Since the first COVID-19 case reported in early December 2019, as of 3 February 2020,
the total number of confirmed COVID-19 cases has reached 17,335 over the whole nation,
and the number is still increasing [1]. At present, in order to prevent the spread
of the epidemic, the Chinese government has implemented strict self- and forced-quarantine
measure across the country. This measure may continue for a unpredictable long time.
The epidemic brought to people in China and the world not only the risk of death after
virus infection, but also unbearable psychological pressure. When facing the extraordinary
situation of public health emergency, people are prone to various psychological and
mental problems. Quarantine for COVID-19 on the one hand increases the possibility
of psychological and mental problems. This is mainly because quarantine gradually
distances people from each other. In the absence of interpersonal communication, depression
and anxiety are more likely to occur and worsen. On the other hand, quarantine reduces
the availability of timely psychological intervention, and routine psychological counseling
is also difficult to carry out in current situation. In order to solve some of the
psychological and mental problems that quarantine may bring, a new type of psychological
and mental problem intervention strategy that is feasible and accessible is urgently
needed.
In addition to the face-to-face routine psychological counseling mode, remote written
counseling may become a new type of psychological counseling mode in the context of
public health emergencies. Structured letter therapy is a kind of feasible psychological
intervention approach. To a certain extent, this new approach can also realize the
merger of consultation, diagnose and treatment. Structured letter therapy should have
the following characteristics:
Includes Patient Page, Intervention Page, and Continuation Page. The Patient Page
and Intervention Page should include at least but not limited to the following items:
Patient page
1) Please briefly introduce yourself, including your gender, age, education level,
and work.
2) Do you have any underlying disease that you think is necessary to tell your counselor
or psychiatrist specifically?
3) What is your question? Please summarize the content of the question in one sentence.
4) Please choose your most prominent emotion from the following items (depression,
anxiety, worried and afraid, hopeless and helpless, if you can’t find the corresponding
emotion, please write down your prominent emotion separately).
5) Do you have any additional questions?
Intervention page
1) Possible reasons for your current emotions, how you should ease them, or how to
learn to live with them.
2) Contents of regular psychological counseling interviews.
3) Your current performance may be part of ___ (a certain psychological problem or
diagnosis of mental disorder considered), and if possible, please complete the self-
rating scale I am to provide.
4) Do you have any questions you need to continue to consult?
5) Go to the Continuation Page.
If the patient’s questions written on the Patient Page are particularly ambiguous,
the counselor or psychiatrist should ask the patient again on the Intervention Page.
Excessive communication with patients outside the consultation process is not recommended
in order to minimize the possibility of invalid or inefficient communication.
Structured letter therapy is free in application scenarios, but it is necessary to
emphasize process standardization. It should not be applied in excess of provided
entries.
Structured letter therapy can play a certain role in counseling psychological and
mental problems that are prone to chronic progression. Because its intervention intensity
is not as good as conventional psychological counseling, and it cannot respond to
sudden psychological crises in a timely manner. It is not recommended for the general
counseling for some acute psychological and mental problems. In addition, special
attention should be paid to the patient’s underlying disease, since some of underlying
diseases may have a significant impact on final judgment of counselors and psychiatrists.
In summary, structured letter therapy has the outstanding advantages of helping psychological
consultants and psychiatrists to continue counseling on psychological and mental problems
under strict quarantine measures, but it also has many potential disadvantages that
need to be further improved.