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

Empowering Yourself with Mindfulness: Attending Intentionally to What Matters in This Moment

By Annabelle Parr

We wake up each day to a new series of updates about coronavirus and its wide reaching effects: perpetually breaking news stories with new research, new statistics, new predictions, new guidelines, new stressors. Our attention is yanked like a yo-yo by the instant and constant stream of news in the palms of our hands. Additionally, attending to what used to be a basic task – grocery shopping – now feels like a massive feat involving lots of planning and caution. For those with kids at home, we are trying to attend to their needs, their schoolwork, and their emotions, even as we do our best to navigate working simultaneously.

Where we used to have separate spaces for separate parts of our lives, at least to some degree, we are now navigating the jumble of integrating every facet of our lives into one space: our home. With so many demands and pressing issues competing for our attention constantly, it’s easy to feel overwhelmed. It’s easy to feel like our minds have been hijacked in the same way that it feels our lives and routines have been.

This is hard, AND…

Yes, this is a scary and difficult time. Yes, there is a seemingly endless list of stressors to occupy our anxious minds. Yes, there is a lot of uncertainty and only so many variables within our control. AND. We are not helpless or powerless. As our hearts are flooded with emotions, our minds retain their ability to make choices about how to proceed when faced with the facts and the resulting feelings. We can choose to empower ourselves within situations in which our control over external variables is limited.

What does it mean to empower ourselves during COVID-19?

When I say that we can empower ourselves, I don’t mean that we can empower our way out of our pain. Our pain – our fear, our anxiety, our grief, our anger – is a natural human response when faced with loss and uncertainty, of which we are all getting an enormous dose. Our pain simply is. It is here for good reason, and it often points directly toward what matters most to us. It deserves to be felt and heard.

Empowering ourselves involves increasing our psychological flexibility in service of greater meaning.

When I say that we can empower ourselves, I am drawing on the wisdom of Acceptance and Commitment Therapy (ACT), which says that suffering is a result of psychological inflexibility. When we increase our ability to think and respond flexibly in the face of pain and stress, we empower ourselves to make choices based on our values. We reduce the struggle that comes from fighting with our pain – as if that were the battle to be won – and we free ourselves up to pursue that which brings meaning to our lives.

In his beautiful work Man’s Search for Meaning, Holocaust survivor, psychiatrist and creator of logotherapy (another form of therapy grounded in meaning), Viktor E. Frankl (1959) stated “that everything can be taken from a [person] but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way” (p. 66).

What if I feel guilty for focusing on meaning when basic needs demand my attention?

It may feel incredibly difficult or even indulgent to consider what brings us meaning when we are facing such a collective threat to our health and our financial stability. It may also feel trivializing to invoke the words of a Holocaust survivor here, as even though what we are facing is difficult, it is nowhere near the level of the atrocities which Frankl witnessed and endured.

Yet he suffered such unfathomable horror, pain, and loss, that the wisdom he emerged with certainly seems worth attending to during our own trying times. Additionally, suffering is not something that is meant to be compared. Frankl (1959) himself noted, “suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore, the ‘size’ of human suffering is absolutely relative” (p. 44).

In other words, we do not have to experience the rock bottom of human atrocity in order to allow ourselves space and self-compassion for our emotional experience in the midst of suffering. This is hard. Your pain makes sense. 

An important piece of the psychological flexibility puzzle is mindfulness.

So, how exactly do we empower ourselves to become more psychologically flexible? A good place to start is with mindfulness, or present centered awareness. Jon Kabat-Zinn (1994), founder of mindfulness-based stress reduction, succinctly defines mindfulness as the ongoing practice of “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (p. 4).

In her book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, & Stress Using Mindfulness & Acceptance, CSAM director Dr. Jill Stoddard (2019) invites us to imagine that when we are not engaging mindfully, we are like airplanes on autopilot. Not fully present to what is happening inside and outside of our skin, we are running on muscle memory. We are still making choices for which we are responsible, but we are not totally conscious of the fact that we are doing so.

It is easy to get lost in this space. When we are running on autopilot, we are more likely to react rather than respond: “if your autopilot has commandeered the cockpit, the space between intense emotion and response is utterly nonexistent, leading to an instant, impulsive reaction. It’s as if the intense emotion is a detonator and the reaction is a bomb” (Stoddard, 2019, p. 45). 

Sheltering in place during a pandemic is likely to create some intense emotions and difficult circumstances to which we may react. If we are on autopilot, we are much more likely to react in unhelpful ways, like lashing out at our loved ones and communicating ineffectively. Additionally, when we are on autopilot we may be unaware of what we are actually feeling and experiencing. We may be more likely to numb out in unhealthy ways, and less likely to attend to the things that help care for our minds and bodies. Also significant, we are likely to miss the little nuggets of joy that fly by us as we zone out into the distance.

So let’s flip it around. What does mindfulness empower us to do? When we show up to each moment mindfully, that is, we focus our attention on purpose, in the present moment, non-judgmentally, we are able to….

• Notice and identify our emotions. Our emotions can span the full range of experience, from afraid to anxious to stressed to exhausted to angry to sad to grateful to joyful. Remember, the purpose of mindfulness is not to judge our experience, but simply to notice it.

• Choose how we internally respond to our own emotional experience. Responding gently, with the same kindness and compassion we might have for ourselves as children, for our child, for our friend, or for another loved one is generally a good place to start.

• Choose action in line with the kind of person, partner, parent, friend, employee, citizen, etc. that we want to be. It can be helpful to consider the qualities of being you aspire to embody, such as being compassionate, loving, loyal, diligent, reliable, kind, etc. Then you can purposefully choose to behave in a way that aligns with your personal values.

• Choose what we point our attention towards. This is especially important right now, given that our smartphones are perpetually present and can alert us to every single news update all day long. It’s important to stay informed enough to stay safe and responsible, but that doesn’t mean we are required to be glued to the news all day. When we are more present, we can make a choice about when we decide to update ourselves, how often, and for what purpose. It’s also easy to mindlessly let the day slip away watching Netflix or going down some other rabbit hole of distraction. It’s okay to watch Netflix or to let ourselves be unproductive, but it’s important that we connect with our intention and our reason for our behavior. When we watch our favorite show mindfully, we get to actually engage with it from a place of enjoyment so that we can return to our other tasks more rejuvenated.

• Be present to the things for which we are grateful. When we are more fully present to the moment, we give ourselves the opportunity to appreciate the sweetness in small moments we might otherwise miss. As much as this period of time is full of tragedy, there is goodness to be found if we know where to turn our attention. John Krasinski is working on helping us out here, with Some Good News. But we don’t need a celebrity news channel to tune in to gratitude and goodness. There is goodness to be found in the gift of time with our loved ones, watching our children play together, waving to neighbors from a solid 6 ft. + physical distance, or reconnecting virtually with friends we rarely find time to talk to under normal circumstances. Mindfulness allows us to be present to the joys when they show up and to actively cultivate engagement with the things that bring us meaning; we might just have to be a bit more creative in how we engage those things right now.

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

References

Frankl, V. E. (1959). Man’s search for meaning. Boston, MA: Beacon Press.

Kabat-Zinn, J. (1994). Wherever you go there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

Stoddard, J. A. (2019). Be mighty: A woman’s guide to liberation from anxiety, worry & stress using mindfulness & acceptance. Oakland, CA: New Harbinger.

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