UCalgary podcasts feature interviews with experts from our community on the COVID-19 situation.

Episode 16: Mental wellness

May 1, 2020

While we stay home to slow the spread of the illness COVID-19, we're also exposing ourselves to other health issues that can stem from isolation, like anxiety and depression. In this episode we talk to renowned psychologist Dr. Keith Dobson about staying mentally well during the pandemic, ways to tell if something isn't right, and strategies for support if people aren't doing well.




Dr. Keith Dobson (KD): If you find, for example, that your daytime routine has started to become severely disturbed, so you find that you just can't wake up and get up in the morning for example, or you find that you are napping during the afternoon when you wouldn't normally do that. Again, signs that your regular routines are starting to fall off would again be a worrying sign.


Nuvyn Peters (NP): That was Keith Dobson, professor of Clinical Psychology at the University of Calgary. And this is UCalgary COVIDcast. I'm Nuvyn Peters.


Corey Hogan (CH): And I'm Corey Hogan. In this time of physical distancing and self-isolation, people are at real risk of developing or worsening mental health issues. A lot of the conditions of coronavirus prevention are also the conditions that can lead to things like anxiety and depression. Isolation, stress at home or work, fear of infection or of not having enough supplies are weighing heavily on people's minds. So how do we take care of ourselves mentally?


NP: For this episode of COVIDcast, we talked to Dr. Keith Dobson, PhD, a professor in our Department of Psychology. Keith leads UCalgary’s Depression Research Laboratory and is a consultant to the Mental Health Commission of Canada. He has conducted extensive research in the areas of clinical psychology, cognitive behaviour therapy, depression and psychopathology. He sat down with UCalgary COVIDcast to talk about the signs and indicators of mental health problems, what people can do to take cares of themselves and stay connected, and how isolation can take a heavy toll on us all.


CH: Well it's certainly something that I've been thinking about a lot as this dragged into, gone from weeks to months, is just how much it rattles the cage. How much you start thinking about the effect of all this on your mind as you go forward.


NP: And certainly there's the physical aspect of not being able to go anywhere and to maintain connection through digitals tools like Zoom and Facetime. But then there's also I think this overlying fear and anxiety about the future. And that plays out as well in our daily interactions with each other and that lack of physical contact.


CH: Yes, no question. In these very limited instances where you have to connect with somebody, you have to stay two metres apart. You don't shake their hand. You exchange smiles and nothing else. And it's tough.


NP: It's a very odd dynamic. And I think as parents, we can't help but wonder about the impact on our children and their sense of belonging and connection with others as well.


CH: Yeah. I just moved down from Edmonton, and my son, who is three, really can't separate the two. He used to have friends in Edmonton, now he's isolated at home in Calgary. And it's tough.


NP: Well, my conversation with Dr. Dobson touched upon all of these intricacies and dynamics so without further ado, let's turn it over to Keith. So thanks so much for joining me today, Keith. I want to first ask you about how we can cope during this time of social distancing?


KD: Yeah, I think this is turning out to be one of the greatest challenges during this time of the COVID-19 pandemic because humans of course are social animals. We want to be with other people. Even in the work setting we often go seek out other people and spend a lot of time trying to understand what other people are thinking and doing. It's a huge challenge. I think in terms of the big issues, obviously it's keeping contact. I think that's the hard part. We need to maintain social distance, but it doesn't mean we need to be actually separated from each other. I have a number of ideas for things to do for example. Media of course, like we're doing today is one of the main ways to keep in contact. We're fortunate, I think living in today's time because we have so many different kind of technological ways to keep in contact from telephone through all of the various face technologies, audio, video technologies. We're really fortunate in that regard. Again, I would encourage people to pick their favorite tool and rely on it, use it as much as they can.


NP: Yeah. Staying connected during this time of social distancing. Although I've heard that people are now calling it physical distancing rather than social, so that people still feel like they've been given permission to stay socially connected to people.


KD: Yeah. I think that's a great distinction because the truth is that even though we're not supposed to be within two metres of each other, we can certainly communicate in lots of different ways.


NP: Yeah. It's hard to navigate feeling those feelings of isolation and disconnect when you can't just run to the coffee shop to connect with other people. Or for many of us go into the office. In addition to staying in touch virtually and availing ourselves of all of the technological tools we have, what are other ways that people can ensure that they're staying in touch with each other and well connected to their own mental health and livelihood?


