COVID-19: Healthy by separation?

Dr. Peggy Bosch

Dr. Peggy Bosch

- Master in psychology →Radboud University Nijmegen

- Heilpraktikerin (Germany)

- Acupuncture → Shenzhou Open University of TCM, Amsterdam

- PhD → Radboud University Nijmegen in collaboration with the LVR-Klinik Bedburg-Hau (Germany)

Situated in Nijmegen

Amsterdam

Paris

Berlin

London

Bedburg-Hau

COVID-19: Healthy by separation?

- Social isolation

- Group versus alone in isolation

- Existential psychotherapy

- How to deal with a hospital admittance or

death in case of separation?

- The role of social media

- Advice

COVID-19: Healthy by separation?

- What do we know from social isolation?

- Definition → is a state of complete or near-

complete lack of contact between an individual

and society

COVID-19: Healthy by separation?

- What do we know from social isolation?

- Types of social isolation →

1) staying home for lengthy periods of time

2) having no communication with family,

acquaintances or friends

3) willfully avoiding any contact with other

humans when those opportunities do arise

COVID-19: Healthy by separation?

- What do we know from social isolation?

COVID-19: Healthy by separation?

- What do we know from social isolation?

- True social isolation over years and decades

can be a chronic condition affecting all

aspects of a person's existence.

-Social isolation can lead

to feelings of loneliness,

fear of others, or negative

self-esteem.

COVID-19: Healthy by separation?

- What do we know from social isolation?

“The magnitude of risk associated with social

isolation → comparable with that of cigarette

smoking and other major biomedical and

psychosocial risk factors. However, our

understanding of how and why social isolation is

risky for health or conversely how and why

social ties and relationships are protective of

health, still remains quite limited”.

House (2001). Psychosomatic Medicine, 63(2), 273‒274.

COVID-19: Healthy by separation?

- What do we know from social isolation?

- Social isolation is both a potential cause

and a symptom of emotional or psychological

challenges.

- As a cause → the perceived inability to

interact with the world and others can create

an escalating pattern of these challenges.

COVID-19: Healthy by separation?

- What do we know from social isolation?

- As a symptom → periods of isolation can be

chronic or episodic, depending upon any

cyclical changes in mood, especially in the

case of clinical depression.

-COVID-19 situation is different! External

cause!

COVID-19: Healthy by separation?

- Group versus alone in social isolation

- Group: For example →

• Big Brother

(television reality

game show)

• (Severe) psycho-

logical (after)effects

up to even traumatic

COVID-19: Healthy by separation?

- Group versus alone in social isolation

- Group: For example →

• Space missions

• COVID-19 is different

→ no reward (However, not getting ill is some

kind of reward?)

COVID-19: Healthy by separation?

- Group versus alone in social isolation

- Individual:

-For example →

• Prison (solitary

confinement)

COVID-19: Healthy by separation?

- Individual:

Prison →

• As well as severe

and damaging

psychological effects,

solitary confinement

manifests physiologically as well. Solitary

confinement has been reported to cause

hypertension, headaches and migraines, profuse

sweating, dizziness, and heart palpitations.

COVID-19: Healthy by separation?

- Individual:

Prison →

• Many inmates also

experience extreme

weight loss due to

digestion

complications and

abdominal pain.

COVID-19: Healthy by separation?

- Group versus alone in social isolation

- Individual:

For example →

• Psychiatry

(isolation cells)

COVID-19: Healthy by separation?

- Group versus alone

in social isolation

- Individual:

• Psychiatry (isolation cells) →

Patients in psychiatric hospitals

are often put into solitary

confinement, when staff members

determine that they are a danger

to themselves or others.

COVID-19: Healthy by separation?

• COVID-19 is different → it feels like

punishment (However, the individual is not to

blame?)

COVID-19: Healthy by separation?

- Group versus alone in social isolation

• Disease isolation (like COVID-19)

serves as an important method to

protect the general community

from disease (especially in a

hospital or community-wide outbreak).

• However, this intervention poses an ethical

question on rights of the individual versus rights

of the general community!

COVID-19: Healthy by separation?

- Group versus alone in social isolation

• In cases of disease outbreaks, isolation can

be argued as an ethical and necessary

precaution for protecting the community from

further disease transmission.

• Other examples from the

recent past → 1) The 2014

Disneyland measles outbreak

2) 2014 Ebola outbreak.

COVID-19: Healthy by separation?

• Several forms of isolation exist (e.g., strict

isolation, contact isolation, respiratory isolation,

reverse isolation).

• COVID-19 → Self-isolation or home

isolation → is the act of voluntarily

quarantining oneself to prevent infection of

oneself or others.

Siegel et al. (2007). 2007 guideline for isolation

precautions: Preventing transmission of infectious

agents in health care settings. American Journal of

Infection Control, 35(10 Suppl. 2), S65–S164.

COVID-19: Healthy by separation?

Existential psychotherapy →

- is a form of psychotherapy based on the

model of human nature and experience

developed by the existential tradition of

European

philosophy.

COVID-19: Healthy by separation?

