Welcome to the Call to Flourish podcast.
My name is Thomas Kronquist, and I'm your host today.
Our guest is Doctor.
Helena Orianna, the director of the Institute for the Psychological Sciences Clinic at Divine Nurse University.
And she will talk to us today about mental health during the pandemic.
Doctor.
Orianna, how are you doing today?
I'm doing well.
Thanks for having me.
How are you doing?
Well, very well.
Thank you for being our guest.
My pleasure.
Can you tell us a little bit about your background and how you came to be the director of the clinic here?
Sure.
I am a graduate of the Institute for Psychological Sciences as a clinical psychologist.
My background is, practicing as a generalist, with a specialty and focus in trauma, working with adults who have survived trauma.
And I ended up coming back to the center for my passion for training.
It's kind of really enjoy clinical work and working with patients, but I also really enjoy the training process and the forming of young clinicians.
And that's exactly what we do here at the center.
We serve our local population offering, affordable therapy for those in the area who might not be able to access care otherwise.
And part of how we do that is our clinicians are trainees.
They're students in our doctoral program who are working under supervision to learn the art of therapy and to contribute to the healing of those under their care.
That sounds great.
Can you explain a little bit how the pandemic or COVID nineteen pandemic has impacted mental health?
What type of problems has it caused?
What's what what has it changed as far as the, practice of, mental health?
This is really like one of the big questions of our time right now.
I think a lot of us are really wondering, and we may not know for several years how to answer that question.
I think it's we're in the middle of it.
So in understanding what the ramifications of the disease itself on those who have lost loved ones, of those who have been ill or been ill for a long period of time, as well as just the impact of all the changes and restrictions and openings and decisions that have been made.
I think it's pretty obvious to say, but there certainly has been a significant impact on everyone who's, who, whose life has just been changed and curtailed by this pandemic.
What we're seeing at our clinic and what I see in my own clinical work is significant stress and the impact of isolation.
We're talking the pandemic, if anything, has been a chronic unpredictable state of stress.
And we've already know, you know, we've never really faced something like this and been able to kind of study it the way that we can now.
But we know that chronic stress has a real impact on our bodies, on our emotions, on our thoughts.
And I think that's part of what we see.
We see a chronically stressed population.
Right.
I think we can all see that.
We know people who have been ill, people who, somebody in their family has been ill and how it affects how it affects them.
One of the things I was thinking about as you were talking is, I know the clinic for a while was doing telemed where somebody, if they wanted therapy or they're getting therapy, they couldn't come in and see their, their health care provider, and they would have to do it virtually.
How does that change things?
How's that change the process, the healing process?
Yeah.
You're absolutely right.
We're actually only offering telehealth services right now, and we hope to maybe reopen for a hybrid model in the future.
I think that it has pros and cons, right?
Telemedicine and the amazing transition that we've done in this field, but in other fields of switching over to zoom and to other platforms has allowed us to maintain care Even when we couldn't meet with somebody.
And that's been a tremendous resource for people to be able to continue meeting with a therapist as opposed to feeling cut off from that resource.
So in many ways, it's been a huge blessing.
And there is good research even before the pandemic that shows that telehealth is effective.
And, and I think we're still seeing that now.
I see that with my own patients and I see that with the clients that we work with at the clinic, that people are still able to engage and get what they need from therapy.
Yeah.
That doesn't mean it's the same thing.
I mean, it also doesn't mean that it's the same.
It's going to be as effective, let's say, or exactly what you need compared to, in person therapy.
Kind of anecdotally, I have seen people pretty split.
So some people really love it and find that they kind of wish they'd done telehealth before.
You know, convenience is one factor.
Like I'm not late for my sessions anymore because I just, I'm already at my computer or, in the DSDC area.
It's certainly like the lack of commute has been really nice for people even taking away the stress of driving has helped people's mental health.
