Anxiety patients handled COVID-19 stress better than most. It could help everyone in the future
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There’s been a rise in people dealing with anxiety over the past few years. But new research finds one of the big recent events which caused lots of people to feel anxious did not have that effect on patients already getting treatment for anxiety.
Around the start of the COVID-19 pandemic, David Rosmarin noticed patients in his offices didn’t seem to be suffering from worsening symptoms.
Rosmarin is a clinical psychologist, an associate professor at Harvard Medical School and the founder of Center for Anxiety — which has about a thousand patients at offices across three east coast states. What he was seeing surprised him, and he wanted to find out if his observations were backed up by data.
Rosmarin joined The Show to talk about what he found.
Full interview
MARK BRODIE: David, I’d like to take us back to the very early stages of the pandemic, because it sounds like this is where the idea for this research came about, because you’re pretty concerned with how people who are being treated for anxiety would handle COVID. And what you found, at least anecdotally, seemed a little counterintuitive to you.
DAVID ROSMARIN: Yeah. I wouldn’t say I was concerned. I would say I freaked out. We had 500 patients at that time at Center for Anxiety, and here we were going to this pandemic. We had to shift everyone to telehealth in two weeks. There are these early reports coming out about anxiety and depression and suicide increasing.
And I was terrified. What’s going to be with all these patients under the care of my staff? How are we going to do this, and what’s going to be the fallout?
And what was really incredible was in the in the months following, we didn’t have a lot of fallout. In fact, our patients — I observed anecdotally, as you mentioned — were doing very well. I even noticed that they were doing better than some of my friends and colleagues who had never had significant anxiety before and had received treatment for it.
And that made me wonder, like what happened? What was that about? It took a couple of years to dig ourselves out from the pandemic, and we actually had to expand our services quite significantly. But at some point I had the opportunity and the data to look and say, “Hey, what’s what’s going on here? And was there a trend?” And when we looked, it was just incredible what we found.
BRODIE: So why do you think it is then that patients who were already being treated for anxiety before COVID, it seems like that treatment almost had like a protective effect.
ROSMARIN: Yeah, I might even call it an inoculation, of sorts of. A behavioral health inoculation, if you can say such a thing. The way that we approach our anxiety, our relationship with our anxiety is the primary determining factor in whether we thrive with it, whether we actually use it in a constructive way or whether it gets the better of us.
And one thing that our patients learn — and we practice primarily cognitive and dialectical behavior therapy — is that anxiety is not a disease. It’s not going to kill you. Something else will kill you. It feels like death, but we’ve never had a patient die from high anxiety alone. And that’s not the reality.
It is an emotion. It is a distressing emotion. But in of itself, it’s not a problem to have high levels of anxiety as long as we can know what to do in order to keep it in check, in order to move forward. And part of what moving forward means is accepting it and learning not to fight against it.
“I think that elements of cognitive and dialectical behavior therapy should be incorporated into the education system. I think this is the kind of thing that we could be teaching university students, or even high school students or younger ...”
— Center for Anxiety founder David Rosmarin
BRODIE: So do you think it’s possible to extrapolate this out and suggest that people who take part in this kind of therapy can also be protected from higher levels of anxiety for other types of events, things that are not specifically the COVID-19 pandemic?
ROSMARIN: I do, and I would go a step further. I think that elements of cognitive and dialectical behavior therapy should be incorporated into the education system. I think this is the kind of thing that we could be teaching university students, or even high school students or younger, and certainly parents and certainly individuals in corporate settings: how to manage their anxiety and how to how to change our relationship with it at the outset to inoculate us as a society against what we’re seeing, which is unprecedented levels of emotional distress.
BRODIE: I don’t want to make it sound as though doing this kind of work is easy, because I’m sure that it is not. But it sounds like this is a seemingly very easy solution to what is a growing — as you pointed out — a growing problem, especially among young people. Is it fair to say that if we just got some majority of high school and college students in this kind of therapy, that the overall rates of anxiety in this country would go down?
ROSMARIN: Well, I think there’s a difference between easy and simple. I do think the solution is fairly simple. We need to change our relationship with anxiety. The way that we approach this symptom, where we call it a symptom. We approach it as a disease. We approach it as a problem as opposed to approaching it as an emotion, as a part of human life.
Let me ask you a question. Have you met anybody who’s never experienced anxiety before?
BRODIE: I can’t imagine I have, no.
ROSMARIN: Exactly! So at what point do we distinguish between a disease, which is the model that we’re currently using, as opposed to an emotion and something that we have to learn to deal with, even at high levels. And just to get back to what I was saying before, there’s a difference between what’s easy and what’s simple.
The solution here is, I think, somewhat simple, but it’s not easy. It entails facing emotional distress heading towards our anxiety, allowing us to experience that, not trying to squelch it or reduce it, and really allowing ourselves, giving ourselves permission and the opportunity to have a range of emotions. That’s very countercultural.
So it’s not easy, but it is simple.
BRODIE: I’m curious about the role of medication here, in terms of either the patients with whom you are working or observing or sort of the population in general. Because obviously for some patients, medication is, if not the way, a way that they help treat anxiety as well.
ROSMARIN: Certainly. Firstly, more than 50% of the patients who come to my offices are on some form of medication, and I support it. I’m not against that.
However, when medication is used as an only or a primary way of dealing with anxiety, I think it reinforces our perspectives that this is a disease, that this is something we need to get rid of.
What I see medication as doing primarily, in a positive sense, is it reduces anxiety to a level that people can tolerate. Now it’s not going to be comfortable. It’s still going to be uncomfortable, but it’s tolerable. So if it takes us down from a nine, an eight or a seven — on a, let’s say, a 10 point scale — down to a four or a five, it’s not going to be fun, but it’s something we can learn to increase our stamina, our capacity, our emotional fortitude over time.
But if the goal is to take it down to a zero or a one or a two, what you’re going to end up with — and this is what happens — breakthrough anxiety, breakthrough, stress, people having those symptoms. And then they’re upset about the fact that they’re anxious. And then that ironically increases their flow of adrenaline into their system and actually makes them more anxious. So it’s a cascade of effects.
BRODIE: So I want to go back to something you mentioned about possibly getting this kind of therapy into schools. Are there places that are doing that?
ROSMARIN: There are few and far between. I’ve definitely done consulting for educational institutions, for curriculum development and for faculty. But it’s it’s not being done en masse. You don’t have a required course at every university, which is mandated by college boards, about your mental health with certain aspects and elements of self-care and these kinds of messages which are embedded.
I think it’s definitely not at the scale that it needs to be. But I suppose there are some glimmers of hope.
BRODIE: Would it take the same kind of sort of perspective change to make that happen as what you were talking about earlier in terms of looking at anxiety not as a disease but as an emotion and something that we need to work to regulate?
ROSMARIN: I do think that’s the core issue here, is that when we turn our emotions into something that we need to get rid of, we actually are using our body against itself. Emotions are neither healthy nor unhealthy. They just are. And they can be used in positive and negative ways. And how we choose to interface with those aspects of who we are really has a massive impact on our mental health.
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