PODCAST: What Integrative Practitioners Need to Know About Telemedicine

As more medical practices find themselves integrating a telehealth model, they’re realizing they don’t have a playbook to ensure a smooth transition.

Robert Cuyler, PhD, discusses the current regulations and what they mean for telehealth. He also shares, if not the full playbook, some practical tips on getting set up for your first remote session.

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COVID-19 and The Perfect Storm: Part 2, PTSD

In my last blog post, I addressed the impact of the COVID-19 pandemic on panic sufferers. Now, let’s turn to PTSD.  We know that recurrent panic attacks and PTSD are related.  The majority of people with PTSD have panic attacks as part of their symptoms, and recent research indicates that people with Panic Disorder at higher risk for developing PTSD after traumatic situations.  Unfortunately, the current corona virus pandemic has greatly expanded the risks of trauma exposure. This global event is both different and similar to other mass traumatic events such as 9/11 and Hurricane Katrina.  Those events were localized, sudden, and had visible consequences. CV-19 is global, unfolding over months, and largely invisible except for scenes from intensive care units and empty streets.

Of course, trauma exposure is ever-present for first responders and hospital personnel.  In ‘hot spot’ settings such as New York City and New Orleans, the unrelenting illness and risk of personal infection can overwhelm coping resources.  The fear of bringing the infection home to family only heightens the stress.  For the rest of us who are not exposed so directly, the pandemic can be traumatic in more subtle ways. Loss of jobs, economic uncertainty, social isolation, and confinement to the home can be sources of trauma. We are hearing from veterans’ groups that wearing a mask can be triggering for veterans who were exposed to threat of chemical attack in combat situations. Unexpected deaths and the inability to gather to mourn can be massively stressful for those directly affected.

New traumatic exposure can trigger acute stress and post-traumatic stress disorders in individuals with no prior history.  People with prior history of PTSD or limited symptoms may experience the development of the full range of PTSD symptoms with these new stressors. The information overload in the media can be overwhelming, with a toxic combination of unrelenting bad news and uncertainty about the future. We expect a somewhat delayed mental health reaction after the initial adjustments to the pandemic. Research following Katrina showed 50% increases in PTSD in the year following the storm.   It’s not only the external situations that can affect at-risk individuals. Similar to Panic Disorder, people with PTSD may be hypersensitive to unfamiliar or distressing bodily sensations. It seems almost daily that we hear of new symptoms related to CV-19, which can heighten the fearful response to unfamiliar sensations such as shortness of breath or changes in smell or taste and then provoke stress symptoms.

So how can we be prepared? It’s not unusual for family members to be aware of changes related to trauma-related stress before the affected individual acknowledges their struggles.  Nightmares, increases in drinking, irritability, isolation, exaggerated startle reactions and emotional numbing can be early warning signals of a stress disorder.  Fortunately, behavioral health assessments and treatments via telehealth are more widely available now, as most office-based care has been temporarily suspended.  Government and private insurers are encouraging use of mental health resources by making services available to the patient’s home and at times waiving co-pays and deductibles.  Early intervention can make a great difference in preventing long-term stress reactions.

Freespira is now available as a treatment for PTSD following diagnosis and authorization by a licensed healthcare professional.  Positive results from clinical trials at the Palo Alto VA Hospital (both veterans and civilians) resulted in the FDA granting clearance for Freespira as a treatment for PTSD. Results from this clinical research showed over 80% of participants achieving significant improvement, with 50% fully recovered from their PTSD symptoms 6 months post-treatment.  Fortunately, Freespira can be provided entirely in the home, without any in-person contact.  Authorization, training, and follow-up can be done completely via telehealth.  Palo Alto Health Sciences is committed to making Freespira available to those in need during this crisis and beyond. We are in active negotiations with the Veterans Administration and major insurers to expand coverage for Freespira for panic and PTSD.

