The program’s Community Mental Health Clinic, which opened in January 2020, aims to provide low-cost mental health services to the Bronx community while also giving third-year doctoral students the chance to gain practical experience.

The project addresses a significant health issue in the Bronx: According to a report from Montefiore Hospital, 91% of the borough’s Medicaid patients live in “a mental health professional shortage area” based on the ratio of providers to the population and its needs.

“The idea is that we live in one of the most disenfranchised communities in America, where mental health services are extremely hard to come by,” said Barry Rosenfeld, Ph.D., professor of psychology. “We’ve got really well-established faculty members who are often experts in their respective areas. We have really strong graduate students who are invested in providing services to the community under our supervision. And wouldn’t it be really good if we could do something to give back to the Bronx?”

The clinic offers services in four areas—adult psychotherapy, child psychotherapy, adult general assessment services, and forensic assessment. Patients can be referred to the clinic from hospitals, the court system, school districts, and others, or can call the clinic for a screening at 718-817-0590. If appropriate and if there’s availability, the patient will receive an appointment with a third-year doctoral student who is supervised by faculty members. Doctoral students only can spend a few hours a week in the clinic so only have about one to two cases at a time.

Ariella Soffer, Ph.D., GSAS ’08, director of the clinic, said that they’ve seen clients with high needs for depression, anxiety, stress, and trauma, particularly now due to the problems and challenges exacerbated by the pandemic.

“What we’ve been seeing, I think, [is]just a profile of exaggerated need that the nation or New York at large would see,” said Soffer.

Rosenfeld said since they opened they’ve had a waiting list, in part because of their low-cost services.

“It’s a sliding scale. So I think it’s often $5 or $10 for a psychotherapy session, as opposed to maybe $250 [at a private office],” he said. “Our forensic evaluations—we have a set fee that works out to probably $5 an hour.”

Like all organizations, the clinic had to pivot to a new virtual model in March. It had been operating in person at its location a few blocks from the Rose Hill campus at 557 East Fordham Road for “a solid five weeks,” before they made almost all services remote due to the COVID-19 pandemic.

“It’s ironic, in some ways, it makes some things easier, like scheduling,” Rosenfeld said. “I think the field of mental health will probably never be the same; I think we will probably always rely much more on virtual mediums than we ever used to. But I think it’s more challenging to develop a relationship [virtually], to have an interactive exchange.”

Despite the challenges and changes the clinic faced in its first year, those involved said they’re excited to keep the work going and see it grow.

Doctoral Students Receive Supervision and Credit While Serving Community

Plans for the clinic had been discussed for more than 10 years, Rosenfeld said, but really came together about three years ago when Soffer was brought on in fall 2018 as director.

“I spent a bulk of the first year basically trying to figure out—how do other schools do this?” she said. “I had graduate students talking to a lot of graduate students in other clinical programs to try to figure out what works,” she said, particularly when it came to how the work could be integrated into the curriculum so students could receive course credit.

Third-year doctoral students in the clinical psychology program, many of whom already have some practical experience from other externships, are divided into the clinic’s four areas.

Each of the tracks has two faculty supervisors. Instead of taking or teaching another course, the students and faculty work at the clinic for a few hours each week. The teams meet weekly, right now virtually, to discuss patients, best practices, and ideas for care.

“The population is clearly one of the most underserved and high-need populations in the New York area, and so I think it provides that opportunity to the students to offer services to people that are really in need, and I think that the faculty offer some niche expertise,” Soffer said.

For Michelle Leon, a third-year student in the program, the clinic has allowed her to explore the forensic assessment field.

“I’ve always been interested in forensic work, but I hadn’t gotten clinical experience in the forensic field at all up until I joined the forensic assessment team this fall,” she said. “I’m getting more of that hands-on experience in an area that I was always interested in.”

Faculty Expertise Benefits Patients

Rosenfeld and Dean McKay, Ph.D., professor of psychology, said the structure allows patients to receive high-quality care from leading faculty experts in their fields, which is something other clinics can’t always offer.

“So my expertise as an anxiety disorder expert—one of the cases that was seen in the clinic was for obsessive-compulsive disorder, which has historically been an anxiety disorder,” McKay said. “We were able to work with a man from the community who had OCD, and was treated by one of our students and was supervised by me and and by Dr. Ariella Soffer. We’re able to fill that gap that maybe is a little less readily available in the community.”