Existential psychotherapy

- It focuses on concepts that are universally

applicable to human existence, including:

1) death

2) freedom

3) responsibility

4) meaning of life

Existentialistic Thoughts

COVID-19: Healthy by separation?

Existential psychotherapy →

- Instead of regarding human

experiences such as anxiety,

alienation and depression as

implying the presence of

mental illness →

*Professor Yalom is an

American existential psychiatrist

who is emeritus professor of

psychiatry at Stanford University

COVID-19: Healthy by separation?

Existential psychotherapy →

- existential psychotherapy

sees these experiences as

natural stages in a normal

process of human

development and maturation.

Yalom, I.D. (1998). The Yalom

Reader: Selections from the

Work of a Master Therapist and

Storyteller. New York, NY: Basic

Books. ISBN: 0465036104

COVID-19: Healthy by separation?

Existential

psychotherapy →

- In facilitating this

process of development

and maturation →

existential

psychotherapy involves

a philosophical

exploration of an

individual's experiences.

COVID-19: Healthy by separation?

Existential psychotherapy →

- stressing the individual's

freedom and responsibility to

facilitate a higher degree of

meaning and well-being in his

or her life.

Yalom, I.D. (1980). Existential

Psychotherapy. USA: Basic

Books. ISBN: 9780465021475

COVID-19: Healthy by separation?

Existential psychotherapy →

- What do we think about dying?

- How do we want to die?

- Who should be there?

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

• COVID-19

situation is

different → no

direct contact

with the

(dying) patient

is possible.

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

• Previous research

(Barth et al., 2016) →

Difficulties in communication

and in the relationship with

the patient admitted to the

intensive care unit were identified as the main

stressors by their relatives.

• With the state of coma being predominant.

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

• Previous research (Barth et al., 2016) →

By contrast, the environment, work routines,

and relationship between the relatives and

intensive care unit team had the least impact

as stressors.

Barth et al. (2016). Stressors in relatives of patients

admitted to an intensive care unit. Revista Brasileira de

Terapia Intensiva, 28(3), 323‒329. PMID: 27737424

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

• COVID-19 situation → The patient dies alone.

• Funerals → Only

in very small

groups and/or are

postponed.

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

• COVID-19 situation → What the exact

consequences will be for the relatives is

unknown yet.

• There's a tension between the demands of a

crisis and people's spiritual needs (The

Economist, 2020)

The Economist (2020). https://www.economist.com/britain/

2020/04/11/how-covid-19-is-changing-funerals

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

• COVID-19 situation →

It is too early to draw

any conclusions.

• This COVID-19 crisis will provide completely

new data and insights → how relatives and

friends (psychologically and physiologically)

deal with his or her beloved ones being/or

dying in a hospital alone.

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

- Previous research showed (in a normal

situation) →

• That people react differently to death.

• Dealing with death, particularly the death of

someone you love, is one of the most

stressful experiences you can go through.

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

- Previous research showed (in a normal

situation) →

• The most common reaction on hearing of the

death of someone close to you is shock.

• Shock can affect you for a few days or a

number of weeks.

COVID-19: Healthy by separation?

- How to deal with a hospital admittance or

death in case of separation?

• Shock →

1) Sick

2) Dizzy

3) Nauseous

4) Dazed

5) Numb

6) Empty

COVID-19: Healthy by separation?

Institute of Medicine.

(1984).

Bereavement:

Reactions,

Consequences, and

Care. Washington

DC: National

Academies Press.

ISBN-10: 0-309-

03438-8

Yalom, I.D. (2008). Staring at the sun: Overcoming the terror of death

A book about all aspects of dying.

COVID-19: Healthy by separation?

COVID-19: Healthy by separation?

- The role of social media

- COVID-19 crisis:

Definition of social media →

are interactive computer-

mediated technologies that

facilitate the creation or

sharing of information, ideas,

career interests and other

forms of expression via virtual

communities and networks.

COVID-19: Healthy by separation?

- The role of social media

- COVID-19 crisis: social media play an

important role →

- Facebook

- Linkedin

- Twitter

- YouTube

- Instagram

COVID-19: Healthy by separation?

- The role of

social media

- COVID-19

crisis: social

media play an

important role →

-Facetime

-Skype

-WhatsApp

COVID-19: Healthy by separation?

- The role of social media

- COVID-19 crisis: social media play an

important role in order to →

1) establish social contact (in times of

forbidden direct/physical contact)

2) spreading (fake) news, facts, and

information

COVID-19: Healthy by separation?

- The role of social media

- COVID-19 crisis: social media play an

important role in order to → Highly interesting

data on usage will come.

• In 2019, it is estimated that there will be

around 2.77 billion social media users around

the globe, up from 2.46 billion in 2017 (Statista,

2018)

Statista (2018). Number of social media users worldwide

2010-2021. Statista.

