Dealing With Nervousness within the Time of COVID-19
Now that we are in the middle of a pandemic, more people are afraid than ever, especially those who struggled with mental health issues prior to COVID-19. And to make matters worse, many of our coping mechanisms, like going to the gym or hanging out with friends, have been taken away.
On today's show, our host, Gabe Howard, speaks to Dr. Jasleen Chhatwal, who explains why so many people have symptoms of anxiety and what we can do about them.
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Jasleen Chhatwal, MD, is Chief Medical Officer and Director of Sierra Tucson's Mood Disorders Program, a premier center for behavioral medicine in residential areas. DR. Chhatwal also serves as an assistant professor at the University of Arizona College of Medicine. She is a specialist in psychiatry and integrative medicine and has extensive knowledge in the fields of psychodynamic psychotherapy, cognitive behavioral therapy, psychopharmacology, neuromodulation including ECT & rTMSand various new modalities.
DR. Chhatwal is active in the mental health community and advocates her patients, colleagues, and profession through elected positions with the Arizona Psychiatric Society and the American Psychiatric Association.
Via the Psych Central Podcast Host
Gabe Howard is an award-winning writer and public speaker living with bipolar disorder. He is the author of the popular book "Insanity Is An Asshole" and other observations available on Amazon. signed copies are also available directly from the author. To learn more about Gabe, please visit his website gabehoward.com.
Computer generated transcript for "Dealing with fear" episode
Editor's note: Please note that this transcript was computer generated and therefore may contain inaccuracies and grammatical errors. Thank you.
Announcer: You are listening to the Psych Central Podcast, where guest experts in the fields of psychology and mental health share thought-provoking information in simple everyday language. Here is your host, Gabe Howard.
Gabe Howard: Hi everyone and welcome to this week's episode of The Psych Central Podcast. I'm your hostess, Gabe Howard, calling on the show today. We have Dr. Jasleen Chhatwal. She is the chief medical officer and director of the Sierra Tucson Mood Disorders Program, a premier center for behavioral medicine in residential areas. Dr. Chhatwal, welcome to the show.
Jasleen Chhatwal, MD: Thank you for having me. I am very happy to be here.
Gabe Howard: Well we are very excited to have you here today because you are also an anxiety expert and a lot of people who are not used to feeling the effects of fear have been traced back to COVID. I want to start with, do you see people who never had anxiety and stress problems before they suddenly developed anxiety disorders due to the global pandemic?
Jasleen Chhatwal, MD: I find that there are a lot of people who do notice symptoms of anxiety and, having never experienced them before, they are really surprised and don't really know what is going on. I think one of our big jobs at this time is to help people become more aware, because I think once you can name the beast, it will be much easier to tame the beast. And I think a lot of people will have a hard time if they don't know what to call it or what to do with it.
Gabe Howard: The Psych Central podcast has been on the air for nearly five years and PsychCentral.com has been around for 25 years. So we are very familiar with the mental health advocacy. And for the most part, it was always in its own little corner. There are people who have a mental problem or a mental illness and understand it. There are people who are developing or have a loved one who develops a mental problem or mental illness and who are looking for information. But, by and large, the majority of the population did not openly discuss this. We saw this change dramatically in the past six months when it suddenly became sort of mainstream news about how adults who had never had mental health problems suddenly found themselves suffering from depression, anxiety, stress and so on suffer and so on.
Jasleen Chhatwal, MD: A lot of people talk about fear like it's a pathological thing. I'm really trying to explain to people how normal fear is. You have to have the neurobiological fear response to be safe as a human. Like going to the Grand Canyon and walking the Skywalk, the fact that we don't just climb over the railing and try to jump down is because we have a biological response to anything that is not normal human Experience or scope. When you think about having a snake on your chair you want to have a fear response so you can panic and run quickly. And what happens when you don't have this fear response is you die because the snake is biting you or you have some pretty negative consequences from it. How can you not be afraid when you are told all day on the news that you need to take all these extra precautions to be sure not to get sick and to make sure your loved ones do not die? This is something that usually causes some level of fear. The difference between this type of anxiety and what is known as a DSM anxiety disorder is that it becomes so overwhelming that you can no longer function. And what we are starting to see are people who may have had higher levels of anxiety before but were able to do things to help themselves, like going to the gym to work out, or running outside or spending time with loved ones. All of these people have had their coping skills taken from them. And this is where you begin to see that they now fall more into this clinical anxiety disorder category. If you look at most mental illnesses, they fall on a spectrum. And it really comes down to how far you are in the spectrum today. It could be a disorder today. But it didn't quite meet the criteria a week or two ago.
