The Long Road Back: Integrating back into life as the pandemic shifts

Written by Dr. Stephanie Unwin-Kuruneri,
a Psychologist and clinical supervisor in Manhattan, NY
[Click here to read more about her]

It was a long, strange, and scary year

We are quickly approaching the anniversary of COVID 19 in the US and its lasting impact on the American psyche. #themoment is trending. Naturally, a lot of feelings are coming up. Anniversaries are typically a time for reflection, and this is no different. Where were you this time last year?  What were your dreams or plans for 2020? What did you have to give up? A lot? A little? Most of it? All of it?

It has been a full year of seasons, missed graduations, drive by birthdays, canceled trips, Zoom calls and masks. Digesting this reality can feel overwhelming, or even retraumatizing to some. However, it is helpful to mourn what was lost. 

As cases decline, vaccine distribution continues, and the snow begins to melt, the reconstruction of community is on the horizon. While exciting as a return to some form of normality can be, this can be anxiety provoking for many, since we all have our own unique pandemic experience. Some of us have lost loved ones, some have not. Some have escaped sickness and others may still be recovering. Some of us have had a bubble, some have had no one. Maybe you have not been on public transportation or aren’t yet comfortable in stores and still have your groceries delivered. As we attempt to reconnect to each other, to repatriate our lives, it will be helpful to remember that there are myriad stories.

What was your story?

Acknowledging your personal experience over the course of the past year can ease the feelings of anxiety and uncertainty that will surely mark this transition period. What was your story? Perhaps you want to share this with trusted friends or maybe you want to journal it just for yourself. While we think about how to move forward, it is important to consider your personal journey. There was been no blueprint for how to manage life during the pandemic and there isn’t one for how to integrate back into the world. You may want to start slow or dive right in. But it’s important to remember that we are the author of our own stories. Each person has their own threshold for safety and risk. For many of us it has been a balancing act as things have relaxed, restricted, and relaxed again. Exploring and identifying your comfort level with different activities will better help you communicate them to the people in your life (friends, family, your boss).

What did you gain? What did you lose?
Transitioning is important and it starts with you.

As with any transition, there is something to be gained and something that will be lost. This does not mean a net-loss by any means, rather more of a shift from one state of being to another. “What did you gain or lose this past year?” is as valid a question as “What do you anticipate gaining and losing as you move forward?” We may gain more social interaction and connection and yet lose a certain predictability that may have been comforting. There will be a period of adjustment and therefore, we need to give ourselves grace as we adjust.   

It starts with you. As the anniversary approaches, try to check in with yourself and how you are thinking about it. Acknowledging regret, loss, jubilation (you made it a year!) are all valid ways to feel, and not just one, you may feel all of them. It will be this, recognizing the impact that pandemic has had on your well being, that will help you more consciously transition back into the world. Happy anniversary! 

A Pause for Justice

Photo courtesy of @bingandruth 6/3/20

We’re taking a necessary pause from our usual posts to honor George Floyd, Ahmaud Arbery, Breonna Taylor (and countless others), and to acknowledge the nationwide anguish ignited by injustice, racism, and violence.

Now more than ever it is time to listen.

To work to understand and validate others’ experiences, particularly those who have been oppressed and marginalized. 

To be open to others’ stories, their truths.

Even if they are difficult to hear. 

Even if they are at odds with preexisting beliefs.

Now is the time to educate and re-evaluate.

To seek allyship by asking those in need what they need. 

To engage despite discomfort.

There are many avenues for action, but one of the most important is to try to find ways to connect and to dialogue with people who are different from you.

We at CoreStory believe that every individual’s story matters and deserves to be heard.

Right now, we hold space for everyone encountering fear, anger, helplessness, and voicelessness.

Don’t hesitate to reach out for support.

Be kind to yourself. Be kind to others.

Blog Series: Talk Therapy When You’re Stuck at Home (Part 1)

Image courtesy of @danielbarretoes

In these strange pandemic times, it feels like things are changing every moment and strangely, at the same time, things seem to never change!  We simply have to roll with it all. This means embracing unfamiliarity for the sake of safety, and talk therapy is no exception. As a result of the need for social distancing, face-to-face counseling is now digital and remote.

Over the next several weeks, we’ll be putting out a series of posts that will outline the full teletherapy experience - what it is, what it isn’t, and how it can benefit you (particularly during the pandemic).

To begin this series, let’s first talk about what teletherapy is, who can use it, and why we’re talking about it.

What is teletherapy?

Teletherapy is a term that refers to counseling services that are provided via the internet or phone. It means you use a computer or phone to have meetings and speak with a therapist--you being in one place (e.g., your home) and your therapist another. You may have only recently begun to hear about this practice due to COVID-19, but it has existed since the 1990’s. We’ll get into much more detail about what the remote therapy process entails in upcoming posts.

Who uses teletherapy?

