Psychiatry | Mount Sinai Today

Pandemic’s Toll on Mount Sinai Front-Line Staff Is Surveyed, and Addressed

Updated on Jun 30, 2022 | COVID-19, Featured, Mental Health, Psychiatry, Research

Recharge rooms were created across the Health System in one of many initiatives informed by surveys of front-line staff.

Front-line staff who were already feeling burnout showed the most signs of mental distress during the height of the COVID-19 pandemic, while those who fared best had an active social network and felt supported by their supervisors. These were among the many lessons learned by a team of Mount Sinai researchers based on two surveys of front-line Mount Sinai staff in 2020.

“The main takeaway is what most people would expect—that if you’re involved in health care during a pandemic, it’s going to take its toll,” says Jonathan Ripp, MD, MPH, Dean for Well-Being and Resilience and Chief Wellness Officer at the Icahn School of Medicine at Mount Sinai. “But beyond that, we were able to identify what types of things may put you at greater or lesser risk of these mental health outcomes, and inform how we can try to mitigate them.”

The results were used in real time to develop programs to help Mount Sinai staff handle the pressures of the pandemic, Dr. Ripp says, and they are being shared with other institutions through journal publications and a Well-Being Toolkit developed by the Office of Well-Being and Resilience.

The three mental health outcomes studied were depression, anxiety, and post-traumatic stress disorder related to the COVID-19 pandemic. Among the more than 3,000 front-line staff members who responded to an initial survey in April and May 2020, 39 percent screened positive for at least one of these outcomes. The most significant factor predicting mental health symptoms was the presence of pre-pandemic burnout, according to studies published by the Mount Sinai team in The Journal of Clinical Psychiatry and Chronic Stress.

At the start of the pandemic, Mount Sinai focused on meeting the basic needs of front-line staff, such as providing free or subsidized food onsite.

“This means that if you already felt exhausted, fatigued, and detached from your work, you were more likely to develop these mental health symptoms during the pandemic,” says investigator Lauren Peccoralo, MD, MPH, Senior Associate Dean for Faculty Well-Being and Development, and Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai. The research team emphasized that burnout is distinct from other mental health issues in that it is more a function of the work environment, and can be remedied by strategies that support workers.

In the earliest days of the COVID-19 pandemic, the Office of Well-Being and Resilience assembled a group of researchers with backgrounds in psychology, psychiatry, survey design, and statistical analysis to examine its mental health consequences on the workforce, in an effort initiated by Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System.

The group sent surveys to more than 6,000 physicians, nurses, social workers, chaplains, and other front-line staff at The Mount Sinai Hospital during the height of the pandemic’s first wave in April and May 2020 and again seven months later. In the first survey, more than 3,000 respondents answered questions from three diagnostic series: the General Anxiety Disorder 7, the Personal Health Questionnaire 8, and the Post Traumatic Stress Disorder checklist. In the self-screening for depression, for example, about 26 percent of respondents reported that on more than half the days of the week, they felt such symptoms as taking little interest or pleasure in doing things, feeling hopeless, losing their appetite, having trouble staying or falling asleep, or difficulty concentrating.

The survey also asked open-ended questions about the respondents’ concerns. “There were a lot of infection-related worries. People were worried about PPE, about infecting colleagues or bringing COVID-19 home to their family members,” says Jordyn Feingold, MD, an investigator in the study, who graduated from Icahn Mount Sinai in May 2020 and is now a psychiatry resident. “There were worries about basic needs like getting food at work, and existential worries like ‘When is this going to end?’ and ‘When is life going to return back to normal?’”

The aid facilitated by the research team fell into three categories: providing basic needs like food and the proper personal protective equipment (PPE) and other materials; providing up-to-date information through channels including web sites and system-wide email broadcasts; and creating well-being spaces and onsite mental health and peer support to reduce the stress experienced by health care workers.

A Second Survey Finds an Increase in Burnout

The surveys also asked questions related to resilience, Dr. Ripp says. Specific factors that were found to be protective against mental health symptoms included getting enough sleep and exercise, having social emotional support, not using substances to cope, having sufficient PPE, and feeling supported by hospital leadership and valued by supervisors.

Simply feeling heard was also important, Dr. Feingold says. “Whether or not we have it in our control to fix all of these things right away,” she says, “just validating the concerns and letting people know that they’re not experiencing this in isolation, I think was really powerful.”

