Anxiety Disorders During The COVID- 19 Pandemic - Alyse Folino Ley D.O., FACN Child and Adolescent Psychiatry MSU Department of Psychiatry - MSU (SCS)
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Anxiety Disorders During The COVID-
19 Pandemic
Webmd
Alyse Folino Ley D.O., FACN
Child and Adolescent Psychiatry
MSU Department of Psychiatry
• December 2019-cluster of cases
SARs CoV-2 Hubei China
• January 13, 2020-first case
outside China
• January 14, 2020-41 confirmed
cases (WHO)
• February 2, 2020 NY Times-
“Medical workers transporting a
coronavirus patient into an
isolation ward in Fuyang, China,
on Saturday. Experts fear a
coronavirus pandemic, but its
severity is uncertain.”-Donald G.
McNeil Jr.
Picture-Chinatopix, via Associated Press
SARs CoV-2 CNN.com Burnett County Sentinel
Fear and Uncertainty During
COVID-19
• 1/27/21 • Illness
• 100million infected • Isolation
worldwide • Death
• 2 million have died • Economic
worldwide
• Academic
• Jan 2021 “deadliest
coronavirus month” • Domestic Violence
79,000 (CNN.com) • Child Abuse
• US- • Elder Abuse
• 25,152,433 cases
• 419,827 deaths
(COVID.CDC.gov)
Fear Anxiety Worry
The fight or flight A feeling of being The cognitive
response enabling out of control, component of
reaction to clear and focused on future anxiety
present danger potentially negative
events-out of
proportion to the
context of life real
situation that
impairs
functioning
Normal vs. Pathologic Anxiety
• Anxiety can be adaptive
• Signals imminent danger
• Cues into important stimuli
• Modifies Behavior
• Social distance, wear mask, wash
hands
• Abnormal anxiety
• Persistent, excessive, coupled
with no objective threat of harm,
or occurring at inappropriate
times leading to ineffective or
Tippi Hedren with daughter Melanie self-defeating behaviors
Griffith and their pet lion -1971
Anxiety in Vulnerable Populations • Elderly • Children and Adolescents • Those with underlining psychiatric conditions • Homeless • Racial and Ethnic Minorities • Health Care Workers
Covid-19 and Underlying Mental
Illness
• COVID-19 may worsen underlying condition
• Those with severe chronic conditions most at risk
• Disruption of mental health services
• Psychiatric
• Therapy
• Case management
• Access to medicine
• Social isolation
• Costa et al (2020)
• 60% of those who had a mental illness felt less connected
since start of pandemic
• Most concerned about worsening of their condition and
running out of medication
Substance Use Disorders and COVID-
19
• Chronic stress may trigger relapse
• Acute withdrawal due to disruption of markets
• Benzos and alcohol-maybe fatal
• Could lead to ingestion of toxic ethanol containing products
• Opiates
• Limited access to treatment
• Medications
• Acute Medical Detox
• Therapy
• Groups-AA
• Rehabilitation services (Spagnolo 2020)Children
• Losses
• Social contacts
• 55 million children and teenagers cut off from school staff members
• Extracurricular
• Academic Changes
• Transitions
• Virtual, hybrid, in-person
• Isolation
• Friends
• Missed Milestones
• CDC –April 2020-October2020
• Mental health visits
• Children 5-11 increased 24% (compared to 2019)
• Children 12-17 increased 31% (compared to 2019)
(Whitney, 2021)College Students • Risk for psychiatric disorders
• Onset of Depression, Anxiety and
Psychosis
• Risk for suicide
• Altered school experience
• Academic stress
• 2020-Graduates
• unemployment
• United Nations Report
• “Unless urgent action is taken,
young people are likely to suffer
severe and long-lasting impacts
Plante. TulsaWorld 2020 of the pandemic.”
(Menon, 2020)COVID-19 and Suicide
• Pandemic may exacerbate an existing crisis
• The rate of suicide for individuals age 10-24 increased by
57.4% between 2007-2018
• CDC June 2020
• Survey of the impact of COVID-19 on mental health
• ¼ of those age 18-24 seriously considered suicide
over the last 30 days
• Impulsivity risk factor in those under 24
(O’Connor, 2020)Return to School?
