Dr. Rachel Goldman joins Rick as a special guest discussing mental health during the times of COVID-19 and how CPTs can support themselves and their clients. What is within our scope of practice and when we should direct someone to a mental health professional. Also discussed are ways to bring up seeing a mental health professional in a way it can be best received. Dr. Rachel is a clinical psychologist and assistant professor at the NYU School of Medicine Department of Psychiatry. She specializes in health, wellness, weight management, eating behaviors, stress reduction, behavior change.
If you'd like more information, check out this Guide for Personal Training and Staying Healthy During COVID-19.
Rick Richey (00:14):
Welcome to the NASM CPT podcast. My name is Rick Richie and today I have another guest. It is Dr. Rachel Goldman and she is a mental health expert and she focuses on health and wellness and I thought she'd be a wonderful person to have on the show today because we've got a lot of things going on, a lot of uncomfortable things within the realm of COVID-19 and what's going on with Coronavirus and how people are displaced in so many ways. They're being displaced at work, they're being displaced because they are sick, they're being put in hospitals and displaced in hospitals.
Rick Richey (00:54):
I just thought it'd be great to have a conversation about mental health and what is it that the certified personal trainer and the fitness professional can do and what are some guidelines that we can follow to help support people within our communities and I thought she'd be a great person to have on the show. I've done other podcasts with her in the past and been on panels with her. She is definitely a great resource for us. Let's welcome her. Hey, Dr. Rachel, thank you so much for being on the show.
Dr. Rachel (01:24):
Hi and thank you so much for having me. This is such a difficult time for many people, so I'm excited to be able to talk to you about ways that we can help others during this time.
Rick Richey (01:37):
Yeah, thank you. Thank you so much and I know that you have a close relationship with a lot of people in the medical profession. There are a lot of people that are getting sick right now and there are a lot of people that are focused on the physical and rightfully so, but can you talk us through some of the things that are going on within the mental space and the mental discomfort that people are experiencing from kind of your position and your understanding?
Dr. Rachel (02:07):
Sure. So there's so much going on if we just think about the mental aspect right now from something as, I don't want to say simple, but from something you know like health anxiety and just fear right now about either getting sick or what to do in this situation. So there's a lot of anxiety. There's also, if we think about people being quarantined right now that can be very isolating for many people, but in particular perhaps people that are living alone or the elderly and like you had mentioned, people are in the hospital and when people get sick and they're on the hospital family members aren't really allowed to visit them. So there's a lot of isolation which can cause depressive symptoms as well. So I would say most of what we're seeing right now is obviously an increase in both anxiety related symptoms and depressive symptoms.
Rick Richey (03:05):
Is there a concern that some people may not be focusing so much on what they can and should be doing regarding their mental health?
Dr. Rachel (03:18):
Yeah, I think generally speaking, I think if we even just talk about anxiety for one second, we feel anxious and we feel worried and concerned when we feel like there's things out of our control and I think many people just generally speaking right now are feeling like there's so much out of their control that that can then lead to the symptoms and these feelings. I mean, I think New York as a whole has been really trying to focus on the mental health aspect as well. I know I've seen it on the news a lot. They're sharing helplines. They're talking about the mental health during this time, but I do think unfortunately there hasn't been as much talk about it nationwide or at least I haven't seen as much about it on the news.
Dr. Rachel (04:10):
Many of my mental health colleagues have been trying to do what they can given the space that we're in right now, offering virtual support groups, virtual community gatherings. I've even had three in the past week. We are trying to get out there and offer information as well as tips and things to do, but I do think it's difficult to focus on that when we are being surrounded by this negative news right now and fear that's really around in the world as a whole, not even in our minds, but it's a reality right now.
Rick Richey (04:50):
Right and you and I are both based in New York. I'm on the upper west side. You're in Kips Bay. We're not far from each other. We're in Manhattan so we're not far from anybody else in Manhattan. I think that's a big problem. Social distancing is being one of the primary mitigating factor. So self quarantine and stay in your house, non essential employees only.
Rick Richey (05:16):
There are a lot of people who are working right now that are really scared and there are a lot of people who are not working right now that are really scared and really nervous. I think for a fitness professional, our therapy a lot of times, self therapy and those are a little air quotes right there. I'm just going to go run it off or the gym is my mental health and in many instances there is a strong correlation with exercise and increase mental clarity and decrease in anxiety, but there are limits to that. Can you talk about some of the benefits that exercise may cause and when is it that we have to either say to ourselves or to maybe even suggest to a client, there's a next step that needs to be taken for you?
