The Unexpected Benefits of Teletherapy

By Annabelle Parr, MA, AMFT and the CSAM team

It’s been nearly 4 months since we started COVID-19 quarantine, physical distancing, and since we transitioned to offering therapy via telehealth at CSAM. We knew from the outset of this shift that research indicates that, assuming that the therapist and modality are an appropriate fit for the client’s needs, teletherapy is as effective as in person therapy. Even still, we were initially apprehensive about this change, as we were uncertain how it would feel to switch from sitting across from our patients to communicating with them through a screen. Despite our initial worries, we have been pleasantly surprised to discover that not only has our experience been consistent with efficacy research, but that teletherapy has actually had a number of additional benefits we did not anticipate.

And given that the past few months have brought a lot of stress, pain, anxiety, grief, and frustration, we wanted to take a moment to reflect upon some of the beauty and connection that we have noticed amidst this tumultuous time. Below are reflections from our team of therapists on some of the benefits they have noticed about the tele-therapeutic process. 

Common humanity: we’re all in this together.

CSAM Director Dr. Jill Stoddard said, “I was worried that telehealth would make the connection with clients less personal, but what I've found is that my clients are now introducing me to their partners, their kids, and their pets, so in many ways I actually feel MORE connected to them. I was also worried about interruptions from my own kids and dogs, which HAS happened, but my clients have been so patient and understanding. In many ways I think they too feel more connected to me because it's all just so human and we're having a shared, unique experience of having to do things from home with our families around.”

Increased connection: a fuller picture of clients’ lives.

Associate Director Dr. Michelle Lopez agreed. She said, “my experience is similar to what Jill described in that I feel MORE connected to clients. Telehealth has allowed me to have a fuller, more colorful picture of what their lives are like which I am able to envision when I am conceptualizing and tailoring treatment plans. It has also been excellent for exposures. When "we" can walk to the client’s backyard or kitchen (or wherever the exposure task needs to happen) in a matter of seconds, it allows more time for the actual exposure task. A few clients have commented on how much easier it is for them to "arrive" on time because they don't have to account for traffic, being unable to find their keys or shoes, etc.”

Superhero sidekicks: incorporating pets into therapy.

Superhero Therapy creator and lead trauma specialist Dr. Janina Scarlet noted that “an unexpected but interesting side effect of telehealth has been the ability to incorporate pets into therapy. Many people’s pets have become their sidekicks on their mental health journey and my own cat, Hera, has become a kind of mascot of an emotional support pet for many of my clients.”

Increased convenience: involving family and doing exposures at home.

Child and teen specialist Thi Wlodarski, LMFT agreed with Dr. Lopez that exposures have been more easily facilitated: “telehealth has been really beneficial for my clients whose rituals are often done at home. Clients are able to complete exposures in the situations that trigger their anxiety instead of having to simulate it in the office. I've also been able to do more family therapy because all members are home together. I've been able to involve parents who wouldn't normally been able to be present in session. 

Comfort and creativity: therapy from the comfort of home.

Dr. Terra Fuhr said, “I have also found telehealth to be a surprisingly smooth transition. Several clients have commented that it feels easier to open up, be vulnerable and talk about difficult topics from the comfort of their own space. I also wonder if being in the environment where they live life may remind them--or prime them--to talk about the most relevant emotions of their day-to-day lives. We've been able to do more creative exposures. And everyone seems to love not having to factor in commute time!”

As always, we are continually inspired by our amazing clients.

Insomnia specialist Dr. Melissa Jenkins agreed with the rest of the team, and added her feelings of admiration for her clients’ courage and perseverance during this difficult time. “Over the past few months, I have been struck by how bravely and thoughtfully people have welcomed therapy into their homes by way of telehealth. In our current circumstances (in which we are faced with many competing demands on our time and energy as we navigate a new way of living amidst coronavirus), it can be really hard to keep appointments and prioritize mental health. I am truly inspired by my adult clients who are committed to prioritizing their mental health, showing up for appointments and challenging themselves, and by my client’s parents who continue making therapy a normal part of their children’s lives. Sessions, of course, look a little different as we engage in therapy together through screens; however, it has been powerful to connect with clients in their more natural environments (as opposed to a therapy office) and to witness continued growth in the face of substantial adversity right now.”

