Can Pandemic Amplify My Trauma-Related Symptoms?
Individuals with a history of traumatic events are reporting more frequent trauma reminders and symptoms during this pandemic: increased intrusive thoughts and/or nightmares; insomnia and disrupted sleep; increased uneasiness, anxiety, and fear; mistrust and emotional detachment or numbing; feelings of sadness and/or overwhelming guilt or shame. There are several reasons why pandemic could be associated with a greater frequency of trauma reminders and trauma-related symptoms. Take heart, as this pandemic will not last forever, and neither will your uptick in symptoms.
Why is this happening?
Traumatic Event = Threat to your life and/or physical integrity; Pandemic = Threat to your life and/or physical integrity
The word ‘pandemic’ comes from the Greek word ‘pándēmos,’ meaning "of all the people.” When ‘pandemic’ involves a life-threatening disease with the ability to affect “all the people,” it seems reasonable to expect that many, if not most people, would perceive a threat to their life and/or physical integrity. Many of the thoughts and feelings that we experience during a pandemic are related to the thoughts and feelings that you may have experienced during and after your traumatic event (i.e., fear, helplessness, loss of control, a perception of separateness or isolation). When broken down in this way, it’s easy to see how thoughts and feelings during a pandemic could result in increased trauma reminders and increased trauma-related symptoms.
Now hear this: There isn’t anything wrong with you. You aren’t broken or damaged. In fact, it’s quite the opposite. Your brain is picking up a very important association here, and it’s working hard to keep you safe. It’s like your brain is shouting, “Hey, you! Remember that time when you were in serious danger (when your trauma happened)? When you weren’t sure you were going to survive? Well, here we are again! It’s a pandemic! Come on, get ready; it’s time to take action!”
Breathe. Sloooooowly.
Now thank your brain for doing it’s job.
You have a good brain; really, you do! It’s important to remember that you have a brain that has survived trauma. This means that your brain may be hyper alert to threat, and a brain that is hyper alert to threat is at risk of producing a greater number of false positives, or false alarms. Your brain is hard at work sifting through, organizing, and sorting data, and it’s looking for any sign or signal that trauma is in the forecast. This is likely to have you feeling more anxious and fearful during times of increased stress (pandemic qualifies here!), and you may notice more frequent trauma reminders during this time. Side note: evidence-based psychotherapy can help your hyper alert brain better distinguish between false alarms and actual danger; this is an important part of trauma recovery work (more on this later).
What can I do?
Know the signs. That is, know the signs that your brain and your body are reacting as if you are in current, imminent danger. When you are reminded of your traumatic event, what happens in your body? Does your heart race? Does your breathing become shallow? Do you feel shaky or hot? Do you start to cry? Become familiar with the ways in which your brain and body remember your trauma. Once you are aware of the signs, you can name what is happening in a matter-of-fact, nonjudgmental way: “My brain and my body is remembering my trauma.” Remind yourself that what happened then is not happening now. “That was in the past. I am safe and well at this moment. There is no danger here.” Be kind. Offer yourself compassion (I cannot stress this one enough; it is critically important and so, so helpful): “It’s really unsettling when this happens. I can offer myself support, love, and kindness. I can remind myself that this feeling will not last forever, and I will feel better soon.”
