AJTS - African Journal of Traumatic Stress

A publication of African Psycare Research Organisation In Collaboration with Makerere University College of Health Science.

Published: 2020-04-27

EDITORIAL: Well-Being And The Traumatic COVID-19 Pandemic

Epidemics and pandemics are psychologically traumatic. A worldwide infectious disease outbreak, such as COVID-19, causes much anxiety and stress.  Anxiety is a normal stress response to danger and uncertainty.  Stress may negatively influence our perceptions and behaviors.  When well-being and physical health are negatively impacted, the stress becomes a distress.  Distress negatively influences our perceptions and behaviors.

Everyone reacts to stressful situations differently.  It is important to be aware of the signs and symptoms of stress and distress in yourself, your loved ones and in others. Mental health workers need to know not only how to help others but also how to relieve stress and distress in themselves and when to ask for help. Amidst this corona pandemic, this issue’s editorial will dedicate itself to these matters.

Common Signs and Symptoms Of Stress and Distress.

Common Behaviors:  Difficulty communicating; Difficulty concentrating or making decisions; Difficulty providing or accepting help; Irritability or outbursts of anger; Increased or decreased energy and activity level; Inability to feel pleasure; Wanting to be alone; Crying frequently.

Common Thoughts:  Hopelessness; Helplessness; Catastrophizing; Thoughts/cravings about alcohol or drugs in wanting to get quick relief.

Common Emotions: Worrying excessively; Feeling depressed, guilty and getting easily frustrated or angry; Feeling confused, numb or bored; Not caring about anything; Feeling lonely or cut off from loved ones or the world; Feeling overwhelmed, demoralized or even suicidal. Paradoxically, some may feel heroic, euphoric, or invulnerable.

Common Physical Experiences: Difficulty sleeping with non-restorative sleep, restless sleep or nightmares. Having stomach aches or diarrhea.  Getting headaches or other physical aches and pains. Having little appetite or eating too much. Sweating, chills, tremors or muscle twitching

Relieving stress and distress

It is important to recognize and heed the early warning signs of stress and distress; and to know that feeling stressed, depressed, irritable and guilty are common in epidemics and pandemics.  Healthcare workers need to recognize how their own past experiences affect their own way of thinking, feeling and behaving. Therapists need to be informed, to maintain day to day self-care routines and to stay emotionally connected with others.  They need to strengthen their resiliency when helping others. They should be able to ask for and accept help when needed. Some may, themselves, need using meditation, prayer or therapy. The following are ways to relieve one’s own stress and distress in today’s Covid-19 pandemic.

Stay Informed: Get the facts. Follow accurate and trusted sources of health information. Sources include: Centers for Disease Control www.cdc.gov, World Health Organization www.who.int. The national/state and local health authorities e.g. the Ministry of Health or the local government.

Sign up for emergency alerts from your local or national/state health authority via text or e-mail.  Limit time spent reading and watching news about COVID-19. They are distressing. Avoid watching or listening to the news 24/7. Limit yourself to a specified amount of time twice daily – morning and evening only. Limit social media exposure as it often contains misinformation and is full of sensationalizations. Ask questions to your immediate supervisor and advocate for yourself e.g. Protective Equipment (PPE).

Maintain day to day self-care routines: Bathe daily and get freshly dressed daily. Eat healthy food and stay hydrated by drinking water. Get enough sleep and rest. Get physical exercise. Avoid excessive caffeine and alcohol. Do not use tobacco or recreational/illegal drugs.

Relaxation: Relax by doing exercises such as deep breathing, stretching. Engage in pleasurable activities. Meditation, prayer or therapy (mindfulness) may be of help to some people.

Emotionally connect with others: Reach out to people you trust. Use telephone, e-mail, text messaging, and social media. Use live video conferencing such as Skype or FaceTime or another platform. Share your experiences and feelings. Maintain hope and positive thinking. Consider keeping a daily diary or personal journal of things that surprise you, make you happy, inspire you, or touch your heart.

Keep things in perspective:  For example “I am resilient, I have overcome challenges before; this is a new challenge.” Follow WHO (www.who.int), CDC (www.cdc.gov) and the national/state and local health authority recommendations. Avoid catastrophic thinking. Maintain hope and a positive attitude. For example: Things will get better; the world is not collapsing; what positive thing can I do today?” Focus on positive aspects of your life and the things that you can control.