Gabe Howard: One of the topics covered on the Psych Central Podcast is that we are trying to explain that mental and physical health are, in fact, they have a lot in common. That said, most people have good physical health most of the time. But you can still catch a cold. You can still get hurt. And that's a very temporary problem. But you can also have diabetes, for example, which is severe and persistent and lifelong. Mental health is the same way. I think a lot of people think that you either have good mental health or are mentally ill and that nothing is in between. Do you think that due to the pandemic, people are gradually realizing that everyone is mentally healthy and that you can have the equivalent of a cold, which in this case is stress and anxiety or panic? Do you think this will help educate people that we are all mentally healthy and anything can trigger poor mental health?
Jasleen Chhatwal, MD: Yes, I think I read a lot more content about it on very popular channels. Maybe your podcast or me is our world, but other people
Gabe Howard: Sure, yes.
Jasleen Chhatwal, MD: If this is not their world for us, we see them talk more about mental health. And in my own world, I'm not trying to talk about someone who just has a mental illness. I think about mental health on a continuum. You can do things every day to improve your mental health, and you can do things every day that may not work really well. The types of foods you eat, the places you go, the people you spend time with, any of these things can all help build that sanity.
Gabe Howard: Dr. Chhatwal, thank you very much for discovering that more people are suffering from anxiety and that this is a very real thing. We have been doing this work for a long time, so we are not surprised. But I think the general population is, and one of the hallmarks of being surprised by something is that they don't know what to do about it. Do you have any advice for listeners who are overwhelmed, anxious, and stressed because of the COVID-19 pandemic?
Jasleen Chhatwal, MD: The only thing we can all do, and maybe do a little bit better, is to become more aware. Naming what is going on for you is really important and naming it, not in the sense of saying, oh, I have disorders or diagnoses anyway, but rather naming how it feels to me? How do I feel in my body? What are the signs that I see for myself? What changes do I see in my behavior? When I realize that you are not so engaged, that you are not as motivated or fulfilled, to say, OK, well, I don't really feel like doing my job, or when my kids ask me a question, I feel upset and want to roll my eyes that this can be a step to say, OK, something is definitely going on. And now let me sit and think about how I feel physically. What emotions do I feel? Some of us have a broader language for emotions and some of us have a narrower language and words for emotions. And that's fine. Even if I can identify with myself, I feel good, I feel bad. It can be a great place
Beginning. And then you start to wonder what your real options are to change things that you feel bad about? Does it have something to do with your job, either the lessons feel too much now or the workload feels too much. Talk to your HR department or, if it is about your personal life, maybe meet up with your partner or with people who live in the household with you, or if you live alone, connect with friends and start really talking about it and after asking the assistance you may need. Another strategy then may be to stick to a certain schedule because we hear a lot about rising pajama sales or people doing the zoom uniform with the formal top and shorts below.
Gabe Howard: I love that.
Jasleen Chhatwal, MD: Yes, it is comfortable, and it can also signal your mind to just relax. However, you are sitting in front of your computer and working. Now your mind is really confused. It's like I should feel relaxed, but I'm doing work. So what we hear from people is that they work longer because they are only connected to the computer now. They still have to take care of their children and now they have to pick up their groceries and wipe them all down like everything got just a little bit or a lot more complicated. So if you're trying to get your life on at least a small schedule, you can say, OK, I'll start my work day at eight and then finish my work day at five, like I normally would.