• Nevada Clark County
• Virtual since March
2020
• 326,000 students
• March 2020-Jan 2021
• 19 suicides vs.9 (2019)
CNN.comOlder Adults • Isolation • Abuse • Self care • Fear • Unable/unwilling to seek medical care • Food restriction • Purpose and contribution • Higher rates of depression in older adults who experience • Anxiety • Loneliness • Isolation
COVID-19 and the Indigenous Community • Navajo Nation –173, 667 members • Strength comes from cultural connectedness • Multigenerational family homes, remote areas Utah, Az, NM) often no running water • DM, Obesity, CVD are common • In Dine’=The big cough • July 2020-7,320 tribal members diagnosed • Blamed for the 1993 Hanta Virus outbreak-decreases rates of seeking help • Historical trauma and discrimination increased rates of depression, anxiety, ptsd, ACEs, addiction and suicide • 70% report experiencing trauma (Levin, 2020)
COVID-19 and the Black Community
• “Racism impacts health outcomes through close
alignment with socioeconomic status in this country. It
is a structural entity that operates on institutions and in
interpersonal dynamics …” Morgan Medlock MD, MPH
• Increased morbidity
• Increased mortality
• Health Disparity
• Michigan -14% of the population is Black
• 30% of COVID cases
• 40% of deaths
(D’Arrigo, 2020)Med Students, Physicians and
Residents
• Fear of illness, death
• Worry of spreading to loved ones
• Burden of caring for the dying
• Uncertainty
• Fatigue
• Loss of income
• Lack of support
• Initial support of health care hero's diminished
• Non-believers
• Health Care workers in NY (July 2020)
• 57% reported acute distress
• 48% reported depressive symptoms
• 33% reported anxiety (Zilber 2020)Neuropsychiatric Impact
• To Be Determined….
• Impaired consciousness
• Stroke
• Cognitive disturbance
• Fatigue
• Psychiatric conditions
• Survivors of 2003-2004 Hong Kong SARs Outbreak
• 369 survivors-40% were diagnosed with a psychiatric
condition 4 years after (Zilber, 2020)Post COVID Infection and Psychiatric Disorders • Lancet November 2020- • De-identified data from 69.8 mill patients in 54 health care organizations • 62,354 diagnosed with COVID Jan 2020-Aug 2020 • Individuals with a psychiatric disorder were 65% more likely to be infected with COVID-19 • 1 in 5 COVID-19 patients are diagnosed with anxiety or depression within 3 months of testing positive for the virus • Increased medical attention • Stress of pandemic
When Does Anxiety
Become a Psychiatric
Condition?Anxiety
• The most common psychiatric disorders in children and adults
• The most prevalent disorders
• 25% lifetime prevalence
• 14% point prevalence
• Onset often in childhood
• Children and Adolescents-6-18% depending on age
• Children may not recognize that their anxiety is excessive or unreasonable
• Decreased verbal abilities to express internal symptoms
• Concrete thought in children under 11
• Frequent physical complaints
• “stomach ache” “head ache”
• Problems with attention, focus and concentration
• School refusal
• Parental anxiety poses a specific risk for anxiety disorders children (Lawrence
2019)Risk Factors • Family history/genetic predisposition • Poor family support • Family discord • Dysfunctional parenting • Parent with untreated mental illness • Poor self-esteem/inadequate self image • Emotional dysregulation • Lack of social acceptance • Substance Abuse
Dimensions of Anxiety Subjective Behavioral Physiologic Tension Avoidance Muscle tension Apprehension Impaired speech and Increased HR Sense of impending motor coordination Dry mouth doom Performance deficits nausea Expectations of inability to cope
Consequences of Anxiety • Emotional • Fear and guilt • Cognitive • Impaired concentration and problem solving • Impaired academic and vocational achievement • Behavioral • Avoidance-school, social interaction • Self-medicating-substance abuse • Physiologic • Poor self care • Lowered immune response
Symptom Variation
• Symptoms manifest
differently at different
ages
• Cognitive
development
• Ability for abstract
thought
• Social functioning
• Communication
skillsAnxiety Disorders • Generalized Anxiety Disorder • Specific Phobia • Social Anxiety Disorder • Panic Disorder • Agoraphobia • Selective Mutism • Separation Anxiety
GAD
• A. Excessive anxiety and worry
• B. Difficult to control the worry
• C. Anxiety and worry are associated
• 1. restlessness or keyed up
• 2. being easily fatigued
• 3. difficulty concentrating
