Weekly newsletter

Anxiety, Depression, Burnout, PTSD, and Covid – Interview with Psychotherapist András Spányik

Balázs Frei 2021.02.03.

We sat down with psychotherapist and occupational health expert Dr. András Spányik to discuss the effects of the pandemic on the mental health of people in general and healthcare workers in particular, as well as how we might avoid or overcome any potential negative psychological consequences, and also explored issues surrounding vaccination in Hungary.

What are the main issues caused by Covid in Hungarian society on a personal level?

It is incredibly varied, because it depends on people’s personalities and circumstances. Based on recent studies from the US,

issues such as Post-traumatic Stress Disorder, insomnia, depression, and anxiety have become significantly more common due to covid.

Something prevalent we have also seen is that some family issues, such as domestic violence, have often been exacerbated by being locked in together due to covid.

Fact

Dr. András Spányik is a medical doctor specialized in occupational health and psychotherapy. He also has years of experience in emergency medicine. He is founder and chairman of the board of trustees of MedSpot Foundation, which is concerned with the mental health of medical professionals, and Medical Director at private healthcare clinic Doktor 24.

For those who at one point caught and were hospitalized with coronavirus, PTSD is a common occurrence. This is because it is indeed a traumatizing experience; we are sick with a potentially deadly virus, have very little information about what is happening, and are totally isolated; we are cut off from friends and family and do not see any human faces as hospital staff are wearing masks. PTSD is even more common amongst those who have to be connected to a ventilator. We also know that covid has some neurological effects, which may contribute to anxiety, headaches, and sleeping disorders.

On the other hand, for some people who suffer from psychological issues, the effects of the pandemic may have eased some of their problems. For example, people who are socio-phobic, and typically feel pressure from their social environment to socialize, which makes them anxious, do not feel such pressure these days. Also, for people with obsessive compulsive disorder who have to wash their hands several times a day, the fact that such behaviors were normalized was helpful.

We hear a lot of conspiracy theories regarding COVID and vaccinations. Are conspiracy theories often popular in such cases? What can we do against these?

Yes. People often want the world to be more predictable than it is, and frequently try to find explanations that allow them to believe that it is, and that they can easily make sense of. We humans are very vulnerable, and this virus has highlighted this fact rather clearly. People want to feel that we have some kind of control.

I think we collectively felt that given the progress we have achieved over the last century, science and medicine could easily deal with a virus. But it has not worked out that way; SARS-Cov2 has turned the world upside down, killed our loved ones, and made many otherwise healthy people extremely sick.

We could not and cannot predict how the pandemic would turn out. Therefore people tried to find their own explanations (sometimes based on conspiracy theories) of how the world works so that they could explain away all of this devastation, and make the world more predictable.

In your perspective as a psychotherapist and an expert on occupational health, what were the main effects of the pandemic on people through changes in working conditions?

Well, before the pandemic, people would fantasize about the “home office,” organizing our own schedules, working from the comfort of our own homes. And it was good, for the first week or two. Then, people started to realize that socializing is a central part of most of our lives; we are social beings.

They eventually started to feel a kind of anxiety and emptiness due to the lack of social contact. Short social interactions such as small talk went missing from people’s lives, and only then did they realize how important they were. Even when people did meet, they did not know how to act around one another as they were afraid of catching the disease, and a lot of communicational value and information were lost by having most of our face covered up by a mask.

Also, many could not lay down their own boundaries. Recent studies have shown that often, people work a lot more when they are at home, because they do not really feel the passing of the time. They are taken out of their usual routine, and do not create a new one, and just keep working a lot more than they usually would.

Another thing is that a lot of people have lost their jobs, which comes with its own mental health issues, but even more people are afraid of losing their livelihoods. This often leads to anxiety and depression, as well as burnout syndrome. Burnout syndrome is no joke; it is now an officially recognized medical condition, a registered disease.

What can we do ourselves to avoid any psychological symptoms as a result of our current situation?

As a worker, it is crucial to set up a daily routine, to decide when we work, where we work, to come up with a structure to our day that we normally have, but are currently missing. It can also be helpful to find new hobbies to occupy our time. We should also try and interact socially, either via the internet or ways that are still permitted, such as taking a walk with some friends in a park. Exercising is also highly advisable, while meditation can also help.

It is also important to not be afraid of seeking help when you need it. Signs that may indicate that one needs help include sleeping disorders, excessive alcohol consumption, or overworking in order to avoid having to deal with the realities of our situations. Studies show that alcohol abuse, online gambling, and excessive porn consumption – which can also be an obsession – have increased due to the pandemic, and you may need to seek help if you experience any of these.

What are and what can employers do to mitigate both the personal and the business costs of mental health issues?

Well, there are several ways of helping prevent burnout when there is no pandemic to worry about. Some companies are making contracts with psychotherapists and psychologists to provide employees with an opportunity to easily reach professional help. There are also groups which are set up for employees to discuss their concerns, to ventilate emotionally. These can still work in one form or another.

How has the medical community, and especially frontline workers, been handling the pandemic psychologically? What is it crucial for the public to understand about the situation?

This is a very, very complicated issue for them. Some medical professionals are far from their family, because they had to move as a result of their positions. They have to spend hours and hours without interruption in protective gear, which is often very warm and sweaty. It is rather difficult to get in and out of, so medical workers often do not drink water in an attempt to avoid having to go to the restroom, and are therefore frequently dehydrated even as they are working tirelessly in an intense environment. They go without meals or beverages for long hours, every day, and they have now been at it for months on end. Many have been reallocated from their usual medical fields, where they might not have been much exposed to serious cases, suffering, and death, and are therefore traumatized.