But then I think on the other end, there are people who really feel like it's insufficient and are kind of mourning the loss of being in person, having a set place aside from your bedroom, aside from your family office, where you're going to talk and work on your mental health to work on problems that are quite painful to be physically present with your clinician.
So I think that people are really kind of across the spectrum.
And that's another interesting thing we'll see as we start to kind of open back up to in person possibilities is how does the field change?
How do people change in their preferences about therapy?
And I kind of predict, and I think others are predicting that we'll see a bigger proportion of clients and clinicians offering telehealth going forward.
But I do think that we will also see a return to in person.
I think some things will go back to quote, unquote normal after the pandemic passes.
Mhmm.
But there are some things that will stay changed.
That's my that's my feeling.
A lot of things are gonna change stay changed.
You mentioned stress as, maybe the biggest problem you're you're you're seeing, people are having during this pandemic.
Are there other mental health issues that are, being caused or exacerbated by the pandemic?
Of course.
Yeah.
I think it's it's hard to kind of pinpoint exactly like what maybe disorder or experiences being mostly exacerbated.
But what I, what I think is happening is the way that chronic stress works and the way some of the nuances of the impact of the pandemic has left people cut off from resources and stabilizing factors in their life that help them maintain higher levels of functioning and help them feel emotionally balanced.
So one kind of really obvious example of that is many people who've experienced sobriety and maintain sobriety for a long period of time are now unable to attend JA meetings.
Oh, right.
Right.
And that now AA has done a really tremendous job of trying to create, online virtual meetings.
But how does anonymity work that way?
What does it mean when you're meeting in somebody's home?
Like all of these questions make something that's very stabilizing and grounding and holding you accountable and helping you manage a struggle is now a source of confusion and a lot of really challenging questions.
And so now you're wrestling with, this is what I always did to cope and it kinda helped me on track is now a stressor, is now a source of confusion and is now, you're kind of regauging, like, how do I stay sane?
How do I help myself stay on track Right.
In the domain that used to be consoling and, stabilizing.
Right.
Well, you've mentioned isolation.
One of the things I've seen in my family during this pandemic is is exactly that.
I have a number of children, and a lot of their activities have been curtailed.
They're starting to open up again.
But, you know, there was a long period where, youth group meetings and social interactions, other things, athletics were all curtailed.
And so we were compacted, if you will, in our house.
We had food being delivered to the stoop the front stoop.
You know, I think a lot of, grocery stores are providing, you know, food that way.
You can order online and things.
Everything was delivered.
Amazon was delivered.
So we were living in a bubble, and I could feel the strain.
I really could feel the strain.
I liken it to kind of nuclear reactor.
We bring the fuel rods together, and things just heat up.
You know?
I could see that in my family.
So one of the one of the questions I have is, it seems to me the longer this pandemic lasts, the greater the chance of problems or long lasting problems.
Is that is that is that correct?
Is that a correct assessment?
I think it's a really intuitive suspicion.
Like, what what I think about is isolation and loneliness were already significant problems in The U S especially pre pandemic.
Young adults were reporting significant amounts of, loneliness and social disconnection in combination with social anxiety and relationship difficulties.
And then you move someone out of the social domain for a long period of time.
Which can compound those problems.
Right.
One of the, one of the things that we kind of know is that when you struggle with something, you need a, there's a certain amount of balance that you have to do between kind of working to take that thing on and stepping away from it.
Mhmm.
And if with isolation and loneliness, you don't have the option of, like, continuing to work on the thing that makes you nervous, like social engagement, let's say.
Right.
The people who are already feeling lonely now feel less and less equipped to engage in the social sphere.
And social interactions are so much more loaded.
What I hear is like you go on a walk and then you have to decide, like, how am I too close to that other person?
Is that person, Wait when somebody's coming?
Yeah.
And so now not only are you feeling lonely, but now you're very hyper aware and concerned.
So I think isolation has impacted everyone.
