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When the Trauma Isn't Over - COVID-19

Part of the growing up process for every child is developing deeply held beliefs about the self, others, and the world – known as schemas – that serve as the blueprints for living and decision making. We begin to answer questions about safety, trustworthiness, good and evil, and draw conclusions about how we can reasonably expect for life to look over time. For example, a child that takes a risk by going out on the monkey bars and falls off might develop a schema of “risk is dangerous and should be avoided” or perhaps alternatively “if at first you don’t succeed, try, try again.” Both would be a reasonable response to the new piece of information that one can fall off the monkey bars depending on how the child processes the event. Once this schema has been developed, it becomes a part of the brain’s map for the world and is used to help make future decisions. Ask that person you like on a date? Better not – it’s too risky. Try out for the soccer team? Third time is the charm! In general, these schemas are useful for avoiding mistakes that have already been made and for finding short cuts to success. We use this process throughout our lives in order to learn about the world and promote self-protection from harm.

Living in a time of a crisis is a fundamentally unsettling and disorienting experience for the brain, body, and nervous system. Full stop. Understandably, living in an ongoing state of crisis can prime the nervous system and body to have a traumatic response. It interrupts our previously held knowings, disrupts our ways of organizing our lives and often forces schemas to be updated or created to accommodate for the new traumatic material. When some people think of the word trauma, they think of “Capital T, Trauma”: acute, discrete experiences that threaten the life or safety of a person. Another type of trauma is “Little t, trauma”: These events might be emotionally distressing but don’t always garner a full PTSD diagnosis and as such can be easier to dismiss by the individual or others.

It’s important to acknowledge a very specific type of traumatic profile: chronic, environmental, recurring trauma over an extended period of time. This might include both Capital T Trauma and Little t traumas but they occur in an ongoing, chronic manner as opposed to a singular traumatic event. These two types of experiences are different in important ways. For one, the brain is able to process and store those experiences in different ways. The impact of a discrete trauma can be life-altering, but the processing phase can begin if the event is over and has been survived. For those living in the second profile of trauma, the threat is ongoing and people often cannot effectively begin to process their traumatic experiences because the danger is not over and the individual is still living in a state of acute stress and crisis. This aspect of a traumatic experience, relationship, or phase of life delays the ability to process and raises the odds that a person will experience some symptoms of a Post-Traumatic Stress Disorder diagnosis in the future. I take the time to distinguish these experiences and profiles because I think it is important to name that for many, many individuals, the COVID-19 impact is not merely an inconvenience but a chronic traumatic period of time. Naming this, acknowledging the power of it, and responding appropriately is an important first step toward surviving and helping the nervous system and brain to process the information in a healthy way.

In my work as a therapist, I have seen the full range of emotional and behavioral responses to this crisis and want to take some time to sort through some of the common responses I have seen to help others find resonance, clarity, and ultimately hope. The continued descent into varying levels of a “new normal” during the COVID-19 pandemic has brought to the surface a range of familiar and unfamiliar emotions for many people. One of the first emotions I want to address is disorientation. Let me say again, living in crisis is fundamentally disorienting. Emotional disorientation can feel like fogginess, confusion, exhaustion, tearfulness, overwhelm, agitation or feeling paralyzed. The brain is trying to find its bearings in the middle of a storm (See Snowglobe article for more on this feeling) and is using way more resource than is typically necessary to get through a day. Despite being almost a month into this, I find that many of the people I talk with are still grappling with this specific feeling state, which is totally normal. I believe that a significant reason for being lodged in this state is that the brain is scanning its rolodex for experiences that are similar and is glitching a bit. Without an adequate blueprint, people are either left spinning in disorientation or rushing into attempting to cope and process using misaligned blueprints with varying results. This crisis varies from other experiences we have had as a collective in recent history in important ways. First, this is global and everyone, everywhere is being affected. When a natural disaster happens, others are able to mobilize around the world and bring support to the affected area through money, resources, support, medical and volunteer staff, etc. When the whole world is in crisis, it can create a greater sense of needing to self-protect, preserve resource for your family, your community, or your country. This is not to say that people are not helping or being generous, merely that there is so much need in so many places that there is not a localized focus. Another major difference is that this pandemic is forcing separation. During other large scale crises, people tend to rush toward the affected area and support can come in the form of vigils, public demonstration, hugs, and community. Due to the pandemic, people are being asked to stay away, keep distance, stay home. People are dying in hospital rooms without their loved ones, funerals cannot be held, celebrations cannot proceed. People are being removed from one of the most profound sources of resilience through trauma – collective strength and support.

