- Mental health experts expect the COVID-19 pandemic to cause PTSD in some people.
- Managing stress and distress now can help mental health in the long term.
- Helping others and practicing self-care can help you cope during the pandemic.
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Helaina Hovitz Regal was attending middle school three blocks from the World Trade Center when the twin towers were struck on 9/11. Witnessing the event and living through the aftermath caused her trauma for years after. She battled anxiety, addiction, and post-traumatic stress disorder (PTSD) throughout her teen years and early adulthood.
In her memoir, “After 9/11: One Girl’s Journey Through Darkness to a New Beginning,” she included an excerpt from her journal she kept as a 12-year-old.
“Everyone has masks on. It’s a ghost town. The hospital across the street is geared up for casualties. They’re telling us not to go outside,” she wrote.
Nineteen years later, this description of New York City feels all too familiar to Hovitz Regal. The pandemic is bringing up similar fears that caused her distress after 9/11, such as being harmed, losing loved ones, vulnerable people and frontline workers, and not knowing how much of a threat, in this case, COVID-19, will cause.
“If I let myself think about that for too long, I can go to a really, really bad place, so I try to focus on what I can do, like check on my elderly neighbor next door and donate what I can afford to the local animal shelter down here,” Hovitz Regal told Healthline.
Her frame of mind is the result of a decade-long journey of recovery from PTSD. Still, she knows she is vulnerable to adverse effects during this time.
Dr. Shaili Jain, a psychiatrist and author of “The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science,” said past experiences like Hovitz Regal’s can affect how we react to the pandemic.
“We are all approaching this pandemic and dealing with it with influence by what was experienced before, so definitely people who have trauma can be triggered by a lot of what they are experiencing and witnessing,” Jain told Healthline.
While there are differences between what happened on 9/11 and what’s happening now, she said the emotions people are experiencing are similar, including anxiety, fear, lack of control, and panic, as well as fear of death.
“The big one I hear from patients is when the grocery stores didn’t have food and when people were lining up for basic necessities. That feeling of panic or not being safe or fear can trigger experiences of prior trauma where you felt those same emotions, even if what you were reacting to was different,” said Jain.
While during and after the pandemic, some people will experience trauma and, as a result, PTSD, Dr. Joshua Morganstein, chair of the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disaster, said there is mixed data on whether or not having past trauma puts you at greater risk.
During research, he said the timing of one’s trauma is often unclear.
“There may be people when we studied them who just experienced the trauma and are having difficulties in the moment, and there might also be people who say, ‘Yes I have experienced trauma, but it was years ago,’ and they have found ways to cope and adapt and thrive. That experience may serve to strengthen their ability to effectively manage stressors and trauma in the future,” Morganstein told Healthline.
Research on PTSD after disasters gives insight that there will be elevated rates of PTSD in the weeks, months, and years that follow the pandemic, Jain said.
She anticipates PTSD mostly affecting:
- Those who have lost a loved one. “Not being able to be there at their bedside is difficult. Funerals aren’t happening, so all those things that we do as a society to protect ourselves and to get through bereavement aren’t there,” Jain said.
- Survivors of COVID-19. Research shows that there’s a lot of PTSD in survivors from the intensive care unit because many can remember thinking they were going to die.
- People affected economically. “We know when we are in a recession and there is high unemployment, a lot of trauma trickles down, and unfortunately, we see higher rates of family violence and partner violence and that violence can contribute to post-traumatic stress,” said Jain.
- Frontline workers. Healthcare workers are exposed to death and dying and the threat of dying themselves. The threat of being exposed to COVID-19 can also cause trauma in essential workers.
Anyone who survives a trauma will have signs of PTSD in the early hours, days, and weeks afterward.
“It’s normal to feel on edge, jumpy, have your sleep disturbed, and memories of the trauma. It’s your brain’s way of adapting to the trauma. It’s in hyperalert in case you need to protect yourself. [Most] will come back down to normal,” Jain said.
If the symptoms continue for months and increasingly get worse after the disaster or event are no longer a threat, if your stress levels keep you from being able to work or care for people you are responsible for, or if you have thoughts about hurting yourself or someone else, you might be experiencing a psychological disorder, such as depression, anxiety, or PTSD.
However, Morganstein said these conditions occur over time and less often.
Distress reactions, such as trouble sleeping, feeling distracted, feeling angry, feeling unsafe, and worrying about developing COVID-19, will happen to more people and earlier than PTSD.
“Things like feeling unsafe and not sleeping well have significant health implications and are major public health issues,” Morganstein said.
As a way to cope with distress, he said people will engage in various health risk behaviors, such as increasing use of alcohol, tobacco, and prescription medications. Additionally, distress can cause more family conflict and, in some cases, family violence will increase.
“People also have difficulty balancing work at home so they will be focused with issues at work and/or the natural business of managing the challenges of the crisis in such a degree that their underlying health and well-being and social connections and other things that help buffer and protect them in the long term may get neglected,” he said.
