Things have changed over the past three months.  Words like social distancing, antibodies and quarantine are part of everyday conversations. Social gatherings are often regulated to Facetime and Zoom. People leave home for walks in parks, curbside dinner pickup and essential errands.  The unemployment level mirrors that of the Great Depression, frontline workers from grocery stores to hospitals weigh the COVID-19 infection risks at work and many residents are unsure if they will be able to afford meals and housing. It has been a challenging time in the state.

New Jerseyans are struggling with the emotional and mental health impacts of COVID-19.  The New Jersey Department of Health and Human Services has set up New Jersey Mental Health Cares with resources and support for residents.  Governor Murphy has encouraged us to ask each other “How are you doing, really?”  For many New Jersey residents the answer is complicated.

How do we begin to cope with the anxiety, grief and uncertainty of COVID-19?  I crowdsourced questions from readers and then spoke with Dr. Jane Benjamin, a psychologist who has been treating New Jersey and New York patients on Zoom throughout the pandemic. In full disclosure, Dr. Benjamin, is not only the Clinical Director at the Counseling Center, she is also my aunt.  We grabbed some coffees, sat on our respective outdoor decks, and Zoomed on a sunny Saturday afternoon.

Mary: To get started, what are the main mental health issues you are seeing in your practice because of COVID-19?

Dr. Benjamin: At the top of the list are a variety of anxiety disorders.  For some people it is generalized anxiety.  For others it is panic attacks.  There are also increasing cases of agoraphobia, which is the fear of leaving home.  This one is particularly tricky.  In this moment, it is hard to call agoraphobia a mental health symptom. This is because we are mandated through “stay at home” orders by our state leaders to stay home.  However, the reality is that we all must get back to life.  For some people it will be extremely hard to get back to life and in those cases the state mandates to stay home can morph into agoraphobia.

In addition, all kinds of addictive behavior are ramped up right now.  Everything from substance abuse, gambling, shopping, food, sex, and porn. And intrafamilial conflict (such as that between parents and kids) is also common in households.

Finally, all forms of grief are of paramount concern.  It not just the loss of human life that people are grieving. People are also mourning the loss of significant life events.  Graduations and weddings have been canceled or considerably altered in form.  People are grieving the loss of time with grandparents and others who are outside their households.  There is just a lot of grief.

Mary: Readers are interested in the different impacts of the lockdown depending on household configuration.  For examples, are solo quarantiners experiencing different impacts than those in multi-person households?  Are there strategies that people can use in different situations to better cope?

Dr. Benjamin: Yes, the stressors are different depending if one live alone versus in a multi-person household.  In households that have couples, the experiences range from spending time together that is easy and fun, to people experiencing domestic violence—and everything in between.

For parents, there is the added stressor of homeschooling their own children and tons of anxiety if their children are falling behind in that process.

And for people alone the isolation is difficult, even for introverts.  Many solo people are experiencing increases in depression and sleep disturbances. Their whole circadian rhythms can get messed up.

Now let’s talk strategies—First, setting up boundaries in a house does not need to equal acreage.  You can be in a small place with other people and learn to respect boundaries.  You can tell your children that you are putting your headphones on and will be alone for an hour. If family members respect the importance of boundaries, you can get private time.  It is critical that you find time to be alone and get space.

Second, for those living alone, it is the art of staying connected—phone calls, Zoom social hours and other outlets.  At least once a day it is critical to interact with another human.

Particularly concerning is the increase in domestic violence and child abuse that is being reported. It is so important that if someone feels unsafe in their home that they reach out the New Jersey Domestic Violence Services.

Mary: Are there unique mental health needs for certain groups of quarantined people, like senior populations, who may be more at risk for age-related depression or anxiety issues?

Dr. Benjamin: For seniors, quite often mental health concerns can manifest as physical issues.  A senior, for instance, who says “I am having headaches” or is falling down a lot, may be masking a mental health issue. When older people don’t feel good emotionally, they often have physical problems.  So sometimes you must read between the lines to see that it is really depression.

Mary: Several readers are concerned about the long-term mental health challenges their children may experience.  A reader notes: “I’ve noticed my teenage kid, who excels in online class work and is generally in good spirits, has never been so clingy.”  Other share that their children are afraid to go outside because the “virus” is there.  Advice?

Dr. Benjamin: For children, there are different strategies and responses depending on age.  For very young children (those under 6 years old), a lot of reassurance and affection is needed.  Parents must also have a lot of tolerance for regression (for example, bedwetting or returning to an old stuffed animal).  You should not be harsh with regressive behavior.

For older children, it is critical that parents and other adults do not pretend that the current pandemic is not affecting them.  If adults pretend that they are fine and that everything is fine, their children will not believe it.  We must acknowledge this is a scary time, but we will get through it.  If adults say to children “everything is fine”, it is isolating for the kids.

For children with special needs (such as autism), this time is particularly challenging.  Parents and adults must try to meet their children’s needs as best as possible and pay attention to what their children are telling them. Take their lead. If they seem fine and unaffected, let them be.  If they seem anxious or not themselves, then talk briefly and succinctly to them about is happening in the world.  Tell then, “things are different in the world, but we are going to be okay.”

And if you child is experiencing big disruptions in his/her in sleep or appetite you should consult a professional.

