Dr.Anne Truong, Episode 5, Be Resilient & Healthy During COVID 19,Managing Stress & Anxiety,04-16-20

Thank you everyone for joining me today on Be resilient and healthy during COVID 19 episode 5. I can't believe this is my fifth week doing this. We started it, I think when the moment we had social distancing order. And today we have a special guest with us, Denise Dickard. She's going to talk about managing stress and anxiety. I'm so grateful for her to be here to be our special guest. And she is just the expert in this field. And at this time that we're in right now, no wonder we have stress, anxiety. You don't know what to expect. Every day it changes. You are bombarded with the news and it's not all good. And we're now being told to stay at home and can't go anywhere. There's a lot of uncertainty. So we can navigate through this and we will get through this together. And so I'm going to go ahead and start and I hope that you all can ask questions at the end to type it in the chat box and Denise and I will try to answer as much as we can. All right, so I always start out with a quote. This is from Vivian Green. She's an author. Life isn't about waiting for the storm to pass. It's about learning how to dance in the rain. And I hope that we all can take that to heart to know that right now it's raining and it's storming. We just got to dance in the rain to make the best out of it, which we can. So again, the sources I get is I change it weekly. So a lot of stuff I get now at the medical literature. I read a lot about upcoming treatments and what really is coronavirus is all about. Every week we learn more and more about it. And then I also go on the Virginia Department of Health for updates. So again, I like the slide because it summarized everything all in one slide. So coronavirus is called the SARS COV2. The disease that it caused is called COVID19. So the common symptom that you get with COVID19 is fever, cough, shortness of breath, muscle aches, and then also abdominal pain, nausea and vomiting. Sometimes you'll get a sore throat and runny nose. But the good news is that 80% of us will have more non severe disease. And so if you catch it, it will be very mild. And then you probably just have a fever and cough. You can just probably, you know, resolve on your own. However, about 30 to 20% have severe symptoms that need to be hospitalized. And about 5% of those subsets actually go to ICU and we'll talk about some numbers in Virginia and see where we're at. So what's the update? I made this slide a lot on this slide, so bear with me and follow with me. And this is last week, and then I'm going to talk about today. So the first number represent last week, which is April 9th. The second number represent today. So in Virginia, total tested last week was 36,000. And this year, total, I mean, this week total tested is 46,000. And out of those of the 46,000 this week, almost 7,000 is positive. So about 14% compared to last week, about 11%. However, it doesn't mean that the cases are going up. We're just testing more. That's all. We just have more kits with more availability. We're just testing more. So good news, that means that out of everyone that tested about 11 to 14% are positive. So that's very good news. And you see a lot of cases in Arlington and then followed by Loudon and Alexandria and Fairfax actually have a high number. And Henrico and our region, which is the Rappahannock region. The Rappahannock region at this point is this actually, this last week number, but it has actually gone up. Our hotspot is actually more in Stafford and Spotsylvania. All right, so hospitalization, number of patients that are hospitalized. So these numbers come up. But it doesn't mean that it's not worse. It's just that we're testing more. So there's about this week, this week, about 1300 that's been hospitalized out of this number here. So 1300 out of almost 7000. And that comes out to about 20%. So that's the same number I was telling you. So, you know, the numbers, projected number, what we see in real life right now. However, I want to stress this point. Equal distribution of all ages between 2079. So there's a myth that, well, I'm young. If I get it, I'll be fine. Nobody, you know, no problem, not really. But in Virginia, as of right now, the percentage, the 20% that's hospitalized, their age ranges from 20 to 79. So we're seeing this in the young and the healthy without any other medical problem. So don't take it lightly that, you know, you will be one of the young, are 20% that get hospitalized. However, you have to see that this number come from this number here and then this number here come from here. So it's a very small percentage. And icu, these are the patients are severe that need to be closely monitored. So out of the 1300 that is in, that is in the hospital here, about 32% are in ICU, which is about the same as last week. And the ventilator, this just shows that a ventilator situate of the percentage of patient that is in ICU only about 18% out of all the patients that's in the hospital only require the ventilator. This is another good news is that we only are using 25% of all the ventilators that are available. Does that mean that we're not going to have a shortage like you would see in New York? The ventilator is a machine that help you breathe. If a person have difficulty breathing, can leave, can breathe on their own. So that's very good news. Last week the death was 109 in Virginia. This week is 208, almost double. And the death localization, you see a lot more in the areas that you'll have a lot more cases, which is in Northern Virginia and central and eastern. And hospitals are still experiencing low supplies of protective equipment in the next 72 hours. So good news here, social distancing is working. That's the good news because these are cases an average per week. These are positive cases. And we're seeing here that week of April 12, there's less cases here compared to the April 5. So that means that staying home and isolation and social distancing is working. We're getting, we're seeing less cases here. We're testing more. So that's good. We're testing more, but we're seeing less cases. And Also in the U.S. overall, that around right here in