With vaccination efforts ramping up across the United States, people are looking forward to a sense of normalcy. However, for many, the thought of things returning to normal brings a paralyzing sense of anxiety. Shannon O’Neill, PhD, licensed psychologist and Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, discusses the post-pandemic anxiety you may be experiencing and how to overcome those complicated feelings.

Why are people feeling anxious as we see signs of the pandemic easing?

It makes a lot of sense that people are feeling anxious and unsettled right now. Just when we were finally adjusting to a new normal with some predictability and flow, the world is preparing to change all over again. Future uncertainty and a sense of not knowing what to expect can fuel anticipatory anxiety. There is even a diagnosis for this feeling: adjustment disorder.

What does that mean?

Adjustment disorder is described as an emotional or behavioral reaction to stress or change in a person’s life. As vaccinations tick up and warmer weather approaches, there will likely be a significant readjustment of phasing normalcy back into our lives, similar to the adjustments made to social distancing or quarantining at home. This can, naturally, cause feelings of anxiety, as well as depression.

In most circumstances, beginning to reintegrate a ‘normal’ routine can enhance ones confidence. So, having the extra protection of the vaccine amongst ourselves and within our community may offer added physical and emotional security for those who are feeling anxious about things going back to normal.

How can I overcome the new feelings of anxiety I’ve developed during quarantine?

A classic treatment approach for an anxiety diagnosis is exposure. Rather than avoiding what is feared, it is important to lean into those activities.

Technology has been a wonderful and very helpful incentive for us to stay home when it was important to do so. Whether enabling us to receive a grocery or pharmacy delivery or attend a virtual happy hour, technology has allowed us to obtain resources and socialize from a distance. However, for some, this adaptation can turn into over accommodation and avoidance.

Thankfully, through repeated exposures to feared stimuli, while also following CDC guidelines, you should eventually become more comfortable. However, this may mean that you will need to ease in with smaller social commitments that have time limits before expanding out to larger outings. For instance, if attending an extended outing with your larger—hopefully fully vaccinated—social group sounds too much, try connecting with a friend you haven’t seen in a year with an hour-long picnic in the park. Once you feel comfortable with these smaller interactions, you can begin to safely expand your social network.

Another good rule of thumb is to know your boundaries and limits ahead of time as this will allow for some predictability and certainty. Ask yourself, what are you willing to tolerate? Is it the group size, rules around mask wearing, or the amount of time you are present? Acknowledging your boundaries and sticking to a plan can offer a good sense of confidence when you leave your home.

How can I tell if my anxiety about leaving the house is agoraphobia? What are the symptoms?

Agoraphobia is a clinical diagnosis under the umbrella of anxiety. This entails marked fear or anxiety across a number of situations whether that is going outside alone, using public transportation, standing in line, or being in large crowds or within closed spaces.

When there is fear of leaving the home, significant avoidance or behavioral modifications can develop. This can be turning down invitations, starting to self-medicate before leaving the home, or engaging in ‘safety behaviors’ such as only leaving the home with a trusted loved one.

How do I know if I should seek care for these feelings?

If current behaviors and emotions cause significant distress, impact daily functioning, or affect interpersonal relationships, it would be a good time to seek help from a trusted provider. Additionally, if self-medication—via drugs, alcohol, or even food—is necessary to white-knuckle your way through a task, seeking help would be important.

Telehealth services have expanded throughout the Mount Sinai Health System during the pandemic and this can be a wonderful way to begin psychotherapy for those with anxiety or agoraphobia. Working towards even just meeting in person with your provider is a great treatment goal at the start of these sessions.

Living through the COVID-19 pandemic can cause stress, anxiety, and depression, not to mention feelings of loneliness and isolation. But when we are under orders to stay at home, it is hard to get help for these issues. Fortunately, telepsychiatry—psychiatry appointments held by phone or  video session—are becoming more and more common and enable you to speak with a psychiatrist while maintaining social distancing. Claire Jackson-Rabinowitz, DO, Clinical Professor in Adult Psychiatry at Mount Sinai Beth Israel, shares some information you need to know about telepsychiatry.

What is a telepsych appointment?

Telepsychiatry is when we provide mental health care via phone or video sessions. Originating in the 1950’s, it has recently become more common as mental health care providers continue to provide care while maintaining social distancing.

We can perform most of  the mental health services we usually provide—aside from administering injectable medications—through virtual appointments. This includes initial consultations, one-on-one therapy, cognitive behavioral therapy, group treatment, family therapy, and medication management.

How does it work?

There are two types of telepsychiatry appointments: phone and video sessions. Most providers prefer video sessions because it gives us visual cues as well as verbal ones. However, if we do not have visual cues, we rely on other indicators such as tone of voice.

Before you log into a session, we recommend you find a quiet, private place to talk. If you are conducting your session over the phone, you will dial the number provided by your clinician or wait for a call. If you are participating in a video session, you dial into the telepsychiatry number and log into the video session on your phone, tablet, or computer. If your provider is still finishing up with another patient, he or she may guide you into a virtual waiting room. Otherwise, the provider will immediately invite you into the virtual session. These appointments generally last between 20 and 60 minutes. These days, with the added stress of the COVID-19 pandemic, mental health providers may also provide quick check-in calls for patients when needed.

In addition to one-on-one therapy, providers have found increased interest in group therapy such as mindfulness, which teaches anxiety-reducing techniques that include breathing and mediation. These skills are especially helpful during times of high stress.

Does telepsychiatry work for everyone?