In the second survey, conducted from November 2020 to January 2021, more than 1,600 responded and of those, 786 staff provided follow-up responses on their mental health and well-being. The results indicate that mental health symptoms have declined, but the prevalence of burnout has increased, Dr. Peccoralo says. “We are still analyzing the data, but one thought is that the traumatic situation has largely gone away, but the work hasn’t. We’re all still working really hard, maybe even harder than we have ever worked before,” she says. “So we have to think about how we can tell if we are pushing people too much, and what we can do about it.”

The surveys have served an important role in helping Mount Sinai take care of its own, and in advancing knowledge of the mental health consequences of responding to a pandemic, Dr. Ripp says.

The needs identified in the surveys have informed the development of new initiatives, including the launch of the Center for Stress, Resilience, and Personal Growth, says its Clinical and Research Director, Jonathan DePierro, PhD, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai. The Center is an innovative service supporting the resilience and psychological health of all Mount Sinai faculty, staff, and trainees through a series of evidence-based resilience workshops, a resilience-promoting app available for download on Sinai Central, ongoing outreach efforts, and up to 14 treatment sessions in its confidential faculty practice.

“Let’s hope that it’s a very long time before something like this pandemic happens again, but should it happen, I think the lessons that we’ve learned can apply,” Dr. Ripp says. “And then of course we can share those lessons, so that other institutions that haven’t had the opportunity to study this trajectory can learn from our experience.”

Alexa Salguero-Diaz: From Trauma and Truancy to Valedictorian

Updated on Jun 30, 2022 | Inside Mount Sinai Psychiatry, Psychiatry

Alexa on graduation day with her therapist, Monica Rojas, PsyD.

On June 25, Alexa Salguero-Diaz joined her classmates from her laptop to deliver her valedictorian speech for their virtual high school graduation. “A few years ago, I didn’t think about my future,” she said. “I didn’t even think I had one. But now, I’m actually excited for my future, and the adventures I’m going to have.”

It had been a long and painful journey for her to get to this point.

Alexa didn’t have an ordinary childhood, and she didn’t graduate from an ordinary high school. She graduated from Mount Sinai’s Comprehensive Adolescent Rehabilitation and Education Service (CARES), an integrated program for teens who struggle with mental health and/or substance use that combines a high school education with intensive psychological treatment. Founded in 1990, CARES aims to prevent the effects of mental illness and substance use on adolescents’ brain development, the subsequent decreased academic performance, and the ripple effects on their lives. CARES is the only program of its kind in the country.

When Alexa transferred to CARES, she was 17 and had been hospitalized for the 13th time for self-harm with the intent to commit suicide. The trauma she experienced due to abuse by a family member at a young age resulted in a lifetime of depression, multiple forms of self-harm, anxiety, anorexia, and bulimia, and addiction to multiple substances including Xanax.

After two years at CARES working with her therapist, Monica Rojas, PsyD, and in various targeted therapy groups including dialectical behavioral therapy (DBT), substance abuse, and milieu therapy, Alexa is in a much better place. She hasn’t used substances for three years, and is stable with no self-harm or suicidality. She is also armed with coping mechanisms and resources to get through any lapses that may arise.

“If I feel like I want to hurt myself, I let Monica or someone else know,” she said. “I’m not scared to go back to the hospital if I need to.”

Childhood challenges

Many of Alexa’s mental health problems can be traced back to genetic vulnerabilities, given her family history of depression and trauma, and the fact that she was abused at the age of seven. She never told anyone, and believes she denied and avoided the memories because it didn’t feel safe to talk about them.

In middle school, bullying and sexual harassment became a huge issue, which led to coping through substances and other risky, life-threatening behaviors. Alexa slowly began to realize there were connections between her past and present as she worked with therapists to understand how she was trying to master the traumas by re-enacting them over and over. “That’s when the sadness started coming. I started hurting myself, and I wanted to die every day.”

As a first generation Salvadorian-American, Alexa made brave efforts to share these stressors with family. But given how taboo it is to speak of abuse in so many cultures, she was unable to receive the support and validation needed.

The trauma from her abuse haunted her, and drugs helped her forget—temporarily. “I got addicted to Xanax, molly—whatever was around, but especially Xanax. I skipped school just to do drugs.” Alexa put herself in dangerous situations in order to use substances, which further exacerbated her trauma.

“I wanted to take away all my bad thoughts and go to another world, but in reality, it made things worse. I just wanted to die,” she said.