Keep your eyes open and your feet rooted to the floor. Look around you. What do you see? Name five things that you can see (e.g., a painting on the wall, the ceiling fan, seven brown shelves, a ceramic vase, my tabby cat). What can you hear? Name five things that you can hear (e.g., the sound of my footsteps, the whirring of the ceiling fan, a distant car honking, my cat purring, the refrigerator). What can you touch/feel? Go around your home or environment (as long as you are in an objectively safe place; if you are not, please seek safety) and touch five things. Notice the temperature and texture of each object that you touch (e.g., the soft fabric on my sofa, the smooth, cool glass of the windows, my warm, soft cat’s fur, the fuzzy leaves on my houseplant, the smooth, cool hardwood floors). Next, look around and locate five things that you can smell, and smell them. Take care to describe the sensation without labeling it as good or bad, pleasant or unpleasant (e.g., the candle on my bookshelf, the flowers in the vase, my houseplant, my cat’s fur, the lavender scent in the air). Finally, can you find five things that you can taste (e.g., my tea, leftover coffee from this morning, a peppermint, a piece of dark chocolate, water)? Similarly, see if you can describe the taste without judging your experience (i.e., instead of “this peppermint is ‘good,” you might say to yourself, “this peppermint is cool in sensation, has a strong or intense mint taste, a tingling sensation, etc.).
This exercise does a few important things. First, it engages your senses, connecting you to the moment that you are living in right now. “Grounding” in this way helps us distinguish between past (trauma; unsafe) and present (current safety). It also helps us detach from intense thoughts and emotions long enough to gain the perspective that we are separate from our thoughts and feelings; that we can observe or look at our thoughts and emotions, rather than looking from them (big shout out to mindfulness practice, which is key to helping us become a better observer of our experience). Using grounding to focus on the present and reduce emotional intensity also allows for greater problem-solving capabilities.
Traumatic Event = Loss of Control; Pandemic = Loss of Control
“We are collectively grieving the world we knew.”
David Kessler, an expert in the area of grief and loss
We are living in very uncertain times. Humans tend to feel safest when we can make reasonable predictions about the future. Uncertainty makes us very uneasy, and perceiving a loss of control feels threatening, just like it did during your traumatic event. Take a moment to check your experience: what are the ways in which you are currently experiencing loss of control during pandemic? Perhaps it’s restrictions related to shelter in place orders, like the inability to work at your workplace, take your children to school, or travel to see loved ones; maybe it’s the inability to visit your medically vulnerable family or friends or the inability to access important parts of your self-care routine, like meeting a friend for weekly coffee or exercising at your local gym. It’s important to recognize that your brain, having experienced trauma in the past, may be “connecting the dots” between your loss of control in the past, and your loss of control now, which may have you experiencing increased reminders of your trauma, as well as increased trauma symptoms. Your brain’s work to “connect the dots” and make associations between past and present may be activating a stress response that was very adaptive during your traumatic event (helping you survive), and not so adaptive in your current context, but the outcome is the same: the body’s alarm system is activated, and the cascade of physical and emotional signals has begun (remember, this is your brain trying to protect you; your brain’s rule, to promote survival: better scared than dead, even if your fear turns out to be a false alarm).
What can I do?
You’ve probably heard this one before: pay attention to the things that you can control.
What are those things? We cannot control our thoughts and feelings (i.e., we cannot stop or get rid of certain thoughts or feelings that we don’t like; take a moment to check to see whether this is true, in your experience), but we can choose how we respond to our thoughts and feelings. We can also choose our actions, and we frequently have the ability to influence or change our physical environment. So let’s focus on these things; the things that we can influence and/or choose. *Notice that controlling what other people think, feel, and do was not on this list.
Try looking at your thoughts and feelings, rather than from them. With practice, this will help you become less reactive to your moment to moment thoughts, feelings, urges, etc. Here is one of my favorite exercises, broken down into three steps:
First, when you notice that your mind has produced a “hot” thought (one that packs a strong emotional punch, like, “This is never going to end”), stop what you are doing and write the thought down on paper.
Next, put this phrase in front of your thought: “I’m having the thought that… [insert original thought].”
Example: I’m having the thought that this is never going to end.
Finally, read your original thought out loud (“This is never going to end”), followed by your new thought (out loud: “I’m having the thought that this is never going to end”). Observe what happens.
