Kim Mills: When the COVID-19 pandemic was declared in March 2020, many people headed home to shelter in place and expected that they would return to their offices and schools within a few weeks. None of us could have imagined how different the world would look one year later, especially that more than 500,000 Americans and 2.5 million people around the world would die from complications of COVID-19. Along with the physical toll of the coronavirus, the pandemic's economic and social consequences have caused what some people are calling a second pandemic of mental health concerns as Americans have dealt with lost jobs, lack of childcare, social isolation, and the illness and death of loved ones.
APA’s Stress in America survey has been tracking this mental health toll over the course of the pandemic. Where are we now? How is our mental and our physical health one year in? Now that vaccines are providing some hope for an end to the pandemic, how are we feeling about returning to our pre-pandemic lives? And what can each of us do that is healthy to ease our stress and anxiety in the face of continuing uncertainty about the future?
Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills.
Our guest today is Dr. Vaile Wright, a clinical psychologist and the senior director of healthcare innovation here at APA. As a spokesperson for the association, Dr. Wright has given more than 100 interviews over the past year about the mental health consequences of COVID-19, including stress, anxiety and loneliness, and offered advice on how to cope and build resilience. She has been a calm and reassuring voice to many as she has offered evidence-based advice on how to navigate the challenges we have all faced during this most unusual and stressful year. Thank you for joining us today, Dr. Wright.
Vaile Wright, PhD: Thanks for having me.
Mills: I just mentioned our Stress in America survey in the introduction. We have a new report coming out on March 11 with fresh data on how Americans' physical and mental health have fared over the past year. Can you tell us in general terms what it found?
Wright: Yeah. What we found in this report was that going a year now into this pandemic, adults are consistently reporting extremely high levels of stress and that this is actually leading to engaging in some pretty unhealthy coping behaviors in order to manage that stress. And that certainly has us really concerned.
Mills: So what are the outcomes? And if they're engaging in unhealthy behaviors, what's happening?
Wright: So what we're seeing is people are reporting undesired weight changes probably related to unhealthy eating habits, disrupted sleep, being less active. And one of the most concerning is increases in alcohol intake. And when you take these together, they start to form a pattern of the ways in which people just are not following the advice we're trying to give them, but are really just failing to engage in the kinds of behaviors we would hope to shore up their emotional wellbeing. And if this continues, the greatest concern, of course, is that it could lead to long-term negative physical and mental health consequences.
Mills: Have these outcomes been distributed evenly across groups or are there particular groups of people or members of specific demographics that have been having a more difficult time this year?
Wright: Since the beginning of the pandemic, we've really seen, again, this consistent pattern of four really vulnerable groups. Those groups are parents with children under the age of 18, individuals from communities of color, essential workers, including frontline healthcare workers, and younger adults. These four groups are just reporting some of the highest levels of stress, some of the worst outcomes, and certainly are individuals that we as a country need to be concerned about.
Mills: For those listeners who might recognize themselves in some of these statistical areas that we're talking about, what should they do to adopt more healthy habits and cope in more healthy and productive ways?
Wright: Well, I think the first needs to come from a sense of awareness, an awareness that no matter what your situation is nobody's immune to what's happening right now and that this is stressful. And if we can kind of just acknowledge that things are stressful and that we can legitimately feel that way, I think that actually opens up some space to really identify, okay, what is one or two areas that I could start making small changes? And then it's about kind of thinking about what those things are. We often beat ourselves up because we aren't successful at our goals, because we only rely on our willpower, as if we can just will ourselves into changing behavior.
And really what we need to do is change our environments, put behavioral goals in place that are really attainable, and then we can build off of those small successes.
Mills: What about the parents of young school-age children, who are among the most stressed out, but also the most pressed for time? Is there any special advice for them?
Wright: Yeah. I think parents really need to do a couple different things. One is, are you asking for help from the right people and at the right times? Are there things that maybe your kids could be doing that they're not, like some small developmentally appropriate chores around the house to take some of that burden off? Is your partner, if you have one, are you on the same page about who should be doing what and how to trade off tasks and how to have each other's back when somebody needs to take a break?
And then you need to ask yourself, are there some things I can let go of? Whether that's unrealistic expectations, so how you should be feeling or concerns about too much device time, even though that may be lifesaver for you right now, and just maybe saying no to some of the things that really you can let go of.
