The Coronavirus Lockdown – Opportunity & Anxiety

Akashi Seijuro_AnnaVanes
Akashi Seijuro by Anna Vanes (c)

As many are noting, including the blogger, Laury Jenneret, who writes with thoughtfulness about the experience in Britain, there have been some positive, potentially, transformational, aspects to the partial societal and economic lockdown in the UK. For those fortunate to have basic needs met, from food to health care – and to not be stuck with an abuser – and with Internet access available, the pause in lives and unfolding of tragedy has also enabled personal reflection and, often with the help of technology, re-connection with people and communities. Laury Jenneret writes, “…I have had so many more conversations, both with friends and people I don’t actually know, that it has made me wonder if social distancing wasn’t what we were all doing before the coronavirus.”

Many individuals, such as those experiencing social anxiety symptoms, may feel excluded from this silver lining in the tragedy – personal renewal and deeper connection – with their greater isolation potentially reinforcing damaging behaviours, as psychologist, Karin Klassen, warns: “Interacting with other people is one of the things that makes us get dressed in the morning, put our face on . . . Without that interaction we might stop doing some of those things that are basic self-respect things. Then because our behaviour changes we start to feel in a way that supports that negative behaviour. We start to feel icky.”

Technology is being put to meaningful use by some at this time, historian, Robin Reich, writes on her blog, expressing hope that the will for communication persists beyond lockdowns. Writer, Catherine Hume, cites the example of Chinese residents who used their lockdown to develop foreign language and other skills, to recommend individuals struggling in their workplaces to investigate online courses to “retrain into a job you can turn into a business. Be self employed. Be a success and be a success without any hassle from co workers.”

Remote interaction does not, however, enable the physical contact, movement and full range of social cues that can make real interaction so fulfilling. Whilst practically beneficial, therapists have expressed concern about some of the challenges that come with remote interaction with clients, including a concern about the emotional detachment it might enable.

Content on the Internet is so diverse and vast, varying in credibility and accessibility, that its sheer volume and range of options can be a challenge for individuals to navigate without a clear idea of their purpose in its use. This can equally apply to online educational and job opportunities as it can for entertainment.

The current transformational opportunity – and, perhaps, imperative – for job-seekers and job-changers is clearly evident and can place a great pressure on individuals, especially, the most marginalised, burdened and isolated. Without public pressure, it is unlikely that government and their agencies, post-coronavirus, will dramatically change their underfunded service support for disabled and/or jobless groups, despite what should be better awareness of the challenges of being housebound.

There is no general answer to how to improve, train and prepare oneself for the uncertain future – on top of caring for one’s health and dealing with the threat of the virus and its societal and economic consequences.  A psychotherapist, Annie Wright, writing especially for trauma sufferers dealing with the pandemic crisis says, in what feels like a universal truism for people currently dealing with serious health difficulties: “(b)ut for now, our only job – your only job – is to take care of yourself as best you can, to weather this storm, to live with your ghosts but to not let them overwhelm you.” For parents and carers and others, an addition must be made for dependents but self-care and attention will be a necessary starting point for all. Social and professional support may be needed by many.

Image designed by Anna Vanes (c)

To read the full blog-post, ‘Gradually, then suddenly,’ by Laury Jenneret, click the link below.

“How did you go bankrupt?” Bill asked in Ernest Hemingway’s 1926 novel The Sun Also Rises, “Two ways,” Mike said, “Gradually and then suddenly.” I’ve thought about that a lot over the past week, as I, like the rest of the world, have looked on in stunned silence as society as we knew it has ground to a halt. We first heard about COVID-19 at the end of last year, and to be honest it just rumbled in the background on our news agenda. We all broadly knew what it was, that it was a virus believed to have originated from a wet-market in Wuhan, some people had heard that it might have something to do with bats, but everyone was pretty vague on the details, because it felt abstract. It felt like it didn’t have anything to do with us. Not really.