In the responses of people worldwide, we can see the floundering, fear, grasping for control, and attempts to find footing on shifting ground. The hurried, frantic focus on productivity, growth, or self-improvement can be hugely misleading at best and downright destructive at its worst. Some companies are trying to carry on like “business as usual”, schools are adopting an entirely new platform for delivering education, and people are being creative in how they use technology to facilitate connection. While this isn’t inherently bad or wrong, it’s important to acknowledge the emotional and logistical whiplash of going to work and school as usual on a Friday, only to be setting up a “home office” and becoming a part time teacher on Monday or having a full social calendar one day only to be isolated and living alone the next. People are resilient. Undeniably. But it is natural that many people would struggle with the speed and intensity of these changes. Dr. Bruce Perry frames the ability to develop stress resilience as requiring three main components: predictability, moderation, and controllability. He further defines trauma as a situation in which the stress response is activated in an UN-predictable, UN-controllable way. It is safe to say that most of us are finding ourselves in a place of unpredictable and uncontrollable stress without moderation or expectation of an end date. For many, these factors can put a brain and nervous system in a position of having to exhaust precious emotional and physical resources to focus on survival thus leeching energy away from other tasks, relationships, or ways of managing.

If there is anything you take away from this piece, I hope it’s this: Your body, brain, and nervous system are hard wired to protect you from pain and suffering. Everything It does is with this goal in mind. All behaviors, even the most “self-destructive ones” are either directly designed to solve a problem or are the byproduct of another protective, coping strategy. We do not do things that do not make sense so long as we can get clear about what problem is being solved. This is most important because there is a lot of fear, judgment, and shame about what is and isn’t a “good way” to cope or manage the uncertainty of this experience.

Many people spend their lives living in bubbles of manufactured control that provide comfort, stability, and a sense of security. Beliefs about the protective nature of working a certain job, making a certain wage, having certain connections or operating along certain guidelines is a recipe for creating a larger sense of control over this world than may actually exist. Without these measures, people feel chaos more strongly and can have reactions of panic or hopelessness. It is one of the fundamental tenets of human behavior that until lower order needs like food, shelter, and safety are sustainably met, no other needs can be effectively filled. People that have spent their lives doing everything “right” by their own metrics are being faced with the unique position of being told that their job isn’t essential, their retirement money isn’t secure, and their local grocery store is out of toilet paper. All of a sudden getting that spreadsheet turned in by your Wednesday “hard deadline” seems way, way, way less important despite pressures from your boss. For those that were already living at the margins of society, their wages, or their health, this crisis has heightened their stress, increased the barriers to elevating their family, and added new fears. With the emergence of these unpredictable and uncontrollable pressures, it is no wonder that many are finding themselves drained, depressed, overwhelmed, and not baking sourdough bread. I first and foremost want to normalize the feeling of collapse. Your brain and body has experienced a trauma – is STILL experiencing a trauma – and it is perfectly ok that you have yet to metabolize it. There is nothing wrong with you. You are not “undisciplined”. You are not useless. Those people who are posting productivity porn on the internet are coping in their own ways, based on their own schemas, and are not necessarily better, stronger, more put together, or mentally healthier than you are. Anxiety fueled behaviors can take many forms and it’s important to not forget that a child coming from an abusive home can be the class clown, the wallflower, the bully, or the A+ student. We all have different responses to trauma and lack of control and they ALL serve a purpose.

In the past week alone, I have gone running, walked my dog, called a friend, ate a whole box of mac and cheese by myself, drank 2 too many beers, thought about waking up and went back to bed instead, and had a crying spell that came out of nowhere. I may have personal feelings about which skills were more or less effective or had better/longer lasting impact but all of them served in a function of attempting to reduce anxiety, seek comfort, or manage uncertainty. I may WANT to choose certain means of coping over others but my ability to select coping mechanisms is fundamentally hindered by me passing judgment on myself and my choices – especially during a time of crisis.

In what follows will be a series of recommendations and considerations to help you manage through this crisis.

First, self-compassion, self-compassion, self-compassion. Being patient with yourself, understanding of the full range of your emotions and attempts to cope. Judging yourself (or others for that matter) robs yourself and the world of extra kindness which is an important resource at this time. Your emotions WILL vary. One day you may feel great and motivated, the next you may feel demotivated and despondent. This is both natural AND disorienting. It means nothing about you, your mental health, or your character. It means you are human and that today you have less resource than the day before. Taking self-compassion breaks (Kristin Neff) regularly is a commitment you can make to yourself on a daily or weekly basis that will promote intention and attention to this important skill. A self-compassion break consists of the following: 1. Acknowledge a moment of pain or suffering. 2. Remind yourself that pain is a part of life and makes you human 3. Attempt to be kind to yourself through it. Doing this at regular intervals through a period of stress helps soothe the nervous system and connect to higher order truth.

