Media Briefings

Social isolation, mental health, and COVID-19

Get Email Updates

What are Media Briefings?

While the most immediate threat from COVID-19 is to the physical health of those infected, the pandemic will also have far-reaching effects on the social and mental health of others living through the crisis. SciLine’s media briefing explored what the science says about how social isolation, fear, and trauma can impact the health of adults and children—all challenges that countless people and communities will face, regardless of infection status.

Journalists: video free for use in your stories

High definition (mp4, 1280x720)

Download

Introduction

[00:00:00]

RICK WEISS: Just to take one minute up-front to introduce some of you to SciLine if you’re not familiar with our work already. We are a philanthropically supported, editorially independent free service for reporters, based at the American Association for the Advancement of Science in Washington, D.C., and we are here to help, in various ways, get more research-backed scientific evidence into news stories and to do that, helping journalists like yourselves make direct contact with scientists and get access to scientifically validated, credible information to put into your stories. We offer a variety of services including our matching service through which you can get in touch with us when you’re working on a story and we will find you, and put you in touch with, a scientist with exactly the right expertise for what you need and someone who has been vetted for both their scientific expertise and communication skills, and other services that you can check out at sciline.org, including media briefings like this one.

The structure for today is, we have three people to talk to you briefly for about five or seven minutes each to make some introductory comments on different aspects of the topic at hand today. Their full bios on the website so I’m not going to take the time to run through them now, but I’ll just tell you briefly who they are and in what order they will speak, and once they have made their presentations you are welcome to hover down at the bottom of your screen and on the Q&Aa box–or even sooner than the end–feel free to stick in your questions, tell us if you want to direct that question to a particular speaker or just generally to the panelists and I will be reading those questions aloud to the panelists for them to provide their answers. So the lineup today, we’re going to hear first from Dr. Roxane Cohen Silver, a Professor in the Department of Psychological Science in the Department of Medicine and the Program in Public Health at the University of California, Irvine.

Her research deals with the short-term and long-term psychological and physical reactions to stress and anxiety, and the media’s impact on some of these dynamics, exceedingly relevant ideas for the situation today. Secondly, we will hear from Dr. Julianne Holt-Lunstad, she’s a Professor in the Department of Psychology at Brigham Young University where her research is focused on the long-term health effects of physical and social connection and isolation. And finally, third, Dr. Robin Gurwitch, Clinical Psychologist and a Professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center and the Center for Child and Family Health. Dr. Gurwitch conducts research on the impact of trauma and disasters on children and will address some of the ways that parents and other adults can support children dealing with the life changes imposed by this pandemic. So why don’t we just get started with Dr. Roxane Cohen Silver.

Presentations

Psychological and Physical Reactions to Stress and Anxiety

[00:03:08]

ROXANE COHEN SILVER: Good morning or good afternoon. I’m sorry, I’m in California, it’s still my morning. I’d like to thank AAAS for sponsoring this morning’s or this afternoon’s event, and I’d like to speak today about coping with the anxiety during a pandemic and how we can best ensure population resilience. This is a stressful time for our country, indeed our world. And we’ve all been through community traumas before. We’ve weathered mass violence, we’ve weathered natural disasters, and indeed my colleagues and I have studied many such events, including the September 11th terrorist attacks, the Boston Marathon bombings, the Orlando nightclub shootings, hurricanes Irma and Harvey. And our research tells us that most will get through these situations. Humans are quite resilient, but somehow this event feels different and it is.

[00:04:00]

And I’d like to take a few minutes to discuss how COVID-19 is unique. This is an invisible threat, we don’t know who is infected and anybody could infect us. This is an ambiguous threat, we have no idea how bad this will get. We have a very uncertain future, we don’t know how long this will last. And this is a global threat, no community is safe. Moreover, our need to social distance conflicts with our natural desire to connect with our friends and family during stressful times. And our typical sources of distractions such as national or personal sports or going to the gym, going to restaurants or bars, movies or travel, are all restricted by this crisis. And it has disrupted all aspects of our lives from our social lives, to our work lives, to the ways in which we worship.

It is extremely important however that we acknowledge that this uncertainty is stressful. And in fact, this anxiety is appropriate under the circumstances. This is a normal reaction to our new normal. And I think it’s important that journalists acknowledge this fact. It’s also important that we tell the truth. The situation may get worse before it gets better. Evidence is strongly suggesting that we are probably not yet in the eye of the storm. But there is a potential to help frame a more positive message, if we work together, we can save lives. And minimizing the uncertainty is disingenuous.

I have been studying the role of the media in the aftermath of disasters for several decades. And it is extremely important for journalists to provide trusted information. People seek trusted information via the media and the media can provide critical guidance in ways in which the public can clearly understand. But rumors and misinformation can appear on social media because it’s not vetted for accuracy, there is no editor deciding what is going to be posted. And sadly, this misinformation can be transmitted widely and very rapidly. And once it is out there, it is very difficult to correct. For about 20 years, my colleagues and I have also studied the ways in which overexposure to the media can amplify stress, with downstream mental and physical health effects, and at the end of my presentation I will present some references that can be accessed on this specific topic.

There are several factors that can impede community resilience such as conflicting political agendas and contradictory messages from our leaders. Insincerity from one’s leaders also impedes community resilience and fostering any kind of community conflict can impede the likelihood of our community bouncing back from this crisis. But there are also several ways in which we can maximize community resilience. We can enlist community support, via strong social institutions that were in existence before this crisis began, such as faith-based alliances. We can promote shared values and community solidarity. And we can bolster confidence in trustworthy authorities such as health professionals who are fighting the disease on the front lines.

It’s also extremely important that we recognize that anxiety is contagious, but so is compassion. And there are ways in which we can bring our communities together, even if virtually. We can take advantage of the technologies that are now at our fingertips. We can encourage positive community outcomes such as altruistic behavior, social cohesion, volunteerism, reaching out to those who are living alone or who are seniors. And as I said, this is a challenging time, but journalists play a very important role, and I thank you for your commitment to helping us as we all cope with this new reality. I have some references that are accessible and can be downloaded free via my web page. Thank you.

[00:09:12]

RICK WEISS: Thanks Dr. Cohen Silver. And I’ll take this opportunity to remind or tell the reporters on the briefing today, all the slides and the reference at the end of the slides, and the video and transcript will be posted on our website within a day or two after this briefing so you can refer back to them. Second, we’ve got Dr. Julianne Holt-Lunstad.