When I took my daughter to…

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‘Ring Ring: telephone work at the end of the world’ – The Challenges of Distance Therapy

Noiz-Vr1_AnnaVanes
Image designed by Anna Vanes (c)

Deprived of social interactions as a form of comfort and as treatment for their illness, individuals with social anxiety disorder symptoms will rely more than ever on therapy and counselling during the COVID-19 virus pandemic. Whilst the NHS in Britain has been providing talking therapies using a variety of delivery methods for some time now, the virus pandemic and government health measures have meant a sudden, greater shift towards electronic delivery, sometimes, without full training for staff.

The necessity of treatment at this time is outlined well in a recent article by a Canada-based psychologist: “Anxiety and trauma is cumulative. The thing that tips the jar of anxiety over causes a whole bunch of issues to spill out. It can bring up other things in a person’s past that they haven’t dealt with before like a sexual assault, a trauma, an affair, a divorce. It can bring out things that remained buried for a long time. So, people have to be aware of that.”

Both patients and therapists will benefit from reading the blog-post linked below in which an anonymous NHS ‘Low Intensity Therapist/Psychological Wellbeing Practitioner’ (LIT/PWP) writes about challenges and recommendations for electronic delivery for therapists/practitioners. Patients too can benefit from understanding some of the challenges faced.

The blogger writes mainly of Low Intensity Therapy, that is therapy which is, according to the British Psychological Society, “delivered in such a way as to reduce the need for extended one-on-one time with a qualified psychotherapist. It typically incorporates self-help books and internet exercises, usually completed under the guidance of a “well-being practitioner” or coach who is trained to follow a highly structured programme rather than having any formal psychotherapy training.”

Being based on skills training, rather than relationship building, and rigid principles and structure, the blogger suggests that Low Intensity Therapy is highly suitable for distance treatment: “I’ve suggested to trainee LITS/PWPs that working on the phone uses the same skills as working with someone who has a visual impairment; plenty of non verbal signals don’t rely on sight: pace, tone, choice of words, reflection, summary and verbal empathy, the use of silence.”

Therapists and other practitioners may experience their own anxiety or uncertainty using what may be a new delivery method: “I used to have quite severe anxiety symptoms when I got phone calls or had to make calls; that subsided after the first few weeks of doing regular telephone assessments! But seriously, if you’re anxious about phone calls generally then use supervision and be gentle on yourself, but don’t let the anxiety stop you.”

The blogger describes feedback from colleagues expressing a concern about emotional detachment: “What was difficult was a feeling that if we took our physical presence away the patient would lose something vital to their recovery. There’s also a sense that we, the PWPs (and I would imagine therapists in other modalities) would lose something about the work that helped and refreshed us too.” The blogger’s own view seems quite clear: “…we thought that we were the magic ingredient, and we wanted to keep that sense of connection for ourselves.”

There are other potential practical shortcomings, such as difficulty conveying visual formulations which are integral to, for example, Cognitive Behavioural Therapy (CBT) and the patient data collection required to measure progress. One suggestion is that this information is provided via digital format before a telephone session.

Face-to-face interaction is particularly suitable for therapies dependent on a therapist-patient relationship and for treatment of specific conditions, such as social anxiety disorder. It provides for more complete human interaction, including physical cues and expressions. However, alternate delivery formats can supplement this through greater focus on, for example, vocal (telephone) and facial communication (video). With more therapy being conducted through electronic means, therapist and patients must consider how to ensure effectiveness – as well, as considering the longer-term place for such formats.

Image designed by Anna Vanes.

To read the full blog-post by ‘Not A Guru,’ click the link below:

Not a Low Intensity Guru

First, you might want to play this song while you read. Thanks Patricia for the mood music!

