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Teletherapy, Popular in the Pandemic, May Outlast It Teletherapy, Popular in the Pandemic, May Outlast It
(4 days later)
The 10-year-old girl was afraid that her American Girl dolls — buried in the bedroom closet — would come alive and attack her. As the girl pointed her iPad at the scary closet door in a remote therapy session, her therapist, Daniela Owen, was able to coach her in real-time to conquer the fear of the dolls.The 10-year-old girl was afraid that her American Girl dolls — buried in the bedroom closet — would come alive and attack her. As the girl pointed her iPad at the scary closet door in a remote therapy session, her therapist, Daniela Owen, was able to coach her in real-time to conquer the fear of the dolls.
“This wouldn’t have been as effective in my office,” Dr. Owen, a psychologist based in Oakland, later explained. “Being able to do the exposure in her room was so much more powerful.”“This wouldn’t have been as effective in my office,” Dr. Owen, a psychologist based in Oakland, later explained. “Being able to do the exposure in her room was so much more powerful.”
Dr. Owen, like the overwhelming majority of therapists, switched from in-person to remote therapy during the coronavirus shutdown. According to a recent survey from the American Psychological Association, three-quarters of clinicians are doing only teletherapy, and another 16 percent are doing a combination of remote and in-person sessions.Dr. Owen, like the overwhelming majority of therapists, switched from in-person to remote therapy during the coronavirus shutdown. According to a recent survey from the American Psychological Association, three-quarters of clinicians are doing only teletherapy, and another 16 percent are doing a combination of remote and in-person sessions.
Many therapists were initially reluctant. Tamara Greenberg, a San Francisco-based psychologist, dreaded the pivot, for example, because she worried it “wasn’t as real a form of therapy.” And now? “I would say it’s really been one of the most surprising, and in many ways pleasurable, experiences of my professional career,” she said. Interviews with more than 20 therapists reveal similarly positive experiences, even as they also acknowledged some downsides, and that they missed seeing patients in person.Many therapists were initially reluctant. Tamara Greenberg, a San Francisco-based psychologist, dreaded the pivot, for example, because she worried it “wasn’t as real a form of therapy.” And now? “I would say it’s really been one of the most surprising, and in many ways pleasurable, experiences of my professional career,” she said. Interviews with more than 20 therapists reveal similarly positive experiences, even as they also acknowledged some downsides, and that they missed seeing patients in person.
As the nation gingerly begins to reopen, many providers say that remote therapy is working so well and offers such convenience to their patients that they will continue with it even after the pandemic.As the nation gingerly begins to reopen, many providers say that remote therapy is working so well and offers such convenience to their patients that they will continue with it even after the pandemic.
Peer-reviewed studies have shown that remote therapy — or “teletherapy,” which is generally done through videoconference — can be just as effective as in-person therapy for treating post-traumatic stress disorder, depression and anxiety, according to Leslie Morland, director of the Regional TeleMental Health Program at the San Diego VA Health Care System. “There’s always a contingent who are pretty convinced that they have to have their patients in the room with them, even though that’s not supported by the data,” Dr. Morland said.Peer-reviewed studies have shown that remote therapy — or “teletherapy,” which is generally done through videoconference — can be just as effective as in-person therapy for treating post-traumatic stress disorder, depression and anxiety, according to Leslie Morland, director of the Regional TeleMental Health Program at the San Diego VA Health Care System. “There’s always a contingent who are pretty convinced that they have to have their patients in the room with them, even though that’s not supported by the data,” Dr. Morland said.
Much of the research was driven by the Department of Veterans Affairs, which sees telehealth as a way to expand access to therapy for veterans who live in tough-to-reach areas. “The research shows that clinicians can be as effective in a telehealth environment as they are in face-to-face,” said the chief executive of the American Psychological Association, Arthur C. Evans. Teletherapy could bring therapy to millions of people who need it. A 2017 study from the Substance Abuse and Mental Health Services Administration found that of the 46.6 million Americans with a mental health issue, only 42.6 percent received treatment. Dr. Morland says telehealth can help close the gap.Much of the research was driven by the Department of Veterans Affairs, which sees telehealth as a way to expand access to therapy for veterans who live in tough-to-reach areas. “The research shows that clinicians can be as effective in a telehealth environment as they are in face-to-face,” said the chief executive of the American Psychological Association, Arthur C. Evans. Teletherapy could bring therapy to millions of people who need it. A 2017 study from the Substance Abuse and Mental Health Services Administration found that of the 46.6 million Americans with a mental health issue, only 42.6 percent received treatment. Dr. Morland says telehealth can help close the gap.
In addition to the obvious benefits of convenience and flexibility, video sessions can give therapists a literal window into the patient’s home. Teletherapy can offer “a much deeper level of knowing the child, and understanding what their world might really be like,” said Lisa Dion, president of the Synergetic Play Therapy Institute, based in Boulder.In addition to the obvious benefits of convenience and flexibility, video sessions can give therapists a literal window into the patient’s home. Teletherapy can offer “a much deeper level of knowing the child, and understanding what their world might really be like,” said Lisa Dion, president of the Synergetic Play Therapy Institute, based in Boulder.
Patients — who asked that their names not be published to protect their privacy — also reported benefits. “Receiving treatment is far less cumbersome, which significantly decreases your stress level, which is a huge part of why you’re in there,” said a 43-year-old female veteran, based in South Carolina, who had been seeing a Veterans Affairs therapist for treatment of depression and PTSD. Or as a 23-year-old software engineer, who sees a therapist for social anxiety and depression, discovered, when she no longer needs to deal with the commute, “there’s not as much time to hype yourself up … there’s less time to ruminate.”Patients — who asked that their names not be published to protect their privacy — also reported benefits. “Receiving treatment is far less cumbersome, which significantly decreases your stress level, which is a huge part of why you’re in there,” said a 43-year-old female veteran, based in South Carolina, who had been seeing a Veterans Affairs therapist for treatment of depression and PTSD. Or as a 23-year-old software engineer, who sees a therapist for social anxiety and depression, discovered, when she no longer needs to deal with the commute, “there’s not as much time to hype yourself up … there’s less time to ruminate.”