Jasleen Chhatwal, MD: And then maybe that evening you can see what enjoyable activities you can do in your home environment? I hear from people that they can't exercise, but I can tell you that pushups don't require a lot of equipment. And so it can now decide that I can only do five push-ups per day. Within the next two weeks or a month, I'll get up to ten. So set realistic goals that you feel you can achieve and that go in one direction. I think two or three months ago I felt like I was just home, going to work and coming back. But I got myself an easel and canvas and picked up something I hadn't done in about a dozen years. I painted. It's not great. I'm not going to sell it, but I did something that was fun. It is really very important at this time to find all that you can do to serve your soul.
Gabe Howard: When it all started, we sort of had the mindset that we just have to crouch and get through, it will only be a few weeks or even a few months. Now here we are and we are starting to learn that we don't really know when this will be over.
Jasleen Chhatwal, MD: Yes.
Gabe Howard: Now we are in a kind of limbo where we don't know if we want to develop new habits that we want to keep for years or if we should still stay in those things, oh, things will be normal tomorrow. The example I always use is: If I lost my job, I would understand that this job is not coming back and I would be preparing for a new future. But if I got fired from this job and they told me we would call you back as soon as things get better. Well what do I do now Am i looking for a new job? Do I wait for things to recover and they call me back and I get back to my life? We don't know when this will end. It's not that difficult for us.
Jasleen Chhatwal, MD: My advice to people and my thought for me and my loved ones is that maybe this is a time for us to really reinvent and rethink what our new normal will be. We know that not only has the pandemic clearly affected the way we live, but also that a potential financial crisis is looming. So if we really restructure our lives and see, are we really on the right track? And even as a human species, is the direction we are going really the direction we need to go? With all of the things we cannot control, we can control how we react and how we begin to make our own decisions in our lives. Connection is pretty important. Make sure there is a regular way to connect with other people, even if you work from home. I've heard these amazing stories about families doing Zoom sessions every week, or playing card games on Zoom, or maybe even turning on something like a video platform and having conversations all day.
Jasleen Chhatwal, MD: We did things like doing things with my in-laws and family while watching a movie at the same time. I also think we are starting to look for employment and sustainable ways of working because we work a lot as a culture. And I think a lot of companies are now realizing that people may not need to be clocked on site or on site as often as we previously thought. So really start to see if that's okay with you because for some people teleworking doesn't seem to work, and for others, teleworking seems like the best thing since sliced bread.
Gabe Howard: You came to a very interesting point with your example of teleworking. Some people absolutely love it, others absolutely hate it. We often see this with fear. Some people handle this pandemic easily. You are literally not afraid. Other people fall apart at the seams. Why does it hit some people harder than others? And then there is this tendency, if you are one of the people you meet really, really hard, to find someone who can handle this global pandemic like gangbusters and compare yourself to them. And I imagine that dealing with fear and moving forward is much more difficult.
Jasleen Chhatwal, MD: The comparison has always been one of the things that breaks your drive and makes you feel really drained because we don't know what that other person's life is like. We don't know what their life experiences were. In terms of mental health, we've long recognized that our early life has a huge impact on how we react later. And some people, either more anxious than others at this point, either do not have access to their usual coping skills, or the other thing could be that a person with more anxiety was likely to have had less favorable childhood experiences or early life trauma. Some of this trauma can be relived when isolated and without support on your own. Finally, at times you may have had a really comfortable and uncited, normal life. And if something suddenly comes and changes the way you live, it may be the first time that you really face something that feels overwhelming. You may not have had any previous experience with it. The more we believe that others are fine, the more likely it is that we will focus more on them than on ourselves. Instead of just sitting and saying, well, you know, Tom seems to be really fine, and I can see that
Gabe Howard: Right.
Jasleen Chhatwal, MD: Gabe's way of killing it, being more connected to yourself is probably your best bet for finding that new normal and moving forward after the pandemic.
Gabe Howard: I really like what you said when we are paying attention to others, clearly not looking after ourselves, and failing to clear the fear by convincing Bob or Jane that Bob or Jane are leading their best lives and therefore I should also lead my best life. There is more nuance and work in it than that. Which leads me straight to my next question: How do I know if I am realistic about the risks and dangers and when to just let fear go through me?
