The pandemic has affected people's psychological health: the effects of isolation
In March 2020, a worldwide isolation regime was introduced. For more than two months, our usual life was paused. At best, work was transferred to online, at worst, it simply died. Meetings with friends - only by video connection, and calls to elderly parents, grandparents - more often and more alarming. We were isolated to save us from the coronavirus, but did we manage to save ourselves? Edition Esquire found out what psychological problems people encountered during the regime of self-isolation, as well as the forecasts of psychologists about the impact of the pandemic on our mental health.
In February, the scientific journal The Lancet published a study on how isolation affects people's psychological state. The authors analyzed more than two dozen articles on the effects of quarantine on mental health, written during or after the well-known global epidemics (in particular, the outbreak of Ebola in 2014, and SARS in 2003). Most articles say that isolation can lead to various psychological consequences: from increased levels of anxiety, insomnia and emotional instability to post-traumatic syndrome (PTSD) and depression.
The results of this study cannot be fully correlated with the current situation, as the coronavirus pandemic for the first time in history led to isolation on a global scale. Scientists have yet to study this revolutionary historical period, as well as its impact on the psyche and human health. However, psychologists are already seeing an increase in anxiety, suicidal feelings, domestic violence, as well as the appearance of panic attacks and emotional dysregulation. Especially severe psychological consequences are predicted in people who have had COVID-19. At the same time, not all quarantines became a serious test, someone found many advantages in this situation and no longer wants to return to the previous format.
“Pandemic, isolation and uncertainty are excellent conditions for the development of depression and the emergence of suicidal thoughts”
“We will be able to evaluate the real consequences of the epidemic later,” says Olga Kalyagina, a practicing psychologist and member of the Association of Cognitive Behavioral Therapy. - At the moment, there is no complete picture of how quarantine and a pandemic affected the psychological state of people. Members of psychological communities predict that after the end of the epidemic the number of calls to psychologists will increase, since the circumstances we are in now are a real threat of the virus, lack of control, uncertainty, social isolation, changing the usual rhythm of life - ideal conditions for development and strengthening anxiety and depression. "
On the subject: New symptoms of coronavirus infection: CDC updated list
Kalyagina notes that in isolation those psychological problems that existed in a person before may become aggravated. And if he does not find ways to cope with them, this can lead to depression, in severe cases - even to suicide: “A person in depression sees the future gloomy and hopeless, and himself - helpless and worthless. Now, in a pandemic, many people may think that it will never end, it won’t turn out anything good, that they’re unable to cope with it. And for some this may provoke the emergence of the idea that suicide is the only way out of this situation. ”
However, clinical psychologist Mental Health Center, a cognitive-behavioral therapist Evgenia Smolenskaya believes that it is impossible to speak clearly about isolation as the cause of an outbreak of psychological problems around the world, because everything depends on a particular person, on how stable he felt before quarantine.
“A pandemic, quarantine, isolation will definitely lead to an outbreak of psychological problems around the world. This is already taking place, ”says Smolenskaya. - But if we are talking about specific people, then not everyone in a collision with such serious changes in his life must necessarily be upset. It depends on many factors: character traits, the presence of mental disorders, resources (financial reserve, social support, etc.) and others. Some factors play against the person - we call it “risk factors”. For example, the history of anxiety disorder in a particular person increases the risk of exacerbation in self-isolation. Other factors, on the contrary, protect (these are protective factors); for example, an introvert programmer who had already worked from home may not notice significant changes in his lifestyle and mental state due to the pandemic. ”
Speaking about a possible outbreak of suicides, Olga Kalyagina notes that elderly people who are completely isolated and middle-aged men who have lost their jobs and financial stability are at risk. Women, according to Kalyagina, are also subject to this, but they statistically more often turn to specialists and find other ways to solve problems.
“The man is pressed by social stereotypes regarding their financial and personal solvency: many men are told from childhood that they should earn a lot, be breadwinners in the family, not show weakness and not ask for help. In general, the situation is now gradually improving: men are more likely to turn to psychologists for help. But there are still more women among the clients of psychotherapists anyway, ”Kalyagina explains.
Evgenia Smolenskaya also notes that women in general tolerate situations of uncertainty better than men.