I think that what we're really seeing is that it's impacting the elderly population.
Mhmm.
And we're trying to understand of how can we resource those who are most vulnerable to COVID, to help them stay physically safe, but how do we care for their needs for engagement?
How do we tend to the families who feel cut off from their loved ones?
And I think they're really acutely experiencing the isolation.
Right.
One thing I've noticed about my my children is, how much they depend on electronics to communicate with others.
You know, when when all of the, in person activities were curtailed, they communicated with their cousins and their friends on video games and different things.
They're they jump from screen to screen, as I say.
And, you know, I understand that's how they interact now because other things aren't possible, but I don't think there has to be a balance, you know.
I think when when things open up, again, as they are, there has to be a shift back to the in person contact.
The so, you know, interacting with somebody on Zoom or a video game is one thing, but it's not the same as being with a group of people and interacting face to face.
Have you have you seen problems with young people becoming too dependent, let's say, on electronics to, to communicate with others?
Yeah.
I think I it's hard to to answer because I think it's it's speaking to a number of complex problems.
Right?
What is the impact I think that it really has shifted.
And I think that, I think that it really has shifted.
And I think that children and young adults will continue to kind of work out the absence of interaction over, ideally, you know, a year or so, but potentially much longer because it is incredibly different to interact in a video game or over chat or Snapchat than it is to interact over Zoom than it is to over to interact in person.
Mhmm.
And I think one of the things that you find is that you can kind of suss out and there's a little bit of distance in electronic communication, but there's a little more freedom, for good and for ill.
Right?
There can be a lot of anxiety that comes from like, how is my comment being taken?
How do I compare to other people?
Mhmm.
But then when you're immediately with somebody that can be really overstimulating and people can become quite anxious and feel at a loss for how to navigate that.
And so I think that there are a lot of differences.
And then when you're coming back to kind of the original interaction domain of face to face in person, I think children do feel confused.
And part of development is that you work those things out in a social domain.
You've learned from your peers, you trial and error.
And I think we'll see that happen as children come back, as they start to interact more of like trying to remember these things.
Does this work?
You know, I think even as an adult, I feel that way of like, now that things are opening back up, there's a sense of like, well, but interactions have shifted Right?
And people's, I think we're all, for example, more mindful of what someone else's preference might be.
Exactly.
And, and not wanting to impose and think about that's challenging as an adult.
That's really hard as a kid.
Right?
That's a very nuanced question.
And now, you're trying to tackle that as a kid with somebody that you wanna be friends with or somebody that intimidates you.
So I think it's complicated.
At an adult level, I find myself, do I shake hands with this person?
Do I do an elbow bump?
Do I you know, different people have different preference.
Some will come up and hug you and wanna, you know, get back to to where things were.
Other people more standoffish and you have to be very sensitive.
Children, it must be even harder, and you kinda piece that together.
Yeah.
One other thing I was thinking about is, there's a sense of loss of control of one's certain aspects of one's life, one's environment.
This pandemic has really changed our sense of what we are in control of, what, you know, what is in con what controls us.
And are there mental health ramifications to that?
Certainly.
It makes me think of kind of an existential perspective on psychology.
There's some famous existential psychologists who talk about the immensity of dealing with the reality of suffering, let's say, or a loss of control or a sense that there are forces in the world beyond your control that impact you significantly.
I mean, that's a big psychological task to kind of wrestle with that both in the abstract, but that also in the concrete.
And I think that it's, it's anxiety provoking, understandably.
And it's also a, a significant area of kind of choice and taking up responsibility and deciding like this is here.
How do I want to deal with it?
How do I, what are the risks that I am willing to take?
Do I want to hug somebody?
Do I want to tolerate that someone might disagree with me?
How do I want to regain a sense of control in my life?
And I think it's something that people in therapy, we talk a lot about, like instead of either ors, both ands.
Mhmm.