• 4. irritability
• 5. muscle tension
• 6. sleep disturbanceSocial Anxiety Disorder
• A. Fear or anxiety about one or more social situations in
which the individual is exposed scrutiny
• Fear of embarrassment or humiliation
• * in children must occur in peer settings and not just
with adults
• B. Fears that he/she will act in a way or show anxiety
symptoms that will ne negatively evaluated
(humiliating or embarrassing)
• C. Social situation produces anxiety which may
predispose to a panic attack
• * in children -expressed as crying, tantrums, freezing or
shrinking
• D. Fear out of proportion to actual threat
• E. Caused distress or impairment
• F. Situations are avoided
• * in children this feature may be absentSpecific Phobia
A. Marked fear about a specific object or
situation
• * in children often expressed as crying,
tantrums, freezing or shrinking
• B. Phobic object or situation provokes immediate
fear or anxiety
• C. Feared object or situation is avoided or endured
with intense fear
• D. Causes distress or impairmentPanic Disorder
• A. Recurrent unexpected panic attacks
• Palpitations, pounding heart, increased HR, sweating,
trembling or shaking, SOB, feeling of choking, chest pain or
discomfort, nausea or abdominal distress, feeling dizzy or
unsteady, derealization, fear of losing control or going crazy,
fear of dying, paresthesias, chills or hot flashes
• At least one of the attacks has been followed by
• Persistent concern
• Worry about the implications of the attack or its
consequences
• Significant change in behavior related to the attacksAgoraphobia
• A. Marked fear or anxiety about 2 (or more)
• Public transportation, open spaces, enclosed spaces,
crowds, outside of the home alone
• B. The person fears or avoids these situations
because of thoughts that escape might be difficult
or help might not be available
• C. Situation produces fear or anxiety
• D. AvoidanceSeparation Anxiety • Normal from 12 months-30 months and briefly in kindergarten and 1st grade • Typically begins during school age • Fear of harm to self or parents
Selective Mutism • A. Consistent failure to speak is specific social situations-at least one month • B. The disturbance interferes with educational or occupational achievement or with social communication
Obsessive Compulsive Disorder
• A. obsessions or compulsions
• Obsessions
• Recurrent and persistent
thoughts, impulses, or images
that are intrusive and
inappropriate and that cause
marked anxiety or distress
• Compulsions
• Repetitive behaviors that the
person feels driven to perform in
response to an obsession or
according to rules that must be
applies rigidly
• The behaviors or mental acts are
aimed at preventing or reducing
distress or preventing some
dreaded event or situationPosttraumatic Stress Disorder • Traumatic event • Intrusive Symptoms: event re-experienced • Negative Alterations in Cognition and mood • Avoidance of stimuli associated with the trauma and numbing of general responsiveness • Increased arousal
Treatment of Anxiety Disorders in Children and Adolescents • Therapy is first line • Cognitive Behavioral Therapy (CBT) • Specific Targeted Therapies (based in CBT) • PTSD-Trauma Focused CBT • Specific Phobia, -Systematic Desensitization • OCD-Exposure Response Prevention Therapy • Panic-Exposure Therapy
CBT
Automatic
Thoughts
Emotional Behavioral Somatic
Changes changes changesCore Automatic
Belief/Schema thoughts
Emotional
changesDysfunctional Functional
Thoughts Thoughts
Behavior
Negative Behavior Positive
Avoid
Self-critical Confront Balanced
Give up
Biased Change Acknowledge
Inappropriate
Feelings Feelings
Anxious Relaxed
Depressed Calm
Angry HappyCognitions Behavior Emotions
Thought monitoring- Activity monitoring-identify Affective education-
identification of automatic reinforcers distinguish between core
thoughts beliefs and physical
symptoms
Identification of cognitive Goal planning Affective monitoring-rating
distortions scales, rate intensity
Thought evaluation- Target settings-practice Affective management-
cognitive restructuring relaxation, anger
management
Development of new Graded exposure-response
cognitive skills prevention
Learn new skills-modeling,
rehearsalResponse to CBT
• Wolk et al-JAACAP 2015
• 7-19year follow-up study on adults who completed CBT
as children
• Chronic and enduring suicidal ideation is found in people
who suffered from childhood anxiety that was not
properly treated.
