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The Neuroscience of a Pandemic

7/25/2020

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Everyone has a story or three about the COVID Pandemic and how it impacted our lives. There may be some funny stories in the mix, but for most people, the best summary of the Year 2020 will be, “I’m glad that’s over…”

As a mental health professional I’m particularly focused on how all this is affecting our thoughts, fears and habits. Don’t for a minute imagine that the consequences will be over soon. In fact, I’ve heard some of my colleagues speculate that the mental health pandemic, in the wake  of COVID-19, may be more destructive than the virus itself. But, that’s another topic. Right now, I want to consider a particular aspect of this ordeal I will term, Pandemic Trauma. Not to be nerdy, but I will abbreviate it for this article as PT. I’m going to argue, based on a neurological principle called Associative Learning, that the long term consequences of this global pandemic will be felt for a generation, regardless of how or if a COVID vaccine is forthcoming.

Let’s first of all make sure we understand Associative Learning. Back in the 1960s, a scientist named Donald Hebb rocked the neurological world with a simple but thought-shifting statement: “neurons that fire together, wire together.” By neurons, he was describing those tiny brain cells that we never see but are always involved in everything we do. The simple version of what is called Hebbian Theory was that if two or more brain cells are activated at or about the same time, a neural connection is actually established between the two cells and so, in the future, when one fires, the other fires as well. Hence, “neurons that fire together, wire together.” I don’t want to get lost in the weeds here, so let me just summarize the significance of Hebbian Theory. It’s the neurological basis for all learning, but also for habit formation. We’ve all experienced it every day of our lives. The clock chimes twelve noon. The neurons in the ear are activated. We hear the clock. But, “mysteriously”, some other neurons are activated at the same time: those in the stomach that make us hungry! “I’m starving. It must be time for lunch.” Neurons that fire together, wire together. This is what Associative Learning is.

That’s just a simple example but I could repeat them for hours! Now, there are some neural activations that are stronger than others. Again, the scientific explanations for all that would get ponderous, so let me just talk about one type of neural activation pattern that happens to be very strong: fear. When particular brain cells fire in a fearful or traumatic experience in our lives, those associations are typically stronger than ever. What that means practically is, we can relive a particular trauma based on Hebbian Theory, even though we’re not dealing with it right now.

For me, that explains why, for so many years of my life, I had a paralyzing fear of hospitals. As a little boy of three, I had hernia surgery and, though I have very little conscious memory of the event itself, my mother tells the story of my emotional state through the ordeal and how traumatic it was, particularly since, in those days, I had to be left alone for much of the time (with my own “Nurse Ratchet”, but that’s another story too!).

What is important to understand is that in those confusing and terrorizing events neural activation patterns were formed that included not only the feelings of fear but the location and sensory data that was stored away in some dark scary cellar of my childish imagination. For years thereafter, when I would go into a hospital to visit someone, those old patterns were reactivated and I essentially relived the hernia surgery and Nurse Ratchet herself. And this noteworthy, I had very little conscious awareness of why.

I remember vividly when this all came into my conscious awareness. I was now a young pastor in my first church. I was making a hospital call to a family with a young boy on life support. The experience activated those old Hebbian patterns in a paralyzing, mind-spinning assault. I nearly fainted.

Now, let me make the connection of Hebbian Theory to PT—Pandemic Trauma. Tens of thousands of us have been touched by the physical consequences of the virus, either through the death of a loved one or the impact of the disease itself. But I would say that number pails in comparison to the hundreds of thousands—perhaps millions—who have been emotionally traumatized by the nonstop assault of fear and confusion to which we have been subjected through the months. Even those who had no direct experience with the disease were exposed to the fears and anxieties that have attended the pandemic. I say this, not in any political way, but when the entire world (not an exaggeration) is being subjected to this daily fear assault, imagine the Associative Learning and Hebbian patterns that are being hardwired into our very brains? And to make it even more serious, remember that most Associative Learning is nonconscious. It’s real. But we don’t even realize it’s going on.

I could say more about how this kind of trauma scars us. In fact, I could even argue that the biological impact on entire populations is likely to be generational. I can’t take time to explore the science. But you’ve heard of the human genome—the system of genes that determines our physical traits. We inherit this from our parents. Did you know, however that recently scientists have discovered another system called the “epigenome?” It explains why, even within genetic systems (like a family, where all children inherit the same genetic material) there are differences between individual members. In fact, some studies suggest that epigenetics involve the emotional control systems as well, and may explain why some people in a family have a mental illness but others do not. Indeed, there is evidence from trauma survivors (such as Jews in WWII concentration camps) that epigenetic changes in the camp were passed along to their ancestors even though they were never in one!

Let’s consider what that might mean for our current pandemic. It won’t impact everyone the same way, but we can certainly say that the combination of Associative Learning and epigenetic transmission, will leave scars for many years to come.