mid April, we're starting to peak and then we're starting to kind of go down right here. And this is an, this is 83 days from the first case, which is January 22nd. So we already, we look like we probably passed the peak and we're about to go down and you're going to see a trend downward here. So it looks like it's coming down slowly. So does it look like around June or to August we have to see because it can go up like this and then go. Or does it go straight down? It depends on if we do good social distancing. Stay home, stay at six feet apart. So this is a very, very good picture here that we're looks like we're passing the peak. All right, so I included this. This is a calculator, so you may want to take a picture of this. It has calculator that you can put your symptoms in there. You put your age and whatever medical condition you have and it'll tell you what your chances are if you're going to get hospitalized, of surviving. And this is very good news. This is from last week that there's a lot of clinical trials going around in the United States and worldwide to find vaccine and medication to combat COVID 19 again, I love this slide because we keep talking about flattening the curve. Looks like we're probably here at this point. We're doing a turn. We're down. And what helped with flattening the curve is social distancing, canceling community event, widespread community quarantine, shelter in place, border closures, respiratory hygiene masks and infection control at the hospital. So it's working. We still need to be. We still need to do social distancing at this time. I want to mention that you are not lowering the number of cases. This is the same number of cases here. This is without doing social distancing or nothing. If we do this, we'll overwhelm the healthcare capacity and more people will die that should not be dying. But if we do this, if we stay below the dash line here, which is the healthcare capacity, the hospital will be able to take care of people and save them all right. Coronavirus testing in our area is more available now. You can get tested by. You have to contact your doctor first, tell your doctor your symptoms. And your doctor will tell you whether that you need to get tested or not or you need to come in. And there's two facilities that does testing, but you need a doctor's order. Better Med care, That's an urgent care facility that is located on Plank Road. This is their number. But you can go on here and make an appointment to do a curbside testing. Mary Washington Hospital is now testing as well. They're testing at, I believe on Princess Anne street and also at Stafford Hospital and at Mary Washington hospital on Route 1. Again, need a doctoral referral. I put this up again because it just summarizes how long coronavirus live on different surfaces on metal, glass and ceramic. Found this on the CDC FDA website. And so if you want to use this as a reference, something to look at. Now, remember, that virus can be on it, but you don't know whether the virus are still alive or is just the dead RNA that is on the surface. All right, again, CDC recommend wearing a mask. Very, very important. Please wear your mask. Cloth mask, the surgical mask and N95 mask should be reserved for healthcare personnel. This is me and my staff. We Wear masks all day long. And it's to protect you, but also protect us as well. This is a recent study that looked at breathing. So when you're running side by side, it's okay if you're six feet apart. However, there's a study that looked at somebody that coughed or sneezed in one aisle. It could travel to the next aisle. So this is going to be beyond six feet. So this person here cough. And look at the droplet. This is real measurement. The droplet can travel far. So more evidence that you should wear a mask and protect you. Even though you may not be near this person, which is six feet away, it you can still kind of get the droplets. So things to do at home. This is just a very short list. But I just found this nice site here and you can stream opera for free from the Metropolitan Opera in New York. And right now there's one. I forgot the name of it. Then next week, I can't wait, it'll be Madam Up Butterfly. And I'm looking forward to that. You can also do virtual museum as well. So just Google that. Governor Northam just I think it was maybe yesterday. Just order recreational businesses to remain closed until May 20th. May 18th. Now originally these business was supposed to open on April 24th. However that has changed. He had delayed that. So these businesses are museum, concert venue, indoor sports facility, beauty salon. I've been waiting for my hairdresser open up her shop. But my hair is outrageous. But it looks like I'm going to have to grow my hair off for a while. So yeah, so this is going to continue until May 8 and then also stay at home order is still until June 10th at this time. This study that just recently came out, scientists have looked at the cases in COVID 19 and find that obesity is the single biggest factor in hospitalization. So meaning that this is a risk factor along with age. So age, the older you are, the more likely that you're going to get more severe symptoms. And then now is obesity. What defines obesity? BMI over 30. So use this crisis and the time that you have and staying at home to take care of yourself and your loved ones. I want to stress that we're starting to see more and more in the studies to see the commonalities of individuals that have severe cases, young and old. They have these common conditions. Diabetes, type 2 obesity, high blood pressure, insulin resistance and heart disease. Now if you have this, you will have more chance of getting more severe disease, which I talked about. Those 20 to 30% that get hospitalized and also requiring ICU. So if you work on decreasing your risk factors or decreasing inflammation, you will raise your body reserve to fight the infection and also to be resilient. So next is ways to boost immunity. You've seen this a lot so I want to show this again. Studies have shown if you do or watch acts of kindness or compassion, it actually will boost your immunity. Denise, have you heard about that at all? Have you heard about that research?

