Speaking of Psychology - Bonus Episode: Managing Your Mental Health during COVID 19 with Lynn Bufka, PhD

Episode Date: March 30, 2020

The new coronavirus has upended our lives, compelling us to stay in our homes, keep our social distance and be wary of everything we touch. Some of us are teleworking but others have lost jobs. This global pandemic touches everyone and it is causing many of us to feel stress, anxiety and hypervigilance. Our guest, Dr. Lynn Bufka, senior director of practice research and policy at the American Psychological Association, and a practicing psychologist herself, has helpful advice for coping, adjusting and making our lives as normal and stress-free as possible.   Join us online August 6-8 for APA 2020 Virtual. Learn more about your ad choices. Visit megaphone.fm/adchoices

It's only getting every customer's order right. It's only a point-of-sale system connected by Spectrum fiber-powered business internet helping you track hundreds of secure transactions. And it's all backed by 24-7 U.S.-based customer support and local technicians. It's only everything. Get business internet advantage free, forever,

when you get four mobile lines from Spectrum. Visit Spectrum.com slash free for life to find out how. Restrictions apply. Service is not available in all areas. The coronavirus has upended countless lives here at home and around the world. We've all become too familiar with new terms, shelter in place, flatten the curve, social distancing. The stock market is bouncing wildly. Just this week we saw the greatest number of unemployment applications in U.S. history,

and there's still no toilet paper at the grocery store if you can even go to the grocery store. So are you feeling stressed yet, anxious at your wits end because you're trying to telework, and the kids are making noise in the next room? And would someone please walk the dog? Welcome to Speaking of Psychology, the bi-weekly podcast of the American Psychological Association that explores the connections between psychology and everyday life. I'm your host, Kim Mills.

Joining me today is Dr. Lynn Buffka, senior director of practice research and policy here at APA, the American Psychological Association. Dr. Buffka is also a practicing psychologist and has been talking constantly to, journalists who are covering the coronavirus pandemic. Normally, Lynn and I would be in the APA recording studio together, but because of the virus, we are teleworking and sheltering in place. So, Lynn, welcome to speaking of psychology. Thank you for inviting me. So for the last couple of weeks,

you've been talking almost nonstop to reporters who are trying to present information that will help their readers and listeners cope in these strange times. What are they asking you and what kinds of tips have you been giving them? Well, they're asking me all the time. Are people stressed? And of course, people are going to feel some degree of stress right now. This is a new situation. It's unprecedented. And trying to figure out how do we cope with something that nobody who's alive today can remember ever having happened in our country before. We don't have a roadmap.

We don't know where to go with this. So, of course, anytime we're faced with that level of ambiguity and uncertainty, it can be stressful for individuals. So we start talking about stress and how is it impacting people. and are there people who are particularly vulnerable to stress at this time? Here, speaking of psychology, we did a podcast on February 10th about the virus when it was far more contained globally and had hardly even touched the United States. As we speak, which is on March 27th, the United States has reached a grim milestone. The U.S. has now surpassed Italy and China as the country with the highest number of confirmed COVID-19 cases. more than 1,100 people have died and that number is rising rapidly.

So what does this information do to people's stress levels and what do they do? What can they do to cope? Well, that certainly makes the COVID-19 crisis seem far more real when we know that we have that many cases in this country. You know, six weeks ago when I was talking with reporters about it, the message was still the same. We need to try to identify what we're afraid of, try to address those fears, figure out how to cope. and do what we need to do in order to protect ourselves and support our communities. But at the time, the threat was fairly distant, and it was a question of would it actually come to us? So people felt a little more relaxed being out, doing the things that they were regularly doing.

