This post includes summaries of what several trauma experts are recommending about managing pandemic trauma, and then looks at what the DMM might offer to gain an understanding from a perspective of using self-protective strategies to survive unique dangers of pandemic danger.
Bessel van der Kolk: a trauma perspective
Steering ourselves and our clients through new and developing traumas
Below is a summary of Bessel van der Kolk’s free 30 minute webinar, hosted by Pesi and the Psychotherapy Networker (link below)
Preconditions for trauma
- Lack of predictability
- Loss of connection
- Numbing out and spacing out
- Loss of sense of time and sequences
- Loss of safetyLoss of sense of purpose
People can act “Disorganized in response to all of this”
- Create schedules
- What do you look forward to?
- Create things to look forward to
- Create a calendar of connections and activities
- Loose physical sense of agency
- Natural response of fight or flight is not available (except with destructive behaviors, drugs, anger, violence)
- Need to take action
- We have stress hormones to move, protect, and take care of ourselves
- We are meant to cook meals together, build houses, gather food, go to work, shovel snow, and make babies and take care of them
- We need to be able to stand up for ourselves and say, “one step further and ……!”
- Learning to control our emotions, behavior, and thoughts.
- Yoga, chi gong, meditation, mindfulness, breathing exercises
- Breathing, 6 breaths in, hold 2 seconds, breath out slowly, focus on out breath
- We are collective creatures. We don’t’ exist as individuals.
- Be intensely engaged with people
- Interaction with other minds, brains, bodies, being in synchrony with others fundamentally shapes who we are
- Utilize the power of voices and faces.\
- When we cry, we’re supposed to get a response, and when we laugh, somebody is supposed to laugh with us. Those are the rhythms of life by which we develop and sustain ourselves.
- Sounds, facial movements, and the synchrony and rhythms between faces and voices keep us feeling alive.
- 1918 pandemic, no phones, no way to have extended social contacts, led to dramatic psychological problems.
- Family meals, games, dress-up, story telling, music making, virtual contacts.
Numbing out vs mindfulness
- How do you restore a body and brain that can be in sync with others?
- To feel your body safely is an essential skill for being in touch with yourself and in sync with others.
- The first thing is to notice yourself.
- As longs as you don’t notice yourself, you are like a chicken with his head cut off. You just run around like an automatic creature that responds to any input automatically: with anger, fear, irritation.
- Once you can observe what’s going on with you, you start being able to make choices.
- This is easier done if there is somebody out there who can help you notice and to name things, as in “This is what is happening to me.”
- The issue is not mindfulness alone, it’s rather mindfulness with self-compassion.
- See that angry part or yourself and acknowledge what that anger has done for you to survive. See that the anger has been a way of managing unbearable threat.
Loss of sense of time, having a future
- This is particularly an issue in a pandemic situation
- When you’re traumatized, time stops, and you feel like it will last forever.
- When you meditate you notice uncomfortable sensations, uncomfortable thoughts, and you go back to your breathing. Then you notice that your thought has shifted to something else.
- If you feel a cramp, you notice it, and something else happens. We live in continuously evolving organisms.
- A very important part of dealing with potential trauma is to live with an inner sense that every moment is different from the next.
- Developing a feeling of safety is a key issue for managing trauma, an internal sense of safety
- Identify what makes you feel safe? Identify what makes you feel calm.
- Touch, cuddle, hold.
- Also, privacy. Everybody needs a place to which they can withdraw.
- Get an agreement about where you can have a private space that you can withdraw to and no one will bother you there.
- Traumatized people feel unsafe inside their bodies: are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness. They learn to hide from their selves.