No, but I'm not surprised.

Yeah, it does boost your immunity. So either watch a video or you look at art and then you perform act of kindness and compassion. It will raise your iga, which boosts your immune protein as well. And then of course you know, managing stress and so acts of kindness in the area. And I want you all to share me your act of kindness that you know about I'm not aware of. I wanted to highlight one more taco program delivering free lunches to elderly patient and also to healthcare facility. Staff of printing now is offering free banners a local restaurant now at this point. And so please, if you have good news stories of compassion kindness, email that to us@admintrungrehab.com we love to hear about it and we love to share that on our weekly webinar. And again, don't forget the people that are really taking care of you. Not all heroes wear capes. Some wear scrubs. And think about your healthcare providers. These are the ER team at Pasylvania Regional Medical Center. I'd love to have a picture of Mary Washington. I'll get that soon. They're the one that's putting themselves at risk, their family at risk to take care of you. Please do social distancing, stay six feet apart and do your respiratory hygiene. It does work and we're seeing the numbers at this point. I would tell you this. Our healthcare workers, these nurses are doctors. When they go home, they don't see their family. They live in the basement or they will stay six feet away from their family. I have a friend who works in the ER and he stayed down in the basement and eat dinner with his family. But he'll stay, you know, six feet away and all right. So that's all I have to say. And the next is Delise Dicker. She is a psychotherapist in private practice who offers workshop retreat and counseling at Camellia Cottage in historic downtown Fredericksburg, Virginia. In 2001, she founded Riverside Counseling and served as director, clinical director for over 15 years until she showed the practice in 2016. Delyse has also worked in the US House of Representative and as an administrator at Harvard University. She earned a doctorate in counseling in psychology from the University of Sarasota as well as the master's of liberal arts degree from Harvard. An award winning playwright. Wow, I didn't know that. Amazing.

It's been a long time ago.

10 years. She wrote a monthly newspaper column called Mindset with focus on mental health issues and helping readers live life to the fullest. All right, Elyse.

Okay.

Well, thank you.

That is some excellent information that you're providing to the community and to us. That was very informative. And I just want to chime in my thanks to our healthcare workers and all, all of those working on the front line is they're keeping things open so that we're able to do our work from home. And it's just we are all really grateful for that. So, yeah, I'm going to be talking about managing anxiety during this coronavirus pandemic. Obviously my field is in psychology. I've treated anxiety for a while. The first thing that came to my mind is that when thinking about anxiety is that we are animals after all, and our animal survival instinct kicks in. So I like the way that it was presented that we are managing anxiety. We're not going to be able to get rid of anxiety because as we are, we have an animal brain at the base and we have that survival instinct, as we should. So I thought for fun what I would do. I was fortunate enough to have a trip to Tanzania last October and I got to spend some time with some animals and spend some time in their habitat. And it was just wonderful to really, I was surprised at how much I identified with feelings I could between them and things. So I added between my slides, I added just kind of a random picture of a couple of animals or an animal or two that might be of interest. And I'd like for you to look at that and let that remind you that some of this anxiety that we're facing is all very normal for us and that we share that with that survival instinct with other animals on the planet. So, yes, I guess you can go next. So this is a couple of baboon friends. You were talking about grooming and not getting your hair cut. I'm in the same boat. I think we all are. So this is fun because this is a couple of friends. I think they're grooming each other and they're probably getting more grooming than we are these days. So that's good.

Well, my dog groomer is open, so my dog got his hair.

Your dog?

I Haven't had a haircut in six weeks.

That's great. Well, maybe we should start visiting the dog.

Maybe we should start going to the dog groom or something.

