Webinar- Balancing Life Post-COVID by Alpha Healing Centre

In our weekly webinars, we talk about various industry scenarios and challenges of rehabs across the country along with the de-addiction and mental health challenges faced by the mental health community and people in general.

In the ninth webinar of the series, we invited Mr Vijay Patel – CEO of Alpha Healing Center along with Dr I.R Rajkumar and Dr Parth Soni. The webinar was hosted by Mr Vikram Kumar – Managing Director of RehabPath, India. In the webinar, Mr Patel, Dr Rajkumar, and Dr Soni shared their views on balancing life post-COVID.

In this blog, you can read the summary of the webinar, or you can watch it online here.

https://www.facebook.com/DeAddictionCentres/videos/801606897068839/?__so__=permalink&__rv__=related_videos

Vikram: Many vaccines are under development, and people are looking forward to returning to their pre-COVID routine. Please help us understand how we can bring a balance in our life post-COVID.

Mr Vijay Patel: Everybody today is wondering how they can bounce back in life post-COVID. The challenges this pandemic has brought have given us many valuable lessons and a new direction for the future. The global community had never seen such a pandemic in the last 100 years, after the Spanish flu of 1919. I request the audience that whatever questions you have, please feel free to ask because we’re all going through this together in the same way.

Dr Rajkumar: Humans have lived in a close-knit society and are dependent upon one another socially, economically, and emotionally. We always have advocated that united we stand, divided we fall. However, these very pillars have been shattered in the present scenario. We have been told to maintain distance, isolate, and stay indoors. The pandemic has been of such gravity that even the socially developed nations having an excellent medical infrastructure have fallen flat and are unable to cope with the onslaught of COVID-19. Poor information about the illness or its treatment modalities has only added to the confusion and insecurity.

The fact that extremes of ages being the most vulnerable and difficult to treat due to the existing comorbidities has put pressure on the public and the governments managing the scenario. The uncertainty of getting infected is leaving us all baffled.

Ratan Tata did say that in 2020, if you are alive, it is your profit.

Don’t look at anything bad that has happened in 2020 but learn to be alive, then we can come out of this situation. Growth always happens when we go out of our comfort zone. Until today, we have been in comfort zones. Now we are exposed to an array of stress.

Stress is a normal response to any emergency. We have all experienced that stress brings out resillience in us. 

An emergency brings many uncertainties and sudden changes in our day-to-day functioning, which is true in the current scenario as well.

Some common symptoms people have come across during the current pandemic include physical symptoms like chest tightness, breathing difficulties, palpitations, digestive symptoms, muscle tensions, headaches, body aches and pains, difficulty in sleeping, and feeling tired.

Psychological symptoms include restlessness, inability to relax, anxiety, panic, sadness, irritability, anger, boredom, and loneliness.

Cognitive symptoms include difficulty to concentrate, forgetfulness, negative thoughts – fears, worries, and hopelessness.

Behavioural changes can also be seen due to stress that is prevalent around increased use of the substance (alcohol, tobacco, or drugs). People isolate, withdraw, spend more time on social media, and get hooked on to the internet as well.

Anxiety and worries can range from mild and transient to severe and disruptive.

In addition to physical symptoms, one may experience the following symptoms often:

• Vigilance to threat – checking for symptoms and COVID-19 related news

We are bombarded with information that does not convey anything specific but an array of doubts in our minds.

• Thoughts related to threat/danger – exaggerate mild symptoms

We often think of adverse or negative consequences like contracting the illness, losing near and dear ones.

• Worry runs us down virtually – what if I contract the virus when I go out and spread it to my family? What if I lose the job? What if I get bad marks?

‘What if’ keeps us worried all the time.

• Anxieties about health, getting medical help, fear of getting infected, reaching home, and basic facilities – everything is put under pressure.

Bill payment is another type of anxiety which keeps on haunting us.

• If they are under quarantine/isolation – stigma, fear of testing positive, anxiety about getting cured are a few things that keep disrupting.