Telepsychiatry works well for many people; some even prefer virtual visits over in-person appointments. Teenagers, for instance, are often excited to meet virtually. When we suggested this approach to our adolescent patients, they immediately downloaded the app and were ready to go. If you have a busy schedule, you may find it easier to squeeze in an appointment when you do not have to worry about travel time to and from appointments. And, in these days of limited childcare, at-home therapy may be easier for parents of young children.

I am reluctant to try virtual sessions. Are in-person appointments still available?

Yes.

We are open, and in-person appointments are available if you would prefer to see your therapist  face-to-face. However, to adhere to social distancing guidelines and keep all our patients safe, we would like to administer telepsych whenever appropriate and possible.

Also, please  keep in mind that in-person appointments during the COVID-19 crisis can be a bit disconcerting  as clinicians will  wear masks throughout the session.

How secure are these sessions? Will my privacy be protected?

We work hard to maintain your privacy and follow all HIPAA guidelines. We use a state-of-the-art security and encryption program for all sessions and we do not record calls nor is anyone in our office when we are speaking with a patient. For all appointments—intake and follow up— we check to make sure you are okay with working virtually. If you are not comfortable or able to complete a session via phone of video, we will work to schedule an in-person appointment.

Telepsychiatry has been very helpful during the COVID-19 pandemic. Many people may feel more stress, anxiety, and depression during these uncertain times. We are happy that we have been able to provide treatment throughout the crisis, and we look forward to continuing to do whatever we can to safely and responsibly provide care for those in need.

How can I make an appointment?

Please call us at the numbers listed below.

Mount Sinai Beth Israel:
212-420-2400 (All Patients)

The Mount Sinai Hospital:
212-241-5947 (Adults)
212-241-7175 (Children and Adolescents)

Mount Sinai Morningside and Mount Sinai West:
212-523-8080 (Adults)
212-523-3082 (Children and Adolescents)
212-523-3083 (CARES, a combined education and behavioral health program for teens)

Psychiatry Faculty Practice Associates:
To schedule an appointment with one of the physicians at The Mount Sinai Hospital’s Faculty Practice Associates (FPA), please call 212-659-8752 or email psychiatryfpa@mssm.edu.

The outbreak of COVID-19 is challenging all of us to cope in new ways. For people with depression and anxiety, life can seem overwhelming in normal times. Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai describes ways to deal with the feelings of anxiety and depression during this crisis.

Stress levels are high for everybody these days. For people who are already dealing with anxiety and depression, what advice would you give?

Many mental health providers are seeing their patients through telehealth. Should you not be able get to an appointment in person, your provider will likely be available to talk to you by phone or by online chat services like Zoom or Skype. It’s very important that while we isolate ourselves physically, we don’t isolate ourselves from the world or from people. If you can’t talk to your provider, make sure you are talking regularly to somebody, whether it’s a family member or a friend.  I encourage people to talk by phone, video call, Skype—or to reach out through social media.

The more we’re in touch with the idea that we’re all in the same boat, the less anxious we may become. Many people with depression and anxiety feel that no one understands them, and this increases the isolation.  Right now, a lot more of us are feeling isolated, so we are experiencing feelings that some people struggle with all the time.

Anxiety and depression are heightened by the feeling that no one can understand. But right now, we’re all going through the same thing and this provides an opportunity to really connect with each other as we realize that we’re part of a greater culture and humanity. I see an opportunity for healing, because more people will be able to empathize. Staying connected on social media and seeing what everyone else is going through may help people not feel so isolated.

I imagine being on social media can be a double-edged sword. How do you gauge when you’re exposing yourself to too much social media?

You certainly have to strike a balance. But I think the problem isn’t so much too much social media, but negative social media. It’s a matter of choosing your friends wisely, and choosing what you engage in. Sometimes we engage with people who trigger us with their negativity or politics that we don’t agree with.

But if you have friends who are posting important news information, humorous things, or positive items, this can be a great way to stay connected. It’s a good distraction from all the uncertainty and can be a pleasant way to spend some time. The positives of social media should be used to their fullest. Some people are sharing life-affirming stories about how people are helping each other. My rabbi posted a short, 20-second prayer that you could recite while washing your hands, while being mindful that your actions are helping to protect other people.  It can be a time to be inspired and connected to all the positives of humanity when we pull together.

Of course if you have friends who are posting things that you find upsetting, blocking or unfriending those people may help you feel in control at a time when you are controlling much less than normal. And that can be healthy. We have the power to mute negative messages.

What warning signs should you look for regarding anxiety and depression?

If you’ve gone a while without bathing, if you’re not eating, or not caring about getting dressed in the morning, letting the house get messy and out of control, then you should be getting outside help or trying to talk to someone. If you have thoughts that keep coming into your head that you can’t get rid of about becoming infected, or feeling everything around you is unsafe, that is also a sign that you might be getting very anxious. Even though there is truth to the idea that things on the outside might not be currently safe, social isolation, self-quarantine, and taking precautions should make you feel in control. If you can’t feel in control or feel your actions aren’t effective in increasing your safety, that is a warning sign.

We are in a real emergency. So it’s appropriate to have rational plans about worst case scenarios. What will I do if I get a fever or a cough? Do I have enough cough syrup in the house? Do I have a thermometer? These are reasonable thoughts to have, and formulating a plan for those things should provide reassurance.  But if they do not, it’s time to reach out to someone.

Mental health is being conducted on hotlines and many medical institutions have been preparing to deliver care like this for quite a while now. This is the day we’ve been preparing for—where people in need can have a reassuring voice on the end of the line that can walk them through their fears and anxieties.