# Network Name Number of Users (in millions)

Country of Origin

1 Facebook 2,375 United States

2 YouTube 2,000 United States

3 WhatsApp 1,600 United States

4 FacebookMessenger

1,300 United States

5 WeChat 1,112 China

6 Instagram 1,000 United States

7 QQ 823 China

8 QZone 572 China

9 TikTok 500 China

10 Sina Weibo 465 China

11 Twitter 330 United States

12 Reddit 330 United States

13 Baidu Tieba 320 China

14 LinkedIn 310 United States

15 Snapchat 294 United States

16 Pinterest 265 United States

17 Viber 260 Israel

18 Discord 250 United States

Source:

Wikipedia

(2020)

COVID-19: Healthy by separation?

- The role of social media

- COVID-19 crisis: different

consumer behavior →

1) Shopping forbidden →

Significant increase in

postal orders/services

such as Amazon

2) Significant increase in

online shopping

COVID-19: Healthy by separation?

Advice

- Social connections (via

telephone, social media,

facetime, skype, etc.)

- See the news only once

a day

- Physical acitivity/

Fitness at home

COVID-19: Healthy by separation?

Advice

- Mindfulness

- Yoga

Creswell, J. D. (2017). Mindfulness interventions. Annual

Review of Psychology, 68, 491-516. PMID: 27687118

James-Palmer et al. (2020). Yoga as an intervention for the

reduction of symptoms of anxiety and depression in children

and adolescents: A systematic review. Frontiers in

Pediatrics, 8:78. PMID: 32232017

COVID-19: Healthy by separation?

Advice

- Keep a kind of daily

routine as much as

possible

- Make a time plan for

every day (Especially for

children this can be very

helpful because they

prefer routine)

COVID-19: Healthy by separation?

Advice

- Intellectual challenges

(computer, reading)

- Television

- Netflix

- Watch movies/series

COVID-19: Healthy by separation?

Advice

- Plan your next holiday

- Plan what to buy

-Try a recipe and cook

COVID-19: Healthy by separation?

Advice

- Existential planning/thinking:

- Draw that lifeline

- Remember your dreams and plan to fulfill them

- Decide not to follow old dreams

- Define new dreams

- Talk about old dreams and new dreams with

your partner/friends/relatives

- Find oud their dreams

COVID-19: Healthy by separation?

Advice

- Existential planning/thinking:

- Write on a sheet what you like and do not like

about your relationship or family life

- Ask your partner or family to do the same

- Discuss and make plans to increase nice

experiences together

- Stay open to each others experiences and try

to find solutions for the less-positive-experiences

COVID-19: Healthy by separation?

- References

• Barth, A. A., Weigel, B. D., Dummer, C. D.,

Machado, K. C., & Tisott, T. M. (2016).

Stressors in relatives of patients admitted to an

intensive care unit. Revista Brasileira de

Terapia Intensiva, 28(3), 323‒329. PMID:

27737424

• Creswell, J. D. (2017). Mindfulness

interventions. Annual Review of Psychology, 68,

491-516. PMID: 27687118

COVID-19: Healthy by separation?

- References

• House, J. S. (2001). Social isolation kills,

but how and why? Psychosomatic Medicine,

63(2), 273-274. PMID: 11292275

• Institute of Medicine. (1984). Bereavement:

Reactions, Consequences, and Care.

Washington DC: National Academies Press.

ISBN-10: 0-309-03438-8

COVID-19: Healthy by separation?

- References

• James-Palmer et al. (2020). Yoga as an

intervention for the reduction of symptoms of

anxiety and depression in children and

adolescents: A systematic review. Frontiers in

Pediatrics, 8:78. PMID: 32232017

• Siegel, J. D., Rhinehart, E., Jackson, M.,

Chiarello, L., & Health Care Infection Control

Practices Advisory Committee (2007). 2007

guideline for isolation precautions: Preventing

transmission of infectious agents in health care

settings. American Journal of Infection Control,

35(10 Suppl. 2), S65–S164. PMID: 18068815

COVID-19: Healthy by separation?

- References

• Statista (2018). Number of social media users

worldwide 2010-2021. Statista.

• The Economist (2020).

https://www.economist.com/britain/2020/04/11/h

ow-covid-19-is-changing-funerals

• Wikipedia (2020).

https://en.wikipedia.org/wiki/Social_media

• Yalom, I.D. (1980). Existential Psychotherapy.

USA: Basic Books. ISBN: 9780465021475

COVID-19: Healthy by separation?

- References

• Yalom, I. D. (2008). Staring at the sun:

Overcoming the terror of death. San Francisco:

Jossey-Bass.

COVID-19: Healthy by separation?

- References

• Yalom, I.D. (1998). The Yalom Reader:

Selections from the Work of a Master Therapist

and Storyteller. New York, NY: Basic Books.

ISBN: 0465036104

Collaboration

1. Psychiatric Research Group, LVR-Klinik

Bedburg-Hau, Bedburg-Hau, Germany

2. Donders Institute for Brain, Cognition and

Behaviour, Radboud University Nijmegen,

Nijmegen, The Netherlands

3. Research Group of Pain and Neuroscience,

Kyung Hee University, Seoul, Republic of Korea

Thank you for your attention!

Dr. Peggy Bosch

E-mail: p.bosch@donders.ru.nl