|Ahead of print publication
Implication of online-based brief psychotherapy in anxiety spectrum disorder during COVID-19 pandemic
Susmita Halder1, Akash Kumar Mahato2, Shinjini Samajdar3
1 Department of Psychology, St. Xavier's University, Kolkata, West Bengal, India
2 Department of Clinical Psychology, Amity University, Kolkata, West Bengal, India
3 Department of Clinical Psychology, Sweekaar Academy of Rehabilitation Sciences, Secunderabad, Telengana, India
|Date of Submission||04-Mar-2022|
|Date of Decision||16-Mar-2022|
|Date of Acceptance||17-Mar-2022|
|Date of Web Publication||07-Nov-2022|
Department of Psychology, St. Xavier's University, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Background: The rapid, ongoing and progressive nature of corona virus pandemic situation is representing global public health disquiet. The uneasiness, apprehension or worry regarding the current circumstances is leading to mental health concern and the quality of life and functioning are being affected and leading to mental health problems. Excessive worry and tension could elevate negative emotions and consternation regarding necessities of daily life, preventive and control measures, life and health threats are the risk factors of aggravation of somatic symptoms. Supportive psychotherapy is an evidenced based therapeutic measure to manage negative emotions and feelings. Aims and Objectives: The present study aimed to explore the application of brief online based brief psychotherapy in the pandemic situation to intervene symptoms of anxiety, somatic concern, and associated negative emotions in daily life. Method: It is a case series of 5 adults with anxiety and somatic symptoms, aggravated in post COVID19 situation therapeutically intervened through brief online based brief psychotherapy. Results: Significant changes in symptom pattern and severity suggest positive indications of online brief therapy for anxiety and related symptoms in pandemic situation.
Keywords: Online based brief psychotherapy, Anxiety spectrum disorder, COVID-19 pandemic
|How to cite this URL:|
Halder S, Mahato AK, Samajdar S. Implication of online-based brief psychotherapy in anxiety spectrum disorder during COVID-19 pandemic. Ann Indian Psychiatry [Epub ahead of print] [cited 2023 Mar 22]. Available from: https://www.anip.co.in/preprintarticle.asp?id=360530
| Introduction|| |
The COVID-19 outbreak in 2020 manifested the global anxiety, panic, and other mental health problems. The outbreak-affected provinces have elicited global worry about becoming infected, and the number of affected patients and suspected cases are increasing and uncertain and unpredictable future of this pandemic has been aggravated by different misconceptions and misinformation. Symptoms such as the intense stress, anxiety, fear, worries, negative apprehensions, irritability, anger outbursts, low mood, and posttraumatic stress disorder are endemic among these psychosocial effects. Biopsychosocial factors are considered to have an important role in the manifestations of different psychosomatic symptoms and other related disorders. Stressful life events and traumas are closely related to various physiological conditions with particularly somatic complaints such as gastrointestinal disorders, chronic pain, and headache. Psychosomatic complaints may develop after progressive traumatic events.,
It is a challenging process to adapt and accept the rapid and massive changes. In this regard, the increased stress level in individuals is expected. The cycle of physiological response can be developed, and potential relationship between stress and somatic complaints and even diseases can be understood. Intolerance of uncertainty and unpredictability of the situation includes the apprehension and belief that uncertain events are unacceptable, unfair, and usually threatening. The thoughts or beliefs like this could make the individuals intolerance to uncertainty and they may have proneness to experience extreme and destructive anxiety, and which can trigger the permanent physiological arousal and distress.
Most online-based psychotherapy treatments are based on cognitive-behavioral models, but other approaches such as psychodynamic, supportive, and integrative psychotherapeutic treatments have also been evaluated. In the pandemic situation, use of online-based therapy has been taken into account and the applicability of online-based therapy in clinical practices has also been flourished as well. The use of supportive therapy in reducing the symptoms of emotional difficulties is well evidenced and practiced. The supportive therapy is related greatly with therapeutic alliance, and addresses the quality of interactions between patient and therapists. In the supportive psychotherapy, the therapist emphasizes on the expression of conscious feelings and emotions. Brief supportive therapy is generally based on conversation and deal with the self-esteem, adaptive skills, or psychological function of the client.
The aim of the present study is to explore the application of brief online-based supportive therapy in pandemic situations to intervene in the symptoms of anxiety and difficulties in daily living.
| Materials and Methods|| |
Purposive sampling method was used, and the range of number of sessions was 7–10. The mode of therapy is brief online-based supportive therapy.