KD: Yeah. Mental health is a whole other issue. I think in terms of the things that we can do to protect ourselves and stay as healthy as possible. And I guess part of it depends for me on whether or not you're living alone or if you're living with other people. Because certainly if you live with other people you have lots of opportunity for social contact and you can play games together. Of course you can do joint communication with other people at remote areas. You can have a FaceTime together as a group. Last night in our family, we actually played games with people here in Calgary where I live and also in Vancouver area. We played it together even though we were all in different areas. That's possible.


NP: Oh, that's a great idea.


KD: I think getting outside is important for people to maintain their own mental health. And again, if you're living with somebody, you can go for a walk with somebody else. If certainly if you meet somebody on the street and you should maintain your social distance, but it doesn't mean you don't have to speak to them or say hi. I've been struck again when I've been outside how many people are smiling and saying hello now that might not have before this event.


NP: Yeah. What should people be watching for? To check in with themself, to say, "Am I doing okay through this?" What are some things that people should notice?


KD: Well, there's a whole bunch of things I think that we can look at. And in fact the Mental Health Commission of Canada has some information on its website about signs and indicators of potential slipping mental health. I've done some work for them and we think about mental health on a kind of a continuum. We use a color coding system, green, yellow, orange, and red to signify different levels. But within these different levels, you can think about different signs and indicators. These include things like your mood. If you find that your mood is starting to shift away from being happy or normally sort of okay, to being more sad, melancholy, anxious, worried. To some extent these are normal reactions to this time. But again, if you find that you're staying there or that it becomes non productive, then this may be a sign that you want to do something. Your thoughts certainly is something you can pay attention to. Again, it's not surprising or not unusual I think at this kind of a time that there's going to be more worry and more concerne about what's happening both with yourself and with your loved ones and your work situation and the world in general. Again, to some extent this is normal and again, we shouldn't be too distressed about it, but if it stays or if you find that you can't put these thoughts out of mind, then that's a sign again that you might want to take some action. Your activities, again, if you find that you are shifting your activities, if you're living at home now for example, and you have to do things differently, that makes perfect sense. However, if you find, for example, that your daytime routine has started to become severely disturbed, so you find that you just can't wake up and get up in the morning for example, or you find that you are napping during the afternoon when you wouldn't normally do that. Again, signs that your regular routines are starting to fall off would again be a worrying sign. Generally I would say look at all the signs and indicators that again, you might be doing okay or you might be struggling and especially if it's a change from your regular routine or your regular way of being, this is a sign that you might want to pay attention.


NP: Right. And I imagine that these are signs that we could, we as friends and colleagues could look for in each other.


KD: Yes. Yeah. And of course this is more difficult to do at a distance. But certainly again, this is partly why I think having a video connection is probably better than just audio. Because in audio of course you can hide the fact that you're sitting in your pajamas in the middle of the afternoon, for example. But that's harder to do in video contact.


NP: Yeah, for sure. I was going to say, what's wrong with that? I'm sure many of us are welcoming to stay in our pajamas in the middle of the afternoon.


KD: And like I say, I think some changes are normal and natural, but again, if you find that this becomes the new normal, then that could be a sign. Again, from a psychology perspective, I think what we would recommend is that as much as you can, you should try to keep your routines normal. You should get up in the morning, have a shower, if that's what you do, or have a shower in the evening, eat your breakfast, try to start your day pretty much normal as much as you can again, and sort of watch what you're doing and how things are changing.


NP: Right. Yeah. I want to further explore this concept of keeping your routines. Many people are now working from home. Many people have children at home so they are trying to navigate both working with, in my case, having three children at various points throughout the day come running in needing something. There's naturally just elevated stress and anxiety I think, and worry and concern in everybody's households. What's your advice for managing that?


KD: Oh, that's a great question. We actually have the same issue going on here where I live and so it is difficult because there are multiple kinds of demands on people's time. And again, you want to stay productive and you want to be responsible to your employer. Again, if you're working from home, but you have to pay attention to your children. And especially if the children are younger, they don't really understand what's going on. They know that it's not school time but they don't really understand all of the implications of the COVID-19 outbreak. I think what you want to do is balance your time as best you can. If you have a partner or somebody who can support you to share the load, so that one of you can take the time to work and the other can take time with the children. This may be one maybe to manage it. Trying to figure out ways that the children can be engaged in things that are healthy. Again, so I wouldn't recommend just putting them in front of the television, for example, but looking for activities that they can do. I think we're still waiting for the school boards to respond fully and to provide instruction to parents about what kind of activities can be done at home. But there were educational programs on television. There's educational books to read. This is children and again, the ones that are here, they have some sense of their curriculum and so again, as much as you can, trying to encourage them in that direction, I think, those are all positive steps.