Which is to say, like, there's a level of things that are not in my control, and I still have some control.
Mhmm.
As opposed to, like, not, there's things that are in control of me, and I don't have control.
It's like, no, there's both.
And how do you make sense?
And how do you build internal and emotional space for both factors, but then also live that out in your life and make choices?
Right.
I think, from what I've seen, the people I'm I've been in contact with, even remotely, the the pandemic has also had some good positive effects, if you will.
I think, it has sort of shattered, a delusional self sense of self autonomy.
You know, it's it's it's it's, it definitely has been humbling in a number of ways.
You know, it's it's I think and it's it's also made people focus on things that I think a lot of us would would agree are essential versus the accidental, you know, the essential things in your lives.
The the relationship with your people in your family, your friends, your faith, for example.
A lot of people I've seen really, grow in their faith, you know, because maybe the sense of loss of control or just the reminder that, you know, we're not in control.
To to to think we're completely in control is really a delusion.
And, so have you seen, positive positive, side effects to this pandemic in in, maybe people you're in contact with in one way or another?
Yes.
I think I think it's a tension.
Right?
I do think that it hasn't been there are certainly those where this has been very painful, and it has not offered an opportunity for growth and success and reprioritization.
And I wanna kinda be mindful of that, that there are those who really haven't had that freedom or the privileges to kind of seize on this moment.
Mhmm.
And that's true while I I do agree.
I think there are some people that this has been very clarifying for, and it's kind of given enough pause to allow people to reprioritize things.
One of the things that kind of came to mind as you said it is, I, I am hopeful that ultimately this pandemic may significantly reduce mental health stigma.
It's a little bit of kind of a paradox, but I think that because of all of the changes that people have experienced and because of the felt experience of those changes, people are more aware of like mental health isn't like over here or mental illness isn't over here as somebody else's thing.
It's like, oh, no.
I'm having a real taste of just how anxious somebody can be.
And I'm able to kind of navigate that.
And I think my hope is that people are becoming much more aware of the need for mental health care for qualified clinicians and how it can really augment and enhance somebody's life, how treatment can be really a source of help and healing, as opposed to a sign that you're broken or deeply flawed.
I think people are really realizing that external factors impact internal functioning and external resources can help you address that so that you can engage in your life in a more adaptive way.
That's very interesting.
I think we're gonna talk about that in our next, our next discussion, our next podcast.
We're gonna go more deeply into that.
Can you can you give us some tips how to maintain good emotional health, mental health during these, challenging times?
Sure.
I think what I've been telling everybody for the most part is the classics are a classic for a reason.
You should think about tending to your physical health, regular exercise, eating well.
These are not the most exciting things.
However, what you see is that people physiologically, feel better after they exercise.
You get dopamine and you get neurological enhancement from having exercise that has a real emotional and psychological benefit.
Good sleep is also incredibly helpful.
Eating well.
These things are the things again, if we return to that idea of, like, what is under your control, maybe even sleep less so for parents.
You know, there's always compromises on that.
But the sense of like these things really care for you.
And then I think like mental health wise, you you can think about like noticing what you're feeling, starting to get curious instead of judgmental.
What am I feeling?
Why might I be feeling that way?
What do I need to do with this emotion?
Is it showing me that something needs to change in my life?
Is it showing me that I need to connect with somebody, and make sure that I'm talking to somebody about what's going on inside of me?
And then I think even I'm a really big believer in routines.
A lot of what's been painful about the pandemic is everything is constantly changing, right?
The terms of what I can do Mhmm.
In my state, the terms of what I'm doing in my job, but the terms of what my children are doing, like, these are fluctuating standards.
Mhmm.
And that is a lot to acclimate to.
But if you find a routine, it kind of counterbalances that.
So regardless of what's happening, I'm getting up at the same time and I'm doing these things every day.
That has a grounding and soothing impact that doesn't necessarily sound very exciting or appealing, but psychologically it's really containing and it really helps you feel more prepared and more, keep the grounded in your life.
