Dr. Phil Provides Tips for Pandemic Mental Health

Welcome, everyone. I'm Dr. John Whyte, chief medical officer at WebMD. And you're watching Coronavirus in Context. We all experienced a lot of stress when lockdown started. And now that we're starting to reopen a lot of folks are experiencing some challenges again. PTSD, sadness. It can be very difficult to cope. So to help provide some tips and some guidance, I've asked Dr. Phil McGraw to come back and tell us what we need to be doing. Dr. Phil, thanks for joining me again. It's nice to see you.

Well, it's good to see you, Doctor. And what a great topic, because quarantine seems to be winding down for a lot of people either in whole or part, and so there are challenges of getting back out there.

I want to talk about this survey that was recently done that you and I had some email on. And it surveyed over 49,000 adults in eight countries, because it's happening all over the world, and it showed that 55% of respondents experience some type of COVID related adversity or trauma. And 1/4 of people have shown clinical signs of mood disorder, and yet only 40% of people said that they're succeeding or thriving. What's the long term impact of these type of results, Dr. Phil, in terms of what we're seeing?

Well, that's a great question, Doctor. And the thing is we do have some precedent for these things from quarantines that have happened in Peru, some in Australia, and the effects are long term sadly. And it depends on where you are on the age continuum, and where you were when you entered the quarantine in terms of your mental and emotional adjustment.

For those that had a pre-existing condition mental health-wise, particularly in terms of anxiety, depression, PTSD, the effects of the quarantine seem to be even more profound. And I think we're going to be seeing the effects for years, if not decades, to come. And I can talk about it a little bit in terms of children and their educational attainment, but then also adults because there is PTSD. You do see confusion with people coming out of this. Anger, anxiety, depression frustration guilt and shame. There's a stigma associated with people being quarantined, particularly around those that have not. And there's a certain learned helplessness that people are experiencing.

And then there's the stress, and particularly that which comes from lost income when they get back out there and have to start building their lives back up. And one of the things that people haven't talked about very much is avoidance behavior, because when they start to get back out there, I think there's a whole lot of people that aren't going to go rushing back out the door and embracing their life with both hands the way it was before. I think there's an intimidation factor. They're going to hold people back. So I think the effects are long term, and that doesn't even address the medical problems because of people being slow to be diagnosed or delaying treatments and therefore allowing diseases to get to a more advanced state.

I want to ask you about this reopening. It was pointed out in the past, 100 years ago when we had the Spanish flu, after that came The Roaring 20s which in many ways was this rejuvenation of life. Do you expect we'll see something like The Roaring 20s after this pandemic finally ends?

DR. PHIL MCGRAW: I do think there will be some pent-up appetite, but after that flu epidemic in 1918, the research shows that as much as 10 years later, 40% of the people were reporting some degree of PTSD. Now they didn't call it that then, but in today's terms it would have been talked about as PTSD. So there were people that were profoundly affected for a long period of time. But do I think there will be a pent-up appetite? I think there will be, and I certainly hope that as people get back into their lives that they kind of do it in a safe way. But I do think sporting events and, hopefully these will be outside at first, and other sort of entertainment-type events will be outside. So people can kind of exercise that pent-up energy where they want to go do something but they'll do it in a more safe fashion rather than a closed in area.

One of the things I wanted to ask you about is the challenges that some people have with change. So some folks can embrace change and do well, but others, I pointed out at the beginning, they got used to lock down life, pandemic life. And now we're saying "We're going to reopen." And it's not a light switch for many people. So there's more change coming now. They had adjusted, and now they have to adjust again. Some people have challenges doing that. What advice do you have for those persons to help them deal with the change that's coming?

Well, Dr. Whyte, I think there's kind of a seven step plan that I think about, and number one is to acknowledge that you are getting out of a comfort zone. I mean people have been locked down. We have gotten used to our worlds shrinking and being much smaller. So don't be in denial about your feelings. I think it's OK to acknowledge, "Hey, this is a challenge for me here. I'm getting back out. I'm having to start negotiating interpersonal interactions again. I'm dealing with a more demanding situation than I was a month or two ago." Acknowledge that. Don't try to pretend it's not the case. And particularly if you're having reentry fear, which at least 50% of the people in an APA, American Psychological Association, study say that they are experiencing reentry fear not associated with the virus, associated with getting back out there in a competitive world.

Number two, take small steps first. So if you're thinking about, "Well, got to go back to the office, or go back to an area where I'm having to be in groups," start off with small steps. Invite a couple over. Go meet a couple at the park. Go do something with a few friends where you are.

