COVID-19 Virus Pandemic Stress Management for Health Care ProvidersDe partme nt of P sy ch iat ry P e t e r O ’ D o n n e l l J r. B r a i n I n s t i t u t eU T S o u t h w e s t e r n M e d i c a l C e n t e r

K ip p P ie t ra n t o n io, P h . D.C h r i s t o p h e r G lo w a c k i , P sy. D.Re e d J . Ro b in s o n , P h . D. , A BP P

• Impact of misinformation

• Overload of information

• Microaggressions and racism

• Loss of usual self care activities (gym, going out to eat, spending time with friends)

• Being a high-risk provider

• Having special events cancelled

• Talking to kids about COVID-19

• Social Distancing

• Loss of routine

• Sharing fears that our patients have

• Putting on “tough” face for patients

• Home life being disrupted

• Fear of contamination/contaminating others

• Feeling the impact of a fluctuating system/lack of Information

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Quick SummaryC o n c e r n s & C o p i n g S k i l l s F o r

SummaryW h a t e l s e w i l l w e c o v e r ?

• General Coping Strategies

• Common Challenges rising from the pandemic

• Recommended Coping Skills for dealing with those Challenges

• Additional Resources

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General Coping Skills

Biological Emotional

• Expressing yourself and talking with co-workers

• Validating and supporting others

• Monitoring your feelings throughout the day

• Engaging in self compassion and setting limits

• Connecting with those we love each day

• 7-8 hours of sleep each night

• Eating 3 healthy meals per day

• Exercise 3 days per week for 30 minutes where your heartrate is over 120 BPM

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General Coping Skills

Cognitive Environmental

• Keep a clean and organized environment

• Identify factors in our environment that are contributing to our stress and eliminate them if possible

• Change your environment if feeling too stressed out

• Recognizing when your thinking is being influenced by your emotional state

• Avoiding black and white thinking

• Not giving into “automatic thoughts” that elicit negative emotions

• Recognizing when our behavior is contributing to negative emotional states

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Social Distancing

Concerns Coping Skills

• Find ways to get outdoors/get out of the house that are still safe

• Start a project in your yard or around your apartment

• Connect with friends online as others may feel isolated as well

• Increase virtual communication with co-workers. Leave them fun digital notes/memes

• Maintaining social distancing can be a very isolating and difficult situation

• This may raise tensions at home, create loneliness, feeling constrained

• You may feel more isolated from your co-workers as well due to social distancing rules

Gardner, Lally & Wardle, 2012; Hersch et al., 2016; Linehan, 20157

Loss of Routine

Concerns Coping Skills

• Creating a new routine

• Taking initiative to set up routines with co-workers

• Accepting the idea that some things won't get done (plates will drop)

• Talking with boss about expectations and priorities

• Most people have felt a disruption in their day to day routine as a result of the virus

• Both in terms of their job and home life

• Extra precautions

• Not being able to get resources

Beck, 2011; Wolf, 20198

Sharing our Patients’ Fears

Concerns Coping Skills

• Recognizing our own catastrophized thoughts (thinking about worst possible outcome)

• Being mindful of how much distress we are absorbing

• It's okay to acknowledge your own fears with a patient (in a professional way).

• Allowing yourself to take a break from talking about it (reserving empathy)

• Many of our patients are sharing their fears of the virus

• In fact, this seems to be the only thing people are talking about

• We as providers may also have some of the same fears

Dye, Burke, & Wolf, 2019; Scanlan & Still, 20199

Putting on a Tough Face

Concerns Coping Skills

• Paying attention to your body – signs of tension

• Openly discussing burn out and feeling tired

• Not giving in to the feeling that if you don’t do it, "it won’t be done right"

• Making the active choice to disengage

• Often there can be pressure within healthcare to be “tough” and work through pressure

• This is appropriate and necessary at times, but also can lead to burn out

• Realizing that the person who is burned out is often the last to know

• This can also lead to mistakes being made

Reb et al., 2019; Wolf, 201910

Home Life being Disrupted

Concerns Coping Skills

• Being mindful that you can only do the best you can

• Accept the idea that you are not going to be a perfect parent right now

• Remember everyone is managing this with children right now. People will understand

• Speak with your boss about your specific family needs

• Home is often our escape from the day-to-day stress of work

• Some of us are having to work from home or manage children/partners/dependents at home

• Many of us are not able to visit family that are out of the state

Phutane, 2020; Qutubuddin & Reddy, 2019 11

Fear of Contamination/Contaminating OthersConcerns Coping Skills

• Recognizing that going out is a necessity at times, and that this okay

• Being mindful of when we are over-analyzing our own behavior. Everything does not have Corona Virus on it