And that's why I think routines are really important.
I think that's a very important point.
One of the things maybe people don't realize, I I I realized during this pandemic is, how my routine has changed.
You know, the work, interaction with friends, you know, even the things you would consider just normal, going to the store, getting this or that, you're getting out, getting doing, you can't do that.
You know, we weren't able to do that or we had to do that in limited ways.
And so a lot of changes to routines.
So I think what you're saying about establishing new routines, we find familiarity and comfort and security in routines.
It's it's it's good to to to establish those new new routines under the, under the present conditions.
So, I I see that in my my experience.
One important thing I'd like to touch on is, differentiating between just, emotional distress, emotional challenges, and when somebody really should seek professional help.
Is there are there, like, clear indicators when someone should recognize that they need to get some type of help?
I think it's a great question.
I I think it's, I think I'm pausing because I've seen so many different reactions.
And I wonder almost if this question is actually about something that occurs on a spectrum rather than like a domain.
So what I mean by that is it's okay to have a reaction.
Right?
This has been stressful.
You're going to have emotions.
You're and we're human.
Part of life, pandemic or otherwise, is that you feel distressed, that things are upsetting to you.
And and that's all within the realm of what's normal.
And so a certain amount of distress happens to someone with or without mental illness.
It's just part of the human condition.
Mhmm.
The way that we think about it as clinicians is on that spectrum.
Like, there's a healthy amount of you're just gonna have a range of emotions and you're gonna have feelings about your feelings.
But when it starts to really impact your functioning, when it starts to impede your ability to, let's say, go through your daily activities, getting out of bed is really overwhelming or you're oversleeping or you're not your house is really falling apart or just you're not able to function as you used to.
That could be at work.
That could be in your relationships.
That could be in your daily living.
That's one sign that we use as clinicians to say something is really happening.
Another sign is when that distress, it doesn't feel manageable anymore.
Like most of us have all learned ways to manage our own distress, things that stress us out.
And, but when those tools are, aren't working and haven't been working for a while, that to me is a sign that maybe there's something deeper going on.
Another way of thinking about it is kind of your classic examples.
If you're, you find yourself crying a lot, becoming very angry, using substances more and more and more, whether that's on a really kind of clear line or just like, this is a real uptake in my use of substances.
This is really a pivot from how I'd want to be using, alcohol, let's say.
Certainly we want to reach out to somebody and seek care if you're having thoughts of hopelessness, if your view of yourself has significantly, deteriorated, or if it's always been that way and that's really becoming problematic.
You feel like a failure.
There's no kind of affection for the self or very minimal.
And absolutely, if there's any thoughts of death, death is an escape or even more overt suicide.
If you find yourself engaging in self harm or thinking about harming others, that's a real sign that there's a lot of suffering going on that needs attention and that you can get help with.
I would say kind of the other part of your question, this is something I always like to kind of touch on.
I think sometimes in the world we have a, an unnecessary kind of split, which is that like when things are really bad, then you should go to therapy.
And if you're kind of doing all right, then you don't need therapy.
Therapy can help regardless.
And you don't have to be alone in deciding that You can go to a clinician and say, like, this isn't how I wanna be.
I'm noticing these things, and I'm not quite sure if I want to do long term therapy.
But I'd like to talk it through over a few sessions of, like, how I'm doing, what I can do, and whether or not therapy can help me.
That's something that a therapist can help you decide rather than you have to decide before you look for a clinician.
That's very interesting.
I think that's very good to to get professional input input from somebody with training to determine what other types of help you might need.
You know, just ask the questions.
Yeah.
But it can be a conversation that you have versus the sense of, like, I have to figure this out before I even meet with them.
Right.
Can help you figure that out.
Yeah.
I think that's very, very important.
So if if somebody is struggling with some of these things we've talked about or they just have questions and they would like to get input, where would you recommend they go?