Because the clinic currently has limited resources, Rosenfeld said they often have to “triage” requests. Cases they can’t handle will be referred elsewhere; severe cases, such as a person with suicidal thoughts, are referred to St. Barnabas or other hospitals.

Community Outreach and Care

Besides just providing direct services, Soffer said they are also working on a community outreach project that would put information and resources directly in the hands of community members who might not need individual therapy.

“We don’t have a huge capacity right now for direct service,” she said. “But we do want to be able to provide as much to the community as we possibly can. So we are also thinking of other creative ways to be able to offer resources and our expertise, so we’re creating a series of four trainings right now.”

Leon said she and two graduate assistants for the clinic are putting together PowerPoints, flyers, and other written materials for the trainings which include information on trauma-focused cognitive behavioral therapy for children, particularly for those who have experienced loss, neglect, or abuse; social media and its impact on children; updated CPR materials; and COVID resources related to mental health.

The materials would be distributed to community leaders, such as local nonprofits and “pediatricians and dentists, and doctors and pastors,” Soffer said, who could get the info to people they know in need.

“We know that COVID-19 is disproportionately affecting minorities,” Leon said, noting particularly Black and Latinx individuals. “They’re already disproportionately affected by health disparities. And so we wanted to also create a resource for them where we’re giving them that information.”

Soffer said that she would love to be able to expand the clinic’s offerings, which could include bringing in a postdoctoral fellow or funding to allow graduate students to spend more clinical hours at the clinic. A fundraiser for the clinic was planned in the spring but had to be canceled due to COVID-19. In the meantime, she said the faculty and students will continue to serve the community in as many ways as they can.

“There’s clearly demand, because the minute we opened, we had a waiting list,” Rosenfeld said. “I get requests all the time. ‘Here’s another case, can I do this?’ So, the need is almost unlimited. We’re hoping we can increase our capacity.”

Dean McKay, Ph.D., a professor of psychology, specializes in anxiety, obsessive-compulsive disorder, and the connections between anxiety and disgust. With winter approaching and potentially leading to more isolation, we thought it would be a good time to talk to him about what we can do to cope effectively during what will likely continue to be a traumatic time.

Listen here:

Full transcript below:

Dean McKay: Look. Anxiety, as an emotion, it’s an important one because it does stop us from having injury and harm come to us. Unfortunately, a lot of times it’s an overcorrection, and the experience of anxiety is definitely uncomfortable. But the flip side is that it also can, when experienced properly, it’s a great problem-solving strategy. I mean, if you’re worried about anything, good effective worry leads to effective problem-solving.

Patrick Verel: the events of the last nine months have thrown us all for a loop. Schools closed, businesses shuttered, and people all over the world began dying from a mysterious airborne virus. In the ensuing months, the United States has experienced a summer of civil unrest and a brutally close and nasty election for president. Now, with the holidays approaching, the coronavirus is raging out of control again. On November 13th, the number of Americans infected with the virus surged to a staggering 181,000 in one day, and the number of deaths reached 246,000.

PV: Dean McKay, a professor of psychology at Fordham, specializes in anxiety, obsessive-compulsive disorder, and the connections between anxiety and disgust. With winter approaching and potentially leading to more isolation, we thought it would be a good time to talk to him about what we can do to cope effectively during what is likely to be a traumatic time. I’m PV, and this is Fordham News.

Let’s talk about anxiety. There are multiple kinds and they sometimes work in tandem in our minds, right?

DK: You’re right. There are several kinds of anxiety, really, several different ways that anxiety manifests. And so, for starters, the reason why we get anxious is because it’s an evolved reaction to protect us from threat. And as a result of experiencing anxiety, in small as well as major ways in the course of our lives, we end up really having basically three different kinds.

One is based on what we call a real threat. So if you have, let’s say, a near-miss accident, or you’re confronted by an assailant, the anxiety that you feel in the face of that is a bona fide reaction to a real, imminent threat that you face, some real danger.

A second kind is where you have a false alarm. We’re evolved to basically overcorrect for threat, and so since in our environment there are certain things that sound or look dangerous, it’s better to know that in advance and act, rather than have to wait until it’s verified. So if there’s, let’s say, a shadow that looks threatening and you’re approaching it, the anxiety that you feel is in response to the fact that it might be a danger. Now, it’s possible that you’ll end up learning later that it’s actually a tree in a formation that resembles an assailant, and so that’s a false alarm. It looked real, but then it ended up being, on closer inspection actually, not.

