There’s no “right” way to feel right now. In the U.S. alone, the new coronavirus pandemic has sickened more than one million people and claimed the lives of over 65,000. We are all worried—about getting sick, about a loved one getting sick, about financial insecurity, about employment, about “doing things right.” The whole situation is enough to make anyone feel confused, anxious, frustrated—and guilty for those feelings, no matter how much you try to tell yourself that things could be worse. All those emotions? They’re normal.
“There is a significant amount of uncertainty, and uncertainty makes it difficult for people to plan,” Joshua Morganstein, M.D., assistant director at the Center for the Study of Traumatic Stress in the Uniformed Services University of the Health Sciences, tells SELF. “An inability to plan into the future, or to have this image in one’s head of what the future would look like—people can feel like they are being fundamentally disrupted. It can be very upsetting…and that is normal.”
Anxious feelings about the new coronavirus are widespread. For some people, these feelings will be overwhelming and persistent enough to qualify as a mental health condition. If you already have something like generalized anxiety disorder, depression, panic disorder, or obsessive-compulsive disorder, you may notice an uptick in symptoms right now. Even if you don’t, the uniqueness of our current situation can lay the groundwork for these kinds of conditions (and others, like agoraphobia) in some people, especially those who already have risk factors like relatives with these health issues.
While stress and anxiety are to be expected during this pandemic, some people will go through trauma too. (We’ll explain more about the difference between stress and trauma later in this piece.) “For some people, living through the pandemic will be experienced as a traumatic event, but much of that will be influenced by a person’s own situation and experience,” Karestan Koenen, Ph.D., professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health, tells SELF. For example, she’s already seen trauma in some people who were hospitalized for COVID-19 treatment and put on a ventilator. “For someone who is at home, who still has their job, is not sick, is doing the things you’re supposed to do but not directly affected—it’s more an extreme stressor than a traumatic stressor,” Koenen says. However, she notes, this can still contribute to mental health issues like anxiety and depression.
So what kind of impact will all of this have on our mental health? Long-term stress can absolutely have negative health outcomes, both physically and mentally. And people experiencing traumatic events during the pandemic could develop post-traumatic stress disorder (PTSD) at some point down the line, which has its own mental and physical repercussions. The good news is, there are a number of ways to try to handle stress—and interventions we can try after trauma—to mitigate these effects. Here’s what the experts have to say about the mental health strain we’re facing as a nation.
Trauma and stress aren’t quite the same thing, but the pandemic can trigger both.
“In our normal life, with no pandemic, we have a lot of stressors,” Koenen says. “A stressor might be as mild as worrying that we’re late to work because we missed the bus, or we have a test coming up. What makes something traumatic is when it at some level overwhelms our ability to cope.”
A stressor can trigger a fight-or-flight response, preparing your body to react immediately to a perceived threat. Think about what happens when you experience a sudden stressor, like a near-accident when driving. When you perceive a potential danger, your sympathetic nervous system tries to prepare you to do whatever necessary to survive, the American Psychological Association (APA) explains. Your amygdala—the part of your brain associated with emotional processing—sends what Harvard Health calls a “distress signal” to the hypothalamus at the base of your brain. The hypothalamus then triggers the adrenal glands, releasing the stress hormones cortisol and adrenaline. Your muscles tense up so you can better protect yourself from injury, your heart begins racing to help pump more blood to your muscles and organs, and your breathing speeds up to increase your oxygen intake. (This is why some people are prone to hyperventilation and asthma attacks when dealing with acute stress or anxiety.) Your body also releases extra glucose and fats into your bloodstream to provide extra fuel.
Once the threat passes, your parasympathetic nervous system helps tame the fight-or-flight response so you can get back to a less anxious baseline, the APA explains. Your muscles relax, your heartbeat slows from a gallop, and your breathing returns to normal, among other effects.
Occasional instances of this stress-induced physiological roller coaster are normal and typically pose no long-term health risks. But a constantly activated autonomic nervous system can affect your health. As the National Institute of Mental Health (NIMH) explains, in the short term, chronic stress can cause issues with every bodily network from your immune system to your digestive system. In the long term, chronic stress is linked to health conditions like migraines, cardiovascular disease, diabetes, high blood pressure, depression, and anxiety.
“The situation we’re in now, we have an extreme stressor that is long-lasting,” Koenen says. “The fight-or-flight response was designed for an immediate threat. If we are reacting to this ongoing situation like there’s an immediate threat, that can disrupt our thinking, our functioning, and how we’re feeling.”
Consider all the things we’re stressed about during the COVID-19 pandemic. There’s stress about our health and our loved ones’ health. Stress about employment and financial security. Stress about how to get supplies, about staying indoors for weeks, about raising kids, about working, about what’s going to happen next. These weigh on us. And that stress has been affecting us, physiologically, for weeks—maybe even months—at this point.