Jasleen Chhatwal, MD: Fear can defeat anyone. It's a neurobiological response. We have this tiny area in our brain, the amygdala, whose job it is to give us signals of fear. It really is that when you feel like you can't quite function in your life, you are not really able to do the things you can normally do, or especially when you start out about suicide to think about or not to want to live or not to want to live it is not worth it to feel like your life is not worth it. These are signs of danger, and these are times when I would say don't even think, seek help. It really doesn't hurt to seek help. And if nothing else, most of our churches have something called warm lines. And you can call them up and talk to someone and see if that helps, as many of us may not be able to think clearly about what is happening to us until we talk about it. I usually say that when you go to a therapist you can always decide not to go for a second visit. It's not like they're forcing you to come over. You at least start to tell your story and try it out as an option, whether that will help you or not.
Gabe Howard: We'll be right after this news.
Sponsor Message: Gabe and I wanted to tell you about Psych Central's other podcast that I host, Not Crazy. It's a face-to-face conversation about the world of mental illness and is moderated by me and my ex-wife. You should check it out at PsychCentral.com/NotCrazy or your favorite podcast player.
Sponsor Message: This episode is sponsored by BetterHelp.com. Safe, convenient and affordable online advice. Our consultants are licensed, accredited professionals. Everything you share is confidential. Schedule secure video or phone sessions as well as chat and text with your therapist whenever you deem it necessary. A month of online therapy often costs less than a traditional face-to-face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.
Gabe Howard: We're discussing with Dr. Jasleen Chhatwal on COVID-19 anxiety and stress.
Gabe Howard: Now Sierra Tucson has launched a program called Health Care Heroes, which is specifically designed to treat doctors, nurses, and other frontline health workers who are dealing with the trauma of illness and death caused by coronavirus. How can you help health care workers heal from this tragic experience? Because so far we've only talked about laypeople coping with the pandemic, but they are literally on the front lines.
Jasleen Chhatwal, MD: Health care workers are already at higher risk of fatigue, burnout, suicide, and that was before the pandemic. Most of us usually go to school and train for years with the aim of helping others. And now that the pandemic has really challenged our own lives and we have had to get to work with increasing fears of exposure as well, most of us may also know health care colleagues who may have contracted and even lost coronavirus their life to the coronavirus. From a healthcare worker perspective, I feel like life is more stressful than ever. You are called to really show up and help people. However, we also didn't have all of the tools we normally need, despite the lack of PPE, the lack of ventilators and the increase in hospital bed capacity. People work longer. More is expected of them and less rewarded because we lose our patients. We see people get sicker. The health workers themselves are helpless. And there was so much stigma about finding mental health support for lay people and then for health workers that it gets worse because then we have to start reporting it to our boards or we have to tell people we have mental health get treatment. Many healthcare workers are used to putting on their armor and saying, I'm fine, I can work long hours, I can do what needs to be done. So, Sierra Tucson as a group, when we were looking around how we could show up and help our community and help our people, we decided to create this program that we wanted to allow people to say that I am not OK. That is the message we want to convey. It's okay to need assistance. And we are there for you. We are also health professionals and experts in trauma healing. We are currently in a unique position to support our healthcare colleagues with a nurturing environment, trauma-focused therapies, and additional peer support. So find ways to help them get back into that mental health spectrum, move closer to mental wellbeing, and move further away from a mental health diagnosis or illness. There are healthcare workers who have previously lived with mental illness. So that they also know that they can take time off and really take care of themselves because they are the most important person.
Gabe Howard: In my view, it does not serve the larger society to have health workers who are so stressed, overwhelmed, or have a mental illness or state of health and are not seeking treatment because it is so useful to be available to me stand when they find themselves in a crisis or possibly in a crisis? So, do you want health care workers who know they are at risk for a mental health issue to stop seeking help because they fear the stigma, discrimination and judgment? This does not serve the common good. Are people starting to see that? Do you see a shift in both the willingness of health workers to seek help and the understanding of society in general that health workers are people too?
Jasleen Chhatwal, MD: Interestingly, it seemed like the pandemic helped people tend to accept that, oh, this is traumatic and you hear the word trauma a lot more. I want to say that it is slowly improving. And I think the more the general public accepts mental illness, the easier it will be for even healthcare workers. But it's still very difficult. It's still not a good place. We're not doing well with our people. I think the big part of it is that we separate physical and mental health, and you just can't. One affects the other. Even with something like fear, what is it?