• How will I manage work (both household and office) if working from home?

Many working women who are managing home in the current scenario with children are under greater pressure.

• In this pandemic, many things are not under our control. It is natural to feel sad, angry, anxious, helpless, and stressed.

 The solution is to understand what we can control. It is easier said than done.

Remember, you cannot stop hypothetical worries from occurring, but you can control your response to them. It is the birthright of your mind to think but you can command your response to the thought. 

Things within your control help you build resilience. For example, following the latest information and advice, focusing on what’s important, your information diet, routine, relaxation, cultivating connection, eating well, exercising, seeking and offering support, voting and activism.

Things outside your control are other people’s decisions and health, news, the government’s actions, schools opening or closing, the state of our healthcare system, cancellation of flights and holidays, traffic, public transport, ageing, and weather.

These uncertainties are not in our control. You must learn to cope up with them.

I always categorise the fight against adversities as wars and battles. A battle is short-lived, but a war is long drawn. In war, patience pays well in the long run. The current scenario is like a world war. You have to be patient enough and learn the dos and don’ts. You should be able to contain the don’ts.

Physical Aspects

Dos could be nutritious food and engaging in physical activities or exercise of your liking at home using online resources.

If nothing else is possible, walk daily for 45 minutes to an hour and sleep adequately. If you are on prescription medication for a health condition, take the medicines regularly as prescribed.

For don’ts, avoid consumption of junk food and drinks. Do not use substance or addictive material to overcome this scenario.  

Psychological Aspects

Dos include – practice acceptance of the current situation without which people can often go into denial believing that nothing is going to happen to them and end up being careless. You can practice breathing awareness, meditation, read books that inspire or make you laugh. Consider this situation as a challenge and tell yourself, “I/We can overcome this.”

Believe in yourself. Practice gratitude every day by remembering at least one positive thing – if you have lived this day, be thankful to the almighty.

Don’ts include – don’t endlessly spend time watching news and browsing through social media about the current pandemic as it can invoke stress or anxiety. The news is bombarded with half knowledge. Nothing is certain at this juncture. We are like a blind man describing an elephant. Don’t read news or watch videos from unauthorised sources as the news can be fake and it can increase stress.

Emotional Aspects

On the emotional side, talk to someone you trust about your negative feelings. Sharing concerns and anxieties always help minimise and cope up with them.

Engage in activities that help express your feelings, such as writing a diary or blog, painting, dancing, and singing. You should have a bag full of activities in the personal domain which you can scan to cope up with the situation. Healthy engagement in such activities will distract your mind away from anxious thoughts.

Don’t give in to the gloom and doom worries regarding the virus.

Don’t bottle up your negative feelings. Trying to suppress or contain thoughts or emotions is similar to sitting on a volcano, which is bound to explode at some point.

One of the techniques we recommend is ABCDE.

The ABCDE Technique

Attention – When you feel distressed, stop whatever you are doing at that moment and pay attention to your inner dialogue. Believe – Do not automatically believe your thoughts. Try to evaluate them critically.

Challenge – Diffuse anxiety by broadening your focus. While thinking of a little something or the bigger picture, you will always find your emotion diffusing. You will be able to minimise anxiety and think if you are feeling calmer.

Discount – Acknowledge that anxiety has been dominating your thinking and let the unhelpful thoughts go. Whenever you reinforce an emotion into thought, it will keep coming back. Learn to disassociate the emotion from the thought. You will be able to look at them more objectively.

Explore Options – What would be helpful to focus on right now? What options do I have? How can I divert my mind?

The THINK Technique

True – Learn to question the thought whether it’s the truth or not. If not, what are the facts and what are the opinions?

Helpful – Is paying attention to the thought useful to me or others in trying to formulate a strategy to cope up with the scenario?

Inspiring – Does the thought inspire me, or does it have the opposite effect? Is it helping me cope up?

