Dr. Robert Leahy: We have to normalize feeling frustrated, feeling irritated, feeling a little bit depressed. You have a right to those feelings, but even if you have a right to those feelings, you also have a right to do things that will help you cope better with those feelings.
Courtney Allison: Welcome to Health Matters Today. I’m Courtney Allison, a senior editor in NewYork-Presbyterian’s Office of Communications. On today’s podcast we’ll talk about what we can do to mentally prepare ourselves for a pandemic winter and how to stay resilient. After months of coping with the COVID-19 crisis, many are feeling fatigued and may be struggling with anxiety and depression. For tips on how to reduce worry and manage anxiety in this challenging time, we’ve turned to Dr. Robert Leahy, a national expert in cognitive therapy. Thank you so much for joining us, Dr. Leahy. Would you mind introducing yourself and telling us a little about what you do?
Dr. Robert Leahy: Thank you, Courtney for having me here. My name is Dr. Robert Leahy. I’m a psychologist on the faculty at Weill Cornell. I’m an attending at NewYork-Presbyterian Hospital. I’m the Director of the American Institute for Cognitive Therapy in New York City, and I’ve written a number of books on psychology.
Courtney Allison: So you and I first spoke at the beginning of the outbreak back in March, and you offered some really sound advice on how to get through this time. My friends and family even know you by name now, because I’m constantly going around offering advice, and saying oh, “Dr. Leahy would say this” and “Dr. Leahy might suggest that” when you’re having a bad day. So I’m really happy to be speaking with you again. This feels like a good time for a check in. How have you been handling the pandemic?
Dr. Robert Leahy: Well, I’ve been doing quite well, actually. I’m surprisingly feeling very good. I’ve been able to maintain seeing patients on Zoom or phone and continue writing articles and doing workshops online. So I’ve been keeping very busy, but I have to say that I feel privileged. This is a very difficult time for tens of millions of people.
Courtney Allison: It certainly is. I’m so glad to hear you’re doing well, but yes, it is a challenging time.
Dr. Robert Leahy: Yeah.
Courtney Allison: So, there’s so much focus right now on the public health crisis, but we also hear about an unseen mental health crisis. At this stage in the pandemic, why is it important for us to be proactive with taking care of our mental health?
Dr. Robert Leahy: Mental health problems touch every family. There’s no family without somebody in the family who has, at some point, some serious anxiety, depression, substance abuse, marital conflict, suicidal thinking, self-injurious behavior, risk taking. This has increased it substantially, feeling like I can’t cope with the stress of life. And so some people will, at sometime in life, will say, “Oh, why can’t people just snap out of it?” The record on “snap out of it therapy” has not been very promising. I’ve never seen a patient and go, “Why don’t you just snap out of that depression?” “Oh, thank you, Dr. Leahy. I feel much better now. Why didn’t somebody tell me to do that? “ People need to feel understood. You need to be there for them.
Courtney Allison: That’s really true now more than ever and as we head into the colder months, I’ve been reflecting on some of things we talked about in the spring, you said something that resonated with me about scheduling your time down to the hour.
Dr. Robert Leahy: Right. So your mind can only be in one place at one time. So if you’re reading your disaster stories online, you’re likely to be pretty pessimistic and anxious. On the other hand, having tasks that you schedule and accomplish will help get your mind off the pandemic or off your anxieties, and you wake up in the morning and you feel like I have a purpose for getting up. I’ve seen people who have been laid off and surprisingly, some of these people actually made this time a very, very productive time. For one thing, they get more sleep, which is actually a pretty good thing. Sleep deprivation’s a big predictor of depression and anxiety and other problems.