We talked about having physical symptoms. You feel like your heart is beating. You have chest pain. People come to the E.R. thinking they are having a heart attack when they have a panic attack. Unless we as a society, the health system and insurance companies in their own territories really marry each other and say it is all health, we really cannot escape the stigma. As we said at the beginning, everyone has mental and physical health. And as the WHO says, there is no health without mental health. So we have to bring them together.
Gabe Howard: I totally agree with your assessment that the pandemic appears to be enhancing understanding of mental health because so many people are exactly in the same boat. You yourself suffer from fear of COVID. Therefore, they are less likely to judge someone who is suffering from anxiety. Even if a global pandemic doesn't cause fear, I don't know what's going to happen. For some reason, when someone says I'm concerned, our first question is why? And then we decide if that's a good reason, it's very unfair. Correct? This is not how fear works to determine if someone should be fearful for the reason they have given. Is that correct?
Jasleen Chhatwal, MD: You are exactly right, Gabe. Anxiety can only be judged with a person's barometer. I am not afraid of heights myself. I used to go skydiving but I have a friend. We went to the Grand Canyon together and they have a walkway on the Nevada side. And we went over it and she said, no, she didn't, she didn't. And I thought, oh, come on, let's go and now I'm trying to hold her hand. And she just couldn't. So I can't say that she is more fearful than me because it's not the same for everyone. In many other situations that I may be scared, she may not be worried. So the fear depends on your own context and on the lessons you have learned in life for things that scare you, on the stories you have, tell yourself. And it is usually from early life experience that you either had a negative experience of something so you are more afraid of it, or you have been told stories about that thing that make you more concerned. So there are all those components that fall into the care category. And then some people just have a little bit more sensitivity.
Jasleen Chhatwal, MD: And that becomes the natural element that is your genetics, like your amygdala, the fear center, like that is attuned. And some people just have a more sensitive amygdala. Your fear response is greater. And then we also know that negative experiences at a young age make your anxiety center react much faster or can be easily stimulated. So if you've had a lot of trauma in early life it's almost like your anxiety muscle is stronger so you can react much faster. This is an evolutionary mechanism for humans to protect themselves. So if we were hunters and gatherers, if we were roaming dangerous areas and spears were hunting us, then our fear of spears would have to be much greater to protect ourselves. And for your listeners who don't know what Speer is, you can google it. It is a wild animal. It's a wild boar that we have here in Arizona. This is really mine
Gabe Howard: Oh wow.
Jasleen Chhatwal, MD: Closest Context. They are mean looking creatures.
Gabe Howard: Dr. Chhatwal, I have one more question that is kind of ironic and that's why I saved it for the end. Der gesamte Inhalt rund um COVID-19 kann überwältigend sein. Es kann störend sein. Es kann schwierig sein, zuzuhören. Wie können unsere Zuhörer das Gleichgewicht halten, um mit den Informationen informiert zu bleiben, die sie benötigen, um wie dieser Podcast sicher zu sein, aber auch nicht von diesem Ansturm der Negativität überwältigt zu werden, der nur durch ständige COVID-19-Informationen hervorgerufen wird? Vieles davon ist beängstigend, ganz offen.
Jasleen Chhatwal, MD: Das ist es wirklich. Ich habe empfohlen und übe dies in meinem eigenen Leben, um eine Art Nachrichtenpause oder einen Nachrichtenurlaub zu machen und nicht mehr auf die Nachrichten zu hören. Denn wenn Leute zu Hause sitzen, hören sie manchmal nur den ganzen Tag die Nachrichtensender. Geben Sie sich also wirklich etwas Zeit, wenn Sie sich den Inhalt ansehen, den Sie sich ansehen möchten, und ihn dann weglegen. Schauen Sie sich auch Plattformen an, die diese Nachrichten möglicherweise in einem schmackhafteren Format präsentieren. Also vielleicht wie dein Podcast.
