Maintaining Mental Health During a Pandemic Part 2: Anxiety, Depression, Stress Management & Coping

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Nathaniel Chin: Hello, Dementia Matters podcast listeners. Thank you for returning to the podcast during this COVID-19 pandemic. I know you have a lot on your mind, and despite being at home, I know life is not easy. It's an understatement to say we are living in an extraordinary time. But whatever you want to call this ongoing experience, it is asking extraordinary things of us. And life doesn't just stop because of it, which is why this podcast continues. I want to pivot here on Dementia Matters and address important issues affecting those with cognitive impairment and those without during this COVID-19 coronavirus pandemic. I cannot cover all the issues and frankly shouldn't. I encourage you to go to trusted sources for specific information such as the U.S. Centers for Disease Control and Prevention, your state and local health department websites, and the Alzheimer's Association. You can also find resources on our website at adrc.wisc.edu. That's adrc.wisc.edu. And that of the Wisconsin Alzheimer's Institute, at wai.wisc.edu for other interesting and important stories on the COVID-19 pandemic. I would recommend my colleague at UW Health, Dr. Jonathan Kohler of the Surgery Sett podcast who has a special series called the Frontlines of COVID. We will include these links to all these resources in our Show Notes for those of you affected by Alzheimer's disease or any cause of cognitive impairment, you know better than anyone that it takes a community to care for those affected and to work on the front lines of treatment prevention and cure. What we face with COVID-19 is no different. We all are needed in this fight and I thank you for whatever it is that you're doing. Take care and be safe.

Nathaniel Chin: Well welcome back, Dr. Walaszek, to part 2 of Dementia Matters. Let me thank you again for doing the interview and for doing part 1, where we covered isolation. Today I'm hoping to talk with you about the anxiety and stress that can happen during the time of this COVID-19 pandemic. And hopefully hear from you different coping mechanisms or suggestions on how we can address this. So thank you for being here! 

Art Walaszek: Absolutely, my pleasure glad to be back. 

Nathaniel Chin: So I guess to start with, can you explain the difference between clinical anxiety disorders such as generalized anxiety disorder, from something like fear or worry. 

Art Walaszek: Absolutely, it's a great way to start and it's you know what's important about this is thinking about what is our normal human experience versus something that might represent a problem and cause some distress or cause some problems with the day-to-day living. So on the one hand fear is completely normal, it's a way of appreciating the stress in the environment and actually kind of organizing what's our response going to be. Folks may remember from school, for the flight-or-fight response, it's a little more complicated now it's fight or flight or freeze. So animals have different ways of responding to threats and in the environment. So you can run away you can fight back or actually pretty commonly is to just freeze you know if you make yourself small and not moving then maybe that threatening thing out there isn't going to get you so we have been finely-tuned over millions of years to respond to those kinds of stressors we have adrenaline that starts coursing when there's a stressful thing in the environment. Our pupils dilate our muscles tense to get ready for action, we start mobilizing glucose or sugar so that we can respond. So there's this whole cascade of events that's normal you know that's, we've evolved to respond to stress in that way and so that's why you know as you tiptoe closer to the edge of a cliff you know your heart rate might start skyrocketing or you may start sweating or you know you stand in front of a crowd of a hundred people at a wedding to give a toast you know your palms get sweaty and your mouth gets dry and all that. These are stressful situations and you're having a normal response to that situation, so we don't you know we don't think that that's pathological or needs any treatment we just recognize that that's yep that we are human beings were mammals or animals that's how we respond to these stressful situations. Now when that becomes excessive and causes a lot of distress or like you can't function from day to day, you know can't go to work or can't pay your bills or can't take your medications or can't take care of your household or whatever, it is because the anxiety levels are so high that crosses over then into something like generalized anxiety disorder which is a condition where people worry all the time and trying to push those worries out aren't successful. If people feel tensed, they don't sleep well, their stomach hurts their head hurts. So they may be irritable so that kind of whole cluster of symptoms plus problems with day-to-day living and distress is generalized anxiety disorder and there are other anxiety disorders out there too, like panic disorder and so on but the dividing line is really how much distress is this causing and is it causing problems with day-to-day living.