• CBT has both short and long term benefits
• Highlights the importance of early identification and
evidence based treatmentsRecommendations in Children and
Teens
• CBT recommended as first line
• SSRIs in Children and Adolescents
• Only medications supported by RCT
• Studies: SAD, GAD, OCD, Soc Phobia
• Equally efficacious
• Fluoxetine, Sertraline, Paroxetine, Citalopram, Escitalopram
• start low dose and titrate toward efficacy
• No improved efficacy with SNRIs (Venlafaxine)
• SSRIs are associated with more rapid greater
improvement than SNRIs (Strawn et al 2018)Child-Adolescent Anxiety Multimodal
Study (CAMS)
• Walkup et al. N Engl J Med 2008, 359: 2753-2766.
• 488 children, ages 7-17
• Separation anxiety, GAD, Social phobia
• Study Arms
• 14 Sessions CBT
• Sertraline (up to 200mg/day)
• Combination
• Placebo
• Anxiety measured at baseline 4,8 and 12 weeks
• Anxiety Disorders Interview Schedule for DSM-IV child
• Establish diagnosis
• Clinical Global Impression-Improvement Scale
• Clinically meaningful improvement in anxiety
• Pediatric Anxiety Rating Scale
• Level of Anxiety 0-30; >13 moderate levels=anxiety disorderKey Outcomes at 12 Weeks Walkup JT et al. N Engl J Med 2008;359:2753-2766
Conclusions • Compared with placebo, the 3 active therapies- CBT, Sertraline and combination are effective short term treatment of GAD, social phobia and separation anxiety. • Clinical Global Impression-12 weeks • Combo 80.7% (P
Scores on the Pediatric Anxiety Rating Scale
during the 12-Week Study
Figure 2. Scores on the Pediatric Anxiety Rating Scale during the 12-Week Study. Scores on the Pediatric
Anxiety Rating Scale range from 0 to 30, with scores higher than 13 consistent with moderate levels of
anxiety and a diagnosis of an anxiety disorder. The expected mean score is the mean of the sampling
distribution of the mean. The I bars represent standard errors.The Pediatric OCD Treatment Study POTS
• A balanced, masked randomized controlled trial:
• conducted in 3 academic centers in the United States
• volunteer outpatient sample of 112 patients aged 7 through 17
years with a primary Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition diagnosis of OCD
• Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score
of 16 or higher.
• Recruited between September 1997 and December 2002.
• INTERVENTIONS:
• Random assignment to receive CBT alone, sertraline alone,
combined CBT and sertraline, or pill placebo for 12 weeks.
• MAIN OUTCOME MEASURES:
• Change in CY-BOCS score over 12 weeks as rated by an independent
evaluator masked to treatment status; rate of clinical remission
defined as a CY-BOCS score less than or equal to 10.POTS
• RESULTS:
• Ninety-seven of 112 patients (87%) completed the full 12 weeks of
treatment.
• Combined treatment also proved superior to CBT alone (P = .008) and to
sertraline alone (P = .006), which did not differ from each other.
• Clinical remission:
• combined treatment was 53.6% (95% confidence interval [CI], 36%-70%);
• CBT alone, 39.3% (95% CI, 24%-58%);
• sertraline alone, 21.4% (95% CI, 10%-40%);
• placebo, 3.6% (95% CI, 0%-19%).
• The remission rate for combined treatment did not differ from that for CBT
alone (P = .42) but did differ from sertraline alone (P = .03) and from placebo
(PApproach to Multiple School
Transition
• Multiple Transitions increase anxiety
• School Refusal
• Requires prompt attention regardless of the cause; the longer
the child is out of school, the higher the likelihood of
treatment resistance
• Treatment: Behavioral
• Limit setting
• Eliminate secondary gain
• Relaxation training
• Exposure
• Increasing lengths of time at school or virtual
learning
• Rewarding child for graduated successWhen to Start Medications • Prolonged course • Limited response to therapy alone • Severely impaired functioning • Comorbid conditions
Treat Co-morbid Conditions
• Anxiety disorder
• OCD
• Major Depressive Disorder
• Trauma/PTSD
• ADHD
• Substance Use Disorder-cannabis
• Psychosis
• Rare 1/10,000
• Bipolar Disorder
• RareCannabis
• Not helpful in psychiatric conditions
• Amotivational Syndrome
• THC (delta-9-tetrahydrocannabinol) content dramatically increasing
• 1970s-less than 2%
• 1990-3.74%
• 2018-20-25%
• Oil, wax, shatter, budder- extracts nearly pure THC
• Daily use
• 0.7% -8th graders
• 3.4%-10th graders
