Support for PTSD symptoms during COVID-19
Support for PTSD
Reinhart Burger, Clinical Psychologist
With the outbreak of COVID-19, we are facing extraordinary government measures intended to keep us, our families and our communities safe. We must follow these measures to support our NHS.
There is still much to learn about how the current circumstances might affect veterans living with pre-existing PTSD, and Combat Stress is exploring ways to study the impact on veterans living in the UK. The aim of this document is to provide some general advice on how to manage potentially increased symptoms of PTSD during this difficult time.
Symptoms of PTSD
Flashbacks (feeling as if the event is happening again) are perhaps the most well-known symptom of PTSD.
However other re-experiencing symptoms, such as trauma-related nightmares, intrusive upsetting memories of the event, and strong physical and emotional reactions when reminded of the event are just as common.
Although it often feels like PTSD symptoms come like a bolt from the blue, it is much more likely that they have been ‘triggered’ by a thought, feeling, or something in our environment.
Because trauma memories are so easily triggered in PTSD, things like news footage of emergency services or military support might remind you of extremely difficult situations from your past.
Triggers can also be much more subtle. Being confined to home, for example, or vulnerability when faced with the vague sense of danger that currently surrounds us may be enough to trigger memories from operations abroad.
How else may PTSD affect you?
Sense of threat
Another hallmark of PTSD is that the body is constantly on alert and ready to spring into action when faced with a perceived threat (you may have heard of this being referred to as hyperarousal). For some, this underlying ‘sense of threat’ in PTSD might be worsened by a fear of catching the virus. This might mean that someone with PTSD feels the threat posed by the virus more acutely, which can feed back into the stress response, creating a vicious cycle. Trying to relax and calm your body down can help – taking deep steady breaths can help reduce the hyperarousal feelings.
Unhelpful thinking
When we are stressed, we also become more vulnerable to unhelpful thinking, so it is worthwhile occasionally checking in with yourself to make sure you are keeping perspective and that your thoughts are still accurate and balanced. You want to be particularly on the lookout for unhelpful thinking patterns - using our managing thoughts worksheet may help.
Relationships
As we know all too well, PTSD and other mental health difficulties can take a toll on relationships. The conditions of lockdown can test even the strongest relationships as people spend much more time in close quarters, with other factors like childcare/caregiving responsibilities and financial concerns adding to the pressure. This makes it all the more important to take care of ourselves and minimise the potential impact of things like withdrawal, irritability, anxiety, or low mood not only on ourselves but also on those close to us and our relationships. As always, communication is key. When conflict does arise, using assertive communication skills (see below) while avoiding destructive arguments that damage the relationship (see Gottman's Fair Fighting Rules), or taking a time-out can be valuable strategies.
Techniques to help you cope
Grounding technqiues
The idea behind grounding is to remind yourself that you are safe and to bring you back into the here-and-now. Many grounding techniques involve a sensory element which helps to hook your attention and interrupt the trauma memory. In fact, it can be helpful to use a combination of mental, physical (sensory) and self-soothing (calming) strategies in order to distract yourself away from the trauma memory as much as possible. Some suggestions are listed here, but feel free to adapt these ideas to make them work for you.
Mental (involving the mind)
- Describe an everyday object
- Categories game – name a city, animal, fruit/veg etc. for each letter of the alphabet
- Make an inventory of everything around you
- Use a safety statement – “I am safe, it’s 2020, I am at home in…”
- Name out loud 10 things in the room that are square/rectangle, brown, white…
- Say the alphabet v..e..r..y... s..l..o..w..l..y... or say it backwards
Physical (involving the senses)
- Hum or sing
- Smell something nice – spices, flowers, herbs, scented oils
- Have a shower or bath
- Look outside and count the trees, cars, birds
- Focus on your breathing – inhale, exhale
- Juggle with balls, keys, apples
- Taste something strong – lemon, mints, menthol sweets
- Use a stress ball
- Make a shape out of plasticine, clay, Blu Tack…
- Twang a rubber band on your wrist – to remind you of the here-and-now
- Touch a natural object – wood, stone, a tree, the earth. Notice its texture, temperature, colour, shape
- Run your hands under cold water
- Take a brisk walk
- Stamp feet hard
- Jump up and down
- Snap your fingers
Self-Soothing (associated with calming and safety)
- Think of a “safe place” where you have felt calm
- Think of a kind statement or look at a flashcard – “I am a good person going through a difficult time.” “I can get through this.”
- Picture people you care about
- Think of things you are looking forward to in the next week
- Plan a safe treat – a special meal or desert, a new book or CD
- Think of your favourite things – seasons, colours, animals, places
- Hold onto something comforting – a blanket, something decorative, a piece of jewellery, a picture/photograph, a soft toy, something that makes you feel safe and calm
- Practise calming breathing/mindfulness
- Walk, garden, swim
- Carry a grounding object in your pocket
Helpful strategies for overcoming triggers
Trigger discrimination
This strategy helps you break the connection between past trauma and present-day reminders. Remember that no matter how bad it feels, it is just a memory and not actually happening again.
To remind yourself of this, notice the differences between ‘Then’ (at the time of the trauma) versus ‘Now’. For example, if the sound of a siren is a strong reminder, you can focus on the differences in the broader context, what you’re wearing, physical sensations, smells, sounds, or other people present. You might, for example, say to yourself “The year is 2020, not 2003. I am at home in England wearing comfortable clothes, not in a desert wearing body armour. The air is cool, and I can hear songbirds in the green trees outside. I am safe now.”
You can try keeping a log like the following:
| Situation and Trigger | What image, thought or memory did this bring back? | How was the trigger different from the original trauma | What can I do to cope? What can I try next time? |
|---|---|---|---|
Assertive Communication
How to communicate assertively
Assertive communication is a way of expressing your needs/feelings whilst being respectful of the rights of others and mindful of how you’re coming across.
Communicating assertively can be extremely difficult when we’re feeling tense or wound up. For this reason, it is useful to have a readily available script to hand which we can call to mind in pressured situations. If we want to communicate our feelings to someone, one useful method is to remember the rule: FACT, FEEL, WANT:
1. Outline the situation objectively
Focus on the facts, avoid elaboration/blame/insults.
2 Describe Your Feelings
Separating your feelings from the situation helps you get distance from them. Stress the significance of using the word “I” and the importance of taking ownership for one’s feelings and not imputing intentions/feelings/beliefs to others.
3 Make a Fair Request
Be sure your request is reasonable, specific, constructive (i.e. say what you do want not what you don’t want) and be prepared to negotiate.
Taking a time-out
Taking a time-out means temporarily getting out of the situation making you angry. It's a way of stopping yourself reacting automatically to whatever person or situation has triggered your anger, and buying yourself time to consider a more measured response.
DOs and Don'ts When Taking a Time-Out
| DO go for a walk, get some air, cool your body down | DON’T go for a drive |
| DO explain why you’re leaving and when you’ll be back | DON’T storm off angrily without explanation |
| DO use grounding and relaxation techniques | DON’T vent your anger or 'take it out' on someone/something else |
| DO think about how you want to behave and the consequences | DON’T stew or ruminate over angry thoughts |
| DO return with a fresh, clear-headed mindset | DON’T avoid the situation altogether or ignore the other person |
Is there someone I can call and talk to?
Our 24/7 free Helpline remains open, so please do not hesitate to call if you need someone to talk to or any guidance during this difficult time.
Combat Stress 24/7 Free Helpline 0800 138 1619.
If you require more urgent help, either yourself or a member of your family, please contact your GP or call 111.
You can also contact the Samaritans on 116 123.