Dr. Rachel (06:09):
Right. Especially I think to the audience that we're speaking with and speaking to right now, running or exercise or going to the gym to sweat it out is a form of therapy and to be honest, I always joke I'm a psychologist, but that's also my therapy. I get that and that can be very difficult right now when we are socially distancing ourselves and gyms are closed. It's important to continue to use your coping mechanisms and that's really what it is in psychological terms. It's how we deal with situations when we're feeling stressed or emotional. So it's a coping mechanism and it's a very healthy coping mechanism for many physical and mental reasons, but we have to continue to use the coping mechanisms that work for us, but we may have to just tweak them a little bit and be creative with how we do that.
Dr. Rachel (07:07):
I think it's been great that a lot of trainers in gyms have been offering online training or online gym classes or sessions. We are still allowed to go outside if we're socially distancing to be active and exercise if that's a run or a walk, as long as we are practicing of course that's socially distancing. I think that's great, but I think at the same time we have to kind of look within ourselves and we have to be insightful enough to know when this isn't working for us anymore and when maybe we need a higher level care or we need some extra support so when that in home workout isn't working and you're still feeling anxious or depressed or have these symptoms or having some negative thoughts, that would be a sign that maybe either that's not working for you any longer and or you just have to switch it up and maybe pull from some other resources that you have.
Dr. Rachel (08:12):
I do tend to tell everybody that we should all have at least three go-to coping mechanisms or behaviors. So one of them that obviously we've discussed is exercise, another one... It could be anything really. It could be calling a friend, it could be reading a book, it could be watching TV, but everybody I recommend having at least three because for instance, if it's really bad weather out and your go to is running, then what are you going to do. If your go to is I'm going to call a friend or call my trainer and your friend or your trainer is not available at that time, then what are you going to do?
Dr. Rachel (08:52):
I always say that one of the three should be something internal that you don't need anybody else for. Perhaps that's a form of meditation or diaphragmatic breathing, like a breathing exercise, but that would be a great time if your go to is not working for you and you still feel those symptoms, say your heart is beating fast, you're feeling anxious, your mind is racing. That would be a time to go to another one of your coping mechanisms and if that also is not working, I would say it's time to reach out for some other support and there's lots of support out there, lots of resources right now that people can be pulling from and I really encourage people to do that. We all need help sometimes and it is not... It does not mean that there's anything wrong with you. It just means that you're human and sometimes we need a little bit of extra support than other times.
Rick Richey (09:43):
I think that's so, so valuable for us. Sometimes we downplay mental health. I think sometimes we downplay mental health in ourselves and other people we can look at it and go, "I can see that they need help," and maybe not focus on how we're being affected by certain things. I think it's valuable to continue to point out and you said it, we try to say it and acknowledge over and over again that just like the heart, just like the lungs, the body, the brain is one of those things. It's part of who we are and it can get sick too and not just physiological, pathological sickness, but there are cognitive strains that get put on, but things like anxiety and depression that really take a toll on people in so many ways between their health and their relationships and their ability to work and work well with others or to stay focused.
Rick Richey (10:53):
I'm wondering just for us in the fitness world, so personal trainers, fitness instructors, people who are working in corporate wellness that have one on one clients, people that are teaching classes. When we have the opportunity to talk to people, we're oftentimes seen as professionals even if we're not a professional in that particular field. So people will ask us what do we think about certain foods and this and that, and we might not be a nutritionist or a registered dietician or... What are some ways then for us in the fitness world and the fitness profession to provide, I guess not so much... I guess not what a licensed professional would do, but any tips that you could give us as non-licensed individuals that can just provide, not counsel, but support for people. What are some things we can do?
Dr. Rachel (11:51):
Yeah and that's such a great question and I think especially given what you have said, so many people do come to fitness experts and professionals looking for those answers as well and I think something that everybody can do regardless of what your area of expertise is, is one to listen. That is being so supportive right there just by listening to somebody and also to validate their feelings. So I think right now in particular many people and I would almost say everybody is feeling some sort of negative emotion at some point during this situation and I think just normalizing that for people in the moment can be very valuable. So by saying something like, "I completely understand what you're going through. It's normal to feel this way. I'm feeling this way also."