Health Effects of Physical and Social Connection and Isolation

[00:09:37]

JULIANNE HOLT-LUNSTAD: Thank you. I would first like to think SciLine for including me on this panel. In light of the current pandemic, it’s critical that we have evidence-based information and actionable steps to help protect the public. And I’m very grateful for the opportunity to share some of my knowledge of the evidence to help with these efforts. Just to give you a little bit of background on myself, I’m a Professor of Psychology and Neuroscience and my area of expertise is focused on understanding the association between social relationships and long-term health outcomes.

I’ve also been a member of the National Academy of Sciences Consensus Committee that recently issued a report just last month on the medical and health care implications of social isolation and loneliness among older adults. And this report provides a summary of much of this evidence, and importantly this report is available to the public. While the scope of this report was specific to those over 50, it’s important to note that social isolation and loneliness can affect anyone at any age. And so my remarks will draw upon evidence that goes beyond this report.

I want to first start by defining a few related but distinct terms. Social isolation is objectively being alone, having few relationships, or infrequent social contact. Whereas loneliness is subjectively feeling alone. It’s the discrepancy between one’s desired level of connection and one’s actual level of connection. And conversely, social connection is used as a umbrella term for the structure, functions, and quality of our social relationships.

So when it comes to the long-term health effects, we now have robust evidence that social isolation and loneliness are independent risk factors for premature mortality. And social connection is a significant protective factor. So for example, my colleagues and I conducted a meta-analysis which combines data from over 3.4 million participants in which we found that loneliness was associated with earlier death by 26%, social isolation by 29%, and living alone by 32%. And this was an increased riskof earlier death from all causes. Conversely, a similar meta-analysis, this time data was combined from 148 studies with over 300,000 participants. And what this found was that people who are more socially connected had an increased odds of survival by 50%.

[00:13:09]

One thing that is important to note is that these effects of social isolation and loneliness as well as the effects of social connection were long-term. These studies followed people for an average of seven-and-a-half years. These risks and data should not be taken as evidence that people should disregard recommendations to practice social distancing, quarantine or isolation in the face of this very immediate risk due to the virus. So it’s clear to make distinctions between short-term risks and long-term risks. But nonetheless, of course, many people are feeling significant distressed due to these recommendations, and concerned about the immediate consequences to both wellbeing and mental health as well as concerns about potential longer-term effects.

And so first as was already stated, we should recognize that these feelings of distress are normal. This is our body signaling a need to reconnect. Just like hunger signals us to eat, and thirst signals us to drink water, loneliness is thought to be a biological drive that motivates us to reconnect. Throughout human history, we have relied on others for survival and proximity to others, particularly trusted others, signals safety. So when we lack proximity to trusted others, our brain and body may respond with a state of heightened alert. This can result in increased blood pressure, stress hormones, and inflammatory responses, which if experienced on a chronic basis, can put us at increased risk for a variety of chronic illnesses. Unfortunately, our current situation can be particularly distressing because we may be feeling a heightened desire to be with others and with few options to satisfy that need.

So it’s important to identify actionable steps that we can take to help mitigate these distressing feelings. So when we face any stressor, research demonstrates that how we appraise or interpret a situation can influence our physiological response. So one potential option is to shift our mindset. Instead of interpreting the situation as being cut off from others, we can focus on doing this to protect those that we love. When mitigating distressing feelings of loneliness, research has found that mindfulness-based meditation as well as engaging in creative arts and expression may also be effective. We also need to recognize that there are maybe ways that we can still remain socially connected while physically distant. If you are living with others, spend quality time to nurture those relationships. And regardless of our living situation, we can reach out to others, offer support to others. Research demonstrates that perceptions of availability of support, so knowing that you can count on others, can help even if no support is received. And giving support may have a greater benefit than receiving support.

Additional research has suggested that expressions of gratitude may be helpful. Gratitude promotes social bonds and is negatively associated with loneliness. Finally, we need to recognize that we have decades of evidence that document the immediate and long-term effects of social relationships. But most of this evidence predates the use of social media, smartphones and other technological devices. We know much less about the equivalencies that these may have. These are tools that can help us through this crisis, but should not become the new norm beyond this crisis until we have more evidence. These undoubtedly have some important strengths, but may also have limitations, and so we need more evidence to determine the longer-term effects. And finally, I just want to provide some additional resources so that you can look to these sources for additional information. Thank you.

RICK WEISS: Thank you very much, Dr. Holt-Lunstad, and we will move now to Dr. Robin Gurwitch.

Impacts of Trauma and Disasters in Children

[00:18:08]

ROBIN GURWITCH: Well, thank you again for having me here to join the others. I don’t have slides so you’re just going to have to listen to me for about six to seven minutes. So I want to start out with a quote by Helen Keller. Helen Keller once said, “Alone we can do so little, together we can do so much.” And I think in times of COVID-19, this has never been more true than it is today. We’re all in this together even though we’re staying at home. As adults, we’re working to make sense of this new normal, but we also have to remember that our children and our teenagers are also experiencing worries and anxieties related to COVID-19. So how do we help? I think first and foremost, parents and caregivers need to talk to their children and their teens. Don’t wait for them to bring it up.

Even preschool children have heard of coronavirus. If you haven’t already done so, our advice is to take a breath and start the conversation. Words could be as simple as, “There’s been a lot of talk about coronavirus or CIVID-19, tell me what you know about it.” For teens, you may use that opening or you may even say something like, “Tell me what your friends have been saying about it.” By listening, you will hear their understanding and you will be able to gently correct any misinformation and misperceptions that they may have about the disease. Adults may be worried that talking about coronavirus would actually make it worse. But really the research doesn’t bear that out and the opposite is actually true. Research after the Boston Marathon bombing found that stress reactions in children whose parents tried to shield them from that event had more stress reactions, more distress than parents who openly talked to their young children about the event.

The next thing we need to make sure is to continually check in with our children to see how they’re feeling and to validate those feelings. Expect emotions, such as sad, angry, scared, worried. Young children could even be happy because, “Now, I have my parents 24/7.” But they may also be worried about what this is all about. When we validate, we show we understand and we hear them We don’t try to talk them out of it. I mean think about it as adults, when you’ve been told, “Don’t feel that way or feel X way about it.” Are we able to quickly make a shift and all of a sudden feel better? It doesn’t work for our children either. So we need to acknowledge some of our own feelings of worry, but this shouldn’t be coupled with, “Oh, my gosh, I can’t do better.” It actually needs to be coupled with, “Here are actions that I’m taking, here are actions that we are taking.”