Necessary – Is it important for me to focus on the thought? Is it goal-directed? Will it help me become a better individual?

Kind – Is the thought kindful? If not, what could be a kinder thought?

Through our ways and means, we can try to cope up with this scenario gradually.

Dr Parth: I would like to discuss other aspects that are also important for balancing a good life.

Social Aspect

Dos include, connect with your loved ones over phone, video call, WhatsApp, and other social media. This is a time to build a good bond with old relationships.

You can attend online activities like music, storytelling, and poetry sessions. 

Visit museums virtually and gain knowledge. You can also play online games like Ludo King, and stay connected while playing.

Don’ts include not wearing a mask or not maintaining social distancing.

Spiritual Aspect

What should we do to take care of our spiritual self and develop a sense of meaning and purpose?

Spend time reading or listening to spiritual literature. It will help stabilise and anchor down your spiritual aspects.

You can also attend online religious and spiritual services, which are being offered to reduce emotional sufferings.

If possible, get in touch with your inner self by reflecting on issues that hold the most significance in your life.

Don’t participate physically in any spiritual or religious gathering without your government’s permission as it will increase the chances of spreading the virus.

Professional Aspect

If you are studying or working from home, stick to a proper schedule similar to pre-COVID-19. It will help you pay more attention and focus on work. If possible, have a specific or dedicated physical workspace at home.

Utilise this time to gain knowledge and skills. Else, you might end up wasting much time worrying about things that are not in your control. You can develop skills by taking online courses or reading.

Initiate the activities that you have been procrastinating.

Do not allow yourself to be distracted while pursuing your work or study at home. Try to dedicate time to your work and do so from a designated place.

General Aspect

Maintain regular routines for sleeping, eating, hobbies, social interactions, and exercise for better physical and mental health. Use problem-solving techniques for work, family, or health-related issues.

Take precautions while going out and doing routine chores. The pandemic should not halt your work. Take specific precautions while entering crowded places.

Use anxiety reduction techniques like deep breathing, meditation, muscle relaxation technique, and mindfulness. One of the methods I would like to mention is abdominal breathing. If we practice it daily for 5-10 minutes, it helps in reducing anxiety.

In abdominal breathing, you need to inhale air gently and slowly while counting to four. Expand your belly as you breathe in. Hold your breath for two counts. Exhale slowly through your mouth for a count of six. This helps your mind get relaxed. Practice it daily for 5-10 minutes or whenever you feel stressed.

Altruism

Many altruistic activities have helped people during the pandemic. The acts of kindness helps stabilise the mind and reduce anxiety.

For instance, healthy people can help others who are in need through certain altruistic activities like by providing essential services such as food, health services, taking care of the elderly, and voluntary services.

Be sure to follow all precautionary measures while doing so.

What if all of this is not working?

Many times, even after trying all these things, we might not get desired results or still feel stressed.

The best possible option, in this case, would be taking professional help from a counsellor, psychiatrist, psychologist, or doctor nearby. 

Right now, many doctors are providing online consultation facilities for treatment and rehabilitation of a person. It is another good option if you are not able to balance life.

Take-Home Message

Stress is a normal response to any emergency. In the last few months, all of us have been feeling anxious amidst the pandemic due to various reasons like health, education, job, and day-to-day functioning. It is only in your hands to cope up with stress.

As Dr Rajkumar has rightly said, we should control what is in our hands rather than worrying about things that are beyond our control.

Gathering correct information, a healthy routine, relaxation methods, problem-solving, accepting the situation, breathing exercises, and not giving much importance to thoughts help balance life and fight this crisis.

One thing I would like to add here. If your mindset is fixed, then you will be scared and worried about things that are not under your control. However, if your mindset is of growth, you will think about taking precautions and developing skills.

If your mindset is innovative, you will learn from the situation and make the most of it.

What you want to learn and which box you choose is up to you.

In every crisis, there lies an opportunity. If you are balanced enough to handle the crisis, you can turn it into an opportunity.

