Suggestions for tele-mental health resources for coping with COVID-19

Suggestions for tele-mental health resources for coping with COVID-19
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Over 50,300 Americans have lost their lives to the coronavirus disease 2019 (COVID-19). This pandemic is also causing widespread confusion, social disruption and significant economic consequences. Many health care systems, associated personnel, and other essential services are stretched beyond the capacity to address the physical health care needs of their citizens. 

Equally important are the mental health impacts of COVID-19 on individuals, their families, and communities. As a psychologist, I'd like to encourage folks, now several weeks into quarantine, to be courageous — give yourself a mental health check-in and seek support if you need it. Here are some assessment tools and resources that can help you. 

During previous pandemics, such as the SARS outbreak in 2003, affected persons experienced intense levels of fear, loneliness, boredom, anger and worry over the impacts of the virus, including the quarantine and the health of their family members. As scientists, governors, and economists try to balance the costs of social distancing and stay-in-place orders with the desire to re-open businesses, a lot of us are feeling a roller coaster of intense emotions ranging from fear, loneliness and boredom to anger and grief. 

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First, it's essential to know that you are not alone. The COVID-19 pandemic is an unprecedented public health challenge with reverberating physical, mental, financial, occupational and social stress on individuals and communities around the globe. You are not alone to be afraid that you or a loved one will contract COVID.

If you're feeling bored, lonely, or irritable because you are adhering to social distancing guidelines, you are not alone. If you're frequently checking in to your national news sources and drop to your knees and cry or want to puke upon hearing the total number of deaths nation and worldwide, you are not alone. If you're trying to manage your work and homeschooling and find yourself wanting to scream at the top of your lungs, you are not alone. Being depressed and anxious when you are unemployed may seem expectable; however, it is essential to work to manage and overcome the everyday thoughts that come with depression/anxiety so you can be more able to seek and realize job opportunities and engage with future employers.

Second, it's essential for us not to minimize the stress we experience from large health or financial hardships to small inconveniences. This is hard — and I don't support putting on a fake happy face and telling people you are coping well when you're not. It's essential to recognize that struggling in the face of this pandemic is normal. 

As a psychologist, I like to tell the people I work with (as well as myself) that it's important, to be honest with ourselves and courageous in examining our emotions. There are plenty of good free online assessments folks can take to help them better understand how they're doing when it comes to depressionanxietyalcohol misuse, and sleep difficulties.

Third, there is no need we have to struggle on your own. If we currently aren't connected socially or spiritually, and we need additional assistance, there are many good opportunities to engage in mental health self-care. For instance, some of us may only need a few reminders or some encouragement to engage in positive stress coping strategies. There are lists of ways we can take good care of ourselves by maintaining a routine, going to bed around the same time every night to get better sleep and not engaging in the excessive use of alcohol and other substances.

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E-mental health applications are particularly promising because of their accessibility, anonymity, and low cost. E-health apps typically can be grouped into four broad domains — psychoeducation, screening, assessment, and monitoring of symptoms, interventions, and social support (discussion groups, chat rooms).

Most of these are Internet-delivered self-help apps involve minimal e-mail or telephone contact with a coach or mental health counselor. One major issue for the public is how to sort out which of these apps are evidence-based and which are unsubstantiated hype. 

The following source can help people access a list of evidence-informed mental health technologies. One fantastic Internet-delivered intervention that has good evidence to help people prevent and manage symptoms of depression and anxiety is MoodGYM.

Not only is this interactive self-help book free to the public, but it has also been translated into several languages. Other programs, which are evidence-based but cost a fee and thus may require you to check with your health plan or provider are, Beating the Blues and CALM Tools for Living.

There are additional mental health resources and apps which are easily accessible and self-paced. One group of very engaging evidence-informed mental health apps are provided by the Department of Veterans Affairs and are free to the public.

For example, COVID Coach which helps individuals cope with stress related to the pandemic; CBT-i Coach, which provides proven strategies to help improve sleep and help alleviate symptoms of insomnia; and finally, Mindfulness Coach, which provides tools to help people find emotional balance.

Moreover, many good mental health providers engage in tele-mental health. Often these are provided through clinical video teleconferencing or telephone sessions, but sometimes even use texting. These allow a therapist and a person in separate locations to see each other and engage in real-time two-way interaction. I know some people don't find this option ideal and to be honest, I also prefer sitting across from an individual, couple, or group and delivering face-to-face care services. Unfortunately, due to shelter in place orders, this can't easily happen for many of us right now. Not being able to leave our homes, however, should not prohibit individuals from seeking or engaging in mental health treatment.  

Numerous organizations offer directories for mental health providers who deliver services online. These include discipline-specific associations like the American Psychological Association and the American Psychiatric Association as well as anxiety and depression groups, listed by state and their specialty areas, that have clinicians who provide tele-mental health services. There's even a group of mental health providers offering short-term, free and reduced tele-health sessions for healthcare professionals, first responders, grocery store employees, and other essential front line workers.

Finally, self-help books that focus on mental health difficulties are also widely available. Unfortunately, there is relatively little research on how strongly these books are grounded in evidence-based behavioral science. In a paper published in 2008, a small group of psychologists identified 50 top-selling self-help books for anxiety, depression and trauma. 

They then rated each book on overall utility; it's grounding in science, the extent to which it offered specific guidance for implementing the self-help techniques and whether it offered potentially harmful advice.

This PDF version of that paper, with a list of all 50 books, is available for a small fee. Some of my favorite, newer work produced since 2008 include: "The 10-Step Depression Relief Workbook: A Cognitive Behavioral Therapy Approach" and "Show Your Anxiety Who's Boss: A Three-Step CBT Program to Help You Reduce Anxious Thoughts and Worry."

Staying physically healthy and safe during the current pandemic requires good management of our mental health. As all of us continue to cope with intense emotions associated with COVID-19, please know you are not alone and good mental health is available. 

Joan M. Cook, Ph.D., is a clinical psychologist and associate professor at Yale University who researches traumatic stress and clinically works with combat veterans and men and women who have experienced physical and sexual abuse across their lifespan.