Psychological First Aid

The pandemic continues, we are losing more people daily to the virus than any other tragic event in our history.  Couple the horrific deaths with an economic crisis equal to the Great Recession, an election that may be the most important of our lifetimes and the intense level of social unrest, we get a plethora of things fraying our psyches.  Many are stressed, afraid and having sleepless nights.  We keep thinking, it can’t get worse and then it does.

What to do with the awful feelings that we are so far from normal that normal may no longer exist?  There has to be a way to get through this.  How do we keep hope alive and be optimistic about the future?

One tactic is found in “We’ll Get Through It”: How To Accept The Uncertainty Of COVID-19,  (Link) where  Gretchen Rubin suggests that we lean into the uncertainty and fear.  She says, “But what if, rather than fighting that uncertainty and getting anxious about it, we just accepted it — or even leaned into it?”

“One of the things that I’m really doing is trying to understand, like, well, there is so much uncertainty, there’s loss, but what am I learning? What am I gaining? What insights am I having?” she says. “Some things are working worse, but some things are working better, and can I gain from that?”

To help her stay focused, she is reminded of the line from the Roman poet Ovid where he says, “Be patient and tough. Someday this pain will be useful to you.”

“I think we all just have to hang in there and hope that one day this pain will be useful,” she says. “And now I think we’re really settling into this different state, as you said, where we realize it’s going to be uncertain for a long time and that we don’t really know what the horizon is and things might move forward and they might move backward.” Rubin points out that things that seemed far in the future have now drawn closer like the upcoming holidays, and she says, “Well, now that’s all coming real, and so I think people’s feelings are changing.”

“So I do think we need to be realistic, but it’s also true that one of the ways that we can feel better about what’s going through is if we do feel like we’ve made good use of the time. And if you feel like, ‘Well, I was safer at home, and so I did organize my basement or I did update my resumé or I did take that online course or I did learn how to use that new software,’ that will make us feel better going forward because it’s something good that came from this. We were able to make good use of it. And that’s comforting because there’s so much we can’t do. I think each of us has to decide for ourselves. Like, am I going to ask more of myself or am I going to cut myself some slack?”

Another tip from Rubin is to focus on your relationships.  She says, “If you’re going to think about happiness, the key to happiness is strong relationships, if you had to pick one thing. So as you’re going through this time, really pay attention to your relationships. Staying connected with other people, going out on the street and smiling at people, your neighbors, over the masks, looking for ways to feel connected to other people, and also, you know, to do good in the world, to feel connected to your larger community because maybe you can’t control the virus, but you could do virtual volunteering or you could do virtual babysitting for somebody who’s got little kids at home and can’t get any work done. If we do good, we feel good, and that will make us feel closer to the people in our lives and closer to our community. And so that is something that’s within our control that will really boost our spirits in a tough time.”

Dr. Noelle Nelson, author of Power of Appreciation and Happy Healthy…Dead, writes in Optimism’s Impact On Mind And Body During COVID-19 Crisis, (Link) that “Studies have shown us repeatedly that optimists have stronger immune systems than those who don’t have an optimistic outlook. Strengthening our immune system is our body’s defense against disease,” says Nelson. “We already know that the coronavirus is deadliest among those with compromised or weakened immune systems. Maintaining and developing a strong immune system can go a long way toward our staying healthy.”

If you’re not a natural-born optimist, Nelson suggests two steps to get you on track during these tough times.

“Institute A 5-Minute Pity Party. A 5-Minute Pity Party is where you acknowledge your frustration over the aspects of your life that have been negatively affected by the coronavirus. You’ve lost your job, you’re struggling with homeschooling your kids or you’re mourning the complete shutdown of your social life. ‘Whatever the reason or reasons,” says Nelson, “it’s time to release your anguish. Get it out of your system (i.e., rant, rave, cry) safely and privately; once your five minutes are up, move to step two.’”

“Value What You Can Today. Look around you. What can you appreciate about your life right here, right now? You say “nothing? ‘There is still plenty to appreciate. It can be as simple as appreciating the roof over your head or you’re in good health. Continue to look for other reasons to appreciate. Be genuine. By doing so, these thoughts of appreciation will have a dramatic, positive impact on your immune system,’ suggests Nelson.”

“Optimism isn’t a cure-all. Yet in every crisis, there is opportunity for new growth and new inspiration when seen with an optimistic eye,” says Nelson. “Let’s keep our moments of dark despair as brief as possible and amp up our times of appreciation. If we do, we’ll come out of this challenging situation stronger and better than ever.”

Going a step further is the advice that we need to practice psychological first aid.  Stacy Colino in The pandemic proves we all should know ‘psychological first aid.’ Here are the basics, (Link) tell us how.

