Using telehealth to find coping skills

LACONIA — In telehealth sessions via phone or computer, Jayme Sullivan, a therapist at Lakes Region Mental Health Center, gives her patients tools that encourage mindfulness and their ability to live in the present.

“Put your feet on the floor and close your eyes,” Sullivan speaks to her laptop’s camera and microphone, while her image appears on screens in her patient's home. “Take a long deep breath, in and out. Let your shoulders drop away from your ears. Repeat that breathing, in and out.  Open your eyes when you’re ready."

“Typically people say they feel so much better,”Sullivan said.

For the past three weeks, Sullivan has used telehealth for one-on-one “crisis therapy, getting people acclimated to the new norm” during the coronavirus pandemic, which requires social distancing and sheltering at home – and avoiding contact in public places including doctor's offices,  whenever possible.  This week she’ll use telehealth to deliver dialectical behavioral therapy to a group of patients with borderline personality disorder, while they tune in together from home.

“A commitment to a DBT program is a commitment to create a life worth living and to stay alive,” a pledge that’s well served and monitored by telehealth, Sullivan said.

Her eight adult patients with borderline personality disorder – ranging in age from 19 to 76 – struggle with urgent and overwhelming emotions. Minor incidents, major upheavals, disappointments and misinterpretations of statements by others can provoke bad decisions, risk-taking, self-destructive behavior, as well as thoughts of suicide, Sullivan said.

Using telehealth, participants track their daily lives, emotions and coping mechanisms in diaries they discuss weekly. “We talk about challenges that come up, triggers and prompting events” – including financial setbacks, fights with partners, and lost sleep – all of which increase emotional vulnerability. “We talk about what kinds of skills you might use before you resort to drinking.”

Through telehealth, patients learn how to use activities to distract themselves from negative feelings, and apply self-soothing strategies, such as taking a hot shower, wrapping in a warm blanket, eating chocolate or walking a pet.

After beginning private sessions through telehealth with calming and centering exercises, "I might say, ‘Now tell me a little bit about what you’ve been up to for the past week. Have you participated in any self-harming this week?  Are you drinking at least eight ounces of water? Physical distancing – yes. Social isolating – no.  Are you connecting by phone, email or Facebook?’”

One woman told Sullivan during a telehealth session that it’s getting easier to become skillful. "We validate that this is hard work and we encourage them. If there’s any time we need DBT, it’s now,” Sullivan said. “We’re walking this journey with them.”