The abuse also created a sense of worthlessness and disgust. “It all started because of that sexual trauma when I was younger. I just felt so useless and ashamed of myself and disgusted with how I am, how I look.” This led to anorexia and bulimia in her sophomore year, coupled with substance abuse and suicidality.

“When I was in my original high school in the Bronx, that’s where my depression and anxiety got really bad,” she said. “I was actually hospitalized 12 times when I was there.” Alexa’s education was frequently interrupted due to these hospitalizations with an average stay of one month. Additionally, one serious attempt landed her in a coma for a week and subsequently hospitalized for two months. Because of these multiple prolonged hospitalizations, Alexa fell behind in school. At age 17, she was still in need of 22 credits and all five of her Regents exams in order to earn her high school diploma.

The path to recovery

In 2019, Alexa transferred to CARES, on the recommendation of psychiatric hospital staff. “It was really the best choice I made,” she said. “I felt so much support.”

Dr. Rojas believes falling behind in school fed into Alexa’s shame and mental health issues, and that interventions for her mental health needed to be integrated with keeping her education on track.

“CARES is the kind of place where we say ‘You can do this,’ and we will work together as a team to help you reach your academic and mental health goals,” she said. Her steady progress in therapy fostered autonomy and confidence, which influenced her academic achievements.

CARES functions as a “warm handoff,” bridging the gap between inpatient and outpatient therapy. The program’s multidisciplinary team onsite consists of psychologists, psychiatrists, social workers, a psychiatric nurse practitioner, DOE teachers, and guidance counselors, along with trainees in these disciplines.

The CARES treatment team works together to make an individualized treatment plan for each patient that includes individual therapy two times per week, group therapy five times per week, family therapy, and medication management. Additionally, students have access to milieu therapy onsite to support students during the school day. The unique support of milieu, or “therapy on demand,” is to help students cope in vivo by coaching them through crises using effective skills in the moment.

Alexa believes the intimacy of the space itself was helpful for connecting with people. “It’s very easy to socialize because it’s just one floor, in one building. It really helped my social anxiety,” she said. She also used this time to explore several aspects of her cultural and sexual identities. “It wasn’t really a big deal, people weren’t shocked. But it did help me feel more comfortable with who I am.”

Of course, COVID-19 presented problems in providing intensive care. Although CARES offered a blended learning option in the fall of 2020, Alexa attended CARES remotely from March 2020 to March 2021 because of concerns around the pandemic. “It was pretty hard because it made it easier to not go to class and group therapy sessions,” Alexa said. But she persevered with the help of her support network and CARES team.

“Alexa’s capability for deep insight and ability to share is so impressive and constantly inspiring me,” said Dr. Rojas. “Even in the substance group for teens, Alexa told her story and it was so helpful for destigmatizing substance use for the others in the group. To be able to ask for what she needs even when she doesn’t feel like it—after everything she’s been through—is really amazing.”

Graduation and the path forward

The New York City Department of Education and CARES staff unanimously voted Alexa as valedictorian, along with one other student. “I was so confused,” she said. “I really never thought that I would even be considered for that.”

In her speech, Alexa provided sound advice to her peers: “To everyone that is here or still in school, or struggling with mental health, don’t let it get to a point where you regret your choices. Instead, make the choices that will lead you to have a life that you dream of. Whatever advantages or opportunities you get in life, take it, because it could be something wonderful.”

Alexa’s love of animals and art led her to create an Etsy shop: Muffin’s Stickers, named for her dog who passed away in January.

“My life revolves around animals. When Muffin passed, I really fell into a deep void. I wanted to die, and I felt completely empty,” she said. “But once I learned how to deal with it, I realized my dog would want me to continue school.”

Art has always been an escape for Alexa, so she began painting pet portraits, which she converted to stickers based on her art as well as custom commissions. In the beginning her customers were mostly friends and family, then informal marketing via TikTok and at CARES helped her attract more customers.

“It really helps to distract me and keep my days busy,” she said. Down the road, she hopes to earn a pet grooming certification so she can open her own pet shop.

As Alexa joined her family, classmates, and care team in Morningside Park for a graduation celebration, she reflected on the last two years of her life. “I came so close to not achieving any of this,” she said. “I could be under the ground or cremated right now. But I’m glad I didn’t succeed in doing that, because the people I met through CARES are the best people ever. The friends I made in the hospital, and the connections I made with adults really helped me a lot and made me feel less alone. I still feel alone and depressed at times, but then I remember everyone I’ve met and imagine how many more people I can meet.”

