COVID-19 has affected public health in a myriad of ways. In particular, it has negatively affected the emotional, psychological, and social well-being of many people, highlighting the importance of mental healthcare and the urgent need for mental healthcare professionals to continue to provide services to their patients. Dr. Nisha Mehta-Naik, and Lauren Rosenblum, LCSW, provide confidential counseling and medical services to all Rockefeller University employees and students. I recently had the pleasure of speaking with Nisha and Lauren about mental health in the age of COVID-19.
Thank you for taking your time to speak with me today! To start, can you please briefly overview mental health resources available to Rockefeller employees and students? In addition, what is the difference between the work that Lauren does vs. Nisha?
Nisha: I am Nisha, I am a psychiatrist and faculty at Weill Cornell Medicine. Lauren will speak more to her role, but Lauren is a clinical social worker. For the past few years Rockefeller has partnered with Weill Cornell Medicine to provide confidential mental health services. Those services usually are on-campus, but of course because of the pandemic, they are now being offered virtually. All Rockefeller employees from graduate students to faculty to staff are able to utilize the Rockefeller mental health services. We recognize that the mental health system is not easy to navigate and that affordable care can be very difficult to find. We see our role as providing psychiatric evaluations and connecting people to the appropriate provider. And oftentimes we are able to provide all the necessary mental health services in-house, although there is no one-size-fits-all model in mental health care. So after an initial evaluation, we take different factors into consideration, including recommended treatment plan, insurance, access, availability, and come up with a shared decision about the next steps. Regardless we make sure that everyone gets set up with the right resources.
Lauren, can you speak as to what your new appointment adds to mental health care at Rockefeller?
Lauren: Sure! I came on with the focus to provide evidence-based psychotherapy in a short-term capacity. We know that short-term psychotherapy is incredibly effective, especially for targeting singular issues like exacerbated anxiety, depression, life adjustment concerns, or external stress, like one finds in graduate school. So I use a wide variety of modalities—a pretty eclectic approach—and cognitive behavioral therapy is certainly one that I resort to often and have used with the student population thus far. Beyond it being effective, it’s also then very helpful just to be able to graduate people out. The idea is that once you obtain these skills and have gone through some modules together, you might not need long-term therapy. As Dr. Mehta mentioned, for those who are interested in continual weekly therapy or more intensive therapy, we really do our best and are pretty successful in referring immediately out. And even following up and making sure it’s a good fit with the next provider.
You mentioned issues like anxiety. Is it one of the more common issues people struggle with?
Lauren: Anxiety is incredibly common! It’s a common aspect of multiple disorders, like depression. Both Dr. Mehta and I see a lot of anxiety right now. I will let Dr. Mehta speak for herself, but short-term evidence-based therapy is incredibly helpful, at least for people coming with anxiety.
Nisha: Exactly! I think what we know is that in society at large, rates of depression and anxiety disorders are quite high, and they are probably under-recognized. What we also know is that there have been numerous studies done in the past few years suggesting that in the graduate school population (especially science graduate students), there are even higher rates of depression and anxiety compared to the rest of the population. I think that’s consistent, and I think that the good news is that treating depression and anxiety helps and people get better and have a better overall experience.
Have the rates of depression and anxiety gone up recently because people are able to better recognize these issues and seek treatment or just because the prevalence is higher?
Nisha: There was a study done recently that highlighted that depression and anxiety levels in the graduate school student population did go up during the pandemic for multiple reasons. I think there is no silver lining in the pandemic, I don’t subscribe to that belief. It’s a tragedy on multiple levels, but I think it has raised awareness of taking care of your mental health and, as a result, I think there is an awareness to reach out for help because mental health has become more of a societal conversation. I also like to think that with the service being available on campus, there will be a positive buzz about it, the word will spread and it will decrease the stigma related to mental health difficulties.
Lauren: And that, in turn, will hopefully help us answer that question. With decreased stigma related to engaging in psychotherapy or psychopharmacology, maybe we can better assess whether we see a larger number of people or if indeed the rates are getting higher.
For people who are not quite there yet, for people who are dealing with stress, but don’t necessarily want to seek treatment for anxiety or depression, are there any tips and tricks you can recommend for dealing with stress during these very stressful times?
Lauren: Both Nisha and I would offer that if there is ever a recurring idea to seek support, please call us. We can certainly offer more structured therapy or a more casual supportive level. But there are tips that are pandemic-specific. We see a lot of people that lose structure, which causes a lot of reconditioning. Aerobic exercise, getting out of your environment is so important—there is a relationship between physical and mental health. So being cognizant of the daily rituals, like hygiene, sleep cycle, getting out, and feeling socially connected, whether it’s in some safe capacity outside or getting on a Zoom call with friends and family.
Nisha: I would echo that. I think maintaining a flexible structure is key, knowing that circumstances may change, that weather changes, and things that you can do in July may not be possible in December. But keeping some level of physical activity up, having some socialization, and some focus on productivity. Staying productive also leads to feeling fulfilled. Productivity may look different at different points of your career development or circumstance.
It definitely worked really well for me! I am a fitness freak, and when I lost access to the gym, I felt the psychological effects. But coming up with a structure, like running every day, really helped in the beginning of the pandemic.
Nisha: Well that’s the thing, too. Researchers have a really unique job that includes a lot of thinking, but at the same time a lot of physical activity. And with things like lab closures, people can easily lose their physical activity in their day-to-day lives, like standing at a bench, or quick social interactions, like seeing someone when you walk into the lab. So much has been lost and then regained in the spirit of time, that having flexibility and recognizing what is lost is really important.
Do you think anything goes when it comes to coping with stress or are there some counterproductive ways to deal with it and something you should avoid?
