A member of our writing team related the following experience\nduring these times of near-lockdown. She had gone out to do some essentials\nsuch as grocery shopping and getting prescriptions filled for her healthy but\nself-isolating husband. Returning home, she threw down her things, wailed,\n“It’s just awful”, and burst into tears. Her astonished husband enquired, “What\nhappened?”<\/p>\n\n\n\n
“I’ve never had errand-running and shopping be such a dismal\nexperience,” she lamented. “After four pharmacies, I could still only get one\nof your items filled, because everyone has panic-bought huge supplies of the\nothers. Pharmacists still don’t know when they’ll get more stock. The grocery\nstore had rows of empty shelves, so your request for bread and milk is not\nfulfilled. There is nary a frozen veggie to be had, and you had better pace\nyourself on the toilet paper we managed to score last month; I’ve been out six\ntimes without spotting a single roll. Does it even exist? The look on shoppers’\nfaces is nothing short of glum. And when I went to check out, the girl at the\ncheckout counter gave me a frozen smile, told me to pack my own bags, and\nconspicuously stepped back, sanitising her hands as I was trying to stuff food\ninto bags and get away. She acted like I was a walking virus!”<\/p>\n\n\n\n
After a mood-restoring cup of tea, our colleague was able to\ndisidentify from the frustration, but her experience — which resonates with\nmany of us trying to do “normal” life in these abnormal times — gave her the\ninsight that the world is actually fighting two pandemics now: COVID-19 and the\nparallel virus of fear and panic which is generating over-reactive, anti-social\nbehaviour, stigma, and other psycho-social problems. It is that “virus” which we\naddress in today’s article.<\/p>\n\n\n\n
Soon after the coronavirus was identified in that now-famous\nmarket in China, myriad articles began appearing about the physical symptoms\nthat infected people may have. More recently, pieces have popped up identifying\nthe psychological stressors and the symptoms we can expect to see as we collectively\ndeal with both the prospect of physical infection and also the need to isolate\nourselves in our homes or elsewhere, forsaking the regular, normal human\ninteractions that we are accustomed to, and which provide the rich texture and\nframework for daily life. <\/p>\n\n\n\n
In late February, The\nLancet<\/em> published a “rapid review” of the psychological impact of quarantine\nand how to reduce it (Brooks, Webster, Smith, et al, 2020). Using three\nelectronic data bases, they found 3166 papers on the topic, of which they\nreviewed 24. The stressors during quarantine were found to be:<\/p>\n\n\n\n Fears of infection:<\/strong> Both fears about their own health and fears of infecting others were reported, with psychological outcomes evident from these fears three months later.<\/p>\n\n\n\n Frustration and boredom:<\/strong> The confinement, loss of usual routine, and reduced social and physical contact with others often caused frustration, boredom, and a sense of isolation from the world. <\/p>\n\n\n\n Inadequate supplies: <\/strong>When basic supplies, such as food, water, clothes, or accommodation were unavailable during quarantine, it was a source of anxiety and anger that continued to be felt four to six months after the quarantine. Study participants reported receiving their masks and thermometers late or not at all. In some cases, food, water, and other items were only intermittently distributed.<\/p>\n\n\n\n Inadequate information:<\/strong> Many participants cited poor information from public health authorities as a stressor, reporting unclear guidelines about actions to take and confusion about why they needed to quarantine. Differences in the style, approach, and content of various public health messages because of poor coordination between the various levels of government and jurisdictions meant that, in Toronto at least, those in the middle of the SARS epidemic experienced huge confusion. The lack of clarity led to participants fearing the worst. Participants also perceived a lack of transparency from government officials about the severity of the pandemic (Brooks, Webster, Smith, et al, 2020). <\/p>\n\n\n\n In late March, The\nTelegraph<\/em> reported that, during the outbreak in China, “generalised fear\nand fear-induced overreactive behaviour were common among the public” while\nfear, anxiety, and post-traumatic stress disorder were commonly on display (Farmer,\n2020). The U.S. Centers for Disease Control and Prevention (CDC) observed\nrecently that the public mental health crisis first spawned by the COVID-19\nPandemic in China had several unique factors that authorities in other\ncountries need to integrate into their considerations as they manage the\noutbreaks in their own countries. <\/p>\n\n\n\n First, noted the CDC, there are many people on the planet\n(and there were many in China) who remember the 2003 outbreak of SARS; that\nepidemic has left psychological scars on social and economic life as a result\nof the