Elisabet Rodríguez: "There are more consultations for anxious-depressive symptoms".

Psychologist Elisabet Rodríguez Camón talks to us about the impact of the pandemic on mental health.

The health crisis of the SARS-CoV-2 pandemic has led the media to focus on the areas of hospitals dedicated to patients with symptoms directly generated by the virus.

However, we should not overlook the fact that a large part of this crisis has been reflected in the mental health of people, even those who have never been infected.

The fact is that psychological complications arising from both the fear of contagion and the perception of risk, as well as the isolation generated by the restrictions imposed by the pandemic, have done great damage to people's mental health. the pandemic have greatly damaged the emotional balance of a large part of the population. We will talk about this with the psychologist and therapist Elisabet Rodríguez Camón.

Interview with Elisabet Rodríguez Camón: the most frequent psychological consequences of COVID-19.

Elisabet Rodríguez Camón is a General Health Psychologist expert in the care of adults, children and adolescents.with a practice in Granollers. In this interview she talks about how the coronavirus pandemic has affected the mental health of society.

What are the types of psychological problems in which you have noticed the impact of the coronavirus in society?

In the last year there has been an increase in the number of consultations for anxious and depressive symptoms in adults, and there has also been an increase in the presence of difficulties in social interaction in the child population.

In the first case, we are working with many cases of panic and agoraphobia disorders, specific phobias of contracting diseases and also obsessive compulsive disorders. In addition, in many cases we focus on addressing strategies for the management of uncertainty, a problem that is also becoming more pronounced in recent times.

As for depressive states, many of the consultations are linked to an interruption of very diverse life projects, with a loss of the realization of a large part of leisure, and finally a higher level of social isolation that is exacerbating feelings of loneliness.

The latter is also leading to a very specific problem, which is the fear and avoidance of social situations. We are encountering many situations in which the fact of expressing oneself emotionally and communicating a difference of opinion, solving discrepancies, reaffirming one's own decisions, among others, is no longer seen as a natural process but as an adverse phenomenon. Thus, we are also carrying out many interventions aimed at retraining patients' repertoire of social skills.

What aspects of the pandemic may favor the appearance of disorders such as depression?

As I mentioned earlier, a prolonged state in which there are restrictions in social contact, in available leisure time, and even in some cases the impossibility of maintaining a job or a routine in general, entails various consequences that can lead to the generation of depressive symptoms.

First, the consequences of the pandemic and confinement have led to an increase in the amount of daily "free" time to think and rethink. We have made it easier for our less busy minds to overanalyze the few constraint-driven events experienced on a daily basis. A key aspect at this point is closely linked to the style of reasoning that people use; this can be more rational, and therefore healthier, or it can contain certain distortions that magnify the negative aspects of the events we experience.

It is very important to know how to detect these cognitive biases and modify them, since the opposite can lead us to normalize this type of pessimistic thinking and to adopt a more irrational general belief system, which is more likely to contribute to psychological discomfort.

On the other hand, a second factor that may have contributed to the development of depressive states has been caused by the very restrictions on access to the pleasurable activities that could be enjoyed before the pandemic. Specifically, our Latino culture is more prone to social interaction and activity outside the home. As a result, we are more accustomed to this type of social functioning.

In addition to this, it is worth considering the postulates of Maslow's theory of human needs, which advocates the relevance of feeling emotionally attached to other people, where affiliation and social recognition are essential elements. Thus, a state of isolation maintained over time can have adverse psychological consequences for the individuals who experience it.

And as for anxiety disorders, what profiles of people do you think are more vulnerable to such a situation?

According to the consensus of expert authors in the field, there are several factors that can predispose a person to show greater vulnerability to this type of disorder, some of them more internal and others more environmental or external.

Regarding the former, there are certain personal profiles that show more marked traits of neuroticism, a component defined by low emotional stability, tendency to worry or nervousness as the most relevant aspects. Characteristics such as high sensitivity or apprehension are also more accentuated.