• We are not in complete control of our ability to control contamination, no matter what we do

• If your hands are turning red or developing sores you may be over washing

• Many of us are thinking about everything we touch and do, in an unprecedented way

• We all should all have greater empathy for OCD - Germaphobia

• This can make us hypervigilant, and we may look for soothing behaviors such as washing hands or showers as means of feeling better

• We may feel guilty about going out or doing things, like we are contributing to the problem

Linehan, 201512

Feeling the Impact of a Fluctuating System / Lack of InformationConcerns Coping Skills

• Take breaks from emails

• Assume positive intent by others, everyone is trying their best

• Recognize other people’s lives are also being disrupted and their communication style may have changed as a result

• Over time things will normalize again

• Radical acceptance (accepting the idea that no control is okay)

• Things are changing rapidly at different levels• Clinic

• University

• City

• State

• Nationally

• Globally

Bossio & Holton, 2019; Doolan, 201913

Impact of Misinformation / Overload of InformationConcerns Coping Skills

• Be aware of your own media consumption – this impacts your mood

• Disengage from social media

• Read beyond headlines

• Take breaks from the news

• Do not spread information until it is confirmed

• The media is invested in making profit through viewership and clicks

• Information is being sensationalized at times

• Some information is simply false

• This can be frustrating as a provider

Cicognani et al., 200814

Microaggressions and Racism

Concerns Coping Skills

• Check in with each other and create a sense of community around discussing stigma

• Do your best to educate patients when possible

• BELIEVE people when they experienced a negative interaction related to their race/cultural background

• Validate that this was not fair, and check in to see how people are feeling about it later in the week

• The fact that the virus originated in China has contributed to prejudice behaviors and microaggressions

• May result in patients being insensitive to certain providers of racial and cultural backgrounds

Ransdell et al., 2003; Roe & Aspinell, 201115

Loss of Self-Care Activities/Routines

Concerns Coping Skills

• Get CREATIVE!

• Use YouTube to do exercise, meditation, and mindfulness at home

• Get a video game that involves exercise

• Read those books you have wanted to read

• Go for a walk

• Talk to friends online and connect

• Start a project!

• Normally we do all kinds of things to take care of ourselves

• Unfortunately, many of these activities involve being around others and have been cancelled

Ransdell et al., 200316

High-Risk Group Providers

Concerns Coping Skills

• If you don’t feel comfortable doing something, tell your manager

• Ask co-workers for help if you feel like you are at greater risk

• Volunteer to be an identified helper who can jump in if someone needs help

• Providers over 65 or immuno-compromised provider may have greater fear of contracting the infection

• Same with those of us with loved ones who are immunocompromised

• We also may be fearful of contaminating these populations ourselves

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Having Special Events Cancelled

Concerns Coping Skills

• You are not alone in feeling this way!

• Don't fall into the trap of feeling like this is a "first world problem" and not allowing yourself to grieve. It's okay to be disappointed

• The process of making changes can bring people together

• More time can make some events even better

• In the wake of social distancing many events have been cancelled or postponed

• This includes sports, conferences, vacations, and even weddings

• This can produce a sense of grief or loss that feels unfair

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Talking to Kids about Corona Virus

Concerns Coping Skills

• Talk with your children about the topic

• Focus on things that are going to stay the same (being together, being loved, supporting each other)

• Come up with daily routines and rituals for your children

• Recognize how your own anxiety may be effecting your children

• Children may be struggling to understand what is happening (just like we are), except they have less agency to manage their lives

• Being out of school and out of their routine can be difficult for many kids

• No traffic!

• Short lines at most take out restaurants

• Lightened/simplified workload in some ways

• A break in routine can be invigorating

• Systems are becoming more flexible

• Telemedicine is being moved forward quickly in many departments

• We are developing protocols for managing future pandemics that may be more difficult to manage

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Enjoy Small Wins

ResourcesW h a t e l s e c a n I t u r n t o ?

• COVID-19 Support Hotline & Email

• An excellent Video/Podcast

• Several Resource Links

Add a footer 20

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Department of Psychiatry – Behavioral Health Support for Employees During COVID-19EAP Hotline: (214) 645-5686

EAP Email: behavioralhealthresponseteam@UTSouthwestern.edu

• The team of APPs, Psychiatrists, Psychologists, and Therapists will respond to emails and calls between 7:30 a.m. and 6:00 p.m.

• This service is considered supportive only. Referrals to more a higher level of care such as counseling or referral to a psychiatrist can be available if requested

• Calls and emails will be treated as confidential and not shared outside the team

• This service will not be documented in EPIC or billed

• Medical records will not be kept regarding calls received on the Hotline.