NP: Yeah, we've done a number of podcasts already around, surprise! You're homeschooling! And also on tips for parents and for children to help navigate these next few months. Ensuring that there's a good balance between screen time and active learning and play as well.


KD: Exactly. And going outside. Again, I think children are certainly welcome to go outside as long as they're not having contact with other people. One of the nice things of course is spring is not too far away, hopefully. And so as the weather gets better, we'll be able to spend more time outside.


NP: Yeah. For people, I want to get back to navigating some of the mental health challenges. For people that perhaps struggle with depression or anxiety and worry, both the economic impact of this pandemic as well as the public health impact is going to be quite dramatic. What advice do you have for people who struggle with mental health and wellness already?


KD: Yeah, so there are a whole bunch of questions embedded in there, but I'll just talk about, the mental health challenge. We know from the literature in the area of depression that there are certain risk factors and certain ways to respond to these risk factors. One of the big risk factors for depression is social isolation. There's actually good literature that even in good times when people become depressed, they tend to avoid or pull away. And by pulling away paradoxically, it actually runs the risk of increasing the sense of depression. There is an evidence based therapy called behavioral activation treatment or behavioral activation therapy. And the focus of it is basically just increasing activities of various types. Two main types that we focus on, one is activities that lead to a sense of accomplishment or completion. Doing things that you feel good about. That could be work or that could be some kind of activity or hobby that you wanted to work on and you can get a sense of accomplishment from. And the other activities that you feel pleasure from. And pleasure could take lots of different forms. It could take the form of social contact, it could take the form of a relaxation, it could be the form of physical activity. Again, it could take a whole wide range but something in that area. I would recommend for people that are struggling with depression that they purposely set up a list of daily activities that they want to engage in. In fact, one idea might be to pick two of each type. Two activities that are related to productivity, two that are related to fun or pleasure. One maybe that's a little bit easier to accomplish and one that maybe is a bit more challenging so that you can move in that direction. The other thing we do in the treatment of depression in terms of activities is we often start with smaller activities and then as the person's depression lifts or begins to lift, we then try to increase the intensity or the importance of the activities, how challenging they are. This is a difficult one though. And especially when we have limited routines and limited ability to move around, it's even harder of course, to do activities.


NP: For sure. And I've certainly seen online a lot of people that are creating different communities, whether it's on Facebook or other platforms to encourage a community connection. And that's been the sense of community that comes out of crisis is often an interesting phenomenon as well.


KD: It is absolutely. And that's been reported in lots of different times when there are crises, in times of war, for example, communities come together.


NP: If someone's struggling with their mental health through this, how can they raise their hand in this environment and say, "I need help?"


KD: Well, I know in the psychological community, which I'm part of, there are a lot of people that are developing or promoting electronic therapies. Access through various kinds of technologies, again phone or other methods. Trying to preserve confidentiality and respecting the nature of the process. But there are a lot of services that are doing that kind of work. The Alberta Health Services, again, for people that are in the Calgary region certainly is up and running. You can call and get services there, so that's certainly possible. You can reach out again, if you're employed, your employee assistance program is still going to be up and running so you can reach out to that number. All of those resources continue.


NP: Yeah, I think it's probably prudent for all of us to ensure that we're keeping from, a general checks on not only ourselves but on our families and our friends as well too. Not knowing how this crisis is impacting everybody, but I imagine that it's quite profound.


KD: Oh, absolutely. In fact, I just saw an article that was published in a journal Lancet. It was just published last week on the psychological impact of quarantines. And they say there are five stressors that are sort of recognized in the literature for quarantine or self isolation times. And these are are affected by the fear of infection, not surprisingly. The frustration and boredom that can come along with being self isolated. We've been talking about increasing activity or maintaining activities. The duration, so the longer period of quarantine or self isolation continues, the more stressful it likely becomes. Concern about supplies, so simply things like the food chain and making sure that resources are available. And the quality of information, so here I actually have to give a bit of a tip of the hat to I think our public health agency of Canada and the government because I think they've been doing a great job giving us good information.


NP: Absolutely. I want to pivot for a moment and ask about how anxiety or depression during this time manifests itself in children and whether that's different than how it might manifest itself in adults and as parents, what should we be aware of?