Actually, if they're vaccinated.

Yeah. Exactly. Make sure you've all got both vaccinations, and as I said, meet outside. But do it. Take a small step to begin with.

And third, I think it's important to focus on those things you do control, because people can feel overwhelmed. And so make sure you focus on things you do control. Like you control where you're going. You control the time. You control how you get there. You control whether you're wearing a mask, whether you're meeting with people that have been vaccinated, how long you're going to spend there. Focus on what you do control, because you're not out of control.

And fourth, I think it's important that we practice gratitude. We're focusing on the challenges, but let's also focus on how grateful we are that we've come through this alive, that we're healthy enough to be getting back out there, and that the world is still standing.

And five, recognize that we're not alone. A lot of people are feeling what you're feeling. And six, give your feelings a voice. It's OK to say, "Hey, are you feeling a little antsy like I am?" I think it's OK to give your feelings a voice so you don't feel so alone.

And seventh is a real big one for me. Give away that which you need the most. If you're feeling kind of isolated, and empty, and worried about getting back out there, reach out to somebody that's less fortunate than you and give them what you need the most. If you lack reassurance, give it to somebody else. Find somebody that seems more intimidated or more timid than you, and go to them and say, "Hey, how are you doing? I just thought I'd chat with you a minute and see if I could kind of help you get comfortable here." Give what you need the most. I promise it'll fill you up the fastest.

And some of these tips do require some degree of self awareness. And when we chatted at the end of last year, you had this great exercise to help people to do a self inventory. You talked about it. You were like, "John, when you talk to people they can rattle off five things that they don't like about themselves easy-peasy. But when you ask them what do they like about themselves, they struggle." So can you go over again with our audience how do they do a realistic self inventory that then helps them with those seven tips you just gave?

If you want to take your inventory and get better, then you've got to set measurable goals. It's not just that you saying, "I want to be happier." Well, my dog wants to be happier. What does that mean? I want to be more engaged. I want to talk to people more. I want to be more active socially. Have measurable goals so you can tell whether you're making progress or not, and then identify the steps necessary to get from where you are. We don't have to leap tall buildings in a single bound. Small changes add up to big results across time, and the rest of this year is going to go by whether you're doing something about it or whether you're not. So make an action plan that even takes small steps in each of those seven areas, and you'd be amazed how much difference accumulates between now and the end of the year.

What do you say, Dr. Phil, to people who are listening to say, "You know what, Dr. Phil, I don't have family support. I don't have good friends that I can count on or rely on. It's just me. It's just me and my kids." What do you say to them? It's not that easy to find support, so what strategies could they utilize?

That's such a great question because not everybody does. And that's why I say the best way to engage is to give what you need the most. If you don't have a great support circle around you, then find a place that you can volunteer. Maybe it's a soup kitchen, maybe it's the Goodwill. Maybe it's down at the Y coaching one of your children's teams. They always need coaches. And trust me, because I'm living proof of this, you don't need to know anything about the sport. You can kind of be the bus driver.

But go give away what you need. Find yourself a support group where you contribute something, and then you start interacting with people that way. And maybe it's the community Art Center. Maybe you're not an actor, but you're painting scenery. Maybe it's helping garden down at the community center, anything where you're saying, "Hey, I have some things to offer. Can you use me? Can I volunteer?" Maybe you train to be on a hotline. Maybe you become a court appointed special advocate for foster children. Find some way to give, and I promise you will have a connection with people. And a common interest creates a common bond, and all of a sudden you have a support group around you.

And it takes work to do that inventory. It takes work to get a plan. I have to ask you this. I had an interesting conversation the other day, and I thought, "I'm going to ask Dr. Phil about this." Everyone is talking about loneliness. Being at home, not having those contacts, but there's also the concept, and I hadn't heard much about it so I wanted to ask you, about a-loneliness. Those folks who have been around the same five or six people the entire pandemic and they need some time to themselves. And how do they do that? What can you tell people about this concept of a-loneliness, that you might need some alone time and that's not a bad thing. Everyone's a little different. So how do we manage that?

It's not a bad thing, and here's the difference, Dr. White. Loneliness is involuntary. Aloneness is voluntary. That's the difference. With aloneness, a-loneliness, you're asking to have some time apart. You're asking to have some time to self reflect. And interestingly enough teenagers that spend 25% to 30% of their time alone in the room with the door shut have a lower level of depression, less frequency of depression. They have better grades, and they have better behavior. So those that take that time for self reflection, or just kind of organizing themselves because they have alone time, really kind of are more buttoned-up and they have their act together mentally, emotionally, behaviorally.

