To learn more about how things have changed, Pittsburgh’s NPR News Station WESA’s health and science reporter Sarah Boden spoke with psychiatrists, therapists, and social workers about what they’re observing in their own practices.
In the following conversation, Boden spoke with Kristen Walker of the Counseling and Wellness Center of Pittsburgh. Walker is a cognitive behavioral therapist who focuses on treating anxiety disorders, which can cause people to fixate on worst case scenarios.
This conversation has been edited for length and clarity.
In many ways, COVID-19 and other recent events have confirmed our greatest fears. How do you help patients navigate this?
One of the things that can be really effective is helping people focus on what they can and can't control: “Well, I have control over wearing a mask. I have control over whether I exercise. I have control over whether I eat a healthy meal.” And all those things help manage some of that external anxiety.
I know that clinicians want to be careful to not over-pathologize a patient. But I do wonder, since March 2020, are more people developing anxiety disorders?
In my experience with folks I've been seeing, yes. I mean, in order to have that anxiety disorder, there are clinical markers that need to be met: feelings of being on edge, constant worry, difficulty sleeping, having a startle response, maybe avoidance of people in situations. All of those different kinds of things are hallmarks of what we would consider an anxiety disorder.
And are we just talking generalized [anxiety]? Or are you seeing all different types of anxiety disorders?
All different kinds. The social anxiety disorder has been tough for folks. One of the things we typically encourage folks with social anxiety disorder to do is to go out there, get in public, meet people, do things to do those exposures. And that's been pretty limited with COVID.
Besides social anxiety disorder, I'm wondering how the pandemic has impacted other anxiety disorders like, for example agoraphobia, which is a fear of leaving your home, being in, I guess, unfamiliar places or places you can't control the environment.
People with agoraphobia tend to not leave their home or I mean, if they do leave their home, they tend to stick close to a routine. Somewhere where they know that they can get out safely. So it's harder for people to kind of rationalize for themselves. “Oh, even though this feels really uncomfortable, this is going to be a good thing for me to go,” because now there's this added layer of COVID-19.
Yeah, it's so interesting. You're talking about the sort of exposure therapy, I guess you could call it, [that] in some ways the exact opposite of what the public health guidance was at certain points earlier in 2020.
Yes, yes. That's completely contraindicated for somebody with agoraphobia, or social anxiety.
I also want to ask about obsessive-compulsive disorder. I think in media, we might see this portrayed as somebody who's constantly washing their hands, or always on the lookout for some sort of danger or calamity in the real world. How have people with this diagnosis been impacted by the pandemic?
The pandemic has been really tough. If somebody does have more of a fear of germs, for example, when they wash their hands they immediately feel better. And what that does is it brings down the anxiety for a temporary time period. Eventually it spikes back up and higher. Now, all of a sudden there's the CDC guidelines coming out, especially early on in the pandemic where you were being told, wipe down your groceries, leave your deliveries outside for a couple of days, make sure you're washing your hands. So that was really tough to navigate.
I suppose, really with any anxiety disorder, the behaviors are not always irrational. It's just calibrating that sort of alertness or protective behaviors to the situation. But suddenly we're in a situation where a lot of those behaviors are being reinforced.
Right. Right. Because it reinforces the need or the urge to isolate.
Looking towards the future, what do you think the long term effects will be of the pandemic on your clients?
It's going to take time to reacclimate to being out there in the world again. So I think it's going to require support, patience, care, gentleness for each other.
This story was produced as part of "Pittsburgh's Missing Bridges," a collaborative reporting project by the Pittsburgh Media Partnership. Check out more of Sarah Boden's work here: wesa.fm/people/sarah-boden