Bracing for the Next Wave

Coping with Rising Anxiety and Depression during the Pandemic

Photo by Fernando @cferdo on Unsplash

“How are you really doing?” This is the question we should be asking each other as the COVID-19 pandemic persists, says Darcy Gruttadaro, Director for Workplace Mental Health with the American Psychiatric Association Foundation. “Anxiety and depression have tripled since 2019,” says Gruttadaro. People are really struggling at home or with work, which, she says, is understandable. “It makes sense to feel stress and to worry,” she says. “We’ve changed our lifestyles completely, we’re in an economic downturn, the US political climate has been intense, and the vaccines are coming out very slowly.”

With the massive increase in people needing help, the mental health system is overwhelmed. “We are under-resourced. There is going to be a tsunami of mental health needs,” says Susan Gurley, Executive Director of ADAA, the Anxiety and Depression Association of America.

Lisan Martin, a social worker in Bethesda, Maryland, says, “There has been a tremendous need for counseling. This pandemic is an ongoing trauma for thousands of people who are losing loved ones — and for the rest of us, who are anticipating terrible things that might happen.”

Most of us have not experienced a pandemic before. “It manifests in us in many ways,” explains Kamakshi Sankar Boyle, LCSW and adjunct faculty member at University of Maryland School of Social Work. “The mind doesn’t know how to make sense of this. Nothing is predictable, so thoughts are racing with ‘what ifs’ — ‘What if I go out to see my friend?’ ‘What will happen?’ The uncertainty of the unknown creates a strong response in the body and mind. We are hyper-alert, vigilant to new information — bad news that comes daily, about COVID-19, politics, the economy — it’s very hard to relax, especially at night. People can’t fall asleep anymore. It’s a daily struggle, insomnia, and that leads to feeling irritable and panicked. There is also more conflict at home. Outbursts and yelling, physical abuse — they are the result of ongoing stress.”

All of this has put us perpetually on edge. And social distancing is depressing. “We have a neurological need for social connection and well-being — we are not intended to live in isolation or fight for survival on our own,” Sankar Boyle says.

Especially vulnerable right now are students, working parents with young children, people with a pre-existing mental health diagnosis or addiction, frontline healthcare workers, and economically disadvantaged families, who have been disproportionately impacted by the virus and unemployment, and who have unequal access to mental health care, according to a recent CDC Pulse Survey and the Center for American Progress.

Students are affected by isolation and uncertainty

“Students haven’t been able to see their friends regularly, so they can’t easily maintain relationships,” says Matt Kamins, a psychologist for Montgomery County Public Schools. “And they don’t know what is going to happen next. This creates apprehension and worry — which are the building blocks of anxiety.”

The longer the pandemic goes on, the more anxious and distant kids will be, and the less they will be learning social skills, Dr. Kamins says. “In school, every day we teach listening, problem-solving, and how to negotiate conflict. We say, ‘Good, I like the way you said that to him.’ ”

But online, teachers can’t always see when a student is withdrawn or upset on a Zoom screen, so school counselors are reaching out to individual students via email. “Student Well-Being Teams reach out to students who aren’t engaged in virtual learning, or have been referred by teachers for potential mental health concerns,” says Dr. Christine Conolly, Director of MCPS Psychological Services.

Montgomery County Schools are also providing weekly periods for counselors to talk with students about the pandemic, provide stress management strategies, and tell them how to get help at home and via school. MCPS’s website, Be Well 365, has online support with links to immediate help and social and emotional lessons including the Waymaking and Mindful Moments video series. There is also a virtual Parent Academy video series that gives families information and support about a variety of topics including how to engage with technology.

Signs of suicidal behavior

Speaking directly to parents during a recent video, Dr. Conolly said: “If your kids are saying, ‘I don’t want to be bothered with any this’, and they’re going away and avoiding it, and not doing it, that is not just a sign of your child being defiant. That is a sign that your child is having trouble with anxiety.” She says kids should talk to their teacher or counselor. “We’re here to help you.”