[00:21:12]

What we know about children in trauma, tell us that it’s coping strategies and actions that are also extremely important. What else can we do? Again, drawing from research, from disasters and trauma and resilience, there’s several beneficial actions we can take to help children and families cope in the face of coronavirus. We have to understand first of all how children and teens react to stress. The scariest day of my whole life was when they handed me and my daughter and said, “Good luck.” We don’t have a manual. And we certainly don’t have the 1-800 number on the back of Butterball turkeys and Legos and washers and dryers that say, “Call this number and we’ll tell you and walk you through it or you can return it and we’ll send you new ones.”

Believe me, when my daughter was about 12, I would’ve valued that 800 number. Anyway, we need to understand, and we have a lot of research that tells us what children of different ages, how they cope and what it looks like when they’re stressed, oftentimes it comes out in behaviors. We need to also understand and recognize that not only has our worldview turned upside down, we’ve broken with what we think about as our presumptive worldview — what we expect to happen. With coronavirus that’s broken and our sense of safety and security really has shifted and now we have to think about this new normal. So when we think about action steps, we know from the research, routine can be extremely important, particularly for children. But when we talk about routine, we want to make sure that we’re building in family time, we’re also building in calm time, quiet time and alone time.

As Roxy was talking about with the media, we started looking at this in our research after the Oklahoma City bombing, and it was born out after 9/11 and continues to be born out in especially in Dr. Silver’s work, we need to take a break from the media including social media. That doesn’t mean I turn off the television and then I get on CNN online. That means I truly take a break. And children need to be taking breaks as well and it needs to be discussed. Very young children should not be watching this at all. But what know about children is if they’re spending most or all of their time related to tragedies that can increase their stress reactions.

[00:23:55]

We need to make sure that we incorporate good self-care, not only for ourselves so we can better take care of our children, but also in our children. Exercise, rest and diet, thinking through, “What have they done in the past to cope? And how can they take those actions?” Finally, connections, connections, connections. I think the other two speakers spoke about that. I would add that that’s incredibly important for children and teens as well. We know that children that have positive relationships with at least one caring adult are more resilient in the face of trauma. So what can we do to help foster those connections as well as how can we help them think of action steps to help others? If we put that together, then at the end of this, as Helen Keller has said, together we can do so much. So with that I will stop.

RICK WEISS: Fantastic. Thank you very much Dr. Gurwitch. Thanks to all three of you for wonderful introductions to the landscape of anxiety and resilience here. So we’re now going to turn to Q&A. I want to remind reporters who are logged in that you can hover near the bottom there, there’s a Q&A icon you can click on, you type in your questions, feel free to designate a targeted panelists if you wish or just leave it wide open, and I will start sharing some of those questions with our panel.

Q&A


How do isolation and social distancing affect adolescents?


RICK WEISS: So I’m going to start with one right here from freelancer, Bonnie Feldkamp, I write for parenting publications and my question is regarding teens. As asymptomatic carriers, adolescents need to practice social distancing. However, adolescence is a hyper-social time when peers begin to have greater influence than parents. How does isolation and social distancing affect this important developmental stage? What mental health concerns specifically affect teenagers at this stage of development? Maybe we could start with you, Dr. Gurwitch and then others who may be interested.

[00:26:08]

ROBIN GURWITCH: Well, I’ll jump in there. Yes, adolescence is that strange time of life. There’s a great book, the title says it all” Leave Me Alone But First Can You Take Me and Cheryl to the Mall? It’s really where adolescents are trying to develop their own sense of self and they still may need their parents and caregivers, but I have a harder time telling you I truly do. I think that’s why it’s so important to ask the question, “Tell me what your friends are saying?” Because if their friends are all saying, “Gosh, this social distancing thing, I don’t really believe it, we’re doing fine.” Then you know where you can start in terms of that misinformation and misperceptions about risk. I think it is important to talk to teens and to acknowledge, “It is not fun to stay inside, it is not fun not to be able to hang with your friends. All of those things are things I wish we could do again and I wish you would be able to do.”. So validating and acknowledging the distress and sometimes the anger and the sadness that comes with that.

Think about how you can connect. Can you have a group call with friends? Can you play a video game with friends? Are there other ways that you can connect with friends and plan that each day? I think it will help with school learning going online because she’ll at least be able to see that my friends are still out there. But can you think of other ways that they can connect and ask them, “How would you like to do it?” I think it’s also really important to recognize, and to help our teens understand, the reason you’re having to do this even if you are at low risk for having serious problems is while you may not have it, you may bring it home to somebody you care about, or you may not know that a friend has an underlying health condition and you may inadvertently make them very ill.

Really asking the question, “Who are you doing this for? How can you be proactive about doing something for someone else?” So as they move forward, we’ve seen this, for example, after school shootings, can you make some meaning out of something that is very difficult for you? And helping them to do so.


What techniques or practices do you recommend for handling social distancing?


[00:28:31]

RICK WEISS: Great. Thank you. I have a question here from Craig Welch, a reporter for National Geographic. Understanding that susceptibility to depression is at least partly genetic. What kind of life experience better prepares people to handle social distancing? What techniques or practices do you recommend? Dr. Cohen Silver I might ask you to maybe address that first at least-

ROXANE COHEN SILVER: Oh, I think-

RICK WEISS: … Is there susceptibility? Is there’s something that people can do to protect themselves especially if they’re susceptible to depression in these circumstances?

ROXANE COHEN SILVER: … One of the things we know from prior research is that individuals who have a history of mental health difficulties are at greater risk for mental health difficulties after something like a community wide disaster like we’re experiencing. And I think it’s very important that those individuals who are now perhaps disconnected from their preexisting therapist or therapeutic relationships still seek out the connection with those individuals online. There’s a great deal of activity right now to move therapy to telehealth and to provide means by which individuals can connect with their therapists. It is important to recognize that there are certain individuals are more at risk for mental and physical health difficulties. That doesn’t mean, of course, that they’re doomed and there’s no evidence that suggests that individuals are doomed to depression or suicidal ideation.