Dr. Rachel (12:48):
Kind of validating those feelings can be very helpful because then people aren't feeling quite alone in such an isolating, socially distancing world that we're in right now. I think listening, giving that validation and then I would also add... One of my top tips for people during this time is to continue or maintain some sort of routine or schedule. I think for instance, if somebody is coming to you as a fitness professional and somebody that you used to train, I would encourage you to find a way to continue to train them if that's through some online support or a phone support or even an email sending some workouts to do because that helps people stay, I don't want to say sane in the clinical sense, but it really helps people with just less anxiety, less overwhelming feelings.
Dr. Rachel (13:54):
What happens is whenever there's a disruption in our routine or disruption in life in general, people get very overwhelmed and anxious, they lose focus, it's hard to concentrate and by just maintaining some sort of structure is helpful and I think personal trainers and fitness instructors can very much so help individuals with that by at least helping them maintain that structure that they had with them even if it's a form of communication and maybe not physically training, but some sort of structure, they can help with that and they can encourage their clients to do that as well. You don't need to have a PhD in any area to say that maintaining structure is going to be helpful. What time have you been waking up? Do you have a bedtime? Are you eating regularly throughout the day? Just kind of like a general check in with somebody.
Rick Richey (14:47):
I love that. It's creating normalcy during abnormal times.
Dr. Rachel (14:53):
Rick Richey (14:56):
I'm going to bring this up and it's probably something that you've heard before, maybe even from some of your clients or patients about their trainers, but I guarantee every single person that's a fitness professional that's listening to this has felt that they've played the role of therapist at some point and sometimes at every point during their relationship with a client that people do come to us, not just for the physical, they do want to talk about their day and they do want to talk about their lives. This realm... I even had a client one time years and years ago, she had gotten laid off at work and she was going to therapy I think probably three times a week and she was seeing me twice a week and she said, "You know what? I think I'm going to cut down on my therapist and come and see you more because I tell you the same things that I tell him, but we also work out." I was like, the problem here is that I don't counsel you. I just listen.
Dr. Rachel (16:00):
Right, but the power of listening is quite powerful just that even so that's good.
Rick Richey (16:08):
I think you're right. I mean the fact that she felt that way and I don't know if it was in jest or not, but many a truth are spoken in jest and a lot of trainers out there know exactly what I'm talking about and that people do come to us for that. What we want to be careful of, Dr. Rachel, is we just don't want to overstep our boundaries so the parameters that kind of give us an idea of what we can do and I think we have an idea of what we can't do and we're certainly not diagnosing anything. We're certainly not telling people what any particular type of counsel that they may need regarding behaviors and what they should do, but listening to people, as you said, being there for them, the fact that we might be their coping mechanism or at least to be the provider of a coping mechanism through exercise is a valuable.
Rick Richey (17:06):
Is there anything else that, aside from being just really a strong listener and a pillar for somebody to lean against and still understand that we as fitness professionals also have to understand where we need to draw the line and say, "Hey, I can't be the person that listens to you talk about these things. I can't do that. I'm not that person for you." What else can we do and when should we look at our client in the face and just say, "I love you. I need to send you to somebody else. You should really..." And how do you address that because it's weird I would think to be like, "Hey, I think you need to go see a mental health professional," when that's not why they're coming to see us and may seem like it's coming out of the blue.
Dr. Rachel (17:59):
Right. It's interesting because I hear this a lot from some fitness professional colleague friends of mine as well, that they reached out to me and say, I really want to refer someone to you, but I don't think they're ready for that yet. I need to give it a few more weeks and then maybe I'll kind of plant the seed that they need some additional help. Yeah, I definitely hear that from people a lot and I think there's a lot we could actually talk about with this because one, you had kind of mentioned kind of the boundary is and I think we have to also remember that as fitness professionals, you need to take care of your own mental health also.
Rick Richey (18:36):
Dr. Rachel (18:38):
It can be extremely taxing on you to hear somebody going through some emotional problems and kind of dumping that in a way on you during all of your sessions. I think you have to be mindful of what you're physically, or rather what you're mentally capable of doing. If you are sensing that you're feeling drained at the end of one of your personal training sessions, that I would say is a sign that maybe it's a little too much. If it's like, "Oh, how was your day?" And it's a little chitchat and then you're done with that piece, then that's fine.