Teletherapy allows us to keep our clients and our communities safe.

Of course, we are all collectively missing the normalcy of life pre-pandemic. And here at CSAM, we look forward to a time when we can see our clients in person again. However, we are also happy and grateful that we are able to do our part in slowing the spread of COVID-19 by offering our services via telehealth for as long as is needed. Remaining at home and offering teletherapy is consistent with our values of keeping everyone as safe as possible while this pandemic continues. As the number of cases continues to rise both here in San Diego and across the United States, the best thing we can do to keep our clients and our communities safe is to stay home whenever possible. Under these circumstances, telehealth allows us to offer the most competent, compassionate and connected care.

If you need support during this difficult time, CSAM is here to help.

Even as we reflect on some of the upsides of telehealth and the strength, courage and resilience of our clients, we also recognize that this pandemic and the upheaval we are experiencing has increased stress, anxiety, and even trauma for many folks. So know that if you are struggling, you are not alone and evidence based treatment is still available to you.

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, insomnia, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Fostering Resilience during COVID-19 by Connecting with Our Values

By Annabelle Parr

As we enter Mental Health Awareness Month this year, we are collectively experiencing not only a global health crisis, but also a stressor which has potentially significant repercussions for our mental health. At the very least, we are likely to be experiencing a range of painful emotions as a result of this crisis. On any given day, I find myself feeling at least some combination of the following: anxiety, fear, stress, grief, frustration and/or exhaustion. 

As an Acceptance and Commitment Therapy (ACT) therapist, when I am struggling, I ask myself the question: can I be willing to have this pain, and still choose to move in the direction of what matters most to me? The goal of ACT is to help us to live more vital, meaningful lives even as we struggle with the inevitable pain and discomfort inherent in being human. And goodness knows this pandemic has given us all a whopping dose of pain and discomfort.

But what does a meaningful life look like during a global crisis?

Prior to COVID-19, I felt like I had developed a pretty good sense of how to move toward what matters even when I feel anxiety or fear or frustration. But this pandemic has challenged me. At first, I felt overwhelmed as it seemed the world had turned upside down, and I struggled to find ways to live my values when life suddenly felt so restricted by forces beyond my control.

So I began to consider: how can I continue to move toward what matters most to me, even as life has become more restricted by this pandemic?

A few weeks ago, I was scrolling Instagram and came across a post posing the question: “if someone told you that you could save a life, would you?” The post went on to remind us that we are all being given that otherwise very rare opportunity, and that in staying home right now, we are actually saving lives.

https://www.instagram.com/igo_medical/

After reading this Instagram, it clicked for me: I don’t necessarily have to do anything monumental or new or different right now in order to make significant, values based decisions. Instead, I can consider what I am already doing – like staying home except for essential errands, or wearing a mask and maintaining six feet from others when I do need to go out, or calling and connecting with friends and family – and I can connect these actions with my values.

What are values?

Values from an ACT perspective are a collection of verbs, adverbs, and adjectives that describe qualities of being; a.k.a. who and how do I want to be in the world? For me, a few of my values include being compassionate, conscientious, kind, and loving.

Connecting with our values can infuse the choices we are already making with purpose.

When I connect even the simple action of staying home with being compassionate or loving, rather than becoming fused with thoughts about how terrible, frightening, or overwhelming this all is, I can ground myself in a sense of purpose and meaning beyond my discomfort. And I can bring my values to anything I do: when I call family or friends, I can choose to show up lovingly; when I go to the store, I can offer gratitude to the essential workers I interact with; when I watch my favorite TV show, I can connect with my value of being kind and gentle with myself. The key is being intentional about why I do what I do.

You are enough just as you are.

