Dr. Jessica Larsen

[JUDITH MEER, HOST] Hello, everyone. I'm joined today by Dr. Jessica Larsen, a clinical psychologist who will be speaking a little bit about the psychological impacts that COVID-19 has created and is leaving in its wake. Dr. Larsen, thank you so much for joining me today. I really appreciate it.

[DR. JESSICA LARSEN] Absolutely. Thank you for having me.

[MEER] So I am very curious to hear from you about -- given your experience working with people who have experienced trauma, both military veterans and civilians -- how is it that a hospital stay, something that's intended to help someone get better, could actually be a traumatic experience?

[LARSEN] Sure, well, that's a great question. So when we think about trauma, we think about situations or life events where someone experiences a life-threatening event, right, so you're concerned that your life or someone that you love or care about, that their life is about to end. So someone going into the hospital very ill with COVID or another illness could experience a trauma in that they're concerned that, for their well being, for their life.

[MEER] What's particularly frightening about the way in which patients are experiencing COVID-19 is this quarantine aspect, right? They aren't next to their loved ones, they don't have them with them as they're undergoing these procedures. And how do you think those factors play into the larger picture of potentially experiencing trauma from COVID-19?

[LARSEN] Sure, so social support or peer support,  support from loved ones is what we think of as a protective factor against trauma. So it's one of the factors that would mitigate stress in a traumatic experience. So things like having family members or having loved ones, having a supportive medical person with you during a medical procedure can really help the patient kind of feel more relaxed, feel more calm, feel more supported. So with  COVID, because the patients are not able to have family members around or supportive people around, you know, it's likely to make the subjective experience, the subjective experience, or experience from the patient's perspective, more stressful, right? I don't have anyone to rely on, I don't have anyone to advocate for me. I don't have anyone, you know, listening on my behalf and trying to support me and making sure that my well being is looked over, is looked after. So with these patients, it makes a lot of sense that they would be experiencing possibly more stress because they don't have family members, loved ones, friends, supporters with them.

[MEER] So let's say that someone has come back home and we are so relieved that they are safe. They've joined their family or those that care for them back home, but family members are starting to notice that things really aren't okay.What might be signs to look for that someone is struggling emotionally or psychologically after returning home from an extended hospital stay?

[LARSEN] Sure. So, you know, in the immediate aftermath of something like this, it's actually kind of normal to have a response where you're feeling and feeling a little bit different, you might feel a little sad or withdrawn, it might be difficult just to get back to your normal routine, especially if it's a physical, if you're having physical symptoms still or pain, it can be difficult to get back to your normal life just because of the physical piece, but also because of the emotional piece, right? You've just been through something that was incredibly scary or frightening, and then going through it alone to make it even more difficult. And so sometimes people start to question kind of the meaning of their life and their, you know, their relationships. It can be a moment where just the meaning of your life you start questioning.

So if you're a family member or friend of someone who has just been through an intense hospital experience with COVID if you notice the person seems sad or tearful or weepy, if they seem to withdraw from you or you know, not just you but, and others, too, though given all of this social distancing we're doing, it might be kind of, you know, difficult to assess that right as the person withdrawing from me or they just being mindful of social distancing. So if you see them withdraw, and if you see them seeming a little bit more anxious, so I'm kind of alert, or like nervous in situations and, you know, trying to avoid situations where they're leaving the house, although again, we're sort of in a situation where we're being asked to do that. So I don't know that that's another good example of kind of assessing.

But if they seem different, and if those symptoms go on for more than a month to six weeks, then that's when we start to really get concerned about sort of post traumatic stress disorder. And in the immediate aftermath, it's sort of normal to feel some of those feelings, but what we know is that a majority of people actually naturally recover from a traumatic event like that. But a small percentage, somewhere, you know, between 15 to 25% of people, will go on to have enduring symptoms and that's when we start to think about post traumatic stress disorder and to think about getting treatment for PTSD.

[MEER] It's really valuable to hear and I'm I'm looking forward to getting a couple of resources from you that we can include on the on the site to make sure that family members and and folks who've experienced COVID-19 know how they can, how they can get help if they feel like they they might need some additional support.

[MEER] You know, as a physical therapist, I view health through the lens of, of movement and and exercise. But as we know, the mind and the body are deeply interconnected. Do you feel that someone's mental health, or do you know from the literature and the research out there, does someone's mental health impact their physical capabilities or their ability to recover physically, and if so, how, how is that?

[LARSEN] So yes, the mind and the body are interconnected. What we know is that stress and anxiety, depression and trauma actually can really negatively impact people's physical health. It can also impact your immune system, interestingly enough, so, you know, people who have anxiety, depression, mental health challenges may actually be more predisposed to getting infections. Um, and then in terms of recovery, it's really hard when you're depressed or you're feeling anxious, it can be really hard to get up out of bed and go to your therapy appointments and maintain those kinds of rigorous schedules that you need to in order to physically recover from an injury. And so, you know, people with mental health challenges may not recover as well as those without them.

[MEER] I want to pivot a little bit and ask you about a topic I've been seeing just just a bit in the news showing up. You know, you and I live right here in New York City. It's the epicenter of this coronavirus pandemic. Many of us are close to those working on the front lines and this virus impacts you whether you are old or young, weak or strong, there really doesn't seem to be any specific demographic that is untouched. For those who have survived, and they may have lost close friends, especially if they were all interacting socially, before everything kind of came crashing down, they may be experiencing, I think what I've been seeing is is survivor guilt, but I, I've only sort of heard that often in like a military context and in combat, and I was hoping you could shed a little bit of light on what that is or how that might actually apply to this situation that we're going through right now.

