the areas of: wholesale trade, mining and logging.  Job losses have also disproportionately impacted teenagers in the workforce, with the current rate of unemployment for those aged 16 to 19 at 14.3%, compared with 4% for those aged 20 and older.  The American Hotel and Lodging Industry has predicted nearly four million people working in the hotel industry may lose their job.  UBS predicts one-in-five restaurants could close due to the virus, with take-out and delivery orders not being enough to sustain business.22  Until the beginning of April, most states were not accepting unemployment claims from people who did not have traditional employers, such as gig workers, freelancers and the self-employed.  However, the Pandemic Unemployment Assistance program recently passed by Congress extends much-needed benefits to these workers.23

Despite the surge in those needing medical treatment during this time, job security of those employed by the health care industry have also waned.  A report from the Bureau of Labor and Statistics indicated the health care workforce lost 43,000 jobs in March 2020; primarily due to job losses in dental offices and private physician offices.  While private practices and smaller health systems were the first to be negatively affected by COVID-19, some of the country’s largest health systems have also faced staggering financial losses – translating into significant job cuts and losses.  The Hospital and Health Association of Pennsylvania (HAP) recently highlighted the financial challenge health systems are facing, stating that in March, "hospital operating margins dropped by an estimated $914 million compared to expectations.”  The report added that Pennsylvania expects massive losses statewide for the upcoming financial quarter – roughly 4.5 billion dollars.  Henry Ford Health System, located in Detroit, announced a mass furlough of nearly 3,000 employees across its six-hospital system, citing net losses of $234.5 million for the first quarter (a decrease of $354.9 million over the same period in 2019.)  Johns Hopkins University (JHU), the umbrella organization which owns 50% of the Johns Hopkins Health System, has sought to implement various cost-cutting measures, including salary freezes for all staff and faculty, the suspension of retirement contributions and a sweeping organization-wide hiring freeze. The salaries of higher-level employees like the university president, provost and deans were also cut.  Johns Hopkins Health System is the largest health system in Maryland and Johns Hopkins institutions are the largest non-government employer in that state.  Before the pandemic, there were projections JHU would bring in $72 million in 2020 - now, it expects to lose $100 million.  Since many of the nation’s hospitals’ usual stream of revenue (e.g. elective surgeries) have been postponed and/or cancelled, health care systems claim they cannot financially stay afloat without sacrificing employee jobs or cutting their pay.24  The Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27.25  While $100 billion of the $2 trillion economic relief package earmarked for hospitals has helped, industry leaders have claimed it was not enough to account for the drastic losses they have endured; further, the House approved another relief bill that includes an additional $75 billion for hospitals.26

Job losses and financial instability have led to unprecedented housing insecurity in the United States.  Mary Cunningham, a fellow at the Urban Institute, warned that shelter-in-place measures have created a situation in which low-income renters are now at high risk for eviction and homelessness, many of whom work in service industries hit exponentially hard by the pandemic shutdown.  Cunningham added that the recent CARES Act, “didn’t do enough to address increases in housing insecurity for the nearly 11 million low-income renter households paying more than half their income toward rent before the pandemic.  Low-income renters, especially those who lose employment during the crisis, will have a hard time paying back rent, and they could face housing situations that spiral out of control.”  Supporting Cunningham’s claims, Avail, which is an online platform for landlords, conducted a survey of 2,775 landlords and 7,379 tenants; results indicated more than half of renters (53.5%) reported job losses due to measures enacted as a result of the COVID-19 pandemic.27  With 78% of Americans living paycheck-to-paycheck28, job cuts and losses will not only impact renters across the socioeconomic scope, but also homeowners seeking to make their next mortgage payment.