I’m thinking about one person who’s made a point of getting exercise. Gets up at 4:30 or 5:00 in the morning and runs through Central Park with his dog. Goes online for meditation classes. Practices his music. Does a lot of reading. Reaches out to try to help other people. So every day, this very proactive planning and problem-solving approach keeps his mind on having purpose. In fact, I actually talked to some people who think, “My, God. I feel a little bit embarrassed. I’m actually not having as bad a time as I thought I would keeping busy, doing things and reaching out to other people and trying to be helpful to other people. So a lot of it has to do with how do you use this time. In a way, think about this as a chapter in your life. This is the pandemic chapter, 2020 pandemic year. How do you use that time? I think having a checklist of things you do every day, having a plan of things that you want to do, reaching out to people you haven’t connected with for a while — actually using your smartphone as a phone. Calling somebody and talking to them. So if you take a proactive rather than a passive approach, if you’re engaging rather than avoiding, if you’re connecting rather than pulling away and isolating… that’s the key thing.
Courtney Allison: That’s great advice. I like that the man you described — running with his dog and connecting with friends — because I think this is a time where people are at risk for isolation and what you described just sounds like he’s really staying connected and engaged with the world.
Dr. Robert Leahy: So I think the other way of using this time is actually try to be helpful to other people. If you’re young and healthy and you’re following all the right protocols, you can do shopping for neighbors who would be compromised getting out. So there’s always something to do that’s meaningful. You have to think, “All right. I can’t do what I used to do. I can’t go to bars. Can’t go out to restaurants like I used to do. Can’t go to big groups or whatever. Can’t travel as much.” Rather than focus on what you cannot do, it’s valuable to focus on what you can do. So you have to be creative about that. Have a wish list of things that you can do and start doing them. Schedule them and then check them off every day. The reason I suggest scheduling them: If you wait around to feel motivated to do it, you’ll just lie there and ruminate and be passive and get very little done. So scheduling it — don’t wait to feel inspired or motivated. Schedule it and do it. Make it an obligation to yourself. And second, check it off at the end of the day. And the reason for that is that you begin tracking your competency and your pleasure in what you like and what you don’t like. Also, what I found is that some people have been able to go online for meditation or yoga or dance or other discussion groups, book clubs and so forth. There are ways in which you can meet other people online and get to chat with them and get to your share your stories and learn something.
Courtney Allison: Yeah, you’re touching on something that was really helpful. So I’m very fortunate. My yoga studio has done a great job of transitioning to online. So we all get on the Zoom and we can all see each other in the gallery view and we wave, and I still feel like I can have that sense of community each day.
Dr. Robert Leahy: I actually think, Courtney, that some of the changes that we’ve had. We’ve had a lot of bad things happen, as everybody knows, 210,000 Americans dead and more to come, tragically. But there are a lot of good things that I see as well. I think, for example, like connecting online, taking courses and all that kind of thing.
Courtney Allison: And so, without minimizing how fortunate we are to have all these advantages of Zoom and phones to connect with people, I think I’d be remiss not to say it isn’t quite the same. So do you have any tips on overcoming Zoom fatigue. Especially, for me this summer, I feel like I really tried to take advantage of seeing people outside and going for picnics. And with the weather turning colder, I think some of that will go away, and it will be back to Zoom and Google Hangouts. So just any tips on trying to hang in there and grasp that connection where we can?
Dr. Robert Leahy: It’s a good point. I know those of us who do a lot of Zoom during the day kind of get worn out. What I try to do is look out the window for part of the time I’m doing Zoom. I mean it’s hard to establish eye contact on Zoom, because you don’t know where the camera is. But I look out the window, so I’m looking out the window at trees and bushes. That’s kind of calming. I think the other thing is to give yourself breaks from Zoom. If possible, arrange some of your contact on the phone or give yourself breaks where you can step outside or go into the other room or walk around.
By the way, so you mentioned during the winter, it’s hard to go outside. No, it’s not hard to go outside. If you have the proper clothing or gear, you can go out when it’s -20 degrees. I’m sure when you were a kid that you were going outside and playing in the winter. So just think, “All right. This winter, I’m going to have to make sure I have some warm clothing and some good boots to wear if there’s snow or whatever,” and get outside. Get some of that sunlight. Don’t think that you have to go into hibernation just because it’s cold.