You know, we obviously have a clinic here in, Sterling, Virginia, but people are watching this.
They're gonna be spread out across the country, maybe in different places around the world.
What what resources are available, generally speaking?
Where do where do people go if they have questions?
Yeah.
This is a very modern answer and a very COVID friendly answer, but the Internet.
Like, it it is kind of the place to go.
It is, there's many websites that have directories where you can search for a clinician.
So let's take psychology today, all1word,.com.
You can search by your location, and then there's drop down menus that let you search for a male or female therapist, for someone under your insurance, for someone who is meeting in person or only meeting online.
You can pick someone with a similar faith background.
You can pick somebody who has a specialty in depression if that's what you think you're coming for.
The the Internet has really come a long way in helping people make some of these decisions.
What I typically tell people is go to the Internet and go to your friends.
Your friends probably are in therapy.
People are it's a we're a much friendlier society towards therapy than we ever have been.
And so if you have someone that you know and trust, whether that's your pastor or a friend that you know that's gone to therapy, go and ask them who they've worked well with, who they might recommend.
And what I tell everyone is when you reach somebody, if they can't work with you or even if they can, ask them if they know of other people.
Right.
Doctor.
Arianne, if somebody has found somebody on the Internet or through, a friend, a recommendation, that can possibly help, with their with their challenges, what they're facing, and they do, follow through, what what generally happens next?
Can you explain the process, for for helping somebody?
Is there a a general process?
How does that how does that work?
It's a great question.
Yeah.
So I'll tell you a little bit about what we do at the IPS center, and and we could talk about how that's kind of a good template for what can happen in the rest of the world.
So let's say you found somebody, somebody whose profile looks like it's a good fit.
Give them a call, or send them an email.
And usually you'll talk on the phone.
And the clinician here, we get a sense of who you are, what you're looking for, and tell you a little bit about who we are, what it means that we're a training clinic, and tell you a little bit about the services that we, are offering.
So right now we're offering telehealth to adults who are living in Virginia.
So then it's kind of an information sharing process.
You'll describe a little bit about what's bringing you in, what your goals are for therapy or what you're struggling with.
And the therapist or here in our case, the center will tell you a little bit about who we are so that you can decide.
Right?
Do I feel like this is the right place for me?
This is what I'm looking for.
After that, you'll typically schedule a first session.
And therapists vary widely.
But at our center, we begin with a kind of extensive history taking, which helps us understand, like, what's the context that you're coming in with.
It's very similar to like at your doctor's office.
Like, you know, what kind of surgeries have you had in the past?
What are you allergic to?
It's a little bit of like the mental health version of that.
What other times of difficulty have you had in your life?
What's the broader context?
And then you'll develop treatment goals together and then you begin working on those treatment goals.
And usually that's a sense of individual therapy once a week talking about what's going on, how you're managing it and what you can learn about yourself and your experiences to, make headway and begin to heal.
So some clinicians don't do a very long history taking.
They kind of just dive right in with you.
And that's something you can ask them about when you call, like, what will the first session look like?
But usually I recommend find someone, give them a call, see who they're like, tell them a little bit about what you're looking for, and then come to that first session.
That sounds great.
Does the IPS center have a website that people can go to for more information?
Yeah, absolutely.
It's IPS center, all one word, .org.
And those who are interested in working with us, we do have appointments available for people based in Virginia.
And you can give us a call at (703) 418-2111 to talk with our intake coordinator to do that exact process of telling us a little bit about what you're looking for, learning a little bit about us, and deciding if we're a good fit.
Doctor Orianna, thank you so much for this interview, for your for your time with us.
I found, I found what you said so interesting and informative, and I hope it helps, helps a lot of people in need.
And I'd just like to thank you for all you're doing for those who are suffering, and I look forward to, talking with you again soon on another topic.
Have a wonderful day.
Thank you so much for having me.