My standards are getting a lot lower. That's fabulous. Yes. Okay, so this slide is a little belabored, this one a little bit, because I have treated anxiety for 20 years, and people come in with anxiety all the time. As you imagine, whether there's a global pandemic going on or not, one of the things that's really important for me when I'm working with somebody with anxiety is to try to find out what, how that anxiety is manifesting for them, because it manifests in different ways. Just like we can have like a physical. I was in a skiing accident a decade ago and I hurt my knee, my left knee. So I have an injury. And if I were to go jogging, I know that I would feel that injury. And I think in the same way, we can have mental health health, not just injuries, but just ways that our brain operates, ways that we're a little more vulnerable. And so looking behind the anxiety to see what kind of ways is the anxiety representing for me, because even though the anxiety we all are facing from the pandemic may be hitting us all, it's going to kind of hit us where it hurts us. So as I go down this list, it is by no means a comprehensive list. I think a comprehensive list would probably be all the diagnosis in the mental health diagnostic manual. But this is a couple of ones that just came to mind quickly as you listen and look at these different types of manifestations of anxiety. Some see if you could think about what the way that anxiety is manifesting for you and where your particular vulnerability might be. So OCD is one of them. I'm calling this list not necessarily a diagnosis of ocd, but I think some people have what I call ishes, like an ocd ish brain that tends to go that way if you get anxious, or ptsd, which is post traumatic stress disorder. If you have had post traumatic stress disorder, that can be triggered with anxiety from the pandemic. You can imagine secondary PTSD is a really important one to think about because I know we can all get a little bit of secondary PTSD if we watch things on the news that maybe we're seeing a little bit too much. Sometimes I turn things off not because I'm not feeling sensitive, but because I kind of over empathize. So if they say we're going to be going down this hallway of this hospital and things are chaotic and it's really a mess. I might turn off the television because if you're prone, I tend to be. I've had PTSD in my past, so I'm a little more prone to that. So that's an action that I would take to prevent getting extra anxiety that way. Depression for some people is kind of a wound or a place where anxiety tends to go. Sometimes there'll be some feelings of hopelessness or some down feelings. Some people struggle with social anxiety. So in the pandemic, wearing a mask or meeting somebody and not knowing how to greet them, if social anxiety is a common vulnerability for you, then you may struggle with some of those, managing some of those issues. Some people struggle with overwhelming thoughts or excessive fears. Maybe going to kind of a worst case scenario. That is a struggle a lot of people have. And you can imagine how that can be triggered by what's going on for us. Avoidance or denial is one that I think is kind of interesting. We probably all know that person who's kind of going, you know, this is not about me. You know, I'm just going to go about my life. I'm, I'm immune. I, I'm not going to face this myself. And they may be having a very dangerous bout of avoidance or denial about, about what's going on. And then another that comes to mind is panic attacks. That's a very common manifestation of a real abundance of anxiety that just kind of tops out in a panic attack. And so if you're prone to have panic attacks, then you may be experiencing more now than you have before. With all that being said, the good news is that if you're really struggling with these things and it's not just once in a while and you're managing it, but the insurance companies, for the first time in my career have been very generous, I think, with mental health, from what I'm hearing, mental health coverage for sometimes covering your copay, sometimes covering co insurance and things. And all the therapists that I know working now, with one exception, are working on virtually through telehealth. So that's something good to think about. Again, I'm just giving that list so that you can see how there are different ways that this might be impacting you. And as we talk about other areas of anxiety, maybe you can keep that in mind and see what you think. We'll go to the next slide. All right, so here's some fun. Here's some zebras. They get in this protective stance. We're not allowed to get that close to each other. But These zebras, I think the stripes are supposed to confuse the predator, but it's fun to see them kind of hugging up and protecting one another in a way that we'll have to wait a while before we can get that close.

I missed that. I'm a hands on person, you know.

It'S, it would be hard to get them to stop. Okay. Another, another cause of anxiety is changing our routines. And I think you mentioned a little bit about this and this is constantly changing as the recommendations are changing. But one of the ones that was a big struggle at our family was the grocery store pharmacy routine. It's like they said, wipe things down with hand wipes and we didn't have hand wipes, so we had to come up with a new routine. My recommendation is that as you're looking at your routines like this, that instead of feeling anxiety every time you go about, say, going to the grocery store in those few times that you have to get out to do that or seeing someone, you know, is to decide at the beginning what you're going to do. Really think about it. It's kind of like this, you know, when you learn if most of you are probably drivers and you've driven a lot, and if that's so then you jump in your car and you drive to work or you drive to the grocery store, you don't even think about which key, putting it in the ignition, turning the ignition. That's because it's become you're autopilot. And the brain, that animal brain, loves autopilot. It loves to just know what to do and not to have to think and break down every single action. And so that's what's hard for us when we're changing a really common routine like going to the grocery store, we're having to think, you know, I wish I had a video of the first time my husband and I went to the grocery store with masks. And we had our masks and then our gloves and we thought we were all set. And by the time we got back with our groceries and we're trying to take our masks off without touching them and then the hand sanitizer falls on the floor and, you know, it was really just a lot of chaos. Fortunately, we started that before they were saying to wear masks out and taking those precautions. So we had a little room to learn. But just know that the first time that you do these routines, you're going to have to think about every single part of it and it's going to be, it's going to feel laborious. But if you just decide, okay, this is where, this is what I'm going to do with the mask as soon as I take it off and things like that. I like to use the story of my daughter. She lives in Seattle, she lives in King County. And if you remember way back in the old days, before we knew what was going to hit us, it hit King county. And I was watching quite closely because my daughter and her boyfriend lived there and they shared with me. I was quite concerned about them and knew things were changing every day. And they shared their routine. He was still at work at a movie theater. So he would come home, he would put his clothes immediately in the wash, he would take a shower, they would wipe down the counters, they would leave their shoes at the door. So they started that routine. It must have been months ago now and they're still, still in that routine. But once that got established, I think it made it a lot easier for them to be able to just come and go as they needed to without rethinking everything. So there's the grocery store routine, there's the wearing the gloves, the mask and the hand washing routine. There's the seeing someone, you know, routine. And then there's that daily routine which, whether you're working or not working from home, you know, that's probably changed a lot. And all of us are working from home. And that routine has had to become who goes in what room and who gets the Internet when and who gets the phone. Yes. So those are, that's the, the changing the routine category that I think is super important. But just get over it and settle on your new routine and move on and you'll feel better about it. And so next we have this beautiful leopard mother talking about me as a mother of my 20 something daughter in Seattle. This is a leopard who has her baby cubs. You can't see them, they're way back behind her, but they're running around behind her and she's protecting them. So I love this photo because.