So it's OK to say, "Hey, listen. Love you guys, but I'd like to have an hour to myself today." And I could tell you a lot of mothers would love to have that. My mother used to say she was going to change her name to anything but Mom because she heard it 1,000 times a day. But it's really healthy to carve some time out for yourself and help your family and loved ones not feel rejected by it. Say, "I'm taking care of myself so I can take care of you, and I need this time for self reflection and kind of self maintenance. I need to gear down to take care of myself so I can take care of you."

And we really have spent all this time focusing on our physical health. We really need to start spending more time on our mental health. You've been involved in addressing these pandemic issues for the past year. I want to ask you, Dr. Phil, and it's really meant to get your expertise and maybe even put you a little on the spot. Looking back, where has been the communication gaps in terms of this pandemic? You're an expert communicator amongst a lot of other things. You've been communicating to the public for decades, and doing it very well. Where have the missteps been and how do we correct them?

Well I think there have been a lot of missteps, and if you look at the epidemiologists and what they tell us about the mental emotional aspects of being in quarantine, the most important thing seems to be to get information to people so they're not in the dark, to communicate to them well so they don't fill in the blanks negatively. You know that old saying "Monsters live in the dark" is true. And if you give people information they tend to manage it really well, much better than they do ambiguity or a lack of information. And I think now we are beginning to be more transparent. And I think we underestimate the public's ability to handle the truth and to deal with it. And so I think transparency in what's really going on helps people a lot.

And John, I think people know the truth when they hear it. And I think if you pat people on the head and say "Oh, everything's going to be fine," versus somebody that comes and says "All right look. Let me tell you what the risk factors are here and what you can do to mitigate that," they're going to believe that more than they're going to believe patting on the hand and "everything's going to be fine." And so I think authentic, transparent communications are really important.

And I think it's that way with your children. You certainly don't ever want to ask children to deal with adult issues. But at the age-appropriate levels, and you know people always say age-appropriate but they never define it. Let me tell you how to define that. You define it by listening to your children, what questions they're asking. And if they're asking a question at this level like, "Is everybody kind of sick, Mom?" Then you answer it at "Everybody's kind of sick" level versus if they're asking, "Do we have a mutant flu out here?" Then you answer at a more sophisticated level. Let them tell you their level of understanding. And that's how you adjust to age-appropriate. Know what their construct system is and where they understand it. But I think our kids need clarity also. And I think as parents if we'll give that to them at an age-appropriate level, because they're the ones that I think are going to have a big problem coming out of quarantine. Because I was talking to Dr. Christakis not long ago, who you may know, he's a pediatrician and epidemiologist, and the educational gap and the developmental and social gaps that have been created during this pandemic going on so long is really going to have a profound impact on these children. And we have to really work to close that gap or it may never close.

We started off by talking about adults in the mental health pandemic that were facing. Where do you expect us to be a year from now in the treatment of mental health issues for adults? Hopefully in a post pandemic world.

Well I do hope it's a post pandemic world. And again, there are different categories of adults and, as you know from this mental health quotient study, which I thought was an excellent study, by the way. I thought they did a really great job with that and such a big sample. We know that that 18 to 24 year-old adult group was hardest hit. And I think that's because they're still learning how to calibrate life. They don't have all of the built in support systems that someone your age or my age might have in place. So I think it may hit them certainly harder.

It was a big difference between the percentage of 65 and older that considered themselves thriving and successful versus the percentage of 18 to 24 who consider themselves thriving and successful. It was like, what, two three times difference? So I think those younger folks are very resilient, but I really hope they listen to some of the thoughts that myself and others have about acknowledging, "Hey, I am a little intimidated here. I do need to really attend to myself mentally and emotionally, and I don't need to be ashamed that I need help. If I need help. I need to reach out and get it."

And that's absolutely right. I agree completely, but we have work to do, and we have to develop a plan to get to that point. It's just not going to magically happen. We want to be able to provide resources and help people understand even some of the tips that we discussed today. I appreciate you taking the time to share your insights as always and give people some useful tools and resources that they can use during these stressful times. Thanks Dr. Phil.

Thank you so much, doctor. I really enjoy talking to you every time. You seem to bring up really relevant, to the point sort of concepts, and you challenged me to think about it. So thank you so much.

I want to thank our audience for watching. If you have questions, you can email them to me at Dr. At WebMD dot net, or post on Twitter, Instagram, and Facebook Thanks for watching.