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How to Reduce Your Risk of PTSD in a Post-Covid-19 World How to Reduce Your Risk of PTSD in a Post-Covid-19 World
(1 day later)
“When will this end? And if it ever does, will I be OK?!”“When will this end? And if it ever does, will I be OK?!”
These are the questions patients in my therapy practice are asking, and I can’t emphasize enough that it’s normal to feel anxious now. The risk of developing a life-threatening illness alongside the loss of the things that usually anchor us is a brutal one-two-punch that would leave anyone feeling on edge.These are the questions patients in my therapy practice are asking, and I can’t emphasize enough that it’s normal to feel anxious now. The risk of developing a life-threatening illness alongside the loss of the things that usually anchor us is a brutal one-two-punch that would leave anyone feeling on edge.
How you handle stress makes a difference in how you ultimately cope. You can create positive habits and reduce response patterns that predict post-traumatic stress disorder, in which a terrifying event leads to symptoms such as disturbing flashbacks and severe anxiety. Unfortunately, we can’t will away sadness and fear. Living through such emotions without exacerbating your pain and suffering takes skill.How you handle stress makes a difference in how you ultimately cope. You can create positive habits and reduce response patterns that predict post-traumatic stress disorder, in which a terrifying event leads to symptoms such as disturbing flashbacks and severe anxiety. Unfortunately, we can’t will away sadness and fear. Living through such emotions without exacerbating your pain and suffering takes skill.
The hopeful truth is that there are proven steps you can practice to improve your emotional health during the coronavirus pandemic.The hopeful truth is that there are proven steps you can practice to improve your emotional health during the coronavirus pandemic.
Here’s a comforting thought in these dark days. For most of us, “the most common response to trauma is resilience,” said Dr. Denise Sloan, a professor in psychiatry at Boston University and associate director of the National Center for PTSD. In fact, the overwhelming majority of people who endure a life-threatening event recover on their own and never meet criteria for PTSD.Here’s a comforting thought in these dark days. For most of us, “the most common response to trauma is resilience,” said Dr. Denise Sloan, a professor in psychiatry at Boston University and associate director of the National Center for PTSD. In fact, the overwhelming majority of people who endure a life-threatening event recover on their own and never meet criteria for PTSD.
When my patients ask me whether things will get better for them, I tell them that trusting they will recover increases their chances of doing so. Expecting the worst actually predicts heightened risk of PTSD, and my clients often notice that they cope with challenges better than they imagine they will. So, I motivate them, as I encourage you, to expand their perspective and consider how they’ve managed during stressful times in the past, and to revisit this reminder of their strength when they’re feeling shaky.When my patients ask me whether things will get better for them, I tell them that trusting they will recover increases their chances of doing so. Expecting the worst actually predicts heightened risk of PTSD, and my clients often notice that they cope with challenges better than they imagine they will. So, I motivate them, as I encourage you, to expand their perspective and consider how they’ve managed during stressful times in the past, and to revisit this reminder of their strength when they’re feeling shaky.
For those who are struggling more profoundly: Research shows that even the most intense feelings of hopelessness eventually pass, especially when you strategize ways to feel better.For those who are struggling more profoundly: Research shows that even the most intense feelings of hopelessness eventually pass, especially when you strategize ways to feel better.
“If you are obsessed with this pandemic, you need to find ways to distract yourself,” recommends Dr. Edna Foa, a professor in psychiatry at the University of Pennsylvania and one of the world’s leading experts in anxiety and trauma. “We are in the middle of the trauma, not post-stress,” she said, highlighting that during a crisis we need to take breaks to soothe ourselves. One study even found that playing Tetris in the emergency room after a car accident appeared to reduce the development of traumatic memories.“If you are obsessed with this pandemic, you need to find ways to distract yourself,” recommends Dr. Edna Foa, a professor in psychiatry at the University of Pennsylvania and one of the world’s leading experts in anxiety and trauma. “We are in the middle of the trauma, not post-stress,” she said, highlighting that during a crisis we need to take breaks to soothe ourselves. One study even found that playing Tetris in the emergency room after a car accident appeared to reduce the development of traumatic memories.
While it’s normal to get hijacked by bad news, add positive activities to your routine to offset the pain. Do something you’d normally do if you were feeling optimistic (without turning it into a negative, like bingeing on a new show and losing sleep). While this might simply feel like another chore, engrossing yourself in something you once enjoyed and practicing gratitude improve well-being and resilience in a crisis.While it’s normal to get hijacked by bad news, add positive activities to your routine to offset the pain. Do something you’d normally do if you were feeling optimistic (without turning it into a negative, like bingeing on a new show and losing sleep). While this might simply feel like another chore, engrossing yourself in something you once enjoyed and practicing gratitude improve well-being and resilience in a crisis.
