“Trauma” has become a bonafide online buzzword, popping up on TikTok, Instagram and anywhere memes are shared. But what weight does the word actually hold? The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.” The Substance Abuse and Mental Health Services Administration says trauma can also stem from a “series of events or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening.” Sound familiar?
The pandemic has taken lives, threatened livelihoods, turned everyday activities into health hazards, and forced people into isolation. Consistent, ongoing exposure to traumatic experiences over the past year and a half has had an impact on mental health — we’ve seen upticks in chronic stress, anxiety and depression symptoms and eating disorders. Experts have even coined a new condition, called COVID stress syndrome, to describe intense anxiety related to the pandemic. They predict that in the coming months, and years, we’ll see more and more cases of post traumatic stress disorder.
But even though we’ve all been living through a textbook traumatic event, with no clear end in sight, that doesn’t mean everyone will develop PTSD or even less severe trauma symptoms. Reactions to crises vary widely and aren’t always proportional to the events themselves. In one study of participants from five different western countries, 13.2% of respondents were experiencing PTSD symptoms related to COVID, despite not technically meeting the criteria for a formal diagnosis.
“In reality, life isn’t black and white,” says Kate Bunch, a licensed professional clinical counselor and president of the Trauma Treatment Center in Rio Rancho, New Mexico. “Not everyone who experiences the pandemic as traumatic would qualify for PTSD, because not everybody who experiences this as trauma is experiencing PTSD symptoms. That trauma might be coming through in the form of depression or anxiety.”
We reached out to trauma specialists across the country to learn about the types of patients and issues they’re seeing and their approaches to treating COVID-related trauma.
Kate Bunch, LPCC
President of the Trauma Treatment Center
Rio Rancho, New Mexico
On what she’s seeing in patients: The trauma people are experiencing is really different. When we have patients come into the clinic, we do have a really intense assessment process that can take six weeks. If you think about big things like 9/11 or a school shooting, these are one-time experiences that people tend to relive in multiple different ways, expressed through multiple different symptoms. With COVID, what we’re talking about right now is an ongoing, chronic, toxic stressful situation. It’s similar to when we work with kids who grow up in neglectful or abusive situations. You can say, ‘This shouldn’t happen,’ but that’s their everyday life.
The human brain can respond to chronic stress in a lot of different ways. Sometimes it’s maladaptive, and you’ll see an uptake in gambling, sex, alcohol and drugs. One of the other things it does is it starts to shut down. It says, ‘I’m not going to recognize this as toxic or abusive,’ and goes into pure survival mode. It will be really interesting to see how different experiences will develop over time as life returns to “normal,” and how people’s symptoms continue or don’t.
On treatment: Patients can come here and vent, and process things, but we know they will leave here and still have many of the exact same experiences over the week. So what we’re focusing on right now is helping our patients find helpful coping skills. Eye Movement Desensitization and Reprocessing (EMDR) is one of the primary methods our clinicians use.
But we don’t just have behavioral health — we also have biophysical health, which houses massage therapy, yoga therapy, occupational therapy, body-based things. One of the things we look at it is we might not talk about what it’s like to be anxious, but we’ll be like, “What was that like for that to be stored in your body?” A patient might be paired up with a yoga therapist who can show them poses to relieve different types of stress they might be facing at various points of the day.
Dr. Ann Beeder, MD, and Dr. Carol Weiss, MD
Addiction psychiatrists, Weill Cornell Medicine Center For Trauma and Addiction
New York City
On the types of patients the center is seeing:
Beeder: I would say the clientele is different than usual. For one, we’ve treated many healthcare workers and other people that had to be in the front row of the fight. There hasn’t been a trauma like this in the medical community, probably since the era of HIV and AIDS hitting the scene in New York City. There are also people who have lost people, people who have been very sick and others who have just been isolated and cut off from friends.
