Cognitive behavioral therapy suggests changes to thinking and behavior patterns. Treatments include learning to relax the body and calm the mind, learning problem-solving skills for psychological situations, and more. It could greatly remedy COVID-based, mental health issues.
Regardless of our own physical and mental health, financial stability, living situation, religious beliefs, or political alignments, there’s no question that 2020 has been a stressful year. The year began with wildfires in Australia that burned over 10 million hectares; at the time of this writing, the coronavirus has killed 1.4 million people worldwide; national and statewide lockdowns affected economies around the world; the United States just came through a very polarized presidential election; and more.
It may be time for people worldwide to consider cognitive behavioral therapy (CBT). CBT focuses on changing our thinking and behavioral patterns, including learning to recognize if and how they’re causing us harm. While many of us are practicing safer-at-home measures, we could have the opportunity and the reason to examine CBT and how it can help.
In an exclusive interview, Dr. Jason Satterfield, Professor of Clinical Medicine, Director of Social and Behavioral Sciences, and Director of Behavioral Medicine in the Division of General Internal Medicine at the University of California San Francisco, offered his professional opinions on CBT for 2020.
Be a Worrywort, When You Can Pencil It In
One of CBT’s practices for managing anxiety is to commit a specific time of the day, or week, to worrying. This can prevent us from worrying all the time, providing us with a specific window of time to be concerned about things.
“Scheduling worry time is really about setting limits on how, when, and where we allow our minds to mull over anxieties,” Dr. Satterfield said. “Some worry can actually be productive, particularly if the problem we are faced with is changeable. Worry time recognizes the need to worry but condenses our worry time into a manageable size.”
Of course, finding a time and place to let ourselves worry is different for anyone working from home or who has children at home. Dr. Satterfield said we should avoid setting worry time in a place where we typically relax, such as a bedroom. Likewise, worry time shouldn’t come just before bed or a family meal. Instead, allow yourself time to worry during normal work hours and in your physical work space. Write about it, say it out loud, close your eyes and think about it—the important thing is to pick a time and stick to it.
“When time is up, put a ‘bookmark’ in your worry portfolio and start again tomorrow,” Dr. Satterfield said.
Family, Friends, Therapy, and a Hard Year
Is 2020 really as uniquely stressful as it seems? Or does it simply seem scarier since we’re in the middle of it? Dr. Satterfield said it’s fair to say this year truly is like no other in recent memory. Between the pandemic, the presidential election, economic woes, and more, the psychological world is seeing the effects.
“In recent surveys I’ve seen, about 40% of the population is reporting symptoms of depression,” he said. “Insomnia is off the charts, alcohol consumption is way up, drug overdoses are surging—we need mental health support now more than ever but finding a therapist is still really difficult.
“Fortunately, the rules that used to limit—actually prohibit—telehealth visits have been waived. You can find a new therapist entirely online and have all of your sessions online.”
Another first step Dr. Satterfield recommended is reaching out to family and friends. He said to tell them how you feel, talk about what you’re struggling with, and recruit “CBT Study Buddies” to work through CBT exercises. Having someone to talk to can help you feel more positive and less alone. Additionally, there are two CBT courses available that Dr. Satterfield taught for The Great Courses.
Grief and Isolation in 2020
Grieving is another process that has been affected by the pandemic. Fear of infection and additional deaths have made people uncomfortable attending memorial services for loved ones who have died, whether those loved ones have died of COVID-19 or not. Dr. Satterfield said that in a way, it reminded him of the early days of the AIDS epidemic. Before it was known that AIDS was caused by HIV, and before we knew how HIV was spread, many patients died alone or were cared for by strangers, for fear of getting their families sick.
“From that epidemic, we learned the importance of compassion, forgiveness, and non-judgment,” he said. “We learned to take nothing and no one for granted because we didn’t know who was going to get sick next. We learned to value, to cherish what time we have together.”
We aren’t accustomed to “remote grieving,” and it will take time for us to mourn those we’ve lost this year. It may be some time before we can join with family and friends for a proper memorial or life celebration service. There are no definitive solutions yet, but Dr. Satterfield urged expressing kindness and compassion for one another.
Whether we’re in mourning or not, COVID 19-induced isolation is difficult. Virtual holidays, distance learning, avoiding social gatherings, and working remotely have given many of us screen fatigue. Virtual visits can seem like a poor substitution for in-person visits, and Dr. Satterfield recognized this as something he also has felt.
He advised against meeting people in-person, saying that it wasn’t worth the risk of infection and that we can’t ignore the guidance of health professionals and experts and pretend there won’t be consequences. However, if someone is absolutely determined to get together with friends, he offered tips for minimizing risk.
“I think many people have created ‘bubbles’ that limit social contacts and exposures,” he said. “Be sure you can trust those in your bubble and be sure to communicate risks you have taken regularly. Try to keep social interactions outdoors, if possible—you get to finally use your backyard or that park down the street.
“Get some extra warm clothes that allow you to stay outside with others longer, get a heat lamp or fire pit, and make more frequent video calls to people you love.”
Dr. Satterfield said that one benefit for going virtual is that you don’t need to limit yourself on who you see or speak with. It may not be the same as an in-person visit, but missing someone today is worth knowing they’ll be alive and healthy in the future.
Dr. Jason M. Satterfield contributed to this article. Dr. Satterfield is Professor of Clinical Medicine, Director of Social and Behavioral Sciences, and Director of Behavioral Medicine in the Division of General Internal Medicine at the University of California, San Francisco (UCSF). He earned his BS in Brain Sciences from the Massachusetts Institute of Technology and his PhD in Clinical Psychology from the University of Pennsylvania.
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