- Domestic Violence: Call 1-800-799-SAFE (7233), or visit the https://www.thehotline.org/help/
Bessel van der Kolk made these comments in a free webinar hosted by Pesi and Psychotherapy Networker, addressing the global coronavirus crisis, titled: Steering ourselves and our clients through new and developing traumas. The talk is available here: https://catalog.psychotherapynetworker.org/sq/pn_001345_body_keeps_the_score_covidemail-117987?utm_source=Silverpop&utm_medium=email&utm_campaign=040520_pn_c_rt_BesselCovidFreebie_830amthrottled
See also https://www.besselvanderkolk.com/
Sue Varma: a psychiatric perspective on loneliness
Coronavirus Quarantines: What It Means To Face Trauma In A Household of One
Below is a summary of an NPR interview with psychiatrist and loneliness expert Sue Varma
When people are lonely, they feel anxious, and can be hard on themselves and blaming themselves. Negative thoughts can creep in, especially when there is a reduced support network. Stress leads to a lot of “noise in our heads” which can make it hard to manage stress.
Micro-connectons can help manage normal daily stressors.
Anxiety, stress, stress related disorders, post traumatic stress disorder are on the rise. Pandemic related stresses include financial insecurity, loss of employment, getting sick, all increase stress. Pandemic stress is different from an event like the 9/11 twin tower attack because there is no visible end, and physical contact is reduced.
Social contact and physical touch are important to manage stress.
Children can handle pandemic stress better than adults, in part because they don’t have so much “noise in their heads”, adults have lived through more and can better project possible dangers in the future, and for better or worse, they don’t have all the words adults do to describe their pandemic experience. Kids need structure, open ended neutral discussions (“What is bothering you?)
4 M’s of mental health, by Sue Varma
For people who are self-isolating alone, they can follow the 4 M’s of mental health.
10-15 minutes every day at least. Any kind of exercise, get outside if possible.
Do something you have control over. Caution: don’t worry about perfection or completion or productivity. Rearrange your closet, cook, crafts, write…
Altruism. Help other people, it benefits both the receiver and giver.
Jeffrey Lieberman: a psychiatric perspective on pandemic anxiety
‘We Will Get Through This’: Advice for Lessening Your Pandemic Anxiety
Jeffrey A. Lieberman, MD, March 31, 2020
Below is a summary of Lieberman’s article.
“The COVID-19 pandemic is an experience that is unprecedented in our lifetime. It is having a pervasive effect due to how mysterious, potentially dangerous, and sustained it is. We don’t know how bad it’s going to get or how long it’s going to last. We have natural disasters like hurricanes and earthquakes, but they are limited in time and scope. But this global pandemic is something we can’t put our arms around just yet, breeding uncertainty, worry, and fear. * * *
“The populations being affected by this pandemic can be placed into different groups on the basis of their mental health consequences and needs. First you have, for lack of a better term, “the worried well.” These are people with no preexisting mental disorder who are naturally worried by this * * *. For such individuals, the equivalent of mental health first-aid should be useful * * * Given the proper guidance and sources of information, most such people should be able to manage the anxiety, worry, and dysphoria associated with this critical pandemic. * * *
“Then there are those who have preexisting mental conditions related to mood, anxiety, stress, or obsessive tendencies. They are probably going to have an increase in their symptoms, and as such, a corresponding need for adjusting treatment. This may require an increase in [help] * * *
“Interestingly, people with serious mental illnesses, such as schizophrenia and nonaffective and affective psychoses, seem to be less vulnerable to the stress-inducing effects of catastrophe. It’s possible that the pandemic could find its way into delusions or exacerbate symptoms, but somewhat paradoxically, people with serious mental illnesses often respond more calmly to crises than do individuals without them. * * * “
Robert London: Is COVID-19 Leading to a Mental Illness Pandemic?
Robert T. London, MD
April 03, 2020
Citation: Robert T. London. Is COVID-19 Leading to a Mental Illness Pandemic? – Medscape – Apr 03, 2020.
This story originally appeared on MDedge.com. Medscape Psychiatry © 2020, https://www.medscape.com/viewarticle/927849
The following are portions of the article
Dr. London is a practicing psychiatrist and has been a newspaper columnist for 35 years, specializing in and writing about short-term therapy, including cognitive-behavioral therapy and guided imagery. He is author of “Find Freedom Fast” (New York: Kettlehole Publishing, 2019). He has no disclosures.
