Prevent PTSD: The COVID-19 Crisis and Trauma

I believe that we are at risk for collective and transgenerational trauma.

Collective trauma is when a group of individuals experience a post-traumatic stress response as a result of the same event. Wartime veterans, survivors of plane crashes, or holocaust survivors are examples of groups that may experience collective trauma.

Did your parents ever have behavior around saving food, household items, or tinfoil that you brushed off as eccentric? What about a parent who uses power and control to get what they want, but seemingly cowers in respect to their own parents? Maybe you’ve visited a country and felt unwelcome as soon as your nationality is discovered? These are indicators of transgenerational trauma.

Transgenerational trauma is when maladaptive coping mechanisms born out of a trauma are passed on to future generations. This is seen in families where parents with individual trauma pass on maladaptive behaviors to their children, in a generation’s leaders creating racial bias through maladaptive messaging, or in whole generations passing on coping strategies to the generation below through observable behaviors (Lara, Svetlana N., Erik, Roger, & Lehman, 2019).

I believe we are experiencing collective trauma, and if we don’t attempt to protect ourselves from engaging in maladaptive coping mechanisms, we risk passing on our trauma to generations and generations to come.

Fight, Flight, Freeze: A Normal Crisis Response.

People’s reaction to the COVID-19 crisis is normal: it is biologically ingrained in us to respond to threats, attacks, or danger with fear, anger, or shock. Or, as many of us know it: fight, flight, freeze.

In response to danger, threat, or attack, our brains are designed to skip all unnecessary physical and mental processes in order to survive. The major three ways of surviving at a biologically basic level are to run for your life (flight), shut everything down and stay put (freeze), or attack (fight) (Nunez & Legg, 2020).

As an advanced species, fight, flight, freeze has evolved. Our survival responses have adapted to respond to non-life threatening stressors on a more appropriate emotional level, rather than succumb to full-blown survival mode. In response to stress or perceived threat, we get angry or frustrated with others (fight), we experience shock or denial (freeze), or become so anxious and panicked that we escape to safety (flight).

I don’t know about you, but in the last month I have felt my survival instincts kick in.

Everyone responds to danger differently — some of us fight, some of us freeze. We aren’t wired the same. I typically flee. My go-to survival response is total anxiety, panic, and a flushed and frantic feeling of “SOMEBODY MAKE THIS STOP!” My husband freezes. He lays on the ground and shuts everything out. I know people who fight. They get angry and frustrated and look for someone to blame.

Whatever your response is, it’s ok. It’s normal. It’s your brain doing exactly what it was designed to do: survive in the face of danger.

So how does this relate to trauma?

Theoretically, any incident where we go into fight/flight/freeze is a traumatic experience — even if it’s small or seemingly insignificant, like getting startled by a sibling. Most of the time, our brains can recover from these “mini-traumas” quickly, and we can go on about our lives.

When our brains struggle to recover from the traumatic event, we may go on to suffer from Post-Traumatic Stress Disorder (PTSD).

Individuals with PTSD experience residual emotional, mental, and physical effects of a traumatic experience for years, if not for the rest of their lives. Some of these symptoms include nightmares, intrusive thoughts or memories, negative mood, hypervigalence, irritability, depersonalization, risky behavior, sleep disruption, self-blame, and more (“DSM-5 Criteria for PTSD”, 2019).

If you have some of these symptoms, that does not necessarily mean you have PTSD — a psychologist or therapist can help diagnose if you are concerned you or a loved one is suffering from these symptoms.

However, it has been found that in the wake of the same traumatic event, some people go on to suffer from PTSD while others don’t (Haglund, Cooper, Southwick, Charney, & Ba, 2018).

It is often the case that those individuals who do suffer from PTSD go on to exhibit maladaptive coping mechanisms to deal with their trauma, including alcohol abuse, risky behavior, suicidality, and social withdrawal.

So why do some people have PTSD and others don’t? How can two people go through the same traumatic experience — like having the same abusive parent, surviving the same traumatic event, or facing the same crisis, yet one leaves unscathed and the other with full-blown PTSD?

It is this exact question that we must investigate in order to prevent lasting emotional, mental, and physical effects of what is happening to us as a human race right now.

There has been ample research on what factors create resilience in the face of traumatic events. Among these are humor, movement, a positive outlook, “active” coping styles, altruism, social connections, acceptance, spirituality, and a growth mindset (Charney, et al., 2004; Haglund et al., 2018; Southwick, 2005).

These resilience factors that protect individuals from developing PTSD are the same factors that can lead to more adaptive coping in response to post-traumatic-like symptoms.

If we can harness the skills of highly resilient people, we can set ourselves up for a lower risk of PTSD, less chance of passing on transgenerational trauma, and higher hopes for our ability to cope with this crisis.