Of course, this advice may sound dismissive if a loved one is sick, or you are in financial crisis. But as A.J. Jacobs, author of “Thanks a Thousand,” has written, you can override your negativity bias by slowing down to notice, appreciate and give thanks. That could mean taking a moment to reflect on all the people who’ve provided the dinner on your table, from the farmer to the delivery person. Not only will gratitude offer you a break from your worries, it also helps others. (And remember to tip generously and if you can, donate to those struggling.)Of course, this advice may sound dismissive if a loved one is sick, or you are in financial crisis. But as A.J. Jacobs, author of “Thanks a Thousand,” has written, you can override your negativity bias by slowing down to notice, appreciate and give thanks. That could mean taking a moment to reflect on all the people who’ve provided the dinner on your table, from the farmer to the delivery person. Not only will gratitude offer you a break from your worries, it also helps others. (And remember to tip generously and if you can, donate to those struggling.)
Another key resource now, and always, is perceived social support — the feeling that we can all get through this together. We are all part of a global community going through the same thing at the same time, a rare occurrence in itself. To experience a sense of community, watch clips of people worldwide cheering for health care workers. Confide in others about what you are experiencing and ask others to share in return. Feeling connected protects against PTSD.Another key resource now, and always, is perceived social support — the feeling that we can all get through this together. We are all part of a global community going through the same thing at the same time, a rare occurrence in itself. To experience a sense of community, watch clips of people worldwide cheering for health care workers. Confide in others about what you are experiencing and ask others to share in return. Feeling connected protects against PTSD.
“People need to talk to one another, especially if you are seeing horrible things,” Dr. Foa said.“People need to talk to one another, especially if you are seeing horrible things,” Dr. Foa said.
If, like so many, you are feeling lonely, it may help to think about your support system more broadly, from the friend who texted you to your neighbors. Participating in a group wellness activity, like virtual mindfulness talks or fitness classes can also improve your sense of connection and mood.If, like so many, you are feeling lonely, it may help to think about your support system more broadly, from the friend who texted you to your neighbors. Participating in a group wellness activity, like virtual mindfulness talks or fitness classes can also improve your sense of connection and mood.
And if you need professional help, there are experts to consult, especially if you believe you are struggling with a psychological disorder. Therapy can make a difference without taking too long.And if you need professional help, there are experts to consult, especially if you believe you are struggling with a psychological disorder. Therapy can make a difference without taking too long.
Thoughts powerfully impact your feelings, so much so that your beliefs predict your risk of PTSD. Look out for self-blaming thoughts, like criticizing yourself for not having more in your savings account to prepare for layoffs, or, for medical professionals, faulting themselves for not being able to optimally care for everyone. Beating yourself up will only leave you feeling tortured.Thoughts powerfully impact your feelings, so much so that your beliefs predict your risk of PTSD. Look out for self-blaming thoughts, like criticizing yourself for not having more in your savings account to prepare for layoffs, or, for medical professionals, faulting themselves for not being able to optimally care for everyone. Beating yourself up will only leave you feeling tortured.
Also observe judgments that supercharge your stress, like, “I can’t take it,” and shift into a more encouraging mind-set.Also observe judgments that supercharge your stress, like, “I can’t take it,” and shift into a more encouraging mind-set.
One way to move away from negative thoughts is to ask yourself, “Is this helpful?” Self-compassion is a meaningful way to cope with pain and while you’re at it, let go of judging others. Studies show that doing so can significantly reduce loneliness.One way to move away from negative thoughts is to ask yourself, “Is this helpful?” Self-compassion is a meaningful way to cope with pain and while you’re at it, let go of judging others. Studies show that doing so can significantly reduce loneliness.
Do you feel compelled to review details of an upsetting experience over and over again? Ruminating is a mental habit where you repeatedly think about “why?” and “what if?” in a way that doesn’t inspire problem solving as much as it leaves you feeling stuck.Do you feel compelled to review details of an upsetting experience over and over again? Ruminating is a mental habit where you repeatedly think about “why?” and “what if?” in a way that doesn’t inspire problem solving as much as it leaves you feeling stuck.
If you struggle with these mental loops, now is a great time to work on your exit plan.If you struggle with these mental loops, now is a great time to work on your exit plan.
One landmark study, which began several weeks before the 1989 Loma Prieta earthquake in California, found that ruminating predicted depression and stress symptoms after the trauma, even more so than being personally affected by the disaster. And not only is overthinking a risk factor for depression and PTSD, it also affects your ability to benefit from treatment.One landmark study, which began several weeks before the 1989 Loma Prieta earthquake in California, found that ruminating predicted depression and stress symptoms after the trauma, even more so than being personally affected by the disaster. And not only is overthinking a risk factor for depression and PTSD, it also affects your ability to benefit from treatment.
