Given all we’ve been through during the COVID-19 pandemic, it may come as no surprise that mental health issues have been on the rise. In fact, the number of people who reported symptoms of depression or anxiety rose substantially when COVID-19 descended.

Options like virtual appointments and apps have made therapy more accessible for people in distress. But many still hesitate to reach out for help. After all, how do you know if you really need to call a therapist? Will therapy even be helpful? How long will it take to see results?

To answer these and other questions, we recently spoke with Soltana Nosrati, a psychotherapist with Novant Health Psychiatric Associates in Huntersville, North Carolina.

Healthy headlines (HH): What trends have you seen in peoples mental health since the COVID-19 pandemic began?

Soltana Nosrati
Solatana Nosrati

Nosrati (SN): COVID threw everyone for a loop. When too much comes at you at once, if you don’t already have or know how to adjust your coping skills, you can develop mental health symptoms.

Think of it like a marriage. If a couple’s marriage is really solid when they have kids, the children tend to magnify that healthy relationship. But if there are cracks in the marriage — and the couple has children because they think that’s going to repair it — that can actually magnify the cracks.

There’s definitely been an increase in anxiety and depression. But I think it's also been more widely acknowledged, so more people are coming out and saying, “Hey, I think I need help.”

It's OK to ask for a little help. Really.

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HH: How can people who are feeling stressed or unhappy know if therapy will help?

SN: If someone’s anxious, depressed or just generally unhappy with their life, I encourage them to consider whether the symptoms are causing a functional impairment in their workplace, home or community to the point where it's noticeable.

For example, maybe someone once could have done X, Y and Z at work. But now they can only do Y effectively, and their supervisor is asking if they’re OK. Or at home: Maybe they were able to shrug off little things and generally got along with their spouse and kids, but now they’re suddenly snapping at everyone all the time, causing tension in their relationships.

Of course, addressing distress doesn't necessarily mean seeking a therapist. Sometimes you just need to give it a little bit of time, and engage in self-care.

But if you're using your distress tolerance skills and coping skills and still struggling, then that's when I would say, OK, it's time to go seek a professional, get some help before this gets worse. Because the longer you hold off, the worse the symptoms can get.

HH: Is therapy the same for everyone?

SN: Therapy isn’t one size fits all, because every single human is unique. If I'm depressed and you're depressed, even though we meet the same criteria for depression, it feels differently for me than for you. So to be successful, therapy must be highly individualized.

For example, I do cognitive behavioral therapy (CBT) with about 85% of my patients, but it doesn't look the same for all of them. In CBT, therapists and patients work together to understand how the patient is thinking about challenges in their life and how to better channel that thinking and how they can shift their behaviors so that they can alleviate their symptoms.

The psychoeducation and the slides I use are the same. But what they take away, how it feels for them, what behaviors they will engage in, and what I say to them that I didn't say to another person — that is specific to the patient and their unique needs.

HH: How long does it take to see results from therapy?

SN: Therapy takes work, and the change doesn’t happen overnight. One small step at a time is how you get better and stay better.

If anxiety is the only issue you have, we can use CBT, and within three months, you will feel better. The anxiety won’t just disappear, but you will be able to see your path forward. 

For depression, it can take about six months to a year, depending on how long it’s been going on and whether there are additional underlying issues. The point is: It does not have to feel like this forever, and it can get better if you are willing to put in the work.

HH: If someone is thinking of seeing a therapist, what should they look for?

SN: You definitely want to look for someone who's a licensed clinician. There are all kinds of licenses that allow people to provide therapy, including licensed clinical social workers (LCSW), licensed marriage and family therapists (LMFT) and licensed professional counselors (LPC). That is not an exclusive list.

Also, make sure you find a therapist you can connect with. If you are not quite sure, and you want to give it a couple of sessions, just let the therapist know. If it doesn’t work, don’t feel badly about moving on until you find the right fit.

HH: When COVID-19 struck, therapy moved out of the office. How successful have virtual and telehealth appointments been?

SN: Well, there's something you gain and something you lose.

With Zoom, I can spend more time with clients, because I’m not spending so much time walking them in and out of my office. It’s given us more accessibility and has also taught patients who never use computers how to connect not only with me, but with their grandkids, too.

On the other hand, I can read people better when I meet them in person than I can on Zoom. Sometimes, someone walks into a room and they bring a vibe with them that you don't get on video, and you can miss out on micro-expressions and micro-behaviors.

HH: How do you feel about therapy apps like Talkspace and BetterHelp? Are they helpful?

Context: A variety of apps can link you with therapists who might work with you via video conversations, or even text messaging.

SN: I think they can be helpful for certain people — but it also depends on how many patients the therapists have to see. If you have too many patients, that takes away from the quality of work that you do.

Also, I think text messages are OK for updates. But in those apps, text messaging can happen just as often as therapy sessions. We need to have boundaries, and it’s important for clients to be able to be on their own, sit with their feelings and do the work. Everything may feel good in the moment, but the true test of a good therapist or good treatment modality — or a good app — is what happens afterward.