Covid Stress, Coronavirus (COVID-19) Trauma, and COVID-Related PTSD

“During the pandemic, we have all been riding on the same water, but in different boats.”
-- Tamar Rodney, PhD, MSN, RN, assistant professor, Johns Hopkins School of Nursing

One day we were all at work, at school, revolving about in the spheres of our worlds, the next we were not. The spread of the coronavirus forced us all into an unfathomable situation for which we had no roadmap and few tools to navigate. The world has lost more than 4 million souls, and we are still counting. Many of us lost jobs, homes, life as we knew it. We have all been walking on a new, uninvited landscape.

It is no wonder that many of us have been feeling some sense of trauma. Some of us experienced short-lived depression or anxiety while others suffered from acute stress disorder (ASD) or adjustment disorder from sweeping life changes. Some people experienced trauma, which developed into COVID-related trauma and post-traumatic stress disorder (PTSD), a specific diagnosis.

Some of us have not experienced any trauma, and others are still trying to figure out how we feel.

Most people recover from a major traumatic event within 3-12 months. The pandemic is not over, people are still dying and getting sick though the numbers are decreasing significantly, More people are getting vaccinated, and in many ways the world is slowly returning to some semblance of “normal.”

Trauma from COVID: All shapes and sizes, or none at all

Experience does not equal outcome.

What sets COVID-related trauma apart is the fact that — unlike most traumas that result from one event — COVID-related trauma has occurred from a repeated series of events.

When the world closed down because of the pandemic, things seemed to get progressively worse. We didn’t know how long it would last and what would happen. The number of people dying or getting sick seemed to increase daily, hourly, everywhere. Risks seemed omnipresent; we were scared for ourselves, our families, our friends.

The Associated Press states that the general life-time risk of PTSD is 8.7%, or 1 in 11 people. Recent reports say that with COVID-related PTSD, that number may increase by 50%.

“The kinds of symptoms people are experiencing from the pandemic definitely check all the diagnostic boxes of trauma and PTSD,” says Tamar Rodney, PhD, MSN, RN, assistant professor, Johns Hopkins School of Nursing whose research and clinical work focus primarily on improving PTSD diagnosis and treatment.

“But we must acknowledge that one’s experience does not equal one’s outcome. Take for example, a single woman whose father was sick and died from COVID-19 in a nursing home. She was not able to be with him or ensure that he was getting the care and comfort he needed. She could not hold his hand, whisper into his ear how much she loved him. She had to worry and grieve alone, wracked with guilt that he died alone. Another woman may have a sick father who lives at her home. Yes, he dies from COVID, but she was able to be there, help him while he was sick, say whatever she needed to say to him on his deathbed. Both are very sad stories of loss, but both women may manifest signs of PTSD in very different ways, intensities, and durations.”

Who is impacted from post-pandemic stress and COVID-related trauma?

Predispositions and environmental factors also play a role in how people react to trauma. Someone who has depression, anxiety, or schizophrenia, for example — pre-pandemic — may experience stresses from COVID far more intensely than someone who has never experienced these issues or conditions, has effective strategies for managing stress, and who may also have a strong support system.      

Loss of a job, financial worries, juggling work/school and family from home, and increased incidents of domestic abuse are examples of how one’s environment can exacerbate the development or deepening of PTSD symptoms.

“I think we need to acknowledge that since COVID was not one event, one trauma, rather a ‘long period of worry,’ people may not be seeking help for their symptoms of PTSD early enough.

“Think about a frontline worker, for example, someone who worked in a supermarket or as a nurse in an ER. Neither had the options to work from home when the rest of the world seemingly did.

“Not only did these people have to put themselves at risk day after day because of their jobs, they also brought that risk home to their families.

“Some healthcare workers I know set up stations in their garage or yard to clean, disinfect, and change their clothes before entering the house.

“Some people stayed in hotels, if they could, so afraid of spreading COVID to their families,” says Dr. Rodney. “All of this creates intense guilt, anxiety, and fear … months of holding one’s breath. We need to do studies on the long-term effects of this kind of ongoing trauma so we can make sure these invisible wounds don’t linger.”

“I’m a big believer that the key to beating PTSD is acting quickly to identify the syndrome and giving the science time to catch up.” -- Dr. Tamar Rodney

Signs and symptoms of COVID-related PTSD

Depressed, anxious, irritable, uncertain, lonely, angry, sad, stuck? It would be hard not to have felt at least some of these emotions as a result of the pandemic.