What do you notice when you try this exercise? What happens when you put the phrase “I’m having the thought that” in front of your thought? When asked this question, most people say something like, “It made my thought seem less final or definitive,” or “It helps me see that this string of words is just a thought, produced by my ‘mind machine’, instead of a fact.” When I can slow down enough to determine whether the thing my mind is giving me is a thought or a fact, something important happens. I begin to create some distance between myself and my thoughts. This brings about added perspective and reduced emotional reactivity. Try it out! Let your experience determine whether this is a useful practice.
Side note: you can do this with feelings and urges, too. Try labeling your feeling or urge (e.g., “I’m having the feeling of sadness; I’m having the urge to drink”). Say it out loud. See if you can be willing to be still with it, and do nothing. Breathe slowly, and make space for your feelings or urge. Just “watch” or observe it. If you can be still with it, without attempting to squash it or make it go away, chances are it will begin to lose it’s intensity in a matter of minutes, or even seconds.
In order to feel more in control, try setting small, measurable goals each day, and commit to completing them (e.g., make yourself something simple to eat for breakfast; fold one basket of laundry; take a walk or sit on your porch for 5 minutes; clean out one drawer in your kitchen or bedroom or home office). Bonus: goal completion is an important part of increasing mastery, which helps reduce depressed mood.
You can also exercise control over your physical environment. Move your furniture around. Clean or tidy up the space you occupy most often. Fill the room with a pleasant, calming scent, like lavender or lemongrass or eucalyptus. Play music that pleases you (sing or dance for an added mood lift). Create a nest-like corner or cozy spot where you can retreat when needed; have some of your favorite things next to you (my picks: a novel or magazine I can lose myself in, a few pieces of dark chocolate, lavender hand lotion, a soft, fuzzy blanket, and a comfortable pillow).
Traumatic Event = No Known Endpoint; Pandemic = No Known Endpoint
I’ve said these words many times during the past several weeks, and I’ve sat with many others who have said something similar: “If I just knew when this would be over, I’d feel better/be able to cope more effectively.”
We can endure a lot of pain, as long as we can set our sights on an endpoint. Pain of indeterminable duration is more difficult to bear. And there it is: yet another way in which pandemic connects to previous trauma. When you are in acute trauma, there is no known endpoint. There is no way to predict or know when the danger will end. This connection may have your brain reacting to the pandemic as if you are in acute danger (just like you were in the past, when trauma was occurring). It’s important to recognize that you are not in acute danger; remind your protective brain of that very important contextual detail (unless you are exhibiting symptoms of COVID-19, in which case, please consult with a medical professional!).
What can I do?
Remind yourself that this pandemic will have an endpoint. Our lives may be forever changed, and we will learn to accept our new reality and cope with the changes. Not knowing the endpoint doesn’t actually interfere with our ability to cope effectively in any given moment, it just means that we don’t know how long we will need to continue to use our best coping skills. This is a really important distinction. It also underscores the importance of treating this as a long-game, rather than a short-game. That means getting extra rest and sleep, sufficient nutrition and hydration, adequate movement and exercise, and social support and connection (*let’s be sure to take a pause and acknowledge that meeting these needs was often very challenging before the pandemic and have compassion for ourselves in our struggle to care for ourselves during pandemic). Taking care of our physical, emotional, social, and spiritual needs will allow for more effective coping over a longer period of time.
Aftermath of Trauma = Avoidance (Isolation; Limited Connection to Things that Typically Help Me Cope); Pandemic = Distance/Isolation; Limited Access to Things that Typically Help Me Cope
After trauma, many people find themselves avoiding people, places, and things that remind them of their life-threatening experience. This avoidance often leads to disconnection from important sources of pleasure and mastery, as well as distancing from others. The disconnection and isolation that you may have felt after your trauma (and may still be feeling) may feel very similar to the disconnection and isolation associated with living in a pandemic. Additionally, the steps that you ordinarily take to protect your physical and emotional health may be harder to access safely at this time (e.g., staying engaged in activities that bring you pleasure and promote a sense of mastery, like taking an art class or bouldering at a local climbing gym; using exercise as a natural anxiolytic/antidepressant, perhaps at a gym where you also benefit from socialization; hiking or cycling with a local group).