“Doctors, like any other people, have weaknesses”: what psychological problems did doctors working with COVID-19 face
Director of the Center for Cognitive Therapy, clinical psychologist Jacob Kochetkov and his colleagues at the Association of Cognitive Behavioral Therapists launched in April this year a program of psychological assistance to doctors and healthcare providers working with COVID-19. The program includes five free consultations with professional psychologists. During the spread of coronavirus infection in Russia, about 40 doctors and paramedics took advantage of this assistance program.
“Doctors, like any other people, have weaknesses. And there are a number of problems that they encountered while working with coronavirus infection, ”says Kochetkov. “Most often, these problems are associated with the disorganization of the system itself: a lack of personal protective equipment, pressure from management, non-payment of cash, etc.”
According to Kochetkov, perfectionist health workers suffer most in this situation: “Imagine a person who has done his job well before this is faced with an uncertain situation. He does not know what will follow his appointment. In a person with a very high level of responsibility for the result, this can cause great anxiety and anxiety. As a result, doctors stop sleeping, constantly think about work, all the time scroll in their head, from their point of view, erroneous actions that actually could not be foreseen. In addition, they have problems with emotional dysregulation. Hard work, strong pressure from different angles, fatigue - all this causes outbreaks of anger, irritation, ”says Kochetkov.
Veronika Salimgareeva is a clinical psychologist from Perm; she worked with doctors and patients in the “red zone” of Perm City Clinical Hospital No. 7. At the end of April, Salimgareeva herself became infected with the coronavirus and could observe the condition of the doctors both from the side of the psychologist and from the patient.
“Constant processing, lack of PPE, lack of a clear treatment algorithm often lead to depletion of health workers: in this state, the psyche seeks to operate with the usual automatic actions avoiding difficulties,” says Salimgareeva. - Doctors and nurses are reduced empathy, defensive reactions make it impossible to imagine what the other person feels. This leads to ineffective strategies for communicating with patients: for example, evading behavior or threats from the police. ”
Both Kochetkov and Salimgareeva note that the main wave of psychological problems will cover people later. In particular, doctors may show signs of moral trauma, which leads to the participation or non-prevention of events occurring against human values.
“Relatively speaking, when there is not enough medicine or ventilators, and the doctor needs to very quickly make a choice who to help,” Kochetkov explains. - Later, the doctor begins to think about this situation, to scroll through all the details in the head. It will seem to him that he made the wrong choice, he will begin to reproach himself and suffer. As far as I know, doctors in Italy had to deal with such a difficult choice. In Russia, at least in Moscow, to a lesser extent. But we can assume that over time, some of them will still begin to ponder their experience. And it can cause moral trauma. ”
“If a doctor seeks help, this does not mean that he is worse or weaker”: how psychologists help health workers
“First of all, it’s important to understand: if a doctor seeks help, but his colleagues don’t, this does not mean that he is worse or weaker,” says Yakov Kochetkov. “We all have our weaknesses.” In this sense, there is nothing wrong with seeking help. ”
The psychologist notes that it is very important to learn how to relax, not only physically, but also mentally. “Our task is to teach doctors to relax between shifts,” Kochetkov explains, “to work with their anxiety, with anxious thoughts. We give advice on how to switch our attention, teach less to demand from ourselves, treat ourselves with greater compassion and more support. We also work with insomnia and help restore a healthy sleep. ”
“I was often called to the“ red zone ”and they said that the patient had psychosis”: what problems did the people of COVID-19 face.
“When I got sick and a therapist in a protective suit came to me, alarming thoughts appeared even then. “I was afraid that even if I have a common cold, a doctor who has been to a hundred calls before may infect me,” says Eugene, who had a coronavirus. - Then there was a lot of excitement due to the situation of uncertainty. The first coronavirus test result was negative. But the heat held on, the smell and sense of taste disappeared. I was afraid to call doctors again. ”
Having been ill at home, Eugene passed an antibody test, which confirmed that he had COVID-19.
“Of course, the level of anxiety during this period has increased significantly,” says Eugene. - It was alarming that the doctors did not yet have a proven treatment plan, and how the disease would develop further. The consequences of the virus are unpredictable. The situation was aggravated by information pressure, since the Internet and the media constantly talk about the horrors of the “red zone”.
