During the third group therapy session, doctoral students from the University of Colorado Denver’s Psychology Clinic asked a group of small business owners to identify the stressors they can and can’t control during the pandemic.

In the “can’t control” category: Further restrictions on businesses, whether children would return to remote learning, who would and wouldn’t get sick. In the “can control” category: preparing kids to go back to school and buying school supplies, communicating with their workplace about changing norms, wearing masks and social distancing.

Then the therapists asked how the business owners might match their coping skills to their stressors. It was a lightbulb moment for those who’d been struggling financially and emotionally since the COVID-19 shutdown last March.

The business owners learned that they deal with controllable stressors by problem-focus coping (problem solving, decision making, research, goal setting). Whereas the uncontrollable, unfixable stressors need an outlet via emotion-focused coping (exercise, journaling, talking with friends, meditation).

“It was surprising and beneficial for a lot of people,” said one student. “A lot of the business owners said they’d never heard coping skills laid out that way.”

The stress management group therapy sessions are just one leg of Energize Colorado, a volunteer-based nonprofit dedicating to helping Colorado small businesses recover and thrive. The program is a lifeline and CU Denver psychologist Kristin Kilbourn, PhD, and her doctoral students are helping as many people as they can.

You Are Not Alone

In a June Wellness Wednesday panel titled, “You are Not Alone,” venture capitalist and Energize Colorado Chair Brad Feld addressed the “three crises” of the pandemic: the health crisis, economic crisis, mental health crisis and—there’s actually a fourth, he adds—the racial inequity crisis. The heap of crises meant that business owners were going to need all the help they could get. Energize Colorado, started by Gov. Jared Polis and headed by Feld, wanted to take them on immediately.

Since last May, the Energize Colorado Gap Fund has given $31 million in small business loans and grants to help small businesses across the state. Through the volunteer efforts of Colorado business owners, managers, professionals, and investors, the nonprofit also offers mentorship, business guidance, professional services, and mental health resources. Group therapy and one-on-one sessions have been big successes.

It’s no wonder the therapy sessions now have a waiting list. Throughout 2020, the Centers for Disease Control and Prevention (CDC) reported that the country is seeing high levels of anxiety, depression, fear, worry, and an increase in calls to crisis lines as a result of the pandemic. Unhealthy behaviors are on the rise, and more people than ever are having trouble sleeping and concentrating.

Denver psychologist Terri Finney, PhD, lead psychologist for Energize Colorado’s mental health resources, recruited Kilbourn earlier this spring. Kilbourn, associate professor in clinical health psychology at CU Denver, supervises the doctoral students who see patients at the Psychology Clinic. But it was her work on stress management in psychosocial oncology, cancer survivorship, and palliative care that drew Finney to her. Kilbourn knows how to help people navigate a drastic new landscape.

Since May, Killbourn has worked with the mental health team to build a successful and free group therapy program that focuses on stress management for Colorado’s small business owners.

“I taught a group therapy class this fall and I thought, ‘Wouldn’t this be a great opportunity?,’” said Kilbourn. “I knew my students could lead these stress management groups. They would get in great training while helping the community. It ended up also helpingthem with their feelings of helplessness in the face of the pandemic.”

Getting Around Therapy’s Stigma

When Kilbourne came on, Energize Colorado began offering up to five free therapy sessions through one of their 100 volunteer professionals. The nonprofit targets four populations that historically have a harder time getting capital and help: women-owned, minority-owned, veteran-owned and rural-based businesses of 25 employees or fewer. Recruiting wasn’t easy. The stigma of therapy kept numbers low to start, even with their free Wednesday Wellness seminars.

“They weren’t well attended,” said Finney. “We wanted to normalize what was going on and let business owners know they weren’t alone. It turns out not many people want to spend another 45 minutes in front of a computer.”

But they began emailing everyone who signed up for the Gap Fund assistance. The sessions began to book up and the team realized they could reach more people with group sessions. And because they labeled the program “stress management” as opposed to “therapy,” the spaces filled quickly.