That's changed dramatically. We are all trying to figure out a new situation, a new way of operating, a new way of surviving for many people. People who don't have jobs right now are not able to work because of the kind of work. that they did is very much in the public. So it's a very stressful time for people who have no way to support themselves, to figure out how they're going to put food on their table for their families. So that's a particular group that's really having a difficult time right now. And then you've got a whole bunch of people across the country who are trying to figure out what exactly does shelter in place mean. What's essential? Is it essential for me to go out to the store and get some bananas because

we're out or do I just wait once a week and try and get everything possible and we eat whatever it is that we've got left by the end of the week? How do I do this? What's the rhythm? And of course, as you said at the beginning, how do I live my life when I've got all these other people or maybe no one else in my house? But it's either me alone all the time or me with the same three, four, five people and nobody else. Very different way of how we're going about our days. So what's the answer? I mean, how do people stay connected? And is it okay to take a walk or go to the grocery store? You know, and the recommendations vary on that. Certainly, we are asked to stay at home to not be out and about in public to any great degree because the transmissibility of the virus is quite concerning. And the severity of the

illness that people have is quite concerning. So the more we can do to reduce transmission, the better likelihood we have of our health care system catching up and being able to respond to the need. So trying to limit our trips out and do the things that we need in order to have food for our table and whatever it is that we need in our homes. That's really critical right now. It depends where you live, though. In a more urban area, you have many more potential contacts with individuals who may be carrying the virus that you may be in contact with. So your risk is going to be higher in those kinds of settings. If you live in a more suburban or rural area, you may be able to be out and still maintain that recommended physical distance of six feet or more between yourself and others.

So there's no perfect answer to how to do that. The recommendation is to really look at what the leading healthcare sources are saying, the CDC, what your local community is telling you to do in terms of how to protect yourself from the virus. Because at the same time, you're also trying to maintain your emotional and physical well-being. And for many people, part of that is regular physical activity. We know that connecting with nature really helps people to feel more balanced and sustained. So there's always pros and cons of trying to reduce your risk for any possible connection with the virus while still also doing things that keep you healthy. And for many people, that is a walk, that is being outside. So it requires really thinking through what your risks are based on the environment and the setting that you're in as well.

So some people are pretty stressed. They're very anxious. They're freaking out over the whole situation. And one resource that's available to a lot of people is telepsychology. Could you explain what that is and how it works and if there are any limitations? So, for example, can people take advantage of it no matter where they live? Right. The question about providing health care via technology, we've expanded that capacity across the

healthcare system in the past couple of weeks. All sorts of medical visits are happening virtually now, whether it's dermatology, whether it's a primary cure visit, and yes, even with mental health. You can receive psychological services via technology. Some providers, some psychologists have been doing that for quite a while. Lots of psychologists are figuring out how to do that now. So there's questions about what kinds of technology really to sustain that continuity of care, video conferencing where you can actually see the other person makes a big difference.

People really like that connection or via the phone is another way that's happening. And yes, that can be available in lots of places for people to access care that way. There's a couple of challenges. One is making sure that psychologists and other mental and behavioral health providers have the technology to provide. services via video conferencing and feel comfortable and competent to do so. So they're all working rapidly to develop that capacity so that they can meet the need. And then there's also the question of finding somebody who has the availability and is appropriately licensed. Ideally, we see health care providers who are licensed in the jurisdiction that we live in, that we reside in.

That's how traditionally health care has worked. And that's done in order to protect the public so that you as the, the receiver of services have, know that there's an oversight body ensuring that the health care professional, the psychologist or whoever, has appropriate credentials, training, maintains their license, does what is expected by the state, by the jurisdiction to maintain their competence. Right now, there is some relaxation of those requirements for people to be licensed in the jurisdiction in which they're seeing somebody. So in some places you can quote unquote see a psychologist across state line.

So I live in Maryland. I might be seeing a patient who lives in the District of Columbia. And some places allow that. States are working rapidly to determine what they need to do in order for their regulations to accommodate this need right now of trying to ensure care gets to the people who need it. Because just because we have a virus doesn't mean we stop having people. with mental health concerns such as depression or schizophrenia or post-traumatic stress disorder who really need care for those issues as well as individuals who are feeling an increased amount of stress and distress because of the world that we're currently living in and the uncertainty

related to the virus. What about insurance? How do I know if my insurance is going to cover this kind of patient care? That's a great question. And the first thing, if you are able to do so, call your insurer or go. to the insurer's website and see what it says there. Medicare is making changes to allow greater telehealth, greater access to telehealth. And private payers, other kinds of insurers, typically follow Medicare's lead. At the APA, we're working really hard to try to identify what

the states are saying is permissible and not permissible and putting together content so our members can advocate with the insurers in their locality to try to, to be certain that the care will be covered, whether it's provided via technology or not. But if in doubt, call your insurance company and ask that question and tell them that there's important reasons for this to happen. The data suggests care can be just as effective delivered via technology. It may feel different at first because we're used to being face-to-face when we receive our health care.