MATERIALS AND METHODS

Our exploratory, empirical research utilized an anonymous, online self-administered survey, that we designed and implemented on the Survey Monkey website.  Questions were asked regarding respondents’ level of stress/anxiety/worry both before the pandemic and at current levels, their general concerns at this time as well as what impact the pandemic has had on their employment and health.  Answers utilized both open-ended, scaled and multiple-choice format.  The sample was obtained via online and social media methods, e.g. the Seattle Anxiety Specialists’ website, SAS Facebook page and Twitter accounts, resulting in a total of 1382 valid completions.  Data was collected over a one-week period from April 16-22, 2020 and sought to collect data at one snapshot in time, during the peak of active Coronavirus cases in Seattle.  We did not utilize the respondents within the Survey Monkey database as previous experience working in the private research sector has shown us that utilizing paid survey respondents can often result in rushed/inaccurate responses and lessen the validity of data.  Additionally, by targeting respondents via SAS’ social media and online presence, there was a higher likelihood of obtaining respondents who suffer from increased stress/anxiety/worry than the general population, which was to assist Seattle Anxiety Specialists pinpoint what specific needs this cohort needs for assistance during this time of crisis.

To qualify for the study, respondents had to meet the following requirements:

• live in Seattle and general surrounding area 

• minimum of 18 years old

Demographically, the sample is fairly balanced regarding respondents’ educational level and age, however, the sample yielded significantly greater females than any other gender – therefore data could not be cross-tabulated for that variable.  Data was then cleaned to remove anyone who did not complete the survey after starting it and those who lived out of the target geographical area.  Data analysis was conducted utilizing SPSS (IBM SPSS Statistics Subscription.)  

RESULTS

Our results found both directional and significant evidence of psychological stressors occurring directly from the Coronavirus pandemic based on comparative data of the sample’s responses on a multitude of measures both prior to and following the outbreak.   

Respondents indicated that money/finances as well as work issues/concerns were there primary worries before the COVID-19 pandemic.  Following the outbreak of the virus, respondents indicated their concerns shifted to focus on their own health and safety as well as for their family.  While there was a shift towards respondents expressing worry towards their own health, as well as the health of those they know, there was also a doubling in expression of care/concern towards the general population and various social issues (homelessness, environmental issues, inequality, etc.) suggesting that the pandemic has caused an increased sense of community and empathetic wanting to take care of ones’ neighbor.  

Utilizing a six-point semantic differential scale, while respondents expressed greatest levels of stress/anxiety/worry regarding their own life in general, the greatest shift in concern occurred for: their friends (3.15); their own health and safety (3.05); and for their spouse/significant other (3.05).  Respondents’ housing situation impacts current stress/anxiety/worry “high” levels reported in: 11.4% of homeowners; 30.6% of renters; 41.9% of those staying with family and 53.9% of those staying with friends.

Roughly 1/3 of the sample, 34.8%, has reported their employment situation has been negatively impacted by the pandemic.  This shift is reflective of increased levels of stress/anxiety/worry regarding life in general, as well as respondents’ financial future.  

Respondents reported nearly one-quarter became sick with some type of illness, and 3% were infected with the Coronavirus.  Additionally, nearly 19% were unsure if they became ill, likely due to the complexity and sometimes vagueness of symptoms of COVID-19.  27% of respondents further noted that they knew a family member or friend who was infected with COVID-19 and 30% became ill with some other sickness.

For those who had gotten sick with Coronavirus or some other illness, the most frequent symptoms reported ranged from: muscle aches/pain; fatigue; fever; difficulty breathing; cough; nausea; chest pain; runny nose; memory issues and a fairly long duration of illness.

Whether they had Coronavirus or some other illness, the primary psychological impacts reported included those found in Table 5.

For those respondents commenting about negative psychological impacts they have endured when a friend and/or family member have gotten sick during the pandemic, their primary responses have been tabulated in Table 6.  Note that several respondents indicated a lack of worry or concern due to the following reasons: finding out their friend/family were sick after they had recovered; the illness was minor; the friend/family member is not close to them and/or they were in good health and had a quick recovery.

Tables 7-8 denote significant differences in stress/anxiety/worry levels among the sample’s youngest and oldest age cohorts.  Prior to the COVID-19 outbreak, respondents 65 and older reported significantly low levels of stress/anxiety/worry (51.9%), whereas only 15.5% of 18-24-year-olds reported low levels during that time.  Additionally, following the pandemic, two-thirds of 18-24-year-olds indicated significantly highest levels of stress/anxiety/worry.

