Epidemic Caused by a Pandemic
Aug 01, 2021"She gave what she had, and she's a casualty of the war in the trenches, as far as I'm concerned," Dr. Philip Breen told The New York Daily News. Dr. Breen was mourning his daughter, Dr. Lorna Breen, 49, the medical director of New York-Presbyterian Allen Hospital's emergency department. On April 26th, 2020, Dr. Lorna Breen succumbed to her self-inflicted injuries. Her tragic suicide brings attention to the potential for many more such tragedies if an early engagement plan is not implemented to diminish the effects of stress and Post Traumatic Stress Disorder (PTSD). The number of Coronavirus First Responders who feel the effects of PTSD is increasing and will continue to do so over the next 6-12 months. We must take preventative measures to minimize the effects of PTSD as these responders reintegrate into their previous, normal routines. Unfortunately, the effects of COVID-19 will not only impact First Responders or Medical Professionals. The impact will be far-reaching affecting everyone from our youth to the elderly regardless of profession, age, nationality, or sex. The only difference will be how we lay the foundation for recovery on an individualized basis.
While reading this article you will learn about the effects of short-term and prolonged periods of stress. After reading this article you will be able to recognize the impact of stress it can have emotionally and physically on the human body. You will also learn about the effects COVID 19 can have on medical professionals, first responders, teachers, parents, children, and everyone alike. And most importantly, how can we overcome these challenges by implementing an early warning system or proactive preventative measures by utilizing an emotional balance plan.
Most individuals have a normal or baseline method of dealing with stress. When presented with challenges or difficult situations, our brains and emotions respond based on previous life experience, skills, and training. This enables us to address the problem and then return to a normal functioning level. This pattern is most often observed when dealing with short-term stress, which can have a positive impact on the human body. It triggers the fight or flight response that stimulates us to quickly respond to a threat or an acute stressor. This response has supported survivability over time. Short-term stress also provides exposure to stressors over a manageable length of time, so that we may develop necessary coping skills.
Stress that occurs for a prolonged period has adverse effects. Prolonged stress interferes with our ability to think clearly and to concentrate. It also affects short-term and long-term memory, causes headaches, and creates heightened emotional reactivity. Prolonged stress can weaken the immune system, thereby lengthening our recovery time from injuries or illnesses.
Additionally, stress can cause numerous other ailments including joint pain, skin disorders, ulcers, eating disorders, sleep impairment, loss of energy, and decreased hormones which can impact the male and female sex drive.
For those serving on the front lines, the current pandemic is creating heightened levels of stress and traumatic experiences over a prolonged period. Many First Responders may lack the
proper coping skills to manage these unprecedented circumstances arising from a crisis of this magnitude. Eventually, when First Responders return to normal 9 to 5 routines, they will be significantly impacted by the extended periods of stress experienced during the COVID-19 pandemic. The impact of this prolonged stress will alter how these individuals can function and perform their jobs.
When we hear about individuals dealing with PTSD, most often we associate the image of military personnel or soldiers returning from war. However, PTSD can affect anyone who has dealt with a traumatic event or has experienced prolonged exposure to stress without proper coping skills to minimize the effects of that stress. PTSD, as documented and researched over the last four decades, can result from an individual traumatic experience or traumatic experiences of longer duration. PTSD can also result from chronic periods of stress, even in as little as 30 days, where the brain functions become diminished or the brain shrinks due to the continuous stressors in an individual's life. As Christopher Bergland wrote in Psychology Today, chronic stress and high levels of cortisol create long-lasting brain changes. Cortisol is often referred to as "nature's built-in alarm" system and is the primary hormone that works with certain parts of your brain to regulate your emotional state. But too much cortisol can be harmful since it can have dramatic effects on the brain's ability to recover and return to a normalized state.
Why is this hormone Cortisol so important in our understanding of PTSD? Because individuals dealing with chronic stress, like our first responders, have continuous overproduction of cortisol that can alter the brain's functioning capabilities. Now consider that for any individual dealing with chronic stress for several weeks, months, or even years, it becomes increasingly difficult for them to return to their pre-stressor, baseline state. However, if individuals have the proper coping skills to manage stressful events, their ability to return to a normalized level can be quicker and less traumatic when compared to those who do not have the proper coping skills.