Lauren: It would just be the reverse of what I said. So really paying attention to isolation. We’ve seen so many people who just don’t feel safe leaving their homes. If you go a few days without having any social connection, it’s something to pay attention to.
Nisha: A couple come to mind. There is so much going on right now, but, in addition to that, there is still normal life stress of professional and personal development. I think it’s really important for people to focus on what they can control. Counterproductive coping strategies would be focusing on things we can’t control. I try to encourage everyone to stay ambitious and passionate and use that to focus on what they can control. Focusing on things that you absolutely can’t control can lead to a lot of undue anxiety and frustration. I also encourage people to avoid putting all their eggs in one basket. Sometimes in professional development, it can be tempting to derive all of your satisfaction and self esteem from career success. I tend to encourage people to think about success and productivity in different ways. Some people put all of their eggs in one basket and think work is the only way they are going to feel good about themselves. For other people it can be other areas, like a relationship or weight.
Lauren: And also sitting still and isolating with rumination. So you need to be really cognizant that you are not socially isolating and sitting alone with negative thoughts.
I think I know what you mean. I think for me, in the beginning, the most counterproductive thing was getting addicted to the news cycle. I thought that if I stayed informed, it would give me some level of control, but then I couldn’t put my phone down. I was unable to stop reading the news. I had to stop that eventually.
Nisha: I think it was all of us! Looking at the numbers every day and then trying to analyze the data. It was so tempting.
It wasn’t very productive though! I had to limit it to once a day, maybe. We briefly talked about it, and you mentioned that if someone frequently thinks about how much they need support, they need to come talk to you. What are some signs that your stress is beyond the normal levels? What are some of the signs that you actually need help with mental health care?
Lauren: I imagine, it’s pretty specific to the individual. We all have different thresholds and different levels of coping. So if it got to a point of severity and someone is getting to the clinically depressed level or feeling hopeless, having a hard time getting out of that mood state, before it gets to the emergent level, absolutely utilize us. I think what we are trying to develop is something that can be more inviting at earlier stages so it doesn’t actually have to get an acute place. If it gets more acute and people are feeling hopeless, they are not feeling like themselves, they are behaviorally isolating and their sleep and appetite might be compromised, panic symptoms, suicidal ideation, those are some not-so-early warning signs.
Nisha: I agree with Lauren. Don’t hesitate to reach out and reach out early because things will get better and treatment can be really helpful. Different people get better in different ways, but we try to have some flexibility in approach. That is part of the benefit of having Lauren on board—she offers a whole different skillset to make sure that people get the support they need. We are also able to get people connected to the right care. Don’t hesitate to reach out! I’d say if you are asking that question, it doesn’t hurt to meet with us even once to just check in. It’s a really challenging time, and grad school is really challenging. If you are wondering, “Is this a normal response?,” we can help keep an eye on things the same way you would with a primary care doctor or an endocrinologist if you have diabetes. I’d say if the way you are feeling is impacting your functioning, whether it be not being able to focus on work, not maintaining the same relationships that you usually do, things aren’t as interesting to you—these are all early signs to reach out.
This will definitely be helpful for a lot of people. Especially now that the days are getting shorter and there are less opportunities to socialize outdoors. So for people who suffer from seasonal affective disorders, for people who tend to get different when it’s fall and winter, how do they make sure that their issues are not exacerbated with COVID and seasonal changes?
Lauren: There are some behavioral approaches. I will use you as an example. You mentioned that during the initial stage of the pandemic, your focus was on constant stressors and news. And also you, being an athlete to some extent, really felt the impact of not being able to go to the gym. So just as you adapted and created your own schedule, I would suggest something very similar. There will be more isolation when it gets colder. Restructure your day to get some sunlight. That means taking a walk for thirty minutes, even if it’s a little cold, and getting some natural sunlight. Doing something like you did, and developing an aerobic exercise plan indoors. Doing enjoyable, pleasurable activities, and coping ahead—being able to come up with some creative ways to be together, to cook together, to socially connect.
Nisha: I agree with everyone Lauren said—exercise and getting sunlight during daytime hours are really important. I would also say, season changes affect some people more severely. Seasonal affective disorder is real, and there are some things that help with the treatment of seasonal affective disorder, including using a sun lamp and vitamin D supplementation if you have low vitamin D. There are also some psychiatric medications that can help with seasonal affective disorder, but before using a sunlamp, vitamin D or a prescribed medication, I would consult with a doctor to make sure there are no contraindications.
Do you think the culprit of seasonal affective disorder is the change in how much vitamin D you are getting, or is it just one of the components?
Nisha: The studies on seasonal affective disorder and vitamin D show a correlation between the disorder and from vitamin D deficiency. Supplementing with vitamin D helps with symptoms. I am not sure the precise explanation in terms of pathophysiology. But it does help!
How do you think mental health care is going to change after we are done isolating?
Lauren: It’s already changed so immediately and abruptly. In the beginning, there was obviously a sense of urgency to get on remote platforms. In some ways, it’s been met with a lot of positivity and ease. I wonder if, because we are able to access more people, and because there is a little more flexibility, it’ll become the standard of care. It’s something that the field is certainly thinking about as an add-on. Of course, there is tremendous value in seeing your clinician in person. We are both excited to get back on campus. But, in our perspective, it has not affected clinical care, which is another positive outcome.
Nisha: I think it may be too soon to tell in the grand scheme of things how much video visits will be part of the future of treatment. But it’s hard to imagine us going completely back to normal. I think this will be part of the new normal, but it may be too soon to tell exactly how much. Part of that will depend on policy, both institutional, national, and state-wide. I agree with Lauren—I think we realized that the quality of care has not been negatively impacted by transitioning to video. That’s been great!
To schedule a confidential appointment with Dr. Nisha Mehta-Naik or Lauren Rosenblum, LCSW, please call 212-327-7257.