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The stress of the pandemic is lifting. People are getting vaccinated, businesses are reopening, and the weather is warming up. So how come we don't feel better?
After nearly a year and a half of grief, constant loss, and ever-present anxiety, we are not ready to go back to “normal." Most of us have been so busy in survival mode that we haven't had the opportunity to process our feelings. Now that the immediate danger has passed, many people are displaying symptoms of post-traumatic stress disorder.
What is PTSD?
Post-traumatic stress disorder — known commonly as PTSD — is a reaction some have after experiencing or witnessing a traumatic event. Typically occurring after exposure to or the threat of death, the brain begins to have difficulty processing the memories of the trauma. As a result, people with PTSD experience recurrent distressing thoughts and nightmares. They may have out-of-body experiences where they relive the traumatic event and sudden distress at related triggers.
PTSD is most commonly associated with emergency room professionals, first responders, and war veterans, but can affect anyone after any violent or traumatic experience. In the United States, post-traumatic stress disorder is diagnosed in approximately 3.5% of the population and is twice as likely to affect women as men.
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Why can COVID-19 cause PTSD?
COVID-19 has already caused an exacerbation of widespread, underlying mental health disorders. Studies, counselors, and emergency rooms all reported increased instances of loneliness, depression, anxiety, agoraphobia, suicidal ideation, and substance abuse. However, the nature of the crisis makes individuals — particularly, but not exclusively, those who were infected with COVID — uniquely susceptible to developing post-traumatic stress disorder.
The circumstances that trigger COVID PTSD are different depending on the individual and their unique experience over the last year. It’s a well-documented observation that people were affected in very different ways by the pandemic, largely along race, gender, and economic lines.
Some are front-line workers who were exposed to death and illness on a near-constant basis over the last year and a half. Some are essential, non-medical personnel who put their lives at risk in order to maintain their income and their family’s financial security. Some are survivors of COVID-19, and may still be dealing with long-haul symptoms or the fear that accompanies near death. Still others may have lost loved ones to the virus, surviving, but having to navigate life without the person they love.
Chief among the diagnostic triggers of PTSD is repeated exposure to death and trauma. At its height, the pandemic was an invisible threat, and for months there was no clear way to defend against it. We didn't know if it was safe to go grocery shopping, accept packages, or go running in the park. Universally, we experienced a rapid shift in the way that we saw and experienced life.
In examining survivors and patients that recovered from COVID-19, over 32 percent displayed symptoms of post-traumatic stress disorder after their release from the hospital. That’s nearly ten times the non-COVID related PTSD rate. In China, 96 percent of those released from quarantine facilities had PTSD symptoms. That research dovetails with findings post-SARS in Toronto, indicating higher rates of depression, anxiety, and PTSD.
Many of us, even if we were spared illness or the death of a loved one, still lost something. Graduations, weddings, vacations were all canceled, and our support systems were decimated. Human beings have a fundamental need for security, and when that is threatened it’s difficult to focus on anything else. It's unnerving for most of us to realize that all of our plans, hopes, dreams, and feelings of safety can be taken away so quickly and so completely.
One silver lining of the large-scale trauma of the pandemic is that it has fueled interesting research on why people do or do not get PTSD. So, even though 32 percent of COVID survivors exhibited PTSD after hospitalization — and that is a lot of suffering — 68 percent of survivors did not. Why? That question potentially holds insights into risk factors apart from the trauma itself.
Because we rarely know in advance that a PTSD-inducing trauma is coming our way, understanding and addressing risk factors is incredibly important. For example, research coming out of Italy shows that healthcare workers who were languishing at the start of the pandemic are 3x more likely to develop PTSD. So being in a state of languishing appears to be a risk factor.
This type of research also points to hopeful strategies for how we might strengthen ourselves against PTSD or lessen the extent or duration of the symptoms in the future.
How do you know if you have PTSD?
