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ISTDP core training with Psychiatrist and psychotherapist at Hyderabad IndiaDr. Sonaa Kakar


The Pandemic has opened up a lot of mental health issues Why ?


There is a real danger in the external world . We can catch the virus and suffer a sudden and painful death. Lets say we go into a jungle and are terrified that a tiger or a hungry big bear may tear us to bits. It will generate a Fight and flight response and activate what we call the autonomic nervous system useful for survival . This system leads to symptoms of increased heart rate, sweating, tension in muscles with pain symptoms, bladder and bowel can be affected, blood pressure changes and migraines . This is called a stress response.


When we are happy and sad we like to reach out to people and loved ones, and it helps form close bonds which includes hugging and shaking hands. With the virus our expressions of love and  closeness in relationships are restricted due to maintaining physical distance as well as the direct effect of fear on their own mental states.

The people who would usually connect with us are grappling with the difficulties themselves. Sometimes we shy away from reaching out because of a fear that this may burden our loved ones. Yet sharing is a key to health. People who would greet each other with a handshake or a hug, now are forced to hold their emotions inside and the full experience of warmth is missing in our interactions. This itself creates stress and a feeling of deprivation of closeness and fosters loneliness.


People have lost their loved ones,lost their businesses, lost their favorite past times,and continue to lose time which will never get replaced . In particular the elderly value every hour they live and it can be very hard for them to go through the year without meeting their loved ones. The multitude of losses generate real grief and sadness because it is something which we will never get back . Especially real relationships.

This adds to more grief in the population and guilt among survivors. Doctors and Paramedical staff are the worst affected as not only are they vulnerable and under stress about catching the virus,but they also deal with large scale sickness and deaths,often carrying guilt about not doing enough for one patient or the other.



Every threat brings an opportunity too. This pandemic has shown us that the most important aspect of human connections  is compassion for fellow beings and yourself. Would you like to remember this period as a special time you could work on your emotions, health, skills or relationships. Would you want to pay attention to a part of you that you would like to develop, which might have got neglected in the fast pace of life.

Keeping connections is the key to survival. We are aware that its always an external crisis that brings up our internal crisis. If the pandemic has opened pockets of distress this may be the opportunity to take a compassionate look at your relationships, losses, suffering or emotional difficulties.





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Anxiety about Choosing Therapy

When people come for therapy ,they have either symptoms like depression ,anxiety or relationship issues. Sometimes they are referred for multiple physical symptoms,like chronic pain,headache,irritable bowel ,gastritis which is linked to stress levels.

This dependence on another person(a therapist) for help arouses anxiety as depending on people in the past meant getting hurt. When the patient gets anxious ,he uses his regular coping strategies which he has learnt would help him survive or keep the relationship,  These strategies helped him in the past  because then the thought of losing a relationship with a caregiver on whom the patient depended on for survival was terrifying, but the same strategies in current relationships may cause his symptoms and problems.

Therefore any attempt to know the patient arouses feelings and anxiety and patterns of coping with anxiety.As feelings arise in the therapy ,so will anxiety and unconscious self defeating patterns . Together the patient and therapist  can  notice them and the patient can work towards more adaptive choices and work more closely with his feelings and wants to reach his real potential ,with least distress.


Video on Pathways of Anxiety


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