Addressing Specific Populations Care Providers: Anticipate and address stress reactions. Feeling under pressure and stressed is common. This does not mean that you are weak or unable to do your job. It is reality. Take care of yourself; this is a marathon, not a sprint. Correct any misinformation. Periodically speak with a trusted family member, friend, colleague, and/or supervisor. Remind yourself and others of the important work you are doing. Honor service by recognizing colleagues for their services and sacrifices whenever possible. Fears about one’s own health and the health of loved ones are common. Do the correct thing and be realistic. Care Provider Team Leaders: Focus on long-term capacity. Ensure good quality communication with accurate information updates. Use the Buddy System: partner less experienced colleagues with more experienced colleagues; Rotate colleagues between higher-stress and lower-stress functions. Provide support, monitor stress and reinforce safety procedures. Be available. Show empathy & understanding. Children & Vulnerable Persons: Children & Vulnerable Persons are especially vulnerable to what they hear, see and feel. Signs and symptoms of their stress and distress include: Increased crying or irritability; worry or sadness with increased need for reassurance. They may regress to outgrown behaviors (for example, bedwetting or toileting accidents). They may resort to unhealthy eating or sleeping habits or engage in irritability and/or “acting out” behaviors. Some exhibit difficulty with attention and concentration or avoidance of activities previously enjoyed or have unexplained headaches and /or body aches and pains. Older ones may use alcohol, tobacco, or drugs. Healthcare workers need to care for Children & Vulnerable Persons in developmentally appropriate ways: Speak about the COVID-19 pandemic. Share the facts. Answer questions. Provide reassurance that they are not the cause of COVID-19. Provide reassurance that they are loved and safe. Provide reassurance that it is ok to feel upset. Share how you manage your own stress and that you will help them manage their stress. Limit exposure to news coverage and social media. Maintain regular routines. People Released from Quarantine: Fears about one’s own health and the health of loved ones are common. Monitoring oneself and being monitored by others is stressful. Post-quarantine emotions are mixed and commonly include: Relief, Guilt, Sadness, Anger, Frustration. Warn them that friends and loved ones may still fear contracting COVID-19 from them even though they have been determined not to be contagious. For Those Managing a Mental Health Condition: Follow the treatment plan. Recognize the warning signs and triggers of the condition/relapse. Engage the support network. Call the mental health provider if symptoms change, have questions, or need reassurance. Telemental health visits are now much used. Make sure medication refills are up to date. Remember that some non-psychiatric medications may interact with some psychiatric medications. Seek advice from your prescriber. For Those Managing a Substance Use Disorder: Follow your treatment plan. Recognize your warning signs and triggers of relapse use e.g. cravings. Engage your support network. Participate in on-line 12 step meetings (https://www.asam.org/Quality-Science/covid-19-coronavirus/support-group) or practicing them. Call your provider/sponsor if symptoms change, you have questions, or need reassurance. Telemental health is often helpful. Be sure medication refills, if any, are up to date. Warning Signs: Seek help if you or someone you know experiences symptoms of stress or distress that are interfering with daily functioning and persisting for more than two weeks. Resources: Call on your health care provider if you have one and if you do not have a health care provider, check the Sources and Reference section at the end of this document; particularly, the National Alliance on Mental Illness – COVID-19 (Coronavirus) Information and Resources. Danger Signs: Seek help as quickly as possible if you or someone you know show these Danger Signs: Suicidal thoughts and behaviors, Child abuse and neglect; Intimate partner aggression and violence Definitions (FAQ) What is Social Distancing? Social Distancing is a way to keep people from interacting closely or frequently enough so as to avoid catching or spreading COVID-19. What is Quarantine? Quarantine separates and restricts the movement of people who have been exposed or possibly exposed to COVID-19 to see if they become sick. Quarantine lasts long enough (14 days) to ensure the person who was exposed or possibly exposed has not contracted COVID-19. What is Isolation? Isolation prevents the spread of COVID-19 by separating people who are sick from those who are not sick. Isolation lasts as long as COVID-19 is contagious. Practice Personal Hygiene
  • Wash your hands thoroughly with soap & water for 20 seconds regularly