Contents

Unfortunately I can’t do hyperlinks within a post in this version of WordPress so I’m sorry for difficulty navigating. There is unlimited room to add to this. If counsellors would like to include any specific learning from their experience please let me know – I can only get my hands on CBT folks at short notice! Roughly the post is organised into:

  • Introduction
  • Setting up an appointment
  • General skills during an appointment
  • PWP/IAPT specific notes
  • High Intensity CBT specific notes
  • Links to online resources
  • References

Introduction

Welcome to the first NaG post written from the self isolation couch. I promise that the cough wont transmit through the keyboard. Please be kind and…

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‘There is Only One Reality’ – Opportunities for Self-Connection

Yuzuki Yukari_AnnaVanes
Yuzuki Yukari by Anna Vanes (c)

The various forms of self-quarantining being imposed or encouraged by authorities across the world in response to the coronavirus pandemic mean that individuals with social anxiety symptoms will, along with others, experience prolonged isolation over the coming weeks. Whilst presenting a potentially challenging disruption to treatment, support and exposure, this period may present an opportunity for connecting with oneself.

Disassociation is a medically recognised response to overwhelming stress. It leads to disconnection from oneself and/or one’s environment and can last for a short or long period. In a recent blog-post, writer, Rachel Ganz, recalls her anxiety and fear-provoked disassociation during her childhood: “I learned very young to displace myself with imaginative distancing. I cannot panic about reality because I don’t keep up with it, I can’t. Most of us live a version of that. Most of us participate only as we want, only as we can.”

Blogger, Zachary Terry, wrote recently of mental distancing in the form of regret and hope. His mother passed away unexpectedly and he writes of the loss triggering deep regret. “I lamented my choices throughout the previous years, wishing I was better, kinder, more loving, more affectionate… I wished I’d been a son who took better care of his mother.”

He came to see spending time purely on regretting as a denial of the present – and reality: “I saw how useless my regrets were unless they caused me to make different choices in the real world – in the present. I began making commitments to myself, my mom, and to God. I started showing more love to the important relationships in my life.”

Likewise, he sees spending time in the future with hopes, whether taking vague or detailed form, as being wasteful unless connected to the present: “…I’ve begun letting go of any dream of mine if I’m not prepared to begin working towards it today. I ensure to draw a clear line from the present towards the future I desire.” He adds, “…prove your dreams aren’t simply fantasies about an alternate future universe that will never exist.”

Individuals suffering social anxiety disorder symptoms, often accompanied by depression, can find themselves displaced or disconnected from the reality of the present or, simply, numbed through disassociation, distraction or, even, medication. As well as leading to difficulties functioning, with the most extreme cases being difficulties with self-care, such as washing or clothing oneself, it can lead to loss of a sense of an identity or sense of being.

Rachel Ganz recommends recording and replaying ones daily life – whether in written, audio or video form – as a means of self-connecting: “Sit and listen. What did you do today? How did you react to the things around you? Was everything ok? Were some things not ok? Who was there? How did those people make you feel?” For sixty minutes, she suggests, “Untangle your experiences. Allow the memory of those experiences to effect you. Trust your soul and let it breathe.”

The listening to oneself forms part of both the recording and the replaying process: “We have been through a lot and we will continue to get through a lot, believe me. OR, don’t believe, and look through OLD texts for inspiration, find the artifacts. Whatever moves you, art, cooking, history, physics…” Even the process of tidying and sorting personal belongings presents an opportunity to connect one’s past and present selves.

Zachary Terry’s form of connecting is to remind himself of the present: “When I fall into discontented moods I try and close my eyes and remind myself that nothing else exists. Here I am, just riding the rise and fall of life’s cruel turns and wondrous pleasures. Here I am on the only mortal adventure I’ll ever know. There is nothing else at all friends.”

Global self-quarantining measures may offer a time for self-connection efforts. However, it may also pose new challenges by isolating individuals from opportunity and support and/or placing them into unsupportive environments. Nonetheless, during this uncertain period, when many are undergoing hardship, self-awareness and self-connection may prove beneficial commitments.

Image designed by Anna Vanes.