But having said that, what I know is that people who live in apartments, who don’t have access to nature or cramped in there and don’t see people, that’s a very, very difficult time. So we have to normalize feeling frustrated, feeling irritated, feeling a little bit depressed. You have a right to those feelings. I would never say to somebody, “You shouldn’t feel that way.” This is a natural response. But even if you have a right to those feelings, you also have a right to do things that will help you cope better with those feelings, and that’s why I’ve made an effort to write things about that and to reach out and talk about it that we can do things that will help us cope with it, like having activity schedules, connecting up with people, having projects that you do.
Courtney Allison: Right, So you also touched on something I found really helpful and maybe you could talk about it a little bit: productive worry versus unproductive worry. I think the way I’ve been dealing with my anxiety for the winter is just obsessively going outside and soaking up every last drop. But you have a great point. I don’t need to totally hunker down again. I can go invest in some warm clothes, a warm coat. So I like how that’s a productive way to spend my worry. Maybe you could share a little bit about productive worry versus unproductive worry.
Dr. Robert Leahy: Right. So worry is repeated negative thoughts about the future, like, “I could get the virus,” or “I could get fired,” or “This could go on forever.” So productive worry is worry that actually leads to a to-do list. So for example, if I go to a supermarket or a drugstore or anything where I’m going to be inside for any period of time, productive worry is: “Do I have my mask?” “Am I social distancing?” “Are they enforcing the rules in that store?” Productive worry leads to a to-do list today, an action plan. So the action plan is bring my mask, social distance, make sure that when I look inside people are complying. And so productive worry leads to useful action. I mean worry evolved because it was useful, because it actually helped you plan for the future. So we have to think about, “When I’m worrying about something, is there something I can do today that’s going to help me make progress?” Most of the things that people worry about in the research, a couple of studies, 85% to 90% of the things people worry about don’t come true. And of the things that happen that people worry about, the research shows 79% of the time, worriers say, “Gee, I handled it better than I thought I would.” So we’re actually good at handling real problems. We’re not good at handling every problem we can imagine. And so what happens with people who kind of generate this, “What if? What if? What if” is they try to solve thousands of problems in a year that never occur. So it’s like cross that bridge when you get to it. If it’s productive worry, what can you do today? If it’s unproductive worry, then you have to shift into what I would call an acceptance mode, which is accept the uncertainty, accept that you don’t control everything, and accept that there could be bad outcomes.
Courtney Allison: And like you said earlier, scheduling time for things you want to do is important. But you’ve also recommended — and I’m surprised at how well it works — scheduling worry time.
Dr. Robert Leahy: Right. So people who worry find that, if a negative thought appears, they spend a lot of time with it; They just dwell on it. It’s like thinking about getting hijacked by a negative thought. Negative thought appears. Something terrible can happen. And then you just spend hours on it. It’s almost as if you feel some kind of obligation or helplessness in the face of that negative thought. So the question is, what can I do if an intrusive thought shows up? I can yell at it. That’s not going to help, because that actually makes it more salient. “Why am I yelling at something if it’s not important?” You can try to suppress it. “Don’t think that. Don’t think that. Don’t think that.” That only makes the thought bounce back.
But what we found is that having people schedule worry time gives them a sense of control and a sense of freedom. So here’s how it works. Let’s say you’re worried about the pandemic, why don’t you do this. Why don’t you have like a little thing you put in your phone. Write down any worries as they pop up and then set them aside to 3 o’clock in the afternoon for 15 minutes. Almost universally, people say, “I can’t do it. No, I can’t, because I have no control. If the thought comes, it just hijacks me.” Yeah, I know that. But what if you were able to postpone that worry till 3 o’clock in the afternoon? What would be the advantage? Well, the advantage would be I’m not going to be dwelling on it. I’ll be able to be more present, more appreciative, more active, more proactive, more productive, all of that. I’ll be more in my life rather than hijacked by the worry. Three o’clock comes around and what people often say… not 100% of the time. They say, “Well, you know, I was able to do it to some extent, and when I got around to 3 o’clock, I found it was the same worry over and over.” At 3 o’clock, I’m probably less worried about it than I was at 10:30 in the morning. So it sounds like these worries lose their power. They dissipate. So worry time is a very effective way of postponing the worry, letting it go for a while, not 100%, and then you come back to it.
