Providing mental health services during a pandemic is a perspective changer. A few weeks ago, I happened to work with three clients back-to-back, providing counseling services through telehealth. COVID-19 has opened a door, and a necessity, to being creative in how we provide services and mental health support. It has also revealed an interesting parallel.
As I worked with these three college students who were struggling with issues related to depression, isolation, lack of energy and anxiety, I realized they were all engaging in counseling from the same environment: a basement or bedroom from which they had not left the entire day. Not because of the debilitating effects of a clinical diagnosis, but rather because they had no need to.
It is well known that casinos spend significant resources honing the psychology of their gambling venues to tap into the gamer’s five senses. Casino designers create an environment that lulls their customers into a trance during which they can lose their financial capital as quickly as they lose their sense of joy, self-esteem and inner peace. There are no clocks or windows. Scents are used that research has shown can increase gaming up to 53%. Customers are well-stocked with free drinks and snacks. All of this is done with the purpose of encouraging gamers to pull that lever or roll the dice one more time.
It has occurred to me that COVID-19 has had some similar effects on our psyches. If recognized, we might use these observations to inform our understanding of some of the mental health pitfalls that our clients are currently experiencing, similar to the way we are informed of the trappings of organized gaming.
Casinos work hard to keep customers hooked to their games. One way this is done is to remove anything that informs the player of time. Clocks and windows are almost never seen because these objects would risk informing those on the gaming floor that they have been there too long or have other things that need their attention.
The coronavirus demanded that many of us work or attend school from home. It has become apparent that our living conditions can affect our mental health in ways we do not readily recognize. Many people’s workstations reside in dark bedrooms or basements in which natural light is limited or eliminated completely. To improve contrast and reduce screen glare, those who are working or attending school from home may draw their curtains. The information that daylight provides about the time of day — morning, noon, night — is effectively lost.
It used to be common to get our news and entertainment via predictably scheduled TV shows and movies. Some even carried time stamps (the 6 o’clock or 10 p.m. news, for example), prompting us to consider our proximity to bedtime. Now we stream our news and television shows with little thought given to a set schedule. We routinely engage in “binge-watching,” which is akin to staring at a slot machine as it rolls around and entices us with “just one more pull” before we go (and then still don’t leave). Whether it was beating rush-hour traffic, catching a school bus, coming home from work or attending evening activities, these actions subtly informed us about the time of day and regulated us biologically, providing a healthier existence until the threat of COVID-19 arrested these tells.
COVID-19 is affecting our sense of time and, as such, impacting our biological regulation of sleep, diet and exercise — three ingredients that can help either protect us against or make us more susceptible to depression and anxiety. For these reasons, I recommend that individuals pay greater attention to their work and entertainment environments. Set structures that encourage relocation and movement. Although it is potentially less convenient, consider watching your entertainment on a different screen and in a different room than where you work or sleep.
Maintain morning rituals and evening activities that help inform what needs to be happening at each point in the day. Consider investing in a dawn simulator alarm clock, and be mindful of the sunrise and sunset and how they can be included in one’s daily schedule. Committing to a balanced and regulated lifestyle during the pandemic will promote improved mental health, rest and rejuvenation.
If you want to help a person lose their money, or their mind, keep them as comfortable as possible. Casinos provide free food and drinks, with incredible customer service, so that gamers never feel the pressure to leave. It’s a sedentary existence to sit at a slot machine or a card table as it eats away at hard-earned resources.
In a somewhat similar fashion, the COVID-19 pandemic has restricted us to our living areas. At first, this was a celebrated comfort for some — easy and seemingly weightless. Those few extra minutes in bed. Never having to get out of your sweatpants. Your living room becoming your office, your entertainment center and your bed. Days and weeks can go by as groceries are delivered to one’s house.
Suddenly, leaving home for any small amount of time feels like a chore or, worse yet, home has become a security blanket and leaving becomes anxiety producing. The more comfortable we are, the more everything else seems like “work” — and certainly less pleasurable.
Metaphorically, I have thought of this as being akin to an astronaut whose “antigravity muscles” (neck, calf, back) begin to atrophy due to underuse after five to 11 days in a weightless environment. Upon returning to Earth, gravity suddenly feels like a heavy weight, and what previously seemed normal is now crushing, unpleasurable and anxiety producing. To mitigate these known effects, astronauts intentionally exercise every day while in outer space, using resistance bands and other adapted machines to keep muscles working.
In a similar way, individuals need to keep working out their social and mental muscles. I fear that when the COVID-19 pandemic is finally over, some people will struggle with the “gravitational pressure” of social engagement because that muscle has atrophied through underuse during this time of physical distancing.
Casino floors are loud. Between the lights, colors, bells, sirens and laughter, it’s little wonder they are often referred to as “playgrounds.” Upon first entering such a place, it seems filled with possibility and excitement, but it doesn’t take long for that sound to become numbing. Research on gaming design tells us that casino games are made to “sound like winning” to increase a person’s drive to engage. Casinos, from the games to the artwork, are designed to draw one in like a moth to a flame. I imagine this is similar to receiving a “like” on a social media account, the new dopamine hit of the 21st century.
It is no surprise to hear that living through COVID-19 is boring. So many people and places we took for granted have been taken away or locked down. The world has been filled with fear, and in many cases, technology has been the answer to keep us safe.
As we continue to use our digital “slot machines” to connect to the world around us, one unintentional effect is that we steadily increase the amount of access we have to passive, yet exciting, communication. It reminds me of learning how food can become a delivery system for sugar, which tastes delightful and delivers an immediate energy rush, but leaves one feeling tired and sluggish soon after. And when we feel tired, we consume more sugar for a quick pick-me-up, resulting in a vicious cycle. Under the COVID-19 pandemic, when our brains feel bored, we are tempted to watch more lights, more colors, more bells to stimulate away the silence and isolation. Much like in a casino, this can trick us into feeling like we are winning when, in reality, we are running ourselves into the ground due to a lack of true novelty.
Dopamine, sometimes referred to as the pleasure neurotransmitter, is actually increased when we think of or engage in something that is novel. Technology can be an amazing delivery system of novelty. However, during this time, it is important that we also find novelty outside of the “casino.”
I have challenged clients to create their own journals titled “Things I learned during COVID-19” and then fill them with experiences, activities and photos. Creating novelty does not have to be hard. It can be as simple as making your own campfire and toasting s’mores, cooking or baking, or learning something new. The process of both planning and physically doing new tasks increases movement and engagement and uses our entire neuro-network to improve mental health. The process of delayed gratification —thinking about something exciting or interesting in the future —also increases dopamine.
Living life in a pandemic is challenging in so many ways. But if we allow it to, it can also birth creativity, intentionality, resiliency and new insights. Even though we find ourselves wandering around our homes in a seemingly numb state at times, it does not have to mean that “the house always wins.” My encouragement to you and those you love is to close the laptop or smartphone, get up from the bells and whistles, step away from the artificial lights, and walk outside to reconnect with a world that is missing you.
Todd Monger is a licensed professional clinical counselor, national certified counselor and approved clinical supervisor who has been providing clinical services for 20 years. He currently serves in private practice at Stable Living LLC, where he provides equine-assisted psychotherapy. He has also served as the executive director of student development at North Central University in Minneapolis for the past 17 years. Contact him at email@example.com.
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