COVID-19: Tips for maximizing psychological health during stressful times

All right. Hi, everyone.

My name is Amin Azam. I'm a psychiatrist by training at heart, a passionate educator.

I work at three San Francisco Bay Area Health Science Universities. And I also work at Osmosis today.

I want to spend some time talking with you all about COVID-19 and mental health during COVID-19. Um in case you're not aware, the San Francisco Bay area is currently under shelter in place, all nine counties.

And so I'm um streaming to you from my home and I wanted to think with you all about the role of taking care of your mental health um in this unprecedented global pandemic.

So uh let me mention a few things first and then I'll go to your questions. So as a psychiatrist, I've been working uh doing group psychotherapy for patients living with chronic medical conditions.

And uh that's been my clinical area of, of expertise, but I've been working with medical students uh for my entire career.

So what I wanna do is focus a few uh comments to um the general population, anybody who's sheltering in place or is uh managing social distancing.

Then I'm gonna talk for you all about how to sort of maintain your wellbeing as students and then we'll open it up to any questions anybody has.

So, um first of all, I wanna just acknowledge uh about the challenges of mental wellbeing during social distancing. So um different parts of the world are experiencing things differently right now.

But um at least uh where I live, we are being asked to maintain the 6 ft distance from anyone else uh to minimize the streaming of the virus.

And so I wanted to make a couple of points. First of all, remember that we are social creatures by definition because we're mammals.

And by that, I mean, we're not reptiles, we mammals like being connected, touching, feeling, being with each other. So let's not fight natural instincts at the same time.

Let's own that we are humans with uh intelligence and therefore, we um can know when we need to be our mammal selves while also uh maintaining social distance.

So number one, I want to encourage you all to maximize collaboration um while minimizing physical contact. What do I mean by that, think about the fact that any kind of uh work groups, you have collaborations used to be around physical spaces, cubicles or office, uh conference rooms and then enter the phone and then the fax and then the email and then the cell phone and then tweeting and slacking and video conferencing.

So we have all of these tools to maintain some social connectedness even if we're not physically in the same space and time.

So um with the value and power of video conferencing, we are, it's sufficiently high fidelity enough if you have enough bandwidth to be able to connect and feel like you're in the same space with people, good old telephone brings in vocal inflections as does uh video conferencing with nonverbal communication.

So wherever possible use those tools if you have access to them to maximize your sense of connectedness with other people.

Number three, I wanna invite you all to be attuned to your physical manifestations of stress. I know personally for me that when I get stressed, I get a lot of pain in my lower back.

And so I am trying more than ever to pay attention to my back and the signals from my back to tell me, hey, I mean, you're stressed and so what I have begun doing now is setting an alarm every day, sort of like a regular regular to say, hey, pay attention to your back.

How are you doing today? Do you need to do more stretching or more exercise?

So I'm just gonna, you know, I'm gonna stretch with you now because I can already feel it in my back. That is helping me with my lower back stress.

And so I ask, and invite you all to think about your own physical manifestations of stress and then um whatever you can do to reduce that or to make sure you take good, healthy care of your body will also help your brain.

So um of course, there's some things that you used to love to do that you can't do anymore. For example, some people love watching sports and a lot of professional sports in the United States have been canceled.

Well, let's think about next, next best alternative. So watching reruns of the NBA may seem crazy but if you found that watching NBA gave you some joy and watching reruns may not give you the same joy, but it may give you a lower dose of that joy, which is a nice offset from any of the other stresses that we're experiencing.

OK. The last point I wanna mention here uh on, on this particular one is that um uh we can still express love and caring through words uh without touch.

So, hugs are a great thing when we were not worried about um passing the virus along, but we wanna make sure we flatten that curve.

So we don't wanna hug. You can still express a virtual hug by telling somebody that you love and care for them.

And we do not spread the virus through our voices. And so that's a great sort of strategy to mitigate the effects of social distancing.

So we can still be social mammal creatures, even if we're not physically in the same space. And one way to do that is to make the implicit feelings explicit out into our brains.

Um That is gonna be ways that we're gonna help get through this as a community together. OK?

I think about some other things uh that might be useful to you. Um Frequently checking in with others.

Normally we check in with our friends with a variety of platforms or tools. Now that the stress level is higher, you should be increasing the frequency with which you check in with your loved ones.

So um we have many tools to communicate at afar. And so if you haven't called your mother for a while and you miss your mom, why not use this time to call your mom?