• 5.8%-12th graders
• Risk of addiction 10%-equal to alcohol
• Use before age 18 increases the risk of Cannabis Use Disorder by 4-7 times
• Cannabis Use Disorder
• 1.5% of Americans (NIDA 2018)Cannabis Use in Adolescents and Risk
• Gobbi et al (2019)
• Neuroanatomic differences in regions with type 1
cannabinoid receptors
• Decreased volume of hippocampus, amygdala, prefrontal cortex
• The younger users of cannabis were at significantly higher risk
of suicidal behavior
• The younger the onset of use the higher the risk
• Depression, anxiety, psychosis, academic and vocational
functioning
• Quitting cannabis by the end of adolescence did not
protect people from most of the serious effectsCannabis
• Induces and exacerbates psychiatric conditions
• Anxiety
• Depression
• Psychosis (induction of schizophrenia, cannabis induced psychosis)
• Amotivational syndrome
• Decreased concentration, working memory, processing speed and IQ
• Paranoia
• Hallucination
• Panic
• Increases risk of violence and aggression
• Reduced school performance
• Reduced life satisfaction
• Impaired driving-10.3% of 12th graders drove after using in the past two weeks
(NIDA-2018)Treatment Approach
• Therapy-CBT/IPT
• Family involvement is essential with children/teens
• Psychoeducation
• Instruction on relapse prevention
• Medication compliance
• Recognizing symptoms of relapse
• Avoiding precipitants
• Sleep deprivation and substance abuse
• School Accommodations
• Remedial education or tutoring may be necessary
• Medication determinationStarting/Monitoring SSRI
• Review risk factors
• Family history
• Past attempts
• Psychoeducation
• Warning signs
• Close monitoring
• Worsening of symptoms
• Activating symptoms
• Risks, benefits, side effects and alternatives
• Suicide risk assessment
• Access to weaponsSSRIs • First line medications • SNRIs can also be used • Start low dose • Limit side effects • Limit anxiety • Increase compliance • Titrate toward efficacy while monitoring for side effects • Allow at least 6 weeks to establish efficacy • Continue 6-12 months once in remission
Medications
• Medications:
• SSRIs are first line
• Fluoxetine (Prozac): FDA approved for the treatment of
depression in children (>8) and adolescents (8-18 years)
• Escitalopram (Lexapro) FDA approved in adolescents
(12-17 years)--April 2010
• All SSRI medications (Fluoxetine, Paroxetine, Citalopram,
Escitalopram, Sertaline and Fluvoxamine)-equal efficacy
• SNRIs (venlafaxine, desvenlafaxine, duloxetine),
Buproprion, Mirtazepine-do not improve efficacy but
may increase SI
• TCAs not more efficacious than placebo in childrenMedications
• Fluvoxamine (Luvox)
• OCD>8
• Sertraline (Zoloft)
• OCD 6-17
• Fluoxetine (Prozac), Paroxetine (Paxil)
• OCD 7-17
• Clomipramine
• OCD >10
• Imipramine
• Nocturnal enuresis, depression and chronic pain >6SSRI Side-effects •Nausea, diarrhea, constipation, increased anxiety with initiation, weight loss or gain, somnolence, insomnia •Very little risk with overdose •Serotonin syndrome
Black Box Warning
• 2004 FDA warning: adolescents-age 24 increased
suicidal ideation
• Meta-analysis of SSRIs and depression in
adolescents- 2400 participants
• Increase in suicidal ideation
• Depressed adolescents
• 3.8 %(SSRI) vs. 2.1% (controls)
• No completed suicides in any of the
studiesBlack Box Ripped from the Headlines •“FDA Links Drug to Being Suicidal”-New York Times- September 14, 2004 •“How Paxil Killed Our Son” -New York Post-September 19, 2004
Black Box Warning Unintended Consequences • Decline in suicide rate from 1990-2004 • 25% decrease SSRI prescription rate in 2004 • CDC-14% increase in suicide rates 5-19 year olds in 2004 compared to 2003
Research on BBW
• Some conflicting evidence
• Increased suicidal behaviors after 2004
• Meta-analysis-JAMA 2007
• US Food and Drug Administration-BMJ 2009
• Decreased suicidal behaviors after 2004
• Analysis FDA reports-Am J Psychiatry 2003,
2007Research On BBW • FDA advisory associated with reduction in rates of diagnosis and treatment with no increase in treatment alternatives Am J Psych 2007 • Number of children and adolescents who were prescribed antidepressants significantly decreased. Shift in care from generalist to psychiatrists Arch Gen Psych 2007 • Children’s depression visits and visits with antidepressant declined after advisory Psych Serv 2011 • Suicide rate among adolescents rose in 2004, the year the warning went into effect, for the first time in 15 years BMJ 2014