Dr. Rachel (19:15):
I even know that when I have a session and I feel emotionally drained afterwards, that's a difficult client and that obviously would be a sign that maybe they need that higher level care and refer them to a mental health professional, but I would say that would be one of the signs and I would also just remind yourself in terms of when people are coming to you and kind of where that line is, what's allowed, what's not. We are all allowed to be human and I think... Think back to like kind of what would you tell a friend and if you're just telling your friend advice that you would tell a friend, I think that's okay. If it gets to be more like in your head, you're giving more advice, you're giving more this is what I would recommend besides obviously seeing a professional, then maybe that's crossing that line, but as a friend, as a human, we can listen, we can normalize a situation, we can validate feelings, we can be empathetic. Those kind of things are okay for anybody to do, but I would...
Dr. Rachel (20:30):
If you feel like the line is kind of getting crossed, I would have that conversation, although it is a very difficult conversation to have, and you could just say something as simple as, "I want to help you as much as I can, but I really think you could benefit from seeing a professional in this area," and you could even bring it back to the ideas that, "I want to make sure that I'm maximizing your time with what I am an expert with." I want to maximize your time at working out and I don't want us to spend too much time on the emotional piece, which obviously is going to affect it and has a piece of it, but maybe somebody else who is better suited to do that can do that so then we can really focus on your fitness.
Rick Richey (21:17):
I like that. I'm going to draw a parallel for the audience listening and one of it... We might do something like corrective exercise, but we certainly need to know when it's time for us to refer out to a physical therapist who specializes in corrective exercise, but also when people go and do physical therapy, there is a wide range of reasons why people go to therapy. Some people go because they've just had a surgery, they've gotten out of surgery, they've broken bone, they've torn ligaments. These are intense orthopedic issues and sometimes people go because they pulled a hamstring, they rolled their ankle and this isn't as much.
Rick Richey (22:01):
I think every time we think about mental health and referring it, sometimes in our head we're putting people, at least they feel like we're putting them in the category of hip replacement and knee replacement physical therapy when maybe you just rolled an ankle and it would be helpful. Going to see a mental health professional isn't because you're broken. It is because you could still use a little bit of mending. You can use some care. You can use some guidance that a professional allows for that other people can't and it's going to provide insights. It's not because you're messed up. It's not necessarily because you're sick. It's not even a mental health disease. It's may just be because you could use help.
Dr. Rachel (22:48):
Yeah, I love that you added that because I think there is still unfortunately a stigma around mental health that we've been trying to break and I think what you just said is perfect because sometimes people just need a little bit of extra help. What I always tell my clients is the benefit of therapy is that you can talk about you and what's going on in your life completely natural without filtering anything because the therapist, or somebody like myself, doesn't know anything, the people you're talking about, the people you're referring to. You're literally painting us a picture and we are going to react to whatever you are telling us. We don't know anything other than what you're telling us and it's a very special time to be able to do that because you don't have to pretend to be something that you're not. You can just be unfiltered, your true, authentic self and even as people don't feel like they need that at times.
Dr. Rachel (23:52):
We can all benefit from that and we are all struggling to some degree or another given the current situation that anybody, everybody could use that added support and sometimes it's literally like you said, like the hamstring pull. Right now, that's what this id. It's kind of helping people cope better with what's going on. That does not by any means mean that somebody has a mental health diagnosis or an illness. It just means that we are human because that's normal and natural to be feeling this way right now and needing that extra support.
Rick Richey (24:30):
That's amazing. If I could just keep you for another minute, because we did talk about something yesterday when we spoke on the phone and I want you to address it, but it goes back to something that I did in my dissertation where I focused on attribution theory and attributional retraining and it just made me think of it because when you were talking yesterday and then you mentioned it earlier today, that things feel like they're out of control. And you said it's very important to focus on what it is that we can control and not just focus on what we can't control. Can you speak to that for a moment before we close out?
Dr. Rachel (25:11):
Sure, of course. Another one of kind of my go to's choose during this time in particular, but with any stressful situation is to remind people that there are things absolutely in life that are not in our control, but at the same time there are things in our control and if we focus on what's in our control, that is going to ease some of that anxiety and that stress. At the end of the day, the things that are in our control are mainly our behaviors, our actions, the way that we think and how we react to situations. So if we can focus on that, what is in our control, it's going to help us get through any difficult or stressful time as opposed to focusing on what's not in our control, which is actually going to get us nowhere good as opposed to maybe in our mind and we might just feel very stuck if we focus on what's not in our control.
