Podcast: Preserving mental, physical health while isolating at home

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Jim Dryden (host): Hello, and welcome to Show Me the Science, a podcast about the research, teaching and patient care, as well as the student, staff and faculty, at Washington University School of Medicine in St. Louis, Missouri, the Show-Me state. My name is Jim Dryden, and I’m your host this week. We’ve been focusing these podcasts on the COVID-19 pandemic and Washington University’s response. And this week, we’re talking with some experts who speak to the problems that are faced by those of us who are pretty much confined to our homes these days. Things like anxiety, depression, even substance use or overeating. Graham Colditz is an epidemiologist and public health expert at Washington University.

Graham Colditz, MD, DrPH: We can still exercise outside and keep distance, but the work-from-home model of sitting down for 12 or 18 hours a day is sort of the exact opposite of the healthy lifestyle that we clearly aim for.

Dryden: He says that as necessary as distancing is, it’s also stressful. And he has some ideas about things that might help us lower those stress levels to keep us as healthy as possible while we try to wait out the pandemic. We’ll also speak to Jessi Gold, a psychiatrist who works with a number of college students and young adults.

Jessica Gold, MD: There are higher rates of people using crisis text line and calling crisis hotlines right now. And it’s not for suicide, but it’s for this, like, anxiety, worry, concern thing.

Dryden: She has some ideas about maintaining mental health during these shelter-at-home days. But first, Colditz says one of the biggest stressors many of us face is that when we’re fortunate enough to work from home, many of us actually put in longer hours.

Colditz: And your work day is expanded because some of your colleagues are sharing childcare with their partners. So one works in the morning; one works in the afternoon. And then, they clean up e-mail at night when kids are asleep, and you get the e-mail when they’re cleaning up. Yeah, to me it’s made the work day– as long as you’ve got a colleague who’s awake, you can be getting an e-mail that you wouldn’t have been getting. One of the things I’ve done for some time is try to leave my cellphone at home alone on its own on Saturday because if my wife and I are out, and the kids want to contact us, they’ll call their mom anyway, right? They’re not going to call me first. And so I’m not tempted to look at e-mail messages and things. Making that effort to disconnect is key.

Dryden: Some people, including some who currently live in my house, have spent a long time trying to stay healthy by going to the gym, swimming at the Y, taking yoga classes, that sort of thing. All of which are kind of bad ideas now. What are some better ideas?

Colditz: The keeping distance, obviously, is key for protection of our overall population and crushing the curve. The goal of staying active still has to be respected, maintained, but we have to adjust how we can do that. We can still exercise outside and keep distance, but the work from home model of sitting down for 12 or 18 hours a day is sort of the exact opposite of the healthy lifestyle that we clearly aim for. And so finding ways to build the standing, moving around, whether you put a timer on to go off every 30 minutes, move around, stand up, put activity back into their life, replacing the trip to the gym.

Dryden: Your research often focuses on how some seemingly smaller things can, over time, have big effects on health. And I wonder what sort of effects you think this quarantine might have? If we don’t get sick, that’s a good effect. But what about some of the negative effects? And other than standing, how might we mitigate some of those?

Colditz: Sure. So the other challenge that we have is– call it the social isolation. People are using the term social distancing, but we really want physical distancing and social engagement, cut off from the media for our mental health. It really pays off to disconnect from all of that flood of news from time to time. And then the other issue really comes back often to diet, the other part of the balance. So if we’re sitting at home and doing all of this, do we start munching more? We’re sitting beside the refrigerator or around the corner from the refrigerator, and suddenly access to food and snacks that we don’t have at work is there at home. And can we still structure this so we’re starting the day and stopping the day? I’ve got co-workers who put a timer on to run, to exercise at 4:00 PM so they actually can stop the day to transition. Otherwise, the workday, the work night, the weekend are just seven continuous days. So life builds some pattern back to actually give us some better mental structure for surviving this really dramatic change in the way we live that happened literally overnight.

Dryden: Is it a problem if somebody has not gotten into a pattern yet?

Colditz: If you look across 100 of your peers either in the city or across the country, not everyone has got to a new work set of habits and environment. So my read is this is going to be a continually changing environment. So again, can you think, instead of talking to someone on the phone, you can go outside and go for a walk and talk on the phone so you get exercise and the call done? In the first week you might never have thought about that. Change up some of these strategies so we’re getting the work done, staying healthy and working to ultimately get past this pandemic.

Dryden: Not to share too much, but in my family, our daughter is home from Chicago waiting this out. And my wife is in the house all the time; I’m in the house all the time. We like each other, but it’s an awful lot of time to spend together.

Colditz: The cabin fever in the way you describe with too many close family members in close quarters just for more than we can bear. Again, is that an opportunity to break the habit? Maybe you used to walk with your dog and your partner. And now, all of a sudden, you’d rather take a walk on your own. Absolutely, finding ways to build boundaries and structures that are going to be quite different from the five days at work and two days at home when you’re at home 21 days in a row.

Dryden: And one of the first things that you said was, “Be kind to yourself.” Is that the foundation of all of this?

Colditz: In fact, we think it really is. We’re all thrown into this with, I’ll say, almost zero preparation, no training program to do this. And so you can see news anchors in their living rooms. Everyone’s adjusting. Relaxing a little on our expectations is really an essential first step to opening the potential adjustment and modification to how we’re living, how we’re working.

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Dryden: Graham Colditz says it’s important to remember that we’re all going through this together, and none of us have done anything quite like this before. That can cause us stress and anxiety according to our next guest.

Gold: I’m Dr. Jessi Gold.

Dryden: Let’s start from the idea that we’re basically all a little more anxious now, and you include yourself in that. Can you give me an example?

Gold: Anxiety comes from the unknown, and absolutely everything is unknown. And we don’t have answers to anything. And I can’t answer any question that anyone asks me like, “When is this going to end?” or “When can we leave our houses, and when will my family be able to talk to my family in person?” or like, “When will people stop being killed by this virus?” All these questions, I don’t have answers to any of them. So when did I know that I was affected? I think I have a lot of friends and family that are on both coasts, so I think I started to realize I was affected when I noticed they were affected. Worrying and concern for what they are experiencing, what they might experience, the kind of stuff that they might be seeing and just kind of not sleeping as well and needing to voraciously stay up and read and look at social media in a way that felt unhealthy to me. Even though I like social media, and I’m often up and reading social media, I did feel like I had probably entered a hyper overdrive state of needing to do it. And that was about when I was like, “Oh. Yes, this is affecting me too.”

Dryden: I assume that translates into a lot of secondary emotions, that anxiousness, like anger, sadness. Underlying chemical changes like higher levels of stress hormones. What can we do?

Gold: Try to figure out what you know works for you. So sometimes people have already thought about that because they went to therapy before, or they’ve thought through it before, and they just haven’t thought about it in a while. So stopping and thinking about what were their coping skills in the past and even writing them down. So writing down what those things are that help us so we can go to them when we’re feeling really anxious or angry or sad. Like some people like mindfulness. So that really just means, kind of, getting out of your head and out of the emotions and getting more into the moment of like, “What am I feeling right now? What am I seeing right now?” Exercise works. So if you’re a person who likes to exercise, you can definitely do that. You have to keep distance from people, but you can still go outside right now. There are a lot of exercise things that are using virtual– you can go do classes online, or people are giving free yoga classes online and things like that which are pretty cool. Some people journal. Those are just a couple of skills that work for people.

Dryden: Wondering whether you think that come June or July, we’ll have a lot more clinically depressed, anxious, obsessive-compulsive, post-traumatically stressed people who were sort of triggered by this pandemic.

Gold: I mean, I think so. We don’t have a lot of evidence to go off of from past pandemics. So what we know is not super applicable. But what we see would suggest that there should be some sort of aftermath. There are higher rates of people using crisis text line and calling crisis hotlines right now. And it’s not for suicide, but it’s for this, like, anxiety, worry, concern thing. But I think we don’t have that kind of evidence to build off of. We can just make assumptions that we will have higher rates of all of it.

Dryden: You work with college students. Are there special problems associated with them heading home during this pandemic?

Gold: Their roles do shift when they go home, and kids do really like going to college to get away, and going home and being home for a long period of time does make for a really different situation. And I think people forget about that when they think about how easy it is. Like, “Oh, we just sent them home, and they’re home, and that’s all.” But it is really different for people.

Dryden: How much do people miss the interactions that they used to have several times a day in the office?

Gold: Yeah. I mean, we definitely take that for granted. Walking down the hallway and saying, “Hi” to a co-worker, that was just something you did because that’s what you had. But I think people who are like, “I am an introvert” still do so much socializing that they don’t even realize. You see people in class even if you don’t talk to them. You see the mail man. You see people when you go check out at the grocery store. And I think we take all of that for granted, and maybe we won’t anymore. It would be a nice aftermath of this if we then go to restaurants, and people are putting their phones down in conversations. We have so many day-to-day social interactions that we don’t even realize we have.

Dryden: What do you see as the biggest risks for us, the biggest mental health risks from this entire experience?

Gold: Self isolation. Isolation is a risk. Loneliness is a risk. Coping skills. So falling back on poor coping skills like substance use, eating disorders would be something that would be at high risk of being something that people would turn to because it’s a way to control something: “I can’t control the outside world, but I can control what goes into me.” Alcohol. I’m sure you’ve heard people being like, “I’m just home. I just want a glass of wine after work now.” And a lot of people are drinking a lot more.

Dryden: I’m assuming you’re seeing your patients by Zoom or FaceTime or something now. Are you seeing an uptick in problems in the patients that you are seeing now?

Gold: It’s mixed, actually. So for a while, it was like people were in this phase, “I need to do food and safety.” Which is like, “How do I figure out my food? How do I get safe? And how do I not die of this disease?” And from my college kids, it was also like, “How do I figure out online classes and getting my stuff back from school and living at home with my parents?” So these immediate things. And now, we’re getting to the phase where some of that is getting handled or has been handled. And now, people are starting to settle more into like, “Oh, now I’m maybe anxious or sad.” Or “Oh, what’s that feeling?” And so there’s more of that coming out. There are also some people that are actually doing amazing with being in isolation. People who actually have pretty bad social anxiety and maybe would have done better with online classes, but never would have chosen it. So people who I’ve been a little bit surprised have done quite well. So I do have a group of people like that.

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Dryden: Both Gold and Colditz say making small changes during these next several weeks can have a big impact on our physical and mental health. Both say trying to make a schedule is very important, as is making sure to move around regularly even if it’s just getting up from the computer to take a quick walk.

Show Me the Science is a production of the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis. The goal of this project is to keep you informed and maybe teach you some things that will give you hope. Thanks for tuning in. I’m Jim Dryden. Stay safe.