Nathaniel Chin: Okay and that last part is I think a really key thing because there is a lot of fear and worry right now because the COVID-19 pandemic, and I'm just wondering you know how does one know if that current feeling is problematic or simply just understandable giving the circumstances we all are facing right now?

Art Walaszek: It's a great question I mean I think we're all in this high level of stress and anxiety with you know the new news every single day about the pandemic and new directions about what to do and uncertainty too, so you know should I wear a mask in public or not perhaps by the time this airs we'll know the answer to that, but you know right now there's you know there's still some confusion about that so uncertainty leads to fear and anxiety as well. If you don't know what the right thing to do is or what's going to be the outcome if I do X or Y you know that leads to some uncertainty as well, so I, to answer your question, I mean I would kind of fall back on well what's the impact this is having on your day-to-day life? If you're still able to carry on with day-to-day life despite these stressors then you know probably what you're experiencing is a normal stress response to all this but if things are starting to kind of break down in day to day life falling behind on tasks affecting relationships that would be another big thing, so if the stress is leading to irritability that's causing a lot of relationship problems that you know that be a source of concern. I think we'll touch later on depression but if the anxiety is leading to some depression and hopelessness and certainly like any suicidal thinking or you know wishing that one were dead, that's you know that's when the alarm bells should be going off that this is not a normal reaction, I need help. 

Nathaniel Chin: You know it seems to me that based on your last two responses, one of the most important things for us to do is really acknowledge how we're feeling acknowledge the worry or the fear or the sadness and then kind of take a step back and take a look at it to see if it's reasonable or not and even if it is you know whether we can control it or not and really move on from there. 

Art Walaszek: Yeah I completely agree I think that kind of self-reflection is really important in stressful situations. It helps with resilience, it helps with coping and just as a bit of a tangent I was looking at a paper that looked at the relationship between wisdom and loneliness and you know we probably don't have an official definition of wisdom but it's probably some combination of knowing stuff but also being able to self-reflect being able to take other people's perspectives and kind of understand where they're coming from it's probably having some sense of like higher purpose and even you know spirituality so folks who measured higher on wisdom whatever you know however you measure that they were less prone to loneliness. And I don't think it's a huge leap to say that they may also be less prone to having trouble with anxiety and depression and so cultivating that ability to self-reflect is really important. And it's also a critical part of a lot of practices like mindfulness or meditation practices are about reflection. Spiritual and religious practices are often about that as well, sort of stepping back looking at the big picture the larger meaning of things is really important when people lose that capacity for self-reflection and that's where we can see some struggles with depression and anxiety. And then in our interventions and how we help people with depression and anxiety we will promote some of that ability to name emotions to recognize emotions and to not let the emotions get the better of us to you know sort of know yep that's there I'm feeling stressed right now, so what am I gonna do about that? 

Nathaniel Chin: You know in our prior episode you also spoke about social media and potentially getting misinformation, bad information. And that probably will be something that we could avoid if we're feeling particularly stressed or anxious I suppose. 

Art Walaszek: Absolutely, I think one of the challenges now is just how hard it is to figure out like well what is the right thing to do and just how big of a deal is this virus and of course, it is a very big deal, but they're competing sources of information about this. So you know, part one is what a reliable source of information so I think of things like the government CDC website or cdc.gov is a really good jumping-off point. And you know things like social media, probably a little more mixed in terms of just how reliable those sources are and any source, no matter how good it is, you really want to take it in moderation so turning those things off and maybe even just rationing here's how much news I'm gonna take in today I'm gonna you know for 20 minutes tune into whatever or go to cdc.gov or whatever it might be and just that's my portion for the day and then I'm gonna turn it off and then I'm gonna focus on other things like my relationships or exercise or reading a good book or whatever the other things might be that are that are beneficial.

Nathaniel Chin: You know something that you didn't mention which I know about you from talking to you earlier, is that you have cats, and so pet therapy or just enjoying the presence of your pet, what do you think about that as far as our person's well-being and addressing stress? 