We are in the midst of an epidemic and possibly pandemic of anxiety and distress. * * * people who report periods of racing thoughts jumping back in time and thinking of roads not taken. They also talk about their thoughts jumping forward with life plans of what they’ll do to change their lives in the future – if they survive COVID-19. * * *
Social distancing has disrupted our everyday routines [and there are dangerous situations everywhere we look and people are taking extreme protective measures such as stocking up on food and weapons] * * *People are bursting into tears, and becoming easily frustrated and angry. Add in nightmares, ongoing anxiety states, insomnia, and decreased concentration. * * *
Juliana Tseng, PsyD, a clinical psychologist based in New York, * * * said that the hype, half-truths, and false information from some outlets in the popular media are making things worse. Dr. Tseng added that the lack of coordination among local, state, and federal governments also is increasing fear and alienation.
As I see this period in time, my first thoughts are that we are witnessing a national epidemic of trauma. Specifically, what we have here is a clinical picture of PTSD. ** * Isolation is both painful and stressful. Frustration, flashbacks of past life experiences plus flashbacks of being ill are reported in people I’ve spoken with. Avoidance, even though it is planned in this instance, is part of the PTSD complex.
What can we as mental health professionals do to help alleviate this suffering?
* * *we can empower people by helping them to develop skills aimed at increasing the ability to relax and focus on more positive aspects of life to break the chain of the stress and tension of anxiety as well as control the PTSD.
For more than 40 years, I have helped people master relaxation techniques and guided imagery. When taught properly, people are able to use these techniques on their own.
To begin, I teach people how to relax, using a simple three-point method:
- Get comfortable in a nice chair, and slowly count from one to three. At the count of one, do one thing: “roll your eyes up to the top of your head.”
- At the count of two, do two things, “close your lids on your eyes and take a deep breath.”
- At three, exhale slowly, relax your eyes, and concentrate on a restful feeling of floating.
- Do this for about 30 seconds to a minute.
- Count backward, from three to two to one and open your eyes.
[The article continues and discusses another relaxation technique] * * *
Some DMM perspective
The following are some miscellaneous observations participants in the Pandemic Trauma Coffee House session discussed. These are not scientifically based but thoughts, and experiences, from session members, and should be considered “food for thought.”
Interestingly, in some cases pandemic danger may not be a problem, and may be a benefit. For some people who have experienced substantial trauma in their lives, they have developed skills for managing their difficult life experiences and the pandemic is just another problem, no worse than what they have been through. This may be an experience of some people who have suffered domestic abuse (physical and/or emotional).
For some people who were previously living isolated lives, the pandemic lock downs are an equalizing experience. For the first time, everyone else is experiencing what they have been experiencing for some period of time and it can be a validating experience. On case was discussed where an isolated person was liberated by the lock downs and able to become unstuck, see things differently, make some choices, and move their life forward.
In some cases, calls to hospitals and helplines for suicidal thoughts and requests for related help were reduced. The session participants wondered if people who often make those sorts of calls do so as part of a self-protective strategy, and now that it can be dangerous to go to hospital, they are able to choose other self-protective strategies.
While the news media reports many instances of increased calls related to domestic violence, many Coffee House session participants felt the opposite, that calls were down. Some speculated it could that people who have a strong control need do so because of a fear of being abandoned, and during the lock down that risk is lower. This could apply to both high A strategies, especially A5, and C strategies.
The DMM is centered in part on how people gain protection from danger. Danger comes in many forms, objective and subjective, financial, health, relational, etc. The COVID-19 pandemic presents new dangers that professionals may need to consider. Some of those could be:
- Loss of relational connection
- loss of privacy
- A new layer of unexpected danger
- Increased somatic cues (which may go unnoticed)
- Normally effective self-protective strategies failing to work during stay at home orders which could lead to situational depression
- Increased state control.
The DMM thinks in terms of what information people access from past experiences to help them predict and avoid future dangers. The pandemic creates a highly unpredictable future where past experiences may not be provide accurate information. This can lead to increased anxiety for all classes of attachment patterns.
One DMM inspired solution might be to make extra effort to give time, or create space to process and let strategies sort out an effective approach. Also, making more effort to gain adequate and useful information may help to process and figure out how to adjust or best utilize pre-existing self-protective strategies.
If you have additional observations or solutions, please share them with us.