Addressing Your Clients’ Anxiety During COVID-19: Using Technology

The COVID-19 pandemic caused by the coronavirus is affecting us all. Schools, universities, offices and businesses are all shuttered. For many, this is a time of moderate to severe anxiety. As mental health workers, we want to allay fear and provide comfort. We also want to teach resilience, self-reliance, and confidence. How do we do this while we are working from our home offices?

A Few Words About Anxiety

During the pandemic, anxiety is being created by three main factors:

1. Ambiguity
2. Anticipation of Negative Consequences
3. Disruption of Daily Routine

Ambiguity: Remaining calm requires a sense of predictability (not necessarily control), that one has a good idea of what is coming next so one can prepare. Currently, our political leaders and medical experts do not have enough information to share with us about how long the pandemic will last, how many people will suffer, how bad the economy will be damaged, and what will happen when “this” is all over. Stress occurs when we need to adapt. But when we don’t know how we will need to adapt – when we lack predictability – this creates anxiety.

Anticipation of Negative Consequences: The possibility that something bad will befall us can create severe anxiety and outright fear. With this pandemic, many people are facing the possibility of losing their job and not having enough money to buy food or keep their home. A small, but significant portion of our community is at risk of becoming very sick or even dying. Perception is more important than reality: The more these consequences seem possible, the more anxiety and fear is felt.

Disruption of Daily Routine: Anyone who has retired can attest to the anxiety one feels with the loss of one’s daily routine to provide structure to one’s daily life. The coronavirus pandemic has created massive disruption to our daily lives and loss of routine. Restaurants, cafes, and theaters are closed. Most employees are working from home or not working at all. We are directed to remain at home and not socialize. Stripped of our daily routine, we are forced to spend mental energy throughout the day thinking about what we need to do or want to do with our time. We lose predictability, resilience to tolerate stress, and the passive comfort normally gained from daily social interactions. This can cause feelings of isolation if not loneliness. Many may find themselves feeling moody or edgy, and possibly in conflict with those sharing a house or apartment.

How do we help our clients manage their anxiety?

Teaching resilience and confidence helps clients manage their stress and anxiety. Below are skills to help:

1. Encourage clients to rebuild their daily schedule, including contingencies and flexibility. When will they wake up? When will they exercise? What activities will they do? What will they eat? Be ready for change!
2. Teach clients that confidence comes from acknowledging their own abilities, and the collective resources and abilities of their social network. Have them list the people in their social and professional network. Have them itemize other resources such as money, housing, and skills that they have to support them.
3. Encourage them to invest time and energy into developing their social network on a regular basis. Create and maintain social connections. During the pandemic, encourage them to reach out using Zoom, Skype, Facetime, Facebook, Twitter, Instagram and best of all a phone call.
4. Clients may be worried about money, loss of loved ones or even their own illness during this pandemic. Ask them to deal with ambiguity by writing plans and including contingencies. When situations are very fluid, direct them to revise their plans again and again.
5. Encourage them to avoid the anticipation of negative consequences. Do not catastrophize. Do not focus on the worst-case scenario. With plans in place, it is statistically unlikely that they will face the worst-case scenario.
6. Encourage them to allow the negative feelings, but also teach them positive self-talk such as “I have plans to manage this event”, “I have resources I can use”, ”I have people I can call”, and “It is unlikely that someone in my family will die from COVID-19.”

Hold Sessions using Remote Video / Teletherapy

How will you monitor your clients’ anxiety and coping abilities when you cannot conduct sessions with them in person? Fortunately, CMS and several major insurers have relaxed requirements to allow providers to use secure HIPAA-compliant videoconferencing software (e.g., Zoom, WhatsApp, SimplePractice, VSee) to provide teletherapy sessions. During sessions, you can set the framework for teaching resilience and confidence.

Assign Digital Homework

Between sessions, have clients document and practice each of the skills above using an electronic journal software application that includes HIPAA-compliant messaging. You can focus on a single skill for a week or have them write out all of the skills one week and continue practicing the skills in subsequent weeks. A journal application should use tags (brief terms for labeling journal entries) to enable clients to label critical thoughts, feelings, behaviors and coping strategies. Work with your clients to create customized tags for each one based on their unique needs. You can then use the tags to track their progress over time. I do this with my clients using CaseKeepers (www.CaseKeepers.com).

Track Moods and Behaviors and Receive Smart Notifications

Using CaseKeepers, I set up automated popup questions that ask my clients to report their mood and anxiety levels. In just one second, they can click on a mood or anxiety level and it is saved in their case. In session, I review their mood and anxiety level over time in a graph. This enables us to look for patterns and triggers and develop adaptive responses.

Efficiency is the key to digital therapy. I do not read every journal entry written by my clients. In CaseKeepers, I set up notifications that highlight the journal entries relevant to key topics or that have been marked as urgent.

In addition, I create alerts that occur when a client’s mood tracker indicates depression or dramatic swings. This allows me to address urgent situations in a timely manner.

Using smart notifications, I respond only to important messages and journal entries. Sometimes I respond to clients using CaseKeepers internal messaging system to do what I call “cognitive shaping” and encourage self-soothing. For example, I ask them “What are you saying to yourself?”, “Are you talking to yourself with gentle compassion?”, or more directly, “Have you called a friend?” or “What do you think is most likely going to happen when this is all over?”

Digital technologies such as CaseKeepers allow me to remain connected to my clients and continue skills development to help them better manage their anxiety.