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S.O.S, Informal Caregivers Need a Telescope to See the Stars Again!

By Michelle Semonella Published 13.05.2021

"and thence we came forth to see again the stars".
"e quindi uscimmo a river le stelle".

Dante Alighieri (Inferno XXXIV, 139)

In the Divine Comedy, Dante and Virgil, after having laboriously crossed the natural burella that connects Hell to the beach of the Ante-purgatory, finally contemplate the starry night sky of the other hemisphere: it is an omen of the new path of light and hope after the previous darkness.

Coronavirus Disease 19, known as COVID-19, arrived in the middle of the journey of our life "nel mezzo del cammin di nostra vita", and none recognized that we are entering the "Hell" (of Dante). Nobody understood the impact and the consequences linked to the new virus. Nobody had seen that on the entrance sign of 2020 was written down "Abandon all hope, ye who enter here" "Lasciate ogni speranza, O voi che entrate". COVID-19 has been recorded as a Public Health Emergency by the World Health Organization. Therefore, to reduce the spread of the virus, several preventive and restrictive measures have been adopted by governments worldwide. Although preventions and restrictions were, and still are necessary, social distancing, lockdown, and mobility restrictions may lead to psychological discomforts.

People's life has been, not surprisingly, impacted and altered. Behind all the pictures which portray people's attempts to face the situation and not to feel alone, singing from the balconies or hanging bedsheets on terraces and windows stating "Everything will be fine", all the restrictions mentioned above, exacerbated the conditions of those who were already in a difficult time, such as informal caregivers.

Thus, COVID-19 covered the starry sky with fear and uncertainty, whereas cities and countries became colors: Yellow, Green, Red. So, within these colors, which is the color of the stars? Which is the color of hope?

During the pandemic, informal caregivers have been facing three main challenges: 1. Emotional distress; 2. Economical stress; and 3. Decreased routine health care options. Due to lockdown and prevention, volunteers, social workers, and individual networks were not able to come, help and offer their services to support informal caregivers. Therefore, an increase in caregiving activities might have been a consequence, which may have led to excessive demands and to the additional burden on the phenomenon of providing informal care. To better understand, further difficulties should be mentioned such as the fear of being infected and, consequently, infect the care receiver, and/or being in quarantine not being able to visit the person they are taking care of. In addition to that and linked to the non-cohabiting informal caregivers, an increase in "competing" care needs has been registered since schools closed during the pandemic, and informal caregivers who are also parents had to manage both children and care recipients' duties and activities. To sum up, a diminished availability in terms of care services from volunteers, social services, and other family members has been registered due to restrictive and preventive measures, while the risk of emotional stress has been higher due to isolation, and fear of contracting the virus, economical aspects non withstanding, linked to job loss or a decrease in working hours, and consequently salaries.

Within this gloomy scenario, there is a need for stars to light up people's hope and not to feel alone. Informal caregivers need support, psychological support, to relieve them from the increasing distress which characterizes the pandemic. Nevertheless, although we grasp that stars have the color of support, we need to understand how to see these stars. Serious and deep consideration is needed to understand which is the lens that will let informal caregivers see the stars and how to offer them this supporting lens.

A shift in perspective has been made in thinking, designing, and delivering psychological support by psychologists and psychotherapists, respecting the restrictions imposed and preventing the spread of the virus. Psychological interventions to support informal caregivers developed during COVID-19, even though were different and various in term of contents and tools, all of them were delivered through digital solutions such as telephones, internet platforms, and videos. Those digital interventions for informal caregivers delivered during the pandemic shown to be efficient and helpful, improving well-being and decreasing stress and negative emotions. Having made a virtue of necessity, the effectiveness of digital psychological interventions during COVID-19 could be a huge milestone in promoting their acceptance and uptake beyond the pandemic. In fact, due to the particular conditions that characterized the caregiving phenomenon, aside from the ongoing pandemic, such as financial strain, geographic constraints, and the lack of time, digital psychological support interventions might be a possible solution to help informal caregivers. Digital solutions may be a good telescope for informal caregivers to see the stars.

"The Guide and I into that hidden road
Now entered, to return to the bright world
And without care of having any rest
We mounted up, he first and I the second,
Till I beheld through a round aperture
Some of the beauteous things that Heaven doth bear;
And thence we came forth to see again the stars."
Lo duca e io per quel cammino ascoso
intrammo a ritornar nel chiaro mondo;
e sanza cura aver d'alcun riposo,
salimmo sù, el primo e io secondo,
tanto ch'i' vidi de le cose belle
che porta 'l ciel, per un pertugio tondo.
E quindi uscimmo a riveder le stelle.
Dante Alighieri (XXXIV, 135-139)

A famous Latin proverb says: "per aspera ad astra", we get to the stars and success through difficulties. Let's help informal caregivers to get to the stars.

About the author
I'm Michelle Semonella, a psychologist with an interest in digital psychological solutions and informal care. I'm currently a PhD Candidate at Bar-Ilan University in Israel.
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Recommended reading
1. Andersson, G., Carlbring, P., Ljótsson, B., & Hedman, E. (2013). Guided Internet-Based CBT for Common Mental Disorders. Journal of Contemporary Psychotherapy, 43(4), 223-233. doi:10.1007/s10879-013-9237-9
2. Andersson, G., Topooco, N., Havik, O., & Nordgreen, T. (2016). Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Rev Neurother, 16(1), 55-60. doi:10.1586/14737175.2015.1125783
3. Bonaccorsi, G., Pierri, F., Cinelli, M., Flori, A., Galeazzi, A., Porcelli, F., . . . Quattrociocchi, W. (2020). Economic and social consequences of human mobility restrictions under COVID-19. Proceedings of the National Academy of Sciences, 117(27), 15530-15535.
4. De Luca, R., Rifici, C., Pollicino, P., Di Cara, M., Miceli, S., Sergi, G., . . . Billeri, L. (2021). 'Online therapy'to reduce caregiver's distress and to stimulate post-severe acquired brain injury motor and cognitive recovery: A Sicilian hospital experience in the COVID era. Journal of Telemedicine and Telecare, 1357633X21990195.
5. Guo, L., Wu, M., Zhu, Z., Zhang, L., Peng, S., Li, W., . . . Chen, J. (2020). Effectiveness and influencing factors of online education for caregivers of patients with eating disorders during COVID‐19 pandemic in China. European Eating Disorders Review, 28(6), 816-825.
6. Lai, F. H.-y., Yan, E. W.-h., Yu, K. K.-y., Tsui, W.-S., Chan, D. T.-H., & Yee, B. K. (2020). The Protective Impact of Telemedicine on Persons With Dementia and Their Caregivers During the COVID-19 Pandemic. The American Journal of Geriatric Psychiatry, 28(11), 1175.
7. Sheth, K., Lorig, K., Stewart, A., Parodi, J. F., & Ritter, P. L. (2020). Effects of COVID-19 on Informal Caregivers and the Development and Validation of a Scale in English and Spanish to Measure the Impact of COVID-19 on Caregivers. Journal of Applied Gerontology, 733464820971511. doi:10.1177/0733464820971511
8. Wind, T. R., Rijkeboer, M., Andersson, G., & Riper, H. (2020). The COVID-19 pandemic: The 'black swan'for mental health care and a turning point for e-health. Internet interventions, 20.
9. World Health Organization. (2020). Director-General's statement on IHR Emergency Committee on Novel Coronavirus (2019-nCoV). Retrieved from