Navigating a pandemic is exhausting; it demands so much of us already, and additional pressure to do more when just getting through the day feels taxing enough can feel less than helpful. Part of the beauty of ACT is that values based actions are not always huge, monumental gestures; in fact, more often, they are the small, intentional choices we make to show up in a particular moment as the type of person that we hope to be in the world. So rather than beating ourselves up for feeling like we are falling short somehow, we might ask ourselves instead, how can I bring the qualities I hope to embody to the actions I am already taking? How can I connect the things I am already doing back with the kind of person that I hope to be? 

“Those who have a why to live can bear almost any how.”

I keep coming back to the wisdom of Viktor Frankl during this time; as a Holocaust survivor and psychiatrist, he is particularly well suited to guide us through crisis. He noted that “those who have a why to live can bear almost any how,” and I might add that those who have a why to act can bear almost any how. The “how’s” of our day-to-day right now pose a whole host of new challenges for us, but when we can connect with a why behind these challenges, we are likely to meet them with much greater resilience.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, insomnia, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

How to Seek Therapy During Social Distancing and COVID-19: Telehealth Services for Anxiety and Stress Management

by Annabelle Parr

Within just the last week, most of us have gone from living our lives as usual to an entirely new pace of life and day to day routine: working from home, homeschooling cooped up kids, adhering to social distancing guidelines to keep ourselves and our communities safe and healthy, etc. As we navigate the COVID-19 pandemic together (yet apart), we are faced with a number of unique stressors in addition to the ones that we might already have been managing, and this may mean that we are experiencing increased anxiety.

Anxiety and fear are specifically designed to help us prepare for and respond to threats.

As Dr. Jill Stoddard put it in her new book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, & Stress Using Mindfulness and Acceptance, “by simple definition, anxiety is a state of future-focused readiness to deal with potential unpleasant events; this is related to but different from fear, which is a more acute reaction to an in-the-moment perceived threat (Barlow, 2002).” It makes sense that many of us would be experiencing both anxiety – as we are grappling with an enormous amount of uncertainty regarding the future health and financial stability of our nation and our families – and fear, as we are facing an immediate threat to our individual and collective wellbeing.

Feeling anxious right now makes sense. Be gentle with yourself.

One important piece of self-care during this time is to recognize and honor our feelings. Anxiety has a purpose: it is specifically designed to motivate us to prepare to manage threats. It makes sense to feel anxious and afraid. A certain amount of anxiety and fear are adaptive in this situation; they are here to remind us that something is amiss. And stress can help us to adjust our behavior in response. As Kelly McGonigal (2013) pointed out, stress releases a combination of adrenaline and oxytocin, which are hormones designed to prepare us for action and to prompt us to connect, increase empathy, and seek and give care to others. All of these feelings are evolutionary responses designed to kick in in moments like this. So as always, responding to our emotions with self-compassion is crucial.

How do I know if my anxiety has gone too far?

If you are finding that the anxiety and stress you are experiencing during this time are impacting your ability to function – that is, if these feelings are negatively impacting your relationships, your sleep patterns (e.g. causing insomnia or impairing your ability to fall or stay asleep), your ability to attend to tasks needed to care for yourself or your family, or you are finding these feelings overwhelming and are unsure how to cope with them – support is available.  

Can I still seek therapy with social distancing requirements?

Despite the fact that we are required to maintain distance from each other and stay in our homes (except for essential work and errands or a walk/run/bike ride outside maintaining 6 feet between ourselves and others) it is important to know that you can still seek and receive therapy amidst COVID-19. Many therapists, including those here at The Center for Stress and Anxiety Management, have shifted to utilizing telehealth in order to both adhere to COVID-19 guidelines and still attend to patients’ mental health needs. Telehealth sessions expand access to care, as they allow therapists to work with anyone living in the state in which they are licensed (CSAM therapists are available to work with anyone in California). Also important to note is that studies have shown therapy via videoconference to be as effective as in person therapy. It is crucial that those who need support during this time are able to access quality care they need, and telehealth allows mental health providers to ensure it is available.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, insomnia, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com