Overcoming Vaccine Anxiety and Apprehension

[MUSIC PLAYING] Hi, everyone. I'm Dr. John Whyte, Chief Medical Officer at WebMD and you're watching Coronavirus in Context. Are you thinking about getting the vaccine? Are you anxious? Do you feel anxiety around it, hesitancy? To help provide some insight and maybe help you think through your feelings, I've asked Dr. Mena Mirhom. He's a board certified psychiatrist at Columbia University. Thanks for joining me.

Thank you so much for having me.

Let's start off with talking about the anxiety that people are having about the vaccine.

Absolutely, Dr. Whyte. So you know whenever we're seeing something that is new and unfamiliar, there is, it's natural and perfectly understandable to have concerns with whatever is unknown. What could be going on? Could there be side effects that we don't know? Is this going to be worth the risk? And this is especially so in a time of turmoil that we're seeing all around us in many, many ways, financial, and political, and otherwise. So there is already a foundation of uncertainty and anxiety that has just been brewing over the past year and a half. And now it comes full spring into this new and uncertain environment where vaccines are being introduced, but there still remains a lot of questions the public has.

DR. JOHN WHYTE: In general psychiatrists don't give vaccinations, correct? It goes more towards internists, family physicians. What can we learn from psychiatry in terms of helping to address this anxiety that people are having?

Yeah that's a great question. I think one of the fundamental lessons that we've learned from the research of vaccine apprehension, because of course, as we know, this is not the first time that there's been a vaccine where folks are hesitant or apprehensive about it. What we've seen, the lessons of the polio vaccine, the measles vaccine, is that there is somewhat of a disconnect in terms of what the medical community prioritizes in the conversation. If we were speaking with two doctors and trying to convince the doctor of hey, this is why you should do this thing, we'll use medical data, hard facts, and that'll get our point across.

However oftentimes with the general public, we don't have a misinformation problem here. We have a relationship problem. When the public looks at the vaccine and says, who are the entities behind this new vaccine. It is pharmaceutical industries, which scare people as big pharma. It is the medical community, which oftentimes we are inaccessible, smart, and distant. And then it's also the government, which depending on your political leanings, there are some times where there is at least fear. When we understand that, psychiatry I think can help the medical community and say, hey, when we're having this conversation it's not always the hard facts. It's not always just the data. It's actually beginning with the relationship. How can we have a relationship with the community and say, this is how we can build trust. And when trust is built, then decisions can be made in a much smoother way.

So give us some more strategies, in terms of maybe how those conversations could take place, maybe the mechanisms by which we distribute vaccines. Does it make a difference whether it's in a hospital setting, or it's in a community center in your local area? What are some of the strategies we can think about, based on those psychiatry principles to address this anxiety?

Absolutely. I would say in the conversation, there are a few do's and don'ts, to be able to have that conversation and the relationship to flourish. One of the first don'ts, is that whenever we're thinking about someone who has a different viewpoint than us, one has, one usual temptation we may have as a medical community is to somewhat speak down to those folks and say, Oh how could you not believe with firm conviction that the vaccine is perfectly safe. And look at the data, it's so convincing.

So we begin by having sort of a humble approach, and we were discussing this in the previous podcast as well, from the medical community of saying, you know what, if you have a different perspective, or if you have questions, that's OK. And we are not going to belittle you. We are not going to name call. We're not going to say that this is anything beneath us to have those concerns, or questions, or fears.

The second step after we don't do that is that we validate. We make sure that the person that we're speaking with feels at the end of the conversation that they are heard, that they are understood, that we are there for them, and that we prioritize their well-being above any particular other agenda that they may think we have as doctors. Once that person can feel that trust, can make and feel that, you know what, this person that I'm speaking to cares about me, and I'm able to be vulnerable with them. That translates into well now we can begin to have a different conversation with the community. Because oftentimes in the strategy, it's not always so much where the vaccine is being disseminated, but more so how our approach is as we go ahead and disseminate the vaccine.

And it often requires more than one discussion, correct? So we shouldn't assume that oh hey, we'll have a conversation, and if we're going to convince them that if they don't decide right then and there, then forget it.