To process thoughts about the pandemic that replay in your mind, one option is to put your concerns on paper. Expressive writing is one way to reflect without ruminating.To process thoughts about the pandemic that replay in your mind, one option is to put your concerns on paper. Expressive writing is one way to reflect without ruminating.
Updated June 5, 2020Updated June 5, 2020
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Another technique, especially when your thoughts aren’t useful, is to engage in mentally absorbing activities, like listening to your favorite playlist while doing burpees; working on a crossword puzzle; or grounding yourself by noticing three sights, three sounds and three sensations in your environment, again and again. When ruminating starts catch it and exchange it for gratitude.Another technique, especially when your thoughts aren’t useful, is to engage in mentally absorbing activities, like listening to your favorite playlist while doing burpees; working on a crossword puzzle; or grounding yourself by noticing three sights, three sounds and three sensations in your environment, again and again. When ruminating starts catch it and exchange it for gratitude.
Another way to think of it: If a friend were going on and on in a way that was obviously making her suffer, you’d steer her in another direction, right?Another way to think of it: If a friend were going on and on in a way that was obviously making her suffer, you’d steer her in another direction, right?
It is instinctive to want to avoid negative emotions, but you also don’t want to suppress or push them away. Instead, notice your emotions, specify how you feel and respond with kindness.It is instinctive to want to avoid negative emotions, but you also don’t want to suppress or push them away. Instead, notice your emotions, specify how you feel and respond with kindness.
Practicing mindfulness and viewing your experience with perspective helps you create a healthy relationship with your thoughts. Try to observe unhelpful judgments before compassionately letting them go, the same way a spam filter sorts junk messages.Practicing mindfulness and viewing your experience with perspective helps you create a healthy relationship with your thoughts. Try to observe unhelpful judgments before compassionately letting them go, the same way a spam filter sorts junk messages.
Ultimately, it’s key to balance accepting difficult feelings, without multiplying them, while increasing your emotional immune system. Later, when this ends, if you find yourself becoming what Dr. Foa described as a “super avoider” — someone who tries to escape thoughts and situations that are no longer harmful — remember that it’s important to face your fears.Ultimately, it’s key to balance accepting difficult feelings, without multiplying them, while increasing your emotional immune system. Later, when this ends, if you find yourself becoming what Dr. Foa described as a “super avoider” — someone who tries to escape thoughts and situations that are no longer harmful — remember that it’s important to face your fears.
Dr. Natalia Garcia, a psychologist in Seattle and trauma researcher, who is uniquely empathic to the plight of trauma, has used her own expertise to cope with the sudden death of her 2-year-old son. She initially struggled to watch videos of him, but after giving herself a grace period where she focused on getting through each day, she was able to return to those clips. Today, she is surprised by how much she cherishes them. “The only thing worse than losing him would be also losing the memory of him,” Dr. Garcia said.Dr. Natalia Garcia, a psychologist in Seattle and trauma researcher, who is uniquely empathic to the plight of trauma, has used her own expertise to cope with the sudden death of her 2-year-old son. She initially struggled to watch videos of him, but after giving herself a grace period where she focused on getting through each day, she was able to return to those clips. Today, she is surprised by how much she cherishes them. “The only thing worse than losing him would be also losing the memory of him,” Dr. Garcia said.
She added: “I can’t say I emerged from the ashes of despair into some majestic phoenix, but I do believe I have experienced growth with exercised intentionality around not letting tragedy be the end all of my story.”She added: “I can’t say I emerged from the ashes of despair into some majestic phoenix, but I do believe I have experienced growth with exercised intentionality around not letting tragedy be the end all of my story.”
Like Dr. Garcia, you can also increase your sense of control by reflecting on what matters most to you. Cultivating a strong sense of purpose based on what you value, and using that to figure out your next steps can give you a feeling of possibility, increasing both your physical strength and emotional recovery. And don’t we all need a sense of possibility right about now?Like Dr. Garcia, you can also increase your sense of control by reflecting on what matters most to you. Cultivating a strong sense of purpose based on what you value, and using that to figure out your next steps can give you a feeling of possibility, increasing both your physical strength and emotional recovery. And don’t we all need a sense of possibility right about now?
Jennifer Taitz is an assistant clinical professor in psychiatry at the University of California, Los Angeles, and the author of “How to be Single and Happy: Science-Based Strategies for Keeping Your Sanity While Looking for a Soul Mate” and “End Emotional Eating.”Jennifer Taitz is an assistant clinical professor in psychiatry at the University of California, Los Angeles, and the author of “How to be Single and Happy: Science-Based Strategies for Keeping Your Sanity While Looking for a Soul Mate” and “End Emotional Eating.”