The DSM-5, the standard for diagnostic criteria in the field of psychology, specifies that someone must have experienced a traumatic event or repeated exposure to indirect details of the traumatic event (such as retrieving remains from homes or working at the makeshift pandemic morgues). In addition, for diagnosis patients must be experiencing one or more of the following symptoms:
- Reliving the traumatic experience
- Having event-triggered anxiety and avoidance
- Feeling hopeless or detached
- Difficulty experiencing positive emotions (anhedonia)
- Difficulty with memory, focus, and concentration
- Feeling easily startled or triggered
- Irritability, frustration, or anger
- Self-destructive behavior (excessive drinking, recreational drug use, or risk-seeking behavior)
- Shame or survivor's guilt
- Decision paralysis
Due to the nature of pandemic, it's common for everyone to be experiencing some degree of anxiety and a sense of languish. However, if these symptoms are interfering with your ability to function on a day-to-day basis or becoming intrusive, it's likely that you have post-traumatic stress disorder.
Only a mental health professional can determine a diagnosis of PTSD. Leaving it untreated can be dangerous and often exacerbates symptoms. Early treatment increases the success of treatment.
What are the consequences of having untreated PTSD?
PTSD will not go away on its own. Even once the acute symptoms are gone, the secondary symptoms still need to be managed. It may be helpful to think of treating it as the physical therapy that often follows an extended stay in the hospital.
Even those who have recovered physically from COVID-19 or who are beginning to return to their pre-pandemic schedules may still experience stress-related effects and symptoms.
Without treatment, COVID PTSD can lead to:
Recurrent fears of dying or of getting sick
People that leave their PTSD untreated may be obsessed with death and the possibility of dying. They may be afraid of every illness, overanalyzing every symptom. These individuals live in fear of the next pandemic.
Guilt over exposing others to illness
Especially prevalent in front line and essential workers, some may be fearful or guilty about having exposed loved ones to COVID. The guilt can be hard to live with, particularly if they've lost someone in their family or household.
Because post-traumatic stress disorder can cause one to disassociate from their feelings and have trouble experiencing pleasure, individuals experiencing it tend to distance themselves even more from their social circles. When they do interact with others, they often have trouble connecting and frequently experience discomfort.
Night terrors, anxiety, and stress can prevent those with post-traumatic stress disorder from getting adequate rest. Unfortunately, this becomes a cycle that often results in them being even more irritated and disconnected during the day.
Inability to thrive
Those experiencing COVID-19 PTSD may lack interest or motivation in their careers, their relationships, and in caring for their own well-being. They may feel as if their lives are out of their control.
Although wearing a mask, social distancing, and frequent hand-washing are smart safety habits, some may be unreasonably rigid or obsessive about these behaviors as a way of coping with their PTSD. They may refuse to be around people even when it's considered safe to do so. These habits may help alleviate a lost sense of control, but may delay confronting the root of the trauma.
Researchers have found that, from prior large scale traumas like 9/11, that victims still struggle with PTSD and depression even today, almost 20 years later. This highlights how serious and important it is to address PTSD because the impact does not just dissipate.
Is there a way to cure PTSD?
Can PTSD be cured? Like many other mental disorders and illnesses, PTSD cannot be cured. However, the goal of PTSD treatment is not to cure the disorder. Rather, the goal of treatment is to bring the symptoms under control so that they no longer interfere with the day-to-day functioning and enjoyment of life.
Therapy is often effective in treating post-traumatic stress disorder. One common treatment is cognitive processing therapy, or cognitive behavioral therapy (CBT). Participants work with a therapist in order to identify the thoughts that arise when they are triggered, replacing them with thoughts that allow them to move past the trauma. Over time, they develop the ability to recognize these thoughts on their own, rather than being overwhelmed by them.
Another successful treatment is exposure therapy. Often used to treat panic attacks, exposure therapy involves controlled interactions with the object or stimulus that triggers the stress reaction. The idea is that after enough “neutral” experiences, the brain will no longer perceive the situation as a threat (known as extinction). With support and over time, individuals are often successfully able to eliminate the stress response to the stimulus.
In some cases, anti-anxiety medication may be prescribed to treat post-traumatic stress disorder.
For those who are healing from PTSD — or are simply reliving trauma symptoms and being overwhelmed by stress — reaching out for social support can be triggering. However, even if it's simply over the phone or a digital connection, talking to others can be invaluable. A coach, a counselor, or even a friend can help you process your emotions and begin to release them. Our fears are often much more frightening when we keep them to ourselves.
Finally, one of the best ways that you can begin to move past the trauma of the past year is to find joy in your days. No one likes to feel helpless, and losing control of everything you counted on can be scary. However, engaging in new hobbies, relationships, and fixing your sight on new goals can help you feel invigorated and hopeful again.
BetterUp Staff Writer