disease. COVID-19 is more easily transmitted than the SARS virus was,\nand the case fatality rate is substantially or even hugely higher than that for\nseasonal influenza (Worldometers, 2020). Second, fear and anxiety are widely\ngenerated from the epidemiological realities that not only does the virus have\na long incubation period, but also its victims are frequently asymptomatic in\nthe early stages when they are highly contagious. <\/p>\n\n\n\n Third, while China has been globally acknowledged as having\nhandled the crisis well once the outbreak was recognised as serious, it has\nbeen criticised for its initial downplaying of the severity; this eroded trust\nin public authorities and led to widespread cynicism about the government’s\ntransparency and competency. Naturally the large-scale forced quarantine\nmeasures were stressful, causing a negative psychosocial impact on those under\nlockdown. Finally, repeated reports of shortages in medical protective\nsupplies, staff, and beds in hospitals caused massive concern around the nation\n(Dong & Bouey, 2020). Sadly, the leaders and health authorities of other\ncountries have seemed not to learn from China’s experience, as these\ncircumstances have been repeated multiple times in other countries caught off\nguard by the virus’ rapid, stealthy spread. <\/p>\n\n\n\n There is a saying that in a disaster, hope is the first\ncasualty. The World Health Organization has just one week ago called attention\nto several less obvious psychosocial considerations during the outbreak; one of\nthem is hope (WHO, 2020). At this writing, news reports have stated that this past\nweek in the United States, 6.65 million people applied for unemployment\nbenefits (The Guardian, 3 April 2020). In Australia, the job losses due\ndirectly to the pandemic have now topped 100,000 (for a country of 25 million!)\n(SBS News, 28 March, 2020). It is difficult to maintain an unwavering stance of\nhopefulness when a person is confined to their home for an indefinite future\nand is likely to be unemployed upon being released. As a mental health\npractitioner, restoring hope may be a major, early therapeutic task you must do,\nregardless of the presenting issue.<\/p>\n\n\n\n The WHO also reports that there has come to be significant\nstigma in regard to this virus. Those who have had it but recovered are on the\nreceiving end of stigma from friends, relatives, and co-workers who fear that\nthey may be infected from the person, despite the person being tested and\ndeclared “virus-negative”. Similarly, many healthcare workers, who jeopardise\ntheir own health and life to serve unwell others, are finding that family and\nfriends avoid them as if they had contracted the virus, a finding also noted by\nThe Lancet<\/em> “rapid review” (WHO, 2020;\nBrooks, Webster, Smith, et al, 2020).<\/p>\n\n\n\n As the economic catastrophes mount with businesses large and\nsmall standing down thousands and closing their doors, individuals feel the\npressure, which means that tensions in those individuals’ families are\nratcheted up. Moreover, many are the partnerships which have rubbed along\nfairly well in the past because the people in them have gone their separate\nways to work during the day, only coming together in the evenings. For those\nsame people now housebound together 24\/7 (often in a rather confined space,\nsuch as a small unit), the result is accelerating tension in the relationship. Those\nwho work with domestic violence have warned that the incidence of this will\ninevitably rise. We can add to that the pressure parents are under to respond\nin healthy ways to children who — also feeling the fear and uncertainty — have\ngreater attachment and attention needs. They are needs which parents, through\ntheir own pressures, are decreasingly comfortable to offer. All of this is\ntotally in addition to the massive strain on our healthcare professionals as\nthey struggle with overwhelming numbers of patients and often inadequate personal\nprotective equipment.<\/p>\n\n\n\n As the death toll increases, we are all more likely than\nbefore to know someone who dies from COVID-19. But even if we and our loved\nones escape that fate, there is no denying that we all have experienced loss,\nwhich we must grieve. Katrina Grace Kelly’s column in the Weekend Australian (Kelly,\n2020) reflects that the obvious losses of job, superannuation balance, and\nshare values are bad enough, as markets tumble and personal wealth is wiped out\n“in the blink of an eye” (p 20). But Kelly exhorts us to also recognise the\nlosses from our sudden inability to rely on those things which ordinarily\ncomforted and held us: personal interactions with family and friends in social\ngatherings, sports meets, concerts, cultural events, and of course meals and\ndrinks at our favourite pubs\/restaurants\/cafes. This is all denied us now, and\nwe must not deny the loss of preferred lifestyle that the closures entail. There\nis individual grief, our collective grief, and sadly, anticipatory grief, as we\nsteel ourselves for more losses to come — and to last for an unknown period. Various\nmodels for dealing with loss and grief (such as Kubler-Ross’ well-known model)\nposit the steps we must go through after initial denial: steps such as\nshock\/disbelief, anger, bargaining, depression, and finally acceptance\n(Kubler-Ross, 1969). The point for us here is that we must be alert to the\nnumerous losses our clients will need to grieve even when parts of their lives\nremain intact. As the losses mount, we are also talking about cumulative grief\n(experiencing second or more losses while still grieving the first).