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Trying Times

A Medical College psychologist offers insights on coping during COVID

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John Abbott

Susan Evans ’74, a clinical psychologist who specializes in the treatment of anxiety and mood disorders, has been on the faculty at Weill Cornell Medicine for more than a quarter-century. An alumna of Cornell’s undergraduate nursing program (which closed in 1979), she holds a master’s in education from Columbia and a doctorate from the New School for Social Research. With many in the U.S. and around the world under enormous stress—emotionally, physically, and in some cases financially—as the pandemic stretches to a year and beyond, CAM tapped Evans (right) for some expert insight and practical advice on how to cope.

How big a problem is “pandemic fatigue”—feeling exhausted, exasperated, and/or despondent about how COVID has impacted our lives?

I think it’s fairly prevalent; in my own experience—hearing from my patients, students I work with, peers, faculty, family, friends—a lot of people are talking about it. You mentioned some of the symptoms, but I think it’s a mix of emotions that also includes boredom, loneliness, and feelings of anger and anxiety. I received so many e-mails around the end of last year and beginning of this year: “Thank God 2020 is over! It’s so great that 2021 is here!” But COVID is raging and we’re still socially isolating, and in a lot of the country it’s cold and we have to stay inside. In some ways, not a lot has changed from December 31st, although of course there’s great news on the vaccine. We’re still dealing with a tremendous amount of uncertainty and uncontrollability. People are not sure how long this is going to go on, when they or their loved ones will get the vaccine, what life is going to be like post-COVID. That combination can be incredibly anxiety-producing and stress-inducing.

How can we best deal with it?

What I’ve been telling people—and what I’m trying to do myself—is that practicing mindfulness can be enormously helpful. It’s a cliché, but take each day at a time, keep your focus on the present moment, and resist the tendency to ruminate about where things will be one or five months from now. The other thing is it’s important to understand how we’re thinking about things. Some people say, “This is going on forever, I can’t stand it anymore, my life has been put on hold and I’ll never get it back,” versus, “What are some things that I can do? What are some areas in my life that I can control right now?” I know this is easier said than done, but your perspective can have a huge effect on how you feel and how you manage the continuing pandemic.

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One common complaint is that COVID has robbed people of the ability to plan and look forward to things like trips and get-togethers. Is there a way to reframe this to promote a more positive attitude?

That’s a challenge. Some of the things that bolster our ability to buffer stress are not available, or at least it seems that they aren’t. Personally, I used to go to the gym every day; it was a big part of my life. And my husband and I love to travel. We enjoy planning trips, taking them, and reliving them—and all of a sudden that’s gone. A lot of people are feeling this way, and it’s a reality; in some ways, if we didn’t feel like this it would be strange. The way to reframe it is, “It’s true, I can’t go to the gym; I missed out on all those trips last year and I don’t know when I’m going to be able to take another. But I’m pivoting and shifting.” I started Zoom yoga classes; it’s not great, but it’s better than nothing. I do Zoom get-togethers with friends, and my adult children do Zoom gaming with their friends. And even though there has been such hardship and devastation, sometimes there are silver linings. I ended up connecting with a friend who lives in California; I have a Zoom call with her every two weeks. Before the pandemic, I’d only see her once a year when she came to the East Coast. So I encourage people to brainstorm: rather than focus on the things you can’t do, be creative and spend an hour thinking of things you can do.

What’s your advice for dealing with friends or relatives who have different attitudes about COVID safety?

That’s a difficult, complicated question. One guideline that may be helpful is to focus on how you feel about this and what you want. That is going to require assertiveness, and it can be uncomfortable. But if you stick with your practices no matter who it is—family, parents, grandparents, grandchildren, your own children—you’re giving a consistent response. I know this is hard; people worry about, “What if I hurt their feelings?” or “I don’t want my kid to feel left out.” There are a lot of thoughts that get in the way of asserting ourselves.

The media has noted a “second pandemic” of mental health and substance abuse issues during COVID. Is that so, and how can people get help?

The U.S. Census Bureau tracks mood and anxiety symptoms, and I’ve been struck by the percentage of people reporting things like muscle tension, being on edge or feeling irritable, or depressive symptoms of feeling sad and down. So it’s highly prevalent. And I’ve also heard about an increase in substance abuse as a result of isolation and working remotely. It’s critical that we address it, and that people be aware that there is access to help in terms of twelve-step programs. Some people actually have more access to them now, in that they can remotely attend a meeting anywhere in the country. And there’s teletherapy, which is booming. Since March I’ve been seeing all my patients via Zoom; there are limitations, but the vast majority of my patients like it because it’s accessible and doesn’t require traveling.

What advice do you have for parents whose children are not doing well socially or emotionally due to remote schooling and restrictions on activities?

There are so many challenges. A lot of parents are working from home and also trying to supervise their kids’ remote learning; teenagers have more independence, but younger kids need assistance. One thing that helps is setting up a clear structure and routine—scheduling fun activities, achievement-oriented activities, remote yoga or dance classes, and also social activities via Zoom or masked playdates outdoors. Parents can work with the school to optimize remote learning, and they should be assertive to get educational accommodations if their kids need them. Another thing that’s enormously helpful is validating their child’s emotions and frustrations—listening to them, being open, giving them space to vent. And if there are real symptoms of anxiety and depression that parents are concerned about, it’s important to avail themselves of services like teletherapy.