Um If uh if you haven't chatted with an all long ago friend that you miss now is a good chance to sort of up the dose of communication.

And what that does is when there is more stress, you feel the greater love or the great greater human connection. And so it again, we're offsetting the stress with some uh reduction in or some increased uh uh love and caring.

Um I also wanna take this time as a psychiatrist to acknowledge that we uh we, there's a lot of stigma associated with mental health or mental illness.

And this is a great opportunity for us to destigmatize it. We are all going through this together.

This is unprecedented. It is of course, logical and natural that you should be or you might be experiencing a higher degree of stress and psychological discomfort.

Um We are gonna learn together how to handle this, but mental health professionals have been doing this on a lower scale for people with psychological distress for a long time.

So it is actually a sign of strength, not a sign of weakness if you begin to reach out to people. And they say, hey, I'm really having a hard time here.

I'm really uh it's really frustrating and overwhelming. I will use a metaphor for you if you think about a crock or sorry, a a pressure cooker.

So pressure cookers for those of you that don't know, they have a little valve at the top and they let off steam. Little by little.

That pressure cooker is your skull. Your feelings are the steam inside it.

We cannot change the fire underneath. Those are the external stressors of the pandemic.

What we can change is how we communicate about the pandemic, what we say. And so if we talk to people, if we let off steam, little by little, it does not build up and explode inside our skulls.

So I want to encourage you to find those release mechanisms, whatever they are for you, you all knew them before the pandemic and use and do those things as much as possible.

Now, so talking about feelings is one way, seeking out mental health guidance from mental health professionals is absolutely another physical activity is a great thing.

Making sure you take care of your regular sleep is a great thing. Distractions are a great thing, minimizing how much uh binge streaming you're getting of news is a great thing.

Consider turning off all of those external sources of information for some protected times of uninterrupted me time or my mental health time.

So those are some practical tips. I'm gonna offer you now about um about making sure you take care of yourself.

If you are a health professional or if you are someone is in the caring professions, I'm gonna offer one last tip and then I'm gonna go to your questions.

The, if you've ever traveled on planes before, that sort of changes. Currently, uh, the oftentimes, the stewardess stewards will say if, if, uh, oxygen masks fall down and you're traveling with someone who needs assistance, be just sure to put on your mask first before you help others.

And I think for those of you in the caring professions who are caring for others, you must, must, must take care of yourself first so that you can continue to sustainably take care of others.

So it's not a selfish behavior to take care of yourself. It's actually a selfless behavior because that's how we can support one another, especially those of you who are in caring professions.

Ok? I'm gonna look to see if there's any questions you have.

Um, and, uh, um, see what ones I can answer for you. So I'm gonna look at the live chat to see if there's specific questions.

Let's see. What do you say if people keep inviting you to do things?

Ok. So I think it's important for us all to know the degree of activity that feels safe and appropriate both for us and for others.

So you need to be able to set some firm boundaries and say, I do not feel comfortable doing those activities and you can say why.

Uh but at least acknowledging that you do not feel comfortable, in fact that doing those activities will make you more uncomfortable by explicitly declaring that to the people who are inviting you that hopefully will help them understand why you're choosing to say no.

Uh Let's see what else. Uh How can we stay productive in studying during the quarantine time?

OK, great question. Well, so uh I am affiliated with osmosis.

I think it's important to acknowledge that osmosis is a tremendous resource. I personally think it's got a lot of resources for you to be productive as medical students or other health professional students because it's designed for remote asynchronous learning.

So watch those videos, do those question banks? Uh use the resources there um Design some of synchronous study groups with your classmates.

There's nothing that says you can't literally study together just like you used to if you had study groups in a classroom or in a library study together, but from afar, join your phones, join your videos and study in parallel, this would be some suggestion.

Ok. Um, uh I couldn't stay in all day.

Uh, someone asked about sort of going out to fill up gas and doing non essential stuff. Ok.

So I want to acknowledge that even in shelter in place here in the San Francisco Bay area, we are reminded that essential activities you are still allowed to do.

So, going out to see your healthcare providers is appropriate, going out to get gas and groceries is appropriate. These are things that humans need to do to survive in our modern society.

And so those are still being permitted. Um When you go out, you want to maintain social distance again, according to the local place that you are, what the recommendations are for us here.

Currently, it's a 6 ft distance from others. Um And so uh understand that you want to be following all the recommendations of your local public health authorities in terms of what is permitted and what isn't, but even in shelter in place, you're still allowed to go out and buy food.