It’s extremely important, however, that we emphasize what has been discussed thus far by all three of us, the importance of connecting and connecting virtually. We now have that capability. We didn’t have that as many as 20 years ago. So we’re very fortunate in some ways that this incident or this crisis occurred at a time when we have a lot of technology accessible to us.


What are some early signs of loneliness?


[00:30:52]

RICK WEISS: Like the one we’re using right now. A related question that maybe would be targeted for you, Dr. Holt-Lunstad. It is from Noah Glick at the Mountain West News Bureau. What are some of the early signs of loneliness that people should be on the lookout for in themselves or in their loved ones?

JULIANNE HOLT-LUNSTAD: Yeah. So as I mentioned, loneliness is that subjective feeling of feeling alone or that discrepancy between one’s actual level of social connection and one’s desired level of social connection. And so most of us are to some extent experiencing more social isolation, so less social contact, face to face, but loneliness is distressing, it’s our body’s signal to reconnect. And so if you start noticing changes in mood, changes in behavior, this may be ways in which people are beginning to try and cope with some of those distressing feelings. And some ways are healthier than others. And so of course, we want to encourage more healthier coping and discourage more unhealthy types of coping. So some healthier types of coping would be similar to what has already been stated, is reaching out to others through a phone call or through text or other kinds of video, virtual connection to connect socially.

Other ways to cope healthy might be a routine or being active, doing creative kinds of expression. Unhealthier types of coping might include excessive sleep, excessive alcohol or substance use, overeating. These may all be more maladaptive kinds of coping. And so if we can look for those kinds of things in our friends, our family, those that we’re living with, we might be able to identify those that may be struggling.


What is the best way to help people suffering from depression, or who live alone, during social distancing?


[00:33:27]

RICK WEISS: Great. A question here from Gina Barton at the Milwaukee Journal Sentinel. What about people suffering in depression who live alone? People who… Someone sometimes only can get out of bed because they have a job to go to. Is there a way, especially to reach out to them and help them as individuals and as communities? .

ROBIN GURWITCH: I’ll jump there. So I think that’s where we have to recognize that we’re… what’s the new hashtag: alone together. So for that individual, if you know that there’s an individual living alone, think about, “Are there ways that you can connect?” Whether it’s when you’re baking, that you ring the doorbell and leave them some baked goods. Whether it is when you take a walk each day, make sure you wave. Are there things too that if that when you go to the grocery store, can you help that individual by bringing something back? I think finding ways to have that connection is important, but also is there something that that individual may be able to do as well? So it’s not everybody’s doing something for someone that lives alone that we stay connected, but also is there something that individual feels that they’re providing in the community too?

I know the other day in my cul-de-sac, there were three neighbors outside all about 12 feet apart, sharing information about the latest kid’s game in the neighborhood in terms of walking through the neighborhood and spying bears in windows. So it may be that that individual that lives alone can participate in that activity in their neighborhood by placing a bear or another stuffed animal for other children to see. So again, I think it is very true that that individual is certainly more at risk because there’s not a physical presence of someone else, but how do we help keep them connected? And what are one or two things that they put in their schedule every single day to connect with someone else? In some way, shape or form, it needs to be part of their daily routine.


Are there any unexpected positive outcomes from COVID-19?


[00:36:00]

RICK WEISS: Great. Here is something from someone who is working on solutions-based journalism. This is, Amanda Eggert from the Montana Free Press. Are there any silver linings or unexpected positive outcomes to this pandemic that you’d like to highlight? I’d like to leave this open to any of you.

ROXANE COHEN SILVER: Oh, I’ll take a second. We do know from prior research that individuals often find meaning in something that is challenging. They learn strengths about themselves that they didn’t realize previously. They connected with individuals who they hadn’t spoken to for some time. In the last two weeks, I can count on five hands how many people have reached out to me that I haven’t heard from in a long time. So we are making… We’re reaching our friends and loved ones in new ways, we’re becoming more capable with technology, we are finding new ways to connect with our neighbors, and all of this can be a way in which we can make sense of this event. Of course, it’s horrible in many ways. As I said, we don’t want to in any way minimize the uncertainty, we don’t want to minimize the anxiety, people are worried and that is appropriate. But nonetheless, people will find some positives from this experience and to the extent to which they can hold on to that, this is likely to help them cope through it.

JULIANNE HOLT-LUNSTAD: I could probably add a little onto that. One of the potential positives here is I think we’re starting to see quite widely the recognition of the importance of our relationships. And there is some evidence to suggest that one of the leading factors for why people don’t participate more socially is they’re too busy. And this is, as stated, a horrible, what we’re going through is awful. But it’s something that is bringing communities together. We can potentially see more solidarity as communities and society and making time to reach out to others, having that time to have a long conversation on a call, looking out for those in our communities who are more vulnerable. I think that this current situation is helping us recognize just how important that is.


What are the signs of trauma-related stress in elementary-school children that parents should pay attention to?


RICK WEISS: Dr Gurwitch, I think a question here probably for you first and this is from Eva Emerson at Knowable Magazine. For elementary aged children, what are the most obvious signs of trauma-related stress that parents should pay attention to? And what would you recommend parents do if they noticed such signs?

ROBIN GURWITCH: Sure. So when we think about elementary school children, what we often see is that they may be more irritable and whiny, even sometimes more defiant than usual, which is challenging because as adults, we’re a little bit more short-tempered and a little bit less patient. So we have to make sure we take a breath and recognize that their irritability and defiance may be a problem of distress. Sleep problems are pretty common in children, so we can’t rule that out. Children may have physiological reactions, headaches and stomachaches. There may not be a medical reason for them, but they’re still very real. One of the things that’s so important to recognize in elementary school children is that attention and concentration may be reduced. So if you couple my changes in attention and concentration, ability for new learning to happen as easily with a new learning platform, recognize that children may have more difficulty, not just figuring out the platform, but also learning the new information and being able to attend to it as well.

As adults, as caregivers and parents, we need to be a little bit more patient. They may need a little bit more help from us with their schoolwork than usual. Even with chores. And I think one thing we forget is to recognize when our children do well. So if you see your elementary school child doing a good job handwashing, we need to tell them that, “You’re doing a great job helping keep our whole family healthy.” When they are helping out with chores at home, when they are helping out with others, when they are participating in family activities. I can’t underscore [enough] the importance of positive praise for children of all ages, but particularly young children so that they see that you recognize that they are being a help and they’re doing something well. You will increase the chances that they’ll feel better about themselves and repeat that behavior too.


