KOJO NNAMDIWelcome back. The Coronavirus pandemic has upended our daily lives, and a cloud of stress and anxiety seems to hover over everything we do. How can we maintain our mental health in a time of crisis? Joining us now is Dr. Mary Alvord. She is a psychologist and the director of Alvord, Baker and Associates. She's also an adjunct associate professor at the George Washington University School of Medicine and Health Sciences, and the author of "Conquer Negative Thinking for Teens: A Workbook to Break the Nine Thought Habits That are Holding You Back." Mary Alvord, thank you so much for joining us.

MARY ALVORDOh, thank you so much for having me, and also for highlighting the importance of mental health.

NNAMDIWell, what have you been hearing from people about how they're responding to the coronavirus?

ALVORDWell, just a range of emotions and thoughts, I think. You know, the last week-and-a-half, in particular, has been just a whirlwind of constant changes and everybody needing to be more flexible, which is easier for some than others, in different situations. But a range of worries and anger and frustration and increasing, I think, worries, too, about finances, and not only the COVID disease.

NNAMDIHow do you think this pandemic is affecting people who might already be experiencing anxiety, depression or obsessive-compulsive disorder?

ALVORDI think it's more difficult. It's more challenging, because we know what underlies so much of anxiety is avoidance. And now, in this situation, we're supposed to avoid and keep our physical distance. And so that increases it. For people who have obsessive compulsive disorder -- and there are many different types, but particularly those, you know, who have germ phobia,-- I think it's more difficult, because now everybody is doing so many routines.

ALVORDAnd I think with all of mental illness and mental health, we want to take all these things and do them so they don't start interfering with our functioning. So, we may all worry. We may all have some catastrophic thinking, which is when you start thinking the worst case scenario. And then we have to sort of bring ourselves back. So, I think those of us who are more vulnerable, it's more difficult. And, in some ways there's opportunities here, as well.

NNAMDIHas your office seen an uptick in new clients or appointments being made?

ALVORDWell, we have limited new appointments, and we've gotten a few calls. Most of what we've gotten is a flood of people either wanting to be seen more often, college students who are now almost all back home and wanting to reengage. And so we are trying to meet the needs of our own clients, because we've had to shift from an in-person practice, even though we've always done a lot of tele-health, but now we are -- as of yesterday, we are 100 percent completely doing tele-health.

NNAMDIMary Alvord, okay, here's the, I guess, million-dollar question. What can we do to calm our anxiety?

ALVORDYou know, I think we can do a lot of things. One of my areas of focus is resilience. And if we look at, over the years, there's five decades of research on how can we be more resilient. How can we adapt and cope? And at the core of resilience is really having the belief that while we can't control all aspects of our life, we can control many aspects.

ALVORDSo, I ask people to focus on what it is that you can control, you know, in terms of looking for opportunities. This is an opportunity to perhaps do things a little bit different. We're certainly being forced to do many things different. You know, most of us are now at home and restricting activities and businesses are closing, but hobbies to develop, creative projects and particularly connecting with friends and family. The nice thing about this day and age is we can connect without physical connections, but from a distance, video chats, texting, phones, social media.

ALVORDAnd then look at what you -- what do you value and what do you like to do? So, what are some activities that you can plug into your day? And I've been recommending people really alter sort of more sedentary tasks, because many are working remotely from home and trying to get, you know, work done at a computer or somewhere else. But vary that with physical movement, because we also know that physical movement helps us with our mood, when we are active, particularly if we're outdoors and in nature. It can mean stepping outside, even if you're in an apartment. But just being outdoors, take some fresh air and vary your activities, you know. And get sleep. Sleep is so important to help modulate our mood. And we can also more clearly think when we sleep well.

NNAMDIDoes social distancing mean we, well, shouldn't be social at all?

ALVORDYou know, I wrote a little bit about this in social media. I was miffed with the term social distancing. To me, what is really meant is physical distancing, but social connectedness. You know, we are social creatures. It's really important to have our support systems, particularly at times of distress. You know, we need to reach out to people currently in our lives, and perhaps even who've passed in our lives, who can be there as support. So, I encourage social connection.

ALVORDWhen walking the other day with a friend, we kept our distance, but there were a lot of people outside. And everyone was smiling and nodding and saying hello, but everyone respecting the physical distance. So, I think we need to distinguish those two very carefully.

NNAMDIA big part of our anxiety comes from the sheer amount of information we're getting on coronavirus from, well, us, the media. How should people be managing their information intake, their news intake if they're feeling anxious?

ALVORDI recommend limiting it to perhaps segments of the day, perhaps morning, middle of the day, if you need to check in, and then in the evening. If you do it in the evening, I would recommend doing it at least an hour before you go to sleep, so that you're not worked up and upset. But I think we need to learn to turn off all of our notifications, and the news is going to be there.