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Recommended Viewing

Timestamps:

00:08 - Why the coronavirus has disrupted our lives

02:00 - How does this outbreak impact our mental health?

06:08 - Skill 1: Bring your offline support online

08:55 - Skill 2: End the endless scroll of social media and the news

12:48 - Skill 3: Reboot your system for habits, rituals, and routines

16:02 - Skill 4: Master a thing that absorbs your mind and challenges you to grow

20:31 - Skill 5: Understand the different between distancing and isolation

23:21 - Skill 6: Find compassion

T h e P s y c h S h o w - S k i l l s fo r m a n a g i n g t h e w o r l d b e i n g c a n c e l l e d

https://www.youtube.com/watch?v=mwrMtJ3DYXg&t=148s

What to do if you get sick?

What to do with kids at home on Coronavirus Break for who knows how long (without losing it)

What to do during social distancing

100 things to when trapped inside

List of Dallas restaurants running takeout and delivery specials

Headspace Meditation App free for Prescribing Providers

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Additional Resources

What to do if you get sick?https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html?CDC_AA_refVal=https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html

What to do with kids at home on Coronavirus Break for who knows how long (without losing it)https://www.cpr.org/2020/03/17/what-to-do-with-kids-at-home-on-coronavirus-break-mental-health-for-parents-too/

What to do during social distancinghttps://www.wpxi.com/entertainment/see-and-be-seen/11-things-do-home/7PCRKBB5VBGO7NMP7AFUC5XAPI/

100 things to when trapped insidehttps://www.usatoday.com/story/life/health-wellness/2020/03/16/coronavirus-quarantine-100-things-do-while-trapped-inside/5054632002/

List of Dallas restaurants running takeout and delivery specialshttps://www.dmagazine.com/food-drink/2020/03/dallas-restaurants-takeout-delivery-coronavirus-covid19/

Headspace Meditation App free for Prescribing Providershttps://www.headspace.com/covid-19

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Additional ResourcesL i n k s D i s p l a y e d

Thank You and Be SafeKipp Pietrantonio, Ph.D.

kipp.pietrantonio@utsouthwestern.edu

https://utswmed.org/doctors/kipp-pietrantonio/

https://www.utsouthwestern.edu/education/medical-school/departments/psychiatry/

Christopher Glowacki, Psy.D.

christopher.glowacki@utsouthwestern.edu

https://utswmed.org/doctors/christopher-glowacki/

Reed J. Robinson, Ph.D., ABPP

reed.robinson@utsouthwestern.edu

https://utswmed.org/doctors/reed-robinson/

1. Beck, J. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press.

2. Dye, L., Burke, M.G., & Wolf, C. (2019). Teaching mindfulness for the self-care and well-being of counselors-in-training. Journal of Creativity in Mental Health, 1-13. doi: 10.1080/15401383.2019.1642171

3. Gardner, B., Lally, P., & Wardle, J. (2012). Making health habitual: The psychology of “habit-formation” and general practice. British Journal of General Practice, 664-666. doi: 10.3399/bjgp12X659466

4. Hersch, R.K., Cook, R.F., Deitz, D.K., Kaplan, S., Hughes, D., Friesen, M.A., & Vezina, M. (2016). Reducing nurse’s stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research, 32, 18-25. doi: 10.1016/j.apnr.2016.04.003

5. Linehan, M. (2015). DBT skills training manual (2nd edition; pp. 464-466). Guilford Press.

6. Ransdell, L.B., Eastep, E., Taylor, A., Oakland, D., Schmidt, J., Moyer-Mileur, L., & Shultz, B. (2013). Daughters and mothers exercising together (DAMET): Effects of home- and university-based interventions on physical activity behavior and family relations. American Journal of Health Education, 34(1), 19-29. Doi: 10.1080/19325037.2003.10603521

7. Roe, J. & Aspinall, P. (2011). The restorative benefits of walking in urban and rural settings in adults with good and poor mental health. Health & Place, 17(1), 103-113. Doi: 10.1016/j.healthplace.2010.09.003

8. Scanlan, J.N. & Still, M. (2019). Relationships between burnout, turnover intention, job satisfaction, job demands, and job resources for mental health personnel in an Australian mental health service. BMC Health Services research, 19(62). doi: 10.1186/s12913-018-3841-z

9. Wolf, C. (2019, August 9). Mindfulness: An underutilized tool for patients and providers alike [PowerPoint Slides]. Scholar Works. https://scholarworks.uvm.edu/cgi/viewcontent.cgi?article=1577&context=fmclerk 26

References