Right here.

Yeah. Do you see them there? Yeah, they're back there. We waited a very long time for her to come out and she just walked out and gave us that look of confidence. But don't get too close to me. You can imagine I had a pretty good telephoto. Yeah, it's a beautiful moment. Yeah. So another thing, and I get this a lot in my practice is the living situations. This is causing some anxiety and some stress as we're in the stay at home order is it's, I think, you know, I call It. The grass is always greener because one client will come in and say, you know, I'm living alone. It's so lonely. I have one daughter, she is. She is alone with her dog. And, you know, people will say that's. That they're lonely. But then other people will come in and they'll say, oh, my gosh, I've had a happy marriage for so many years and now we're together all the time and I'm going to strangle him. So. So there's a lot of different living situations that can cause just some stress. So I have some remedies for that. One of them is to talk about and establish the household routines so that you're not constantly bickering, you know what I mean, over the. Did you wash your hands or did we wash the fruit before we came in? You have this. You have everything already established. And you know what you need to do. You want to recognize and respect each other's struggles. So just like on that first list of struggles that people have, I think it's really important to know, you know, the differences. I know one of my daughters was here right at the beginning of our staying at home. And she is. That she's wonderful to live with because she is very neat, very well organized, slightly OCD ish, I think she would admit about keeping things in their place, having things done correctly. She really kept the place looking beautiful. And I, on the other hand, like to what my friend, one of my colleagues, calls gerbling. I like to gerbil. That's where, according to her, she's a nurse. She said, this is like, I like to cuddle into the couch with a coat, you know, a blanket and a jar of peanut butter with a knife and maybe half a bag of chocolate chips. And so, you know, you can imagine that our styles were. We had the little struggle with our different styles. So both of us had to. And I think we both really did step up to the plate. I had to remember that she needed me to kind of fold up my stuff and declutter the couch a little bit when I was done. And she did a pretty good job if I was irritating her. Just finding another space in a different part of the house. So just respecting each other as you're seeing how the anxiety is manifesting in different. Different people. These two things. The next two things go together. Find an indoor place where you can have some privacy. And I know some people are like, ah, there's just no place. I just, you know, I know, I know that we don't have maybe as tiny apartments here as they might in some of the bigger, bigger cities. But I know when my kids were little, I felt I couldn't have a sibling single spot to myself. And I had, for some odd reason, I had a huge closet. So I made a little meditation corner in the back of my closet with a beautiful cushion and some little pictures and some incense. And that was my personal space. So I feel like that you can, even if it's a corner of your house, find a place where, where you can get away from the other people that you're living with in case you need some time. The other side of that is to find an outdoor place, if possible, where you can maybe visit nature. So if you're able to find a little special alone place outside, that's super nice. Used to have a tiny, tiny apartment when I was in my 20s and my outdoor space was literally crawling out my window onto a fire escape. And the fire escape became my outdoor place because I could see the clouds, I could see the stars at night. But I really think that that allows us to reduce anxiety when we can really get back to nature and get centered. So the final thing on this stay at home and living situation category is if you live with who is at higher or lower risk, and I guess we talked about earlier that there's a lot of risk at every category. But if someone is really at a different level, then you should talk about it and decide on the way you'll operate together or apart if that's the case through these difficult weeks. So that you've sort of predetermined, okay, if you go see your friend who does this or that, then you really can't come back and live here and be with your grandfather who has some other issues. But just knowing that beforehand instead of getting upset about it later, I think it does a lot in reducing anxiety. So, and here are the elephants. I loved the elephants. They're at the watering hole. I had a video there. There were many more of them. And they're slinging the water around and just having a ball out there in the, in the water. So there they are in their outdoor space, really enjoying it. And this is what I'm suggesting for you. Maybe not get out in a water puddle if you need to have some fun.