Aaron Shin, principal at Parkland Middle Magnet School in Aspen Hill, Maryland, hosts weekly Zoom chats for kids and parents with administrative staff and counselors, so they will feel comfortable approaching them with questions they may have.

“Not knowing is a huge anxiety producer,” says Parkland PTSA president Laura Mitchell. “The more information we can provide, the lower the anxiety level. We’ve made it our mission to give parents and kids as much information as possible, and as current as possible, because it is rapidly changing.”

A small grant to a PTSA group prevented a tragedy

After an online Family Chat with parents about the signs of depression and suicide or self-harm, Mitchell says one mother went up to her child’s room and talked to her. She had thought her daughter was bored and frustrated with isolation, but she was contemplating suicide. Because her mother knew what to ask her, that child got the help she needed before it was too late.

“This is an extremely stressful time,” says Rachel Larkin, Director of Crisis Prevention and Intervention at the counseling center EveryMind in Rockville, MD, and online. “Our counselors hear from students age 8–22 every day who are dealing with so much anxiety and trauma. During quarantine, they feel trapped in their homes with parents and siblings. Teens naturally pull away from parents, but because they are still at home with online learning, they can’t be apart from their parents, and there is conflict.”

Dr. Avy Stock, Director of the Ross Center of Northern Virginia, sees young adults in her practice who have been increasingly distressed. “Not surprisingly kids are reporting anxiety around social relationships, academic and college pressures, and family conflict. I don’t think the content of the stressors is that different, but the intensity of the anxiety is clearly magnified.”

Distress calls and texts to EveryMind increased by 48% six months into the pandemic, and there was a 145% increase in kids talking about family conflict. Children as young as 9 and 10 have been suicidal. “There is a lot of self-harm in this area. Kids are trying to deal with too much and they need to learn how to cope. Fortunately, Montgomery County helped us purchase much-needed equipment to make more specialists available.”

The pandemic is intensifying pre-existing mental health issues

Before the pandemic, Amelia Ruben sometimes struggled with ADD and anxiety. Currently a student at American University, she recalls, “When COVID-19 started, I spent hours on assignments because I couldn’t focus,” she recalls. “I kept asking myself, ‘How long is this going to last? Will I have to keep taking classes online?’ and, ‘What am I going to do with my life?’” As the pandemic persisted, Amelia had racing thoughts, a sign of clinical anxiety, when fearful thoughts spiral toward panic. “What if my parents get sick and I can’t see them in the hospital? When is this ever going to end?”

Ben Kapit is a 20-year old filmmaker currently living with his parents in Rockville. He has social anxiety and is on the autism spectrum. Ben’s father is a doctor, so Ben is very aware of the health risks associated with COVID-19. Because not everyone wears masks, he doesn’t want to leave his house. When he does go out on rare occasions, he says, “I’m hyperventilating behind my mask and stimming (gesturing uncontrollably). If I see someone not wearing a mask, I might say, ‘Hey, dude’ and signal for him to pull up his mask over his nose and mouth. But I sense a severe lack of compassion for community these days.”

Ben tries to work, but he can’t concentrate on writing or starting any new projects. “I’m a storyteller and the way I get inspiration is by being with people. I haven’t felt inspired to write, which is a stress for me. I have ideas but I can’t get them on paper.”

The lack of physical contact has also been hard. “I don’t mind Zoom, I’m used to it. But I miss my friends. I’m a hugger, and this lack of physical contact or mental stimulation from hanging with my friends is just really hard. I stay home a lot.”

Touch deprivation is real. Without it, we feel depression and anxiety even more, and our immune systems weaken, according to Dr. Tiffany Field, the director of the Touch Research Institute at the University of Miami’s Miller School of Medicine. When we’re anxious, the stress hormone cortisol rises and can interfere with the body’s immune response. Some people are dying from the virus because of touch deprivation. Some are desperately lonely and resorting to suicide.

Affectionate touch from someone in your ‘social pod’ or ‘bubble’, or even hugging a pet, biologically lowers stress levels and releases the neurotransmitter dopamine, and oxytocin, the body’s own “feel good” chemicals.

