Fernando Huerta: "We are poorly trained to manage the aversive".

Psychologist Fernando Huerta talks to us about anxiety and depression in times of COVID-19.

Beyond the medical and economic implications of the SARS-CoV-2 pandemic, we must not forget that the crisis unleashed by this situation has a strong negative impact on the mental health of many people: drop in income levels, limitations of movement, risk of suffering a potentially fatal disease or that our loved ones will suffer from it, etc.

This type of psychological distress is often expressed through anxiety disorders and depression, two of the most common psychopathologies. To learn more about the relationship between these and the coronavirus pandemic, on this occasion we spoke with the psychologist Fernando Huertaan expert in the treatment of this type of problems.

Interview with Fernando Huerta: anxiety and depression in the pandemic crisis.

Fernando Huerta Moreno is a psychologist and trainer, and has been helping people with problems such as depression and anxiety disorders for more than 25 years. In this interview he talks about how the coronavirus pandemic has had an impact on people's mental health through these two types of psychopathologies.

Given that anxiety disorders and depression are among the most frequent psychopathologies in Western societies, is it to be expected that, in the face of the pandemic, they will also be among the psychological disorders that grow the most in terms of number of cases and influence on people?

Yes, it is normal for them to grow, because the prevalence of both problems is already high in our societies.

There was a proportion of people who had signs and symptoms of anxiety or depressive disorders, but have not addressed them, and when a factor such as the pandemic appears, all these people see the problem increase considerably, also begin to be affected other individuals who had no signs of either pathology, but because of this new issue in their lives begin to have them, although usually to a lesser extent in terms of intensity and frequency of the same.

Evidently, the longer the situation remains, the more damage will be done, to a greater extent to those who already had these manifestations. But also to those who had none, since when we see a threat and it is not solved, we get stressed and our mood is affected in an almost unavoidable way in a graduated way, depending on the previous predisposition of how we were when this variable appears and the type of personality that each person has as a base.

What elements of the pandemic do you think contribute most to the emergence of cases of anxiety disorders in this context of the COVID-19 crisis?

The first is that it is an unknown situation for us, which requires special daily attention to something potentially dangerous, which can really harm or kill us, especially for some people who due to their physiological and psychological characteristics have a weaker immune system, previous diseases or genetic predisposition and therefore are more vulnerable to have worse consequences to the contagion of this disease. In addition, there are people who are very frightened of illness or other events, or were already very anxious or depressed, and this also reduces their immune system to a certain extent.

The second factor is that we can lose or have lost people we love in our lives, with all that this represents or would represent. In cases of loss we must learn to adapt to the new situation, and that is always a complex thing that is not trivial. Normally an adaptive disorder is produced as a normal reaction, and this fact will have to be restructured both cognitively and behaviorally, in order not to have stable negative consequences in our existence.

On the other hand, the simple negative expectation, that is to say, to see in imagination that something serious happens to our loved ones, or even can cause their death, generates a lot of anxiety in a stable way and lowers our mood progressively, and as time goes by and things do not improve, we can enter into anguish and helplessness.

Another aspect would be that without realizing it, our personal software to face situations of this nature was not prepared in our society, if we compare it with respect to other times or other places. In the past, the number of dangerous diseases was very high, and the means to deal with them microscopic, because health science had not advanced, or their remedies were not available due to the economic characteristics of the country.

Our tolerance for frustration has been going downhill on this issue and many others. We were almost shaping our life very closely to what we wanted, and now everything has changed drastically, which causes us great disturbance. Not being able to go out, the masks, not being able to relate to each other as before, the impossibility of traveling... there are many factors that have changed in a negative way and we have been caught slack in terms of the level of preparation to face them. We are very little trained to aversion and uncertainty, because we live in societies that have sold us the fallacy that everything is appetitive, that everything was controlled and predictable.

Finally, it should be pointed out that the accessibility we have to relatives, friends, acquaintances, neighbors, co-workers, people affected by the disease, whether mild, severe or lethal, is becoming more and more frequent. But it is not only the disease and its possible primary and secondary consequences in us or in our loved ones or close ones that matter, but also others such as labor issues, which has become complicated in some with what that implies, since it affects us in many aspects; we depend on income for a wide variety of issues. All this puts us on alert and makes us see things in a more apprehensive way, increasing our anxiety and undermining us emocinally.

And as for clinical depression, in what ways do you think this situation can reinforce the presence of this disorder among the population? Through isolation measures and the reduced ability to engage in hobbies and stimulating activities outside the home, perhaps?

Normally, when we have some anxiety more or less frequently on a daily basis for several months, depressive symptoms usually appear as a consequence. It is very logical that it is produced by the tension and by the negative vision, which ends up damaging our mood. Once we have this, or if we already had it before the pandemic appeared, in the first case it will usually increase until the circumstances change, and in the second case it will be worse.