Mills: So how do we change our environment in ways that will make it easier for us to do things that are healthy?
Wright: Well, we have to sort of identify where some of our problem areas are. So if you're that kind of person that you know is maybe having that extra glass of wine in the evening that’s making you uncomfortable, try not keeping so much wine in the house. If it's not there, it's really hard to actually engage in it. If you're having trouble sleeping, whether that's going to bed at a regular time, set yourself an alarm, an alarm about an hour before you'd think is the right time for you to go to sleep, so you can start winding down. That means turning off devices and maybe doing some soothing activities and just preparing yourself for sleep.
Similar in the morning, if you're hitting the snooze button over and over and over again, put your phone or your alarm far away from your bed, so that you actually have to get up and go turn it off. So those are the kinds of behavioral things we're talking about. It's really helpful if you can incorporate others in your goals as well. So finding somebody who like you maybe wants to get out of the house a bit more and take walks, can you guys put that on your schedule and then adhere to it, really agree to meet because you know that the other person is depending on you.
So those are the kinds of things that we can start off small, and again, have some decent successes that can build on each other and make you feel like you can be even more effective.
Mills: What about people who have been trying to work their way out of these behaviors and they're just not succeeding? How do they know when it's time to reach for outside help?
Wright: Historically, we've always said that the red flag to reach for outside help was when your feelings and your behaviors are really interfering with your ability to function in a significant way. So typically that means really being unable to work or not being very effective at work, not being able to take care of yourself or your kids, or if you're a young adult, not being able to go to school. But I think at this point, we really need to revise that advice and just say at any point in any time, it's perfectly acceptable to go seek out professional help, in particular in these sorts of areas around behaviors.
Because psychologists can really help you identify what are those steps that need to be taken in order to be more effective and then again, can hold you accountable because they'll follow up and see how you're doing, and then help troubleshoot with you on how to make different changes. And yes, sometimes we can do that on our own, but what's really beneficial from a professional is that one, all the time gets to be about you. It's not a reciprocal relationship, so you don't actually have to worry about how they feel and so that really allows you to focus on yourself and to get the help that you need.
Mills: As one of APA's leading spokespeople throughout the pandemic, you've talked to many, many reporters about some of the coping behaviors that they've been hearing about and observing. What are some of the more creative behaviors you've encountered through the course of the year?
Wright: I think certainly I've heard a fair amount of different sorts of things, obviously stress baking was the large story for a while. I kind of enjoy talking with people about this nostalgic feeling that people have, that they want to watch old movies and old TV shows and listen to old music from their childhood to bring them back to happier times. I think for me, one of the more interesting developments has been around this concept of the Zoom fatigue and the ways in which technology can play a pretty significant role, but how also it isn't a panacea and we can't overly rely on it to fix everything.
One of my favorite research studies that's come out is that people talk 15% louder on Zoom calls and video conferencing calls and that it takes that much more energy, and that's part of what contributes to that Zoom fatigue. And in our household, the joke is that I talk much louder than 15% when I'm on my Zoom calls and drive everybody pretty crazy.
Mills: Zoom is a challenge in itself because if you were in a meeting with people, you could talk over each other, you could have side conversations and Zoom doesn't let you do that. So it's really in a sense imposing a kind of discipline on us. I mean, do you think that might be good in the long run?
Wright: I think it could be good. I mean, one of the challenges is even with a Zoom call, people don't like silence. So even though you can't talk over each other, it doesn't stop people necessarily from trying. And I think that's what it's really demonstrated is how artificial it comes across when we're trying to have these large meetings. So you're maintaining this total sustained eye contact, which we never do in real meetings. In real meetings, we're looking at one person, maybe we're looking at our phone, you're constantly looking at yourself as well.
And so you're asking yourself is that really what my mouth looks like–
Mills: I need a haircut.
Wright:–when I talk? And so it just requires a lot more effort and concentration. And when you do them back to back to back without any breaks, it's just exhausting.
Mills: One of the other behaviors I've read about quite a bit is the fake commute. What is that and how is that helping people?
Wright: Yeah, I heard about that one a while back, and it seems to have made a resurgence. It's this idea of, again, I think it puts some structure and routine in our lives when we have a commute. It represents the beginning and the end of our workday in a really concrete way that we've lost now that so many of us are working from home in the same place that we live. And so I think what the fake commute is it brings this mental structure to the beginning of your day. So it can look like just walking out of your house, taking a trip around the block and then coming back.