We're not suggesting you run out of food and starve at home. Why is stress associated with pain in different regions, different people?

Ok. So good question.

So, um obviously, uh pain is a subjective experience, but we're doing a lot of research to understand the sources of pain and that pain in and of itself is a disease or, and is not merely a symptom of other diseases.

So, stress manifestations in different people's bodies occur in different ways, probably due to their own previous experiences in life or watching others around them and how stress is manifested.

So there's a lot of imprinting that will occur um uh in childhood as you're raised by whoever is um um adults around you and likely you see and carry forward stress in ways that you saw role modeled by adults around you.

Lots more research to learn about that. Most of us are having a real hard time studying how to improve your focus.

OK. So um I'm just gonna suggest that um those of you that have had times in your life when you've needed to focus, had strategies or tips you took to be able to study or you know, taking a driving test is another example.

So um you need to really focus on that. So think about what all the distractors are that are making it hard to study and throw them out of the room that you're in.

So turn off Twitter, turn off your cell phone just to minimize all the external distractors that you can. So therefore you are able to single task or focus on the task of studying even when you do all that, I know that it will be hard to study.

So I'm not suggesting it's gonna be super easy, snap your fingers. What I am suggesting however, is that you can maximize your power of effective studying by minimizing distractions.

And then think about the techniques that you use to help focus. Is that taking a couple of deep breaths?

Is that meditation? Is that a few um sit ups or something like that?

Um Think about the things that you know, that really center you and do those things as much as possible before you sit down to a dedicated period of studying.

OK. Um Let's look at some others.

Um My medical school suspending clinicals. OK.

So just today, I saw an email to all the faculty at all the US medical schools suggesting that in fact, they reco the Association of American Medical Colleges is re recommending that all medical schools suspend all clinicals.

Um uh And so that uh each medical school is gonna make the local decision for their students and their population given where the virus is and the penetration of the virus in that location.

And so again, I'm gonna employ you to follow the recommendations of your medical school leadership or your health professional school leadership about what to do and not to.

There is a lot of discussion on the Doctor Ed Lister of faculty at across uh global medical schools and other health professional schools around how can we create alternatives to in person clinical rotations?

So know that there's a lot of active discussion going on there around that. So that way we can try to provide you um the optimal second best things to actual patient care.

So, um so I think that we want to take advantage of those as your schools roll them out. So that way you're aware, uh that way you can continue to learn even if you're not learning in the care of real patients and in real clinical environments.

OK, understandably we have autonomy. So can we convince someone who doesn't respect quarantine advice and wants to go out?

OK. Thank you for that question.

That's a really great one. I'm glad you asked it.

This is one of those things where health professionals have chosen to go into health because you are by definition professionals in training if you're not yet graduated.

Uh But uh after you graduate from your program, there isn't something magical that suddenly says because you have initials after your name, now you are fully trained, you will be continuously training the rest of your life.

So even from the day you begin your health professional training, we are expecting you to be the professionals that we want you to be in the future.

What I mean by that is that I am asking you all as health professional students to role model, the highest levels of professional behavior.

And that highest level means that you are role modeling that we should for the public. Good, adhere to the quarantine or um shelter in place recommendations or whatever those are at your local institution.

And then we want to maximize the information the the spread of high quality information. So I will tell you at the end of this live chat, some of a website that osmosis has produced where we are producing high quality, reliable health information.

And I want you to share that with all of those people who are not respecting the recommendations of the public health community.

Well, we want to do is maximize high quality information. So we maximize knowledge about what needs to be done to maximally flatten that curve.

So um what you can do is role model for others that we are all in this together. It's not us anymore.

It's not what's good for me. It's really what's good for us and that's why we're all in this together.

So I encourage you to, to think about that. Um OK.

Um uh answering questions related to I'm gonna, I'm gonna focus on q uh questions related to mental health. I will let you know that we will have another, ask me anything coming up with Dr Rishi Desai who is a pediatric infectious diseases expert uh tomorrow.

And so I'll again, I'll, I'll go over that at the end of this too but know that we will have another uh several more. Ask me anything osmosis sponsored live um youtube stuff and you'll get some more of those uh questions answered about the virus transmission and about surfaces and about um distance and duration of infectivity and all of that is gonna come later we wanted to focus today's questions on your mental health and your wellbeing.

So uh how do you have any uh tips on how to avoid being so sad about canceled event trips? Ok.

Um yes, I do have some tips. So uh I think it is, it is an, is an adage that we wanna um hope for the best but plan for the worst.