Another helpful antidote to the intensity of anxious thoughts is practicing mindfulness meditation. Noted local mindfulness expert Laurie J. Cameron writes in her book The Mindful Day that integrating a quiet and compassionate practice throughout each part of your day, from morning to evening, can significantly lower stress and improve your wellbeing.

“On our best day, we are working at about 60% of our normal capacity.”

Jennifer Jordan, Family and Hospice Nurse Practitioner, and Family Program Director, Insight Meditation Community of Washington, quotes a helpful reminder from Dr. Doug Fagen, Head of Psychological Services at the Lab School: “On our best day, we are working at about 60% of our normal capacity.”

Jen’s counsel is to widen our lens. “Begin a gratitude journal,” she says. “Meditate, exercise, listen to music, and try a new creative endeavor.” Gratitude practices help us soothe our over-stimulated nervous systems by reminding our brain and nervous system about what is going right — instead of focusing on everything that’s going wrong.

“In these times we are in, our nervous systems go into overdrive. There is a tendency to become hyper-aware of all that is going wrong. Brain imaging studies show that when we are stressed, the brain’s fight-flight-freeze center — the amygdala — lights up and takes over our executive functioning. The prefrontal cortex and memory center go dark. In effect, when we are in the stress response, which most of us are in right now, we can no longer access our higher decision-making center of the brain.”

In order to be able to think clearly and make healthy decisions, we need to induce the relaxation response, she says.

“Take one deep breath in, and release a longer exhale. Write a list of 25 things you’re grateful for. I do this every day and it really helps. We can literally change our brains. Neurons that fire together, wire together.”

Parents of school-age children are struggling

As the pandemic pushes deeper into winter and we spend more time indoors, COVID-19 has severely affected parents’ mental health — primarily mothers of young children, according to the CDC. When many jobs went online last April, parents were suddenly working from home without child care and had to simultaneously help their kids adjust to Zoom classrooms. Mothers took on the majority of this responsibility. One Bethesda mother of two young girls was desperate. “I am about to lose it,” she said. “I just started a new job, I’m working from home, my kids don’t understand these Zoom classes, and I have no child care.”

Almost a year into the pandemic, many mothers have left the workforce or have declined promotions because of pressures within the home — which has severely set back the women’s movement for equity in the workplace and caused significant stress.

Among mothers who are still supervising their kids’ in-home learning while struggling to do their own work at home, 70% say that managing distance learning is a major source of stress, according to the American Psychological Association. “Parents tell us that working while Zoom schooling is impossible,” says Stephanie Rosen, Executive Director of the National Alliance of the Mentally Ill (NAMI) in Montgomery County. Zoom classes, themselves, can be highly stressful for students and parents — and teachers. Network connection issues, lag time, and confusion about locating and sending assignments add to an overall sense of overwhelm, especially for children with learning differences.

“My daughter Ellie is in 3rd grade and she has dyslexia, so that adds a layer of complexity and time — which I don’t have enough of,” says Jenn Pellegrini of Brookmont, Maryland. “While I’m working in my home office, I may be on a call and I’ll walk into Ellie’s room to see how she’s doing, and she’s on the floor crying. So I put off my meeting to help her right away.”

Jenn and her husband Brian both work full time, so every morning they get up at 5:30 to get their workouts in and make breakfast before they wake Ellie for her language therapy, which begins at 7:15. Because reading is difficult for Ellie, every night, Jenn and Brian read the material that Ellie will be taught the next morning. They also preview her math instruction, because the new teaching method just uses symbols and numbers, which don’t mean anything to someone with dyslexia.

“We hired a tutor to help Ellie learn math, and we feel fortunate to be able to do that. But all of these kids are learning new material along with new technology, at the same time. Touch screens, text boxes, new procedures, and expectations are all just too much at times.”

Since teachers have 25 + kids in each Zoom class, when one student signs off, they can’t reach through the screen to see how they are doing. But Jenn doesn’t fault the teachers. “They’re doing the best they can in a tough situation,” she says. “They have altered Ellie’s learning plan and we are in good communication.”

