Health Newsfeed – Johns Hopkins Medicine Podcasts

First responders and frontline workers have largely soldiered on during these last two years as covid continues to morph. Karen Swartz, a psychiatrist at Johns Hopkins, says when that pressure it released there could be a big impact.

Swartz: My concern is, as we finally emerge from the Covid infectious disease disaster that for the first time many will be experiencing a sense of being overwhelmed, and be able to actually feel their depressive symptoms or anxiety symptoms. I have particular concerns for those who are on the front lines: first responders, healthcare workers, delivery teams and those keeping essential production moving, who have never really had rest during this long challenging period. Some may even experience PTSD because of traumatic experiences they had during this pandemic, working on the front lines.  :32

Swartz reminds those in these positions to pay attention to how they are feeling, as PTSD in particular responds well to intervention, and the sooner the better. At Johns Hopkins, I’m Elizabeth Tracey.

One in three adults is reporting mental health problems as the pandemic continues, the most recent CDC data indicate. Karen Swartz, a psychiatrist at Johns Hopkins, says anxiety is extremely common, and depression is hard on its heels.

Swartz: With depression they’ll describe feeling much more negative about themselves and about the future. They also have significant distress. Their capacity to feel joy is blunted, and they have feelings of sadness or irritability or a lack of feeling. Most often they also have changes in sleep, appetite, energy and focus. During the pandemic there’s been a clear pattern, where younger individuals seem to be having more anxiety and depressive symptoms compared to older individuals. Younger adults, say in the 18 to 30 range, report much higher rates of anxiety and depressive symptoms, than those who are older.  :33

Swartz says treatment is especially important for this young group as depression is well known to recur and can become more severe. At Johns Hopkins, I’m Elizabeth Tracey.

How can you tell if you or someone you love is developing anxiety as a result of the pandemic? Karen Swartz, a psychiatrist at Johns Hopkins, describes the most common characteristics.

Swartz: With anxiety, an individual has a level of distress that often interferes with functioning. They have ongoing tension, and have negative thoughts that are spinning in their mind. They feel off, often with increased heart rate, or trouble catching their breath, and their stomach can feel upset. Anxious people can get into the habit of avoiding activities that make them nervous to make them feel comfortable. And this often leads to someone significantly restricting their activities or even having disability. They also have an ongoing feeling that things aren’t right, and that bad things are likely to happen.  :31

Swartz says the good news is anxiety can be managed. A number of different psychotherapeutic techniques and a variety of medications, either alone or in combination, will usually be effective. She notes that developing a trusting relationship with a therapist is key. At Johns Hopkins, I’m Elizabeth Tracey.

You’ve seen them- the people who continue going about their daily business, cheerfully unfazed by the omicron craziness. Then there are others, furtively visiting the grocery store at 4am to reduce their risk of infection. Karen Swartz, a psychiatrist at Johns Hopkins, says she’s observed almost everyone falling into one of three groups.

Swartz: I believe there are three groups of people. The first is surprisingly resilient. The second is understandably exhausted, and the third is concerningly vulnerable. The rates of reported anxiety and depressive symptoms quadrupled in the summer of 2020, compared to the baseline rates of the summer of 2019. The rates of depression and anxiety symptoms remain three times higher than the baseline rates prior to the pandemic, and the recent CDC data, thirty percent of adults reported having significant anxiety or depressive symptoms.   :31

Swartz says transitions between groups are possible, and if you’re one of the vulnerable group seeking help may be your best course, especially if you feel things are getting worse. At Johns Hopkins, I’m Elizabeth Tracey.

The beat just seems to go on and on with Covid and the Omicron spike. Karen Swartz, a psychiatrist at Johns Hopkins, says what we all need is a dose of resilience, and oh so fortunately, we can help ourselves develop this quality by practicing gratitude and other strategies.

Swartz: Another very effective practice for improving resilience is using a variety of relaxation techniques, including doing progressive muscle relaxation, yoga, meditation, mindfulness training, and exercise.  Mindfulness training is something that with practice we can all do effectively. There are also a number of apps or programs available online to help people develop their own mindfulness practice. All of these mindfulness relaxation techniques focus on positive activities and doing things that reduce our level of stress and distress.   :30

Swartz notes that the most recent CDC data indicate that many of us are experiencing mental health challenges in large part because of the pandemic, so cultivating resilience is especially important right now. At Johns Hopkins, I’m Elizabeth Tracey.