[LARSEN] Sure, well, survivor guilt as it was sort of initially, research was basically in combat veterans, when you know, groups of soldiers were working together and there'd be an incident and one or a few of those soldiers would unfortunately pass away, but those who remained would feel a real sense of sadness and guilt related to the fact that they survived while their comrades did not. Um, so it does make a lot of sense this idea of survivor guilt or guilt because you survived and, you know, a person that you care deeply about did not, would apply in this situation, especially when we see that this virus tends to spread amongst groups of people who have close contact, right, so family members, or groups of people that sing together, right, we've saw the the chorus or the choral group that, unfortunately, were affected by this as well. So if you're in a close group of friends or family members, and you see the spread of this illness, and it would make a lot of sense, that the folks who survived the infection would feel a tremendous sense of guilt having having recovered and lived if their loved ones did not. So certainly that would be, you know, a real opportunity for some therapy. If you find yourself feeling survivor's guilt, or, you know, even just, you know, we're seeing a tremendous amount of loss going on right now too, even if you're not feeling guilty from it, you know, a loved one passes away from COVID, there's a tremendous amount of you know, sadness and loss going on in our communities as well. And so it's a great opportunity to reach out and get some therapy for it, talk to someone about the feelings that you're having. You're not alone. This is a you know, survivor guilt is certainly a very common experience for people to feel when they experienced a loss like this. Um, and you know, I really encourage people to talk to a licensed psychotherapist.

[MEER] So that was that was really helpful, as a follow up to that: if someone is recognizing their struggling, and they do want to seek out some additional support? Where would they start? How would they know what type of therapy or therapist is the is the right person for them, or is the right type of therapy?

[LARSEN] Sure. So, you know, there are a lot of really great therapists all throughout our area, you want to make sure that you're going to someone who has a license, so within the mental health field, there are psychologists, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists, all have graduate level training and are licensed in the state, which means that they, you know, have a board overseeing the work that they're doing to make sure that they're practicing ethically. So you want to make sure first of all and foremost that you see a licensed person, and then secondly, depending on the issue that you're going for, so today, we sort of talked about Post Traumatic Stress Disorder, like kind of post traumatic stress symptoms, we've also talked a bit about depression and anxiety. So you can see specialized therapists for each of those issues. If you, if you're worried about a loved one or you yourself feel that you might have Post Traumatic Stress Disorder, you want to see someone who, if you can find them specializes in an evidence-based treatment for PTSD. So the two major ones are prolonged exposure, or PE, or CPT, which is cognitive processing therapy. You can go to the, there's websites for either one of those, the VA actually has done extensive research in both of those treatment modalities. And you know, they've proven to be effective for people who have PTSD. So, you know, I'd really encourage folks to reach out to therapists that are trained in these evidence based approaches because you want to kind of get the most bang for your buck if if you are suffering with PTSD. There's no reason to keep suffering when you can go and get a treatment that's effective for it. And effective in a few months rather than a few years. As far as depression or bereavement, anxiety, really seeing someone, you know, cognitive behavioral therapy is a general approach that many therapists practice. It has a lot of evidence behind it for both depression, anxiety, and also for bereavement and loss. So I'd encourage whoever you see to have some training in CBT.

[MEER] That's exceptionally helpful to shed some light on what are the most, the best practices, and like you said, kind of the best bang for your buck, right now, when when there may not be a lot of, a lot of time or a lot of bucks.

[LARSEN] You know, and for folks, if you know therapy sometimes is out of reach for people, either their insurance, their insurance policies don't cover it, or they can't find a provider in their area if they live in more of a rural area. There are some really great free resources out there that the VA has created. There's a PTSD coach app that you can get on the App Store, you can download it, it's free. And it gives you sort of some exercises to go through, you can put a journal in there. The VA does not collect any of this information. But it's something that you can use yourself and keep the data on your phone. And then there's an mindfulness coach that they've also created, and that's really good for anxiety. It helps you with sort of like relaxation strategies, what we call mindfulness, is kind of being in the here-and-now bringing yourself to kind of present, focused awareness, and helping to bring down your arousal levels so that you can remain calm. So both of those apps are available for free. And I really encourage people as sort of like a first step, if you're not sure if you want to start with therapy, or you just can't get access to it, to download those apps.

[MEER] That's great. I'll make sure to include links to those in our resources section as well. Dr. Larsen, I know you have to get back to your own patients that you're working with, and do you have anything else to add that might be helpful for folks to know on their journey back to health?

[LARSEN] You know, just stick with it, it's, um, you know that our minds have an amazing way of recovering when we just, you know, take the time and be patient with ourselves. And, you know, I know a lot of people are really hurting right now. And I think we can all feel that. But if you can, you know, draw on the strengths that you have and draw on the people around you. And certainly seek out therapy, because it can really be life changing.

[MEER] Dr. Jessica Larsen, thank you so much for taking the time today to speak with me this has been very insightful, very helpful, and I hope will be an excellent opportunity for folks at home to get connected to the resources and the information they need so that we can heal from from the pandemic that we're all experiencing right now. Thank you so much.

[LARSEN] Thank you.

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