The role of OH in reducing the mental trauma of Covid-19

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Front line workers and those who have been dangerously ill, or have lost relatives or been exposed to domestic violence, customer aggression or suicide may have been traumatised during the pandemic. Ensuring they aren’t left struggling to cope alone is crucial to facilitating their recovery, explains Deborah Pinchen.

While the Covid-19 pandemic has been stressful for most people, it’s been deeply traumatic for many others. From the rape victim who can’t wear a mask, due to her post-traumatic stress disorder (PTSD) being triggered when her mouth and nose are covered through to the tens of thousands of front line health workers the British Medical Association is predicting will become sick with PTSD, many individuals are now struggling with symptoms of trauma brought on or triggered by the pandemic.

Trauma is officially defined, under the diagnostic and statistical manual of mental disorders (DSM-5), as resulting from exposure to actual or threatened death, serious injury or sexual violence. It can lead to intrusive symptoms, including flashbacks, nightmares and avoidance behaviour, such as avoiding places or stimuli associated with the trauma. It can also lead to changes in mood and memory, negative beliefs, such as self-blame, fear, anger and shame, or feeling alienated from others.

However, while not everyone exposed to a traumatic event will go on to develop lasting symptoms of trauma, some people who are exposed to seemingly less traumatic events, such as an aggressive outburst by a customer, might, depending on their past history, go onto develop PTSD.

Similarly, someone who for months has been told they must shield might also become anxious when told it’s now safe to return to the physical workplace. They may experience heightened anxiety response and become traumatised by the idea of returning to work. Due to believing their life is still at risk, or that their employer doesn’t understand or care about the threat to them, regardless of whether or not they’re actually at risk.

Understanding the symptoms of trauma

As with most things in life, trauma is a spectrum. At one end people may have a few symptoms of trauma, such as intrusive thoughts, at the other, they could have full-blown PTSD.

The main four symptom clusters of trauma include:

• Avoiding things that put you in mind of the thing that traumatised you.
• Hyper-vigilance, making you feel jumpy or interrupting your sleep.
• Flashbacks and constantly replaying events in your mind.
• Low mood and feelings of sadness or not feeling anything at all.

Critical to supporting as many people as possible is “normalizing” trauma, by giving them upfront education about the symptoms that are a natural reaction to any unnatural event they’ve been exposed to, as part of your ongoing mental health or psychoeducation initiatives.

Reassure people that they can expect to start to feel better over time but also educate them how to recognise if their symptoms are becoming worse, putting them at risk of developing PTSD. The symptoms of PTSD include extreme physical reactions, such as nausea, sweating or pounding heart, nightmares, extreme anxiety, invasive memories and intense feelings of distress that can make the individual feel like the trauma is still happening in the moment. These symptoms are often severe and persistent enough to have significant impact on their day-to-day life.

Destigmatise asking for help by explaining what services are in place, such as the Employee Assistance Programme (EAP) or any wrap-around trauma counselling services. Plus why you want them to be able to access this support, at no cost to themselves, at a time when they would have to wait months to access support via their GP.

Providing appropriate support

In the event that people at work were exposed to a trauma, such as a colleague committing suicide, it’s important that this news is communicated in the right way to everyone in the immediate aftermath. Access to counselling should be provided for those who might be feeling particularly affected, with a debriefing session 72 hours afterwards and follow-up PTSD screening and support two to three weeks later.

If someone has experienced a trauma outside of work, or become vicariously traumatised by an event that happened to someone else triggering their own past traumas, it’s essential that managers know how to look out for and spot the early warning signs. Not least because something as seemingly non-traumatic as a strong-smelling detergent might be enough to trigger someone who experienced that smell while in intensive care in hospital.

Warning signs that someone is struggling with trauma include avoiding certain places, people or situations, sleep disturbance and being more irritable or easily aggravated. They may not lose their temper but will be more on edge.

If managers are concerned, they should give the person an opportunity to talk in a confidential space and ask open-ended questions that show concern, by observing the person’s behavior and asking if they’re okay.