Art Walaszek: Well I'm very biased as the owner of, I guess my family would chastise me for saying owner, perhaps parent or better yet servant to two cats and I think pets are it doesn't have to be cats obviously it could be dogs or hamsters or chinchillas or whatever. I think you know pets are critical you know their and especially cats and dogs but other creatures that you know, they have emotions too and I think they can be in tune with us as well. So the value of touch you know that's something that we're gonna miss out on quite a bit while we're all in lockdown you know the less hugging less other social interactions, you can still pick up and hug your cat or you know rub your dog's tummy or whatever it is you do, you can still do all that stuff and touch is incredibly important for our well-being so absolutely. And if you don't have a pet, I mean so there are websites galore of you know various feeds online of videos of different animals and you know they're all these delightful videos of like the animals being let loose in the aquariums right now for example and so you know that could be really kind of heartwarming stuff as well so even if you don't have a pet those are much more positive you know good for emotional health kinds of things to watch online or on TV.

Nathaniel Chin: Art, some of the questions that I've been getting in clinic are you know what can people do about the worry or stress that they're feeling right before bed and then that stress is getting in the way of their sleeping and I've been asking them to write in a journal things that they're appreciative of or things that they're grateful for or that they just simply enjoy and to reflect on that. I guess I'm wondering from your professional opinion and personal opinion you know what do you think of gratitude journals?

Art Walaszek: It's a wonderful idea. It sort of belongs to a school of thought called positive psychology in other words you know what are the things that you can actively do to work on your emotional well-being and gratitude is a great exercise for that. You know it's free it doesn't cost you anything to say thank you to someone or write down, you know a common strategy people do is think of three things that you were grateful for today and make note of it or write it down or say it to someone or whatever. And I think especially if the gratitude is about a person you know I may be grateful for the banana bread that's in front of me but I should probably be more grateful to my family member who baked the banana bread and brought it to me. So that I think it's a really powerful personal and interpersonal experience to you know to kind of share that gratitude so I think it's a great idea. I don't know that you have to do it like every night I think it could be like one of multiple different strategies that that you have. Certainly you know other things like turning off the TV or turning off the internet you know well before bedtime to try to promote like you know that kind of getting into the nighttime routine is important. Not drinking alcohol right before bedtime. I think the temptation is oh my goodness I'm really stressed I need to wind down I'm gonna have some wine or beer or whatever, it doesn't really work it's actually counterproductive because it may affect sleep that may affect balance and may affect memory so not a terribly good idea. So you know kind of scheduling things that are kind of calmer and you know more emotionally healthy in those 1 to 2 hours before bedtime I think is a great idea to promote some good sleep. 

Nathaniel Chin: What recommendations do you have for people with a clinical diagnosis of anxiety disorder or depression who feel they're no longer stable because of their pandemic and before you answer that I just want our listeners to know that this is not formal clinical treatment recommendations, I guess I'm just asking you Dr. Walaszek, just from your experience what things that you might mention or recommend in a very general sense. 

Art Walaszek: Absolutely it's a great question. We know that many of us suffer from anxiety disorders, from depression, from other conditions and a time of stress like this is it's a time of risk for people with anxiety disorders and depression and other conditions. So we definitely want to be on the on the lookout for you know maybe the condition had been stable and now it's starting to get worse again because the person is fretting and not sleeping well and kind of starting to spiral somewhat. So one is just monitoring and just recognizing okay how am I feeling? Am I feeling different than I have been before, am I starting to have struggles in my day to day life from my relationships with people? Two is reaching and getting help so if you have an established relationship with a therapist a psychiatrist, primary care doctor, whoever it is with whom you talk about your mental health, reaching out to that person and letting them know that you're having a harder time and seeing if they have any recommendations for you. Especially being mindful of any suicidal thoughts so that's that's a particular concern certainly for people under stress if they have anxiety disorders or depression and especially if you're kind of lonely and isolated that can start to be an issue as well. There was, there were studies after another epidemic called the SARS epidemic in 2003, that rates of suicide went up and they went up kind of immediately afterward and then as long as one year out those suicide rates were higher and it was thought that a lot, and that was especially true in older adults, and so it's thought that some of the isolation some of the fear, some of the worry that am I gonna be a burden on my family, those things kind of drove the suicidal thinking so that's a red alert alarm bell 911 situation. If you know if you're developing thoughts of suicide or your loved one is developing thoughts of suicide you know stop what you're doing call 911 or if you you know call your your doctor call someone, let them know that's going on because that's something we need to address, so that this pandemic doesn't take yet more lives.