Then the third one is what we called learned alarms, and so because our environments are idiosyncratic to us, and over the course of our lives we end up having certain anxious experiences, some of those are ones that are specific to us, that we might find to be potentially dangerous. So, those are ones that we learn to be afraid of and we start to avoid those, as well. Now, those also don’t have to be bona fide dangers, but because we’ve consistently avoided them and we’ve consistently associated those with the experience of anxiety, then we have that association.

Let’s say that you were out at night and you were attacked. In fact, you survive. Now, in the future you got to, let’s say, those same places and you see shadows or figures in those places that might not be real threats. You might experience anxiety, anyway, and that would be a learned alarm.

PV: It feels like right now we’ve got all three kind of mixed up together.

DK: Well, that’s true. The issue that we face with a pandemic is that it activates anxiety in a very specific way, and it does call all three of those to bear.

First of all, there’s a real threat, so we know that in our midst there is something that is dangerous. Now, what makes it more challenging is that we can’t see it, so the examples that I used of a real alarm is where there’s like a visible danger. But now there’s an invisible one, and we have to now learn other ways to manage it. That means connected to that there are going to also be, let’s say, false alarms. So, you encounter somebody who looks sick. They’re not sick, necessarily, or they’re sick with something other than COVID. That would be a potentially false alarm.

Then there are learned alarms, because we’ve now been taught, based upon public health information and other media sources, that there are certain things that we should avoid. So, let’s say if you’re the kind of person that routinely wears a mask, a learned alarm is if you encounter somebody coming really close to you who’s unmasked. That’s going to also pose a pretty significant threat.

PV: You’ve conducted research directly connected to anxiety and the coronavirus. What can you tell me about your findings so far?

DK: First of all, given that the threat of COVID is an invisible one, that only manifests visibly in people who are ill, we really have five major dimensions that we can describe as being relevant factors that are implicated related to COVID. Those factors are what we call contamination and disease risk. So, that concern that you may have contracted an illness, or a concern that you may have come in contact with something, that would be one facet of this COVID-specific kind of reaction.

The second is because we are acutely aware of the social and economic consequences, that forms another factor that activates a lot of anxiety for people. So, we are concerned about our own well-being, but then kind of competing with it is also the concerns about social and economic consequences of the disease.

Another factor, so the third of these five, is traumatic stress reactions. This is a largely traumatic event for the public. It’s a pretty widely shared traumatic event, and some people experience it more acutely than others. So, if someone has contracted and survived COVID, or if someone has had someone close to them pass away or contract and remain ill with COVID, there’s a lot of ways in which COVID is experienced by sufferers.

Obviously, the biggest concern that we have is the risk to one’s life from COVID. But then there are also people who survive it, who are the so-called long-haulers that we hear about, who have neurological consequences and all kinds of lasting physical consequences, multi-systemic consequences. And so, those form the basis for a series of traumatic reactions that sufferers may have.

A fourth factor is a broader social category of xenophobia. This has been observed in prior pandemics, by the way, where the natural desire for the public, given that we want to make seen that which is unseen, so what better way to do it than to ascribe cause to a group? We’ve seen this happen in multiple ways. For example, the attribution of the disease to being brought to these shores from China has led to some xenophobic reactions to people from China. Or even to, in a smaller scale, things like not eating Chinese food.

Then finally, the last factor: that is an anxious-related response is checking. People engage in checking behavior either for themselves, to see whether or not they’re ill. It’s sort of like this internal monitoring that people might engage in. Let’s say for right now if somebody were to feel a little bit of a scratchy feeling in their throat, they might start to really pay much more attention to that than they might have pre-pandemic. Because they are now attending to whether or not maybe they’re coming down with the illness, and there will be some checking that they might engage in to see whether or not this represents the onset of illness.

So, on the one hand, there’s a constellation of individuals who have what we would call a COVID Stress Syndrome. They have elevated levels of many of those five factors, and that leads to all kinds of other mood and anxiety reactions, ones that we might see pre-pandemic. People get depressed. It’s a lot to manage if you experience all five of those factors that I just listed. That’s stressful, and people experience it in a pretty demanding way.