In the past, the teletherapy option has been aimed at particular demographics such as people who have limited access to services, lack of transportation, or mobility issues. More recently, in response to the necessary transition to remote services due to coronavirus, teletherapy has demonstrated that it can be used by virtually anyone. Most insurance providers will cover telehealth visits. In light of the pandemic health crisis, insurance companies have temporarily modified certain policies to make it easier and more affordable to receive telehealth services. It is always a good idea to call and double check with your plan.

Why might you use teletherapy?

You may have noticed how online / telephone therapy has become an unusually hot topic due to the public health crisis. The uptick makes sense as the quarantine has forced many in-person services to shut down, or be delivered remotely when possible. What this means for you is that if you were previously in therapy, it doesn’t have to end. You now have the option to transition to teletherapy. Similarly, whether you’ve simply been wanting to try therapy for a while, or the pandemic situation has caused extra stress, teletherapy is a convenient outlet for immediate emotional support.

Have you done therapy using video or phone? What did you think of it? Share your story below.

Keep a lookout for our next post in which we’ll outline practical ways to help you prepare for teletherapy sessions.

Gut Feelings: The Connection Between Digestive Health and Mental Health

Image via Consumer Reports

Body + Brain, Together Forever

Over the past decade, diet, nutrition, and general health have become particularly hot topics. Health encompasses both our emotional and physical well-being, so it shouldn’t surprise you that they’re intimately connected.

The Human Microbiome

Emergent research has pointed more and more to the gut-brain linkage. Many studies have begun highlighting the role of inflammation and the importance of maintaining a balanced microbiome.

What is a microbiome, you ask? It is defined as the collective genomes of the microbes (composed of bacteria, bacteriophage, fungi, protozoa and viruses) that live inside and on the human body.

Gut Health’s Relationship to Mental Health

The body reacts to stress in two primary ways - hormonally and immunologically.

Hormones

We know now that chronic stress can create elevated levels of the stress hormone cortisol, leading to physical and emotional issues such as anxiety, depression, high blood pressure, headaches, as well as gut issues. But this is only half the story.

The Immune System

The other half is that our immune system is also affected by stress. Our immune system responds to stress like it’s an infection, creating inflammation to counteract it. This system is highly effective at protecting our bodies from pathogens, but if the inflammatory response persists for too long, it can create the same sorts of physical and emotional issues as with elevated cortisol levels.

Tips For A Healthy Gut

Diet

Studies suggest that to encourage a healthy microbiome, it’s best to:

• Limit refined, processed, or saturated fat ingredients (e.g. white sugar, white flour, meat/dairy fats).

• Incorporate fermented foods (e.g. active culture yogurt, kefir, pickles, sauerkraut, miso, tempeh, or kimchi).

• Include fiber-rich foods (e.g. whole grains, legumes, whole fruits and vegetables).

• Look into a low FODMAP diet.

Probiotics

• Disclaimer: despite much hype, probiotics on their own are not currently FDA regulated or reliably proven to be effective in alleviating symptoms of mental issues such as anxiety or depression. However, research suggests that they are helpful when used in concordance with psychiatric medication. The question remains: can probiotics alone (without pharmaceutical medications) alleviate these symptoms? We’ll have to wait and see what future studies tell us. In the meantime, if they work for you, run with it.

Take Care

• Keep stress levels to a minimum.

• Stay hydrated.

• Get proper sleep.

• Exercise, do yoga, meditate, or try diaphragmatic breathing exercises.

The Takeaway

As always, it’s important to always be tuned in to your body and emotions. If things feel out of whack - you’re not sleeping well, feeling anxious/depressed/exhausted, having digestive problems - then perhaps it’s time to change something. The solution will look different from person to person; the balance of our bodies and minds is unique to us. But don’t underestimate the power of nutrition. We can harness that power to help keep us well, too. Joy Yang, a National Institute of Health microbiome researcher said it best:

“We have learned that the bacteria living in and on us are not invaders but are beneficial colonizers. The hope is that, as research progresses, we will learn how to care for our microscopic colonizers so that they, in turn, can care for our health.”

What do you eat that makes you feel good, happy, and healthy? Leave a comment below!

Further Links

• https://www.psychologytoday.com/us/blog/evolutionary-psychiatry/201404/the-gut-brain-connection-mental-illness-and-disease

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641835/

• https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection

• https://www.genome.gov/27549400/the-human-microbiome-project-extending-the-definition-of-what-constitutes-a-human/

• https://www.mindbodygreen.com/0-28182/6-ways-to-boost-your-nutrient-absorption-by-improving-your-gut-health.html

• https://www.psychologytoday.com/us/blog/the-future-brain/201810/breakthrough-microbiome-study-links-gut-neurobehaviors

• https://stanfordhealthcare.org/medical-treatments/l/low-fodmap-diet.html

Online Counseling: The Future of Therapy?

https://bit.ly/2OLYksI

Thanks to the internet and its infinite apps, we’re able to gratify almost any need in an instant. So much of our day-to-day has become on-demand and platform-based. Curious about someone? Facebook. Hunting for a job? LinkedIn. Need a ride? Uber. Want a date? Tinder. Hungry? Seamless.