Alexa will begin outpatient therapy at Mount Sinai in the coming weeks as part of an individualized continuum of care. In her free time, she stays busy with her Etsy shop and is currently applying to trade school to obtain her pet grooming certification.

Mount Sinai’s Department of Psychiatry is one of the largest and most prolific in the world. With our new series, Inside Mount Sinai Psychiatry, we showcase stories from every corner of our Department including our training programs, patient care teams, and scientists. We believe psychiatry and mental health are the building blocks to fulfilling lives and thriving societies; via these stories about our faculty, trainees, and staff, this series shows the myriad ways we work toward that. Whether it’s manning the front desk of an opioid treatment clinic, researching how psychedelics work in the brain, or training future clinician-scientists, our team is relentlessly pursuing the best for those suffering from mental health issues.

Sharely Fred Torres, MD: Fostering Culturally Sensitive Therapy

Jun 23, 2021 | Diversity and Inclusion, Inside Mount Sinai Psychiatry, Psychiatry

Sharely Fred Torres, MD, with her grandfather in Puerto Rico.

The racial and ethnic disparity in mental health care is a critical issue facing psychiatry—and health care as a whole. Lack of access, a dearth of racially and ethnically diverse providers, and increased need across the board due to ripple effects from COVID-19 have intensified the need for minority providers. The Substance Abuse and Mental Health Services Administration (SAMHSA) launched the APA SAMHSA Minority Fellowship Program to address this. Sharely Fred Torres, MD, a rising second-year resident at The Mount Sinai Hospital, was just awarded this year-long fellowship, which begins in October 2021.

“One reason I knew I wanted to go into psychiatry is that there are so few minority providers, which is not a problem that is unique to psychiatry,” she said. The Mount Sinai Hospital is at the border of two socioeconomically distinct neighborhoods of East Harlem and the Upper East Side, so the inpatient psychiatry unit sees very diverse patient populations. “In my medical training at Mount Sinai, I would say that more than 50 percent of my encounters are in Spanish. I feel really lucky that I can talk to many of my patients in their native language as a bilingual person. They’re much more comfortable with a doctor they can relate to, and more likely to be honest about topics they would otherwise keep hidden.”

The path to psychiatry

Dr. Fred Torres was born and raised in Puerto Rico, and has been interested in pursuing a career in psychiatry since she was young.

“I realized that working in medicine could allow me to work with all kinds of populations and help people in the most fundamental way possible, which is their health,” she said. Regarding her interest in psychology, she said, “I really liked thinking about what drives people’s behaviors and decisions. It applied to so many interactions I’d had.” Dr. Fred Torres’s psychology course at Harvard was taught by Professor Dan Gilbert, who inspired her to pursue psychology as her college major with an emphasis on social and cognitive neuroscience. She joined Harvard Medical School’s Family Van program, which provided disadvantaged neighborhoods in Boston with preventative health screenings such as blood pressure, cholesterol, and blood sugar levels, as well as medications.

“I loved the medical aspects, like learning how to take someone’s blood pressure, but I also loved listening to their stories,” she said. “When the patients spoke about loss and trauma, it really became clear that the lack of access to mental health services was a huge problem in this community.” It was during these years that she also realized that many of her college peers were navigating emotional stressors in school. “I noticed mental health issues affect everyone. But not everyone seeks care.” This led her to join Harvard’s Student Mental Health Liaisons program to advocate for mental health services for college students. She worked with the director of Harvard University Health Services to ensure that freshman orientation at Harvard featured workshops on mental health services so that freshmen had the information early on, rather than waiting for a crisis to seek help.

In medical school, she became one of the first students at the Icahn School of Medicine at Mount Sinai to be accepted to the Primary Care Scholars Program launched in 2015. Through this four-year scholarship for students interested in providing primary care to underserved communities, she provided longitudinal care for patients in a variety of primary care settings. Her medical school tenure was five years, because she took a scholarly year to research under the mentorship of Adriana Feder, MD, and Mercedes Perez-Rodriguez, MD, PhD. “That year really grounded my interest in psychiatry,” she said.

Research and APA SAMHSA Minority Fellowship Program

Dr. Fred Torres is grateful that she is able to take advantage of the APA SAMHSA Minority Fellowship Program for psychiatry residents who are committed to addressing mental health disparities through a scholarly project. She plans to research cultural components that shape post-trauma trajectories within the World Trade Center (WTC) first-responder cohort that Dr. Feder has been studying for many years as the associate director for research at the WTC Mental Health Program.