For single parents, the stress of double tasking work and online learning is more acute. Brooke Houghton-Dorsey, who lives in Bethesda, is a mother of an eight-year-old girl, Amy. When COVID-19 forced the closure of schools, Brooke was teaching and advising as a school administrator. She was online all day with students and teachers while trying to be present for her daughter.

She told Amy, “When you’re hungry, get food,” and pointed to a snack shelf she had created in the refrigerator that she could reach. She told Amy’s teacher that Amy wouldn’t be able to turn in all her work. Fortunately, the teacher was understanding.

But there was no break in Brooke’s day. “I was always on,” she says. “If I wasn’t teaching, I was running a meeting. I couldn’t just ‘be.’ It was completely exhausting, beyond stressful. I wasn’t doing either job as a parent or educator well.”

Her stress and anxiety shot up to the point that when she was between tasks or appointments, “I didn’t know what to do with myself,” she recalls. “I was doubting myself, never able to be at rest. I knew I was supposed to be somewhere, but I was just blank, almost comatose.”

She knew this was not sustainable. “Something’s got to give, and it’s not gonna be my daughter,” she said. So she gave up the administrator position. “Do I miss that money? Absolutely. But at the end of the day, I can actually close my computer. I’m only responsible for my daughter and my students.”

Her daughter later entered a child care cohort with 12 other students and two teachers. “Everyone wears masks, and there are temperature checks 2–3 times a day. The cost is astronomical, but my family is helping and my employer set up a crisis fund for parents.”

Students across the country will be returning to school soon, which will bring its own set of anxieties for both students and teachers, although experts agree that students will benefit greatly, both academically and psychologically, and that some children will be safer in school than at home.

Employers are worried about their employees

The pandemic has radically altered the workplace. According to Pew Research, 71% of workers whose jobs allow them to work remotely are working from home, with little social contact, and they are expected to be on Zoom for meetings throughout the day. Over time, people lose energy for virtual meetings. “Zoom fatigue is real,” says Sankar Boyle, LCSW. “Our brains are not equipped to read social cues on a screen. That’s too much work. ‘What did she mean by that? Who is supposed to talk next?’ This is not a natural form of healthy connection. The brain is working overtime to figure out tone, context, social cues — and it is exhausting.”

APA workplace expert Darcy Gruttadaro advises employers to meet one on one with their employees and to show empathy. “Start a meeting by saying, ‘I’m rattled by all of this. We’re all rattled.’ Have each person share a word about how they’re feeling.” Corporate leaders are seeking guidance on empathic communication, she says.

What about the 60% of US employees who cannot work from home?

Most Americans who have lost their jobs during the pandemic could not work from home because their jobs were in the service industry, such as retail and hospitality, both of which lost half a million jobs in January alone. These are minimum wage jobs that have been eliminated due to closures — reflecting the hard reality that the COVID-19 recession has disproportionately impacted lower-income Americans. Many people who were already economically disadvantaged are now unemployed, hungry, and on the verge of experiencing homelessness — with little or no access to mental health support.

Community Health Workers (CHWs) have been critical links to care. CHWs are trusted members of a community who help their neighbors navigate complex health care systems while offering information and dispelling fears about the virus.

Luis Cardona works with black and brown teens and families living at the poverty level throughout Montgomery County, Maryland. As director of the MC HHS Positive Youth Development Program, he changed focus from gang intervention to food distribution when COVID-19 hit, and he trains Community Health Workers. “We partnered with area food banks like MANNA and SOME, and local restaurants that were on the brink of bankruptcy just gave us food. It’s been beautiful,” he says.

But the stress level has been very high. “The primary breadwinner in the home is at work, exposed to the virus,” Luis says. “Most of the deaths in these communities have been the breadwinners,” Luis says, “and the families tell us, ‘We have no food now.’ ”

For families who have lost a parent, grief often comes after food has been delivered. “Two weeks later, families tell us, ‘I need that support now.’ So his staff provides family support and coaching via telephone since they cannot do home visits while the virus is active. There is an urgent need for the coping skills training they provide. Within the first month of the lockdown, there was an 80% increase in domestic violence. Youth suicides are up, as are youth runaways and substance abuse.