There’s a flip side to this, though, and it’s one that we’ve seen here. There are people who, as we’ve had well-documented in the news in this country, people who are basically denying that COVID even matters. So, you see people who are neglecting to bother with wearing masks and are not engaged in social distancing, and are basically taking the position that, really, this is nothing, and why are you making a big deal of it? They have low levels on all of those factors, and also would feel that their personal risk is just low, for reasons that have little to do with reality.

PV: I hope this doesn’t sound flippant, but it seems like this is a golden age of time to study anxiety.

DK: Well, that’s true. There is an abundance of anxiety, and rightfully so. The theory that helps to describe why we see some of these things that I’ve described as those five-factor,s is called the behavioral immune system. It’s basically an automatic process that we have evolved, which is when there’s an unseen danger, what steps can we take to try and make it as seen as possible? What ways will it be visible, and how can we protect ourselves?
DK: So, it’s an important evolved feature, and in order to do it successfully it does require anxiety. Look, anxiety as an emotion, it’s an important one because it does stop us from having injury and harm come to us. Unfortunately, a lot of times it’s an overcorrection, and the experience of anxiety is definitely uncomfortable.

But the flip side is that it also can, when experienced properly, it’s a great problem-solving strategy. If you’re worried about anything, good effective worry leads to effective problem-solving, and that’s true for everything. We would get very little done if we never, ever worried. We’d be like, “Oh, whatever. I guess that will come and go. The deadline is here and gone.”

And if we didn’t worry about getting diseases, then we’d probably get sick and die very easily. There’s a value here to this, and so it’s not flippant to say that. It’s actually accurate, and a lot of my colleagues and I, we’ve been very, very active during this time.

PV: I want to talk a little bit about this connection between the virus and xenophobia because I think that’s really interesting.

DK: There’s a lot of talk right now about tribalism in our politics, and so this does kind of cross the barrier into the political realm. In politics right now, the tribalism suggests that you have groups of people that form coherent wholes: they share attitudes and opinions and culture. But that notion of tribalism goes back also centuries; and tribes, as let’s say bubbles of groups, they would also be protective of themselves.

One way to protect themselves would be to make sure that outsiders who carried, literally, disease risks that would be foreign to them and could wipe them out, they would then be vigilant to guard against that. And so, an outsider would be deemed dangerous, just for being an outsider. So, xenophobia … We’re hardwired to be somewhat xenophobic. That doesn’t make it defensible, but it is certainly a bulwark that we have to work against.

Now, in the modern era, because in modern technology we don’t really need to have that kind of disease vigilance about outsiders the way that we once did, with the rising of a more global economy and the fact that people can travel all over the place very readily. It doesn’t change the fact that you can capitalize on that natural xenophobic impulse, at least in some individuals.

In 2018, President Trump went to great pains to talk about the caravan of people who were coming north from Central America, and his descriptions of it were very much designed to capitalize on that disease risk that people are concerned about. He’s done this all along, from the beginning of his campaign.

That notion is something that we see now, and now bringing it fast forward to the pandemic, Trump’s use of terms like “the China virus,” which has been roundly attacked as a xenophobic statement, is exactly for that reason. It’s to try and assign an ethnic cause to the pandemic. We see this throughout history, and politicians have known how to capitalize on it, on the left as well as the right. I mean, there are left-leaning leaders who have certainly used this.

PV: I want to move from the theoretical to the concrete for a second here. I left Brooklyn in March with my wife and our five- and eight-year-old, and we moved in with my in-laws in Vermont, so we could work remotely while they attend school online. My father, who is 72 years old, died of COVID about three weeks after we left.

I’ve had very few opportunities to see the rest of my family, and thanks to the New York City school situation it’s unclear when we’ll be able to return home. So, I have a bit of anxiety these days. Everybody’s situation is unique, of course, and I know I’m probably not alone when I describe this sort of crazy situation. So, what advice would you give to fight this kind of anxiety, which is born largely from circumstance?

DK: Sure. First of all, I’m really so sorry for your loss. I know we spoke prior to this podcast, and it’s tragic. Your life has been touched in a very specific way by this virus, and so adversely. The experience that you have of anxiety, in terms of returning to what might resemble a pre-pandemic way of life, is a hard one to imagine. So, that traumatic kind of symptom that I described before as one is particularly salient for you.