“When Hurricane Maria hit Puerto Rico in 2017, I was in the beginning of my scholarly research year. Being directly impacted by that experience made me realize I wanted to shift my learning to focus on trauma-based research,” she said. “I saw how in the face of trauma, despite much loss and hardship, there was also a sense of support growing in the community in Puerto Rico with people at home coming together to support one another through this shared experience. I was proud and inspired by my community.” Dr. Feder let her know that she could learn about trauma by working with the WTC cohort, a unique population affected by the same traumatic event, in which there is a significant Hispanic population as well.

Dr. Fred Torres wants to explore culturally unique resilience factors within this group. “In much of the Hispanic community, no one talks about anxiety or depression,” she said. “Instead, there is a tendency to go to church and pray when faced with life stressors.” She hypothesizes that depending on the individual, the religious factor and other culturally specific variables can serve both as a barrier to and enhancement of resilience, strength, and meaning after a traumatic incident.

Via qualitative individual interviews during her fellowship, she plans to compare the Hispanic WTC cohort to other minority and non-minority counterparts to identify culturally specific factors that contribute (or detract) to resilience. She hopes the findings from her fellowship research are ultimately incorporated into culturally sensitive therapy for trauma. The Mount Sinai Hospital’s psychiatry residency allows time for research projects in the second year, and Dr. Fred Torres’s mentors, Dr. Feder and Dr. Perez-Rodriguez, will guide her in her scholastic work.

Career plans

Once she finishes residency, Dr. Fred Torres hopes to focus on outpatient therapy for many psychiatric conditions such as personality disorders, depression, anxiety, and trauma. “I like the idea of longitudinal, years-long relationships with patients,” she said.

After residency, she hopes to continue to pursue research and academic interests in order to better inform the care she provides patients. “In this career, you can help anybody,” she said. “There’s nobody who doesn’t need health care. I feel privileged to be in a position to help someone on such a fundamental level. But within the field of psychiatry, we face unique challenges to providing care. Our practices are not as clear-cut—you can’t draw someone’s blood and with a biomarker determine that they have depression or anxiety, in the same manner that you can measure someone’s cholesterol level for example. We rely on the psychiatric interview. I enjoy this challenge of working with patients through that subjective space together.”

Furthermore, as she did in medical school and her residency with the Admissions Committees, Dr. Fred Torres hopes to continue efforts to ensure the diversity of the medical field by recruiting diverse medical trainees and increasing academic support for students who are underrepresented and/or disadvantaged in medicine.

Learn more about the psychiatry residency at The Mount Sinai Hospital

How Can You Tell if Someone You Know May Have PTSD?

Updated on Jun 30, 2022 | Featured, Mental Health, Psychiatry, Your Health

Many people think post-traumatic stress disorder (PTSD) is something that occurs mostly in soldiers returning home from war. Not so. In fact, PTSD affects millions of people throughout the United States, and the numbers are no doubt rising due to the pandemic.

In this Q&A, Jonathan DePierro, PhD, Assistant Professor, Psychiatry, and Clinical and Research Director, Center for Stress, Resilience and Personal Growth at the Icahn School of Medicine at Mount Sinai, explains how PTSD develops, what some of the warning signs are, and why having symptoms of PTSD is not a sign of weakness.

What is PTSD?

PTSD is a mental health condition that can develop after someone goes through a life-threatening event, like a car accident, combat, or a serious illness; or when sudden life-threatening events happen to a loved one. Seeing and hearing about human suffering and death at work over and over, like medics, nurses, and 911 dispatchers do, can also contribute to PTSD.

Jonathan DePierro, PhD

What are the symptoms of PTSD?

PTSD involves four types of symptoms that happen at the same time.

Intrusions – reliving the event with upsetting memories, nightmares, or flashbacks where it truly feels as if the event is happening all over again
Avoidance – trying very hard to avoid any reminders of the trauma, including talking about what happened
Negative thoughts and emotions – feeling depressed, angry, numb, mistrustful, guilty, or ashamed
Hyperarousal – feeling on edge, irritable, having difficulty concentrating, being easily startled, and having poor sleep

These symptoms also need to last for more than a month, be distressing, and/or cause problems for you in your life. Some people may notice changes in their mood, behavior, or relationships right after a trauma; but for others who develop PTSD, symptoms might not develop for many months.