Second, come up with your Daily Regulatory Plan. Another Bruce Perry concept that I just love is the idea of a daily regulatory plan that addresses our need for predictability, controllability, and moderation for resilience. One of the problems with modern life is that people are so. busy. It has almost become a badge of honor to be the busiest person in the room – the most responsibility at work, an active social life, commitment to physical fitness, and other hobbies and interests. While for some, this is the recipe for a meaningful life, for most it is out of proportion, not intentional, and falls apart under stress. I personally know the frustration of having all of my plates spinning perfectly – working at near max capacity, training for an upcoming race, following a nutrition plan – only to have a hellish week at work or strain a muscle, or have a tough conversation with a loved one and have it all come crashing down. Most adults are not in the habit and practice of planning in scheduled, regulatory actions into our daily life.

Think of 2-3 things that you enjoy to do or that make you feel better on a typical day – drawing, writing, reading, running, cooking, talking to a friend, taking your dog on a walk – and identify the following:

1. How predictably and regularly do I need these activities? Many of us do the full out sprint and try to go as far as we can with as few breaks as possible and then collapse into a heap. Not that this doesn’t work – but it’s certainly less efficient. Maybe going for a run on Saturday is regular and predictable enough for right now or maybe since I’m extra stressed, I’d be better off going for a run at the end of every work day. In this time of increased stress, I’d encourage you to consider what 1-2 things can you do daily even when you don’t want to. I will go for a walk with the dog at lunch every day and then read before bed. Even making space for “bad things” like I will eat one cookie every night after dinner. Planning, scheduling and holding our commitments to ourselves (with some self- compassion for our imperfectness) is a way of building trust with our body and brain.

2. Consider spacing and dosing. One of the most common patterns I see in people is the all or nothing, feast or famine mentality about these regulatory behaviors. People very easily fall into the mindset of “if I can’t do X activity for X amount of time, it’s not even worth it”. I totally get it. We get ideas in our heads about what is the optimal and then sell ourselves the lie that there will be a time in the near future where all optimal conditions have been met and we’ll take the spa day, go for the 10 mile run, finish the book we started, or call our moms. Especially in times of crisis, opting for some over none is a critical step for supporting your nervous system. We are far better off taking 4 minutes out of every hour of the day that we’re awake to walk, play a silly game on your phone, doodle, listen to a song, or text a friend than to spend those same minutes working and planning to do those things “later”. Without proper attention to how much and how often, we end up on a clear trajectory toward too much, all at once. People that find themselves binge drinking on Friday night or eating an entire box of cookies in one sitting, or engaging in other harmful behaviors like cutting are often at the unfortunate end of not having tended to themselves during the week. As you would with a workout routine or piano lessons, consider how often do I need to do the activity and for how long? Using the same examples as above, I may feel that it’s best to run 1 mile every weekday or it may feel best to do the same mileage but on Tuesday and Thursday I will run 2.5 miles. I may want to take 10 minutes in the morning before work, 10 minutes at lunch and 10 minutes at the end of the day to play my guitar, go for a walk, or play with the dog vs. going for a 2 hour walk on Saturday.

Given the chronicity of stress and pressure that we’re under, your regular ways of managing stress are likely to be less than effective and less than what is needed to get through. Be gentle and patient with yourself during this time. You are working to help provide a safe, secure, predictable structure for your brain and nervous system during an unsafe, insecure, and unpredictable time.

A final note about all of this. While this is a unique trauma for us all, that by no means is to say that you don’t have some blueprints in your head from other times and situations that feel similar. Part of what may be getting activated in your brain is emotional memories or traumatic experiences from childhood, a depressive episode from your twenties, or the fall out from getting fired from a job in your thirties. It is common for people to associate rest, being homebound, isolated, or having this much free time as a sign that they are sliding into a depression or are not valuable. While this is an understandable association and reasonable concern, it is important to make discernments between then and now. How are these situations not the same? This important question will help you sort out what is present reality and what is history. Am I isolating because of the stay at home order or am I avoiding phone calls and text messages and staying inside because I am too depressed to move? Keeping yourself in present day reality, being patient with your humanity, and attempting to establish a predictable, controllable coping plan are some of our best ways to build resilience through this trauma. There are no hard and fast rules or guidelines for how to survive. Everyone is doing the best they can. Getting and having the right support can make all the difference. Talking honestly with safe family and friends or seeking therapy can be invaluable for navigating the ins and outs of living through trauma.

I hope that in all things, you be and stay kind to yourself and others and that you find strength and resilience in yourself and those around you.

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