Jasleen Chhatwal, MD: Jeder kann sich auf Psych Central einstellen. Sie haben einen großartigen Sinn für Humor und versuchen, ihn zugänglich zu machen. Einige Leute hören sich die Late-Night-Comedy-Shows an, die Ihnen die Informationen geben, die Sie brauchen, aber mit einem Kichern. Sie können auch Nachrichtenagenturen abonnieren, die jetzt tägliche Newsletter haben, die sie Ihnen mit den Überschriften senden können. Vielleicht sagst du also, ich werde nicht alle Nachrichten lesen, sondern nur einen Newsletter erhalten und ihn mir einmal am Tag ansehen. Dies ist eine Möglichkeit, Ihre Belichtung nicht nur in der Menge, sondern auch nur in der Intensität zu reduzieren. Und dann ist es gut, es mit positiven Dingen auszugleichen, mit Dingen, die Ihnen Freude bereiten, mit Dingen, mit denen Sie sich in Ihrer Welt besser fühlen. Ich hoffe, Ihre Zuhörer werden etwas tun, um das Leben eines anderen aufzuwerten. Und das kann in der Form geschehen, dass ältere Nachbarn beim Einkaufen unterstützt werden und dass sie sich bei ihren ebenfalls gestressten Freunden melden. Eine Art Buchclub zu gründen, was auch immer Teil ihres eigenen Interesses ist, aber eine Möglichkeit, sich besser zu fühlen, denn wenn wir jemand anderem einen Wert geben, ist dies wirklich unsere beste Möglichkeit, uns etwas Positives zurückzugeben . Dies kann ein Weg sein, um in dieser Zeit mit mehr Freundlichkeit in unserer Welt voranzukommen und wirklich in der Lage zu sein, unsere Gemeinschaften auf eine gesündere Art und Weise wieder aufzubauen und in eine Richtung zu gehen, als Land, als menschliche Spezies, die uns alle aufnehmen wird eine positive Richtung mit den Lehren, die wir aus der Pandemie gezogen haben. Wir können diese Lektionen nicht verschwenden lassen. Das wäre eine Verschwendung eines ziemlich schrecklichen Zustands. Und normalerweise denke ich, wenn es Widrigkeiten gibt, möchten Sie versuchen, etwas aus diesen Widrigkeiten herauszuholen, eine Lektion zu lernen und eine gewisse Belastbarkeit aufzubauen, damit Sie in Zukunft mehr Fähigkeiten haben, um in Ihrem Leben voranzukommen.
Gabe Howard: Wir wollen den Silberstreifen in der Wolke finden.
Jasleen Chhatwal, MD: Auf jeden Fall ja.
Gabe Howard: Vielen Dank, dass Sie hier sind. Wo können Leute dich online finden?
Jasleen Chhatwal, MD: Ich bin auf LinkedIn präsent. Dies ist einer der Orte, an denen ich mich verbessern möchte. Ich bin auch auf Twitter. Ich habe Twitter noch nicht richtig verstanden, aber ich habe erst letzte Woche angefangen. Das ist mein Ziel für den nächsten Monat. Ich werde versuchen, das zu lernen. Und wenn einer Ihrer Zuhörer bei Twitter hervorragend ist, dann würde ich sagen, senden Sie mir bitte Tipps und ich werde Ihnen bei der Aufklärung über psychische Gesundheit helfen und Ihnen interessante Informationen über psychische Gesundheit senden.
Gabe Howard: Das klingt nach viel. Once again, thank you so much for being here. We really, really appreciate it.
Jasleen Chhatwal, MD: Thanks so much, Gabe, it was so wonderful to talk to you.
Gabe Howard: All right, everybody, my name is Gabe Howard and I’m the author of Mental Illness Is an Asshole, which is available on Amazon, or you can get signed copies for less money by going to my website at gabehoward.com. You can also subscribe to the show’s Facebook page just by going to PsychCentral.com/FBShow. Please remember to subscribe to the podcast. Share us on social media. Rate, rank and review. Use your words. Tell people why they should listen and remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere, simply by visiting BetterHelp.com/PsychCentral. We’ll see everybody next week.
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