The need for mental health support is increasing urgently

“What we are seeing is an increase in the level of care required that is higher than our capacity,” says NAMI Executive Director Stephanie Rosen. Volunteers with Montgomery County’s chapter of NAMI are seeing their support groups double in size and the need for intensive mental health care increase.

“These groups are open to everyone and serve a wide spectrum of mental health needs,” says Rosen. Training is available for people who have lived experience with mental illness and wish to help facilitate support groups, which are currently online.

Emily Buenting has been a member of NAMI for several years. She has bipolar disorder and generalized anxiety disorder. Before the pandemic hit, she was in a good routine, taking walks through Bethesda with her emotional support dog, writing her blog, seeing her psychiatrist, and taking her medications. When the quarantine advisement began, she stayed indoors to protect herself and spent more time by herself. She started watching more TV, eventually binge-watching Shameless and Homeland.

“It seems like our lives changed in a flash,” Emily says. “One day we were going about our business having meals in restaurants, face-to-naked-face hugging and shaking unwashed hands.”

As time went on, she missed seeing friends and family. She missed getting hugs. By May, she had very little energy and was not motivated to do anything. Her sister moved to be closer to her, and they talked more frequently, but Emily knew she was becoming depressed.

“It’s painful to be removed so much from other people,” she says. “It’s a slippery slope from feeling ‘down’ to fantasizing about not being alive, to taking the steps to end your life.”

With the rising urgency of mental health needs, more and more people are turning to their doctor or mental health professionals, who are, themselves, at risk.

“Mental health professionals are people themselves, who are also now dealing with the changes brought by tele-mental health, new processes, and stressors on the field,” says Susan Gurley of the Anxiety and Depression Association of America.

“Our members usually gain a lot of continuing education about new approaches [to treatment] at conferences, where they enjoy personal interaction, as well,” she says. “All of the mental health organizations have pivoted to virtual training and webinars. So we encourage our members, psychologists, psychiatrists, and researchers, to talk about their stress on our Zoom calls. There is a community dialogue.”

But there are not enough mental health professionals to meet the increased and intensifying need for treatment, Gurley says.

How can the US meet overwhelming mental health needs for healthcare workers?

Healthcare workers have been rightly applauded for heroism. But as the pandemic continues, first responders and ER doctors and nurses are extremely stressed, with 86% experiencing anxiety and 76% emotional exhaustion, in one study.

Healthcare workplaces can help by being open and supportive about the very real and very understandable emotional pain that Covid has brought, and the cumulative impact it has had over the past year.

Jane Callen is a volunteer EMS Lieutenant and therapist with Montgomery County Fire Rescue Service (MCFRS) and the Glen Echo Fire Department in Bethesda, MD. She has been with GEFD for 15 years and has seen a great deal of trauma, and she knows how continual trauma impacts her fellow volunteers.

“First responders are on the front lines facing trauma 24/7,” Callen says. “How is that emotionally managed? By learning to compartmentalize. As soon as one crisis ends, it’s time to clean up, train, and be ready to do it again …and again.” Emergency room doctors and nurses have faced constant trauma during the pandemic as well, and the toll that takes can be tragic. When ER physician Lorna Breen died by suicide in April 2020 after caring for Covid patients at New York-Presbyterian Allen Hospital and contracting the virus herself, the medical community was in shock.

Fortunately, there is greater awareness now and more help for healthcare workers suffering from stress, anxiety, and depression.

“MCFRS is changing,” Lt. Callen says, “and my role during the pandemic, providing mental-health support, is indicative of that attitudinal shift. Increasingly, we are acknowledging the mental health toll of constantly living in a world of trauma. We’ve made it a priority to support mental health because we recognize the imperative of speaking openly about and acknowledging the impact of trauma. That’s crucial because the risks of not dealing with it are non-healthy coping strategies and even suicide.

Callen went back to graduate school in social work a few years ago to gain the skills to better serve disaster survivors, hospice patients, and first responders. “I never imagined that a pandemic was lurking around the corner, and those skills would be super important to truly serve my peers,” she says.

How can communities help one another cope?