And so in healthcare. So uh if, if a doctor is discussing with a patient, the possibility that something might be cancer, we together hope that it's not cancer but doctors are and other health professionals are planning for the possibility that it is.

And so one of the things that I think can help with uh let so apply that concept out now to, to uh physical and emo um not just physical but emotional health.

OK? I really hope that my wedding is not gonna get canceled in three weeks, but I'm gonna plan for the worst and suggest that it's possible that the quarantine and the shelter in place will extend longer than we want it to in service of keeping the um flattening the curve and keeping the pandemic at bay.

All right. So if I'm planning for that worst, how do I start planning with my loved ones about alternative, next best alternatives to that event?

So I know it sounds like Pollyannish of me to suggest that you can have a wedding online. Of course, you can't it's not the same thing.

Of course, you can't, but you can think about the most important elements of that that can be done remotely. So can you possibly have a video meeting where the most important people at that wedding be present the bride and the groom and the most important central core core people that you wanna have?

So it isn't the same. Of course, I'm not suggesting that, but can we at least think of ways where we can maintain quarantine and social distance and also maximize social uh connectedness.

Some of you may have already seen. There's some videos online already of the Italians that are playing uh on their balconies and singing to each other.

That is a beautiful example of maintaining human connectedness while also maintaining quarantine. So I want you to think creatively about ways that you can address the things that are frustrating and not the way you want them to be.

Uh So that way you can try to maximize your psychological wellbeing, even if that's not happening, the way you'd always want it.

The same is gonna be true about Match Day coming up this Friday. It's not gonna happen the way that everybody had wanted.

We need to maintain health of the public and that means health of our students and that means health of the events of the co of the um of Match Day.

So we wanna make sure that uh we think about ways to maximize social connectedness while minimizing physical touch. Some of the advice I give you at the beginning of this call.

So um how are you gonna share that news with your classmates when you can't be in the same room together? Google Doc, something like that allows everybody to concurrently type and share or obviously the the social media tools that we have will be good examples to do that.

OK. My question away from the vaccines to be given the green light early than usual.

Uh Rishi will answer that tomorrow. Um We need to make sure that they are safe before we administer them to the public.

Um OK. Uh if you are immunocompromised, OK.

So the people who are the most vulnerable to the sickest uh to become the sickest with Coronavirus are the the very old and those who are medically compromised.

And so those are the ones who need to be following those quarantine uh uh recommendations, the highest I run psychotherapy groups for patients living with chronic medical conditions.

So that's anybody with active symptoms. No cure starting last week.

Even before we had our shelter in place for my patient population, we moved to online video conference psychotherapy groups because it was too risky for them to be in person with me in a room.

So that is the kind of thing where I'm II, we want everyone to survive this pandemic and we need to take care of the sickest of the sick and those who are most vulnerable need to be doing the most possible to keep themselves safe.

So, um uh what are some good tips about uh stress? Uh I um I wanna uh invite you to, I, I'll just repeat what I said.

Um Know how stress manifests in your body, find things that uh that, you know, already give you joy. As long as they are things that are permissible with your local social um distancing regulations are things that you can maximize.

I'll give you a personal example. I love being out in nature with my family.

I can't go out in nature with my family as much as I used to before because of the current situation. But I can look right now at that window outside my house here and I can look at that tree and I can study those leaves.

I can step outside my front door. I can open my window, I can feel the natural air, I can feel the sunlight on my face.

It's not the same, it's a cheap substitute, but it is a substitute that I'm gonna be doing much more of as I shelter in place to make sure that I take good care of myself as well.

OK? Um In fact, we at osmosis will be offering some um mental health breaks.

Um And, and we're gonna do a guided meditation session and a yoga session. So, um those are definitely other ways where we are trying to build relaxation techniques as a global connected community, even if we're not physically in the same room.

OK. Uh A lot of friends are being irrational with their thoughts.

All right. Yeah.

Great question. All right.

So, um that's a tough one. under stress, humans are not at their best behavior logically.

And so um thinking about uh being forgiving of those that are being irrational um because I'm a medical educator and a psychiatrist, I'm a big believer that education is a, is a useful tool in mitigating some of the paranoia and distress.

So the more we know uh then the more that uh we share with our patients and our loved ones, the less stress and paranoid and distress they may experience.

And so, um and there are some good tips about how to do that. Um But again, the goal here is maximize information that is accurate and teach those others uh that um the things that are the truth about the virus and, and let's dispel the myths about the virus.