COVID-19, Panic and The Perfect Storm: Part 1, Panic

The media is chock full of stories about the corona virus pandemic and its impact on mental health. I find that the terms fear, anxiety, and panic are often used interchangeably these days, so let’s start with a few distinctions, taking fear first.  Fear is best described as response to a threat, and today we have all too much to fear, from lost income, to concern about our own or our loved ones’ health, to uncertainty about how long this crisis will continue.  Fear eases when the threat eases or we find positive actions to handle the threat (for example, social distancing, wearing a mask, revising a personal budget to account for financial changes).  Fear is not a symptom or a mental health condition.

Anxiety, on the other hand, can range from a transitory experience that we all have from time to time to an unrelenting and distressing mental state. Anxiety can be situational, which is the state of the world we live in now.  Anxiety becomes a mental health concern when it overwhelms our capacity to cope or it persists when the real threat diminishes. We can hope that will be soon.  We see anxiety as an exaggerated and persistent state, both mental and physical.  On the mental side, common reactions include difficulty concentrating, belief that the worst will happen, and distress about uncertainty. Physically, anxiety can take the form of restlessness, muscle tension, nervous stomach, tremulousness, and sleep disturbance.

Panic, we’ve come to learn, is distinct from fear and anxiety.  Panic attacks are characterized by sudden intense fear, with a combination of physical and psychological features, usually peaking rapidly and lasting 10 to 30 minutes.   The physical features can include rapid, pounding heartbeat, shortness of breath, chest pain, trembling, and dizziness. The psychological features of a panic attack include fear of dying or loss of control, fear of impending doom, and feelings of unreality. About 30% of Americans have at least one lifetime panic attack and just over 10% had a panic attack in the prior year, according to research.  While just about everybody is fearful and anxious, at least to some degree, during the CV-19 pandemic, only a subset of the population is likely to have formal panic attacks.  The combination of genetics, developmental factors including exposure to trauma, and respiratory physiology create the risk for development of panic attacks.

So now let’s turn to panic in the time of a pandemic.

No big surprise, we are in strange times. Some people with persistent panic attacks are coping pretty well. Those whose panic attacks are triggered by crowds, driving, airplane travel, or other external stressors are sometimes feeling better than usual, since triggering events are officially unavailable! Avoiding stressful situations is common and can be debilitating, and those panicky reactions are likely to return once social distancing is eased.  Another source of panic triggers, unfortunately, is getting much worse. Hypersensitivity to bodily distress and symptoms is a hallmark feature of panic, even for medically healthy panic sufferers in ordinary times. Our daily news is full of sad and distressing news about illness, death, and a growing list of CV-19 symptoms. For those who fearfully tune in to their bodies in the best of times, sensations of shortness of breath, racing heart, or other new or distressing physical sensations can rapidly escalate into panic.

So, what are options for individuals with panic in these extraordinary times?  A focus on maintaining a regular schedule, controlling what we can control and letting go of what we can’t can be useful. Getting regular exercise is crucial, and a safe, socially-distanced walk outside daily can be very helpful. Daily exposure to sunlight helps regulate our sleep cycle.  Staying connected to those we care about is essential, and thankfully we have Skype, Zoom, and Facetime to help us stay in touch with those we can’t see in person.

Freespira is a proven treatment option for people with recurrent panic attacks, and is also available for use completely from home, which is vital in a time when in-person health care has essentially been shut down.  Authorization can be done via telehealth, as can training and follow up visits. In addition to normalizing respiratory patterns, Freespira use over the recommended 28-day period also develops important self-management skills that can be employed regularly after the system is returned.  Most clients learn to recognize when their breathing gets irregular when stressed and can readily shift back to the Freespira breathing style, which can help manage anxiety symptoms and prevent panic attacks from mounting.

From time to time, Palo Alto Health Sciences (Freespira) will share articles or blog posts from guest authors. Some of the information presented may not be consistent with the science-based and clinically-proven method behind Freespira. In such cases, we share the article or blog post for general informational purposes only, without any endorsement or recommendation.