<\/p>\n\n\n\n We have been advised repeatedly by health authorities that\nelderly individuals, particularly those over 80, are most at risk from COVID-19.\nWhile this is borne out by mortality statistics, there are additional high-risk\ngroups when we consider mental unwellness. Numerous reports identify the\nfrontline healthcare workers (doctors, nurses, ambulance workers, and others)\nas among those most likely to experience the depression, anxiety, and PTSD that\nare emerging with this virus; they are also at risk from secondary traumatic\nstress through being exposed to so many traumatised patients fighting for their\nlives (Dong & Bouey, 2020; Brooks, Webster, Smith, et al, 2020; WHO, 2020).\n<\/p>\n\n\n\n The CDC cites the notification by the National Health Commission\nof China, back in January, 2020, that a special intervention workforce convened\nto deal specifically with mental health issues identified five additional\ngroups as key intervention targets: confirmed patients, individuals suspected\nof having COVID-19 and awaiting test results, individuals who have been in\ncontact with COVID-19 patients, unwell people who refuse to seek care, and\nsusceptible members of the general public (Dong & Bouey, 2020). <\/p>\n\n\n\n A separate article in The\nLancet<\/em> has just identified a major group, whom we as mental health\nprofessionals must take note of: those who had pre-existing mental health\ndisorders when the pandemic began to spread. Concern was raised that, for those\nin psychiatric hospitals, the risk of transmission is greater because of\ncognitive impairment, little awareness of risk, and diminished efforts\nregarding personal protection. Moreover, those with mental health issues may\nhave more barriers in accessing timely health services due to discrimination against\nthem. Even when they do receive treatment, however, such individuals’ COVID-19\ntreatment may be less effective due to the mental health co-morbidities. Finally,\nas such patients take in the general emotional responses to the pandemic, they\nmay relapse or experience a worsening of condition due to high susceptibility\nto stress compared to the general population (Yao, Chen, & Xu, 2020).<\/p>\n\n\n\n We can choose interventions from a range of therapies,\ndepending on the symptoms most prominent or troubling to the client. Here are a\nfew samples to illustrate the basic (really, not rocket science!) responses on\nour part that will go a long way toward relieving angst. Note how many of them\ncan be in the category of merely getting some perspective.<\/p>\n\n\n\n Beyond Blue (2020) reminds people to remind themselves that\nthis is a temporary period. The isolation, the restrictions on freedom, the\nhealth threats, and also the massive unemployment, will not last forever. Beyond\nBlue is taking a leaf from the positive psychology playbook here. Martin\nSeligman, the “father” of positive psychology, noted that an optimistic\nexplanatory style contributes greatly to one’s happiness. It consists of\nnoticing that — even as bad as any particular event is, a person can reflect\nthat the event will not be all of the following: permanent<\/em> (that is, most things will pass), pervasive<\/em> (e.g., even if you lose your job, you may still have\nsustaining relationships), and personal<\/em>\n(i.e., you may hate being under lockdown, but it’s nothing personal; we’re all\nin this together) (Seligman, 1992). In other words, we can get a sense of\nperspective.<\/p>\n\n\n\n One of the first skills Psychosynthesis practitioners teach\ndistressed clients is often that of disidentification. A two-step process\nconsisting of first identifying with the stressor and then disidentifying from\nit, the skill is paralleled by the mindfulness process called defusion, in\nwhich the person practicing the skill first fuses (identifies) with the feared\nthought (e.g., “I could get sick and die from this”) and then distances him\/herself\nfrom it (disidentifying or defusing) by creating an Observer Self. This Self watches\nthe client be consumed with fear or worry, but from some distance, where the\nworrisome thought is not as potent. Disidentification and defusion create a\nmore spacious psyche, which affords clients the ability to see their problems\nfrom further away than before; the threat level decreases (Assagioli, 1973\/1984;\nHarris, 2009). <\/p>\n\n\n\n In CBT-based psychologies, the practitioner works to help\nthe client reframe limiting, unhelpful, and\/or irrational thoughts, replacing\nthem with more adaptive, realistic ones. Thus, thoughts such as, “I’m sure I’ll\nlose my job in this pandemic, and I’ll never work again” are reviewed and\nevidence is sought for them. Even if the person is\/has been working in an\nindustry which is closing up during the pandemic (for example: the aviation and\nhospitality industries), there is no evidence to suggest that these industries\nwill not roar into life again when lockdowns are lifted and we are on the other\nside of the pandemic. Beyond that, the client can be probed to examine if s\/he\nhas ever lost a job before, for whatever reason. If so and the person has been\nworking recently, there is clear counter-evidence to the assertion, “I’ll never\nwork again” (Beck & Weishaar, 1995).