So, even again, in our own osmosis uh COVID website, I'll mention it at the end of this. Um You will see we've got a series of videos and resources in fact versus fiction about the virus.

So we're, we want you all to spread the word of what is actually correct and what is uh fake about uh the, the, the myths that are spreading, in fact, the misinformation in some ways is I think spreading more virally than the virus itself.

OK. Um All right.

Uh I really stop anxiety attacks. OK.

Right. OK.

So for those of you that are experiencing extreme distress and those kinds of anxiety attacks or panic attacks, this is where I think the value of local mental health professionals can really be helpful to you.

So I want you to take advantage of those local resources. And I also really think that turning off the news is a really smart idea because if you're not allowing all of those external distresses in to continue to escalate, um you can at least hold steady at the current baseline that you're in.

Um um uh So that would be a strong piece of advice, use your local mental health resources so that they can be there to support you and talk you through these situations.

Um And also when necessary, see mental health professionals uh for acute treatment. If you're feeling suicidal, you should use your local uh resources.

So, you know, 911 in the United States or uh suicide crisis hotlines um make sure that you reach out if you're worried about loved ones that you're worried might be feeling acutely suicidal.

I want you all to reach out to them and look for your local mental health resources because uh our, our goal is to prevent all preventable death and we wanna make sure that we prevent anybody who's feeling.

So psychologically distressed that they are feeling overwhelmed and and would consider taking their own life so important for me to remind you of that as well.

Ok, potential mental consequences of social distancing. So obviously, there's a lot uh to say about that.

Um mammals who are kept apart from one another suffer from a lot of both uh physiologic and um distress. We as humans know more about the mental health consequences to humans of social distancing.

So we wanna do everything we can to maximize social uh con connectedness while minimizing physical contact because that will mitigate or reduce the social distancing challenges.

I'll take time for one more question and then I'm gonna move to some sort of closing remarks. Uh What do you think about the education the police force uh received regarding mental health, I received crisis intervention.

I an all professional can intervene along with cops. Great question.

Um There are different degrees of mental health uh education provided to law enforcement in different jurisdictions. So that's true different by city, by county, by country, et cetera.

So the more that we can educate our law enforcement professionals about mental illness and about uh deescalating situations to ensure everyone's safety, the healthier everyone will be that's not just the individual suffering from acute psychological distress or acute mental health symptoms, but also the law enforcement individuals and the community around them.

So I am a big, big fan of maximal um education to law enforcement professionals about mental health, about treatment and about uh deescalating situations.

I'm gonna stop with my live answer questions there, but I'm gonna do some uh uh closing remarks first before I wrap up. I want a special shout out to the medical students who are in the midst of match week.

I already hinted at that this is a major event in your lives and I am super excited for you all for Friday and wishing uh your um the the results that you're hoping for.

Um I want to invite you to share your Match Day celebrations as much as possible. So, uh osmosis is here to help that sharing.

We have some uh tag us on social media and we'll be happy to share. Shout it out from the mountaintops as much as possible.

I still remember my own Match Day and that was over 40 not, not that long, over 30 years ago. Uh So it's a very monumental day in your lives and even in the midst of a global pandemic, uh let's celebrate with you.

Second, uh osmosis is continuing to build the other, these kinds of events. So tomorrow at 12 p.m.

Pacific, we will be offering a guided meditation uh live youtube event on uh tomorrow at 3 p.m. Pacific.

Uh Another, ask me anything in this case, as I said, it's with Rishi Josai. Uh who's gonna answer any question about COVID-19?

And uh some of the questions I chose to defer today. Um We will also have a yoga session on Saturday, March 20 whatever that is first um at 9 a.m.

Pacific. So that way you can continue with your physical health as well.

So I mentioned our COVID-19 osmosis website. I'm gonna uh we have video recordings for high quality health information and uh fact versus myth about osmos.

I mean, excuse me about COVID-19. That website is osmosis.org/covid-19.

We will continue to build more resources at that website as we develop them. And I just want you to know that if you think about, for those who didn know osmosis about our core values as a company, one of them.

And I think this is just so fundamentally 22 of them, I'll just stay with two and then I'll close it. Number one, start with the heart, that's what we're doing.

Uh The whole osmosis team is doing it. And number two, we've got your backs.

Um So we really want to be here for you, reach out to us, be there for each other as a global community. We will get through this global pandemic as long as we mammalian maximize social connectedness uh in the context of minimizing social distance.

OK. Thank you all very much and be safe out