In a recent study, it was found that individuals who had undergone therapy for anxiety before the onset of the COVID-19 pandemic fared better in terms of managing their anxiety during the high-stress period of the pandemic compared to the general population. Published in the journal PLOS One, the research highlights the importance of cognitive and behavioral skills in coping with anxiety during global stress events, suggesting a kind of protective shield for those equipped with these techniques.
The COVID-19 pandemic has undeniably had a profound impact on the mental health of people worldwide, with a significant uptick in anxiety levels reported across various demographics. A notable increase in anxiety was documented from the early days of the pandemic in 2020, continuing through the initial rollout of vaccines in early 2021.
Amid this backdrop of widespread uncertainty and heightened perceived threat—a known trigger for anxiety—the study aimed to explore the pandemic’s effects on the treatment outcomes for anxiety, specifically the role of pre-pandemic therapy in navigating these turbulent times.
“At the start of the pandemic, I was terrified about my patients. The Center for Anxiety had to shift 500 patients to telehealth in just 2 weeks, and there were early reports of anxiety, depression, and suicidality on the rise,” explained study author David H. Rosmarin, the founder of the Center for Anxiety, an associate professor at Harvard Medical School, and author of Thriving with Anxiety.
“I was very concerned about our patients with pre-existing anxiety disorders in particular. Surprisingly, I noticed that we did not have decompensations, increased safety risk, or escalations in need to hospitalize our patients.
“On the contrary, I observed clinically that our patients who were in treatment before the pandemic seemed to be doing better than others. This paper grew out of those “on-the-ground” clinical observations: Last year, I realized that we had the data to evaluate whether there were trends, and that’s what we did.”
The researchers conducted their study by analyzing data from 764 patients at the Center for Anxiety, a multisite outpatient clinic in the northeastern United States. Participants were categorized based on when they received treatment: before the pandemic, during its onset, throughout the pandemic, and after vaccines became available. Using self-reported measures of anxiety and detailed clinical interviews, the study tracked changes in anxiety levels across these groups over the course of treatment, specifically focusing on the first 100 days.
The researchers observed a pattern of anxiety reduction that held consistently across all groups, regardless of when their treatment commenced. This trajectory was characterized by an initial rapid decline in symptoms, succeeded by a steadier, more prolonged period of improvement.
This uniformity in treatment outcomes suggests a broad efficacy of therapy in managing anxiety, indicating that the skills and strategies learned through therapeutic interventions like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are robust against the exacerbating potential of large-scale stressors like the pandemic.
“Having an anxiety disorder can make us surprisingly resilient if we get the skills/tools we need,” Rosmarin told PsyPost.
Intriguingly, the researchers found that those who had received therapy before the pandemic did not exhibit a spike in anxiety levels during the early, acute phase of the pandemic, a time of heightened uncertainty and stress for the global population. This observation hints at the enduring nature of the benefits conferred by therapy, suggesting that the coping mechanisms acquired through treatment can effectively mitigate the impact of significant external stressors.
“The findings are counterintuitive, but on the other hand, it makes sense that having a behavioral health concern can actually become a blessing if it sets a person on a more healthy trajectory going forward,” Rosmarin said.
“Our findings optimistically suggests that the acquisition of psychosocial skills — such as recognizing and understanding your feelings, learning how to relax your mind and body, challenging negative thought patterns, and confronting rather than avoiding the source of your anxiety — is a key predictor of mental health, wellbeing, and resilience. Those who acquire such skills can benefit, even when facing significant life stressors,” added co-author Steven Pirutinsky, an assistant professor at Touro University.
However, this study is not without its limitations. The sample, while clinically diverse, was predominantly from a well-educated, higher socioeconomic background in the northeastern United States, which may not reflect the broader population’s experiences. Additionally, the pandemic-onset group was smaller than the others, potentially affecting the study’s findings. Despite these considerations, the results offer valuable insights into the role of therapy in fostering mental resilience.
“Geographically, these patients were in the Northeastern United States, generally well-educated and higher in socioeconomic status brackets,” Rosmarin noted. “However, there is other research to suggest that high SES individuals had the largest increase in anxiety during the pandemic, so in some ways, our findings are even more telling.”
Looking forward, the researchers are keen to explore the positive aspects of anxiety. Rather than viewing it solely as a disorder, they suggest that anxiety can also drive self-improvement when individuals apply effective coping strategies. This perspective shifts the narrative from anxiety as a pathological condition to a potential catalyst for positive change.
“I’m interested in how anxiety can potentially help us to thrive and grow in life,” Rosmarin explained. “We tend to think about anxiety and other concerns as ‘diseases,’ and I don’t think that’s fully accurate. Yes, anxiety can become disordered, but it can also be a catalyst to growth and positive change when people implement tried-and-tested methods in their lives.”
The study, “Response to anxiety treatment before, during, and after the COVID-19 pandemic,” was published March 13, 2024.