And it just gives you, I think, some mental time to prepare and set yourself for your workday. Same thing at the end of the day, it really provides these, I think, bookends, too, allowing us to really let go and have some boundaries around our work that we've lost.
Mills: Based on your expertise in human behavior, what do you think the longer term consequences of this year of stress and anxiety will be? Is the concern that a second pandemic is coming? Is that warranted?
Wright: I think it's hard to predict the future, but I will say that if past behavior is the best predictor of future behavior, then these results from the Stress in America surveys over the past year suggest that we could be in pretty significant trouble. That despite the amount of advice that us and others are giving, people are just really struggling with something that none of us were ever prepared to deal with for this sustained period of time. And so I think that we really need to be having larger conversations about our mental health and our emotional wellbeing in a way that hasn't gotten elevated yet, so that we can start engaging in better coping behaviors.
And that doesn't look just like going to psychotherapy because that's not a solution for everybody, but it's about really meeting people where they're at, whether that's in the workplace, in the schools, in churches, in wherever the case may be. I think we really need to start having more of these conversations and reaching out to each other and asking each other really how are we doing today?
Mills: Is the fact that we're hitting a one-year anniversary significant in the sense that people may be reacting even more strongly to the realization that “oh my God, it's really been a whole year that we've been living like this?”
Wright: Yeah. We know from the research on trauma and PTSD that anniversaries can be pretty significant triggers for individuals who've experienced some level of threat, and so it wouldn't surprise me that people are having a particularly hard time right now. I think it brings on a sense of reflection and reflection can be good, but it's also about our mindset a little bit and having some balance. So I'm hearing a lot of discussion about all the negatives that have happened over the last year and how people have felt like they "lost" a year.
And while it's true that we have lost many milestones, people, jobs, etc., I do think that there has been gains that we've seen in the last year that people can look on and feel some gratitude for. I think the most important being how we have come to reevaluate the importance of relationships, both within our family, but with our friends and with our coworkers. And I do hope that some of that can continue on, that we continue to prioritize and really value family over things and the things that we realize we could live without for a whole year.
And then just again, reevaluate how we want to live our lives going forward so that we continue to live lives worth living.
Mills: Yeah. It's really interesting how we've become more intimate with the people who are coworkers. We see their homes, they're there on Zooms and their kids come running in with “oh mom, I just skinned my knee,” or things are just happening or the plumber is at the door, I've got to go. It's just really a completely different feeling, and I think we're going to see workplace changes. I mean, what are you anticipating that the workplace will be like when the pandemic is declared over?
Wright: Yeah. I think it's going to really vary depending on probably the field you’re in and even maybe the area of the country that you're in. But I do think work is fundamentally never going to look quite the same. We have demonstrated that I think people can effectively work in a more flexible manner. And whether that means working from home more frequently, whether that means working slightly more flex hours so that you can take time maybe in the middle of the day to address things that before you would have felt like you couldn't because of the strict ways that I think all of us had been thinking about how work is "supposed to be."
And I think a lot of those old notions have been demonstrated to be outdated, that they don't really reflect the real world that most of us are living in right now. And so I do think that using technology and having some flexibility and really prioritizing work-life balance in a better way will become more of the norm going forward for most people.
Mills: One thing that people are thinking about more right now since we have three very effective vaccines that are getting into people's arms, they're thinking, what's it going to be like when things start to return to normal? What did APA’s survey find about how people feel regarding the idea of going back to seeing friends, eating out, traveling, engaging in those activities where we're going to be seeing more people face-to-face again?
Wright: Yeah. I think we're seeing an interesting dichotomy where there's this real desire to want to see our families and have things not look like they do right now, but there's a lot of anxiety about it as well. So we found that over nearly 50% of adults reported that they felt either uncomfortable with returning to life how it was before the pandemic and reporting concerns about sort of re-engaging in these one-to-one face-to-face kinds of conversations. And that held true regardless of whether you'd actually have the vaccine or not.
