(gentle music) – Dr.
Yellowlees, thanksfor being with us.
– Good, well, thank youvery much indeed, Pam.
– Our viewers might notice that we are practicing social distancing.
– That's right.
(Pam laughs) Six foot apart.
– We're sitting about six feet apart.
Can you help remind peoplewhy this is important? – Sure, I mean, look thecoronavirus is spread by person to person contact.
So people cough, andthey sneeze the droplets, and go on to somesurface, or somebody else, or onto their own clothes.
Somebody then touches thosedroplets with their hands, pick them up, move to the mouth, and the nose, and the eyes, where they can then be essentially put into the next person's body.
So it's very simple.
Very easy form oftransmission unfortunately.
And that's why socialdistancing is so important.
I mean, the aim is actuallyto not transmit like that.
– And this six feet is thesafe distance to do so.
– Basically, because it's hard to sneeze or cough that distance.
As someone who practices psychiatry, what does this social distancing, on a societal level mean to you? – I think it's something that'svery new to a lot of people, and it's difficult for people.
We're all used to shaking hands.
– [Pam] Yeah.
– You know, the youngergenerations in particular are used to hugging.
And we simply can't do that now.
So we've got to change a lotof our most basic sort of core social interactions.
At the same time, apart fromjust not touching people, we need to actually be cleaner.
We need to wash more frequently, we need to use sanitizers onsurfaces that we're touching that other people may touch, and so we've got to be much more careful about our whole environment.
So it's a big change.
And it's something that peoplefind hard to sort of keep up.
It's easy enough initially, but then it's very easy tostart falling into a sort of, I guess bad ways.
– You're an expert onwellness, and mental health.
When it comes to the social distancing, not all social circles are created equal, not everyone reacts thesame way to the sort of self-isolation, it'sharder on some people.
What are some of the elements that might make it harderfor certain people? – I mean it depends a lot, quite honestly, on your motivation, and on your knowledge.
One of the key things inthis whole situation is to get good quality information, so that you know whyyou're acting on something.
Very few people willchange their behavior, or change their activities ifthey don't know why that is.
So it's really crucial thatpeople get good information from places like the CDC, theWorld Health Organization, from good quality professionalnews organizations, local and national.
And this is not a time forgetting most of your information from social media, quite honestly.
– You know, I think thatthe social media is creating a lot of anxiety for people.
– I think that's right, and I think that one ofthe difficulties here is that people get frightened, and we know that if you getfrightened, you get anxious.
And actually, a reasonable level of anxiety is actually good forpeople, it makes you change, it makes you do appropriate things.
But if you're not anxiousenough, or if you're too anxious, then you tend to behavein a way that isn't in your best interests.
And so, you perhaps, for instance, start going to a grocery andtaking all the toilet rolls.
(both laughing) – Don't do that! – No, there's no reason to do that.
(Pam laughing) – And so, wheel turned, obviously is that you ignore the wholething and you go to bars, and you sort of socializeexcessively with people.
And you don't practice social distancing.
So, some anxiety is really good for us.
– Okay, but how to you know if you are, I think what you're describingas optimally anxious, how do you know when you're too anxious, or not anxious enough, and what do you do? – So I think one of the trapshere is to spend too much time looking at the news.
We all want to be informedabout what's going on, but we do not need to beinformed every five minutes.
We do not need to be constantlylooking at our phones.
It's actually very goodto keep in the moment, and to ignore news for periods of time, to do other things that areperhaps more interesting, go for a walk, you know, talk to some people.
Have other sort of interactions that are obviously sociallydistance wise safe, but which should take yourmind off some of these issues that are going around us at the moment.
– I'd like to know what you're doing, what your sources of information are, how often you're checking them, and how you are keeping youranxiety at an optimal level? – Yeah, I think that'sa very fair question, and you can see I've got myphone right in front of me.
– Yeah! (laughs) – The good news is it's off.
And I'm not gettingany messages right now.
So I try and deliberatelykeep my phone off, and not look at it duringmeetings, or during other times.
Clearly if I'm seeing apatient, I'm not looking at it.
So I think that's very important.