All this results in the almost innate development of behavioral inhibition in the face of the unknown or uncertain. In fact, in anxiety disorders a maintaining factor of the symptomatology is precisely the avoidant behavior, which prevents the person from perceiving the situation that he/she considers "threatening" as surmountable, since he/she is unable to face it. Thus, working on the reduction of such avoidance is usually one of the most important objectives of intervention in anxiety disorders.

On the other hand, this can be combined with environmental factors such as repressive or overly self-critical educational styles, where autonomy and active coping with adversity have been poorly encouraged.

A significant component of responsibility for events is also observed, whereby the person tends to erroneously attribute to him/herself the sole responsibility for situations in general, and this leads to increased alertness and vigilance in order to control and avoid potential errors or mistakes of his/her own.

Another significant variable refers to the cognitive interpretation that the person elaborates before certain situations, by which he/she classifies them as threats or dangers, when in fact they do not present that value. The latter also contributes to maintaining a state of constant tension, which can lead to anxiety disorders with greater probability.

Finally, the occurrence of previous adverse external experiences such as illnesses, traumatic situations, problems that act as stressors derived from the different spheres of life such as family, marital, professional or social can also precipitate the appearance of this type of disorder.

How have the confinement measures affected those who already had a psychological disorder associated with social isolation?

In its aggravation, undoubtedly, and also in the appearance of other problems comorbid to the original one. The "permanent" character that this pandemic situation is adopting is a factor that adds more complexity to the psychological problems that a person may have previously presented. The human being is prepared to tolerate a punctual, transitory, circumstantial state of stress, which can be understood as adaptive and natural; but not so much to support that same state of uncertainty, tension or sadness for more than a year uninterruptedly.

In the area of social relations, as indicated above, there have been increasing problems when dealing, dialoguing and interacting with other people. The mechanism of behavioral habituation explains that stimuli or situations that we are used to dealing with cease to cause a state of alertness in our nervous system.

Thus, after more than a year of pandemic, it seems that human beings have "de-habituated" to this type of situations, and therefore have stopped normalizing them. In this year we have encountered many cases in which the fear of negative evaluation, the feeling of being observed and judged in social contexts has increased significantly.

Can the fear of contagion become pathological?

Yes, of course it can. It is more likely to be so when different variables or factors acting together are activated; as I mentioned before, some more internal and others more contextual. It should be mentioned beforehand that the experience of fear by itself is not a problematic phenomenon. One belief frequently observed in patients is the tendency to avoid experiencing the unpleasant.

Fear is a clear example: although it generates unsatisfactory sensations in our organism, fear is a useful and necessary emotion because it communicates the existence of a potential danger or real threat, and allows us to prepare ourselves to face it. The problem is when in neutral situations where there is no real threat, the person generates a distorted and irrational cognitive interpretation and behavioral avoidance of coping occurs. It is at this point that fear becomes pathological.

How is it possible to address these problems in therapy, from the cognitive-behavioral model?

From the cognitive-behavioral model we work from the analysis of the problem based on what is called the triple response system: cognitions and emotions, physiological reactions and behavioral factors, all of them closely related to each other.

Thus, depending on the reason for consultation and diagnostic orientation presented by the patient, we define which thinking styles and beliefs are dysfunctional and we work to make the patient adopt a more realistic and rational type of reasoning. On the other hand, emotional intelligence contents are addressed and resources are provided to learn how to identify and express emotions more adequately.

As for the second factor, the physiological, it is treated with greater emphasis on problems of anxiety and stress. In these cases, training in breathing techniques, mindfulness-type meditation and relaxation exercises are usually applied in order to reduce and regulate the person's nervous activation.

Finally, as regards the behavioral variable, dysfunctional behavior patterns are analyzed and through techniques such as modeling or behavioral rehearsal, the learning and practice of more effective behavioral alternatives is worked on, as well as trying to promote the increase of daily pleasurable activities or the progressive confrontation of complex or problematic situations. Progress and improvement in these three areas occurs at a faster rate in patients who carry out the proposed tasks between sessions, so that cognitive-behavioral therapy is really a dynamic process of joint work between therapist and patient.