Levels of stress/anxiety/worry are correlated to respondents’ perception of the duration of the pandemic: those anticipating the pandemic to be “nearly over” indicate significantly lower levels of stress/anxiety/worry compared to the 51.9% of respondents who report high levels, and perceive the pandemic to be “ongoing and widespread a long time.”

Respondents aged 18-24 anticipate the COVID-19 pandemic to be “ongoing and widespread a long time” significantly more than the older cohorts.  

While respondents are more likely to wear masks than gloves as personal protective equipment (PPE), their perception regarding the virus’ duration impacts how often they wear PPE.  Those who perceive the pandemic to be “nearly over” never wear a mask 47.8% or gloves 69.6% of the time when out in public.  Conversely, significantly more respondents wear PPE if they perceive the pandemic will be “ongoing and widespread a long time,” with 46.9% wearing a mask and 20% wearing gloves 75% of the time or any time they are in public (Tables 11-12).

There are polarizing correlations between age group and wearing PPE: those 65+ are significantly more-likely to wear masks and gloves in public compared to those 18-24 years-old (Tables 13-14).

Roughly 9-in-10 respondents report their quality of life has been impacted by the COVID-19 pandemic; nearly half of the sample indicating “significant” impacts.  Of those 9-in-10 respondents, 19.5% of respondents have sought therapy at this time, with 64.3% saying they have not.  (16.2% chose not to answer this question.)  Those 18-24 reported the greatest impact on their quality of life (Table 17).  Respondents 55+ were least-likely to seek out therapy during the pandemic (Table 18).

When prompted for any comments regarding whether they have sought therapy at this time, respondents reported financial aspects as well as difficulty finding a therapist as their main hinderances.  Moreover, six respondents stated that they had reached out to therapists to begin counselling and never heard back from them.

As noted in previous research, low-income renters have been greatly-impacted during the pandemic and face housing instability.  Our research has found that the pandemic has produced high levels of stress/anxiety/worry for home-owners as well as renters and those staying with family and friends.  Mindful of low base-sizes, those staying with friends during the pandemic report highest levels of stress/anxiety and worry at this time.

DISCUSSION

Our results highlighted the importance of utilizing both open-ended and closed-ended answer choices in a survey or when speaking with a patient in therapy.  Although respondents indicated that money/finances and their work/retirement and/or school situation were of lessened worry to them during the pandemic than they previously were, these variables were reported to have the greatest shift in stress/anxiety/worry among respondents.  While respondents were less-likely to voice as much concern for money/finances and their work/school situations in a pandemic situation, the stress and anxiety for these matters were latently significant, impactful in their lives and require addressing to ease stress during this time.

Tables 7-8 stress/anxiety/worry among age groups: while those 65+ are in the highest-risk group regarding COVID-19, this cohort is the most-likely to be retired and thus financially secure in the sample.  While those 18-24 face the lowest health-burden of the pandemic, they are financially the most negatively-impacted regarding finding/maintaining secure employment, which is reflected in this cohort’s significant levels of stress/anxiety/worry.  The highest perception that the pandemic will be ongoing and widespread is also likely leading to 18-24-year-olds enduring the greatest level of stress/anxiety/worry at this time (Table 10).  Likely due to the susceptibility and health risks to those 65+, this group is significantly most likely to use PPE in public; those least-likely to wear PPE comprise the 18-24-year-old cohort, who are medically least-likely to face serious health consequences if infected with Coronavirus (Tables 13-24).

Roughly 9-in-10 respondents report their quality of life has been impacted by the COVID-19 pandemic; nearly half of the sample indicating “significant” impacts.  Of those 9-in-10 respondents, 19.5% of respondents have sought therapy at this time, with 64.3% saying they have not.  (16.2% chose not to answer this question.)  Those 18-24 reported the greatest impact on their quality of life (Table 17).  Respondents 55+ were least-likely to seek out therapy during the pandemic (Table 18).

When prompted for any comments regarding whether they have sought therapy at this time (Table 19), respondents reported the financial cost as the biggest hinderance, particularly during this time of financial uncertainty and/or with many earning less than what they previously have (e.g. 35% of the sample reported being laid-off, furloughed, their business suffering, etc.)  