But the data suggests for mental health concerns that it can be just as effective if it's delivered via both video conferencing and the telephone. That's great to know. So just to be clear, now, Medicare is insurance that covers seniors, people who are generally over 65 and aren't working and have other insurance. But what about Medicaid? What about people who are lower income who may be relying on Medicaid? Right. Medicaid is a insurance that is determined state by state by state. Medicaid too is also, on a state-by-state basis, making more flexibility in terms of the options for how care is delivered. Because many people who receive Medicaid are also at risk, at higher risk for coronavirus than the average people in the population, because these are individuals who have perhaps other kinds of health conditions or perhaps not able to work because of health conditions, right? So they need to have Medicaid as their insurance, but it also means because of the health conditions, they might be more vulnerable to COVID-19, thereby making it even more of a priority that those individuals have access to care through technology.

But it's not a given that it's going to happen in every single state. As an organization, APA is working on these kinds of issues as are other health care organizations. I am hopeful that we will see a lot more flexibility in terms of how care gets paid for, what kind of care gets paid for. So long as we're providing quality care and meeting the needs of our patients and can demonstrate that, I hope that payers will still see the benefits then for paying for that care, regardless of whether it's delivered in person or delivered over the phone. What's happening for people who have, say, substance use issues?

Maybe they're in recovery. They've been going to AA or NA meetings. and now they can't. What are they supposed to be doing? Well, I've just learned recently there are some great online resources for A&NA, and for anybody in that situation strongly encourage you to look for those. A friend of mine just sent me a link to a whole bunch of resources for online N.A. And I've heard wonderful things for people who've connected with groups.

So it is possible to get that kind of support through online. through virtual means, but it's going to be different, right? We're going to have to make a little extra effort to find the right one that works for us and to make those connections. Part of why AA and NA is so valuable is that individuals are in a group with others who've had similar experiences, and that can be a very powerful support for someone trying to make significant changes in their life. Getting that support through virtual means is possible and can make a difference.

a person's life. And I would say it's critical in order for someone to maintain the kind of lifestyle, the sobriety that they have been attaining in their life and to keep sustain that because that's going to be critical for long-term well-being. When we're under stress, there's the challenge of feeling pulled into the things that make us feel good in the short term. And substances can make us feel good in the short term. But the long run can be really problematic for people who've got a history of not using them and using them well and in abusing them and having problems with that. So anything we can do to help ourselves, help the people we care about, not return to that path will be critical right now.

And of course, there are a lot of applications out there that allow you to reach out to your friends. And if you've got sponsors, if you're in a program where you need to do that, I mean, you can do that online, right? There's Zoom and Skype and many ways of connecting now, FaceTime. Absolutely. I mean, it feels like, it feels a little hard right now because it's different, right? It was easy to show up at a meeting and see your sponsor.

Now you have to make a little more effort to connect to your sponsor in a different way. But once you create that pattern, create that habit of doing it, and this would be for any connections that people have in their lives. Once you make these new connections, have a standing date with your best friend on Tuesday nights, it will become easier to do those connections in new ways. and you can still get that same sort of intimate close connection that can be sustaining and provide the support that we all really want right now. So some of us out here are in quarantine, maybe because we've been exposed to someone with the virus or maybe even have the virus but aren't sick enough to be in the hospital. These are people who are probably experienced a host of even different feelings. What are the psychological impacts of quarantine and what can people do to manage that? Yeah, we know that quarantine can be hard.