To deal with that in some way, probably it will be necessary to be able to return to your environment that you lived in originally. Just to really start to etch new memories in, that will be present to allow you to recapture some sense of normalcy, given that you experienced this loss in a rather significant way. And now it’s going to be very much crystallized with your experiences of life now, in a way that’s so abnormal from what it was prior to this.

That’s true for most sufferers, people who have lost a loved one. They’re going to face some real challenges going forward, especially when the pandemic is over. There’s going to be this really lingering memory of this event, and the way to really handle it is to honor the person that they’ve lost in a way that’s meaningful for them.

In the meantime, there are some other lingering issues, and the stop-gap measures are things like the extent that you can engage in any kind of social practices now. We do have the benefit of remote technology that allows us to stay connected with people; and it’s easy to not do that, because we get busy with things, especially if you have children. But to try and capture some of that. Like, married couples who have children, it’s very difficult now. You’re home all the time with your kids, and how do you get time alone?

Well, that’s a very significant challenge, and there needs to be some creative problem-solving around how to do that, even to steal away some time alone, because that’s something that couples usually try to do. If you routinely did that pre-pandemic, and you’re not doing it now that we’re eight months on, that’s something that should be done and really prioritized. That will help to alleviate some of the anxiety because you can share with each other some support.

If you don’t have someone in your life but you have a social network, you should definitely make sure you stay connected to people. If you are a solo person, and you’re not connected to somebody right now but you have a social network, you really want to strengthen that as much as you can, and make sure you stay connected to people. Maybe rekindle connections that have dwindled a little bit.

All of those help to buffer anxiety. You know, that shared experience so you don’t feel so isolated can put a block on it. It also allows you to share information with people that facilitates problem-solving, which is really the point of experiencing anxiety in an adaptive way.

PV: I would imagine there would be people out there even who don’t necessarily … who might not have lost somebody, who might just look back and say, “Oh, my God. What happened to the life that we had in New York City?” in particular.

DK: Right. Loss is very global right now. There’s loss in terms of not just potentially loved ones, which is maybe the most profound in this case. But loss of livelihood, change of livelihood to something that is not what was desirable before. Maybe you had an ideal or a very desirable lifestyle beforehand, and that’s been upended. Loss of time with loved ones, because of distance and inability to connect because you can’t travel. That’s something that a lot of people are experiencing.

On a personal side for me, my daughter lives in Florida. We haven’t seen her since the end of February. We happened to go to visit her in February and we really haven’t been able to travel down there since, because my mother-in-law, who’s 84 years old, we’re the sole caregivers and it’s just too risky. So, a lot of people experience these kind of losses.

PV: Yeah. I’m glad you brought up that your daughter and the holidays because that’s something that I do think is important to note for this conversation. I wonder if you have any thoughts for people who right now are hearing this, and are very anxious about whether they’ll be able to have any semblance of a holiday. Whether it’s this coming Thanksgiving, or even Christmas and New Year’s and Hanukkah, and all the other holidays that the winter months usually bring us?

DK: Yeah. This week, as we’re speaking, also brought some hopefulness. That is, it seems that there is very rapid and encouraging news on a vaccine, so maybe the first time in months that people feel a glimmer of optimism that maybe this is going to be over. So, it’s hard to do this in the moment, because you’re thinking “this year,” “this holiday,” this thing that we’re looking forward to so much, like Thanksgiving. Which … I, too. We love Thanksgiving. My family, we celebrate Hanukkah. We love the holidays to spend time with our kid, or to at least have some engagement in a real meaningful way.

But if you think about it in the course of your life, you’re going to celebrate the holiday around 75 or 80 times, and so you’re going to miss it once. It’s not even really that you’re going to miss it entirely. This is an opportunity where we might want to think about creative alternatives. Since we do have the luxury of remote technology, there is something to be said for at least making sure that you maintain contact for the holiday. Yes, it’s not the same. Absolutely, you’re going to feel the change and the difference. It is going to be abnormal.

But think about the fact that we have some measure of optimism on the horizon that you’ll be able to do it next year. And, yeah. It’s frustrating, but the other side of it is that we want to contain the spread. The danger really remains great. So this is, I think, probably the best alternative, is that we have to think in terms of how many more holidays do we get to enjoy? And we get to look forward to the fact that we can enjoy them because we’ll be hopefully making sure everybody stays healthy.