  • Use hand sanitizer regularly
  • Disinfect heavily trafficked and regularly touched surfaces with anti-bacterial wipes regularly
  • Use a tissue to cover a sneeze and cough, or into an elbow
  • Avoid touching your face especially your eyes, nose, and mouth
  • Avoid contact with those who are sick
  • Stay home when sick
Top 10 Practices (Partners In Health)
  1. Social distancing does not mean emotional distancing – use technology to connect widely
  2. Maintain daily routines and schedule, seven days a week – don’t go overboard
  3. Exercise and physical activity – daily if possible
  4. Learning and intellectual engagement – read books, limit internet activity
  5. Positive family time – work to counter negativity
  6. Alone time, outside if possible – remember don’t isolate
  7. Focused medication and relaxation
  8. Remember the things you enjoy and that you can do – find a way to continue doing them
  9. Limit exposure to TV and internet news – choose small windows and find ways to cleanse yourself after
  10. Bathe daily, if possible – reinforce the feeling of cleanliness and well-being
Top Reminders (Partners In Health)
  1. Things will get better eventually; the world is not collapsing; I will not catastrophize.
  2. Most people are doing their best, are helping others, and will persevere.
  3. Be resilient. You have overcome challenges before; this is a new one and it will also pass.
  4. This is a particularly strange and unprecedented situation; humor helps once in a while.
  5. If you have obsessive or compulsive thoughts related to the virus, or the broader uncertainty, go and wash your hands and remind yourself that anxiety is normal in this situation. If your mind is playing tricks on you, do slow breathing and move your internal dialogue onto something else.
  6. Live in the moment, think about today, less about the next three days, and even less about next week. Limit thinking about the next few months or years for now.
References and Sources
  1. Credible COVID-19 Health Information: Centers for Disease Control and Prevention https://www.cdc.gov, World Health Organization http://www.who.int/en
  2. CDC Coping with a Disasters or Traumatic Events https://emergency.cdc.gov/coping/index.asp
  3. Taking Care of Your Emotional Health https://emergency.cdc.gov/coping/selfcare.asp
  4. Managing Anxiety & Stress https://www.cdc.gov/coronavirus/2019-ncov/prepare/managing-stress-anxiety.html
  5. Substance Abuse and Mental Health Services Administration. Tips For Social Distancing, Quarantine, And Isolation During An Infectious Disease Outbreak https://www.samhsa.gov/sites/default/files/tips-social-distancing-quarantine-isolation-031620.pdf
  6. World Health Organization: Mental Health and Psychosocial Considerations During COVID-19 Outbreak https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf?sfvrsn=6d3578af_8
  7. Alcoholics Anonymous: https://www.aa.org/assets/en_US/en_updatesoncoronavirus.pdf
  8. American Psychiatric Association: Coronavirus and Mental Health: Taking Care Of Ourselves During Infectious Disease Outbreaks. https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2020/02/coronavirus-and-mental-health-taking-care-of-ourselves-during-infectious-disease-outbreaks
  9. Psychiatric Association Foundation – Center For Workplace Mental Health. Working Remotely During COVID-19. http://www.workplacementalhealth.org/covid19tips
  10. American Psychological Association. Five Ways to View Coverage of the Coronavirus https://www.apa.org/helpcenter/pandemics
  11. American Society of Addiction Medicine: COVID-19 Promoting Support Group Attendance https://www.asam.org/Quality-Science/covid-19-coronavirus/support-group
  12. Center for the Study of Traumatic Stress: Coronavirus and Emerging Infectious Disease Outbreaks Response. https://www.cstsonline.org/resources/resource-master-list/coronavirus-and-emerging-infectious-disease-outbreaks-response
  13. Interagency-Agency Standing Committee. Briefing Note on Addressing Mental Health and Psychosocial Aspects of COVID-19 Outbreak Version 1.1. https://interagencystandingcommittee.org/the-inter-agency-standing-committee. https://interagencystandingcommittee.org/system/files/2020-03/MHPSS%20COVID19%20Briefing%20Note%202%20March%202020-English.pdf
  14. National Alliance on Mental Illness. COVID-19 (Coronavirus) Information and Resources https://nami.org/getattachment/Press-Media/Press-Releases/2020/COVID-19-and-Mental-Illness-NAMI-Releases-Importan/COVID-19-Updated-Guide-1.pdf?lang=en-US
  15. Partners In Health: 10 Mental Health Tips for Coronavirus Social Distancing. https://www.pih.org/covid-response. https://www.pih.org/article/10-mental-health-tips-coronavirus-social-distancing?utm_medium=email&utm_source=pih&utm_content=3+-+Irsquove+put+together+a+list+of+10+tips+&utm_campaign=20200320_EM100_glb_em_COVID19_fnd_MHtips_donation_2_0_cgsource=20200320_EM100_glb_em_COVID19_fnd_MHtips_donation_2_0_cg