To read Zachary Terry’s full blog-post, ‘There is Only One Reality,’ click below:

Walking Forward

Let’s Do a Fun One

I’m taking a break from writing solely about my trials this week. Let’s do something fun and philosophical. Some weeks ago I mentioned I’ve experienced a great psychological awakening. It was a series of sequential attitude shifts that paved the way for transformative change. I want to share one of the concepts that helped me. I learned to live here in the present, in thereal world. I learned to loosen my focus away from the three false realities I used to fantasize about.

The Real World

We human beings live here and now. Our brains constantly experience a slightly delayed continuous present moment. This is all that there is. What happened five seconds ago isn’t real. What’s going to happen in five seconds from nowdefinitelyisn’t real. Right here, in thispersistentpresent,is the only universe where cause and effect flow…

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‘My View on the Mental Health System’ – Invisible Illnesses and Waiting for Crisis

Lost in the Echo
Lost In the Echo by Anna Vanes (c)

Those suffering seriously with illness but able to, apparently, from the outside, function relatively well, may need a health crisis before they find their care needs being met. The assumption for such individuals (often internalised by the person themselves) can be that as long as they are able to perform the basic tasks in their daily lives, they do not need or deserve resources or attention.

Delaying or denying treatment to such individuals until a breakdown or peak of crisis can mean greater personal harm for the individual and more costly and extensive treatment needed for the individual. From all perspectives, a more attentive and early intervention approach is sorely needed from the healthcare system.

Individuals must, in the absence of a well-funded and effective healthcare system, be advocates for themselves. This means, overcoming internalised stigma of seeking help and overcoming barriers to access placed in their way, whether from commitments such as employment or by resource-starved healthcare systems. For individuals experiencing social anxiety or depression symptoms, this need to be assertive and an effective communicator can be an unassailable barrier to receiving necessary attention and care.

“i end up feeling guilty for needing that appointment,” a blogger writing about their mental health journey shares. “i am always aware at how stretched the GPs are and dont want to feel that i am wasting their time.”

Work and other commitments can make attending an appointment difficult. As a fast food worker explained, she is given her shift times from week to week, meaning that it is “almost impossible” to schedule a doctor appointment in advance.

In the UK’s NHS, patients are typically entitled to 10 minutes to see their doctor and with internalised self-doubt and busy waiting rooms, patients may feel pressurised to accept less than this. For individuals with mental health issues, such as anxiety, communicating with a doctor effectively under this pressure can be difficult. This is exacerbated in cases of multi-morbidity, where multiple illnesses are present and interact, making understanding, diagnosing and treating more complex.

GPs (General Practitioners) in the UK report being overwhelmed by patients to the extent of their judgment being affected by fatigue and irritability. One in 10 reported seeing some 60 patients in one day, double what they consider to be safe. Medics surveyed were working an average 11-hour day, including three hours of administration. One Hertfordshire GP said: “There is a point where I feel cognitively drained; after about 20 patients, there is not an iota of empathy left.”

Social anxiety disorder is typically treated on the NHS with Cognitive Behavioural Therapy (CBT). Having completed a self-report questionnaire on anxiety and depression, an individual who passes a certain threshold is referred to therapy. As the mental health journey blogger writes: “you are restricted to how many appointments you are allowed to have and the waiting list is huge. For some people Therapy needs to be longer term, but that isn’t always available to the people who APPEAR to be functioning well. Going private is so expensive and out of my price range, so it isn’t really an option for me.”

Increasingly, mental health sufferers in UK who have not reached peak crisis point, must turn to private treatment whether in the form of counselling or therapy.  The cost of private treatment and the challenge of identifying suitable and legitimate treatments from the vast array available can be barriers. Without intervention or treatment, individuals may struggle with their illness medically untreated, doing long-term and, potentially severe harm to themselves – until a crisis or breakdown makes them visible to the healthcare system and to themselves.

Image designed by Anna Vanes.

To read the full blog-post ‘My View on the Mental Health System‘ written by a blogger recording their mental health journey, click below: