Podcast: Remaining resilient while the pandemic drags on

Jim Dryden (host): Hello and welcome to “Show Me the Science,” conversations about science and health with the people of Washington University School of Medicine in St. Louis, Missouri … the Show-Me State. As we continue to detail Washington University’s response to the COVID-19 pandemic, in this episode, we speak about resilience. Many of us have not been at our best emotionally as we’ve had to adjust to restrictions, social isolation and just the unknown. Dr. Eric Lenze is a psychiatrist at Washington University and he says in addition to its devastating effects on physical health, the pandemic has had the potential to be particularly harmful to the mental and cognitive health of older adults.

Eric J. Lenze, MD: Because it puts them at risk for negative emotional, cognitive and even brain health effects from social isolation. There’s evidence that social isolation in older adults even increases their risk for Alzheimer’s and related dementias.

Dryden: Lenze has launched a study looking at whether practices such as regular exercise and mindfulness training might make older adults more resilient as the COVID-19 pandemic continues. Meanwhile, at the other end of the age spectrum, child psychologist Neha Navsaria says the pandemic is testing resilience in kids. Online school, social distancing during lunch, not being able to hang out with friends as often, and other pandemic-related changes have made life a lot different for children.

Neha Navsaria, PhD: Often, I think resilience is viewed as a trait, like, either you’re resilient or you’re not. And it’s important that we know that resilience is actually more of a process based on, sort of, what their parents model, what the teachers model. And if they’re seeing a therapist or a psychiatrist, what gets discussed in those sessions. Using these as opportunities for growth.

Dryden: It’s difficult to predict what the next several weeks and months will bring. Will it be safe to travel for the holidays? Might we face a double whammy this year with COVID-19 and influenza? Lenze says the uncertainty makes resilience that much more important.

Lenze: One of the more stressful things to human beings is uncertainty. It’s been like playing one giant game of whack-a-mole for the last year and a half. You think it’s down, and it comes back up somewhere else. And what this has led, most recently with the emergence of the delta variant, is just great uncertainty about the future. We’re seeing this in higher levels of anxiety throughout the population and particularly in older adults. The COVID-19 pandemic has been a disaster for health, but it’s also a vast and unwanted natural experiment into the negative effects of social isolation and stress. And we think that older adults’ vulnerability is particularly acute in the U.S. response to the COVID-19 pandemic. The extreme social distancing that has gone on, for example, during the lockdown periods are, on the one hand, one of the most effective tools we had, but likely has a disproportionate negative effect on older adults because it puts them at risk for negative emotional, cognitive, and even brain health effects. There’s evidence that social isolation in older adults even increases their risk for Alzheimer’s and related dementias.

Dryden: So you had been studying a group of people looking at improvements in cognitive and emotional health that may result from things like mindfulness training and exercise. So how do you transition from that into resilience from COVID?

Lenze: In a previous study in the four years prior to the COVID-19 pandemic, our research team recruited 585 older adults and then randomly assigned them to receive mindfulness training or exercise or neither of the two, and this was all done prior to the pandemic. So when the pandemic came, we realized that we had the opportunity to assess the changes in these older adults over a long period of time, but then also to look at whether the people who received mindfulness training and were practicing mindfulness with meditation at home and the people who are exercising were protected from those effects. If you thought about like a psychological practice that would help people get through the stress and uncertainty of a pandemic, you could hardly do better than mindfulness because it teaches you a number of things. One is simply how to relax during a high-stress time. The other is how to be in the moment rather than being focused on the future or stuck in the past. A third, though, is people learn empathy skills from mindfulness practice as well, which is something that seems to be in short supply in our country these days.

Dryden: Exercise is another component of the study. Is it possible to do the type of exercise that you want folks to do without, you know, going to the gym where they would be potentially exposed to the virus? I know a lot of us are trying to exercise at home, but it’s not the same thing as it was before.

Lenze: So there’s a lot of ways that exercise could help brain health. First of all, exercise is physical activity, and being physically active rather than sedentary is likely helping with brain health. Second, exercise can be social. People can do it in groups. In fact, people can even do that during a pandemic over video which we’re doing in the study. But beyond that, some of the specific, let’s say, active ingredients of exercise that we think might be most helpful for brain health are that it increases aerobic fitness, you can run faster without getting out of breath, and it can increase your strength, your actual muscle build and muscle strength, both of which have been tied to better brain health in older adults. But what we don’t know is whether that means that if you do those things, it will improve your brain health and your resilience. That’s what we’re trying to test here.

Dryden: What about you, your own resilience? Do you practice mindfulness?

Lenze: One of the first things I did when I started doing mindfulness research, now almost 10 years ago, was I took a class in mindfulness-based stress reduction, and I found it was incredibly insightful. One of the things I learned that I apply in my everyday activity is you are not your thoughts. So you can have thoughts, even bothersome thoughts going in your head. You don’t have to act on those thoughts. You can just say, “Well, there’s those thoughts again. Whether they be worries or regrets about the past, I don’t have to listen to them.” The other thing that I found is that mindful breathing, even for a couple of minutes, can be very helpful to produce just a relaxing state and I actually often use it to help fall asleep at night.

Navsaria: My name is Neha Navsaria, I’m an associate professor of psychiatry in the division of child psychiatry and I am a child psychologist.

Dryden: Kids were sent home. They had to do school online. Sometimes they came back. Most kids, I guess, are back in the classroom now. Personally, I know a number of children who were doing well, but they didn’t do so well when it came to online school. When you were working with kids who have learning disabilities or ADHD, those sorts of things, how difficult is it for a child like that to stay engaged at school during all of this turbulence?

Navsaria: So I think what’s been interesting about this pandemic period is that we’ve learned a lot about kids’ learning profiles and how it matches their environment. So for the kids who are anxious and especially around social situations, some of those kids just thrived in the virtual setup, and it’s been harder for them to return back to school. I think a lot of kids have forgotten what it’s like to read in-person social cues. So even the kids who did not have any pre-existing anxiety or difficulties reading social cues, even we’ve heard reports that they’re experiencing the social anxiety because they’ve just forgotten what is it like to interact. And then there are kids where being back in person has been a great thing because kids really thrive on routine and structure and that social-connectedness. And even if they’re 4 feet from their friend or they have to eat lunch with this, sort of, plexiglass in between them, the connectedness is still there. And when we talk about what are some factors that help kids become resilient, just having that connectedness to their teacher is a really important one. You know, you see a mix of things. And I think what’s interesting is, for some of the kids, it’s kind of in some sense we had a year to really get to see what the potential was that they could have. And then you just don’t see that when they return back, and so it makes you question how we should be structuring school these days and how we should sort of match the learning environment to their learning profile because it sort of tells us that all kids really have this potential to thrive. It’s just figuring out what are the best conditions that they need.

Dryden: Now, as a grown-up, I bring perspective to something like this. I mean, really, it’s kind of a blip in some ways. My life, I feel like this would be considered a short period of time if this does indeed ever end. Does that make it easier for a child to adjust because masks and social distancing are just the way it is or more difficult because they don’t know anything else?

Navsaria: So that’s a great question and, obviously, a lot of it depends on the age of the child. So right now when you look at younger kids, in some sense, like you said, it’s the norm that’s just been created: that we wear masks. We adjust when the rules change. So in some sense, that has become the norm. I think for older kids being part of a group, being with your peers, that was part of what you do in that stage of development. A lot of that was removed and they were kind of left like, “What am I supposed to do now?”

Dryden: Recently, we’ve heard a lot about the dangers and evils of social media. But I wonder if during the pandemic, it was a lifeline?

Navsaria: So what we’re finding, and these are at least early observations, is that we’re seeing kids not necessarily wanting to meet up in person anymore because they’ve gotten so used to the social media and used to just having Zoom calls, having sort of online interactions with folks. So much, especially for adolescents, a lot of their identity and sort of their developmental task is to create that social network and sort of find their place in a group. And in some ways, social media allowed that to still happen. Yes, obviously, there are risks and there’s sort of the negative side of social media. But in a lot of ways, as you said, it sort of created one factor of resilience in this whole process that they were able to maintain those connections, and then they kind of carried that forward even though a lot of things are back in person.

Dryden: The length of the pandemic is getting to me, at least, where four weeks, six weeks, four months, six months, 12 months could do that. But it sort of reminds me of a snowy March where we’ve been living through winter and we can see that spring is near, and then it snows and it’s like, “Oh, great.” And I’m wondering what sort of effect the last several months of getting close and then, “No, we’re not really close,” and, “We don’t have to wear masks, and now we do,” those sorts of pulling the rug out from under children, what effects does that sort of thing have on their resilience?

Navsaria: What is interesting is that, at least the kids that we see in our clinic, those issues of, “Things keep changing. We thought it was going to be like this, we thought it was going to get better, now it’s not” — those are actually not the presenting issues that come up in the clinic. And I think that has been interesting because I think for — I think for adults, these are issues that often come up in conversations, but kids actually don’t talk about that as being their triggers. They do talk about the general frustrations, but it’s not the frustration that is sort of the trigger of their anxiety or the trigger of an episode of sadness or depression. For kids, it’s this, sort of, overall issues of, sort of, systems changing for them. So what school was like, what the whole system was like for them, what school was like last year versus what it is right now. And then sort of what’s going on with their family — do they have more access to their family, do they have less access to the family. The Child Mind Institute released — they do a state of children’s mental health, they do a report every year and they just released it. And, obviously, COVID is a big part of that. And they talk about how although a number, I think it was close to 50%, of adolescents feel some type of — experienced some type of struggle during the pandemic time, many of them also checked off feeling hopeful. So, yes, all these stressors are occurring. All this unpredictability is occurring. But to your point about the light at the end of the tunnel, I think they’re still holding on that there is a light at the end of the tunnel, and there is something to be hopeful about, which is positive. And this is early data. We still don’t know what the state of mental health for kids will look like six months from now, a year from now.

Dryden: My grandmother, and I’m sure she was not the only one, would say, “What doesn’t kill you makes you stronger.” Is that necessarily true when we’re talking about mental health? I mean, the struggle of these last 20 months and however many more months we’ve got left is going to leave a mark, right?

Navsaria: It’s definitely going to leave a mark, but it’s all kind of how we navigate this whole process. So that’s where the idea of resilience in children comes in. Often, I think resilience is viewed as a trait, like either you’re resilient or you’re not. And it’s important that we know that resilience is actually more of a process, and that’s the part that makes you stronger. And it’s not that we’re not supposed to experience adversity or uncertainty, but it’s what we do with it based on sort of what their parents model, what the teachers model. And if they’re seeing a therapist or a psychiatrist, what gets discussed in those sessions, using these as opportunities for growth. And another key piece to resilience is then labeling those skills. As children are attaining these skills, saying, “Hey, do you realize you just solved a complicated problem? A few months ago, that would have really gotten you upset,” or “That would have just really made you sad.” Whatever it is, labeling those things because it’s how you, sort of, develop that resilience and then learn how to apply it in different situations.

Dryden: In my neighborhood, I’ve noticed kids on their bikes with their masks on, playing together in groups like they always would with their masks on. Kids, teenagers are resilient in that they adjust to reality perhaps more easily than those of us who are set in our ways do.

Navsaria: Yes. I think that is very true that kids, they learn to adapt. In a lot of ways, their brains are still developing into young adulthood. So that also contributes to some of the ability to adapt. In a lot of ways as adults, like you said, we’re set in our ways and it’s largely because we’ve had a routine and a structure that has existed for a very long time, and it’s ingrained in our brains, literally. So that is harder to move away from. And, obviously, as you get older, it’s harder to move away from them. Versus kids, they do well, they thrive on structure and routine, but they also have this adaptability where if the structure and routine change, then they adjust to it. Again, it comes back to looking at what factors contribute to being resilient. So, again, developing coping skills, identifying and learning how to monitor and regulate your emotions, having a positive adult figure, having a sense of safety, routine and structure, having a sense of self-efficacy and control. Research has shown this time and time again that those are the things that contributed to positive outcomes.

Dryden: Perhaps the most positive outcome of all would be news that the pandemic has receded and life will be returning to the way it was before any of us had ever heard of COVID-19, but Navsaria and Lenze think that’s not likely to happen any time soon. And that means it’s important for kids, older adults, and everyone else to work on things that might help them be resilient in the face of the uncertainty that lies ahead. “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. If you enjoyed what you’ve heard, please remember to subscribe and tell your friends. Thank you for tuning in. I’m Jim Dryden. Stay safe.