George S. Everly, a clinical psychologist and professor of international health in the Center for Humanitarian Health at the Johns Hopkins Bloomberg School of Public Health, and author of The Johns Hopkins Guide to Psychological First Aid, says, “The pandemic is like the never-ending story,” says Everly. “What makes this more psychologically toxic is that we keep receiving new impacts” as resurgences and new outbreaks occur, and more collateral damage to life and work, as we knew them, becomes apparent.

Colino reinforces that never-ending story, she says, “Meanwhile, on a daily, sometimes hourly, basis we’re subjected to bad news from multiple directions — not just about the pandemic, the economy and racial issues, but about political scandals, civic tensions, fires, floods, conspiracy theories and more — without the in-person support of friends, extended family and colleagues because of the pandemic. ‘The world seems more uncertain than ever — uncertainty is a powerful toxin,’ Everly says.”

Fortunately, you can dial down your stress reactivity and come to your own emotional rescue — or that of others — with PFA-based strategies. Here’s how to put the actual components of PFA into practice for yourself and those you care about:

Address basic bodily needs.  Make a conscious effort to consume nutritious foods, stay hydrated, get enough sleep, do some form of physical activity every day, and avoid using substances such as alcohol or cigarettes to cope, advises Kaushal Shah, a psychiatric researcher at Griffin Memorial Hospital in Norman, Okla., who has done research on PFA. Besides being important for your overall health, these healthy lifestyle practices are a vital part of PFA.

Avoid further harm. Protecting people from additional distress is a key aspect of PFA, and there are several ways you can do this for yourself and others. First, check to make sure conditions are physically safe, then take steps to ensure emotional “safety” by treating others and yourself with respect and compassion. “Remind yourself that whatever you’re feeling or going through right now is perfectly normal,” advises Nancy Haugen, a clinical psychologist in San Francisco. “That [acknowledgment] tends to bring down some anxiety.”

In addition, try to protect yourself from information overload. New research, involving 6,514 adults in the United States, found that people who have higher daily hours of covid-19-related media exposure and exposure to conflicting covid-19 information in the media are at greater risk for pandemic-related acute stress and depressive symptoms. To prevent this effect, limit your media exposure.

Keep calm to carry on. Maintaining a gentle tone of voice can have a calming effect on distressed people around you. In addition, remind yourself and encourage others to do a relaxing activity — such as yoga, mindfulness meditation, deep breathing or progressive muscle relaxation — every day. This will help you de-stress in a given moment and maintain your psychological equilibrium, Shah says.

At regular intervals throughout the day — or when you feel stress-overload coming on — hit the pause button on what you’re doing and focus on deep breathing. “You can override stress with deep breaths that cause the diaphragm to go up and down. Then the brain starts to calm down,” explains Haugen. Moreover, research has found that engaging in diaphragmatic breathing reduces stress hormone levels and blood pressure, as well as subjective measures of stress.

Set priorities. In tumultuous times, it’s easy to feel overwhelmed with worries and fears. That’s why PFA encourages people to consider their most urgent needs, including how to prioritize and address them, versus what can wait. To that end, it helps to distinguish between what you can and can’t control and to encourage loved ones to do the same. Then focus on the situations you can do something about, such as how you protect yourself and your family, how you behave toward others and how you spend your free time. To help with this resilience-building shift, Haugen recommends framing your goals as “I choose,” which involves a sense of agency, instead of “I want.”

Build hope. Especially during periods of uncertainty, it’s important to stay positive with learned or active optimism and remain forward-focused, Everly says. One effective way to do this is to consciously focus on what’s going right in your life now. Research has found that having a ratio of three positive emotions to every negative emotion helps people flourish. You can stack the deck in your favor by “looking for positive moments and holding onto them throughout the day,” says Haugen. If you want to formalize the process, consider keeping a gratitude journal. A 2019 study found that adults who did this for 14 days experienced an increase in positive moods, happiness and life satisfaction, as well as a decrease in negative moods and depressive symptoms.

Connect with others. “The single best predictor of human resilience is support from other people,” Everly says. So, help people identify sources of social support in their lives with a reminder that the goal is to practice “physical distancing,” not “social distancing,” during the pandemic. Reach out to friends and family members on social media and make an effort to rekindle old friendships by phone, text, email or video conferencing. Also, consider establishing your own coronavirus-safe pod or bubble so you can spend in-person time with supportive people.

Practice good communication. When people are distressed, practice active listening by giving them your undivided attention and letting them take their time expressing themselves, rather than pressuring them to talk or immediately providing advice. These are key PFA skills. Try to truly understand the person’s concerns and feelings and show empathy and use supportive words and phrases that reflect the key points he or she made.

Reinforce coping skills. Ask someone who is distressed how he or she coped with difficult situations in the past and encourage the person to use those strengths and strategies to handle the current situation. (Do the same exercise yourself.) This contributes to a sense of confidence and competence that will allow them to face and manage the current challenge. It also builds resilience. PFA practices may be among the coping skills you call upon to face another difficult situation in the future.