Communities that are economically disadvantaged have limited access to culturally sensitive health care. Some are wary of approaching doctors with any mental health concerns because of stigma and historical mistrust. So, how can people who are suffering in silence find help?

“Train lay people to be the frontline — give people someone to talk to,” says Susan Gurley of ADAA. “Just someone who says, ‘How are you?’ is worth so much. People can become self-absorbed, and we have to mitigate against that. One has an obligation to reach out and check on people and be really present and mindful.”

Luis Cardona’s caseworkers have been working long hours, trying to get people what they need. “Many families don’t have phone service now because they can’t pay the bill,” he says. “So we are checking on people through their front door.”

They are doing everything they can, but sometimes they get anxious about getting the virus. When they feel unwell even for a moment, they are afraid they have it. Luis coaches his team to take breaks and meditate.

After a break, they go right back to work. Sometimes at the end of the day, there is no more food to give. “One of my guys had to tell a mother the food supply for the day ran out. She looked at him and said, “That’s ok, someone else needed it more than us.” And he looked at her and said, “You know what? I’m going to find you some food. I’ll be back.”

Finding Hope

Despite the grim scope of COVID-19 and its unknowable future, Cardona has hope. “The human spirit has been broken by this virus,” he says. “We’re looking for ways to cope. But if there’s anything to pull out from this, the acts of kindness, love, and compassion have been really helping our young people.”

When young people are relieved, so are their parents. Brookmont mom Jenn Pellegrini says, “The moment the school day ends at 11:30, kids stream outdoors to the neighborhood green to run off steam. Neighbors have rallied together so kids can have safe socialization and get stress and anxiety out.”

Neighbors can also help each other by putting two chairs or a Friendship Bench outside where people can see it, and then sitting with one person they are concerned about, safely distant, and asking, “How are you, really?” Let people know, “You’re not alone. There is help.”

If you would like to help your community, you can train to be a mental health/substance abuse counselor. Mental Health First Aid courses teach about recovery and resiliency — the belief that individuals experiencing these challenges can and do get better and use their strengths to stay well.

Mental Health Resources

• National Suicide Prevention Lifeline 1–800–273–8255
• CDC — Stress and Coping with Coronavirus Disease
• Anxiety and Depression Association of America helps people find mental health treatment, resources, and support and accelerates the dissemination of research into practice.
• American Psychiatric Association Foundation complements the professional work of the APA via public outreach programs and support aimed at eliminating stigma, overcoming mental illness, and advancing mental health.
• APA Mental Health in the Workplace

• Alcoholics Anonymous (AA)

• Narcotics Anonymous (NA)

• National Alliance for the Mentally Ill (NAMI)

• NAMI Navigating a Mental Health Crisis
• NAMI Warning Signs and Symptoms of Mental Illness
• NAMI Stigma-Free Video
• Crisis Text Line Text “NAMI” to 741–741
• Self-Compassion.org Dr. Kristin Neff

DC resources

• D.C. Department of Behavioral Health Access HelpLine: 1–888–793–4357
• NAMI DC email namidc@namidc.org phone 202–546–0646
• AA https://aa-dc.org/

Northern VA resources

• 211 Dial 211 for local resources
• NAMI VA https://namivirginia.org/
• AA https://aa-dc.org/

Montgomery County, MD resources

• Click here for mental health resources and guidance from the Montgomery County Health Department.
• 24/7 Crisis Center 240–777–4000
• EveryMind 24/7 Hotline 301–738–2255, Chat Line every-mind.org/chat every day 8 am to midnight, Text 301–738–2255 every day 8 am to midnight
• Abused Persons Program (24/7 crisis line): 240–777–4210
• Victim Assistance and Sexual Assault Program (24/7 crisis line): 240–777–4357
• Adult Abuse & Neglect 2/4 Reporting Line: 240–777–3000
• Child Abuse & Neglect 24/7 Reporting Line: 240–777–4417

Montgomery County, MD NAMI Resources

• NAMI Montgomery County
• Free Online Support Groups
• Free Online Classes
• All Free Online Programs
• Community resources Montgomery County Mental Health Resource Guide by Subject