In the present study, the number of clients was five of both genders with the age range of 34–70 years [Table 1]. The clients were mostly having complaints of disturbance of sleep, anxiety symptoms, negative emotions, and apprehensions regarding health and situations during the COVID-19 pandemic, feelings of uncertainty and insecurity, fear and panic attacks, and deteriorating social interaction. From the conceptualization of cases, it had been understood that present participants were having COVID-19-related anxiety disorders along with depressive symptoms. The symptoms are manifested during lockdown and it impacted upon clients' overall functioning. Clients were cooperative throughout the sessions, and the rapport was easily established with the therapist.
In the present study, sociodemographic details and clinical datasheet were used to elicit personal information of the participants along with Beck Anxiety Inventory, and General Well-being Schedule was used to assess the clinical symptoms of the participants during the study.
Intervention process [Table 2]
Educating the client about symptoms
The supportive therapy was focused on the exploring and [Table 2] explaining symptoms that are causing distress to clients. Through active listening, interaction, and interviewing, the understanding of symptomatology was done.
To reduce the anxiety symptoms, uneasiness, palpitations, and physiological changes due to negative emotional feelings, relaxation training was conducted to each client and the clients were practicing it regularly. As it was online-based psychotherapeutic intervention, deep diaphragmatic relaxation technique was used. It helped to reduce the physiological activation of the clients.
Activity scheduling and externalization of interest
For each client, tailor-made, customized schedule of activities was prepared by therapist with the feedback of interest areas of the client. Activities were arranged through which can divert the client from the emotional difficulties.
Changing sleep patterns
Focusing on unhealthy sleep patterns due to pandemic situations helped the client to maintain the sleep for proper hours, and the quality of sleep was also improved. Maintaining sleep diaries and logs are the tools used for healthy sleep patterns.
The therapist focused on exploring, defining, and eliminating the negative environmental factors that are disturbing the psychological balance of clients or target to address the deficit and difficulties in the living situation of the client causing emotional problems.
The emotional feelings and disturbances were pented up in the clients, and those are manifested as symptoms of anxiety, fear, and panic attacks as well. Venting out feelings helped the client to validate their own feelings and expressing it in more adaptive way.
Rationalization and reframing negative apprehensions
Negative apprehensions of the client were explored in the sessions, and through Socratic questioning and thought challenging, the client's automatic thoughts and beliefs were alternated and through guided discovery, the client's worries regarding health, future, and situation were managed.
Focusing and refocusing on the emotions and reframing the negative thoughts by alternating, repetitively, were causing immediate relief in the clients. However, it was also reported that the symptoms were recurring after weeks and through repetitive refocusing on the content of thoughts started to weakening the belief of clients. Verbal reassurance was often given to the clients, and those who can verbalize their doubt about their ability to get well. Reassurance is also used for clients, to reduce the grip of fears, arising out of irrational thinking.
| Results and Discussion|| |
The present study was aimed to explore the application of brief online-based psychotherapy in pandemic situations to intervene the symptoms of anxiety and difficulties in daily living. Online-based psychological intervention services have certain advantages over face-to-face consultations, especially in the current situation of pandemic. Online services are helping the individual in many ways, starting from its flexibility in getting appointments, travel time, and cost too. Furthermore, Pietrabissa et al. identified advantages of telepsychology, which reduce waiting time for the consultation as well as the expenses. Because of these advantages, various approaches of psychotherapy can be tried in online mode and continued postpandemic too.
Outcome of the therapy
Brief online-based supportive psychotherapy was conducted over 7–10 sessions. It was seen that there was a significant improvement of the symptoms [Table 3] and [Table 4], and the clients were having less physiological discomfort than before. Engaging in activities of interests diverted the clients from negative emotions and feelings. Supportive techniques explored and analyzed the symptoms of clients along with encouraging the relief. Recurring symptoms were also managed through weakening the beliefs repetitively.
In the post-COVID situation, the changes in daily living, occupational, and interpersonal functioning impacted upon the clients overall psychological well-being. In the present study, the clients were having extreme fear, anxiety, and negative apprehensions regarding themselves and others. It has been found that fear of dying, uncertainty, and unpredictable nature of future situation elevated the symptoms, and sleep pattern was also disturbed.
The online mode may be used not only as a substitute in compulsion but also as standard procedure for clients who may not attend regular face-to-face therapy sessions due to infrastructural limitations. Even after 2 years of its outbreak, the expression of psychological distress and decreased coping is no less, has raised the emergence of brief and comprehensive psychotherapy through online mode. In future, the online sessions may also be merged as part of physical sessions as per requirement.