Consensus • Same increase in SI not found in studies on anxiety disorders • Untreated depression is the most serious risk for suicide • FDA warning was not intended to discourage legitimate treatment • FDA warning was not intended to be a contraindication
Anxiety Disorders
• Helpful
• Cognitive Behavioral Therapy
• Collaboration with school
• IEP, 504, behavioral plan, counseling, tutoring,
accommodations •
• Psychoeducation for parents and caregivers
• SSRIs/SNRIs
• Safety plan
• Remove all weapons from the home
• Close monitoring
• Involvement in positive peer- related activitiesNot Recommended
• Alternative “therapy”
• No evidence base
• Delays proper treatment of a life-
threatening condition
• EEG diagnosis by non-physicians
• Cause/exacerbation of symptoms
• Cannabis (THC), Alcohol, illicits
• ExpensiveOutcome • Early identification and treatment • Severity of illness • Co-morbid substance use disorder • Level of hopelessness • Family stressors
Resources for Children, Teens and
Families • AACAP -
https://www.aacap.org/coronavirus#families
• Tips for transition back to school
• How to Talk to Your Kids about Coronavirus - New York Times
• 5 things to remember when talking to kids about the Coronavirus -
Chicago Tribune
• Just for Kids: A Comic Exploring the New Coronavirus
• Comic: How To Turn Your Home Into A School Without Losing Your
Sanity
• The Clay Center for Young Healthy Minds - Self-Care for Resilience
Resources
• A Parent's Guide to COVID-19 - The Rush Cast Podcast
• Tips to Keep Children Healthy While School’s Out
• How to Explain the Coronavirus Pandemic to Young Children -
Newsweek
• Tips for Supporting Student Wellness During COVID-19
• I Have a Question About Coronavirus: Clear Answers for All KidsResources for HCP
Videos, Podcasts and Webinars CBT MGH- https://vimeo.com/398929603/0dcf0ba166 Webinar Series HMS: Regulating emotions and building resiliency in the face of pandemic Role of anxiety- https://vimeo.com/398662331/748f60ecce Slowing the brain- https://vimeo.com/398675016/b40bf3a0ba Charging up and staying connected- https://vimeo.com/400727093/254169fb7e Exploring thoughts- https://vimeo.com/401092639/094cc41127 How family members and friends can support COVID caregivers – HMS https://youtu.be/rcaYlDOQsHY Caring for yourself and others during COVID-19 pandemic: managing health care worker’s stress – Schwartz center for compassionate care • https://youtu.be/F4LU-EoAFew
Videos, Podcasts and Webinars Free 3-session video course on resiliency skills for healthcare providers MGH Resiliency and prevention program https://www.resilienceandprevention.com/healthcare-providers Clinical Self Care in the time of COVID- Mc Lean Hospital (available with Spanish & hindi subtitles) https://www.mcleanhospital.org/video/dr-blaise-aguirre-offers- covid-19-coping-tips-health-care-workers
BIPOC (Black, Indigenous and people of color) Self-guided resources
The Safe Place: Free smartphone app focused on psychoeducation and
self-care for minority mental health, geared towards the Black
community
Liberate: Free meditation app designed specifically for the BIPOC
community and led by BIPOC teachers
Racial Trauma Guide: Virtual guide on coping with racial stressors and being an
ally, developed by the EMPOWER (Engaging Minorities in Prevention Outreach
Wellness Education & Research) Lab
https://www.psychology.uga.edu/racial-trauma-guide
Black Emotional and Mental Health (BEAM) Toolkit & Resources
https://www.beam.community/tool-kits-educationResource: COVID Coach From: U.S. Department of Veterans Affairs Free app to support coping and resilience during the COVID-19 pandemic. Includes tools for tracking mood, managing stress, navigating caregiving, staying healthy and connected and connecting to further resources as needed
Resource: Mindshift CBT (app) Free interactive cognitive-behavioral tools to manage anxiety, develop more effective ways of thinking and take positive action Resource: Stop, Breathe & Think (app) Free app to help notice feelings and reactions, practice mindful breathing, and broaden perspectives via guided meditations
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