Is it possible for extreme stress to trigger severe or persistent mental health illness?


[00:41:44]

RICK WEISS: Great reminders. Thank you very much for that. A question here from Taylor Knopf of North Carolina Health News, is it possible for extreme stress, disruption of schedule, et cetera to trigger more severe and persistent mental illness? If so, what are the signs of that? And what are the steps one could take to stabilize that condition? At what point is higher medical care necessary?

ROXANE COHEN SILVER: We have some evidence from prior crises that individuals are more likely to engage in unhealthy behaviors such as increased substance use. As we’ve heard thus far, sleeping too much, perhaps eating too much. I think that we’re hoping that this sense of social distancing and social isolation will not continue for six months or more. I think that if it does continue for well beyond one or two more months, we might need to figure out ways to address that. But the challenge is right now that mental health care providers are helping with their own changes in their life circumstances–they’re coping with the ways in which they are providing services to their clients and to their patients—so o I think that this as Dr. Gurwitch has said, a playbook for this, we really don’t know, we can use some evidence from prior stressors, but this one is so different in so many ways that I think we’ll just have to wait it out. I don’t know if the fellow panelists have other information that I’m not familiar with that they can answer this question.

ROBIN GURWITCH: I would like to piggyback on what you just said. I think it’s important to know that there are hotlines out there, distressed or distress hotlines, suicide hotlines, mental health hotlines, every state has a mental health association that probably has a hotline. So if you’re ever feeling that, “I’m feeling overwhelmed by it,” I think reaching out to a hotline is important. There’s also now with new technology texting as people feel more comfortable with that. I continued to do quite a bit of consultation with mental health clinicians around the country. Their clinics have all now gone to telehealth and they’re still continuing to take on new clients and take on new referrals. So my guess is if you are feeling distressed, again, you can reach out to your local mental health association. Some places are having psychologists do a given hour, so they’re setting up for new individuals, but your health centers around the country, your community mental health will probably also have numbers to call or ways that you can get help quickly.


How will social distancing influence the role of technology in our interpersonal relationships in the future?


[00:45:03]

RICK WEISS: A question here specifically for Dr. Holt-Lunstad from Amanda Eggert, Montana Free Press, how do you anticipate that this extended period of social distancing will influence the role of technology in our interpersonal relationships for better or worse going forward?

JULIANNE HOLT-LUNSTAD: That’s a huge question. And in fact, it was a huge question even before this crisis. So we have decades of evidence on the health effects in terms of social isolation and loneliness and conversely, the protective effects of being socially connected. This spans across physical health, mental health, cognitive health. But this evidence is decades old, right? And so it predates the existence of many of these tools that we’re now relying on so heavily. And while there is this growing body of evidence around technology, it’s all very short term correlational. And so we still have so much to learn when it comes to really understanding the effects of this, not to mention there’s so much complexity in terms of the availability of types of tools and applications and environments that we can possibly use and how they’re used and who’s using them.

And so it becomes incredibly complex and now we’re adding this crisis on top of it. So one of the things that certainly will be interesting is that this situation, because we are now in a position where we need to use these tools, it will be a real test of the strengths and limitations. And I hope that this will really step up our scientific evidence around this. One of my concerns though is that this will become a predominant means of communication. And that’s not to say that there might not be strengths of this, but we don’t want to lose that fac- to-face also, we do know we do have evidence of that, and if we lose that, that could potentially lead to a longer-term public health crisis. And so we need to find ways to regain a sense of normal face-to-face social connection once this crisis is over. And where we identify strengths of technology, we can embrace those when there’s evidence to support those. But like I said, I really hope that this really does strengthen some of the evidence around this.

RICK WEISS: And I’ll just acknowledge a similar question from Amanda McCracken, a freelancer in Colorado, “When this is all over, are there any long-term bad habits related to virtual living that experts can anticipate developing among isolated populations?” I know you’ve addressed that. If anyone else who wants to chime in on that point before we move onto something else, feel free. Our tech-enabled future.

ROBIN GURWITCH: I want to cite some research and Dr. Silver, this may be yours. So you jump in. I want to think about social media not only as, “How do we connect?” butut “How do we get information?” And so we know from research that getting information from trusted sources, a consistent message for example from our public health, the CDC, others allows us to somewhat manage our anxieties and worries a little bit more if it’s coming with that single sole message, coming from that trusted source versus getting all of our messages through social media that may have lots of different things happening. So we need to step back. How are we using social media? Is it for connection or is it for information gathering?

ROXANE COHEN SILVER: Research does make it clear that social media is a larger source of misinformation and rumor than we typically get from traditional media. As I said previously, there isn’t anybody who is monitoring and vetting the information for its truthfulness or its veracity. And so it’s extremely important that journalists from more traditional sources who have more traditional opportunities to provide information, provide authoritative information as well as make clear who the authoritative sources are. And I’ve seen really excellent examples of this in most of the media sources that I’ve been following myself. I think that there has been really a tremendous outpouring of excellent, authoritative information, guidance, that has been shared through many traditional sources of media. And I think that it’s extremely important. And that’s one of the reasons I’m gratified to see this panel this morning… I’m sorry, this afternoon because it’s extremely important that we get evidence-based information out to the population.


How do you suggest convincing older kids to stop connecting with friends online when they need to go to sleep at night?


[00:51:03]

RICK WEISS: Well, you’re talking our language here at SciLine for sure. So thank you for that. Question from Jenifer Madden, a freelance reporter based in Virginia. We’ve talked about the importance is communicating through these technologies, how do you suggest convincing older kids to stop connecting with friends online and using video games when they need to go to sleep at night?

ROBIN GURWITCH: Again, I think it’s also about routine. So when we have a schedule, how do you do it now? How did you do it before? Because there is some growing evidence about before COVID-19, about tweens and teens spending too much time on social media and an increase in anxiety and depression and other mental health concerns, sleep disruption because they’re so afraid of turning it off. And so again, we need to step in and put some barriers on that, make sure that you have time that is device-free for teens as well. And to build into that routine, what happens at sleep? What happens at bedtime? What happens to those devices during sleep? Because when sleep’s disrupted, there’s a cascading effect of other concerns and challenges.


What types of community-based mental health outreach are needed for kids without supportive guardians, or those in the foster-care system?