I think exercise, and your physical health is really important.
So I certainly, I walk regularly.
I try and keep myself reasonably fit, within the bounds of whatever is appropriate social distancing.
But there's no reason why youcan't go walking, running, and out and about like that, as long as you're notinteracting with people.
And so I think, keep physicallyfit, do yoga, do exercise.
Meditation is good.
I think, you know, forinstance if you are someone who gets very anxious, one app that I actuallyuse is called CBT-i Coach, which is an anxiety appthat the VA puts out– – [Pam] Oh nice.
– For veterans.
And it's intended for veterans who've got post traumatic stress disorder, who come back from Iraq or Afghanistan.
But that particular app has a huge number of really good tools onit that people can use to help manage their anxiety.
Almost like having atherapist in your pocket.
– Nice, can you say thename of that app once more? – Sure, it's CBT-i Coach.
– There we have it, CBT-i Coach.
– And it's a free app youcan download from App Store, it's curtesy of the federal government.
– Nice! What are your suggestions on how to exercise the sortof social distancing, and in ways that promoteemotional and mental wellness.
Especially for people who, say, have a lot of social contactsand feel really isolated, and just feel sort of out of sorts to not be in constant touch, or a person-to-person contactwith their loved ones.
– So I think one thing thatis really helpful to do, and I actually do this personally, is to think about who reallyare the most important people in your life, who are yourintimate social contacts, what's essentially yoursupportive social network? Now most adults literally only have four or five people like that.
They might have a spouse, you know, a sibling, a parent, a child, maybe one or two friends.
But think about these peoplewho are your intimate friends who could really helpyou if you're in trouble, and actually deliberatelyincrease your contact with them.
Not necessarily in person, but using the phone, or video conferencing, orsome other communication that you find relatively appropriate, and spend more time actuallynot just connecting, but reconnecting with thereally important people.
The reality of life is we actually have relatively few good friends, we have a lot of acquaintances.
– Now, ignoring youracquaintances for a few weeks actually isn't gonna do you any harm.
But ignoring your reallytrue friends is a problem.
So I'd look at that.
– I think that a reallyinteresting way of putting it.
Because when you lookat one's social circles, there are multiple circles, right.
There's the large one, of people that you're just intouch with every now and then, maybe do holiday cards, and then it gets smaller and smaller.
And you're talkingabout this inner circle.
– Right! So really focus on that inner circle.
And, in fact, the silverlining to this whole episode may be even in fact, a lotof people actually improve their relationships withthese really important people in their inner circle.
– That's a really nice way to look at it.
And you're right! That much of it is an opportunity.
– Right, exactly, so it's not all bad.
And I think, you know, but concentrate on those.
I'll give you an example, I'm one of four children, I have two sisters and abrother, in other countries.
We have a simple WhatsAppgroup that we use, and we're on thatconstantly, the four of us.
And we send photographs, we send clips of kids, we send whatever we're doing at the time.
We give ourselves a bit ofanxiety and trouble about who we're supporting interms of different games and things like that.
But we keep in close contact.
And I think, you can actually set up these little social networkgroups, and then you use them.
And you actually mayfind that you get to know your really important people much better.
– That's really nice.
When should people seea healthcare provider? At what point doesanxiety become something that needs attention? – So I think anxiety is very common throughout our whole population.
Probably about 5% of the population has significant amounts of anxiety.
I think if you're getting so anxious that you are excessivelyavoiding a whole lot of things, for no good reason, is a real sign that you should go and see someone.
So, in fact, you're reallynot going out at all, and you're social distancingat home to the level that you become quite agoraphobic, and actually can't walk outand go around the block.
Or if you're getting alot of panic attacks, and have episodes when you hyperventilate, when you get extremely anxious.
These are signs of more severe anxiety than I think would bemerited by being involved just with the coronavirus situation.
– At that point then, one would want to, say contact a doctor, or see a doctor.
People are being discouragedfrom leaving the house, though, for any sort of non-essential matters.
I mean, this would be essential for many, but there are options too.
UC Davis Health, for instance, offers video visits to patients, is this something thatpeople could consider if they feel like they need to talk to a healthcare provider? – Absolutely.