Hungary Applauds Healthcare Workers Every Day at 8pm
Hungary Applauds Healthcare Workers Every Day at 8pm

In Budapest every evening, more and more people are showing their appreciation towards those who are fighting against the coronavirus on the “frontline” in hospitals – doctors, nurses, and healthcare workers – by applauding in their windows and on their balconies at 8pm, while Danube-side hotels lit their windows in heart-shapes.  On Sunday, the applause […]Continue reading

Medical professionals are thus in a very overwhelming situation. Although currently, due to the large amounts of adrenaline they are getting from working in this intense situation, they might feel superhuman, they are, of course, not. Many of them are expected to develop symptoms of PTSD after the crisis is over, and some of them are already showing signs of the disorder, or others such as depression.

We will know a lot more about this issue in a couple of weeks, because there is an ongoing survey that we are doing amongst healthcare workers, including medical professionals and administrative staff alike. In this survey, many have already been found to be showing symptoms. A large number of them have decided to write to us expressly and extensively about their current situation and mental health after receiving their survey results, telling us their personal stories.

They are generally not psychiatrically ill people, but they do not feel well currently. Some of them are already on medication such as antidepressants. We try and direct anyone who is found to be showing symptoms towards professional help, and our foundation, MedSpot, offers these people free help. I feel that there is not nearly as much emphasis on this topic as there should be.

What can we do to help the situation?

We set up a system for helping medical professionals in collaboration with Eötvös Lóránd University of Science, and we accept donations. Firstly, we created an app that focuses on short progressive relaxation exercises to help healthcare workers relax during the few minutes of their breaks. We also have psychiatry professionals available online who can help with PTSD symptoms and prescribe medication as needed.

We are also raising awareness of this in order to help normalize the seeking of professional help for healthcare workers. This is also crucial, because there is an inner conflict within medical practitioners in Hungary regarding looking for help.

Society and therefore they themselves expect healthcare professionals to be the strong, reliable medical staff who solve other people’s problems. How can they be that if they themselves need help?

Such impediments to seeking and receiving help must first be removed in order to properly deal with the issue at hand.

As both a psychotherapist, and a member of the medical community in general, what would you say are the greatest obstacles to reaching an effective level of vaccination? How can we overcome them?

The greatest obstacle is people’s willingness to take the vaccine, or lack thereof. This means that regardless of the specifics of a political situation, this is always mostly an issue of politics and social attitudes. Here, social responsibility, personal beliefs, interests, and rights clash in an irreconcilable manner. We can only hope that people will be persuaded to do the appropriate thing, because it does not seem to me that employers or the government could have the right to make vaccination compulsory. Because of all this, the fact that communication has been confusing so far is a serious issue.

We need to have a careful, professional plan for communicating about vaccines which relies on people who are qualified to talk about them.

We need to, for instance, talk about side effects. They exist, and we frequently hear about severe allergic reactions and the like. However, these are extremely rare in reality, and not at all more common than in the case of other medications as commonplace as algopirin or aspirin, or indeed some other vaccinations. We only notice these reactions to the vaccine because everyone’s eyes are on the issue. I believe that for instance this is crucial to understand, because otherwise many people get the flu shot every year who are now on the fence about vaccinating themselves against covid.

There are otherwise three central questions regarding vaccines. First, whether you can still transmit the disease even if you are vaccinated. Second, whether you can still get sick. Third, if you do develop symptoms, how severe they can be.

At the moment, we have no precise understanding of whether you can still transmit the disease if you are vaccinated. With regards to symptoms, it is important to note that although the effectiveness of the different vaccines is varied, and you can sometimes become sick, they all prevent people from developing severe symptoms. This means you avoid all of what scares us about the coronavirus. This is of paramount importance both on a personal and a societal level.

How will Hungarians’ behavior change once they are vaccinated? How could this – and a potential false belief that vaccination allows them to move and act freely – affect the course of the pandemic?

This primarily leads us back to the question of whether you can still transmit the disease even if you are vaccinated. If you cannot, no problem. If you can, then it can be an issue if people start acting as if they can do whatever they want because they are vaccinated. The danger then becomes that many people get sick quickly and overwhelm our healthcare system. In such a scenario, many people would die. This is therefore something that we must avoid, we must remain cautious and vigilant.

Perhaps the government will decide to ease restrictions if there are enough people vaccinated. There are tremendous economic pressures to do so. The question is whether we can trust people with doing the right thing, remaining careful and protecting others even if it is not mandated.

When the coronavirus crisis is over, will this be a bad memory, or could we feel like this was a success?

There are typically phases of crises. First is the honeymoon phase, where everyone tries to unite and face the threat collectively. This is when we were clapping for medical workers, discovering how we could do all our work through zoom meetings online, donating a lot to aid organizations and the like. Then, people got tired and frustrated, social distancing took its toll on our well-being. We are just leaving this phase, protracted much longer than it usually would be in any other crisis, and entering the phase of reconstruction, a time of slow, arduous rebuilding.

It depends on how we overcome it. We may one day look back on it from a position of safety and well-being, and think proudly of a crisis we collectively overcame, and remember spending a lot of time with our families fondly. There are children who are very happy today that they get to spend time with their parents they otherwise would not. They will certainly have good memories of these times. It is also medically proven that we are more likely to remember good experiences in the long term.

Featured photos by Attila Lambert/Hungary Today.