With so many people working remotely and getting their entertainment at home, screen time has gone through the roof. What’s your advice for best practices?

This was a problem way before the pandemic, that children and adults are spending an inordinate amount of time on screens. It’s mind-boggling how many texts kids send a day, and I’m sure it’s gotten a lot worse. In general, be aware of your screen time—a lot of devices now track usage—and balance that out. Come up with an amount of time that seems reasonable and try to stick to it. Screen time can be like a rabbit hole, and it takes away from other meaningful and pleasurable activities you could be engaging in, including things like exercise and meditation. On the other hand, screens are helping us in terms of being able to exercise and have social hours remotely. So the main thing is to be judicious and aware of how you’re using it and what effect it’s having on your psychological wellbeing.

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People who live alone are coping with isolation, while others in crowded households are suffering from a lack of privacy; might you have advice for each of them?

Both situations can be very stressful. If you’re living alone, it requires creativity in how you manage the loneliness and isolation, and the same goes for how you manage feeling overwhelmed if you’re living on top of each other. Let’s say you have two kids and a partner; coordinate a way that you can carve out time for yourself, even if it’s just half an hour, and then your partner can have their time. If you’re living alone, do everything you can to stay connected socially and emotionally. Yes, there are real losses in terms of the tactile experience of hugging someone. It’s tough, because as humans we’re geared toward that, but we can’t do it right now.

Some people are fortunate to be employed, have stable housing, and otherwise be fairly unscathed—and they may feel guilty about being relatively OK while others are suffering more acutely. What perspective do you have for them?

This is a common reaction; I just heard it today from someone, these feelings of guilt that they are rather unscathed, and at the same time are touched by the devastation of families who’ve lost members to COVID. The way to think about it is: it’s good to be grateful—in psychology, we often recommend practicing gratitude as a way to promote wellbeing—but don’t put that guilty twist on it. You can acknowledge the things you’re grateful for and also have the recognition, empathy, and sadness that other people have suffered tremendously. Both things are going on; it’s not an either/or.

For months, many people looked forward to a vaccine as the light at the end of the tunnel—but the rollout has been problematic. How can we temper our impatience?

Working on perspective will also be helpful here. Yes, it’s frustrating. There was a myth that 2021 was going to come around and everything would be great—but in fact, this is going to be a long haul. It’s not over, and we’ve got many months of this ahead of us. So reframe your perspective to say, “This is uncertain, I don’t know when I’m going to get the vaccine; let me try to practice staying present and patient that this is where things stand now.” Try to focus on the present moment and let go of the obsession and rumination about what’s next, or the perspective that it’s not fair. Again, I recognize that this is easier said than done. These are practices—skills that we encourage people to use—and it takes a little work to get there.

Hundreds of thousands of Americans have died from COVID, in addition to deaths from other causes—but our grieving rituals have been disrupted. How can we process grief under these circumstances?

It’s another very challenging situation. The fact that so many people were not able to see their family members in the hospital when they were dying and had to have a nurse hold up an iPad to say goodbye to their loved one—it’s beyond devastating. But people have made amazing adaptations to allow for grieving. There are Zoom funerals, online memorials, these remote processes that people are using to connect with friends and family. It’s challenging, but they’re doing it.

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It’s cold and wintry in much of the U.S., a time that many people already find difficult and depressing. How can we best combat the seasonal blues now?

Some of the things we might do in the winter to bolster our mood, like going to a movie or museum—things that get us out of the house—are not available. So we have to make an effort to go outside and get some natural light if we’re able to; if you have a lunch break, take a walk for half an hour. There’s a tendency with seasonal affective disorder to crave carbohydrates, which can also have a negative effect on mood, so pay attention to your diet. And there are a lot of published scientific studies of light therapy, so a light box [a device that simulates sunlight] can be enormously helpful.

By way of perspective, is there anything to which you can equate the current situation in terms of how it’s affecting people?

It’s certainly unprecedented in my lifetime, that’s for sure—and I think it is for a lot of people. I’ve heard this compared to war, for example World War II, and I’d imagine there are certain similarities. One is that the war went on for a long time, and there was uncertainty—people didn’t know how it was going to turn out, what was going to happen next, when it was going to end, whether they were going to see their loved ones again. That’s what we’re living with right now—both uncertainty and a feeling of not being able to control the circumstances.

After the pandemic is over, do you anticipate that there will be aftereffects like mental, emotional, or child-development issues?

For the most part, people are incredibly resilient. I think the vast majority, including children, will go back to their baseline sense of mental wellbeing, but there will also be people who have lingering effects. They may vary in degree, from some having anxiety and depressive symptoms to full-blown substance abuse disorders or major depression, and we’ll need to get them help.

On top of the pandemic, we’ve been inundated with headlines about political violence and a divided nation. What’s your advice for keeping spirits up when it feels like we’re getting hit on all fronts?

Well we are, and that’s a fact. I think it’s important to pay attention to what news you’re consuming and how much, because it can add to the stress of a difficult situation. What each of us can do is take an inventory of the things that bolster us, nurture us, and contribute to our sense of wellbeing—and also the things that detract from it. You want to really pay attention, be aware, and get in touch with what nurtures your soul.

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