Additionally, many people are feeling increasingly anxious, sad, bored, and/or lonely and may find themselves attempting to pass the time or avoid painful feelings through less healthy means, such as drinking more alcohol, snacking excessively or overeating, spending/shopping (online) outside of their budget, etc. Those who live alone are particularly vulnerable to isolation and loneliness, which may remind them of times in their past when they felt neglected or abandoned by important others. Others may find themselves in more frequent, close proximity with people who are destructive or abusive; this can turn a stay at home order or shelter in place situation into an acutely traumatizing situation. Whether you are living alone or with others, there are certain factors specific to both circumstances that can lead to increased trauma reminders or symptoms of distress.
What can I do?
Stay connected to important others. Connect with someone each day, even if it’s for a brief period of time. Schedule virtual, face-to-face calls, talk on the phone, text, write an email, or go “old school” and send a card or letter. In keeping with local public health guidelines related to physical distancing, consider how you might connect with neighbors (i.e., porch-to-porch or stoop-to-stoop conversations); if you have an outdoor space (e.g., backyard), can you invite a friend or family member for coffee/tea and conversation, while observing the recommended guidelines (have them bring their favorite commuter mug)? Challenge yourself to do something each day to connect with someone you care about (remember, they likely need the connection just as much as you do).
Find nature. Connection with nature shares some of the benefits of connection with others. This shouldn’t serve as a complete substitute for social connection, but you can mix it up a bit, if you’d like. Bonus: Going for a walk in the woods can also connect you with a sense of pleasure and mastery (natural antidepressant).
Make/Create. Let your inner maker, artist, or musician loose (talent not required!); create something that you can display in your space (even better if you can share it with others!). Pot some plants or plant seeds for a small vegetable garden. Make homemade cards that you can send to loved ones. Color or paint by number (these days, it’s not just for kids!). Pick up a musical instrument you haven’t played in a while/always wanted to learn. Learn a new language. Use an online service to print photographs and make a scrapbook or photo album. Redesign or redecorate a room in your home or personal space (with items or art you purchase, or with those you make/create). Share your creations with others.
Work to balance time alone and time with others. This can be especially difficult right now. If you are living alone, creating time with others can be challenging and doesn’t always feel as rewarding as you expect/hope for. Do your best, and keep trying. If you are living with others and need time to yourself, give yourself permission to request time alone, and ask others to help you make time for yourself. If you are sharing space with someone who is physically, emotionally, or sexually violent and you need help, you can call the National Domestic Violence Hotline: 1-800-799-SAFE (7233). A number of additional resources related to seeking help/seeking safety can be found here:
https://www.samhsa.gov/sites/default/files/social-distancing-domestic-violence.pdf
In summary, there are a couple of things I’d like you to “hear” again:
First, many people who have experienced trauma are experiencing an increase in trauma reminders and trauma-related symptoms during pandemic. This is normal and to be expected, given the similarities between trauma and pandemic (discussed above).
Second, there is nothing wrong with you. You are not broken.
Third, be kind to yourself (for more on this critically important stance, check out www.self-compassion.org).
Fourth, this pandemic will have an endpoint, and so will your uptick in reminders/symptoms.
Fifth, any therapeutic work that you have done on your own or with a therapist will not be “undone” by this pandemic; this uptick in symptoms is temporary and will not undo all of the courageous and hard work that you have done.
Finally, good help is available. Evidence-based therapy for anxiety and trauma are effective and can help you feel better, faster. If you are local to Baltimore, you can look us up at www.bepsychotherapy.com. If we are unable to meet your needs, we will help you find someone who can.
be. kind and (self)compassionate, and stay safe.
See you on the other side.
Dr. Sara Nett is a Clinical Psychologist and co-owner of be., an evidence-based psychotherapy practice in Baltimore, MD.