It’s important that managers don’t attempt to counsel the person or discuss the trauma in detail, as this can embed rather than cure it. Managers do, however, have a vital role to play in signposting people towards appropriate counselling services.

When to rehabilitate

With charities warning that the NHS doesn’t have the resources needed to support the number of people who have been traumatised during this crisis, employers have a valuable role to play in rehabilitating skilled employees who would be costly to replace and train up to the same level otherwise.

How well someone recovers from a trauma depends on how well they process it and whether their trauma is due to a single event or a complex layer of events. The latter is more difficult to treat, but by identifying and treating the earliest or most distressing events first, you can significantly reduce the impact that the other events are having.

For example, a paramedic triggered by witnessing the loss of lots of lives during the pandemic, but who was also on the scene at, say, Grenfell and the London bombings, might only need to process their experience of the London bombings if this was the most distressing event to them and the ‘stuck belief’ – for example, “I should have done more” or “I am in danger” – is the same across all events.

Adaptive therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) can deal with trauma in as little as three sessions, with one session to establish the root cause of the trauma, a second to treat it and a third to equip the individual with reasoning skills to protect themselves in future. Although complex traumas can require more sessions.

EMDR works by getting both sides of the brain to communicate because in a traumatic situation, the side of our brain that governs how we see, hear and feel dominates and can overwhelm us. For example, in a domestic violence situation, someone leaning over the victim with an angry look is the visual, being shouted at is the auditory, smelling alcohol on their breath is the olfactory and being hit and tasting blood is the taste.

With so much stimuli being processed, cognitive function shuts down and they enter a survival mode. The flashbacks are their brain trying to process events, but they get stuck and constantly relive them. Which embeds the trauma further and can also increase the risk of the individual turning to drink, drugs or gambling to forget.

The aim of EMDR is to revisit events in a calmer setting to remove the negative feeling of helplessness. Bilateral stimulus, eye movements, or tactile tapping, is used to move sensory data to the other side of the brain so it can be processed to create a clear beginning, middle and end to help the brain realise: ‘I am safe now’. Or if the person is stuck in feelings of guilt: “I did all that I could”.

Group counselling, conducted by someone who knows what they’re doing, and Cognitive Behavioural Therapy (CBT), to change how the individual is thinking and behaving, can also be good for trauma, but if there is significant trauma, these therapies can take longer.

Another thing employers can do to help is recognise that, for many, coronavirus is an unseen terror. It’s one thing to help someone continue working from home or conducting meetings online, if this is being done for positive reasons. But if they’re doing this to avoid facing their fears, this could lead to longer-term problems down the line.

In this context, it might be better to help them consider how they can face their fears now, by talking to a counsellor about what’s really worrying them and allowing them to manage their fears in a more manageable and positive way.

References

“Male suicide hits two-decade high in England and Wales”, ONS September 2020, https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2019registrations

“Rape survivor whose PTSD means she can’t wear masks”, Sky News September 2020, https://news.sky.com/story/coronavirus-rape-survivor-whose-ptsd-means-she-cant-wear-masks-calls-for-greater-awareness-for-exemptions-12066415

“Trauma of coronavirus frontline could leave staff with flashbacks”, Huff Post, April 2020, https://www.huffingtonpost.co.uk/entry/coronavirus-could-spark-nhs-ptsd-crisis-say-mental-health-experts_uk_5e9eeda6c5b6a486d07f3b28?guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAGgylQNs9Q2NcaqnaIJBhzL66XYx0mUu2iSG-0Q-umfZh9yIfznbf_wH7Mlb6j9PWBNQ33wT4AhRaWFxP0daVW5Oqd9PaLTyWMniW6jVhY2ZLq1YVmWygaGDiz8P3RIfvQD0Rcfq9CiZl8yTAZHXnf9yh-avKYFmhLzAAwlGaJlR&guccounter=2

“For many in Britain the lockdown of domestic abuse isn’t over”, The Guardian, September 2020, https://www.theguardian.com/commentisfree/2020/sep/03/britain-lockdown-domestic-abuse-help-violence-camilla-duchess-of-cornwall