Tackling Trauma
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COVID 19 and Trauma
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Unprecedented in our history, the words in March 2020 “stay at home” echoed across our four nations. We were then in a national lockdown, a worldwide lockdown.
Suddenly isolated and in quarantine, stress became a daily experience along with a sense of grief as each of us began experiencing multiple losses alongside the uncertainty of our future.
A new term ‘lockdown fatigue’ has been adopted since the pandemic with people feeling emotionally numb and tired.
When stress persists over weeks or months, this becomes chronic which can then compound into trauma.
LOSS FEAR UNCERTAINTY ISOLATION STRESS TRAUMASYMPTOMS
Christine A. Courtois, defines trauma as:
“an inability to self-regulate, self-organize, or draw upon relationships to regain self-integrity,” which is associated “with histories of multiple traumatic stressors and exposure experiences, along with severe disturbances in primary care giving relationships.”
In September 2020, Healthline stated,
‘We’re experiencing mass trauma from Covid-19.’
Emotional Impact of Covid-19
Fear of uncertainty
Fear of death
Fear of family/friends dying
Fear of having the symptoms
Boredom
Frustration
Sense of isolation
Anger and anxiety
Depression and suicide
Sadness
Feeling numb
Hyper-arousal is a when you experience high levels of anxiety. People become easily triggered by tiny or insignificant things which can lead to negative emotive reactions.
Hypo-arousal is when people become withdrawn, ambivalent in engaging in day-to-day experiences, their mood is flat.
General Impacts of Covid-19 Quarantine
Financialloss Socio-economicdistress Concern aboutbecominginfected ortransmittingthe virus Homelessness Obesity Prematuredeath Psychologicaldistress Lowincome Loss ofwork Poverty Increase indomestic abuse Increase insexual abuse Working fromhome -over working Parents homeschooling Higher alcoholconsumption Self-harm Hospitaltreatmentsimpacted Hospitalappointmentsonline - stressful Hospitaloperationscancelled GPappointmentsonline-stressful Trauma relatedmental healthdisorders Pre-existingmental healthdisorders worsen Difficulty sleeping- nightmares Difficultyeating
Socio-economic Implications of Covid-19
Inhibited travel Inhibited tourism Aviation industry Hospitality Sport Shops closing Working from home - offices closing Agriculture - lack of workers/pickers Family dynamics - domestic abuse/addiction to gaming Job losses Household poverty Reduced nutrition Reduced physical activity/fitness
The Impact of Isolating for Those who are Shielding
Initially, there was a sense of safety self-isolating for those who were shielding. That was the honeymoon period.
Then the term of isolation was extended!
For some, living on their own, the isolation begins to compound the feeling of loss, fear and uncertainty and feelings become overwhelming.
Loneliness
Depression
Anger
Boredom
Anxiety
Withdrawal from communication
Frustration
Family members can go out shopping, some go to work.
As the restrictions are lifted, some can go to the gym, swimming or to a restaurant.
Not the person shielding!
Quote from a man shielding alone:
‘When we were allowed a haircut, I went to the barbers. Later I reflected that this was the first time I had felt another human’s touch since March (2020)’.
Conversely, people who were shielding still have clinic appointments, scans, and treatments.
The fear of being exposed to Covid-19 or NHS staff treating them can exacerbate fear.
Quote from a 24year old man shielding and recovering from Osteosarcoma (a type of cancer) which later spread to his lungs:
‘The results from my MRI scan were given to me by phone, on the door-step of my home with my Mum and Girlfriend standing on the road, all of us distanced. When the results were given and were negative, all we all wanted was a hug’.
What has been lost?
There are many circumstances and experiences which have caused stress, toxic stress which over time can compound to trauma.
The impact of Covid-19 is experienced with some differences within various groups of people, however, there are also many similarities.
INFANT and CHILDREN – Loss
69% of children stated their mental health is now poor (Young Minds, 2020) YOUNG PEOPLE – Loss In late January 2021, the children’s commissioner, Anne Longfield, warned that young people’s mental health services were “unable to meet demand” in a pandemic and a coalition of child health experts warned in a letter to the Observer that “children’s welfare has become a national emergency”. YOUNG ADULTS – Loss ADULTS – Loss OLDER ADULTS– Loss
What do we fear?
ContractingCOVID TransmittingCOVID Death Becoming anxiouswhen outside People notwearing masks Loss ofwork/school Going to publicplaces (shops etc) Publictransport COVID newson radio/television Fear for ourfriends/family Being afrontline worker
Wanigasooriya et. al. (2021)
Lockdown Fatigue
Pandemic fatigue can be described as a state of exhaustion.
Also known as quarantine fatigue or pandemic fatigue is prevalent within society due to feeling demotivated when self-isolating.