We have learned a way of interpreting the world and processing emotions and now our vision is going to be determined by that style of thinking that is usually given by a very typical format of anxious or depressive type, or both, so we take data, interpret them and label them following that format that guides us without realizing it, conditioning us negatively.

As for isolation, there are undoubtedly direct correlations between social relationships and mood, restrictions affect any sphere of relational life, whether in family interaction, work, school, purely recreational or any other type. Social interaction, whatever type it may be, is extremely important for people's mood.

Teleworking is not a blessing for the state of mind because it isolates us; being all day with the computer, tablet, cell phone or television... Everything in its right measure is good, but when we abuse it for whatever reason, it turns against us.

What advice do you recommend to follow in order to adapt to the new situation and prevent the onset of anxiety disorders and depression?

Establish personal social protocols of action within the limitations and prudence, do not forget all the daily reinforcements that we have and that are fixed-term. And to think that it is something temporary that is on the way to being solved, to take it as a vital challenge that has touched us, and that for many generations that we have not gone through any really complicated circumstance is something only relatively penalizing with respect to other situations of greater depth, with much harder consequences objectively in their lives, that many people have had or have on a daily basis, but have developed by habituation greater ability to adapt according to their usual circumstances, thinking that we can do it too.

It is also important not to forget that we have more tolerance to frustration than we think, although we have practiced it little; it is a matter of progressively putting ourselves in a progressive way, so we will get stronger, as we achieve it we give ourselves positive feedback, and every day we will be stronger with respect to a situation.

It is also true that the human being has a good resilience when things happen to us that limit or injure us, so if we train it well we will get good results; not immediately but in the medium and long term. Our ability to accommodate to events is better than we think, and we will return to our previous state better than we think.

Moreover, all this can help us to appreciate the situation in which we tend to live thanks to science and technology, a rather pleasant or controlled world, thanks to its good use, in which everyday life is quite conducive and rewarding.

How does one know at what point an anxiety or low mood problem has already acquired the severity of a disorder that requires going to a psychologist?

When the discomfort has an important frequency and intensity, or is maintained for more than three to six months approximately, my advice is to go to a professional, since the punishment is very hard and it is not convenient to endure it because of the suffering and the consequences, or because once we acquire a habit and a direction of negative thinking it is more difficult to undo it. It is for these two reasons that it is desirable to intervene, to cut the intense and concomitant discomfort, or not to make stable a cognitive interaction and pathological response in our relationship with the environment and internally.

If the level of suffering is harmful on a daily basis, or if there are habitual interferences in our normal life, in our work, in our relationships, in our hobbies or in any other vital area, it is that we are paying too high and disproportionate to the external situation, and it would be good to address it clinically.

If we have acquired psychopathological habits and have automated them, they should also be treated, otherwise we will feel almost the same even if circumstances change, because we have created neural networks that prevent us from thinking and acting correctly. In this way we will avoid chronic anxiety or low mood.

In cases where the person has already developed a very disabling disorder of either type, what is done in psychotherapy to help him/her overcome it?

The first thing to do is an individual history, in which the different aspects of the person's life are explored. We need to know this well to make a serious approach to the approach, a problem is not understood outside a vital context, because it is determinant. This history is complemented with a biography, so that no pieces of the puzzle are left unknown and to avoid mistakes due to lack of data that could be important when facing the specific problem.

Next we pass personality tests. Personality is the internal structure with which a subject relates to the world and to himself, therefore it is also fundamental. To explain it in a more understandable way, we would say that it is our operating system, which makes us think and act from a certain perspective with what that means at all levels; in addition, it will also determine in part the way the treatment is carried out, since it must be adjusted to that structure.

Then there are specific tests for each problem, either for anxiety or for mood. With these tests we obtain the intensity and also the diversification, that is to say, the seriousness of the problem and also to which areas the pathology has spread, in order to establish priorities when it comes to act. We cannot give the same importance to minor things as to those that are serious, the latter would be the first to be treated and the former we would leave for later.

Subsequently, an analysis of variables is made, which are both structural and situational causes that have created the disorder and also maintain it. For a problem to have arisen we must have had a learning process; furthermore, for it to remain present, there must be factors that make it persist in a person, otherwise it would have disappeared quickly, and that is why knowing the elements that have created it and those that keep it there is essential for a good treatment.

Finally, techniques and strategies are applied according to the above, the problem, the environment, the lifestyle, the variables and the personality. To do this, we must explain the theory to the person, make a training, an adjustment of the same, a graduation and request that they have an attitude of involvement and co-responsibility with the professional, since we are the technicians, but he is the one who executes, especially in behavioral techniques because cognitive techniques can be applied to a greater extent in the office or online by the professional, but still has to learn and activate them outside.

With all this, a diagnosis, an evaluation and a treatment would be made, both problems would be tackled. Psychology as a science obtains very good results, as long as it is used and worked properly by the psychologist and the client, solving problems that are painful for people, but whose prognosis is good when we intervene in them, so we should not despair about them, but address them to eliminate the discomfort and thus achieve well-being and happiness in our lives.