ALVORDAnd this is probably the fastest moving cycle that I have experienced in terms of work, because interjurisdictional practices changed for psychologists. They have released some of the standards, etcetera. But, even so, if you didn't catch it by the morning, you can catch it in the middle of the day or in the evening. So, I think we need to limit it and make sure we're doing other things.

NNAMDIHere is Jeffrey in Maryland. Jeffrey, you're on the air. Go ahead, please.

JEFFREYHi. I'm calling for your question about what we're doing to keep our mental health. And I've just gone back to a hobby that I had to put to rest because of quality and cost reasons. And I can honestly say, in this new digital world, because I haven't -- my hobby is building guitars, and I haven't really been in a position -- I have both respiratory issues and cardiac issues, and I haven't really been able to express myself through my hobby until this coronavirus really has me kind of housebound.

JEFFREYAnd instead of the home becoming a prison, it's become my solace again. And just to reestablish, you know, an old craft, because I extended the hobby to the point where I consider myself a craftsman in that hobby, and even though I do have some quality issues with getting quality components to work with, even still, making the most of it and showing that progress as I move on because, you know, it's an arduous process. It's not the kind of thing that you can kind of accomplish in a day.

NNAMDI(overlapping) Let me see what Dr. Alvord thinks about that. Mary Alvord, what do you think about what Jeffrey's doing?

ALVORDWell, I think it's excellent. I think, you know, what I said in the beginning, this is a time also for us to look for opportunities. And it sounds like Jeff looked into an opportunity to reengage a former hobby, now that he has the time and isn't able to go on. I think part of what makes us resilient is problem-solving and really figuring out, you know, how can we take initiative to do things to make ourselves happier. You know, what can we put into place so that we don't feel helpless and, as he said, so we don't feel a prisoner in our home, but rather it's our sanctuary, maybe, or just a place that is tolerable? And how can we make the best out of this situation?

NNAMDIWe've got an anonymous listener who emailed: I'm wondering if the expert could specifically speak to the trauma of enduring domestic violence and struggling with substance abuse during this time. Do you have any advice other than a hotline or a policeman, immediate safety is concerned. I should mention that, last week, we did a show about the expected rise in domestic violence during this time. And we'll be tweeting out a link you can find for that show.

NNAMDIBut the same emailer said: what about those of us adults, children or elderly who just live with a kind of moderate level of tension and emotional abuse daily? Often, the times at work or school are a reprieve from family dysfunction. How can we create a reprieve for ourselves in this time? What are strategies to keep in mind that may not be helpful during normal life, but that are necessary during a lockdown? Dr. Alvord.

ALVORDWell, I think a few things. One is, perhaps we can find a safe space within the home, or within the confines, so that there is a place that is designated as a place where you can go to. There are ways that you can calm. And I'm not saying -- you know, it is a very complex issue, domestic violence and substance abuse, much more than we can go into right now. But if you can stay calm, then that helps the clarify of thinking and really determining action.

ALVORDYou know, one thing is, we can go outside, so we don't have to stay in the home. And, yes, going out has been a respite to going to school. That's a concern of a lot of the college students coming back home, getting into situations that are not ideal. And I think we need to do things to just calm ourselves, whether it's body relaxation, visual imagery, or really, I say to people, what would you suggest to somebody else in your situation? You know, what other strategies can you implement to help yourself, so that you're not feeling like a victim all the time?

ALVORDAnd, the difficulty is, if everyone's stuck in the same house, that is potentially an escalator. So, find someplace outside, even, that you could go to. And then reach out to the hotlines and, you know, those other resources.

NNAMDIWell, since you mentioned things we can do, I'm hoping you can lead me and our listeners through a brief visualization. This is one of the relaxation techniques that you recommend to handle anxiety.

ALVORDI do. I would love to do that, and it's actually something that I use frequently with children, teens, adults that I treat. And I use it myself. So, if everybody can just get in a comfortable space, the caveat is that, often, I ask people to close their eyes. Obviously, if you're driving, please don't do that, (laugh) but perhaps you can listen to this and try it later.

ALVORDBut get into a comfortable spot and take a deep breath in, hold it, and then slowly breath out. And, in your mind, visualize a place that you would like to go to. It can be a real place. It could be a made-up place. It could be somewhere where you've never been but you would love to go to. And think about what objects are there and the colors. What colors bring you calm? What colors soothe you?

ALVORDAnd since you can control the scene, decide what would be the perfect temperature of the air, and how that would feel on your skin, and how it would just surround your body. It could be an outdoor cool spot. It could be warm, hot. You could be bundled up. This visualization is really something you can use anytime, and you can make it up, and you can change them.

