Anxiety and Depression  |  Impact of COVID-19

Are You Traumatised by COVID-19?

BY DR PEARLENE NG

6 August 2020  |   7 min read

As of 21 June 2020, the WHO has reported more than 9 million cases of COVID-19 with close to half a million deaths around the world. The actual number of cases is likely to be higher than reported. The threat of COVID-19 to lives is significant.

The severity of COVID-19 also necessitated various widespread measures that impacted many aspects of our lives. Nations entered lockdowns, people had to be isolated and jobs were threatened. COVID-19 has upended lives and sent people into uncertainty and confusion. During the pandemic, our sense of safety, certainty and control of our lives has been shaken. COVID-19 can result in psychological and emotional trauma for many of us. For those infected or severely affected by COVID-19, the ongoing pandemic can be a traumatic event.

A traumatic event is defined as an event when a person is exposed to: death, threatened death, actual or threatened serious injury, direct exposure through witnessing the trauma, learning that a relative or close friend was exposed to a trauma, and indirect exposure to aversive details of trauma from people such as frontline workers caring for COVID-19 patients.

Trauma can be understood as the psychological and emotional responses to a distressing and frightening event perceived as overwhelming one’s ability to cope. As a result, the person may experience a plethora of emotional, cognitive, and physical symptoms.

Trauma can be understood as the psychological and emotional responses to a distressing and frightening event perceived as overwhelming one’s ability to cope.

In the extreme, exposure to a traumatic event can lead to Post-Traumatic Stress Disorder (PTSD). To be clinically diagnosed with PTSD, a person would need to display signs and symptoms of significant distress and impairment in functioning that is not attributable to substance use or other medical conditions for a period more than a month after the event. The full impact of COVID-19 is still yet to be seen. Taking reference from the SARS outbreak in 2013, the South China Morning Post reported about 40% of recovered SARS patients in Hong Kong continued to suffer from PTSD two years after the pandemic. In Singapore, 12.8% of the staff surveyed in a rehabilitation department taking care of SARS patients demonstrated PTSD symptoms. This indicates that those whose loved ones were infected by COVID-19 or died from COVID-19, and even those simply overwhelmed by the impact of COVID-19 could experience trauma.

With the commencement of phase 2 of the post-circuit breaker period, returning to work and social activities may be comforting for some, but may induce anxiety for many others —especially those significantly impacted by COVID-19. For example, one mother whose son was confirmed to have COVID-19 and who was subsequently placed on home quarantine described her experience as traumatic. When she returned to work as a cleaner in an office a month later, she experienced a fear of being alone and anxiety about her doing her work. Being instructed to thoroughly clean the office as part of precautionary measures against COVID-19 evoked memories of her home quarantine period when she had to thoroughly clean her house. Fortunately, not everyone who has experienced a traumatic event will develop PTSD. Although we may experience anxiety or trauma and show some symptoms, most of us recover from it within a month. It is important for us to be aware of how we are affected by COVID-19 and the various related events. We can monitor how we are coping by looking out for any of the below symptoms, which can be easily remembered by the acronym RAIN:

  • Re-experiencing

    • Flashbacks i.e. reliving the traumatic event and feeling and acting as though the traumatic event is happening again.
    • Rumination about the traumatic event.
  • Avoidance

    • Avoidance or attempts to avoid memories, thoughts and feelings of the traumatic event.
    • Avoidance or attempts to avoid people, places and activities that may evoke reminders about the traumatic event.
  • Increased arousal

    • Feeling scared and startled easily, as though danger is always lurking around.
    • Feeling anxious and worried.
  • Negative perception

    • Developed negative perception of oneself (e.g. I am useless) or about the world (e.g. the world is a dangerous place).

If you are experiencing any of the RAIN symptoms, below are some ways to cope:

1. Relaxation techniques

Keep yourself calm and control your anxiety by using different relaxation and self-regulation techniques such as breathing, muscle relaxation, and other mindfulness techniques.

2. Change your narratives and thinking

Our thoughts and perception of the traumatic event affects how we feel and predicts the severity our experienced trauma and symptoms. Look out for self-blaming, or overgeneralising thoughts like, “it is my fault” or “the world is very dangerous” and instead, change your way of thinking by recognising these thoughts and framing them in a more positive and factual way, such as: “I did my best” or “there is a higher risk of infection at this place but safety measures have been implemented to keep me safe”.

3. Choose courage and resilience over avoidance

It is instinctive to avoid triggers or memories of the traumatic event. However, suppressing or pushing these thoughts away may cause you to feel even more anxious when you get reminded of them or encounter related incidents in the future. Instead, remind yourself that you have overcome the experience hence the resilience to be where you are today. Choose to face your fears and find ways to cope with the triggers and anxiety that may arise.

4. Grounding techniques

If you find yourself experiencing any flashbacks or intense anxiety or fear triggered by any reminders, it can be distressing as though you were reliving the event. It is important to remind yourself that you are in the present moment, that the event is over, and is not happening again. Use grounding techniques to help you stay in the present. Grounding techniques can include:

    1. 5,4,3,2,1 — Describe your present environment in detail by using all your senses e.g. Pointing out 5 things we can see, 4 things we can hear, 3 things we can touch, 2 things we can smell and 1 thing we can taste. If you cannot remember this, just describe whatever you see in your environment.
    2. Reorientation — reorient yourself to the present by asking yourself questions such as:
      • Where am I?
      • What day is today?
      • What is the date?
      • How old am I?
    3. Focus on your body sensation. If it helps, touch something or hold onto something. Focus on how the item feels and your body sensation. Does it feel warm or cool? Rough or smooth? Soft or hard? It will be good if you can hold onto an object that is comforting to you such as a rosary or blanket.
    4. Safety statement — develop a paragraph to anchor yourself to the present. You can expand on it by describing your environment and what you are doing.
    5. e.g. “My name is _________; I am safe right now. I am in the present, not in the past. I have recovered from COVID-19. I am out of the hospital. I am at _____ now. The date is _______. We are in Phase 2 of post-circuit breaker.”

5. Seek Professional Support

If your distress and anxiety remains high and you are still worried about your PTSD symptoms, seek specialist therapy with a mental health professional such as a Clinical Psychologist. You can call Viriya Psychological Services @ 6256 1311 or email psychsupport@viriya.org.sg to speak to a Clinical Psychologist.

The contributor is a Clinical Psychologist at Viriya Community Services.