I mean, for instance, on the anxiety side, the department of psychiatryat UC Davis Health has, for a long time, offeredvideo visits to patients, if they wish.
And it's been a choice.
What we've done literallyin the last week or so, is ring almost everysingle patient we see, and we're now seeing 95% of all patients who are coming to our psychiatricout-patients on video.
– [Pam] Oh wow! – So we've almost exclusively converted what was a traditional in-person clinic for psychiatric treatmentinto an online clinic.
Now, a few people are still coming and there are reasons for that, there's nothing wrong with that.
– [Pam] Yes.
– What we will eventually I think move to, and I think, again, thisis another silver lining in this virus crisis, is we'llincreasingly be seeing people in a hybrid manner, as physicians.
Not just in psychiatry, but in all disciplines.
And patients will make thechoice as to whether they come and see us in person, or electronically.
Using either video, or thephone, or asynchronous methods, like going through MyChartand things like that.
And I think we're going to find that this virus situation isactually going to speed up our move towards usingmore electronic means for consultations in general.
– Your research, and youknow a lot about this, your research focuses agreat deal on telemedicine, or using technology to deliver care, so this must be a reallyinteresting time for you, as a scholar, to observe what's going on.
– It's fascinating, and infact, it's actually really, it's almost painful on one level.
I mean, I've spent thelast 20 years trying to relax regulationsand make things easier to be able to see patients at home, and in their home environment on video, and within a week of thecoronavirus really being taken seriously by the federal, sort of leaders, they've relaxed all of therules about telemedicine.
And literally today.
And so, now, suddenly thereare essentially no barriers for any of the payment orregulatory systems that we have.
They've all been takenaway with this emergency.
And so people are nowgoing to get used to seeing their doctor on video.
And doctors gonna getused to working on video, so there's no reason why, when some of these rulesand regulations come back, as they inevitably will, why we shouldn't continue on working in a slightly different way in the future.
And quite honestly, in a waythat is better for patients, because their healthcare willbe more accessible to them.
– We have found thatour patient satisfaction with video visits is quite high.
– Right, and I think that's what we found all over the world.
And so people can seetheir primary care docs, their surgeons, theirphysicians in internal medicine, obviously their psychiatrists, an awful lot of disciplines, now taking out telemedicine.
And I think this is goingto be clearly accelerated by what is a dreadful situationwith the coronavirus.
– So many people are working from home, including here at UC Davis Health, how do you suggest peoplemaintain their wellness and emotional wellbeing whilethey're working from home? – I think the first thingis to think about structure.
– [Pam] A routine? – A routine, absolutely.
I mean, that's one of the reasons why work is so good for us.
I mean, you know there'snothing almost more stressful than just being unemployedwith nothing to do all day.
– [Pam] Indeed.
– So, if you're athome, develop a routine.
If you're working, obviously work from home.
Work in the same way asyou would work from work, with set hours, and set tasks.
If you're not working at home, then give yourself some tasks, and get yourself into a routine, whether it's looking after the children, whether it's helping with otherpeople who need caring for, or else take on some new projects at home.
And do something usefulwhile you're there.
– I've found myself thatwhen I am working from home, the routines are reallyimportant to really sort of, hone in on working, otherwisethe lines get very blurry, if you try to do something, like a home-related task, and then a work-related task, and then a home-related task.
Is this one of the reasonswhy that sort of structure is so important to draw boundaries? – Yes, I think it is.
I mean, you know, again, ashumans we actually do better if there are boundaries.
I mean, you know, that's notnecessarily a popular view, but it is true.
And so, if you can setthose boundaries at home, so give yourself a schedule.
Actually diarize inwhat you're going to do, what tasks you're going to do, as if you were sitting at work.
– Do you have advice for people who are starting to find that they're getting a littlestir crazy in their homes? Their children are home from school, you know, to maintain good relations with the people that yoursharing these four walls with? – Yeah, I mean it's very hard.
I mean, I think everybody knows exactly what you're talking about.
– [Pam] Yes.
– There isn't a single magical answer.