Now let us consider all of the medical professionals or any COVID-19 First Responder. Before joining the fight against COVID-19, these professionals had various levels of training to cope with stress. As the battle continues with COVID-19 these same professionals are not able to return to their families, nor do they have the opportunity to de-escalate from the continuous COVID battle. The chronic stress felt by these professionals laboring in the trenches will have lasting effects because this new, higher level of functioning and stress will be established as their new norm.
Can we ever return to a norm that was pre-covid or will we need to establish a whole new norm that will require new coping skills which will allow us to adapt? Although the reality is we may not ever be able to go back since we will not be able to unsee or forget quickly all of our experience during COVID-19, we can and will learn that through resilience we can establish a new norm. At some point, these individuals will return to their 9-5 jobs, their medical practices, their families, and their friends. How will they cope with battle scars that have been left behind during "their time of war"? How will they make that transition when they no longer have the heightened levels of stress in their lives? (Note: Please imagine for a moment living in an environment where there is no light or sound for several weeks and then suddenly you are thrown onto a stage with blinding spotlights and piercing sounds. Covering your ears from the
sound or eyes from the light will not diminish your body's response to the over-stimulation felt as a result of the changing environment. This type of sensory overload can lead to an emotional or physical response that could impact anyone who is trying to integrate back into their "normal" state. )
Most of you may have heard about NASCAR Driver Ryan Newman who was involved in a horrific accident on the last turn of the Daytona 500 on February 17, 2020. Most consider Newman as a walking miracle considering he walked out of the hospital two days later holding the hands of his two daughters. This was a picturesque moment millions of fans would have thought impossible as they witnessed the initial crash. However, even after the horrific crash and spending only two days in the hospital, Newman was ready to go back to the driver seat almost immediately. Most individuals, outside of being a NASCAR driver, would be traumatized by such an incident. Due to Newman´s developed skills and training in the world of racing, his
¨normal¨ coping skills are at their best when he drives almost 200 mph. He has learned and practiced over and over how to maintain his baseline at such high speeds. An individual who may not have exposure to driving at high speeds would likely not be able to recover as Newman did, simply because coping skills and baselines are at different levels for everyone. However next, we can discuss proactive measures anyone can take to minimize the effects of prolonged stress as a result of COVID-19 by implementing an Emotional Balance Plan.
Back to ¨Baseline¨ with an Emotional Balance Plan
As a "modern" society and culture, if we do not learn from previous mistakes, history will repeat itself. I am not referring to previous pandemics, I am referring to the thousands of soldiers returning from war who did not have access to services needed to minimize the effects of traumatic experiences on their emotional wellbeing. We now understand, even though our understanding may still be limited, what effects PTSD can have on an individual who has dealt with a traumatic event or prolonged periods of stress.
Now let us consider our same medical professionals as they return to their patients. The quality of their functioning essentially depends on how well they can develop their coping skills, allowing them to return to their normalized state before COVID-19. And as a good attentive partner or fellow medical professional, we want to assist these peers by easing their integration period and by helping them develop a pathway that can lead to success.
One of the ways we can limit PTSD symptoms is by assisting Coronavirus first responders in developing an Emotional Balance Plan (EBP). An EBP can consist of the following five steps that will guide anyone dealing with stress or PTSD. A proper EBP should include a
self-assessment, emotional labeling, creating space, basic physical care, and developing self-control.
Step 1- Self Assessment: Conduct a self-assessment anytime you are feeling overwhelmed or stressed to assess if your emotional level is high or low. What often happens as a natural process of human behavior is when your emotional levels increase your ability to make rational and clear decisions will diminish. Simply put, when emotions run high, rationality runs low. If
your emotional levels are high, your follow-up should be to determine ¨why¨ the emotional level may be high. This process can begin to identify certain emotions you may be feeling which leads to step #2.