If we're not sick, but we're in quarantine, we're doing this for the larger good, really. We're doing it to try to prevent population, widespread population disease. And remembering that and remember that altruistic value of we're doing something for the larger community helps us accept the situation that we're in. But it's not surprising that people are going to feel some boredom, are going to feel irritation, unhappy, feel like it's unfair. acknowledge those feelings. Recognize that that's what you're feeling, accept that that's how you're feeling, but then move from that. Try to let go of it and focus on the things that you do have. If you're not sick, you still have your health. You hopefully have access to the resources that you need or you can begin to problem solve for how to get access to those resources and you can do

things to try to find ways to connect online, even if you're not interacting physically with others. If you are sick with COVID-19, you're staying quarantined in order to not spread it in the community. That's critical. Hopefully, you have somebody who can provide you with the assistance you need while you're sick because you could be really sick and not have the energy to get out there and do what you would normally do or even to get yourself fed. So trying to do the things. And to keep your health going while you're in quarantine will be your critical step when you have the sickest part of it. For anyone who has not yet had the disease, but the potential is there, now would be a good time to think about how would I manage quarantine if that happens to me.

And do I have enough in my household? Am I able to get sufficient supplies in my household? Should I become sick and unable to go out? So use the time right now to begin to begin to have, you know, even if it's two weeks worth of canned soup and that's why you eat for two weeks, that's what you eat. At least it's there. It's something you don't have to worry about and be stressed about should the event that people fear happen. And that is to actually develop sickness because of the virus. So do you have any advice for people who are teleworking, but they also have their kids at home

and maybe they need to be helping them with the schoolwork or they're fighting over who gets to use the computer when? How can people deal with that? For all of us right now with these changed circumstances, giving ourselves a little grace and giving the people we live with a little grace is going to go a long way. We're all feeling some feelings maybe we weren't having a couple weeks ago and they may come out in surprising ways. Recognizing that, being a little more patient with yourself and the others in your household is a good starting point. But then talk with the other adults in your household about what each of you is hoping to accomplish. while you're under this time being at home.

How can you best do that in ways that feel balanced and fair so that you each are able to work? If that's what you're both trying to do, as well as parent take care of other household responsibilities, try to have a game plan with the people that you live with. And then think about the kids, what are their needs right now? You know, for really young kids, really, they just want to have a stable base. They want to feel loved. They want to know that they've got the attention of the people who are important in their lives. For older kids, you're going to be thinking about trying to maintain some structure with them

and help them continue with their learning, but it's not going to be perfect by any means at all. And certainly middle school kids and teenagers and college students who are suddenly home and weren't expecting this are going to have an array of emotions just like their parents and the other adults in the house. Giving them space to acknowledge those emotions is important. But once you've done all that, try to figure out routines that are going to work for your household. There's no perfect answer, but having some expectations around who gets to have access to the computer when, trying to carve out some workspace, some physical workspace, so that others in the house understand that if you're sitting in this chair with a laptop in front of you, that's when you're working. You will let them know when you can be disturbed because not all of your one is going to have the luxury of having private spaces to work in. So figuring out ways to communicate to others, here's my work time, here's my workspace.

I need you to respect that is going to be critical in order to have some functioning and continue to work down the road. If you're able to work from home and it's tough going, talk to your managers too. They may also be experiencing some tough times with teleworking, see how you can work out some new solutions with them. That might be you could start working super early in the morning for a few hours. Then you're on the parent shift or you're on the take care of the household shift for a while, but you return to your task later in the day.

Work with your colleagues to figure out strategies so that the essential work can get done while we all adjust to this new, what we hope will be a temporary reality. I think another challenge is knowing when your workday actually ends because we're all plugged in all the time and it's really easy just to keep working even when, hello, it's six o'clock and maybe I should knock off. Oh, absolutely. And I have found for me having a dedicated workspace and keeping pretty much to my regular work hours has been important. But I don't have the distraction of a young child.

And I have a little separation of space. For people who are trying to balance more hands-on parenting and work, that becomes more of a challenge. But if you don't have that extra challenge of kids that are demanding your attention all the time, finding a way to sort of be clear to end your work day, to walk away from that space and create some ritual to change to, okay, now I'm home for the day and I'm offline, I'm not working, is really important. For most of us, that's our commute. Even if our commute was a 10-minute drive home from the office, that was a transition time. It's still good to build in the transition time even when we're working from home. The transition may need to be longer than the 50 feet from your desk to the kitchen where you're

now fixing dinner. So one of the questions I've been asked by some reporters is what will be the impact of missing some of life's milestones. Some people haven't been able to attend their parents' funeral, for example. And countless young people are going to be deprived of the ritual of graduation from high school or college. What do we know about the long-term impact of missing these ceremonies? I don't know how much we know about the long-term impact of it. But in the immediate moment, there's going to be some grief. There's certainly going to be some disappointment about this. it may feel very unfair, particularly, you know, siblings like, my brother got to have a graduation. I don't have one.

