During the onset of the COVID-19 pandemic, loneliness, isolation, fear of infection and financial woes culminated in a perfect storm of factors which caused depression and anxiety for many Americans.
In the first year of the pandemic, an uptick of depression and anxiety increased on a global scale by a sobering 25 percent, according to the World Health Organization (WHO).
Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during early 2020, compared to the same period in 2019, according to Centers of Disease Control and Prevention.
University of Houston’s RESTORE Lab founder, Dr. Michael Zvolensky (PI) is collaborating with co-principal investigator, Dr. Michael Businelle on a $2.7 million grant from the National Institute of Mental Health (NIMH) to study the impact of a digital therapeutic which promises to alleviate some of the anxiety and depression triggered by the COVID-19 pandemic. The NIMH grant has been funded in partnership with HEALTH Center for Addictions Research and Cancer Prevention (PI: Dr. Ezemenari Obasi)
“It’s not just general stress. It’s a depressive mood, isolation, social exclusion, a bubble of heightened anxiety. It’s becoming noticeable at all levels; all demographics and all age ranges are seeing these changes,” Zvolensky said. “This project is about really testing and developing a digital therapeutic for anxiety and depression that will be easily disseminated and hopefully will be efficacious across a very diverse population.”
Businelle echoed that pandemic stressors and mental health triggers have tipped the scales for many Americans. Businelle explained that even before the pandemic, 11 percent of all Americans were experiencing significant symptoms of anxiety or depression at any given time. Recent research has shown that about 40 percent of Americans now experience significant symptoms of anxiety or depression, according to Businelle.
“It really feels like we all have been in a pressure cooker in the U.S. since early 2020,” Businelle said. “We have been moving from one crisis to the next. When COVID first hit, we didn’t know what to expect. Many Americans lost their jobs. Many of us lost loved ones to COVID. We have also experienced stressors related to George Floyd, political turmoil and the war in Europe. Furthermore, there have been substantial increases in alcohol use and family stress.”
Zvolensky explained that the anxiety and uncertainty created by the pandemic has been profoundly heightened for some underrepresented communities throughout the U.S.
“While the pandemic has had an adverse impact on all of us, to a large extent especially in terms of mental health—certain subpopulations are experiencing more mental health problems including racial and ethnic minority groups,” Zvolensky said.
To allay some of the most sensitive triggers of the pandemic, the digital therapeutic called the EASE app can quickly assess in real-time the most debilitating stressors. Zvolensky said that the EASE app works by assessing anxiety sensitivity and specifically how pandemic-related stress is affecting mental and physical health.
“Through the app, we give them coping tactics that are appropriate to one’s background,” Zvolensky said. “The app has a dynamic feature where people are prompted five times a day, inquiring about a person’s mental health. Finally, we have COVID-19 tracking health feature that is linked to other social and community resources where they can gain help.”
The EASE app study involves 800 participants including 200 Black Americans, 200 Latinx, 200 American Indian and 200 non-Latino White people. Participants are currently being recruited in Oklahoma and Texas, and the initiative has been expanded a nationwide study.
Dr. Businelle emphasized that the EASE app is a timely intervention since it promises accessible therapeutic solutions in real-time especially among marginalized communities who have barriers to health care.
“Importantly, some groups of Americans have faced even greater struggles to obtain quality mental healthcare,” Businelle said. “For instance, many racial and ethnic minority groups like American Indians, Blacks, Hispanics or Latinos have faced additional barriers to obtaining mental health care services. These barriers include cultural stigma to seeking mental health care, lack of insurance and discrimination.”
Supportive features of the app include the psychoeducation and mental health literacy modules that help participants foster coping strategies.
“We have lots of different modules to help cope with grief, anxiety and depression, for example,” Zvolensky said. “In general, there are many people who do not seem to understand how this global stressor has taken a toll. That’s been an eye-opening experience. It is valuable to learn about them, correct cognitive thinking and improve emotional well-being.”
Businelle elaborated that the app had two basic components, including mental health check-ins and psychoeducation videos and mental health messages.
“First, it prompts morning and evening check-ins that provide tailored messages designed to meet the current needs of the users,” Businelle said. “Second, the app contains videos and messages which explain the basics, like what mental health is and how psychological interventions work. The app’s coping toolkit aims to help users boost their coping skills, including coping with stress and worry, coping with sadness and depression.”
Delving into the more profound findings about mental health concerns during the pandemic, Zvolensky underscored a deeper truth about mental health often running an imperfect course throughout a person’s lifetime.
“Mental health requires active care—self-care and self-awareness,” Zvolensky said. “It’s an awareness and understanding that no one has perfect mental health their whole life. It waxes and wanes over time. That element is interesting to me. Historically, we’re so focused on getting the right treatment. We wanted to put together the best evidence-based digital therapeutic that tries to cover the range of things that need to be covered.”
The need for self-monitoring and self-care has been especially heightened during the pandemic, and technology has become an essential tool for mental health interventions.
“The pandemic made us all rely on technology more,” Zvolensky said. “We found that more people are utilizing digital health platforms to deal with health and mental health issues. We are very intrigued by why what we might find.”
For Zvolensky and Businelle, developing the EASE app was an approach that could offer an accessible strategy for real-time therapeutic and educational support amid the uncertainty of the pandemic.
“Even before COVID-19, there weren’t enough counselors, psychologists, and psychiatrists to meet the needs of the public,” Businelle explained. “Now that the number of adults with anxiety or depression has tripled or quadrupled, there are even longer wait times to receive needed mental health services. Our current mental health system is over-stressed and under-resourced.”
The intervention is also an important, visionary step to therapeutic approaches in preparation of the next pandemic, according to Zvolensky.
“When your stress is tapped, your mental health is going to drop,” Zvolensky said. “When you’re under chronic stress, your mental health will worsen. It’s the chronicity of this which is exhausting. We will be better prepared when the next pandemic comes. This is certainly not the end of it. As a society, we can also adapt and be prepared.”
By Alison Medley