Another thing that is counterintuitive, if I can share this with the audience, is what I call the boredom technique. Like if you had a fear of the elevator, what I would do is I would have you get on the elevator and go up and down the elevator 50 times. The first few times, you would be very anxious. “Oh my God. You’re putting me on the elevator. Why are you making me anxious?” But what happens after a while with a fear is that the more you practice the thing that you fear, the less anxious you become.
Now the same thing can be true with the intrusive thought, “The pandemic will never end.” If you repeat that thought for 15 minutes slowly like a zombie, it’s like getting on an elevator. Initially, you get very anxious, but repeating it slowly after a while, you actually get bored with it. So it’s really what we call an exposure technique, but this time you’re exposing yourself over and over and over again to your feared thoughts. Again, a counterintuitive exercise, something that people would not do spontaneously. But if you want to get over a fear, do the thing that you fear most. Sometimes progress is counterintuitive. Progress comes in ways that you don’t think it will.
Courtney Allison: Switching gears a little, we’ve all been at this awhile now, so as we enter winter, can you talk a little bit about resilience and how a person might build resilience to continue weathering this time?
Dr. Robert Leahy: Well, as I said earlier, Courtney, that you don’t have to hibernate. You can go outside. Go for walks in the winter. It gives you a sense of freedom. You can still meet people outside social distancing, if you like. You can wear your mask or your scarf around your face, and you can laugh together. So I don’t think that harboring in place is necessary in the winter or any time, even in the rain. So that’s one thing, I think, to keep in mind. Be a bit more versatile. Be more flexible. Be more willing to tolerate a little bit more discomfort, so you become resilient.
Being resilient means tolerating what I call constructive discomfort. Constructive discomfort is something that is uncomfortable that moves you forward. It’s like exercising or it’s like watching your diet. It’s maybe uncomfortable, but discomfort, it’s not going to kill you. In fact, it could be that isolation and passivity could kill you. So get out and connect. Make a special effort of having a list. What I did at the beginning of the pandemic is I made a list of a lot of people I wanted to contact. Then I began doing that, and some that I continue to contact with a pretty regular basis.
So you can continue connecting, doing all the things I described. You can exercise outside. If there’s no ice on the ground, you can walk and run. You don’t have to think of yourself as so fragile in terms of being outside or doing things. Keep yourself active, have a plan, check it off and do it. Think about the alternative: passivity, worry, rumination, isolation. You have a choice.
Courtney Allison: Absolutely. So you mentioned that you’ve been reaching out to people and connecting with people that maybe you didn’t use to speak to so much. I wonder, is there anything else you’ve learned from this experience or lessons that you’ve taken? Anything that maybe surprised you?
Dr. Robert Leahy: I guess what I’ve taken from this is that this pandemic, in my view — other people may not share this view — brings out the best in people and the worst in people. I remember coming out of an elevator in an apartment building, wearing a mask, and this guy walked in. He was about 30 years old with his female companion. Neither one of them were wearing masks. And I said, “Masks.” And he looked at me with his defiant, macho attitude and said, “I don’t follow the rules.” He was proud of his independence macho thing. So I think, unfortunately, and this is a sad thing about human nature, that there are a lot of people who just simply don’t care about putting other people at risk. These are people whose attitude is not only self-destructive, but destructive to other people.
On the other hand, there’s a good side. People reaching out and trying to help other people. People being generous. The heroic people who are in the medical profession. It’s absolutely incredible. You know, Courtney, that many of our colleagues at NewYork-Presbyterian have suffered psychologically, physically. These are people who really represent what’s noble in human nature. People who deliver food, people who are working in the supermarkets, people who are working at UPS or Federal Express, dropping the packages off — these are people who are the front lines. These are people we should respect. So I think we see the dark side and the bright side of human nature.