Step 2- Emotional Labeling: Once you´ve conducted a self-assessment, identify what emotions you may be feeling and label those emotions. Each emotion you label will be one step closer to identifying the underlying feelings behind those emotions. By labeling each emotion, we can begin to understand what or why the feelings may be occurring. Additionally, each emotion may be connected to other underlying concerns thereby increasing the emotionality internally. For example, receiving a pay cut at work may elicit feelings of anger and frustration. Underneath the anger and frustration may be the fear of increasing financial debt, falling behind on the mortgage payments, inability to fulfill financial responsibilities for the family. And underneath these fears may be the overwhelming fear of loss of empowerment and independence.
Step 3- Creating Space: This is the step where the brain is given time to achieve some clarity by providing physical separation and distance from the stressor and time to process the stress. Often pausing or momentarily changing the environment can be enough to escalate the recovery process back to a baseline. It may not always be easy to ¨take a break¨ in the moment. However, creating space sometime during or after a stressful event can allow the brain to process what has taken place and then internalize the stressor to prevent long-lasting effects.
Step 4- Basic Physical Care: Eat healthy, exercise, get enough rest. Of all the steps in this emotional balance plan, this step is possibly the most difficult because the brain is already overtasked and under immense pressure to continue to function. Therefore, attempting to eat a healthy meal when a person is dealing with fear, anxiety, depression, stress , or any other highly emotional event, often leads to identifying what is the quickest and easiest form of food to digest. And when a person is too stressed to sleep, the cause can often be a brain under constant pressure that has a difficult time slowing the thought processes down leading to restless nights of sleep or not being able to sleep at all.
If a person is dealing with PTSD or depression an adverse effect can be
too much sleep or not having any energy to complete the simplest of tasks, such as cleaning a room, personal hygiene, getting out of bed , etc. When a person is not able to eat healthily or get a good night's rest they may rarely have the energy to even want to consider exercising.
Scientific Research on the effects of exercise on the body has shown it has more of a positive impact on overall physical health than other activities. Exercising even 20-30 mins a day can have positive outcomes on our emotional and physical well-being. Exercise allows parts of the brain, such as the hippocampus to enlarge which controls learning and memory. The effects of exercise can also lead to eating healthy and a better night's sleep. Create a plan that specifies what time you will sleep, what times you will consciously take a break to eat a meal , and specific times when you will exercise.
Step 5- Developing Self Control: Oftentimes when I´m teaching classes related to hostage negotiations or crisis negotiations, I teach that there is only one thing we can truly control in a crisis and that is ourselves and our emotions. Everything else is a perceived sense of control. This holds when we are dealing with any situation where we may want to affect a change.
When an individual is dealing with momentary stress, chronic stress, or PTSD, this element of control is an area where we often feel lost. Not being able to control anything in our life, personal or professional, can be a major contributing factor when we are feeling stressed out or emotional. By taking control just in areas where you can you develop a sense of accomplishment. To begin you may not be able to control a lot of things at work, school, friends, or oftentimes family issues. However, if you can take control of your sleep, eating habits, exercise, emotions, or a small part of your day then it can begin to shape how you internalize and perceive emotions. Lack of control in one's life can often feel chaotic even in the simplest of situations. Taking control of yourself is one of the most important factors in dealing with stress or PTSD.
As we look back and think of our heroes, who are the Doctors, Nurses, Paramedics, Medical Professionals, and all other First Responders, who are impacted by COVID-19 even with their skills and training. Consider how can our teenagers, working parents, teachers, or any adult maintain a level rationale of recovery through such a stressful time? And as we move forward, what do you consider to be your new norm. Now wearing masks and maintaining social distance are new ways of living. It may be short-term, meaning it could last for the next three to six months or it could be longer as we continue to witness the dramatic impact of COVID-19. Also minimizing all or some social etiquette that we have practiced our entire lives is not an easy task. However, rather than being forced, if we were to change our perspective it would give us more control in our choices thereby making the transition a bit easier. Integration into a new norm may not be easy, rather we as a human race have learned that life will never be easy or perfect but we can and will overcome these challenging times. Many of you may recall Christopher Reeves who played Superman. As he endured some of the most difficult times in his life after his accident that left him paralyzed from the neck down, it did not seem to diminish his outlook on life as he said the following, "I think a hero is an ordinary individual who finds strength to persevere and endure in spite of overwhelming obstacles." These moments in our life may seem overwhelming, however keep in mind these obstacles too shall pass.
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