Then there are traumatic events due to COVID-19, which can have much more severe effects than general stress related to the pandemic. The fifth version of the Diagnostic and Statistical Manual, which mental health experts use to make diagnoses, has a specific clinical definition of a psychologically traumatic event: “Exposure to actual or threatened death, serious injury, or sexual violence” either by experiencing it, witnessing it, hearing about it happen to a loved one, or being exposed to the details repeatedly or in an extreme way. What makes a stressful event cross the threshold into being traumatic, then? It’s usually both unpredictable and uncontrollable, and it’s typically violent in some way as well. When you experience a traumatic event, your body experiences a more extreme, longer-lasting version of the fight-or-flight response we described above, Koenen says.
In the first few weeks after a traumatic event, the National Center for PTSD explains, it’s completely normal to experience upsetting memories of the event, feel on edge, have trouble sleeping, and struggle to complete your normal day-to-day activities. You might feel dizzy or nauseated, lose your appetite, have flashbacks, or get nightmares. Most people will find that those symptoms dissipate over time, but people who experience them for at least a month, and severely enough to impact their relationships or work lives, may have developed PTSD, the NIMH says. But gauging how long is “normal” for these symptoms to stick around and when they’ve become persistent enough to qualify as PTSD is complicated because many people who have or are experiencing trauma as a result of COVID-19 aren’t a few weeks out from the experience—they’re still in it and may be for the foreseeable future.
Morganstein is particularly concerned about the traumatic experiences of frontline health care workers. “Part of the challenges are the complexities around how people die and having to make decisions about which people get limited resources,” he says. “Medical personnel understand that at some point, people die. But what we’re less equipped for is that there may come a circumstance where we have one ventilator and two people who both need it. It’s a very rare and unusual circumstance where a health care provider has to make a decision where one person lives and one person dies.” After making these types of choices and witnessing so many deaths, providers might second-guess their decisions, feel immense guilt, and obsess over the situation and what they could have done differently. For some, this can develop into PTSD.
There are other situations related to the new coronavirus that can cause trauma, like having a loved one die without being able to be by their side in their final moments, or being an emergency worker who goes into people’s homes and finds them dead from the disease. And while the clinical definition of trauma is quite narrow, the life-threatening nature of COVID-19 itself—especially if you’re in a high-risk category—could make exposure to the details of the pandemic traumatic for some people, Koenen says, even if it’s not affecting them directly.
If we intervene now, we can help to prevent and treat pandemic-induced mental health issues.
“We can’t ignore the experiences people are having and just wait and see who develops PTSD,” says Morganstein. And while PTSD is often debilitating if someone does develop it, it can be treated with the right medication and therapy, as can mental health issues like COVID-19–related anxiety.
The problem, of course, is that mental health resources can be hard to access under regular circumstances, never mind when there’s a pandemic and many health care systems are overtaxed. This access can be especially difficult for people in communities bearing the brunt of this pandemic’s destruction in our country, including black and Latinx people, those with low incomes, and people who already don’t have access to quality health care.
For example, one important intervention is trauma-focused cognitive behavioral therapy (CBT), which can help people reframe their thoughts and behaviors after a trauma. But therapy can be prohibitively expensive, which is a particularly big barrier at a time when so many people are dealing with financial instability. And the idea of finding the right therapist, which can be an exhausting process even in the best of times, seems even more wearying and unrealistic if you’re caring for sick loved ones, filing for unemployment or business loans, confronting any of the other many bureaucratic processes to which this crisis has given rise, or generally feeling completely tapped out due to this pandemic.
Fortunately, formalized mental health care is becoming a little more accessible for some people right now. “A lot of insurance companies have approved telehealth, meaning people doing mental health care by video or phone,” Koenen says. “That increases people’s ability to access services.” If you have health insurance, see if your plan offers remote mental health care. If you are uninsured or underinsured, some therapists are offering more affordable care on a sliding scale. And if you’re working in health care on the front lines of the crisis, the therapy platform Project Parachute is offering free teletherapy for people like doctors, nurses, paramedics, and social workers.
Digital-first therapy programs are also an option, and many are pivoting to provide mental health support that’s specific to the times. Talkspace, for example, has put together a COVID-19 response strategy that includes therapist-led Facebook support groups and discounted subscriptions. You can also reach out to resources like Crisis Text Line, which offers free counseling 24/7 via text (you can get in touch by texting HOME to 741-741).
Another major intervention we can offer now, which Morganstein especially recommends for health care providers and other essential workers, is formalized peer-to-peer support systems.
“In the military we talk about ‘battle buddies,’ and some health care facilities have adopted the same kind of language,” Morganstein says. “A battle buddy is someone who you’re in regular contact with, who you provide mutual support and encouragement to. You remind each other to take breaks, to get something to eat, you ask how they’re doing today, tell them they did a great job with such-and-such. And when you really see someone going in the wrong direction, you reach out and get help from others. Because battle buddies don’t let each other fall off a cliff.”