Every day seems the same, the ritual of cooking, limited socialisation, and the constant task of disinfecting.
Schooling and working from home, it is as if there is no escape from the same four walls.
Your freedom has been taken from you with a sense of uncertainty for your future.
Reasons for Lockdown Fatigue
• An overload of Covid-19 information, infection, and death rates
• Being isolated and away from family and friends
• A change in routine, not having a routine
• Home schooling
• The uncertainty of employment or schooling
• Feeling angry when people are not following the rules
• Fed up with being cautious
• Feeling scared going food shopping
• The uncertainty of when it will all end
The impact of Lockdown Fatigue
• Sadness
• Lack of motivation
• Feeling angry and frustrated, having angry outburst
• Feeling irritable
• Depression
• Exhaustion, feeling burnout as if you have nothing more to give
• Having difficulty in making decisions
• A lack of motivation
• Feeling anxious about anything and everything
Brain Fog
An article in the Guardian by Moya Sarner (4th April 2021) discussed the phenomena of ‘brain fog’; how trauma, uncertainty and isolation have affected our minds and memory. Day’s blend into each other and there is a lack of new experiences which stimulate the brain, such as travelling to work, interacting socially with friends, family, in school or in the workplace. Follow the link to read the full article.
Coronaphobia
Traumatic events can lead to specific phobias.
Garcia, (2017)
A phobia is an anxiety disorder characterized by persistent, excessive, unrealistic fear of an object, person, animal, activity, or situation. Phobia makes people avoid the triggers of fear; when such avoidance is not possible, it causes anxiety and distress.
American Psychiatric Association, (2013)
Arora et. al. (2020)
Recovery is to Promote Resiliency
• Relationships – talk and share your thoughts and feelings, phone, video call, social media, or text
• Reassurance – planning trips out so that you feel safe
• Routines—provide familiarity and structure
• Avoid the news
• Exercise burns off adrenalin from constant stress and release good-feel endorphins
• Relaxation, mindfulness
• Regulation techniques – learn how to cope
Links to other pages for emotional regulation techniques:
Exposure to Your Fear
Planning small steps will support you in overcoming your fear. This video is about a phobia/fear of bees, but this technique can be adapted to Coronaphobia:
https://www.youtube.com/watch?v=2z-ZGt_vD5Aandt=224s
Covid Facts
Covid-19 Patients
One in three Covid patients put on a ventilator experience extensive symptoms of post-traumatic stress disorder.
The most common PTSD symptom experienced by Covid-19 patients was intrusive images, sometimes known as flashbacks. Examples of these could be images of the intensive care unit (ICU) environment, ICU doctors wearing full personal protective equipment or other patients in the ICU.
Chamberlain et. al. (2021)
An estimated 2.1 million 10–17-year-olds are living in a household where there has been difficulty paying the bills.
The number of children needing support from food banks in April 2020 was more than double the same period last year (107% increase).
BBC Children in Need, 2020
Research by Oxford University found that 34% of COVID-19 survivors were diagnosed with a neurological or psychiatric condition within 6 months of being infected. Follow the link to read the full article.
A study, published in BJPsych Open, found around a third of hospital healthcare workers reported clinically significant symptoms of anxiety (34.3%) and depression (31.2%), while almost a quarter (24.5%) reported clinically significant post-traumatic stress disorder (PTSD) symptoms.
Wanigasooriya et. al. (2021)
References:
American Psychiatric Association. American Psychiatric Publishing; 2013. Diagnostic and Statistical Mental Disorders (DSM-5®).
Arora, A., Jha, A. K., Alat, P., and Das, S. S. (2020). Understanding coronaphobia. Asian journal of psychiatry, 54, 102384.
Chamberlain, S., Grant, J., Trender, W., Hellyer, P., and Hampshire, A. (2021). Post-traumatic stress disorder symptoms in COVID-19 survivors: Online population survey. BJPsych Open, 7(2), E47.
Garcia, R. (2017). Neurobiology of fear and specific phobias. Learn. Mem. 2017; 24:462–471. Doi: 10.1101/lm.044115.116.
https://www.bbcchildreninneed.co.uk/wp-content/uploads/2020/11/CN1081-Impact-Report.pdf
Taylor S. (2021). COVID Stress Syndrome: Clinical and Nosological Considerations. Current psychiatry reports, 23(4), 19.
Wanigasooriya, K., Palimar, P., Naumann, D., Ismail, K., Fellows, J., Logan, P., Ismail, T. (2021). Mental health symptoms in a cohort of hospital healthcare workers following the first peak of the COVID-19 pandemic in the UK. BJPsych Open, 7(1), E24. Doi:10.1192/bjo.2020.150
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