What causes PTSD?

One of the important things to keep in mind about PTSD is that it is the result of a person being exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one or more of the following ways:

Experiencing it yourself
Witnessing the event(s) firsthand
Learning it happened to a loved one
Indirect exposure to aversive details of the trauma, usually by nature of one’s job

The American Psychiatric Association estimates that about 7 percent of adults in the United States will develop PTSD during their lives. People who do develop PTSD are not “weak.” They have experienced an event that they struggle to understand, and their bodies and brains are “stuck” replaying the event and all the upsetting emotions that come along with it.

How can you recognize the signs of PTSD in someone you know?

People with PTSD struggle to make sense of what happened to them or what they witnessed. They might have upsetting images or memories of the most upsetting parts of the trauma, even though they spend a lot of time trying to avoid anything that might remind them of what happened. The events feel too overwhelming to think or talk about. Spending time with others feels like a lot of work and more stressful, so people with PTSD might withdraw and spent a lot more time alone. Sleep and attention problems are common, because the body is so “on edge” and still reacting as if the trauma is still happening in the present moment.

We also know that people with PTSD tend to see themselves, the future, and other people in their lives through certain “mental filters.” One example is that people with PTSD often blame themselves for things that happened during the trauma, even though that does not make sense. Some of our health care workers experience “moral injury” – blaming themselves all the time for something they did or did not do during the worst of the pandemic.

How is PTSD diagnosed and treated?

If you are concerned that you may be experiencing symptoms of PTSD, speak with your health care provider. They may refer you to a mental health clinician, who can review your symptoms and make a treatment plan. You should also know that depression and PTSD often co-occur, so mention any symptoms of depression you may be experiencing to your providers so they can better understand your needs. If you are concerned about a friend or loved one, speak to them and encourage them to seek help.

Treatment for PTSD directly address avoidance, fear, and negative thoughts. Catching negative thoughts and trying to change them, to make them more realistic and helpful, is a key part of many treatments. Treatment also involves rebuilding a sense of safety that often feels so absent in people with PTSD. Some people with PTSD also find antidepressant medications to be helpful.

Get more information from Mount Sinai about PTSD

Learn more about PTSD from the National Institute for Mental Health

Find additional resources at the National Center for PTSD

How to Cope With Post-Pandemic Anxiety

Updated on Jun 30, 2022 | COVID-19, Mental Health, Psychiatry, Your Health

Young woman sits in window sill while looking at phone

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.

Learn more about Behavioral Health at Mount Sinai

Psychiatry Residents Win Multiple Awards

Updated on Jun 30, 2022 | Psychiatry

Psychiatry residents at the Icahn School of Medicine at Mount Sinai have been awarded several prestigious prizes and fellowships this year in recognition of their exceptional patient care, outstanding leadership, and remarkable research prowess.

Top row, left to right: Tim Becker, MD, PhD, (PGY-3); Sharely Fred-Torres, MD, (PGY-1); and Young Jung Kim, MD, PhD, (PGY-4). Bottom row, left to right: Isobel Rosenthal, MD, MBA, (PGY-2); Andrew Smith, MD, PhD, (PGY-3); Brian Sweis, MD, (PGY-1); and Genevieve Yang, MD, PhD (PGY-3).

Tim Becker, MD, PhD, (PGY-3) was selected as a 2021 American Psychiatric Association Foundation (APAF) Child and Adolescent Psychiatry Fellowship Program and won third place in a New York State Psychiatric Association Poster competition

Sharely Fred-Torres, MD, (PGY-1) was selected as a 2021-22 SAMHSA Minority Fellow through the APA Foundation.

Young Jung Kim, MD, PhD, (PGY-4) won second place in a New York State Psychiatric Association Poster competition.

Isobel Rosenthal, MD, MBA, (PGY-2) won an APA leadership award and a Group for Advancement of Psychiatry fellowship.

Andrew Smith, MD, PhD, (PGY-3) was admitted to the competitive Research Colloquium for Junior Psychiatrist Investigators through the APA.

Brian Sweis, MD, (PGY-1) won second place in the New York County Psychiatric Society Research Awards.

Genevieve Yang, MD, PhD (PGY-3) won an Outstanding Resident Program award from the NIMH and received a pilot grant from the ANRP at Mount Sinai.

Please join us in congratulating our exceptional residents!

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