The above types of support can also help prevent other behaviors linked to trauma, because most people who experience trauma won’t actually develop textbook PTSD. Instead, their trauma might trigger health-risk behaviors like increased use of alcohol, tobacco, or prescription medications—and interventions can help with those problems too.
While this might all be a lot of information to digest, especially given everything else going on, simply knowing some potential outcomes of stress and trauma—and recognizing that they are normal—can be helpful.
“It’s important to convey to folks the range of things that are normal and expected responses,” Morganstein says. “In this pandemic, for every one person who develops a psychological disorder, there will be a number who have trouble sleeping, who feel unsafe…. Normalizing things for people is one of the first elements of how we help.”
There are also ways we can try to cope on a day-to-day basis.
While there’s no one-size-fits-all solution to all this, there are some broad guidelines we can all be following to help protect our mental health.
First, limit your exposure to anxiety-inducing stories and news about the pandemic. Morganstein stresses that media about COVID-19 is an important source of health care information, but “it’s also a source of distress and a way of distress being transmitted,” he says. “Research has consistently shown that increasing exposure to disaster-related media also increases a person’s psychological distress. It makes people’s sleep worse and has been associated with increasing use of alcohol, as well as increasing risk of depression and post-traumatic stress symptoms.” Instead, Morganstein recommends checking trusted sources for any updated health information that you and your family need, and stopping there. He says we shouldn’t leave news playing in the background and that it’s especially important to shield kids from emotionally distressing media broadcasts. Instead, give children age-appropriate information that they need to know.
Beyond that, do your best to follow your self-care routines, even in seemingly small ways. “One of the things that is easily overlooked, because people are busy mentally and physically dealing with a crisis, is basic self-care,” Morganstein says. “It’s not a new idea, but this is shaping up to be a marathon, not a sprint. Do things like getting sleep, eating as regularly as possible, staying hydrated, exercising, going out for a walk…to relax, to focus elsewhere, to allow stress in our bodies to be diminished.”
You can also rally behind the kind of systemic change that would better support those who are most vulnerable right now. “Unlike with COVID-19, which we couldn’t anticipate, we can anticipate a mental health crisis and implement things that might prevent that,” Koenen says. “We can really strengthen the social safety net. Policies that help people stay in their homes, that protect people’s income and allow them to have adequate access to food and basic needs, are actually things that will improve people’s mental health.” You don’t need to be a policy wonk or well-versed in economic theory to contact your local elected officials and show your support for legislation that supports renters, homeowners, small business owners, and everyday workers. Taking this step might help you feel a little more powerful at a time when it’s natural to feel powerless.
Lastly, as saccharine as this may sound, you can try doing a good deed. “If you can do something to help somebody else, this actually creates a positive physiological response for the person doing the good thing,” Koenen says. “Altruism really helps us feel better, and it can help us feel hopeful.” Consider what you’re able to offer another person right now, like picking up groceries for an elderly or immunocompromised neighbor on your next trip, donating to a cause important to you, dropping off a care package for someone who could use it, or just writing a letter to someone you miss.
It’s normal to have a tough time right now, but healing is possible.
The ultimate takeaway from all of this: Don’t feel guilty for being stressed, anxious, or depressed about what’s going on. All you can do is your best. “We’re kind of at war right now, to some degree,” Morganstein says. “The enemy is invisible, or very, very small. And we’re in a situation where our resources are limited and systems are becoming overwhelmed.”
And it’s easy to focus on that, to dwell on the bad things that are happening. If you’re dealing with stress and anxiety from the pandemic, know that dark moments and dominant thoughts don’t necessarily have to characterize your full experience during this time. (“A quarter can block out the sun, if you let it,” Morganstein says.) We can’t control what is happening, but being as flexible as possible with yourself—including by extending yourself some grace—might help you make it through.
“That’s one of the things that I think is particularly important in a pandemic, because things seem to change so often,” Koenen says. “I’m finding that even with some of my very own coping strategies, which are very organized, I need to switch it up some days. Every day or every week, we’re in a new place, we get different information. There are so many unknowns. So we constantly have to recalibrate our expectations. Flexibility is even more important now.”
And if you’re one of the many, many people who are wading through trauma due to this unprecedented crisis, know that healing is possible, as impossible as that may seem now. In fact, some people even experience positive psychological ripple effects after a trauma. This is a phenomenon known as post-traumatic growth, and it can lead to changes like a deeper belief in your personal strength and an increased appreciation for life. “As Hemingway said in A Farewell to Arms: ‘The world breaks everyone, and afterward, many are strong at the broken places,’” Koenen says.
That’s not to say that going through COVID-19 trauma will be remotely easy or even “worth it,” but that eventually emerging from this darkness as a changed—but not broken—person really is possible.