[00:52:33]

RICK WEISS: A question and we’re just about done here. I’m going to squeeze in one or two last questions. And this is from Kavin Senapathy a freelance reporter based in Wisconsin. I’m going to shorten it a little bit, but she’s asking, what kind of community-based mental health outreach should be happening for kids without supportive adults or who are otherwise marginalized, could you comment on, for instance, kids in foster homes that aren’t in ideal situations?

ROBIN GURWITCH: Yes, I think that’s something that is getting talked about but not very loudly. Next month, April, is child abuse awareness month. And I think it’s important that we recognize that there are children where being at home is not the safest place. And so making sure in the context of keeping families safe, if you’re worried about any concern and you can shape it in COVID-19, that somebody may be getting sick or worried, here’s a number to call. So giving children some action steps that they can take if they’re ever worried. If they’re already in foster care, there’s usually an assigned… well, there’s not usually, there is an assigned case worker to that child. Making sure that caseworker’s continuing to check in, so foster parents recognize that. I love Kelly Clarkson, but what doesn’t kill you doesn’t necessarily make you stronger. Trauma upon trauma, we know from all of the adverse childhood events experiences work that the more we layer traumatic events on children, the worse outcome not only in childhood, but also in adolescence and well into adulthood.

We need to make sure that those children absolutely are connected with case workers, with their therapists that they’re already seeing. And if foster parents or kinship care are ever worried, again, reach out, call your local mental health center and ask for help.


What is one take-home message for journalists covering social isolation and mental health during COVID-19?


[00:54:42]

RICK WEISS: Thanks for that. We are just about out of time and I want to give each of our speakers an opportunity just to make a little bit of a closing remark. If there’s one take-home message you want to make sure reporters leave today’s briefing with or a final point you’d like to make, let’s just run through and take a half a minute each to do that. Dr Cohen Silver, anything you want to hammer home at the end here?

ROXANE COHEN SILVER: I think what’s most important is that we recognize that at least for the time being, this is our new normal, and the anxiety and uncertainty and ambiguity are difficult for us to cope with, and that’s okay. I think it’s important that we don’t in any way minimize this. I think it’s important that we’re honest with our communities and that we make clear that we are all in this together and that we will get through this and be I think ultimately, I don’t want to say stronger, but I certainly think we will get through this as we have quite a number of other very large scale disasters.

RICK WEISS: Thank you. Dr. Holt-Lunstad.

JULIANNE HOLT-LUNSTAD: Yes, thank you. I would just like to emphasize what many people are feeling, the distress of social distancing, being isolated from others, this is normal. This is a normal response, and that we can mitigate some of the effects of this distressing feeling by still remaining socially connected while at a physical distance. So many have argued we ought to change the term from social distancing to physical distancing because we still can connect socially in many ways. But I would also just like to emphasize that it is important just like any other lifestyle factor that we need to make sure that we are maintaining a healthy lifestyle while we’re going through this crisis. This will help us get us through and will help lessen any of the other potential physical health effects that may continue beyond this crisis.

RICK WEISS: And Dr. Gurwitch.

ROBIN GURWITCH: I think for me it would be echoing what’s been said, but also connections, connections, connections, particularly for children. So not only with grandparents and other relatives, but with their friends. Even young children getting to Facetime with their friends or some other way to see their friends. Those connections become imperative right now and I think again, when we get through this, which we absolutely will, if nothing else we’re going to be the most hygienic nation. We have all learned about 20-second handwashing, we have all learned about how to cover our mouth and nose when we sneeze and cough. So look at some of the kinds of things and think about, “How are we making meaning out of this new event to move us forward into the future?”

[00:58:00]

RICK WEISS: That’s a great note to end on and I want to thank our panelists so much for your help during the past hour. I want to remind the reporters on the line that the video and transcript from this briefing will be up within the next day or two if you’re on the sciline.org website. I also want to ask the reporters who are logged in right now to take the one minute it will take you as you shut down this briefing, you’ll get a prompt for a three-question survey. It really helps us a lot to keep these briefings designed in ways that can be most helpful to you. So please take that minute and help us out with answers to three very quick questions. Otherwise, please follow us on Twitter @realsciline. Check out our website sciline.org and join us for our next briefing. We anticipate another one on a COVID-related topic within the next week to 10 days. So keep an eye out on the website for that. And thank you all very much for your help today. And with that we’ll sign off.


Creative Commons LicenseThis page is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. License applies to text and video only. Journalists are free to use any text or video on this page with or without attribution to SciLine.

Dr. Roxane Cohen Silver

UC Irvine

Dr. Roxane Cohen Silver is a professor in the Department of Psychological Science, the Department of Medicine, and the Program in Public Health at the University of California, Irvine, where she has been actively involved in research, teaching, and administration since 1989. An international expert in the field of stress and coping, Dr. Silver has spent almost four decades studying acute and long-term psychological and physical reactions to stressful life experiences, including personal traumas such as loss, physical disability, and childhood sexual victimization, as well as larger collective events such as terror attacks, war, and natural disasters across the world (e.g., U.S., Indonesia, Chile, Israel).

Dr. Silver is the President of the Federation of Associations in Behavioral & Brain Sciences (FABBS) and was the 2016 President of the Society of Experimental Social Psychology. She was also a founding Director and Chair of the Board of Directors of Psychology Beyond Borders, an international nonprofit organization that facilitated research, intervention, and policy development in the prevention, preparedness, and response to terror attacks, conflict, or natural disasters across the world.

Dr. Robin Gurwitch

Duke University School of Medicine

Dr. Robin Gurwitch, a Clinical Psychologist, is a Professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center and the Center for Child and Family Health. Dr. Gurwitch specializes in work with children, particularly those considered at-risk. Since the bombing in Oklahoma City in 1995, she has devoted much time to understanding the impact of trauma and disaster on children and ways to increase resilience, including stressors related to military deployment. She has helped to develop materials for the American Red Cross and the U.S. Department of Education for use in communities and in schools, including programs for disaster mental health and secondary traumatic stress. With a focus on these issues, Dr. Gurwitch has served on state and national committees and task forces as well as consulted with federal and state agencies and school systems.