Yet most therapists interviewed acknowledge that even if remote therapy is effective, it has its downsides. On top of the baseline Zoom fatigue that many of us experience, therapists must be extra-vigilant for nonverbal cues that are easier to spot in person. “In a room you have more cues, so if you relax and miss one cue, you can pick up the next,” said Dr. Dion. According to the A.P.A. survey, 76 percent of therapists said that treating patients remotely is more challenging than in-person.Yet most therapists interviewed acknowledge that even if remote therapy is effective, it has its downsides. On top of the baseline Zoom fatigue that many of us experience, therapists must be extra-vigilant for nonverbal cues that are easier to spot in person. “In a room you have more cues, so if you relax and miss one cue, you can pick up the next,” said Dr. Dion. According to the A.P.A. survey, 76 percent of therapists said that treating patients remotely is more challenging than in-person.
Some things simply can’t be done over video. If a patient is in tears, how do you hand them a tissue? Or if a patient is really struggling with something, as Mirjam Quinn, a Chicago-based psychologist, put it, “Sometimes if there are no words, you can touch somebody’s shoulder, you can sit next to them. That’s gone. And that’s something that I really miss.”Some things simply can’t be done over video. If a patient is in tears, how do you hand them a tissue? Or if a patient is really struggling with something, as Mirjam Quinn, a Chicago-based psychologist, put it, “Sometimes if there are no words, you can touch somebody’s shoulder, you can sit next to them. That’s gone. And that’s something that I really miss.”
Another drawback: It can be tough to find privacy, especially during the pandemic when everyone else is sheltering in place. Patients may retreat to a car, a closet or even the toilet seat. A 25-year-old living with his parents and brother in Modesto, Calif., who sees a therapist remotely for anxiety, depression and attention deficit hyperactivity disorder, worries that his family can hear his therapy sessions.Another drawback: It can be tough to find privacy, especially during the pandemic when everyone else is sheltering in place. Patients may retreat to a car, a closet or even the toilet seat. A 25-year-old living with his parents and brother in Modesto, Calif., who sees a therapist remotely for anxiety, depression and attention deficit hyperactivity disorder, worries that his family can hear his therapy sessions.
“It’s this weird thing when the doctor asks me, ‘Has the medication given you any sexual problems?’ And I had to answer that.”“It’s this weird thing when the doctor asks me, ‘Has the medication given you any sexual problems?’ And I had to answer that.”
Updated July 7, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Providers can face the same privacy challenges, as their own kids or cats or dogs could come bursting into the frame. As Dr. Greenberg described, one day her husband didn’t realize she was on a patient call, and he started pounding chicken in the kitchen. She said her patient asked, “What’s happening to you? What’s that banging?”Providers can face the same privacy challenges, as their own kids or cats or dogs could come bursting into the frame. As Dr. Greenberg described, one day her husband didn’t realize she was on a patient call, and he started pounding chicken in the kitchen. She said her patient asked, “What’s happening to you? What’s that banging?”
Therapy apps like BetterHelp and Talkspace, which allow users to text in silence, both report growth in sign-ups since the pandemic began.Therapy apps like BetterHelp and Talkspace, which allow users to text in silence, both report growth in sign-ups since the pandemic began.
Teletherapy also raises knotty questions over insurance policies (would it be covered?), HIPAA privacy regulations (is it legal and ethical to use Skype?), and state-to-state licensing requirements (could a therapist in Brooklyn see a patient who lives in Hoboken, N.J.?) In the pre-Covid era, these questions alone were enough to keep most providers from practicing teletherapy. Then Covid slashed the red tape. Medicare quickly changed its policies to cover most telehealth, many private insurance companies followed suit, and clinicians could use FaceTime or Skype without worrying that they were violating HIPAA.Teletherapy also raises knotty questions over insurance policies (would it be covered?), HIPAA privacy regulations (is it legal and ethical to use Skype?), and state-to-state licensing requirements (could a therapist in Brooklyn see a patient who lives in Hoboken, N.J.?) In the pre-Covid era, these questions alone were enough to keep most providers from practicing teletherapy. Then Covid slashed the red tape. Medicare quickly changed its policies to cover most telehealth, many private insurance companies followed suit, and clinicians could use FaceTime or Skype without worrying that they were violating HIPAA.
Whether the regulations remain loosened after the pandemic is an open question; the A.P.A. sent letters in May to all 50 governors (as insurance regulation differs state-by-state), urging them to grant a 12-month extension of the new policy after the pandemic is over.Whether the regulations remain loosened after the pandemic is an open question; the A.P.A. sent letters in May to all 50 governors (as insurance regulation differs state-by-state), urging them to grant a 12-month extension of the new policy after the pandemic is over.
“If there’s a silver lining with the pandemic,” said Dr. Morland, it may be that “when the dust settles, we will be able to increase the number of people who get care.” Or as Dr. Quinn said, laughing a bit, “It’s going to be hard for all of us to go back to putting on pants on a regular basis.”“If there’s a silver lining with the pandemic,” said Dr. Morland, it may be that “when the dust settles, we will be able to increase the number of people who get care.” Or as Dr. Quinn said, laughing a bit, “It’s going to be hard for all of us to go back to putting on pants on a regular basis.”