Already at the end of the regime of self-isolation, Eugene decided to turn to a psychologist: “Such a desire arose earlier. But quarantine aggravated many problems: a large number of fears accumulated, my emotional state became unstable. I don’t think that turning to a psychologist is a manifestation of weakness, it’s an attempt to build a sincere dialogue within ourselves. ”
Psychologist Veronika Salimgareeva, who worked with coronavirus patients and who herself had an infection, recalls that one of the main causes of psychological problems is related to the uncertainty of the situation and the lack of awareness about the disease and its own condition. “When I was called to the“ red zone ”, I often heard the phrase from the doctors that the patient“ started a psychosis ”. Talking with a person, I realized that of course there was no psychosis. Imagine that he is locked up, his movement is limited and, in fact, no one talks to him, does not explain what and why. This causes great anxiety and anger. Someone can cope with this, but someone does not work self-regulation, and he begins to show aggression. When we don’t know what is happening to us, we begin to draw all kinds of horror films, catastrophic scenarios in the head. The nervous system reacts to such thoughts by activating stress hormones, because the brain does not distinguish real threats from imaginary ones. And isolation deprives a person of instinctive defenses against anxiety - flight or activity, ”says Salimgareeva.
In addition, according to her, the ill-conceived organization of the work of hospitals affects the psychological state of patients in many respects. For example, keeping in one department patients with different types of pneumonia.
“Imagine a person with pneumonia, but without COVID-19, who is already at the recovery stage, is being placed in the coronavirus patient’s room,” explains Salimgareeva. - That's it, a person is considered contact, and his stay in the hospital is extended for another two weeks. This approach has led patients to revolt in a Perm hospital. ”
Yakov Kochetkov believes that some patients who survive COVID-19 may subsequently develop post-traumatic stress disorder (PTSD) or panic attacks: “This will mainly affect those who were in intensive care or at least were hospitalized,” emphasizes Kochetkov. - The more severe the condition, the worse the consequences. According to research, more than 30% of people who have gone through resuscitation in their lives have post-traumatic stress disorder. This is a very high number. Therefore, we can expect that people who survive COVID-19 may well develop PTSD. But even people with a less severe form of coronavirus infection can have manifestations of the so-called panic disorder, in other words, panic attacks. Covid is often associated with a feeling of suffocation; a person who has had them has experienced a very unpleasant condition when it is difficult to breathe. After recovery, a person begins to listen more carefully to himself, and it may seem to him that something is wrong with his lungs. Then the panic begins, and the person begins to suffocate again, although there are no objective reasons for this. ”
“Violence becomes more violent in isolation”: how isolation has affected domestic violence
Under quarantine and coronavirus restrictions, the incidence of domestic violence has risen sharply worldwide. Back in early April, UN Secretary General Antoniu Guterres declared that “we are witnessing a terrifying global outbreak of domestic violence.”
In early May, the Commissioner for Human Rights, Tatyana Moskalkova, reported that in Russia, during the self-isolation regime, starting April 10, the number of cases of domestic violence increased 2,5 times.
“For many specialists working with this problem, the increase in domestic violence was not a surprise, because various extreme situations, which include a pandemic, usually lead to such consequences,” explains Elizabeth Velikodvorskaya, psychologist at the St. Petersburg Crisis Center for Women. - People who are prone to commit violence, in particular domestic violence, in isolation resort to it more often and to a greater extent, the violence becomes more cruel, more severe. Secondly, in quarantine, the possibilities for providing assistance to victims are becoming much less. ”
In May 2020, 1009 women turned to the Crisis Center of St. Petersburg. This is almost twice as much as in the same period last year. Every month since the spread of infection in Russia, the number of cases has increased by 10–20% (in March - 795, in April - 852, in May - 1009). Specialists of the center expect this number to grow further.
“When a woman is faced with domestic violence, it is very difficult for her to talk about it. The topic is considered shameful, and often we can hear: "Yes, she herself is to blame," "she chose him," "she brought him to." But the first thing we recommend to everyone who finds themselves in this situation is to ask for help: call or write to the crisis center or any other organization where they deal with this problem. Breaking the silence is one of the most important steps on the way out of the situation of domestic violence, ”Velikodvorskaya emphasizes.
Since it is not always possible to call, especially in quarantine conditions, when the partner is constantly nearby, you can write to the crisis center - its accounts are on all social networks. Then everything depends on the specific situation: the victim may receive psychological or legal assistance, as well as seek asylum.