Mary: Many people are concerned about our front-line workers—those in our grocery stores to our health care facilities. What are the challenges front-line workers are experiencing and how can we better support them?

Dr. Benjamin: Front-line workers are pretty uniformly traumatized. But trauma has a delay on it and doesn’t always hit at the time of the crisis.  And for people who are in the midst of the crisis on the front-line, this may not be a good time to unpack anything.  But there will be a time when they will need all kinds of help.  There needs to a fund, much like 9/11 fund, that completely pays for the treatment for these workers.

Mary: Many of us know people who have lost friends, co-workers and family to COVID-19.  What are the best ways to support them, especially considering social distancing?

Dr. Benjamin: The main thing you want to do is listen and ask what they need (don’t assume you know). Do not start sentences with “I know how you feel”—don’t make it like you get it.  A death from COVID is a traumatic loss—this is someone whose death came out of the blue as part of a global pandemic. It is also important to know that there is grief and stalled grief.  When someone first grieves a loss, they may lose sleep, have appetite changes, and experience anxiety and depression.  If that stays for month and months that is stalled grief.   At that point you might recommend to the person that they get mental health support.

Mary: As people attempt to bring back some of the routines in life, they are often increasing their risk.  Readers are interested in how to mentally manage the anxiety they feel.  For example, one reader notes that “as I start to return to in-person work or visit a friend at their house, my risk of infection increases.  I worry about doing these activities and then visiting my elderly mother and unknowingly infecting her.  How do I manage that?”

Dr. Benjamin: We have to normalize anxiety.  For many people it is scarier today to figure out how to get back in the world then it was in March and April.  Two months ago, we were told not to go anywhere.  Now there is a lot of ambiguity about what we can do safely.  Expect anxiety. And people must gear their activities to what they can stand at the moment.  There is not one template for this. It is important to start slowly and see how that feels.  Perhaps try going out to a certain place.  If the anxiety is too overwhelming then dial it back. We are accustomed to look to officials for concrete guidelines, but that doesn’t exist right now.

And if folks are in a household with a teenager these situations can be quite complicated.  It is important that the parent decide how much interactions that teenager can have.  Have these discussions with them.

Finally, it is critical that you do not measure yourself by what a loved one or friend is doing—listen to your own insides.

Mary: Another related question also highlights the changes in routines and social interactions.   How can I navigate my relationships with people as we slowly open up the state.  For instance, one reader asks “How do I maintain friendships and family relationships if I am not comfortable in settings where it is harder to social distance (for example—at a restaurant)?

Dr. Benjamin: A good rule I tell my patients is that you are going to maintain virtual connections with people and introduce live connections as you are able to manage and tolerate it.  There is no point to plunge yourself into situations right now that are uncomfortable.

Mary: Uncertainty seems to be a main theme of the times. One reader asks, “How can we deal with all this uncertainty, especially uncertainty with no end date? And how can we differentiate uncertainty with risk? It seems that many people went into the lockdowns thinking it was going to be some weeks (then months) of staying in and then things would go back to “normal. The longer this goes on, and listening to the science, makes it clear that this isn’t happening any time soon, which is causing all sorts of uncertainty and stress.”

Dr. Benjamin: The uncertainty is real. We have to normalize that anxiety right now.  That being said, there are certain kinds of anxiety that do warrant treatment.  For example, if someone is having panic attacks, they need to see a mental health professional.

And we all need to try to get better at living in the present moment.  It is not easy.  One idea is to try apps like Calm and Headspace.  Even ten minutes of mediations and breathing exercise can be very helpful to ground yourself in your body.  And try to limit news consumption

One thing that is also important is that while it is true that we are uncertain about the future now, uncertainty is not new.  In the pre-COVID reality, the future was never certain. We just fooled ourselves to think that we were in control of it.  Just acknowledge that life was uncertain before COVID and is still today.

Mary:  What do you see as the long-term mental health impacts of COVID-19? For example, if things go back to some form of “normal”, what long lasting effects should we expect will stay with people?

Dr. Benjamin: At the beginning of the quarantine people dealt with their physical needs (food, housing).  Now that we have been in this situation for months, the emotional needs start to surface.  It is quite to normal to feel worse now than you did in March.

One thing we will be dealing with across the board is post-traumatic stress (PTSD).  This is particularly true for front-line workers.  This has been very scary time for many people and trauma takes some time to digest

In addition, I think there is a chance that phobias in children may spike.  They may manifest in different ways.  For instance, children may say “I can’t go outside because I am scared of bees”. Or they don’t want to return to school because of a fear of school shootings.  Children may experience a general feeling that there is something scary outside

And the isolation and loneliness for people who cannot get back into world may be particularly profound.

But there are things you can do. First, stay connected to people you love, even if its virtual.  And bring back things in your life that feel familiar to you.  For instance, is there a park where to you like to walk, or a particular food you like to cook. Do those things.

And, perhaps most important, we need to destigmatize mental health conditions and the treatment that helps them. Go see a mental health professional for a few sessions.  Don’t torture yourself—this has nothing to do with strength.  If you need help, please reach out.

Mental Health Resources in NJ

List of Toll-free Helplines/Hotlines

Mental Health Association in NJ

New Jersey Domestic Violence Resources

Family and Children Resources