But what if you’re looking for therapy?

Telepsychology aims to make counseling easy to access. It simplifies and speeds up the process of finding a therapist. No more going to an office for a weekly appointment. For most platforms, it comes down to a quick sign-up, survey, live chat evaluation, and then via an algorithm, voila! You’re matched with a counselor. Sounds streamlined enough, but inevitably it’s more complex than that. For starters, which platform to choose?

Telepsychology Options At A Glance

Within the past several years, telemedicine has brought with it a wave of new online counseling platforms. These platforms offer a variety of modality options: video conferencing, live chat, audio, and texting. Some charge per session, others offer monthly subscriptions, with varying eligibility for insurance reimbursement. The table below offers a side by side comparison of the most popular recent online counseling services.

Note: The Wirecutter, a New York Times product review company, recently published several informative articles about online counseling [see below for links]. Their team tried several of these services, ultimately choosing AmWell and DrOnDemand as their top two picks. Preliminary research has indicated that video is the preferred modality, likely because it gets as close to an in-person therapeutic interaction as technology allows.

Benefits and Risks

As with any new tool, online counseling comes with a host of positives and negatives.

Pros

• Highly flexible

• Eliminates barriers to treatment - ideal for clients who are highly anxious, homebound, disabled, dealing with PTSD e.g. veterans, or living in rural areas

• Normalizes mental health treatment and decreases stigma 

• Serves as a great introduction to therapy on the road to longer-term treatment

Cons

• Hinges on accessibility to / reliability of technology

• Introduces legal issues (clinicians are geographically bound by their license to practice in a certain state)

• Brings up ethical issues (client privacy, limitations with crisis intervention)

• Limitations of technology with regard to establishing an authentic connection

• May not be ideal for high-risk cases or clients dealing with serious diagnoses

• Can be more financially driven than care driven - companies compromise services provided to clients, and fail to support / protect clinicians

• Are often launched by people who come from a tech background, not a mental health background; without enough clinicians on staff, team might not fully grasp the legalities and ethics of HIPAA compliance, geography-based practice limitations, etc.

Teletherapy has already showcased its potential to normalize mental health treatment and to maximize client access to these services. At the same time, its pitfalls are not insignificant and affect both clients and clinicians. For clients in crisis or dealing with severe diagnoses, the digital interface may not provide sufficient support. Depending on the platform, clients are not always required to provide identifying information, making proper crisis intervention very difficult for a therapist to carry out. In this vein, client privacy is an ongoing concern. Platforms are usually HIPAA compliant, text is SSL encrypted, but therapist access to client records and a client’s right to remain entirely anonymous remain gray areas.

Additionally, technology in general creates a certain barrier that may compromise an authentic therapeutic connection. Imagine being in the middle of an intense, emotional video chat with your therapist and all of a sudden the screen freezes or the WiFi cuts out. It’s a tall order to replace the in-person therapeutic relationship; online counseling is doing its best despite the restraints of technology.

The Takeaway on Teletherapy

Therapy doesn’t need to cling to the couch or fear the smartphone’s influence. Mental health treatment has to be able to evolve with the culture. At the same time, online therapy services shouldn’t compromise quality of care, or legal and ethical standards of the field. Teletherapy companies are a delicate combination of revenue-driven business and nuanced, human service. In online counseling's ideal form, protecting practitioners, supporting clients, and honoring the therapeutic process should always come first.

How do you feel about online therapy?

Would you try it? Have you tried it?

Is it the future or just too strange?

Share your thoughts and experiences with us! We’d love to hear from you. 

Leave a comment below.

More Links About Online Counseling

• http://www.apa.org/monitor/2011/06/telehealth.aspx
   
• http://www.apa.org/pi/disability/resources/publications/telepsychology.aspx?tab=2
   
• http://www.apa.org/monitor/2017/02/online-therapy.aspx
   
• https://www.npr.org/templates/transcript/transcript.php?storyId=325488110
   
• https://nationalpsychologist.com/2018/03/get-on-board-or-be-left-behind-teletherapy-is-the-future-norm/104283.html
   
• http://www.wbur.org/onpoint/2017/06/20/the-future-of-mental-health-therapy
   
• https://thewirecutter.com/reviews/online-therapy-services/#our-pick-amwell
   
• https://thewirecutter.com/blog/text-therapy/
   
• https://thewirecutter.com/blog/online-therapy-experience/
   
• https://www.thecut.com/2016/12/the-potential-danger-in-therapy-apps-like-talkspace.html

What Is Narrative Therapy?

Narrative therapy begins with the simple question:

“What is your story?”

In a nutshell, this approach:

• Views the client as the expert and author of his/her/their life story

• Separates the person from the “problem” with a non-blaming attitude

• Empowers individuals to change their thoughts and behaviors - to essentially rewrite their story however they envision it

Click here for further reading about this style of therapy and how it can help you.