​I have no doubt painted a very bleak picture! It is indeed the “bad news” of COVID-19. However, as a biblical neuroscientist and Christian counselor, I am always delighted to follow up the bad news with the good news! And there is good news. The good news is not that masks or social distancing or even a vaccine will save us all. Even those developments would probably be insufficient to undo the traumatic activation patterns in those hardest hit. No, the good news is that Hebbian Theory can also be applied to renewed thoughts and transformed emotions. Inserting new ones on a regular basis means new neural activation patterns can be established. New thoughts and feelings that “fire together wire together” also.  What this means for us is that we can change the way we think and feel about COVID. We can even change the way we think and feel about the fears and anxieties that have traumatized us. It won’t happen by itself. But there are practical ways to do it. It’s what I do in my counseling practice with others; it’s why I’ve written so many resources to share on my website; and perhaps most importantly for me, it’s what I myself have learned to do with my own pandemic trauma. 
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5 Reasons You Probably Don't Want Online Counseling

7/24/2020

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I’ve heard people say online counseling doesn’t work.
I’ve heard it too—for many years now. In fact, when I got my counseling degree (about 15 years ago) my professors took all of two minutes to dismiss it as “something that will never catch on…” I guess they didn’t anticipate COVID-19. To the larger question, though: does it work? Have there been any scientific studies to actually provide evidence about that?  I cannot go into great detail but here are three recent studies: [1]

​A 2014 study published in The Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
A 2018 study published in The Journal of Psychological Disorders found that online cognitive behavioral therapy is, "effective, acceptable, and practical health care." The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
A 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
I could go on with recent research but you get the point. The claim that online counseling doesn’t work is not true. No doubt there have been many who practiced it poorly and even unethically, but that doesn’t mean the method itself is the problem.

I don’t want my personal problems on the internet!
Most of us hear stories all the time of identity theft, of foreign hackers in data bases and social media abuse. Maybe you’ve even been warned, “if you put it on the internet, everyone can see it.” Why would anyone even think about sharing their deepest and often darkest secrets in such a venue? Let’s think about this fear, however. Let’s consider that the actual issue is the security of our information and how protected it is, not just the way it is communicated.  So, if online counseling is not digitally secure, it is very correct to worry that anyone could find it.
It is for this reason that special online technologies have been devised. Your mental health is not the only kind of privileged information out there. Consider what banks and financial firms have to protect—not to mention hospitals and insurance companies. Because information security is so important, I’ve developed a whitepaper on the key legal, ethical and practical considerations for online counseling, titled, Protecting Personal Information in Online Counseling.

I want to be with a real counselor not a digital one!
This is probably the problem that ranks highest for me—both as a counselor and even at times a client. You get my point, I’m sure. I was thinking about my birthday during COVID-19. If you asked me last year would I rather have a “real” party with family and friends in the room or a virtual party on Zoom, there would have been no contest! But since my birthday came at the height of the stay-at-home order, that was not an option. And, to be honest with you, I was just happy to have them all in the Zoom gallery that day.
I think this is very comparable to real vs. digital counseling. While most everyone would prefer face-to-face, there are many times circumstances will not permit it and digital options are better than none at all.  To make online counseling effective it has to be conducted correctly and respectful of the unique challenges of the medium. I’ll talk about trust in a moment, but let me say here that an effective online experience requires some additional skills not always utilized in face-to-face sessions. For example, both counselor and client need to take more time to communicate clearly and then verify that the other person understands. In my online practice I have adopted some technological features to expedite that, including the use of feedback buttons. I will frequently ask the client to use the buttons and scales to give honest nonverbal feedback during our meetings.

How can I trust a counselor I have never met in person?
Whether you realize it or not, you rely two or three times as much on what a counselor does not say than what he or she does. That is true of the counselor and you also. It’s because we depend so much on what experts call “nonverbal communication.” In other words, we communicate and understand by such nonverbal cues as facial expressions, posture, tone of voice, and other subtle messages. Most of the time we are not even aware we are doing it. I say it this way, 70-80% of conversation is not what we say but who we are. What happens to conversation when we are doing it on a computer screen instead of in an office? This is especially true when we’re trying to determine if we can trust someone. We rely more on these nonverbal cues than even their words.
All this internet stuff stresses me out. I don’t really understand how it works.
​

During the height of the COVID lockdown I was involved in daily Zoom meetings often lasting several hours. Like the others, I was just sitting in my home office! I hadn’t driven anywhere in my car for a couple weeks and the only people I saw in person were my wife and daughter. So, why, after a Zoom meeting was I so exhausted! I coined the term “Zoom Fatigue” to describe it. Especially in the early days of the pandemic we were being pommeled with fear and bad news every day. I remember my first trip to the bank to make a deposit, worrying about even touching the deposit slip after the teller gave it to me. In other words, there was a lot of stress brought on by all the unknowns. I also remember my first time hosting a Zoom meeting. I had attended them before but never hosted. And some of the people who were attending couldn’t get into the meeting. I found that enormously stressful.
This is the thing: if you are not real comfortable with digital technology anyway, the thought of doing counseling online seems more stressful than just doing nothing. I understand that, believe me. There are lots of biological and psychological reasons I could give you why we react this way, but all I will say now is, “I get it!” However, that reason is not a good excuse, simply because the stress that is burdening you enough to need counseling to begin with is much, much worse than the “internet stuff.” To accommodate online clients who get easily confused or frustrated by all the unknowns of the media I have instituted certain procedures during online sessions—such as talking on the telephone first if necessary so we can talk about how to get into the online appointment not just try to figure it out themselves.


[1] Retrieved at https://www.psychologytoday.com/us/blog/what-mentally-strong-people-dont-do/201911/does-online-therapy-work
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J.E. Rose, LPC

Jim Rose is an ordained minister, licensed professional counselor and the director of Fortress Institute. 

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    J.E. Rose, LPC

    Jim Rose is an ordained minister, licensed professional counselor, and director of Fortress Institute. 

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