PV: Let’s talk about the future. Let’s say, fingers crossed, that a vaccine is approved this winter; and by this time next year we’ve returned to our offices, schools have reopened, and the economy has begun to crawl back out of the hole that it’s in. What kind of psychological aftereffects can we expect in the years to come?

DK: First of all, there will probably be an uptick in mood disorders, so depression is probably going to be the thing that will be a lingering aftereffect. In all likelihood, people who were anxious prior to the pandemic or prone to being anxious, it may kick it off for some people. The return to a pre-pandemic life, to whatever extent we retain that level of comparable lifestyle, I would imagine over a reasonably short timeline, in a matter of months, not years, a lot of those anxious reactions will fade.

So, let’s say there are some people who may be much, much, more attentive to washing. They’re probably not going to develop OCD, like based on contamination fear. It will probably snap back once it’s clear that it’s safe. For people who may have treatable levels of contamination fear, they probably were near to developing OCD prior to the pandemic, and this was the stressor that pushed things over the top. So, I would not think that these are pandemic-specific, but more like this was the stressor that got it going.

The other thing that I think will be left over will be probably a fair bit of alcohol and substance use problems. We see that now, and those are harder to shake. Those are habits that people develop. Alcohol is abused because people like it, and so after the pandemic is over, if you’ve been drinking a lot, you might continue to drink a lot. Maybe you’re going to carve out the time to work and do other things that you did before, but alcohol abuse will stick around.

And alcohol has a great history of alleviating anxiety. I mean, it has all kinds of horrible other consequences attached to it, but it’s well known that people engage in what they call self-medicating, to use a mental health term. And self-medicating, if we manage it effectively, it’s not universally bad, and I don’t think we should refer to it as such. It’s a mental health term when we talk about people who are alcohol abusers, and it’s what we call secondary.

So, secondary meaning like the first thing that really was there was anxiety problems, and that individual identified alcohol, or other drugs like opiates and other kinds of medications, as a way to tamp down their anxiety. So, they don’t have to necessarily deal with it through other structure coping mechanisms, they can just drink it away. And plenty of people do that. The notion of saying, “I’m going to have a drink to unwind,” that statement alone is a self-medicating statement. You don’t have to have an alcohol problem to make that statement.

PV: Okay. That makes me feel better.

DK: Yeah, good. Yeah, yeah. This doesn’t have to be like, oh, let’s reveal your psychiatric problems on the podcast. There’s a giant normal range, here.

PV: I’ve already revealed way too much in this podcast.

DK: Yeah. This was a very … Yeah, yeah. We both did a little bit of sharing here.

PV: What gives you hope right now?

DK: I probably really only felt hopeful, myself, in the last week-and-a-half. I’m trying to avoid being overly political, but I’ll be personally political right now. I think the election results point to some things that I think will change in a way that will be beneficial for us, at least in terms of the country managing COVID more effectively. I’ve had the good fortune of having a pretty large network of colleagues in other places, and what I hear about them doing in other countries, it’s stark. And it’s not political, by the way.

I have friends across the country in Canada. I have colleagues in almost every province, and in Canada … They have all kinds of political divisions in Canada, like deep, deep political divisions like we have here. But they did not politicize the virus. That’s the one thing that they did not do, and Canada is one of the countries that’s actually doing the best.

I frankly don’t blame Canada for keeping Americans out. We’re not allowed to go to Canada right now. We’re not about to be able to go anytime soon and for very good reason, because in this country, we’ve been doing a terrible job of it. The idea that maybe that’s going to change is something that I feel very optimistic about.

That and the news, I think, they would not report these promising vaccine findings without there being some reason to expect that it will be ultimately scalable so that the public at large can benefit from it. Those are the two things that give me real, true optimism about this. Had we had this conversation three weeks ago, I would have really struggled to answer that question, frankly. I don’t know that I would have been able to end on a more upbeat note, so I’m glad that we’re speaking now.

Mentorship During a Move

During the course of her doctoral studies, she met and married her husband, who was an active-duty member of the U.S. Navy, and they had a child. Soon after, he got stationed in Italy, and the family moved there. With help from McKay, she was able to complete her dissertation while thousands of miles away from campus.