Dr. Rachel (26:14):
In order to move forward we have to focus on what is in our control and there's a lot of things on a daily basis that we can still do that's in our control. For instance, waking up in the morning, setting the clock and maybe waking up at a certain time, doing your physical activity or movement, eating your meals, maybe limiting the amount of time that you're watching the news.
Rick Richey (26:38):
That's a good idea.
Dr. Rachel (26:40):
Right now that you know that's causing a lot of stress and anxiety because people just constantly have the news on all day. We have control over these things and I think it's best for people to, once again, kind of be aware of what's working for you. If you are doing something that's not making you feel good and making you feel low or anxious or depressed, you can change that, but being mindful of what is in your control is actually very powerful and can completely change somebody's emotions and how they're feeling overall just by changing what is in our control.
Rick Richey (27:19):
I love that. I know that there might be a lot of people who would very much like to explore some mental health services for ourselves or suggest that for loved ones and others, but we may not know anybody to recommend. Is there a way to help us navigate that? Are there... I do know that there are some apps out there. I know Michael Phelps was somebody that was a spokesperson for an app. I did a project with a company called AbleTo. I feel like there are a lot of things out there that people can utilize and I don't know where you stand on that. Is that something that people should look to technology? I feel like if not before COVID-19, certainly now during and after, we might forever be changed, but what are the steps? How can we find an appropriate mental health professional to help?
Dr. Rachel (28:16):
Yeah, great question. We're in a very interesting time right now where we're all socially distancing so even therapists like myself, so we went to virtual therapy. If somebody is interested in therapy, you're not going to obviously go to somebody's office, but we're doing online virtual therapy and a great place to find a therapist in general, not even during this time, but always is by going to the website psychologytoday.com and they actually have a find a therapist, psychologist or a counselor search. So that's just kind of like very generally speaking, it's a good place to start. That was psychologytoday.com and then also there are some great apps and I think the apps are great for certain situations.
Dr. Rachel (29:11):
For instance, right now if somebody is feeling a little more anxious or in a little more depressed than normal, this is a completely new symptom for them because of the situation, maybe an app would be helpful. The one that you were referring to with Michael Phelps I think is Headspace and there's some other great ones. There's also great meditation apps if somebody just thinks that they just need like an extra source of support to help them calm down.
Dr. Rachel (29:38):
There's other apps as well, but I would say you need to kind of look at your severity right now. I think if somebody is feeling very anxious and they're feeling like this is out of their control and they really need some extra level of support, perhaps speaking to an expert mental health professional would be better than just through an app at this time, but once again, I think if they're more just general symptoms that we're all feeling, but you could benefit from some extra support an app may be useful for that.
Dr. Rachel (30:10):
Then of course I'm always happy to help people connect with others as well. So if people wanted to reach out to me, I have a great database, just of resources and colleagues around the country that I can refer people to as well depending on what exactly people are looking for, what their symptoms are and even perhaps the type of therapy that may be best for them because there are different types of therapies. So there's different types of therapists as well.
Rick Richey (30:36):
Well what are some of the ways... If you don't mind sharing your social media handles, your email, whatever it is that you would like to share with the listeners here that they may be able to find you in even if it's not to DM you or send you an email just to even follow you and kind of get some insights into you and your life?
Dr. Rachel (30:56):
Sure and I'm always happy if people do want to DM me or email me that they are looking for a therapist, I'm happy to point them in the right direction just remember that email and DM and Instagram et cetera is not therapy. Just to put that out there, but my website is drrachelnyc.com and then my Instagram is also DrRachelNYC and my email address can be found on both of those, but that's firstname.lastname@example.org and once again, I'm happy to connect people, I'm happy to just say hi or whatever people have questions about, I'm happy to provide a resource if I can.
Rick Richey (31:46):
Dr Rachel, you've been fantastic. This has been by far the longest of the NASM CPT podcast episodes and that is probably because having a guest and it's not just me talking, but it's also because you've been so interesting and so helpful and I just wanted to say... I want to express my gratitude to the information that you've provided and the wealth of knowledge that you have. Thank you.
Dr. Rachel (32:11):
Sure. Thank you so much.
Rick Richey (32:12):
All right. Guys, thanks for listening. This is the NASM CPT podcast.