Twenty-twenty (2020) was a really long year. As one Twitter user posted, “Just don’t ask, ‘What else can happen?’ 2020 takes it as a challenge.”
In the past 12 months, we have had wildfires, a world-wide pandemic, racial justice protests and counter-protests, a difficult election year, and murder hornets (!). And, even though we are well into a new year, we are not even close to out of it. Last year feels like it has never ended.
People are done. People want the pandemic to be over but it is not. They want the election year divisiveness to be over but it is not. They want to move on but they can’t. As we have seen with any traumatic event, the fears and anxiety and frustrations that have built up over the past 12 months threaten to derail mental health recovery efforts and send greater numbers of people into crisis.
On-going trauma, categorized as complex post-traumatic stress disorder (C-PTSD) in the International Classification of Diseases (ICD), comes as a result of prolonged uncertainty, fear of danger and stress.
For some, the on-going anxiety may not cross over into diagnosable illness. For others, and especially friends and families of the more than 400,000 Americans who have died because of COVID-19, it has the potential to lead to a diagnosable illness.
“For a lot of people, it would qualify as a trauma,” said Sarah Lowe, Ph.D, assistant professor of public health at Yale University who researches long-term mental health consequences of traumatic and stressful life events.
“There are many people who have been hospitalized or had a family member hospitalized or lost a life and of course, that can be traumatizing.”
Even those who have not experienced the grief of losing a loved one may be feeling the effects.
“There is literature out there where people talk about the capital ‘T’ trauma found in the DSM-5 but there is also the little ‘t’ trauma,” said Jonathan Green, Ph.D, a clinical psychologist in Boston who specializes in trauma-related reactions.
“Certainly with the pandemic, there is this invisible threat that puts people on the alert and makes them anxious and vigilant and even hyper-vigilant. So, there are certain symptoms of PTSD even when it is not the whole diagnosis.”
For psychologists working with clients with past trauma history, this year can exacerbate symptoms.
“A lot of this can trigger specific things and in ways we might not think about,” said Lowe. “Certainly, with everything going on in the political climate there are people who have experienced racially-motivated trauma and find themselves right now moving in a world where they are wondering what are the thoughts of everyone around them and are they really safe?”
Some past trauma sufferers are finding the coping tools they have developed over time and treatment have been more difficult to use this year.
“A lot of folks on my case list were doing well and a lot of the skills they leaned on to function can’t be accessed right now,” Green said. “They are really struggling.”
What advice do our experts have for psychologists who may not specialize in trauma during a time when just about everyone can claim to be experiencing some level of trauma?
“First, I don’t think we can assume everyone will be affected in the same way,” said Lowe. “Some patients anecdotally are actually doing better. Maybe those with social anxiety are finding a certain freedom from having to go out into public social settings. Of course, others may be directly affected by illness or violence. It is all worth discussing and putting out into the open.”
It is important to watch for changes in the way clients carry themselves or carry on a conversation, according to Lowe.
“In terms of things to look for, I would say are changes in symptoms but also in behaviors,” said Lowe. “Is this person spending less time with friends, even just connecting virtually? Are they sleeping in more? Are they exercising less? Have eating habits changed? Of course, most therapists are already trained to watch for these things. Maybe just being more purposeful in assessing changes.”
Green has found himself going back to teaching and tracking basic skills, like stress management and diaphragmatic breathing.
“Most psychologists have done stress management trainings,” he said. “Dust those skills off and take it more seriously. Track the clients and help them to do it consistently. Being able to self-regulate gives us a sense of control regardless of what we are struggling with. Putting that in people’s hands is huge.”
It can also be more important this year for therapists to monitor their own mental health and coping skills.
“I think it is a real challenge now because we are all going through it together,” said Lowe. “Therapists are having to maintain social distance changes in their jobs, doing more work remotely and dealing with their own fears about illness and family or friends’ health. For someone whose job is endlessly listening to others, it would be natural for their own feelings and anxieties to impede their effectiveness. We need to be mindful how things are going with our own mental health.”
Seeking outside mentoring or social connections is important for therapists. Set up regular consultations or meetings with colleagues, even if it is just for the social support of having conversations with others who are going through the same experiences.
“The hard thing about all this is feeling alone in what we are going through,” said Green. “We need to talk about personal things. It is good for us, too.”
Even if the vaccines return us to a freer lifestyle and the political unrest dies down, we will see lingering results of this tumultuous year. Some may be positive, like a renewed focus on social justice and climate change, but others may be more difficult.
“The pandemic is going to have long-term impacts,” said Lowe. “We know that the people who have been impacted the most will be at greatest risk of mental health problems and we need to be aware of that.”