Nathaniel Chin:  And I think that's a really important point to emphasize is that even though we are in our homes and we are social distancing and in essence isolated you're not alone, the health care system is still there for you and then when you're having those concerning symptoms there are people on the other end whether it's the phone or telemedicine or the ER that can help you. 

Art Walaszek: Absolutely and I would also, you know we've been focusing on anxiety a lot and I kind of touched on depression but that's another big one and it ties into another normal human experience. So sadness, so we all get sad that's just a normal thing you know we get some bad news or we lose someone or some thing or something doesn't quite meet our expectations you may get sad and so that's totally normal. Grief is also normal and you know unfortunately there may be a lot more grief in the coming months so recognizing those signs of grief and again unfortunately a lot of the normal things that we do with grief like reach out to each other, have a ceremony, have a funeral, you know remind ourselves about our social ties. That's going to be difficult in the coming weeks and months with some of the restrictions related to the pandemic so you know, we may have to turn to things like more online memorials or other ways of still having those rituals that are really important to us. Going to religious services through some sort of online or other format, those are going to be really important to help us with the normal grieving process so that's all normal stuff. It can turn into depression. So a clinical depression is where someone is sad most of the time and it's affecting their relationships it's affecting their day-to-day functioning and may lead to some suicidal thinking as well so in addition to anxiety, depression is going to end up being a big issue during the pandemic. 

Nathaniel Chin: And there will be help though there are people like yourself as well as psychologists and therapists and counselors who are also at home or at work who eventually will be able to help people. 

Art Walaszek: Absolutely, you know it's an interesting thing that's happening in kind of the delivery of mental health here that I think folks should be aware of. You know most of us have very rapidly switched over to either telephone or video interactions with our patients and it's really it's you know it's been remarkable because it's a way to stay in touch even though you know a person can't come into the clinic, we can still stay in touch by phone or video and so those mental health services are available and so if you are struggling reach out you may not be able to see in person your therapist or other doctor or clinician, but there are other ways to connect like by phone and by video. 

Nathaniel Chin: And to end our interview today Dr. Walaszek I guess I would like to ask a question for our listeners with cognitive changes whether it's mild cognitive impairment or dementia, do you have any specific recommendations for them or their caregivers as they are also feeling quite anxious and stressed about the pandemic? 

Art Walaszek: Absolutely I think there are significant benefits to be had from trying to maintain social ties as much as possible so you know there's going to be there'll be less people coming into the home for example to help out there'll be less ability to go out to social gatherings so trying to maintain as much as possible whether it's by phone or video or whatever other means trying to maintain social ties as much as possible. So that's true both for the folks with MCI or dementia and for their caregivers, because the caregivers are going to need that relationship support that emotional support as well. You know we touched on this earlier and an episode one, the value of routine and trying to kind of maintain normal routine as much as possible and maybe even find some new routines some things that you didn't have time for before. You know maybe again with television or the internet or radio or other resources finding some new things to add to one's routine in addition to all the other self-care things that that we've talked about earlier.

Nathaniel Chin: Well that's wonderful information and for those that are on the website we'll also have Dr. Walaszek's part one there as well and I guess with that, Dr. Walaszek, thank you for being on Dementia Matters and doing these two interviews for us. 

Art Walaszek: Absolutely and I really appreciate your attention to this issue, you know first and foremost with the pandemic we have to save folks lives from the virus from the infection, to do everything we can. But at the same time and very soon thereafter we'll have to be thinking about kind of the psychological consequences of all this and so you know I'm really glad you're getting folks thinking about what we can do to help folks out psychologically. 

Nathaniel Chin: Well we do anticipate having you on in the future so be ready for that, Dr. Walaszek. 

Art Walaszek: Thank you, look forward to it. 

Nathaniel Chin: Please subscribe to Dementia Matters on Apple Podcasts, Spotify, Podbean or wherever you get your podcasts, and rate us on your favorite podcast app. It helps other people find our show and lets us know how we're doing. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health, and the Geriatric Research, Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private universities, states, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Bonnie Nuttkinson and edited by Bashir Aden. Our musical jingle is "Organisms" by Chad Crouch. Check out our website at adrc.wisc.edu. That's adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments, please email us at dementiamatters@medicine.wisc.edu. That's dementiamatters@medicine.wisc.edu. Thanks for listening.