Dr. Julianne Holt-Lunstad

Brigham Young University

Dr. Julianne Holt-Lunstad is a professor in the Department of Psychology at Brigham Young University where her research is focused on the long-term health effects of social connection. Dr. Holt-Lunstad’s research examines the influence of both the quantity and the quality of social relationships on long-term health and on risk for mortality, and the biological pathways (e.g., cardiovascular, neuroendocrine, genetic) by which such associations may occur. Her work has been seminal in the recognition of social isolation and loneliness as risk factors for early mortality. She has provided expert testimony in a US Congressional Hearing, provided expert recommendations for the US Surgeon General Emotional Well-Being in America Initiative, and is currently a member of the technical working group for the UK Cross Departmental Loneliness Team.

Jump to comments from experts on:


On whether it is normal to feel so much stress about COVID-19.


“It is extremely important … that we acknowledge that this uncertainty is stressful. And in fact, this anxiety is appropriate under the circumstances. This is a normal reaction to our new normal. And I think it’s important that journalists acknowledge this fact. It’s also important that we tell the truth. The situation may get worse before it gets better. Evidence is strongly suggesting that we are probably not yet in the eye of the storm. But there is a potential to help frame a more positive message: If we work together, we can save lives. And minimizing the uncertainty is disingenuous.” (March 30, 2020)

Roxane Cohen Silver, Ph.D.
Professor of Psychological Science, Medicine, and Public Health at University of California, Irvine

“We’ve all been through community traumas before. We’ve weathered mass violence, we’ve weathered natural disasters, and indeed my colleagues and I have studied many such events, including the September 11th terrorist attacks, the Boston Marathon bombings, the Orlando nightclub shootings, hurricanes Irma and Harvey. And our research tells us that most will get through these situations—humans are quite resilient. But somehow this event feels different, and it is. … This is an invisible threat; we don’t know who is infected, and anybody could infect us. This is an ambiguous threat; we have no idea how bad this will get. We have a very uncertain future; we don’t know how long this will last. And this is a global threat; no community is safe. Moreover, our need to social distance conflicts with our natural desire to connect with our friends and family during stressful times. And our typical sources of distractions such as national or personal sports or going to the gym, going to restaurants or bars, movies or travel, are all restricted by this crisis.” (March 30, 2020)

Roxane Cohen Silver, Ph.D.
Professor of Psychological Science, Medicine, and Public Health at University of California, Irvine

On ways to alleviate stress and make the most of a bad situation.


“It’s extremely important that we recognize that anxiety is contagious, but so is compassion. And there are ways in which we can bring our communities together, even if virtually. We can take advantage of the technologies that are now at our fingertips. We can encourage positive community outcomes such as altruistic behavior, social cohesion, volunteerism, reaching out to those who are living alone or who are seniors.” (March 30, 2020)

Roxane Cohen Silver, Ph.D.
Professor of Psychological Science, Medicine, and Public Health at University of California, Irvine

“Research demonstrates that how we appraise or interpret a situation can influence our physiological response. So one potential option is to shift our mindset. Instead of interpreting the situation as being cut off from others, we can focus on doing this to protect those that we love. When mitigating distressing feelings of loneliness, research has found that mindfulness-based meditation as well as engaging in creative arts and expression may also be effective. We also need to recognize that there are maybe ways that we can still remain socially connected while physically distant. If you are living with others, spend quality time to nurture those relationships. And regardless of our living situation, we can reach out to others, offer support to others. Research demonstrates that perceptions of availability of support, so knowing that you can count on others, can help even if no support is received.” (March 30, 2020)

Julianne Holt-Lunstad, Ph.D.
Professor of Psychology at Brigham Young University

On whether isolation and loneliness pose physical risks to our health.


“Just like hunger signals us to eat, and thirst signals us to drink water, loneliness is thought to be a biological drive that motivates us to reconnect. Throughout human history, we have relied on others for survival, and proximity to others, particularly trusted others, signals safety. So when we lack proximity to trusted others, our brain and body may respond with a state of heightened alert. This can result in increased blood pressure, stress hormones, and inflammatory responses, which if experienced on a chronic basis, can put us at increased risk for a variety of chronic illnesses.

“We now have robust evidence that [long-term] social isolation and loneliness are independent risk factors for premature mortality. And social connection is a significant protective factor. So, for example, my colleagues and I conducted a meta-analysis which combines data from over 3.4 million participants in which we found that loneliness was associated with earlier death by 26%, social isolation by 29%, and living alone by 32%. And this was an increased risk of earlier death from all causes. Conversely, a similar meta-analysis—this time data was combined from 148 studies with over 300,000 participants—and what this found was that people who are more socially connected had an increased odds of survival by 50%.

“One thing that is important to note is that these effects of social isolation and loneliness as well as the effects of social connection were long-term. These studies followed people for an average of seven-and-a-half years. These risks and data should not be taken as evidence that people should disregard recommendations to practice social distancing, quarantine or isolation in the face of this very immediate risk due to the virus. So it’s clear to make distinctions between short-term risks and long-term risks.” (March 30, 2020)

Julianne Holt-Lunstad, Ph.D.
Professor of Psychology at Brigham Young University

On whether technological approaches to staying connected can substitute for physical time together.


“We have decades of evidence that document the immediate and long-term [positive] effects of social relationships. But most of this evidence predates the use of social media, smartphones and other technological devices. We know much less about the equivalencies that these may have. These are tools that can help us through this crisis but should not become the new norm beyond this crisis until we have more evidence. … One of the things that certainly will be interesting is that this situation—because we are now in a position where we need to use these tools—it will be a real test of the strengths and limitations. And I hope that this will really step up our scientific evidence around this.” (March 30, 2020)

Julianne Holt-Lunstad, Ph.D.
Professor of Psychology at Brigham Young University

“One of the things we know from prior research is that individuals who have a history of mental health difficulties are at greater risk for mental health difficulties after something like a community-wide disaster like we’re experiencing. And I think it’s very important that those individuals who are now perhaps disconnected from their preexisting therapist or therapeutic relationships still seek out the connection with those individuals online. There’s a great deal of activity right now to move therapy to telehealth and to provide means by which individuals can connect with their therapists.” (March 30, 2020)

Roxane Cohen Silver, Ph.D.
Professor of Psychological Science, Medicine, and Public Health at University of California, Irvine

On whether it is important sometimes to take a break from the news.


“We started looking at this in our research after the Oklahoma City bombing, and it was borne out after 9/11 and continues to be borne out. … We need to take a break from the media including social media. That doesn’t mean I turn off the television and then I get on CNN online. That means I truly take a break. And children need to be taking breaks as well. … What we know about children is if they’re spending most or all of their time related to tragedies, that can increase their stress reactions.” (March 30, 2020)

Robin Gurwitch, Ph.D.
Professor in Psychiatry and Behavioral Sciences at Duke University

On whether tech-mediated communication will become the “new normal” for socializing and getting information.


