HIV Specialist - March 2021 - 38

BEHAVIORAL TELEHEALTH

Distress
■ Can

occur in response to any
adversity.
■ Commonly seen in response to
the COVID-19 crisis.
■ More severe among workers on
the front lines of responding.
■ Often does not meet criteria
for a psychiatric diagnosis or
require specialized mental health
interventions.
■ Often responds well to supportive
strategies.

Disorders
■ Usually

accompanied by
persistent severe subjective
distress and/or functional
impairment.
■ Meet recognized diagnostic
criteria (ICD, DSM).
■ Call for evidence-informed
mental health interventions such
as medication and psychotherapy.
■ Rules have been relaxed for
providing mental health services
by virtual means.

Anxiety is a normal
reaction to fear and stress
which helps us to react to
situations that produce
those feelings, but it
can become debilitating,
producing physical reactions
such as a rapid heartbeat,
wobbly legs, feeling faint,
choking, or an overwhelming
sense of dread.

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If distress impacts activities of daily life for several days or weeks,
or if symptoms are severe, formal mental healthcare will be needed
as part of the response. Healthcare workers may be very attuned to
observing these aspects of their patients' health and well-being, but
often are inclined to ignore or minimize their own need for care;
awareness can combat some of the obstacles, including stigma, which
keep people from seeking help.
When attempting to gauge a person's level of distress during a crisis,
the first mental health condition that typically comes to mind is PTSD.
However, acute stress is associated with a multitude of mental health
problems, most prominently depressive disorders, anxiety disorders,
and substance use disorders. In the U.S., the rate of PTSD among people
up to the age of 75 is 8.7 percent and in any given 12-month period the
prevalence is 3.5 percent.6 And, of course pre-existing BH conditions
may be exacerbated during the pandemic, and these disorders were
prevalent among people living with HIV prior to COVID-19.7
As the World Health Organization (WHO) Pyramid of the Optimal
Mix of Mental Health Services shows, much of what is helpful to
people can be done at the informal and community levels.8 With
greater intensity and severity of symptoms, the intensity of treatment
increases and the need for more specialized services also increases.
Effective approaches to treating symptoms associated with these
disorders include either one-to-one or group Cognitive Behavioral
Therapy (CBT); Cognitive Restructuring; Medication (antidepressants can help with symptoms of sadness, anxiety, and irritation); and
relaxation, mindfulness, and improving sleep, diet, and exercise.7
In the domain of self-care, talking with someone about feelings, especially anger, sadness, and other strong emotions, no matter how difficult it seems, is one way of relieving stress. Being able to voice these
feelings in a safe and supportive way is essential. Adopting methods
to promote physical and emotional well-being through healthy food,
rest, exercise, relaxation, and meditation can bring a sense of mastery
and control over at least some of what is occurring during the pandemic. And, finally, within what's possible, maintaining a routine in
the familiar and daily without taking additional responsibilities is an
important limit to set for healthcare workers.
One concept that is worth noting is the idea of " post-traumatic
growth. " It feels good to have responded to a crisis, to have helped,
to have been useful. For healthcare workers in particular, they have
gotten better at caring for people with COVID-19, which is reflected in
a lower rate of death, even when cases spike. They've increased their
comfort and expertise in using the internet and a variety of virtual
platforms for patient care, work meetings, and getting training to
build their capacity for further growth. It is likely that many of the
shifts to virtual care made during COVID-19 will be retained as they
have solved many care integration and coordination as well as transportation issues for both healthcare workers and patients.
Healthcare workers and our patients share many of the deprivations and losses arising from the COVID-19 pandemic. Common
human issues include loss, death, grief, social isolation and loneliness.
We tackle these along with our patients, and all of us are maintaining
our own well-being and that of our communities using virtual platforms for now and into the foreseeable future. HIV

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HIV Specialist - March 2021

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