NNAMDIIt helped a lot. I'm now too relaxed to continue doing the show. See you later. (laugh)

ALVORDOh, just to say, you also would want to include the sounds, because we want this to be multisensory. And so, it could be silence, too, that you want in your scene, and smells and tastes, so that you really have a full visual image of this. And what's wonderful is, you know, you can even use this for 15 seconds, anywhere, because it's in your head. So, it goes with you. It's portable.

NNAMDIYou work a lot with kids and adolescents at your practice.

ALVORDWe do.

NNAMDIWhat should parents and caregivers be aware of when it comes to their kids' stress at this time?

ALVORDWell, I think in terms of recommendation, we want to have as many routines as possible. Some of the schools are getting online. Others, I think, will take longer. And so parents really need to manage a lot of what goes on daily. And I recommend varying the routines, again, from like sitting, reading, listening to music, to going outside and moving.

ALVORDI think what we need to look for in terms of trouble spots are if we see a sudden change in behavior, our child seems particularly irritable. With children, they don't often say, I am sad or, you know, I'm down or I'm anxious. A lot of times, what we notice is irritability. And, you know, is their sleep pattern changing? Are they talking about, you know, what we call the what-ifs? What if this happens, or what if that happens? That is what we call catastrophic thinking and the worrying that goes on.

ALVORDSo, look for any changes that you see as a parent. But, for them, try to get them engaged. I think his is a great, you know, opportunity to do creative art projects and just create stories and just a lot of things that maybe do not lend themselves in a normal situation, and now we're sort of stuck at home. The good thing is, we have electricity. You know, during snow storms, often, we're stuck at home, but we don't even have our lifelines of electricity and the internet.

NNAMDIMany psychotherapy practices are now pivoting to tele-health and tele-therapy, something that your practice has been doing for quite a while. What should we know about tele-therapy, and are these sessions as effective as in-person sessions?

ALVORDYes. The research is very clear about that it has an effectiveness across many different difficulties and mental conditions. The research really started -- the good research started in the 2000s, with the VA, and has really progressed and has really been exponential since about 2011, I would say. And I think it's a wonderful modality. You know, we are losing some services, like we can't really do psychological testing very easily over video.

ALVORDBut, for most parts, we can do it, and we can do it ethically. There's a relaxation of the licensing laws. So, for example, my practice is in Maryland. We can continue with our current patients in D.C., even though some of us are not licensed in D.C. So, during this pandemic, we can see them via video. But we can't take on new patients from D.C., because, as I said, we're closed for in-person sessions. We are operational, though. All of our staff is working.

ALVORDThe other thing to look for is, you know, there are white boards on these. You can share things on the video with the therapist. We are using the HIPAA-compliant platforms so that privacy and confidentiality is still upheld. And it's an adjustment. You know, most practices have not been doing it. Certainly, there are very few probably nationwide that are 100 percent. And now, we have shifted, almost all of us, to, you know, 99 to 100 percent being video therapy.

NNAMDIWe only have about a little less than a minute left, but do you think tele-health becoming more common during this pandemic will have lasting changes for the way people access health resources, going forward?

ALVORDI hope so. And I say that because I see tele-health as a way to decrease barriers, because for so many, you know, it started where it was decreasing barriers for a rural population who couldn't get to specialists. But, you know, in the D.C. area, it could take us an hour to go practically nowhere. (laugh) And so it helps us include people that we might not, otherwise. And it helps us bring interpreters in for a short amount of time to a video session perhaps, if we need for language, if we need for sign language, as well. And I think it's just helping us break barriers.

ALVORDMy goal -- I started a nonprofit charity a few years ago -- is to really help increase access to mental health and mental care. Because the mind and the body are connected, and we have to take care of both parts.

NNAMDIIndeed, there are a number of other resources that you can get for people experiencing anxiety. You can find links to those resources at our website, kojoshow.org. Dr. Mary Alvord is a psychologist and director of Alvord, Baker and Associates. Thank you so much for joining us. This segment on maintaining mental health during the coronavirus pandemic was produced by Cydney Grannan. And our conversation about undercounted groups in the census was produced by Kurt Gardinier.

NNAMDIComing up tomorrow, are you showing symptoms of COVID-19? How long could this social distancing last? Local medical professionals weigh in on the latest coronavirus news and answer your questions. That all starts tomorrow, at noon, but today is a big day for us here on this show. It's the birthday of our managing producer, Monna Kashfi, who is allowed to break the Kojo rule of never working on your birthday, because, well, we're in a tough situation right now. And that's just who Monna is, always there when needed, with efficiency, grace and a sense of humor. So, happy birthday from the entire Kojo Show team, Monna Kashfi. Oh, and thank you all for listening. I'm Kojo Nnamdi.