<\/p>\n\n\n\n In this therapy — as stated in its name — the practitioner\nhelps the client to focus on solutions to the current problems (Ackerman, 2017).\nNo, the client may not be able to go to the gym, but what at-home exercising\noptions might there be? Online yoga workouts, fit balls, and dumbbells may\noffer heretofore ignored possibilities for keeping fit. Beyond that, the\npractitioner can probe for how the client may have coped with situations that\nwere similar (in whatever way) in the past. How might these solutions be\nre-formed to work for the current situation? What coping skills can be\nidentified to be recruited now?<\/p>\n\n\n\n Does the client have a spiritual holding to call on in this\ncrisis? Can those practices come more to the forefront of the client’s life? Mindfulness\nand other stillness practices, such as the Buddhist loving-kindness meditations\nor progressive relaxations can help the client to relax, centre, and find peace\nin an agitated world.<\/p>\n\n\n\n Whatever school of psychology we employ to recruit useful\ninterventions, the bottom line is that those who are able to find meaning and\npurpose in the events happening to them during the pandemic — or anytime — are\nable to reduce suffering, enhance their resilience, and become beacons of light\nto others in our collective dark times of pandemic spread. A primary\nPsychosynthesis tool but widely adopted in many other schools of psychology as\nwell, “MPV” identification establishes what has ultimate meaning, clarifies what\nthen is one’s purpose, and enables choosing which values are then enacted\n(Assagioli, 1973\/1984). It is a powerful antidote to the virus of fear and\npanic sweeping the globe.<\/p>\n\n\n\n In this article we have outlined how, in addition to the\nobvious stressors of restriction, inadequate supplies, and unclear information (which\ninduce symptoms such as fear, frustration and boredom), there are many less\nobvious threats to tend to in the current environment. These include the\nwildfire-like spread of hopelessness, stigma, a sense of pressure, and the\nindividual and collective need to mourn our many losses, not least of which has\nbeen the loss of our affluent society’s free and easy lifestyle. We identified\nwho is at higher risk during these times, and outlined samples of the kinds of\ninterventions that, as practitioners, we can offer clients whose lives have\nbeen turned upside down. <\/p>\n\n\n\n And what of our stressed colleague after her routine errand\nrun? She ultimately came to realise that, as irritating as the current times\nare globally, the contrast with how we are normally able to live, work, and\nplay gives rise to an immense gratitude for what we have had (another\nresilience skill!), and the will to engage on all fronts, that our collective\nrebound to a new normal may be permeated with genuine peace, cooperation, and\nempathy as we stamp out the other<\/em>\nvirus. We all have a role to play in that, but as mental health practitioners\nwe may have a starring role.<\/p>\n\n\n\n A member of our writing team related the following experience during these times of near-lockdown. She had gone out to do some essentials such as grocery shopping and getting prescriptions filled for her healthy but self-isolating husband. Returning home, she threw down her things, wailed, “It’s just awful”, and burst into tears. Her astonished husband […]<\/p>\n","protected":false},"author":193,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[91,67,70],"tags":[],"class_list":["post-4752","post","type-post","status-publish","format-standard","hentry","category-loss-grief","category-stress-management","category-trauma-disaster"],"yoast_head":"\nThe less obvious signs of trouble<\/h2>\n\n\n\n
Hopelessness<\/h3>\n\n\n\n
Stigma<\/h3>\n\n\n\n
Individuals feeling under pressure and children needing more\nattention\/attachment due to uncertainty<\/h3>\n\n\n\n
Loss and grief<\/h3>\n\n\n\n
Who is most at risk in this environment?<\/h2>\n\n\n\n
Our response: Interventions that can help<\/h2>\n\n\n\n
From positive psychology<\/h3>\n\n\n\n
Psychosynthesis and mindfulness<\/h3>\n\n\n\n
CBT and the reframe<\/h3>\n\n\n\n
Solution-focused therapy<\/h3>\n\n\n\n
Mindfulness and other stillness practices<\/h3>\n\n\n\n
Finding meaning, purpose, and values (MPV)<\/h3>\n\n\n\n
Summary<\/h2>\n\n\n\n
References<\/h2>\n\n\n\n