“This was the nineties, so the internet was not what it is now,” Rafanello says, noting that McKay and the GSAS administration were incredibly supportive as she dealt with the difficulties of transcontinental scholarship. “Trying to get articles wasn’t easy like it is today, but I persevered.”

Helping Police Departments Hire More Equitably

Today, Rafanello works with adolescents and adults at her private practice in Morristown, New Jersey. She also works for several New Jersey police departments, evaluating job applicants for psychological fitness, while helping departments create interview and evaluation practices that are equitable for all applicants, regardless of their background.

“I think right now, we have a great opportunity to look at how we select police, and when they are police, how we take care of them,” she says.

She also says that a lack of adequate funding for social programs and agencies that support mental health, like New Jersey’s Division of Youth and Family Services, puts more pressure on police officers. “When people [who need mental health support]fall through the cracks, the police have to come in, and they’re not trained to do that.”

Providing Treatment, and Finding Hope

On the treatment side, Rafanello provides individual and group DBT (dialectical behavior therapy) treatment and works with many young people who are experiencing additional stress, anxiety, and depression because of COVID-19. Like many psychologists, she has had to move her sessions from in-person to Zoom.

“DBT’s about mindfulness, interpersonal effectiveness, emotional regulation, distress tolerance, all the things that everybody needs,” she says. “By keeping those roots going and teaching those skillsets and offering the phone coaching, we’re able to get them to use those skills, even during a pandemic and even in-between sessions.”

Rafanello says that millennials and members of Generation Z are more willing to confront mental health issues than those who came before them. She is very clear, however, that they are not overly sensitive.

“Everybody calls them ‘snowflakes,’” she says of the young people she sees. “These are the Black Lives Matter people, these are the Parkland shooting [activists]. They’re the ones that are dealing with the pandemic and going to school and making it all work. They are not snowflakes at all. I’m hopeful about the next generation of leaders, and I’m confident that Fordham is going to educate them.”

‘A Richness of Opportunity’

Rafanello says that her own education at GSAS was instrumental in her success as a psychologist.

“I was exposed to some of the brightest minds in psychology at the time,” she says of her GSAS professors. She also specifically highlights valuable experiences like landing a part-time job at Montefiore Medical Center and taking a developmental psychology class in which staff from Sesame Street visited to talk about the ways the show developed content to keep children emotionally and mentally engaged.

“[There are] so many great training opportunities and research opportunities. There’s just a richness of opportunity that extends beyond the campus because New York [itself]really is an important campus.”

To illustrate the nature of disgust, Dean McKay holds up an untarnished blue pen and poses a hypothetical: He found it buried in something foul and smelly (we’ll spare you), but he’s completely cleaned it.

“So I assure you it’s fine. Would you like to use it?” he asks, rhetorically. “You’d probably have great hesitancy.”

Such is the potency of disgust, says McKay, Ph.D., a Fordham psychology professor who studies its role in behavioral disorders. His work is part of a trend: After years of avoiding it—perhaps understandably—in their research, scholars are giving new attention to this often-irrational emotion that holds such powerful sway.

“There’s an increased recognition that disgust has been underappreciated in the value it has for understanding human behavior, and then also warrants further examination in the role it has in psychopathology,” McKay said.

His own work centers on disgust in conditions like childhood anxiety disorders and obsessive compulsive disorder. He’s in the early stages of devising therapies that target disgust, which is so well-hidden that usually people don’t even mention it when seeking help.

“We tend to not be terribly aware of the things that disgust us, except the most brutally obvious things,” he said.

That’s why disgust is understudied, he said. “In a lot of ways, clinicians have been guided first and foremost by what their clients report, or by what others around them report. It was difficult to see its relevance, and there wasn’t really a good theory that said, ‘Here’s why we might expect disgust to play a role in psychopathology.’”

McKay discovered that role while helping one of his patients deal with her contamination fears. Using a common approach, he asked her to touch various intimidating things—like a fresh, clean trash bag in a wastebasket—and rate her anxiety.

“She said to me, ‘I’m not anxious at all. I find it yucky,’” even though she had expected to be afraid, he said. Other objects brought the same reaction. Over and over, “she used the language of disgust to describe her experience and not fear,” McKay said.