“In quarantine, we, together with hoteliers from St. Petersburg, launched a joint program to help women who experience partner violence,” said Elizaveta Velikodvorskaya. “Since May, hotels have provided the center with several rooms where women can be accommodated, because in isolation they cannot always go to elderly parents or friends, and a safe haven in some cases is simply vital.”
“We need to maintain hygiene for the sake of hygiene, not for reassurance”: how to get out of quarantine if the virus has not disappeared
“I did not leave home for 68 days. And only in early June for the first time in all the time of self-isolation I went for a half-hour walk. For all this time, I never even went to the store, I have an established, completely contactless delivery. But I noticed that once a week when I take food (although I don’t see the courier), I start coughing on the same day or the next. This is psychosomatics, because I am very afraid of getting infected, ”says Elena (name changed). - When I first went outside after isolation, I was in a mask, did not go into the shops, just walked for half an hour. But when I came home, it seemed to me that I had nothing to breathe, I began to cough, I began to shoot in the lungs. "
As the clinical psychologist at the Mental Health Center, Yevgenia Smolenskaya, notes that being afraid of contracting infection even after lifting the restrictions and self-isolation regime is an objective problem because the virus hasn’t disappeared anywhere: “If, due to fear of infection, a person is in constant alarm, refuses to work, doesn’t let him go anywhere children, all endlessly watered with a sanitizer, it ruins his life. He needs to formulate a new concept of the world, including radically accepting the increased risks of getting sick or dying, and continuing to live with this understanding. Radical adoption is one of the skills that psychologists teach their clients. Even if we ignore the virus, there are a lot of situations in a person’s life when he has to radically accept some kind of reality. Without accepting it, he creates much more problems for himself. It ruins his life. Acceptance, even if it is accompanied by a high level of discomfort or mental pain, brings less suffering. "
Yakov Kochetkov, specializing in work with obsessive-compulsive disorder (OCD), adds that one of the possible consequences of a pandemic will be the development of OCD: “One of the main types of obsessive-compulsive disorder is fear of infection, pollution, and obsessive hand washing. People with OCD, long before the pandemic, washed their hands dozens of times a day for hours, maintained very high hygiene and suffered from this. Now, many people who have not had this before may have some symptoms of OCD. It is important to understand that hygiene is necessary for hygiene, not for comfort. If you wash your hands to calm down, this is a bad sign. If you wear a mask, wipe products after the store, water everything with a sanitizer to calm down, and then do the same a second time and a third, then you need to seek help from a specialist, ”concludes Kochetkov.
“It is impossible to say that people suffer and only suffer in isolation”: the positive consequences of the pandemic and quarantine
Despite the complexity of the situation caused by the coronavirus, many found advantages in it. The most obvious is that you don’t need to spend time on the road to the office or to study, but this saves the nervous system, allows you to sleep more and save money. There was more free time to find a hobby or start playing sports.
“It is impossible to say that in isolation people suffer and only suffer. This will be a great exaggeration, - emphasizes the psychologist Evgenia Smolenskaya. - There is no guarantee that if you are quarantined in a situation of uncertainty, then you will certainly develop depression, anxiety disorder, panic disorder and PTSD. Man is a very stable and at the same time very fragile creature. What will win is a rather unpredictable story. Many people have discovered a lot of advantages and benefits in the new world. For example, some of my colleagues began to gather at Zoom and learn belly dancing. ”
According to Smolenskaya, for some people, such stressful situations, on the contrary, become an impetus for something new in life. For example, to launch a startup or to rebuild your business for the digital environment and the needs of society in a pandemic. So, many companies decided to redesign their production for the production of antiseptics and medical masks. Isolation had a particularly positive effect on the business of logistics and IT companies, as the demand for delivery and Internet services during this period increased significantly.
In addition, during quarantine, Russians began to transfer significantly more money to charitable foundations. According to the monitoring of fees, more than 600 Russian NGOs help socially vulnerable groups. In March, the number of online transfers increased by 37% compared with February, and in April increased by another 38%. Moreover, in April, the average transfer grew by 7% and amounted to 1021 rubles - this is the highest figure in the last year and a half.
According to analysts, funds at the very beginning of the epidemic asked people to help those who became even more difficult during the crisis. And people reacted, although many of them are worried about their own future.
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