Written by Trish Haak, LCSW

"How very little can be done under the spirit of fear."
— Florence Nightingale

I believe Nightingale's statement reveals great courage and wisdom, yet I also want to acknowledge that anxiety is a normal response right now. We feel threatened because we are; therefore, managing our mental and emotional energy cannot be done with the mind alone.

This article has three goals:

  • To share three approaches from experts on trauma research.
  • To provide recommendations for healthcare workers.
  • To offer grounding exercises and something to embrace every day.

Goal 1: Three Approaches from Experts on Trauma Research

Stephen Porges, M.D., proposed the Polyvagal Theory. Our social engagement system is our "first defense."

Let’s embrace our social engagement systems and reframe social distancing. Coining a colleague’s recent comment, let's embrace physical distance and social closeness.

  • Being alone with thoughts can trigger worsening anxiety and OCD symptoms, and contribute to a downward spiral. Use the phone and technology to connect with peers and clients.
  • Have encouraging chats with others daily
  • Humor may seem insensitive, but it is also healing. And it's okay: Laughter also stimulates the parasympathetic system/vagal response.
  • Create a routine check-in with others every morning or evening or both.
  • Continue to be creative in ways to support one another.
  • Remember that joy follows gratitude, so share your gratitude with others.

Daniel Siegel, M.D., and the window of tolerance on regulating emotions and neuroscience work on mindfulness:

  • Anxiety is a normal response right now. Practice ways to calm the brain.
  • Know your baseline and warning signs regarding sleep, diet, and behavior, and adjust accordingly. The key is building resilience to mitigate the allostatic load of stress from continued crisis.
  • Take the opposite action for the emotion (i.e., anger -> kind gesture).
  • Watch any negative thinking, which will in turn affect feelings and behaviors.
  • It is key is to engage positive behavioral strategies in response to emotional cues.

Bessel van der Kolk, MD, part of a group of physicians that developed the "PTSD" diagnosis. The brain “gets on with life” through active coping. When we physically move and/or mentally plan (when we feel or are truly trapped), we set ourselves up for a cycle of competence versus passive coping (freezing, despondency).  

  • Dr. van der Kolk notes in his book, The Body Keeps Score: Brain, Mind, and Body in the Healing of Trauma, that when you are traumatized, it’s very hard to sit still and do mindfulness. however, taking moments to pause and allow our bodies to feel, are healing. From practice, I’ve observed how this practice can reduce the impact of cumulative anxiety and potential for trauma symptoms. Dr. van der Kolk shares that "getting to know ourselves" is what helps us heal, whether it be yoga, theater, mindfulness, music, or befriending a pet. Such activities enable us to actively feel and process overwhelming experiences that may have left us trapped in a state of fight or flight. This establishing of a "coherence" between brain and body builds physical and mental resilience.
  • Integrating physical and cognitive/emotional experience allows us to "move on." The way we hold our body influences how we feel and, in turn, our body’s ability to withstand stress.

Goal 2: Managing Healthcare Workers’ Stress Associated with the COVID-19 Virus Outbreak
 Excerpt from the U.S. Department of Veterans Affairs

Providers should engage in these behaviors:

  • Self-monitoring and pacing
  • Regular check-ins with colleagues, family, and friends
  • Working in partnerships or in teams
  • Brief relaxation/stress-management breaks
  • Regular peer consultation and supervision
  • Time-outs for basic bodily care and refreshment
  • Regularly seeking out accurate information and mentoring to assist in making decisions
  • Keeping anxieties conscribed to actual threats
  • Doing their best to maintain helpful self-talk and avoid overgeneralizing fears
  • Focusing their efforts on what is within their power
  • Acceptance of situations they cannot change
  • Fostering a spirit of fortitude, patience, tolerance, and hope

At the same time, providers should avoid:

  • Working too long by themselves without checking in with colleagues
  • Working “round the clock” with few breaks
  • Feeling that they are not doing enough
  • Excessive intake of sweets and caffeine
  • Engaging in self-talk and attitudinal obstacles to self-care, such as:
    • "It would be selfish to take time to rest."
    • "Others are working around the clock, so should I."
    • "The needs of survivors are more important than the needs of helpers."
    • "I can contribute the most by working all the time."
    • "Only I can do..."

Goal 3: Grounding Techniques

  • 5-4-3-2-1: Notice 5 things you see, 4 things you feel, 3 things you hear, 2 things you taste/smell, and 1 thing you are grateful for.
  • Look at pleasant pictures of anything you enjoy: nature, friends, family
  • Engage in activities you enjoy
  • Talk to someone
  • Briefly use cold temperatures to calm: hold ice or cool down
  • Breathing: in and out through the nose, find the natural rhythm, notice the fluctuations. Also focus on exhaling thoroughly to breathe more deeply and achieve a relaxed state.
  • Be here, now, without judgement, like a curious child, to your surroundings
  • Progressive muscle relaxation: tense and release each muscle group
  • Autogenic training: self-statements of calm to "induce" calm response
  • Affirmations, spirituality, music, hobbies, and the like

A final note on something to embrace every day

Most of all, on daily basis, look for the things that you are grateful for, that you've achieved, that bring joy, and/or make you laugh. However difficult, the human brain needs breaks from stress. This activity may ultimately bring you a moment of peace at this most difficult time.

What works for one person, does not necessarily work for the next. Please feel free to share what has worked for you as it may help someone else. With your permission, I will post your suggestions as I receive them.