Yeah, well, you know, my, I, I, I have a trip that was supposed to go to South Cape Town, South Africa, at the end of April.

Oh, wow.

And to, and then do a safari. So I'm looking at this and say, oh, my God, what If. Yeah, I had it all planned. Bought my plane ticket and hotels and booked it and everything. Yep.

Yeah.

So.

Yeah. Well then.

So now it hurt just to see those pictures.

Well, it helped. Maybe it helps a little bit, you know. Yeah. I'll tell you what, later I'll show you the mo. Okay, so now we're to the good stuff. So the good stuff is this, you know, and we're going back to that. Animal brain, our rudimentary brain does not like too much nuance. It likes to know if things are good or bad. So it's really hard. It's sometimes hard for us to hold together the idea that this is really horrific thing that's happening across the globe. It's causing a lot of pain and a lot of suffering for many, many people. At the same time, it is opening up some new areas that have some potential good for us. And, you know, I think we have a hard time in our psychologically sort of balancing those two maybe without feeling guilty or feeling like, you know, we wouldn't wish this on anyone. But at the same time, we do need to embrace the good stuff and we need to do that in our everyday life right now. It's super important. The first thing on this list I put down is to breathe. It's two things that's good for your lungs. I'm not a medical doctor, but I'm pretty sure that it's good for your lungs to do breathing exercises. And I know it also reduces anxiety. I would suggest that you Google this. If you do yoga, you probably know a lot of them. One of my favorites is called alternate nostril breathing. You can just google that. It takes a bit to learn it, but it really is calming and centering and very, very important at this time. There's other types. There's a three part breath and there's skull cleansing, I believe breath that, that is very rigorous and there's a lot of good ones. And find, find a couple that you like and maybe sit and practice a couple of times during your day. Also visit nature and use all of your senses because when you're. I have a little place where I sit outside, I listen to the birds. I actually go barefooted so that I can feel the grass under my feet and the coolness of the grass, smell the grass. You know, just really enjoying what there is in nature for us. If you can. And if you're not able to get outside because of your living situation, open a window.

Right?

We got to do the best we can exercise. So that is always on the list. But very often I am hearing people now say, well, I went to the gym and I was in this class and I did great. And we are having to find new ways of exercising. And my new way. I didn't even think I liked gardening, but now I go out to the place where I listen to the birds and I literally dig up a fern and plant it somewhere else. You know, don't go to get the plants, but I move them around a bit, and I really enjoyed it. I really think. I don't know that I've become a gardener, but it's been a lot of fun. Create a routine that is healthier than you had time to do before. So this, again, it sounds like I'm a very routine person, and I'm actually not. But if there's ever a time for a routine, it's now. So create a routine where you get up. And I was asking one of my daughters what she did to reduce anxiety, and she said, I get up every morning, I get dressed like I'm going somewhere, I clean up my room and I go about my day. And she said, if I don't do those things, I don't feel relaxed and I don't feel. I don't. I don't feel as good for the day. So I think that's good advice. Use technology. I know that everyone, probably most everyone I'm talking to has used technology more in the last month than they have in a long time. I know I've learned a lot about different types of technology. We've played games, family games from Seattle, and I have a daughter in Boulder. And I have one who was in Richmond, now here. And we do online games. We just. We're having. We. We have a ball with that. We have a family thread. We'll post what we're doing. If I get worried, you know, kind of just say, hey, who's doing what? I just say, why doesn't everybody give me a picture of what they're doing today? But about technology, I will say that I did read that FaceTiming, as opposed to talking on the telephone, some type of video conferencing, as opposed to just audio, actually creates more dopamine. Did you know that?

No, I didn't know that.

Yeah, I will have to look a little bit to find it again, but I was not terribly surprised by that. But it's nice to know. So for. Especially for clients, most of my clients now, we definitely do some type of video rather than just a telephone call. But certainly with your family and friends, you can Have a Zoom party, I imagine that's.

That's right. Yeah. A Zoom happy hour.

We had a Zoom happy hour the other night and we talked about what. We have an idea group and we go around with an idea and I. Our idea was, what's something that's good that has come out of the pandemic for you? And everybody went around and had a few of the things we've talked about and it was cocktail hour. It was fun. Finally, I have just a nice list. Cuddle, bake, garden, read, watch old movies, clean and organize. And best of all for many of us is sleep late. I've never slept so late before. It's wonderful. 8:30. Yeah. So that's great. And then I think one of the.

Benefit of staying home.

Yeah, stay home. This last little picture, just a fancy bird gathering sticks for the nest. It's got a name I didn't have time to figure out. Maybe you'll see it when you do get to do your trip. And you can. You can come back with the name.