And I think that part of what's driving this anxiety is again, this level of uncertainty that even as we have these three great vaccines, there's still a lot of uncertainty about what's going to happen with these new variants and how long will these vaccines last and can someone be asymptomatic? And so in the face of all that uncertainty, we become really ineffective at making good risk threat assessments. We have a tendency to either overestimate risk or underestimate risk, and that then translate into our behaviors. And we have to ask ourselves, is it safe to see friends and family now? Is it safe to eat inside that restaurant? And having to make those decisions over and over and over again, one, it's exhausting, but, two, you're always not sure if you're putting yourself and your family at risk. And so I think that's really what's driving a lot of this stress about reentry.
Mills: And yeah, I mean, you raise the question of how you navigate relationships with friends and family members who have different ideas about what it's okay to do now, because there's just so much uncertainty. How best can people navigate making those decisions and where should they be getting their information so they know what risks are reasonable and what risks are just not?
Wright: Yeah. So certainly we want to be following the best scientific advice that we can find. So that's really institutions like the CDC and the WHO. So following those sorts of recommendations is a good place to start. And the second is, one, really having some grace for yourself and for others as we’re trying to make these decisions. I think we have a tendency to get judgmental just because somebody maybe sees something differently than we do. And instead of sort of approaching it with judgment, I think if we can approach it with grace and that everybody really has their own level of risk that they're comfortable taking.
And then you need to sit down with your family or whoever you sort of interact with and come up with a plan of what you're comfortable with based on your individual risk factors, including where you live, and then just unapologetically stick to it when someone challenges you on it. You can be firm but friendly, and I think that's just the approach, and flexible. Because as more information comes in, we need to be able to adapt and maybe make new choices, and that's perfectly okay.
Mills: Maybe this is an unfair question, but what can we expect to see the next time APA goes out and surveys again? I mean, with the vaccines getting out there, should we start to see the stress levels drop? I know we'd like to, but do you think that it's likely based on your experience over the past year and just over time?
Wright: I think for some groups, we're likely to see the stress levels come down. It's going to be in particular older adults, they report some of the lowest levels of stress in the first place. But I think for them, what's been most stressful, has been the lack of interacting with family. And I think one of the first things we're going to see with the vaccines rolling out is the ability for small families to come back together, for grandparents to see their grandchildren.
I do really continue to worry for the four vulnerable groups that we talked about before. I think we've also seen in our research that as kids are going back to school, parents reporting lower levels of stress. So the sooner we can get schools safely reopened, I think will help that group. But for individuals from communities of color and essential workers, I have strong concerns for their mental wellbeing going forward. If we don't make some systemic changes, these are not individual level changes, but changes within our healthcare system, within obviously our social system, as well as ensuring that people have resources that they've lost.
I think unless those things really happen at a more population health level, then we're going to continue to see individuals really reporting that they're struggling.
Mills: On balance, more optimism or more pessimism right now?
Wright: I've always leaned towards pessimism. Oh, obviously I said it first, so it's such a Freudian slip on my part. I'm an optimist, darn it! No, I'm feeling optimistic. I think that there are more people out there that want the vaccine than don't, although I do think vaccine hesitancy is still an issue, and I think that it needs to be addressed again at a larger level. And within the communities that community leaders come forward, they're vocal and they're visual about accepting the vaccine and providing that opportunity. And I think hopefully that these conversations will continue and maybe even elevate now that we're moving forward and we're less focused just on our physical health.
I think the natural pivot will have to be to talking more broadly about our mental health and you can't fix something until you acknowledge and are aware that it's an issue. And so I think that's where we need to get to.
Mills: Well, thank you for joining us today, Dr. Wright, it's been a pleasure talking with you as always, and I hope to see you in the office again one of these days.
Wright: Yes. Let's hope so.
Mills: You can find links to APA's COVID-19 information and resources, as well as our Stress in America surveys, on our website at apa.org. And you can find previous episodes of Speaking of Psychology there or on speakingofpsychology.org, or you can get them on Apple, Stitcher, or wherever you get your podcasts. If you have comments or ideas for future podcasts, email us at speakingofpsychology@apa.org. That's speakingofpsychology, all one word, at apa.org. Speaking of Psychology is produced by Lea Winerman. Our sound editor is Chris Condayan.
Thank you for listening. For the American Psychological Association, I'm Kim Mills.
Vaile Wright, PhD, is a clinical psychologist and the senior director of health care innovation at the American Psychological Association. As a spokesperson for APA, Wright has given more than 100 interviews over the past year about the mental health consequences of COVID-19, including stress, anxiety and loneliness, and has offered evidenced-based advice on how to cope and build resilience.
