What is pertinent to witness as a mental health practitioner, is the “not-so novel” psychological impact that this coronavirus has brought to people worldwide. The World Health Organization recently made reference to the physical consequences of Covid being well-documented; however, the mental health challenges are less well-considered.
Where the original statistic for those experiencing a mental health problem was previously 1 in 4. Indeed, the office for national statistics has recently published a double percentage of cases of depression alone.
We know, however, that this statistic is largely determined by those who seek support. In my experience, I have little doubt that there is a significant percentage of folk who continue to function with distressing symptoms who never access services.
A global threat of imminent danger, insurmountable death rates, no known cure. The treatment for self-preservation and survival.
Stay indoors, and avoid activities that provide reward, enjoyment, comfort, closeness and support. Isolate while managing resource limitations – food shortage, medication shortage, job loss, residential eviction
The basic themes of common mental health disorders are threat-based appraisals.
A global sense of perceived threat, danger, catastrophic outcome, Intolerance of uncertainty, unpleasant and unwanted thoughts, anxiety, impending doom, hyper-vigilance, sadness, and hopelessness.
Not unsurprisingly, Mind recently published data that 2 out of 3 of those with pre-existing mental health conditions, showed their symptoms worsened during the lockdown.
However, this pandemic has triggered not only those who had previously overcome such disorders but has placed doubt in the mind of those that had not yet experienced such effects.
Impact on treatment
Treatment for such disorders using cognitive behavioural therapy places emphasis on challenging misconceptions by gathering a range of evidence to fully assess cognitions and challenge any distortions. It aims to support people to discover and adopt behaviours that may be unhelpful in maintaining a sense of threat as well as problem solve tangible events and increase confidence in coping when real events threaten emotional well-being.
For example, in the case of health anxiety, due to fear of illness and resulting consequences, we often see people checking for symptoms, seeking reassurance and misinterpreting physiological sensations as harmful.
In cases of obsessive-compulsive disorder and also worry, we know that the element of doubt (‘what ifs…’) lead us to try and neutralise our anxiety by using behaviours to check with an attempt to prevent harm.
The treatment of most commonly experienced anxiety disorders would be to expose to imagined threats and Habituate to the outcome whilst gradually reducing safety behaviours to minimise distress, tolerate uncertainty and learn that catastrophe may not always be present.
Mental health pandemic
The tricky bit:
- The current threat is real, not hypothetical, so thoughts are not necessarily distorted
- Uncertainty is sustained
- Many behaviours which contribute to the maintenance of anxiety and depression disorders are currently advisory
The likelihood for most is that those experiencing enhanced responses to a current objective threat will in time pass but for those who are already meeting the clinical threshold, barriers exist.
We modify our internal anxious or negatively appraised predictions via different experiences, resources, and messages and access new learning through activities, roles and experiences external to our own biased belief system.
So not only are our most feared predictions being confirmed currently, our strategies to help us manage the anxiety they produce, have been reduced through isolation.
The strategies we would usually advise for treatment now require a creative view.
Recent research has identified considerations of the contraindications to treatment, in particular, the cost/benefit of exposure treatment and a need to risk assess contracting coronavirus against reducing symptoms of mental health distress.
Time for change
As Jassi reports, it may be that treatment models may need adaptation in some cases whilst the virus remains in our communities. Examples of resourcefulness during restricted periods may include; the use of video technology for self-perception study in social phobia, and virtual reality mechanisms for phobias.
The likelihood is that, until a vaccine emerges, the world will remain within a cloak of uncertainty for those with mental health problems, those with emerging symptoms and those who may go on to develop symptoms later.
What better time to think of mental health support and in particular early intervention, than when most of our population will have experienced some degree of heightened distress?
We can`t reduce uncertainty immediately. We can learn strategies to tolerate the unknown now and in the future. We can certainly make changes to the situations which maintain low mood or anxiety and adapt treatment approaches to yield the best possible outcome for mental distress.
No one was ever immune from mental ill-health not ever will be, there is no vaccine. If symptoms arrive, however, we can recover. We don’t have to die from mental illness.
We need to start talking, keep talking and expose ourselves, with compassion along the way, to uncertainty in our world in the healthiest way possible.
Let’s make talking about mental health the norm!
Rebecca Meagher is a cognitive behavioural therapist. Rebecca offers CBT treatment, mental health awareness training, consultancy and clinical supervision.