CU Denver students co-lead the four-part, stress management virtual groups filled with restauranteurs, retailers, early childhood educators, dance studio heads and owners of travel companies. Throughout the sessions, the therapists cover how to manage stress, identify distorted thoughts, use social support, and learn cognitive behavioral techniques.

More importantly, small business owners find community and a support from others who are dealing with the same uncertainty day in and day out. The participants from rural communities didn’t take that connection for granted.

“They told us they were immensely grateful for being able to participate in the groups,” said another student. “They said they felt super isolated where they lived and without our program, they wouldn’t have otherwise had this opportunity. Technology has given us a wider reach.”

Many of the business owners spoke about their own distress, but also worried about their employees. They hoped to return and share the mental health techniques they’d learned.

“We expected distress, but I was most surprised by people’s resilience,” said one student. “This is work: We’re asking them to learn skills, think about them, and apply them. They are engaged, interested, and taking on something new during a pandemic.”

“People stayed engaged,” said Finney. “Usually, you see a drop-off rate, but we’ve had really good attendance. Everyone who signed up showed up. They stayed and gave us great feedback.”

Because there was such a demand, the therapists are doing larger workshops, too.

Pioneers of virtual group therapy

That transition to virtual therapy was a learning experience for both the therapists and their clients. At the beginning, the students were teaching the small business owners how to use Zoom and then had to explain that this was their first time doing virtual therapy, too.

“There’s really very little research out there about virtual groups and very little within the clinical realm,” said Kilbourn. “We had to scour to find what we could, so this class has had to innovate and think on their feet. They’re that first generation and the next group of leaders who will be teaching others how to do this.”

For a profession that relies on nonverbal cues to assess what people aren’t saying, a Brady-Bunch-grid virtual Zoom group comes with challenges.

“The majority of our communication is nonverbal, so to take that away required an adjustment period,” said another student. “In a large group, identifying who has something to say, who wants to talk next, who said something that they want to discuss more… Trying to get those nonverbal cues through a screen is something I’m still working on.

“When you do face-to-face groups, there’s this emotion in the room,” said Kilbourn. “Our brains can incorporate what’s going on—the verbal, the non-verbal—and it helps you with group cohesiveness. For example, when someone turns off a camera, we have to check in with them because we have to figure out if they’re crying because of their emotions or if they turned it off because their child just walked into the room.”

They’ve found the key is to break up responsibilities between two co-therapists. One can lead the group, the other can be in charge of the chat to check on individuals throughout the session. And in a large group, it can be helpful to use a breakout room for a smaller, more open discussions.

The group has had to make up rules as they go. The group uses the first session to address them. They ask the members to be present (unlike a patient who decided to call in while driving) and discuss the challenges that come with Zoom therapy. One big challenge is the loss of privacy. When a therapist can’t control the environment, it makes it difficult to guarantee privacy in the same way.

“We can only see what the camera is showing us,” says Kilbourn. “We can’t see if there are other people in the room listening in.”

Post-Crisis Mental Health Symptoms

For all of the growing pains, there’s been a lot of gratitude on both ends. Several of the students say their interest in group interventions has solidified. Helping several people at once—and seeing them connect and support each other—had a big impact on the group at the Psychology Clinic.

The new set of tools they’ve given to small business owners should help through the next stages of the pandemic, vaccines, and slow re-opening, but everyone’s work is far from over even when the pandemic is.

“We keep reiterating that even when you come out of a crisis—when you come out of fight or flight—there’s usually an uptick in mental health symptoms,” said Finney.

And there’s one category of business owners that still isn’t receiving or reaching out for help: men from rural areas.

“We’re having a hard time because they’re isolated and have the mindset of I don’t need anybody,” says Finney. “That’s why we’re seeing more suicides in rural areas where they have more access to weapons.”

Their focus now is to increase the numbers of therapists and target rural populations. A recent round of funding just came through to help their cause.

“We’re going to see if we can partner with the Professional Bull Riders association,” says Finney. “If some of these men are willing to hop on the back of a three-ton bull, I think we can convince them to try therapy.”