I think that's the reality of life.
Sometimes people just haveto try and get some space.
– [Pam] Yeah.
– And that's often the best thing to do.
To just, you know, go into separate rooms, or somebody go for a walk, the other person stay at home.
Just try and do your own thing.
It's particularly difficult with children, especially if the children are anxious, and are maybe a bit afraid themselves, because they don'tunderstand what's going on.
So, again, you know it'simportant to give children reasonable information, butnot enough that it's scary.
What role does physical activity play? You mentioned how niceit is to get outside.
How important is physicalactivity to overall wellness, especially in a stressful time like this? – Well, we know thatphysical health is good for your mental health.
And there's no question about that.
So, you need to eat well.
One thing people forget about is sleep.
Sleep is really, really important.
Try and get, you know, sevenor eight hours of sleep.
Don't skimp on that.
And, essentially look after yourself with as good food as you can, and through trying tokeep reasonably calm, and through setting theschedule that we talked about, that it can include, youknow a walk at lunchtime, or a walk in the evening.
Something like that.
– For people who areexercising outside too, I presume the six feet ofdistance still counts, as well.
– Oh absolutely, no, no, it's very important.
And again, you know, gymshave essentially been closed, and that's because people are sweaty and coughing and sneezingall over the place.
You know, if you're lucky enoughto have an indoor machine, then that's fine.
But I think walking is aperfectly good exercise.
And again, in this situation, there's no reason why you can't walk.
But again, don't gotouching lots of things.
– And don't touch themailbox all over the place.
Take your wipes with you, make sure that you're actually clean, and you're touching clean surfaces.
So, you can walk, but just be careful.
Another one of your areasof scholarly research is the wellness and mental health of people who work in healthcare.
What are healthcare workersgoing through right now? – So, it's a verydifficult situation being a healthcare worker in this environment, because the reality of life, is the reason for allof the social distancing is because we don't haveenough intensive care beds, we don't have enough ventilators, and we don't have enoughhealthcare workers who may remain fit and healthy, to be able to look after patients who will need intensivecare in our hospitals.
– Right, and that's if the spike that we've all seen on that, the curve graphic that we've all seen, if it spikes as high as it could, which is why we're trying to flatten it.
– Right, and so healthcareworkers actually have to think of themselves as beinga bit like ventilators.
They've gotta actually think of, they've gotta keep themselves well.
They've gotta be extracareful, and extra concerned.
So that they, themselvesdon't have to go off, and be self-quarantinedfor currently two weeks.
So, I mean I think forall healthcare workers, it's a difficult situation, because we're used tolooking after everybody, and a lot of us feel guilty about the cancellations occurring, and typically in out-patient clinics.
But in fact, those sorts of cancellations are actually good for us, because they give us a bitof chance of remaining well.
And I think actually carrying on, and doing our normal workis probably the best thing most healthcare providers can do.
– How do you recommend thatpeople support friends or family who work in the healthcare industry? – I think it's like inany other situation, a friendly phone call, anice email, a nice note.
Just making sure that people know that they're not forgotten.
It's been fascinatinglooking at some of the video from overseas, in Italy thedoctors have been coming home and they've had crowds ofpeople applauding them.
– [Pam] Aww! – And, I think people are acknowledging what some healthcare workers are doing, and how important that job is.
And how courageous manyhealthcare workers who are, particularly in emergencydepartments and intensive cares, are having to be inthis current situation.
– This current situation is really, sort of raising the gamutof human emotions, I think.
And to hear you talkabout how important it is to cut yourself some slack, and give other people space, seems to me like it'd be areally important message too, to extend some patience toyour fellow human beings.
– I think that's true.
And at the same timealso, be very aware of, and try and be in the moment.
Try and look around you, and value what we have.
We're still, you knowthe great majority of us are going to survive fine, we're gonna get through this, this is not the end of the world, and we're going to be okay in the end.
So, as we go through whatis a difficult situation, let's just also lookat the world around us.
You know, smell, literallysmell the flowers.
Look at the green grassas you're walking around.
Try and actually thinkabout some of the beauties of the world, not just allthe pains and the horrors.