After a survey of his other patients found that disgust at least played a part in their disorders, he delved further into the topic. Last year, in a study of children grappling with anxiety disorders and obsessive compulsive disorder, he found that disgust was somewhat mitigated by traditional therapies that help patients confront the things they fear.

But greater progress calls for new therapies tailored to disgust. McKay noted that fear and disgust involve entirely different bodily systems: Fear is governed by the amygdala—considered the “seat of fear”—and the sympathetic nervous system, which rev the body up into fight-or-flight mode. But disgust comes from the parasympathetic nervous system, which in this case relaxes the body to slow the absorption of any germs picked up from something yucky.

Disgust also involves the insula, a brain region associated with taste and gustatory responses (hence the “gust” in “disgust”). One possible therapy would help people acclimate themselves to the symptoms of disgust, like nausea, but much more research is needed, McKay said.

Disgust comes in different varieties, McKay said. Contamination fear, “the quintessential disgust problem,” can repel people from objects that are obviously clean, like an unused garbage bag or that blue pen he held up. Another variety of disgust, the law of similarity, spooks people when something looks too much like a disgusting object, as in the movie Caddyshack, in which a floating candy bar sends swimmers fleeing from a pool, he said.

Other disgust triggers are culturally specific—like, say, ice cream on steak, or sex acts considered abusive—or related to death or injury.

Then there’s the “stink of moral decay,” which prompts disgust because of the possible stigma it carries, McKay said. In one classic study, people refused to put on a sweater that, they were told, had once been worn by Adolf Hitler. (Even if it had been washed. And worn by Mother Teresa after that.)

This moral disgust was one aspect of a course he has recently co-taught with English professor Leonard Cassuto. The course, Literature and Psychology of Disgust, covered the influence of disgust in aesthetics, social stigma, prejudice, and racism, as shown in literature. “There’s a litany of books that deal with this,” McKay said.

In other research, he’s working on a project with another scientist who has found that disgust may play a role in some forms of posttraumatic stress, like the kind that follows sexual abuse. McKay also won a grant to study the role of disgust in misophonia, a disorder in which particular sounds cause intense emotional reactions.

He hopes to do more work on trauma and disgust now that disgust is reasonably well established as a research topic.

“I think it’s changing a little bit and gaining a little bit more acceptability,” McKay said. “We’re now at a point where some of those basic questions have really been satisfactorily answered and so now it’s moving to a different realm.”

If one or all facets of this thoughts-feelings-behavior triangle become dysfunctional, though, life can fairly quickly turn chaotic. Luckily, therapeutic techniques such as cognitive behavioral therapy help restore our inner life to harmony and break the cycle of disorder.

The question is: Are these techniques doing enough?

Psychology Professor Dean McKay, Ph.D. recently published Working with Emotion in Cognitive-Behavioral Therapy: Techniques for Clinical Practice (November 2014), a book he co-edited with his former doctoral student Nathan Thoma, Ph.D., GSAS ’08, ’11, a clinical psychologist in New York City.

The book features writings from leading psychologists on the role of emotion in cognitive behavioral therapy (CBT), a psychotherapy that focuses on the relationships between thoughts, behaviors, and feelings. This short-term, goal-oriented, and empirically validated treatment aims to change a client’s problematic behaviors and thinking patterns, which thereby improve how the client feels. It has proven to be effective for a range of psychopathologies, including depression, anxiety, and post-traumatic stress disorder.

The problem, McKay says, is that the emotional aspect does not always get its due, which means that clients sometimes leave treatment with a reduction in symptoms, but without fully resolving the issue at hand.

“Clients often seek treatment due to a range of emotional struggles, ones that might linger after successful treatment for behavioral problems and [improving]patterns of thinking,” said McKay, who specializes in treating people with anxiety disorders. “While emotion has never been neglected in CBT, the emphasis on emotional processes has not been as high as it is for the other two domains.”

The book offers information about emotional processes and includes techniques that clinicians can use to better address emotion in therapy. Topics covered include the use of mindfulness therapy and the importance of exposing clients to difficult emotions so that they learn to face uncomfortable feelings rather than use maladaptive behaviors to escape them.

“CBT has long emphasized behaviors and thoughts (or cognitions) as centrally important in psychopathology,” McKay said. “But [we]developed the book in an effort to fill an important gap in the available sources for clinicians.”