“One of my concerns … is that this will become a predominant means of communication. And that’s not to say that there might not be strengths of this, but we don’t want to lose that face-to-face also, we do know we do have evidence of that, and if we lose that, that could potentially lead to a longer-term public health crisis. And so we need to find ways to regain a sense of normal face-to-face social connection once this crisis is over. And where we identify strengths of technology, we can embrace those when there’s evidence to support those.” (March 30, 2020)

Julianne Holt-Lunstad, Ph.D.
Professor of Psychology at Brigham Young University

“Research does make it clear that social media is a larger source of misinformation and rumor than we typically get from traditional media. …There isn’t anybody who is monitoring and vetting the information for its truthfulness or its veracity. … So we need to step back. How are we using social media? Is it for connection, or is it for information gathering?” (March 30, 2020)

Roxane Cohen Silver, Ph.D.
Professor of Psychological Science, Medicine, and Public Health at University of California, Irvine

On how parents should talk to their children about COVID-19.


“As adults, we’re working to make sense of this new normal, but we also have to remember that our children and our teenagers are also experiencing worries and anxieties related to COVID-19. So how do we help? I think first and foremost, parents and caregivers need to talk to their children and their teens. Don’t wait for them to bring it up. Even preschool children have heard of coronavirus. If you haven’t already done so, our advice is to take a breath and start the conversation. Words could be as simple as, “There’s been a lot of talk about coronavirus or COVID-19, tell me what you know about it.” For teens, you may use that opening or you may even say something like, “Tell me what your friends have been saying about it.” By listening, you will hear their understanding, and you will be able to gently correct any misinformation and misperceptions that they may have about the disease. Adults may be worried that talking about coronavirus would actually make it worse. But really the research doesn’t bear that out, and the opposite is actually true. Research after the Boston Marathon bombing found that stress reactions in children whose parents tried to shield them from that event had more stress reactions, more distress than parents who openly talked to their young children about the event.” (March 30, 2020)

Robin Gurwitch, Ph.D.
Professor in Psychiatry and Behavioral Sciences at Duke University

On signs of trouble parents should be watching for in their children.


“What we often see is that they may be more irritable and whiny, even sometimes more defiant than usual, which is challenging, because as adults, we’re a little bit more short-tempered and a little bit less patient. So we have to make sure we take a breath and recognize that their irritability and defiance may be a problem of distress. Sleep problems are pretty common in children, so we can’t rule that out. Children may have physiological reactions, headaches and stomachaches. There may not be a medical reason for them, but they’re still very real. One of the things that’s so important to recognize in elementary school children is that attention and concentration may be reduced. So if you couple my changes in attention and concentration, ability for new learning to happen as easily with a new learning platform, recognize that children may have more difficulty, not just figuring out the platform, but also learning the new information and being able to attend to it as well.” (March 30, 2020)

Robin Gurwitch, Ph.D.
Professor in Psychiatry and Behavioral Sciences at Duke University

On what parents can do to support their children during this crisis.


“As adults, as caregivers and parents, we need to be a little bit more patient. They may need a little bit more help from us with their schoolwork than usual. … And I think one thing we forget is to recognize when our children do well. So if you see your elementary school child doing a good job handwashing, we need to tell them that, “You’re doing a great job helping keep our whole family healthy.” When they are helping out with chores at home, when they are helping out with others, when they are participating in family activities. I can’t underscore [enough] the importance of positive praise for children of all ages, but particularly young children so that they see that you recognize that they are being a help and they’re doing something well. You will increase the chances that they’ll feel better about themselves and repeat that behavior too.” (March 30, 2020)

Robin Gurwitch, Ph.D.
Professor in Psychiatry and Behavioral Sciences at Duke University

On the signs that someone is coping well—or not coping well.


“We want to encourage more healthier coping and discourage more unhealthy types of coping. So some healthier types of coping would be similar to what has already been stated, is reaching out to others through a phone call or through text or other kinds of video, virtual connection to connect socially. Other ways to cope healthy might be a routine or being active, doing creative kinds of expression. Unhealthier types of coping might include excessive sleep, excessive alcohol or substance use, overeating. These may all be more maladaptive kinds of coping. And so if we can look for those kinds of things in our friends, our family, those that we’re living with, we might be able to identify those that may be struggling.” (March 30, 2020)

Julianne Holt-Lunstad, Ph.D.
Professor of Psychology at Brigham Young University

On whether there are positive outcomes to be had from this pandemic.


“We do know from prior research that individuals often find meaning in something that is challenging. They learn strengths about themselves that they didn’t realize previously. They connected with individuals who they hadn’t spoken to for some time. In the last two weeks, I can count on five hands how many people have reached out to me that I haven’t heard from in a long time. … We’re reaching our friends and loved ones in new ways, we’re becoming more capable with technology, we are finding new ways to connect with our neighbors, and all of this can be a way in which we can make sense of this event. Of course, it’s horrible in many ways. As I said, we don’t want to in any way minimize the uncertainty, we don’t want to minimize the anxiety, people are worried, and that is appropriate. But nonetheless, people will find some positives from this experience, and to the extent to which they can hold on to that, this is likely to help them cope through it.” (March 30, 2020)

Roxane Cohen Silver, Ph.D.
Professor of Psychological Science, Medicine, and Public Health at University of California, Irvine

“One of the potential positives here is I think we’re starting to see quite widely the recognition of the importance of our relationships. And there is some evidence to suggest that one of the leading factors for why people don’t participate more socially is they’re too busy. And this is, as stated, a horrible—what we’re going through is awful. But it’s something that is bringing communities together. We can potentially see more solidarity as communities and society, and making time to reach out to others, having that time to have a long conversation on a call, looking out for those in our communities who are more vulnerable. I think that this current situation is helping us recognize just how important that is.” (March 30, 2020)

Julianne Holt-Lunstad, Ph.D.
Professor of Psychology at Brigham Young University

Creative Commons LicenseThis page is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. License applies to text and video only. Journalists are free to use any text or video on this page with or without attribution to SciLine.

Panelist presentations

Download

Video: high definition

(mp4, 1280x720)

Download

Video: standard definition

(mp4, 960x540)

Download