We’ve had people who were 9/11 survivors say that some of the same feelings were triggered in them during the pandemic and that the same kind of sense of demoralization. But the problem I think that’s different with the pandemic is that it’s not a discrete event. Although the fire burned for 100 days where the World Trade Center was, it was 100 days. And this instead is almost two years so far. The idea is that it’s really fixable if you get treatment.
On what patients are experiencing:
Beeder: We’ve seen many patients with PTSD. The pandemic’s been going on for a year and a half, and usually people begin developing the symptoms of PTSD months after the incident or trauma occurred.
Weiss: There’s been so much loss and fear. COVID has exacerbated anxiety and depression in people who have struggled with it their entire lives.
I also think that one of the things we saw during the pandemic is that many people who had prior traumas — those traumas got re-triggered. The isolation, the fear, and the sense of danger and imminent death or harm to oneself have really had an impact on people. Another thing is that the confusion now and the demoralization now is huge. People are just fed up and confused about what’s the right and wrong thing to do with the rise of Delta.
Beeder: We’ve had people who were 9/11 survivors say that some of the same feelings they dealt with in its aftermath were triggered in them during the pandemic. But the problem I think that’s different with the pandemic is that it’s not a discrete event. Although the fire burned at the World Trade Center for weeks, this has lasted for nearly a year and a half.
Beeder: We use a combination of medication, group therapy and different trauma-focused modalities, sometimes focused on attachment or family-related issues. Even if someone has PTSD, their story is very unique to them and they must be treated that way. Our primary method of treatment is a type of therapy called EMDR, which is a more quiet and quick treatment that allows for the same kind of processing of the event or the events, as does exposure therapy.
On types of patients: Deer Hollow is a residential trauma and PTSD treatment center. Because of our focus, we usually get a lot of first responders, so police officers, firefighters and EMTS. And we have seen quite an uptick in clients who are in the medical professions, doctors and nurses. We’ve also seen an uptick in clients who have been sober for a while but were re-triggered during the pandemic.
On treatment: I think what sets us apart from other treatment centers is that it’s a very intensive program. Our clients do group trauma therapy seven days a week and then meet with their individual therapists and our medical director, who is a psychiatrist, weekly. We help our clients develop shame resistance and use techniques like psychodrama, in which clients act out events from their past. We also employ a lot of DBT (dialectical behavioral therapy) skills to help clients regulate their emotions on their own.
Dawn Potter, PhD
Clinical psychologist at the Cleveland Clinic
On the types of patients: Across the board, we know the demand for mental health disorders has gone up during the pandemic. I do specialize in PTSD. I’ve specifically been taking referrals for patients with long COVID symptoms — symptoms of COVID that didn’t go away after their initial infection. In those patients, we are screening them for anxiety and PTSD — and we’re specifically seeing a lot of PTSD related to hospital stays.
On the challenges of the pandemic: There’s a delicate balance between trying to target avoidant behaviors, which are really common in PTSD sufferers. They frequently try to avoid certain things to avoid feeling re-triggered, which is especially hard during a global pandemic.
If you are traumatized by something related to COVID, you may wish to avoid the news, socializing, leaving your house or anything that could potentially create a risk for catching COVID again. This can be especially tricky to treat, because some of these behaviors might be similar to social distancing. Avoiding crowds is a common symptom of PTSD, but it’s also probably a good idea.
On treatment: To specifically treat PTSD, I use something called cognitive processing therapy (CPT), which helps people reframe negative beliefs they’ve developed due to traumatic experiences. That can help them sort of retell and reimagine their story and what happened to them. I also do dialectical behavior therapy, which isn’t necessarily a treatment for PTSD, but can help people who are having a difficult time processing certain emotions.
It helps them develop coping mechanisms to deal with their feelings rather than resorting to destructive tendencies like risk-taking and substance use. That can be helpful for PTSD too. It doesn’t directly treat trauma, but can help with other symptoms that are interfering with a person’s quality of life.