The 5 Resilience Factors

Below are the 5 most accessible and learnable skills we can tap into right now in order to bolster our resilience. It is my belief that by harnessing these resilience factors, we can reduce the likelihood of experiencing post-traumatic-like symptoms in response to this global crisis.

Positive Emotions and Humor

Having a hopeful outlook has been linked with resilience in the face of stress. Everybody remembers Eyore from Winnie the Pooh, right? And how nothing ever works out for him? And how he is perpetually sad, low, and hopeless? What about Dory, the almost pathologically optimistic fish from Finding Nemo, who despite tons of setbacks has a continuously positive outlook on life?

Both of these characters experience hardship, yet they have two totally different outlooks on their situations. And while their stories are different, I would consider Dory much more resilient than Eyore — she is more inclined to continue to push forward, try again, and not give up in the face of a challenge or stress.

When we look at the brains of highly resilient people, the same is true: individuals who face stressful experiences with optimism, hope, and even humor tend to experience lower spikes in stress hormones (Southwick, 2005).

Here’s the kicker: our brains are really effing smart, and they adapt quickly. The more experiences our brains have of not stressing out when we face hardship, the stronger that part of our brain becomes.

In a nutshell: the more optimistic we are, the less we stress. The less we stress, the more optimistic we become.

Geek out with me: Our prefrontal cortex is the part of our brain that makes decisions based on experience — it is our “affective working memory.” When we have certain experiences, our brain records the outcomes and logs them as “positive,” or “negative.” In the future, our brain anticipates certain outcomes and “engage[s] in behaviors directed toward avoiding punishment and/or acquiring rewards” (Southwick, 2005).

Individuals with high functioning affective working memories have a positive outlook on what’s to come. As a result, they have lower spikes of stress hormones. This creates a continued positive feedback loop of optimism (Southwick, 2005).

Simply by choosing to have optimistic thoughts, engage in humorous, joyful activities, and looking for “silver linings,” we start to strengthen our affective working memories and train them to be optimistic.

The result? Lower risk of depression, “anhedonia and hopelessness resulting from traumatic stress exposure” (Charney, et al., 2004).

Active Coping Styles

An active coping style is one that works towards the issue at hand, rather than withdrawing or avoiding it.

There are two active coping styles: “problem-focused” and “emotion-focused.” Problem-focused coping styles are those that attempt to solve the problem at hand, while emotion-focused coping styles aim to accept and address the feelings that arise in response to the event (Haglund et al., 2018).

An example of a problem-focused coping style might be making pros and cons lists, while an emotion-focused coping mechanism might be practicing radical acceptance or mindfulness of the emotions.

Both of these approaches exude a “leaning in” quality, rather than an avoidant quality. Individuals who practice these coping styles approach a stressful event with curiosity, acceptance, and openness: all key factors in overcoming stress rather than succumbing to it.

In contrast to active coping styles are “passive” coping styles, which attempt to distract, detach, or avoid the problems and emotions related to the event altogether. Examples of passive coping styles may be acting as though the person is unaffected, refusing to acknowledge a problem, engaging in distracting activities like drinking, using drugs, sleeping, or dissociating (Haglund et al., 2018).

While passive coping styles are effective (otherwise they wouldn’t be coping styles), they are not long term solutions. These coping mechanisms offer bandaids rather than building blocks for future resilience. Passive coping styles teach our brains that stress is something to avoid and that cannot be overcome, while active coping styles teach our brains that while stress is upsetting, we are capable of experiencing and moving past it.

Altruism

Altruism — the act of giving back, paying it forward, helping others, or generally acting out of a moral compass has been shown to enhance resilience factors.

People who take on an altruistic role experience fewer post-traumatic stress symptoms than others when facing the same traumatic event (Haglund et al., 2018).

This is why when you look on your Instagram or Facebook feed, you’ll see that psychologists, philanthropists, social workers, and people in the helping profession seem to be coping well, if not too well in response to COVID-19.

But why?

Let’s say you and I get in a car crash together, and you are stressing the F out. If I go into altro-mode (nope, not a real word, but boy how it slides off the tongue), I immediately start to remove myself from the situation and see it from an outside, helper’s perspective. I start to observe your stress and consider ways I can help you to relieve it. I may speak to you in a calm, soothing voice. I might offer you a blanket or bottle of water. I may begin to talk to you about ways to reframe the situation or guide you through paced breathing.

By helping you to engage in these stress-reduction behaviors, I am inadvertently teaching myself that these are positive stress responses. As a result, I help you and I help myself to cope with the crisis in an adaptive way that promotes future resilience (Charney, et al., 2004).

Flexible Thinking

Flexible thinking is the ability to construct reframes, especially in the face of a seemingly destructive event. Reframing is a beautiful technique in creating a new way to think about something. It is the act of choosing to see or think about a situation in a radically different, and often positive way. This act is referred to as “cognitive reappraisal,” and is a technique used in Cognitive Behavioral Therapy (CBT) (Haglund et al., 2018).