Dr Rajkumar: As Dr Soni said that every crisis opens up an opportunity, so you should never give up. Perhaps this prayer sums up our message very effectively – God, grant me serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

The mind is a wild horse. You need to learn to tame it. The two things you need to command are cognition and emotions. If you can master these two, you can guide the horse in your preferred direction. The mind is impulsive. It will keep testing you. It is your ability to see, contain, and give it a direction by critically evaluating your thoughts. Reinforce the goal-directed rational thoughts that will help you live a quality life and ignore the others.

Vikram: Please help us understand about the works of Alpha Healing Center.

Dr Rajkumar: We at Alpha Healing Center follow a holistic approach to help people who are affected by substance abuse. In this, first a detailed psychiatric evaluation is done. If we find the patient suitable to get into our centre through voluntary admission, we take them in and usually detox them. After detoxification, we expose them to a variety of treatment measures in the form of psychological therapy, art therapy, hypnotherapy, yoga, music therapy, swimming, and other outdoor/indoor activities. 

There is a proper schedule from morning 7 a.m. to evening 10 p.m. We keep them engaged so that they are able to help themselves and work out conflicts gradually. The primary therapist looks after the conflicts that have either been the triggers for the substance use or its sustenance, helping patients learn new coping mechanisms. Psychiatric treatment also goes along with it. Medications can also be used for managing cravings or mood disturbances. About 30-35% substance abusers will have mental illness or about 30-40% people with mental illness can have substance abuse problems. Comorbidities have to be addressed, so there would be medicinal treatment as well.

Rehabilitation needs at least 10 to 12 weeks. So, we have our 12-week program, which consists of medical treatment and psychological therapies. It has a strong follow-up as well.

Rehabilitation centre is the first step in addiction management, it is not the end. The rehab programme continues life-long because addiction is a chronic disease. It is not something one can make a wish to come out of. It needs strong support.

In the follow-up, we look at their ability to manage the triggers, situations, and find better coping mechanisms for their life to be smooth. Life is always a challenge to an addict. We at Alpha wish and commit to stand by them and help them work out. 

If we find the family is either the trigger or cause of substance sustenance, we also involve them in the family therapy process during the 3-months course at the centre.

Vikram (Question from the Participant): Do you think when the vaccine comes out, people will start living a normal life as before without worrying about getting infected by COVID-19?

Dr Rajkumar: We must understand life will now be evaluated as pre-COVID and post-COVID. The scenario is bound to change. We all have been saying until now that together we are strong. Even if a vaccine comes out, there are mutant strains of the virus for which one vaccine may not be the solution. We are finding different strains of the virus of which some are virulent while others are mild. Merely because we have a vaccine will not give us a blanket cover and we should not think that we are free to go back to old ways of living. This change is permanent in our life. We have to educate ourselves and condition our minds to adapt to the changes.

Vikram (Question from the Participant): What are your views on suicide cases? Do you think the number has gone up? What could be its solution?

Dr Rajkumar: Humans are insecure because they don’t know what will happen in the next moment. The pandemic has only enhanced this insecurity. It has made it difficult to find or connect – physically or emotionally – with the people around because everyone is concerned, worried, and tensed. A sense of desperation is creeping in. This is where you need rein in the two-horse within, i.e. the mind has to be reined in. Thoughts and emotions must be understood. You need to learn the do’s and don’ts of the things to reinforce. An array of behaviours and activities will help you gradually develop resilience and cope up.

Suicide is never a solution to any problem. How bitter or bad life may be today, there will be opportunities. As good times don’t stay long, bad times don’t stay long either.

I always tell my clients to believe in themselves, have faith, and be a die-hard optimist. It will help you look forward in life. You have to practice as it does not come on its own.

Vikram (Question from the Participant): The pandemic has forced us to stay alone. Even if we want to travel, we cannot do that out of fear or love for our family. We have also chosen to stay alone, away from our family. This has taken a toll on mental health. What is your advice as per the current scenario and for post-COVID to balance life?