I hope so. I thought it was a crane initially, but it's.

I know the safari driver was very surprised and pleased to find it and told us the name, but it escapes me now.

What, what, what? Where were you at? Were you in Kenya?

In Tanzania. Tanzania, yeah. So we had two different places.

Wow. Okay.

I hope you get there and you will. It's just a matter of when, right?

It doesn't matter when. No. I have credit, so I'm gonna have to go before my credit ends on my airline. On that. Yeah, definitely.

It's. It's well worth it. It's one of the best trips. It's a trip of a lifetime, honestly.

No, I. It was gonna be my trip of the lifetime in 2020. So now I'm. Now I'm looking at my living room and my family room, my backyard. So. Thank you. Thank you, Delyse. That was wonderful presentation. I have all sorts of questions, but I want to make sure that our participant is able to ask questions as well. So for those that like that want to know more about Delise, this is her website here, camelliacollege.com and her phone number is 5403714000 and she's located on 207Amelia street in downtown Fredericksburg. We are so delighted that you're here to offer so much nuggets about anxiety. And so I believe I have a couple of slides. I love this quote. Yesterday's history, tomorrow is a mystery, today is a gift of God or higher being, which is why we call it the present. It is our present. So enjoy what you have, and no matter what, it will be over. So we now would like to open up for any question, concern, and you can type it in the. The chat box, and I'll be able to pull that up. Okay, so. Or you can talk and I'll mute you if you want to. All right, so everybody should be able to. Let's see. Well, some people left. Unmute, unmute. Some people left. So don't be shy if you have any question. Well, I can start. Let me see if I can pull up the chat box here. Here's a chat. All right. All right. So I don't see anybody on chat. So if you. I have some questions. Why does routine relieve anxiety?

I think that routine. We have routines that we're not really aware of them being a routine. Like if I get in the car and drive to the store, the way that I drive there, I'm not really thinking about that as a routine, but it's just become a part of what I do, and I don't have to think about each different aspect of it. But now we're changing the way we do things, even if it's something as simple as going to the store, and we have to reestablish a different way of doing it. You know how when you take off your mask, like, for me, I've never really worn masks. I got out my sewing machine and I made some masks, but I had never really worn a mask before. So trying to figure out the routine of how putting it on properly and then taking it off without touching and. Right. Is what I'm calling a routine. Even. So it's that kind of thing, and it's.

It distract you from your anxiety. So if you have a routine that.

It'S a distraction I don't get anxious about. Say, like, the first time we went to the store with masks, it was new to us. And so the anxiety came from, oh, my gosh, I just touched my face after I touched the outside of my mouth, and my husband actually dropped his on the floor. And then he picked it up and hung it on the vent of the air conditioner so that the air blew through it, you know, so it was. That was all anxiety provoking because we were just like, oh, no, you know, now, you know, that's the last thing you want to do with the mask is, you know, blow air through it. So things like that, we had to establish this is where we're gonna hang them in the car. Then when we get Home, you know, we throw them in the wash, things like that so that you don't have to think about it once it's established and you know that you're doing the safe thing. You've already thought it through.

Yeah, right. And I don't see any other questions. I'll leave. So the, the people that do does avoidance and denial and you said that is part of anxiety. Do they know that they have anxiety when they do that?

Well, there's, you know, most of those categories. I based on something in the, the dsm, the diagnostic manual. I was thinking avoidant personality disorder possibly or I was thinking of sometimes, you know, with grief or with. There's a period of denial where you're not acknowledging what's really going on because if you did it would just feel overwhelming. So you just. Your brain really I think protects you from the grasping the scope of what's really happening. Yeah, so that's where I was, what I was thinking about with that.

Great, great. I don't see any more questions, but I'll ask a couple. What do you think gonna happen during and after this? COVID19 over for mental health wise. What do you think will be the sequoia?

Yeah, I think during it, you know there is a lot of anxiety. There is also a lot of other things sort of creeping up depression and. But I think we're probably tolerating it now better than we will when it's. When. I don't want to say over because it does sound like it's just going to change and change and change until we get back to some kind of newer normal. But I think it's going to take quite a toll. I mean lots of people are losing loved ones. That's the hardest. There is nothing harder. And then the way people are passing away and the way that we're not able to be with them in, in the way that we would if they were in the hospital for something else or at some other time. And the fact that, you know, we're not able to come together and grieve together with one another is all of that really changes those comforting habits and, and gestures that we've had my whole lifetime.

Right now. What do you suggest for someone that knows someone that has Covid. That's been hospitalized but they do okay and they come home. How do you cope with that? How do you cope with that grief or that that unknown?