Or, you know, she got to go to prom last year and now I'll never have a prom. So there's clearly going to be some disappointment, some grief about this. You clearly are not going to be the only one not having these experiences because people across the country. And you're actually not, this isn't the first time this is happening to anybody either. My next-door neighbor lost his father over the holidays very unexpectedly. He had planned a whole trip with college friends to go to Europe for a few weeks and canceled all of that. Of course, he's grieving his dad, but he's also really disappointed to lose that experience. This happens to people for a variety of circumstances.

We're all in it together this time. The plus of it is perhaps you're able to create down the road a more meaningful way to celebrate these milestones. Perhaps the big graduation ceremony with a speaker that you really weren't that interested in and family putting a lot of money into traveling to get to it didn't have that much appeal to you. Maybe a ceremony that is with the people who matter the most to you and the opportunity to get together with your closest friends from high school or college to celebrate is a more meaningful way to do it. So really encourage people to think about that and how best to do it. But we haven't talked at all about funerals. And I think that's a really important one.

Losing a loved one, whether it's because of COVID-19 or all the other kinds of reasons. People are still sick and dying right now, whether it's cancer or heart attacks or car accidents, grieving is really important. We need to have time and space for that. And the rituals really help us cope with that. We're not necessarily going to have the rituals we expected. And we may not be able to have all the people we care about together with us at that time to get the hugs, but we can still share the tears in different kinds of ways. And it's going to require some flexibility and adaptability to figure that out. But it's going to be essential for people to do that so that they can feel the love of the community around them while they're going through something very difficult,

but also so they can honor the person that they've lost and remember that person in the life that was hopefully very well lived. Yeah, I think that's really important. So Dr. Buffka, you're also under a lot of stress because of the coronavirus and the nature of your job. What are you doing to cope? I'm trying to follow my own advice. So I'm sticking to a routine as much as I can. I still get up in the morning and try to exercise every day. I'm trying to be careful about what I'm eating, that I'm eating fruits and vegetables and not just carboloading because it's really easy if it's right there in your kitchen.

When I go to the office to work, I'm eating the food that I bring. with me. So I'm trying to be thoughtful about the kind of food that I'm eating. I'm exploring some new ways of connecting with distant family. I was supposed to visit my parents next month and that's probably not going to be happening. But we've been figuring out how to connect via Zoom. My father and I've learned how to play a favorite card game together over the phone. So we're trying some new things and we're trying to share ideas with others so that we can learn from that and perhaps have some greater appreciation for when we will be together face to face down the road. And maybe these things are so much fun that we'll keep doing them.

Yeah, I now have a standing date with my father every Tuesday and we're really looking forward to it. Great. Well, Lynn Buffka, thank you so much for joining us today. It's always a pleasure to talk to you. I hope you've helped some of our listeners feel better and a little bit more control of their lives. I hope so, too, because it's not an easy time right now, but we need to really think about

that basic foundation. of ensuring we're getting our activity, our physical connections, I mean our social connections with others when we're not able to physically be with them. And to just recognize that we've got an array of emotions that we didn't expect to be dealing with right now and it's okay to have them. But we want to make sure that they don't overrun us so that we can look ahead and figure out how do we cope with the situation that we're in. Definitely good advice. Thank you. So for our listeners, if you have any comments or ideas that you want to share about our podcast, you can send an email to Speaking of Psychology at APA.org. That's Speaking of Psychology, all one word, at APA.org.

And please consider giving us a rating in iTunes. You can find previous episodes of Speaking of Psychology on Apple, Stitcher, Spotify, or pretty much wherever you get your podcasts. You can also go to our website and download all the episodes at www. Thank you for listening. I'm Kim Mills with the American Psychological Association.