Dr Soni: Humans are social animals. We live alone because of one or the other reason. The difficulty arises when we are not comfortable with ourselves – be it our emotions, issues, or trauma. We find it difficult to handle ourselves. It is where the social aspect can help us connect with people not physically but virtually. Also, the spiritual element – the more we understand the meaning or purpose of our life, the calmer we start to become. For those who are believers, faith helps during such a crisis. We have to figure out ways to communicate with people like our meeting right now. We have to talk, interact, and share our emotions and feelings. It will help us tackle loneliness. Spend time with self.  

Dr Rajkumar: We all have to pay a price for what we do or don’t. Acts of omission and commission always come with a price as actions and thoughts we profess and practice have consequences. We must learn to evaluate the merits of a situation.

If I go or stay back, what are the merits? Is it worth it? This is something we must convey to ourselves and practice routinely, not only during the crisis.

Secondly, loneliness is mostly a state of mind. We all are lonely even in a crowd. We all can have a company even when we are alone. It is what we are conveying to the mind. It again comes back to cognition and emotions. If we can command or control them, we can make the right call at the right moment.

My advice to people who have suicidal thoughts is to talk to a doctor or therapist. Talk to someone about it because this thought cannot be just gotten rid of. You have to gradually resolve it in your mind with external help. There may be a need for some intervention, either physical or chemical, depending upon the evaluation.

Vikram (Question from the participant): The next question is about homemakers and the friction inside homes. People are now living together in closed spaces. Apart from being really close, they feel like they don’t have any personal space. It is tough in a city home living 24 hours with the entire family. What is your advice to make sure things are in order, and there are no unpleasant situations?

Dr Rajkumar: Healthy communication is of prime importance. You have to respect other people’s thoughts and actions. If you accept that, the other person will also do the same. We must learn to agree to disagree because every person can have an opinion. Space is something that we have created around us. Those spaces are bound to be intruded by other people in one situation or the other.

We must accept that it won’t happen overnight. It will evolve gradually. A conscious effort has to be made. It is why we tell our clients to be mindful of what they want to do or are doing so that they can handle that particular thought or behaviour.

Once you accept, it is easier to cope up with the situation. It is an evolving process. Initially, there will be a little tug of war. We must practice this to establish an equilibrium gradually to become comfortable even in crowded spaces.

Dr Soni: It is like fine-tuning your radio. Suppose a frequency is coming at 98.3. Until you adjust the receiver appropriately to reach that frequency, disturbances and noises won’t go. Similarly, you must try to communicate and adjust to make the perfect musical harmony. It is all trial and error. You will slowly reach that state if only you keep the channels of communication open.

Vikram (Question from a participant): Is there a way to identify the suicidal behaviour of an individual?

Dr Rajkumar: I cannot say that we have a 100% guaranteed way of identifying this behaviour, but we can see people withdrawing who were formerly interacting, communicating less, feeling low, irritable, being lost in their thoughts. They may be voicing their suicidal behaviours or thoughts as fleeting thoughts, not necessarily as being consistently present. Perhaps the people in the surrounding would be able to pick it up at the earliest. Change in attitude or behaviour from the usual routine of the individual should somewhere tinkle the minds of the surrounding people.

These changes should be looked into for subtle depressive features.It can help put a query in the minds of the people around to reach out for help. 

Vikram (Question from a participant): With so many restrictions going on and Alpha Healing Center being located in Vadodara (Gujarat), are the admissions still open for the programmes?

Mr Patel: During the peak months of lockdown, our centre was open for admissions as a part of essential services. We have always advised people to seek local help for emergencies. If you are planning to come for recovery, whether it is due to substance use or mental illness, certain protocols must be followed. For instance, if a person is travelling from Mumbai or Delhi, he needs to get all the required reports from a doctor for evaluation. We receive these reports through email or WhatsApp. As per the doctor’s assessment, we advise the patient to visit.

