Resilience and Recovery in the Era of the COVID-19 Pandemic
Patricia K. Kerig, Editor in Chief, Journal of Traumatic Stress
Debra Kaysen, President, International Society for Traumatic Stress Studies
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In 2019, the Journal of Traumatic Stress (JTS) created a virtual special issue (VSI) designed to bring together a collection of articles previously published in JTS addressing the theme of that year’s International Society for Traumatic Stress Studies (ISTSS) Annual Meeting, “Trauma, Recovery, and Resilience” (Ford & Kerig, 2019). The time is ripe for us to revisit that topic in the light of the global trauma which has us in its grips, with the COVID-19 pandemic continuing to rage as we write this in mid-April of 2020. As was pointed out in the introduction to that earlier VSI, the research represented here attests to the remarkable capacity for resilience among those who endure trauma around the world, across societies and cultures, diverse populations, and myriad types of traumatic experiences.
Although some research published in JTS to date has uncovered resilience-promoting processes in the contexts of mass traumas and wide-ranging natural disasters that likely will have parallels to the present, important questions for future research will be whether there are potentially unique aspects of the current situation. For example, whereas most of the existing literature has focused on events that have affected a specific community or region of the world, exceptional to the present pandemic is its truly global nature, as it is now reaching into the farthest corners of the planet and affecting populations far from its epicenters. By the same token, most previously researched traumatic events have been discrete and time-limited; for example, whereas tornadoes, hurricanes, or earthquakes may recur, the specific one named in a study typically has ended by the time the research is published. In contrast, the present pandemic is a widespread and ongoing threat with no clear end-date in sight; and, even in regions that have experienced reductions in the number of cases, there is the continuing danger of a new surge of infections.
Another striking feature of this pandemic is the way in which all aspects of community life have been disrupted even for those not directly exposed to the virus, as stay-at-home orders deprive people of their livelihoods, educational and social services, and access to vital goods, as well as the healing power of human physical contact. The effects of quarantine and social distancing on those who live solitary lives may be unlike anything we have studied to date, and attention will be needed to understand the ramifications of stigma against those who have been exposed and those who are the targets of blaming attacks (Ho, Chee, & Ho, 2020). This pandemic, parallel to what was seen in the recent Ebola outbreaks, is affecting normal grieving processes, religious and cultural rituals, and people’s ability to access typical sources of social supports during times of loss (Van Bortel et al., 2016). Moreover, individuals affected by COVID-19 may progress rapidly from being ill to dying, and prohibitions against the presence of visitors in healthcare settings leave many of those with COVID-19 to face death without the comforting presence of family or friends (Wallace, Wladkowski, Gibson, & White, 2020). The impacts on healthcare workers are particularly profound (Greenberg, Docherty, Gnanapragasam, & Wessely, 2020), with life-and-death decisions in the balance, contributing to the potential for hindsight bias and what can best be construed as a form of moral injury (Litz et al., 2009; Kerig & Litz, 2019). Moreover, in many nations, among those truly heroic persons striving to save lives or provide essential services on the front lines—the medical personnel, the first responders, the cleaning staff, the delivery persons, the mortuary workers, the personnel doing mandatory shifts in correctional, health care, and psychiatric institutions—without proper personal protective gear or adequate equipment, the construct of moral injury is increasingly and explicitly being referenced (Dean, 2020; Kristof, 2020; Stoycheva, 2020; Topol, 2020).
Importantly, despite these risks and challenges, this pandemic affords us a unique context in which to better understand the processes that lead to resilience. One open question is whether this global event will bring people together into a sense of shared experience that will confer an additional source of resilience arising from the recognition that we truly are in this all together. In this regard, technology is affording us unprecedented avenues for remaining connected across great distances, sharing resources, providing one another support and aid both instrumental and emotional, and offering inspiration, whether in the form of recounting acts of kindness and generosity or streaming heartwarming videos of those in quarantine serenading one another from their balconies.
As usual, appended to this VSI is a list of resources on promoting resilience in the face of COVID-19. The list is growing every day and likely will be outdated by the time this VSI is posted—but that is a testament to the ways in which trauma scholars and clinicians have rolled up their sleeves and dedicated themselves to providing the best of their intelligence, care, and skill to the greater good of our international community.
Dean, W. K. (2020, April). COVID-19 is making moral injury to physicians much worse. Medscape Psychiatry. https://www.medscape.com/viewarticle/927859?nlid=134889_424&src=WNL_mdplsfeat_200407_mscpedit_psyc&uac=323116DZ&spon=12&impID=2339052&faf=1
Ford, J. D., & Kerig, P. K. (2019). Resilience and recovery. Journal of Traumatic Stress, Virtual Special Issue.
Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during COVID-19 pandemic. BMJ, 368. doi: 10.1136/bmj.m1211
Ho, C. S., Chee, C. Y., & Ho, R. C. (2020). Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Annals of the Academy of Medicine Singapore, 49(1), 1-3.
Kristof, N. (2020, April 11). Life and death in the “hot zone.” New York Times. https://www.nytimes.com/2020/04/11/opinion/sunday/coronavirus-hospitals-bronx.html?searchResultPosition=1
Litz, B. T., & Kerig, P. K. (2019). Introduction to the special issue on moral injury: Conceptual challenges, methodological issues, and clinical applications. Journal of Traumatic Stress, 32(3), 341-349 . doi:10.1002/jts.22405
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29, 695-706. doi: 10.1016/j.cpr.2009.07.003
Stoycheva, V. & Merchant, Al. (2020, April). For health workers, COVID19 can be a moral injury pandemic. Psychology Today. https://www.psychologytoday.com/intl/blog/the-everyday-unconscious/202004/health-workers-covid19-can-be-moral-injury-pandemic
Topol, E. J. (2020, March). US betrays healthcare workers in coronavirus disaster. Medscape Psychiatry. https://www.medscape.com/viewarticle/927811#vp_2
Van Bortel, T., Basnayake, A., Wurie, F., Jambai, M., Koroma, A.S., Muana, A.T., Hann, K., Eaton, J., Martin, S. (2016). Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bulletin of the World Health Organization, 94(3), 210.
Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief during the COVID-19 pandemic: Considerations for palliative care providers. Journal of Pain and Symptom Management.