According to Dr. Rodney, there are four main buckets of symptoms from COVID-related PTSD:

• Intrusion: Having memories or concerns about trauma that interrupt a flow of thought or emotional well-being, such as nightmares or flashbacks that produce upsetting thoughts.
• Avoidance: Purposefully avoiding people, places, or things that remind you of the trauma or, on the flip side, showing no interest in activities that were once enjoyable.
• Negative Mood: Reacting to life in a negative manner or not at all; hopes and plans for the future may feel changed, or no longer attainable or even desirable.
• Hyperarousal: Acting in ways that are not in keeping with your regular reactions, including difficulty sleeping, irritability, and difficulty concentrating.

“People need to notice what is happening to them and their loved ones. Have their pre-pandemic habits and routines changed? Are they masking their feelings with negative behaviors? Are they pushing family and friends away? Time is definitely our friend when it comes to recovering from trauma. But what is most important is to understand that, depending on the individual, issues from COVID-related PTSD may linger and manifest in unexpected ways,” says Dr. Rodney. “Seeking help when needed is brave and smart.”

“As researchers and health providers, there is still so much we don’t know and also much we cannot change about COVID-related PTSD,” she adds.

How can we start to heal from COVID stress?

Whether you are struggling yourself, or it’s a loved one who is: start a conversation.

Open up to trusted individuals like family or friends. There is great power — and relief — in validating and accepting how you feel. “I am not where I used to be … I don’t feel okay … I am really scared for my husband … I don’t recognize my sister; she acts as if she had given up on herself …” Sharing your feelings, no matter how difficult that may seem, in turn makes it safe for those trusted friends to reciprocate. Maybe they are feeling the same way or maybe they have the same worries about themselves or a loved one who may be experiencing symptoms of COVID stress.

Sharing starts the healing process.

When to seek professional help for COVID-related mental health issues

“Years ago, I met a veteran who talked with a reporter about his experiences in combat. For 17 years, he had never shared a word of his experiences or struggles with his family — relationships that became damaged or estranged — but when the reporter asked, he shared. For all those years, he had never processed his trauma, or learned to deal with it. His wounds only started healing once he shared his story with the reporter,” says Dr. Rodney. “That is one main reason why I got into this work. I want people to know when and how to seek the help they need … 17 years is 17 years too long.”

Accepting that we, or a loved one, needs help comes from a place of great strength. If symptoms are not going away, if symptoms are affecting daily life, it is time to seek professional help.

Effective treatments for post-pandemic trauma

In a safe and trusted space, health professionals apply therapeutic principles to treat a person’s symptoms one by one.

Some of the best treatments for PTSD include:

• Cognitive Behavioral Therapy (CBT), or “talk therapy”
• Prolonged Exposure Therapy (PE)
• Medications when needed for issues like depression or anxiety
• Eye Movement Desensitization & Reprocessing (EMDR)
• Creative Arts Therapies

Some complementary treatments you can do at home are:

• Establish or reestablish a healthy sleep regimen
• Adopt a healthy lifestyle and practice self-care
• Practice Yoga or Meditation

One positive from the pandemic revealed that there are more opportunities to seek help — with a computer, from home. “Our telehealth program offers everything that our face-to-face program offers, minus the acupuncture because we can’t put needles in people remotely, at least not yet. I was really excited that the pandemic afforded us the opportunity — and need — to expand into telehealth,” says Sheila Rauch, PhD, ABPP, director at Emory Healthcare Veterans Program in Atlanta, Georgia whose research focuses on examination of mechanisms involved in the development and treatment of PTSD and improving access to effective interventions.

“I’ve been working in telehealth in Veterans Affairs for years and seeing that it’s actually a great opportunity for people who will never physically be able to come to a specific site to get those specialized services and have those transformative changes still occur in their home where they’re able to access this care conveniently and effectively seems like a game changer,” says Rauch.

What are the biggest lessons we have learned about COVID-related trauma and PTSD from the pandemic?

Mental health issues should not be treated any differently from physical issues. The brain is an organ just like the heart, liver, spleen — all can develop illnesses, all can be treated. There is no shame in needing medical attention.

“Mental health assessments should be an integral part of a person’s annual physical,” says Dr. Rodney. “Mental health assessments are as important as bloodwork, yearly screenings, or any other part of a ‘physical.’ If this were the case and the societal stigma around issues of mental health no longer existed, the onus on the individual to seek treatment when something is wrong would be lifted. You do not want to wait till there is a crisis; prevention works best for the body and the mind.”

“It’s human nature to be resilient, and I applaud the expanding conversations around mental illness, but I am worried that in a year’s time with the great eagerness to get back to normal that some of the lessons learned will be forgotten.”
-- Dr. Tamar Rodney

Everyone has been experiencing the pandemic differently. Time is on our side when it comes to healing, but we may need to acknowledge that we are forever changed in ways we could never have before imagined. Yes, there will be lingering challenges for many of us, no doubt, but maybe sometime down the road, despite our frustrations and feelings of collective loss, we discover opportunities to learn truths — about ourselves, our minds, and our place in the world — that might have otherwise remained hidden.