The second question is, can they come only for a visit? We have a virtual tour facility for this. We show the facility via a 10-15 minutes WhatsApp video call so that they have a fair idea of the place before visiting.

The third question is about travel. In the early months, due to travel restrictions trains/flights were not operating. Now those restrictions have been eased for travelling. The government has introduced a system wherein you can take an e-pass for travelling via road. Initially, we proactively applied for the e-pass to respective state governments and got it approved for our patients and their family. After the e-pass approval, the family could travel and visit the centre. If they were willing and our team of professionals approved, we took the admission. 

For a virtual tour – once the individuals visit our website, they can fill up the form. My colleague and I contact them and enquire about their problems in confidentiality. If it is a technical discussion, we arrange a meeting with the doctor. If the discussion is regarding the visit, my colleague arranges a video tour based on their convenient time. Through a WhatsApp video call, we give them a tour of the facility, which also includes details of the programme. If they want more technical information, a doctor answers their questions.

Dr Rajkumar: Usually, if it is a single or two substance abuse problem, we advocate a period of at least 3-months at the centre. Evidence has shown that 60-70% people who stay for 3-months in a rehabilitation centre are able to maintain sobriety. But not all of them agree to commit to a 3-months programme, some opt-out at the end of 1 or 2 months. For those who have stayed for one month, the rate of relapse is as high as 60-70%. The rate of relapse is between 40-60% for people who opt out at the end of 2-months.

It means the shorter the duration of stay, the higher the relapse rate. We have seen this and put forth our views from the records we have had.

In case there is a mental problem associated with the addiction, the duration of stay at the centre can be longer. In the case of comorbidity or multiple addictions, the treatment plan needs a longer period. There can be schizophrenia and addiction or bipolarity and addiction. The treatment duration can range between 4-7 months depending upon the individual.

Vikram: What message would you like to share with our audience?.

Dr Rajkumar: I look at life or my personality in three facets – personal, professional, and social domain. I must have a mix of activities in all these three domains every day of my life.

The personal domain activities include anything that can enhance your self-esteem. It could be any hobby, exercise, music, or a game. There must be two or three such activities.

Healthy social interaction within the family and outside is a must.

Depending on age, there are some professional responsibilities that you have to shoulder – be it as a child, adolescent, adult or as an elderly individual. There are professional responsibilities which you have to take up and get involved in them.

A healthy mix of activities from these three domains is essential for a strong personality to evolve like a balanced diet is needed for a healthy physique.

I always keep saying that you have to take responsibilities for the consequences of your thoughts and actions.

Mr Patel: In the last 3-4 months, positive thinking has helped me believe in myself. There were challenges in the peak months of March and April when everything was shut down. If I look at the last 2-3 months, much knowledge has been gained by the medical fraternity. The way the governments and countries have taken initiatives around the world, we can now travel safely.

Many restrictions have been eased. Earlier, we were not able to go out. If we practice wearing masks, maintaining social distancing, and sanitising our hands, I think we can live a more peaceful life. At the same time, we can bounce back slowly in the activities that we were pursuing earlier.

To take accountability of our actions, we must evaluate our priority and urgency of the situation. My job continues to be a priority, but my family needed me more; therefore, I decided to travel with my family. This is a positive sign.

On the side of my professional work, I am able to pursue my work irrespective of the place. This is something I have learned and practised over the years. I would advise all the communities to follow the same.

Dr Soni: You have to learn to accept the situation. If you focus on the things that are beyond your control, you will feel miserable. Learning to accept the situation as it is helps take it as an adventure that you can try to overcome. You also have to remember that nothing is going to be permanent. This too shall pass. You just have to hang on. Rather than overthinking about it, have faith in yourself. You will be able to overcome this pandemic crisis.

If you have any other substance abuse problem, get help as fast as you can. Go to your nearest psychiatrist or a rehab centre and get the help you need. All the rehabilitation centres are open. 

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