Identifying good things in your life, using your strengths in new ways, and practicing gratitude all help people improve resilience, studies find. Karen Swartz, a psychiatrist at Johns Hopkins, says results were seen with very modest effort on the part of study participants.

Swartz: Interestingly in this study they did these simple positive psychology exercises for only one week. doing those for one week led to an improvement in happiness scores that lasted at follow up at one, three and six months. One of the things that I’ve been talking about extensively during the pandemic is practicing gratitude. Among these positive psychology exercises I think it’s the one that is most straightforward and also one of the most effective. Taking time, often at the end of the day, to reflect on things you’re grateful for, is tremendously helpful.  :33

Swartz says although these exercises sound simple they do work, so she encourages people to try them and see for themselves. At Johns Hopkins, I’m Elizabeth Tracey.

Resilience. Many of us want more of it, especially now as the pandemic continues to rage and stability seems far away. Karen Swartz, a psychiatrist at Johns Hopkins, says you can build your own resilience muscle by engaging in simple practices based on a study of easy techniques pioneered by Martin Seligman.

Swartz: His team did a study of over 400 individuals, where he had one group doing one of three possible positive psychology exercises. The first was to identify three good things in their life every day. The second was after completing a survey to identify strengths, to try to use one of their strengths in a new way each day, and the third was completing a gratitude exercise. Once a day when the participant wrote about at least three things they felt grateful for.  :28

Swartz says embarking on a personal program first using one of these strategies, then perhaps adding another, may initially help you feel more in control, and then help you reframe your experiences and improve resilience. At Johns Hopkins, I’m Elizabeth Tracey.

Our internal hardwiring known as our nervous system is divided into a steady state mode, known as the parasympathetic arm, and the fight or flight mode, known as the sympathetic arm. Karen Swartz, a psychiatrist at Johns Hopkins, reminds us that for almost two years now we’ve been living on high alert.

Swartz: Many have been living in a fight or flight mode for months and months at a time. And that’s taking a toll, both physically and psychologically. So how can we manage this high level of stress? One important step is to manage expectation. We need to recognize that we’re all going to need to adapt, to make changes and to deal with the very different circumstances that we’re in. We also need to be better about identifying the support and resources we have, and actually utilizing them.  :27

Swartz says most of us enjoy a much more robust network of support than we may recognize. Beginning with family and friends may allow your entire circle to realize that these emotions are more common than not at this point in the pandemic. At Johns Hopkins, I’m Elizabeth Tracey.

Disasters have been happening for a long time now, and so have studies of them. Karen Swartz, a psychiatrist at Johns Hopkins, reminds us that we can view our current predicament through the lens of history, and perhaps regain some calm.

Swartz: Any time there’s a disaster, whether it’s a hurricane, or a global pandemic, there’s a predictable psychological response. Early on the entire community will rally to the challenge. This early positive response, with an improvement in psychological wellbeing, is predictably followed by a period of exhaustion and disillusionment when you have a disaster that’s lethal, that goes on for a long time, that has a lot of ambiguity. That’s when you have a disaster of uncertainty. This combination is a setup for the greatest number of psychological consequences.  :33

As increasing rates of mental illness worldwide attest, even if you don’t become infected with Covid-19 you may still experience threats to your health. At Johns Hopkins, I’m Elizabeth Tracey.

Some people quip that change is the only constant in life, and that’s demonstrably true about Covid-19 and the pandemic. Karen Swartz, a psychiatrist at Johns Hopkins, says that very quality is one of the greatest challenges for most of us in dealing with it.

Swartz: Change itself is challenging. Some people who are more extroverted embrace change and enjoy change. Those of us who are more introverted find change inherently challenging. There are other factors that make change harder to manage. These include whether it’s a short term or a chronic issue, whether it’s expected or unexpected, or whether it’s a choice or imposed. Unfortunately, the Covid pandemic incorporates all of the most challenging elements: at least initially was unexpected, it’s been chronic, and it feels very much imposed.  :31

Swartz says simply being aware of one’s own response to change can be helpful, and notes that other coping strategies like limiting one’s attention to both news and social media may be good strategies. At Johns Hopkins, I’m Elizabeth Tracey.