Courtney Allison: We’ve spoken before about adjusting to the new normal, and you shared some ingredients about how to develop a coping mindset. One in particular, I remember, surprised me. It was “Go on a politeness binge,” because I think I was asking what can people do with their partners or roommates when people are in close quarters. I thought your answer might be, “Oh, have a direct conversation. Keep communication open.” And you said, “Nope. Treat them like a total stranger. This isn’t the time to air every grievance. Just be super, super nice. This is a tough time.” Can you tell us a little more about why that ingredient is so important — the politeness binge?
Dr. Robert Leahy: I think that it’s natural if you’re living with people that everybody’s going to feel some stress at times, whether it’s from the pandemic of other things. A lot of anxiety and depression is substantially higher now than it was before the pandemic according to national surveys. You are going to have a lot of frustration, feel cooped up and a lot of people talk about that. I think when you talk to people about, “What would you want from your partner,” a lot of people will say, “What I want my partner to do — or my friend or my parents or my kids whatever — I want them to show they appreciate me. I want them to say, ‘Thank you.’“ But, yeah, going out of your way to say thank you for your partner cooking dinner or helping out with things or delivering things or just simply being who they are. No one ever said to me, “Gee, what I can’t stand about my partner or my friend is they’re so grateful and appreciative to me.” I think the same thing with your friends and your contacts. Being polite, being appreciative, showing compassion. Boy, that’s a really good feeling. So it’s not just politeness, but also compassion for people. You can even practice compassion in your meditation, thinking about people in your life that you just sort of wish kindness toward, like, “I really wish my friend will be happy, will be healthy and all that” and just access that kindness and that loving feeling in yourself. That’s a great antidote to fear. It’s hard to be afraid when you’re compassionate and loving.
Courtney Allison: So something else that stuck with me was about reducing expectations of yourself or changing your expectations. I think you said something like, “If you used to be able to run a 7-minute mile, picture throwing a 50-pound bag on your back and trying to do the same thing. It just won’t happen.” I think you even said, “Lower your expectations so much that even if you fall, it’s still a step up.”
Dr. Robert Leahy: I can imagine I said something like that. OK. Well, yeah. All right. I’ll take it. So part of frustration is expectation. Like if I expect that I’m going to do everything that I did before, my life is going to be exactly the way it is, I’ll almost by definition be frustrated. So part of this is changing the expectation to match reality. Now reality is different. I’m not going to go inside restaurants. I’m not going to be goiing into my office and hanging out with my staff and seeing patients for a while. I change my expectation to match reality.
And then to be flexible about what I expect. And then make the very best of what I have, which it doesn’t mean it’s perfect or that I love every minute of it, but to try to make the best of it. It’s not as bad as it could be. It’s not as good as it can be. It is what it is. Maybe I can make it better. Maybe I can have a more productive day or maybe I could reach out to friends or be more grateful. There’s always room for improvement. But there’s also the reality that things could be a lot worse as well.
Courtney Allison: Absolutely. As always, this has been incredibly helpful, and it’s such a pleasure speaking with you.
Dr. Robert Leahy: Thank you, Courtney. It’s great to have an opportunity to talk to you again and share some ideas. I hope some of these ideas might be helpful to people. Even if they’re not helpful now, if you think about them later, it might pop into your mind that maybe this is something I can do. So listening to somebody talk doesn’t mean, “Oh, now I feel completely different.” It’s sort of like: Here’s a set of tools. Maybe some time you might try using them. You never know, maybe you’re a good carpenter.
Courtney Allison: Thank you so much, Dr. Leahy.
Dr. Robert Leahy: You’re welcome. Thank you.
Courtney Allison: Dr. Robert Leahy is the author of The Worry Cure. For more advice from Dr. Leahy, be sure to check out healthmatters.nyp.org. That’s where you can also listen to more episodes of Health Matters Today, and find more stories of science, care and wellness from NewYork-Presbyterian.
I‘m Courtney Allison, your host. This episode was produced and edited by Andrea Woo and by audio producer Ben Chugg, who also wrote our music. Sharon Cotilar is our editorial director and executive producer.