You know, I haven't had anyone in that category yet, so I think it would depend on the person. Some people are just very resilient and optimistic. And I think they might feel good that their friend has had it and now they're okay, and now maybe they have some immunity and, you know. Yeah. So I think that it just depends on the person. And that's where it kind of goes back to those vulnerabilities. Are they seeing that in a, in a positive way or is it something that they're, that they're grieving?

Right. Yeah. No, it's. I think that more than ever, I think after this it's, you know, counseling will be much needed to address the issues that we're going to have. Not counting the issue of, you know, staying at home, being isolated and not getting into your routine that you're used to.

That'll be really hard for people with, like, social anxiety. You know, some things where they've gotten accustomed to being out. Out of society. Yeah, yeah. It's. It's just, it's really going to be tough.

Yeah. And I think there will be a new norm after this. And the point that I didn't say in my talk was that, you know, people think, well, it's going to be over in a few weeks. It's actually, you know, SARS COV2 will be in time. It's going to be like the flu. It won't be gone. We'll be able to control the number of infection because vaccine can come out and we're going to have medication that will treat the severity of the symptoms and decrease the number of deaths. But it's not going to be gone. It'll be seasonal. And wearing masks and social distancing and respiratory hygiene will go on probably for about a year until a vaccine comes out. Year, year and a half until we have vaccine and we have enough testing and the blood work to really know what this is about. So it's not a short term thing. It'll be a new norm, at least from my perspective. Even in my, in my office, you know, we disinfect everything now after every patient and we cover. We disinfect and cover anything that, like a cord or anything that may be in contact with someone that we never thought of before. Even pens that we leave out for a patient to sign. It has to be a different pen. You have to disinfect that pen.

Yeah.

Afterward. Or you throw it out. Yeah. We see the pen. Even a coffee maker we have in the waiting room. We had to take that out because you can't have anything that is shared. Yeah.

And you just have to think through all these.

You don't think about that.

First time. Yeah, yeah.

We have a coffee maker for our patient and, and so we take that out now, unfortunately. But you know, we, we tell our patient if you want a cup of coffee, they'll make it, we'll make it for you. But we can't have a share with multiple people, you know.

Right.

And just things that we take for granted. Yes, that was what we take for granted. Now we can't even a water fountain and we have to cover the water fountain. You can't share the water fountain anymore. And, and yeah. Aspect of going to the dentist now that, that's something that I, I worry about whether, you know, how you're going to be able to go to the dentist and with you know, them working on your mouth to aerosolize and all that. And they have to create a whole new room and environment at the negative pressure room. So it's a whole new norm. It is a whole new norm. Those, you know, I don't know, you know. But the dental's office been closed now for at least over a month I believe. And they only see patient for emergencies, but not for routine cleaning. I, I had my six month schedule for April 11th and of course I never had it. Now I'm probably going to wait another six months.

I know, me too. I missed one another grooming thing. Right. I was supposed to have my teeth.

When we come out of this, our hair will look terrible. I know.

We can have our roots showing.

We have bath teeth on top of that.

We're a mess. I know, your nails look awful. I'm like, well that's just par for the course now. But you're right. And I hadn't really thought through things like the dentist. There were already people, there are a fair number of people who are afraid of saying things like going to the dentist anyway. So doing that now is going to be a big concern. But I really liked what you said about how it builds our immunity because with kindness, when we're kind and I have seen, have you seen just this undercurrent of kindness between the grocery clerk and the person checking out or the UPS person when he put something on my porch? You know, there's just this, even though we can't get anywhere near each other, we're voicing our, you know, our feelings of gratitude to each other and that's, that's a really positive change.

Yes. And so a sense of helping others and the sense of kindness, actually it's the fulfillment of gratitude for that you feel that you're serving a higher purpose. So I don't see any other questions on the chat box. And so I'm much, much grateful that you were able to join us today and on this webinar. And we will have one every Thursday at the same time at 7. And we'll just kind of, you know, talk about different things. So our attendees, you know, I'm ready.

To be a participant. I can't believe I didn't know about this before. So I'm going to be joining to just to listen.

I'll definitely send you an invite. We'll do it on every Thursday at 7 o'. Clock. And you know, I would love for you to join and be part of our discussion. You know and I'm sure we can have a lot of questions for you as well too. So. And last week we had Dr. John McLaughlin and he did meditation. So he did a 20 minute meditation session and afterward I felt like I was about to fall asleep. I went after him and I did not have my same energy I had before. I was very, very mellow. So this time I decided to go first because I was, I was afraid I was gonna get too mellow with this. So. But, but thank, thank you everyone for joining us today. Thank you. Delise much. Appreciative very much.

I appreciate it. It was so.

Yeah. Everyone be safe, be healthy and I'll see you next week. Thank you. Take care.

Bye bye. Thank you.