The second most-prominent reason for not attending therapy during this time of acute stress is reported to be difficulty in finding a therapist and not knowing where or how to seek one out.  Further, some respondents added that they would need an appointment other than standard Monday-Friday, 9:00am-5:00pm and finding a therapist with hours to accommodate their schedule has proven difficult.  Others reported reaching out to therapists, only to not hear back or be contacted for an appointment.  Further, during this time of decreased services and stay-at-home ordinances, six respondents expressed issues with video-chat and/or phone sessions and said they would do better with in-person therapy sessions.  Lastly, three respondents were altruistic in their reasoning for delaying attending therapy and cited not wanting to take away limited resources from those who may need counseling more than themselves.  

To provide the greatest assistance to those significantly psychologically impacted by the COVID-19 pandemic, therapists and counseling services should enact the following:

• advertise their practice’s availability and acceptance of new patients; 

• offer appointments with varied hours, such as early morning, late night and weekends;

• offer in-person appointments in a safe and clean environment;

• provide low-cost counseling options, if possible; 

• and provide free online resources and guides to assist with psychological stressors and trauma during a pandemic.

Tables 5-6 support the findings of the CDC regarding common signs of distress during the pandemic.  While our research finds commonalities with the list the CDC warned to be mindful of, our sample noted several other manifestations of distress at this time.  Healthcare providers should therefore be cognizant to address these issues/ailments in patients during the pandemic.  

REFERENCES

1. “2019 Novel Coronavirus Outbreak (COVID-19),” Washington State Department of Health (2020) www.doh.wa.gov/emergencies/coronavirus   

2. Ibid.

3. “Coronavirus Disease 2019 (COVID-19): Situation Summary,” Centers for Disease Control and Prevention (2020)  www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html  

4. Ibid.

5. Ibid.

6. Ibid.

7. “Data Models on COVID-19 Deaths in Washington Offer Hope, Challenges,” KOMO News (2020)  https://komonews.com/news/coronavirus/new-models-show-social-distancing-making-positive-impact-in-washington-state 

8. “COVID-19 Projections: Washington State,” IHME (2020) https://covid19.healthdata.org/united-states-of-america/washington  

9. “2019 Novel Coronavirus Outbreak (COVID-19),” (2020)

10. “Coronavirus Disease 2019 (COVID-19): Situation Summary,” (2020)  

11. “2019 Novel Coronavirus Outbreak (COVID-19),” (2020)

12. “Coronavirus Disease 2019 (COVID-19): Stress & Coping,” Centers for Disease Control and Prevention (2020)  https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html#risk 

13. Ibid.

14. Ibid.

15. “Emergency Preparedness and Response: Taking Care of Your Emotional Health,” Centers for Disease Control and Prevention (2020)  https://emergency.cdc.gov/coping/selfcare.asp 

16. “COVID-19: Roughly 1 in 10 Workers Have Lost Their Jobs in the Past 3 Weeks,” MarketPlace (2020)  https://www.marketplace.org/2020/04/09/covid-19-unemployment-claims-6-6-million/

17. “Nearly 60% of People Who Have Lost Their Jobs Due to the Coronavirus Pandemic are Women, According to Report,” Business Insider (2020)  https://www.businessinsider.com/coronavirus-unemployment-women-60-percent-2020-4

18. “COVID-19: Roughly 1 in 10 Workers Have Lost Their Jobs in the Past 3 Weeks,” (2020)  

19. “Home Page,” Washington State Employment Security Department (2020)  www.esd.wa.gov 

20. “Employment,” Washington State Employment Security Department (2020)  https://www.esd.wa.gov/unemployment/help 

21. “Unemployment Insurance Relief During COVID-19 Outbreak,” U.S. Department of Labor (2020)  https://www.dol.gov/coronavirus/unemployment-insurance

22. “Nearly 60% of People Who Have Lost Their Jobs Due to the Coronavirus Pandemic are Women, According to Report,” (2020)  

23. “COVID-19: Roughly 1 in 10 Workers Have Lost Their Jobs in the Past 3 Weeks,” (2020)  

24. “Even Nation’s Largest Health Systems Laying Off Health Care Workers Amid COVID Pandemic,” ABC News (2020)  https://abcnews.go.com/Health/coronavirus-victim-americas-largest-health-systems/story?id=70317683