For example: If a spider shows up in your room, you might freak out initially. A cognitive reappraisal or reframe might be if you then think, “well, spiders eat mosquitos, so it’s actually a good thing this spider is here because otherwise I’d get eaten up by those buggers!”

The ability to cognitively reappraise on a larger scale — like in the face of a crisis — allows you to move past an initial, and likely stressful thought into a reframe that reduces stress and anxiety.

“Neuroimaging studies indicate that individuals who use cognitive reappraisal to deal with adversity have strong “top-down control” of emotions. They can modify their reaction to stress or trauma by activating the prefrontal cortex, which then modulates amygdalar response to the situation” (Haglund et al., 2018).

Another type of flexible thinking is what existential psychiatrist Viktor Frankl calls “meaning-making.” In his account of surviving the holocaust he discusses meaning-making and its role in his survival (Haglund et al., 2018). Frankl made meaning out of a horrific situation: he believed his purpose was to survive so he could tell his story of life in a concentration camp. When facing each new stressor during his experience, he reminded himself of this purpose and constantly reframed his initial thoughts and responses, and ultimately survived without any post-traumatic stress symptoms.

When my high-school sweetheart passed away, I could not recover from the grief. I felt guilty that he had died, while I had lived. For eight months, I beat myself up for being alive, telling myself “it should have been me.” One day, I saw a hawk flying above me on my daily run. For five minutes, this hawk flew by my side, non-stop. Something inside me believed it was my friend, and that he was telling me to keep going. He was telling me to live because he couldn’t. To this day, when I feel depressed, I remind myself of the meaning I made out of my friend’s death: to live life to the fullest because he never had the chance.

Acceptance

Acceptance is the simple act of acknowledging reality as is. When we accept reality as it is, we can stop fighting, denying, or avoiding it and begin processing, overcoming, and moving past it.

There is often resistance to the idea of acceptance, because people sometimes mistake acceptance for resignation to or agreeing with something. Acceptance does not mean resignation. Acceptance says, “I surrender,” while resignation says, “I give up.” Nor does it equal agreeing. Acceptance is the act of acknowledging reality, while agreeing is the act of approving of or liking reality. I can fully accept a situation without giving up, and I can fully accept a situation without liking or agreeing with it. (Tartakovsky, 2018).

Radical acceptance is a Zen Mindfulness practice that has been used in a variety of therapeutic models, including Dialectical Behavior Therapy (DBT). DBT was created as a therapeutic approach for individuals with Borderline Personality Disorder (BPD), who often experience abnormally high or seemingly over-reactive stress responses. Typically, this is due to a high sensitivity to threat that has developed as a result of past or ongoing trauma.

Many of the therapeutic tools in DBT are aimed at re-training the brain to observe situations as less threatening than a person with BPD’s brain typically interprets them. Among these techniques is Radical Acceptance, the act of accepting so deeply and viscerally that one finally creates space to problem-solve, adapt and cope, and eventually recover from the stressful situation (Tartakovsky, 2018).

By practicing radical acceptance, we give our brains the opportunity to see the situation at hand as approachable and solvable, rather than threatening and dangerous. This creates space for us to adapt our thinking about the situation, our coping strategies in relation to the situation, and ultimately the intensity of our stress-response.

This is a really excellent time to incorporate these practices into your response to COVID-19.

For anyone who has experienced high amounts of stress, sleep disturbance, anger, hypervigilance, or depressed mood, I invite you to practice at least one of these skillsets.
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If you haven’t been doing any of these things, that’s ok! That doesn’t automatically mean you’ll experience a post-traumatic response. And, there is no harm in experimenting with one or more of these and simply observe the effects.

It is my hope that as many of us as possible can recover from this crisis with few to no post-traumatic symptoms. I hope that with the continued support, advocacy, and resource-sharing we see from multiple sources, that goal can be accomplished.

We can prevent widespread trauma if we continue to spread the wisdom, resources, and kindness that I have seen online. There is no contribution too small to help with this effort. I hope one day, the generations after us will look back and see this point in history as a time of kindness, community, and great resilience — not of cowardice, cruelty, and retaliation.

Take care of yourselves, pretty humans. We can do this. You can do this. We are resilient.

References

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Choi, K. W., Sikkema, K. J., Velloza, J., Marais, A., Jose, C., Stein, D. J., … Joska, J. A. (2015, October). Maladaptive coping mediates the influence of childhood trauma on depression and PTSD among pregnant women in South Africa. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500677/

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Hall, K. (2013, December 15). Three Blocks to Radical Acceptance. Retrieved from https://www.psychologytoday.com/us/blog/pieces-mind/201312/three-blocks-radical-acceptance

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