Implication of the study: In this study, the focus of therapy on the clients was to reduce the symptoms of anxiety, fear, panic, and negative emotional apprehension as well as to improve daily living functioning. Brief online-based supportive therapy was based upon the therapist's understanding, observation, and responsiveness along with motivating clients to catharsis emotional feelings through ventilation, expressing interest areas, and reducing anxiety symptoms through therapeutic intervention. The following strategies were taken to intervene and manage symptoms of the client, respectively. In the pandemic situation, there was high prevalence of manifestations of psychological symptoms along with decreased quality of life. Patients infected with COVID-19 have been found to be more indicated to have psychological and emotional distress but those who are not infected and maintaining the protocols of the prevention are also victimized of clinical psychiatric disorders. The efficacy of psychotherapeutic measures in case of these population has been explored and analyzed as well. Existing presentation of symptoms of the clients might have exacerbated by the long-lasting social isolation due to exposure to either the coronavirus or associated social distancing, and the existing social isolation increased the symptoms in the emotional vulnerable group. In the previous studies, it has also been found that the responses of people with emotional vulnerabilities to different types of extreme situations such as earthquake are evidenced to have higher levels of avoidance-related coping being associated with higher distress which leads to decreased social functioning and this is also evidenced in current case series.
| Conclusion|| |
Brief supportive psychotherapy is a conversation-based dyadic treatment method whose focus is the maintenance or increase of patients' adaptive skills, self-esteem, or psychological functioning by supportive techniques. The process is modeled on communication with the client, and the therapist responded more frequently through supportive techniques. In addition to data-based praise, reassurance, advice, and active guidance, clarification of doubts, confrontation or challenging negative thoughts, and interpretation of situations are useful. While the efficacy of supportive psychotherapy in anxiety and stress-related conditions is well established; indications of its brief version in online mode are not studied well. The pandemic situation warranted changes to be made in the delivery of psychotherapy and counseling services across all models, which could be challenging for therapist as well as client to adjust with the new model. The virtual presence of the therapist might not have assuring the presence of the therapist risking drop out of the client from the sessions. The application of online brief supportive psychotherapy may be extended with other clinical conditions to explore its efficacy and widening its generalization.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al.
The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.
Williams SE, Zahka NE, Kullgren KA. Somatic symptom and related disorders. In Carter BD, Kullgren KA, (Eds.). Clinical Handbook of Psychological Consultation in Pediatric Medical Settings. Berlin: Springer International Publishing; 2020. p. 169-81.
Barkmann C, Braehler E, Schulte-Markwort M, Richterich A. Chronic somatic complaints in adolescents: Prevalence, predictive validity of the parent reports, and associations with social class, health status, and psychosocial distress. Soc Psychiatry Psychiatr Epidemiol 2011;46:1003-11.
Pacella ML, Hruska B, Delahanty DL. The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review. J Anxiety Disord 2013;27:33-46.
Carleton RN, Sharpe D, Asmundson GJ. Anxiety sensitivity and intolerance of uncertainty: Requisites of the fundamental fears? Behav Res Ther 2007;45:2307-16.
Greco V, Roger D. Uncertainty, stress, and health. Pers Individ Dif 2003;34:1057-68.
Andersson G, Paxling B, Roch-Norlund P, Östman G, Norgren A, Almlöv J, et al.
Internet-based psychodynamic versus cognitive behavioral guided self-help for generalized anxiety disorder: A randomized controlled trial. Psychother Psychosom 2012;81:344-55.
Butler SF, Strupp HH. Specific and nonspecific factors in psychotherapy: A problematic paradigm for psychotherapy research. Psychotherapy 1986;23:30-40.
Pietrabissa G, Manzoni A, Algeri D, Mazzucchelli L, Carella A, Pagnini F, et al.
Facebook use as access facilitator for consulting psychology. Aust Psychol 2015;50:299-303.
Halder S, Mahato AK, Samajdar S. Psychological impact of COVID-19 pandemic and its coping: A one-year follow-up study from India. Taiwan J Psychiatry 2021;35:203-7. [Full text]
Horan WP, Ventura J, Mintz J, Kopelowicz A, Wirshing D, Christian-Herman J, et al
. Stress and coping responses to a natural disaster in people with schizophrenia. Psychiatry Res 2007;151:77-86.
[Table 1], [Table 2], [Table 3], [Table 4]