Absolutely. Absolutely. There's a little bit of patience on our end here, and part of that patience, we have to understand that we often need a couple of discussions to be convinced of something that's new for us as well. And that's perfectly OK, for us to have the willingness to go the long game. This is not going to be a problem, COVID unfortunately it's not going to be solved tomorrow, and when we understand that as a medical community, we know that we're invested in the community. We know that we're here for you, and that we're going to continue to be present, continue to answer questions, and especially from a psychiatric standpoint, sometimes answering those questions, the same ones over and over again and that's OK.

I had a patient just yesterday who we've been having the same discussion about a particular area of anxiety in his life, and he finally said, you know what, Dr. Mirhom, I'm ready today to take that next step. So I didn't do anything magical yesterday, it was just now that he is ready and I was just present.

What about scare tactics? It seems like what we see on the news are a lot of scare tactics, that people are utilizing to convince people to get the vaccine in terms of the number of deaths, number of hospitalizations. We see in other areas of health that scare tactics typically don't work for patients. What are your thoughts relating to that part of messaging around the vaccine?

Yeah, I think it's understandable that the media would use those tactics because at the end of the day there are more clicks and more views when there's more fear. But when it comes to translating into actual behavioral change, what we know from the data is that, that just doesn't work. You know it looks great, maybe it'll get more ratings. It'll get more noise. But if we're looking to have actual behavioral change, the positive interaction will always outweigh the fear, or the scaring, or those scare tactics that are used.

So it's important for us as the medical community to not buy into that approach of scare tactics, but saying, you know we're realistic with risk. Let's not, we're not toying around with it. Certainly COVID and by now we understand the risks involved, but it's helpful, I think for us to frame it in such a way that this is life saving, this is encouraging, this is the way that we can get back to things that we love, as opposed to really having people cower in fear. It just doesn't really help.

And then you and I have been talking about this, Be More Satisfied mantra. And I'd like you to explain to our viewers what you mean by that.

Sure. Sure. You know I've been thinking a lot over the past couple of years of ways that we can distill down some of the medical literature to something else that we can remember, something we can sort of go day by day by, and I explain this to patients on a daily basis, and I figured every now and then I may use an acronym, or a mantra to sort of go with it.

So the mantra or the idea is that we are specifically in a time right now where it's hard to be satisfied, hard to be grateful, because there's so much pain and difficulty around it. So from a general standpoint first is that we want to have the mindset, the approach of I will be determined to be more satisfied, more grateful of the things that are around. And then we say, well, how do you specifically do that?

Well the data tells us that there are four domains of the human experience that you want to focus on. We can sort of break it down a little bit together here, is that the B in Be more satisfied, B- E. So it's biological, there is a brain element to this. There are brain basics that we can discuss and delve into.

The E in it is that there's environmental factors, the things that are around us impact how we feel inside and how we behave. And then there is the more satisfied.

So the S in the more satisfied is the spiritual. And the M is the mind. So the mindset, the kind of cognitive approach that we can have, the thoughts that we have do determine our lives. There is this wonderful loop that we've come to see over the years of the cognitive, and the behavioral. The thoughts that we have, and the actions that we take, and one can influence the other and we've seen that they actually also lean towards and they impact even our actual biological make-up.

The thoughts that we have can begin to influence our very brain chemistry, which is amazing. Then lastly as we said, the spiritual, there's a role for that as we've seen in the literature as well.

Are you hopeful that we'll reach 70, 80% compliance with vaccinations to achieve herd immunity?

I really am. You know everything that I'm seeing is that there is a lot of optimism. There is a strong push that involves the community, the government, the medical community. I think as long as we're approaching this with, as we were saying in the previous podcast, with humility, with patience, and with resistance, then I really do think we can get there.

Dr. Mirhom, I want to thank you for taking the time today to share your insights, to help us think about it in a little bit of a different way. And recognizing that being more positive as well as being more satisfied, is going to help us address these issues of anxiety around the vaccine. So thanks for providing that guidance.

Thank you so much for having me Dr. Whyte. This was absolutely wonderful. I'm so grateful to have the time to explore this with you.

And if you have questions about COVID, or the vaccine, or diagnostic testing, drop us a line. You can email it to me at [email protected], as well as post it on our social properties, Twitter, Facebook, Instagram, and Pinterest.

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