The good news is that many people show resilience.
“The vast majority of people will ultimately do well, including people who have difficulties along the way and people who have existing and underlying mental health conditions,” Morganstein said.
In fact, research on previous disasters and stress in general implies that many people will experience what is called “post-traumatic growth” as a result of the pandemic.
“Post-traumatic growth is an increase in their perception of their ability to manage future difficulties. We know that people have a whole range of biological issues, psychological issues, and social issues that both strengthen them in times of adversity and can add to their challenges,” he said.
Taking care of your mental health now is the best way to cope.
“We as a society can do things and support ourselves and others that will ultimately improve the well-being of our entire society long before we get to the issue of developing psychological disorders,” Morganstein said.
He said to think of the pandemic as a marathon, not a sprint.
“[Health experts] say we are looking at multiple years with this flaring up at different times, perhaps as we have seasonal changes and as we reopen, so endurance comes from [continuously] taking care of the basics. That means things like eating healthy, getting sleep, and creating life patterns and new routines will remain significant parts of how we experience this event. It’s these small acts that happen over and over again,” he said.
Jain agreed, noting that change is the only constant right now.
“Part of it is accepting the situation for the way it is. Have flexibility, not only in your actions but in the way you think. If you’re a person who likes a rigid routine or needs to know that their plans will go through the way they want them to, this is not a good environment for you. It’s a fine line between acceptance and flexibility,” she said.
Other ways to manage distress include:
1. Helping others
Hovitz Regal finds comfort in checking on family, friends, and neighbors.
“At a time like this, it’s so important to stay connected to friends and family, not just to lend them an ear, but to be heard yourself. Human connection and support is crucial,” she said.
Morganstein said simply listening to people can help them feel calm.
“Things we know help people during disaster and adverse events that help them feel safer and calmer include enhancing feelings of social connection, improving our sense of community reliance, and improving our sense of hope and optimism,” he said.
People who believe they live in stronger communities have lower rates of PTSD after disasters, he added.
“[Building strong communities] can really have a significant mental health impact in a positive way for all of society,” he said.
2. Practicing self-care
Healthy activities that improve your mental health should be part of your daily routine, said Jain.
“Whether that’s meditation, yoga, mindfulness, taking walks, listening to music, cooking a beautiful meal, or reading a book. Whatever your healthy coping strategies are, you have to double down and do those at least once a day,” she said.
For Hovitz Regal, part of self-care involves engaging in healthy distractions.
“Right now, there’s nothing wrong with binge-watching, binge-podcast listening, binge-reading; whatever you need to do. We need a healthy escape from what’s going on right now. And these are much better alternatives than the other things we do to self-soothe and try to force that escape, like drinking, drugs, excessive online gambling, or shopping,” she said.
3. Limiting news consumption
While the news can keep you informed on important information regarding the pandemic, the 24-hour news cycle and social media access can be overwhelming.
“Sometimes people can’t drag themselves away. Stay informed, but pick the source of news you like, and make sure you have chunks of time you are free of news and COVID to let your brain rest and get distracted. Don’t watch it before sleep or in front of children,” said Jain.
Avoiding the news helps Hovitz Regal protect herself from being triggered. A few weeks into the pandemic, she watched a New York Times 5-minute documentary about a New York City hospital.
“It was the one thing that unleashed many of the traumatic feelings I experienced around 9/11 — sadness, anger, fear, helplessness, panic — so much so that I got caught in the freeze response (the one that comes when you can’t engage in fight or flight), crying and crying for hours, unable to move from my place on the couch, and I had to call my therapist first thing in the morning,” she said.
She suggests spreading positive and hopeful stories.
“Since so much out there is bad, see if you can find the good, and if you can, be the change you want to see on social media. Give folks uplifting and happy content. See if you can find things that are fun and lighthearted, or positive stories related to the people who are helping right now,” Hovitz Regal said.
4. Knowing it will be over
Knowing the pandemic will eventually end gives Hovitz Regal comfort.
“I am speaking as someone who witnessed and lived through what felt like the end of the world and thought nothing would ever be OK again, and the most crucial thing I can say is to remember that at some point, it will be over,” she said.
While we wait for the end to come, she added, “In order for it to get better for us personally, we have to make sure we’re doing the work we need to on our inner selves in order to process what’s upsetting, challenging, and new in a healthy way, and learn how to best take care of ourselves in each other going forward.”
5. Getting help
Many therapists are offering
“We have good data to support that PTSD treatment via telehealth is just as effective as PTSD treatment is face-to-face,” said Jain.
Hovitz Regal leans on therapy regularly and suggests finding a therapist who specializes in the issues you are experiencing, as well as getting a personal referral if possible.
“Reaching out for help is not a sign of weakness, but of strength. There is no reason to have to white knuckle through emotional suffering, especially when mental health has such a strong impact on physical health, too,” she said.
“If you’ve been waiting for the right time to reach out, it’s now.”