KD: Yeah, yeah. The main thing that we know different between adults and children of course, is that children may not have the language or the ability to express themselves in the same way. Many of the signs and symptoms are the same. We look for things like avoidance. We look for things like crying or simply becoming quiet for example. These are signs of anxiety and depression. But children may not have the language ability to talk about their feelings or to be able to name what their thoughts are. That's the big difference. I think as a parent again, what you'd want to do is look for signs like being quiet, becoming isolated, wanting to spend time by yourself or by themselves, the child. Crying again would be a good clue. Obviously that something is distressing, so we can do it. It's going to vary somewhat on the child, but the signs and symptoms are much the same as we look for in adults.


NP: Right. And as parents, I think managing our own levels of anxiety and stress around our children is probably pretty key as well too.


KD: Absolutely. One of the things I think, and again I've said this in some other interviews is, as parents we need to recognize that children again don't understand things the same way that adults do. They don't have the world view and sort of the longterm vision and the perspective that this is going to pass soon. For a child, something passing soon might be a matter of hours or even minutes in some cases. Whereas, adults can take a longer term view of things. What we need to do is, think about the child and think about his or her ability to understand what we're saying and try to give the message at a level that it can be received because if the child is distressed or if they don't have, again, longterm vision you need to more provide support in the short term. Let them know that you're with them and that you're going to take care of them. And that as long as this happens, you'll be there for them. That's probably the most important message.


NP: Yeah, well that's an important message for all of us to hear as well too. That we are in this together and I think, developing supportive, caring communities is probably the one silver lining of this crisis.


KD: I have to say too, that my perception is always that humans are amazingly resilient. Having worked with people who've had what I would describe as horrific childhoods, having been the victim of different kinds of childhood adversity, people often are able to rise above and to chart a course that they want to move towards. Again, I think the resilience of humans is something we can't overlook.


NP: And in that mindset as well too, what contributes to those aspects of resiliency?


KD: Well, that's a bit of a paradox because you can't know that somebody is resilient unless you actually face adversity. Here we are, we're in the face of a huge adversity, which again, we don't know all of the details. We don't know how long it will last or how severe it's going to become. But again, in a sense it's an opportunity if you want to think about it like that, for us to prove how resilient we are and how well we can get through difficult times.


NP: Right. And I imagine getting back to your very helpful suggestions around having a sense of accomplishment or pleasure as well too gets into that goal setting. Setting small, achievable things that you want to do today is probably really critical to help navigate all of those feelings and emotions that you're going through.


KD: Yeah, yeah. I think that's critical. And again, I think we need to set appropriate goals. Obviously we're not going to learn a language necessarily in the next week, but we can start to pursue the interests that we have. Make a nice meal for example, or do something smaller that we can manage in the time we have.


NP: Yeah. Well this has been very helpful suggestions, Keith. I'm so grateful for your time and your advice and your participation on this podcast.


KD: Well thank you. And if I can just have one last thing. I just going to say from the same article I was talking about, about the psychological impact of quarantine. They actually identify from the literature two strong stressors after the quarantine ends that affect people's judgment in how they were doing. One of these is finances. Again, the bigger the financial impact we can expect, people are going to have more stressful outcomes. We know that a lot of people unfortunately have either been temporarily laid off or in some cases businesses are going to fail. Especially for people who are lower income or people who are fighting financial stress, we can expect that there's going to be some longer term impacts. In this sense, again, it's great that the governments are stepping up and creating some short term relief packages, but we're going to have to be careful I think to watch how the economy returns. And then the other, and then the other that they tag in this article, and it's the last one is actually about stigma and social rejection. They actually identify that people who've been affected, so most of the other research has been done for other viruses and other outbreaks. But what they say is that people who've been affected sometimes actually continue to face stigma and social rejection even after the acute infection goes over or passes. That's going to be very interesting to watch to see whether or not people who have actually suffered COVID-19, have longterm stigma or social rejection associated with it. Hopefully not. Again, hopefully the science will improve and we'll know more about the longterm impact of having been infected. But that's an interesting one from the literature.


NP: Yeah, those are interesting. Two very interesting dynamics that we will have to watch collectively very closely as we start to emerge into this new reality. That this concept of uncertainty and the unknown can be quite overwhelming.


KD: Absolutely.


NP: Well, thank you for joining me today, Keith. And it was wonderful to connect with you.


KD: My pleasure. Thank you. And thank you for doing these podcasts for people.


CH: Thanks to Keith for taking the time to chat with us today. And thanks to all of you for listening. You can subscribe to COVIDcast on Apple, Google, or Spotify. You can also find episodes and other community resources, including webinars and expert advice, at Ideas for future episodes can be emailed to COVIDcast is a production of the University of Calgary. Thanks for listening.


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