25. “Unemployment Insurance Relief During COVID-19 Outbreak,” (2020)  

26. “Even Nation’s Largest Health Systems Laying Off Health Care Workers Amid COVID Pandemic,” (2020)  

27. “More Than Half of Renters Say They Lost Jobs Due to Coronavirus,” MarketWatch (2020)  https://www.marketwatch.com/story/they-could-face-housing-situations-that-spiral-out-of-control-more-than-half-of-renters-say-they-lost-their-jobs-due-to-covid-19-2020-04-09

28. “78% of Workers Live Paycheck to Paycheck,” Forbes (2020)  https://www.forbes.com/sites/zackfriedman/2019/01/11/live-paycheck-to-paycheck-government-shutdown/#26f5b64d4f10

Free App for Covid19 Anxiety Management

We are excited to introduce you to COVID Coach, a free app designed to provide evidence based anti-anxiety tools and enhance emotional support during the coronavirus pandemic. This app is not a replacement for therapy or psychiatric treatment for anxiety, but it is still a great tool for those struggling with increased anxiety during this time.

Developed by the licensed clinical psychologists at the National Center for PTSD at the VA, it joins other free, widely-used mental health apps like PTSD Coach and Mindfulness Coach. Although this is an app developed by the Department of Veterans Affairs, it is intended for use by everyone in the community (not just veterans and not just people suffering from PTSD) and is available for both iOS and Android phones.

Like other apps developed by the psychologists at the National Center for PTSD, it is designed to be totally private and secure. This means that no email account or password is required. It also means that user data are not collected.

COVID Coach offers access to stress management tools such as audio-guided mindfulness and deep breathing, as well as exercises designed to address anxiety, trauma reactions, and relationship conflict. It also has quick links to resources for finding crisis care and mental health support, and service agencies for families and those seeking basic fundamentals.

The VA let us know that Covid Coach will be updated regularly and that they encourage your feedback on ways it can be improved upon.

We hope that you’ll help us spread the word about COVID Coach!

Covid-19 Community Survey

Seattle Anxiety Specialists, PLLC is a private group therapy practice in Seattle specializing in treatments (such as CBT) for anxiety and anxiety disorders. We’re conducting this survey as a public service, to help individuals and organizations in the Seattle area get a better sense of the impacts of COVID-19 on the stress/anxiety/worry levels of our community.

If you’re living in the Seattle area, please take a moment to fill out our Covid-19 Community Survey.

Your honest feedback will be used as part of a research study and will help provide mental health resources for Seattle and surrounding areas. This survey can be completed in just a few minutes.

We’ll post the results on our website in a few weeks.

ALL RESPONSES ARE ANONYMOUS AND CONFIDENTIAL: Our survey is built through SurveyMonkey, a highly reputable organization that doesn't sell user data to third parties, provides secure encryption, and provides tools so that surveys can be made completely anonymous and confidential.

RISKS AND BENEFITS: There is minimal risk involved in participating in this study. Participants may experience some discomfort or negative emotions in disclosing their feelings (e.g., anxiety, stress, and worry). We cannot guarantee that you will receive any benefits from this study, but it may help you to better understand any negative feelings you’re having. Although you may not receive direct benefit from your participation, others may ultimately benefit from the knowledge obtained in this study.

PARTICIPANT’S RIGHTS:  If you have read this and have decided to participate in this project, please understand your participation is voluntary and you have the right to withdraw your consent or discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled. The alternative is not to participate. You have the right to refuse to answer particular questions.  The results of this research study may be presented at scientific or professional meetings or published in scientific journals.  Your individual privacy will be maintained in all published and written data resulting from the study.

CONTACT INFORMATION: 

If you have any questions, concerns or complaints about this research, its procedures, risks, and benefits, contact Dr. Jennifer Ghahari by emailing JenniferG@seattleanxiety.com.

If you are not satisfied with how this study is being conducted, or if you have any concerns, complaints, or general questions about the research or your rights as a participant, you can also contact the Seattle Anxiety Specialists Institutional Review Board (IRB) to connect with someone independent of the research team.

Thank you for your help and participation!