COVID-19: Traumatic Stressor or Stress?
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Global events, such as the COVID-19 pandemic, impact people in different ways. This fact sheet reviews how to distinguish between stressful and traumatic events, identify factors that may influence our experience of these events, and understand the unique impacts of the COVID-19 pandemic.
What is a stressful event?
Stressful events involve undesirable, unplanned, abnormal, and/or uncontrollable experiences that threaten our day-to-day functioning. Reactions to internal or external stressors may be physiological (e.g., sweating, fidgeting) and/or psychological (e.g., heightened negative emotions and thoughts). Stressful events are common and may impact overall quality of life.
What is a traumatic event?
Traumatic events involve exposure to actual or possible death, serious injury, or sexual violence. A person may experience the trauma directly, witness it, learn that it happened to a close family member or friend, or experience repeated exposure to aversive details of it. Most adults have lived through at least one traumatic event, and many have experienced more than one event. Trauma can also be chronic, meaning that similar events happen many times over a long period of time. To be diagnosed with posttraumatic stress disorder (PTSD), symptoms must develop following exposure to one or more traumatic events.
Some examples of traumatic events include:
- Sexual or physical abuse or assault
- Serious vehicle accidents
- Combat or war zone exposure
- Serious medical events
- Violent or accidental death of a loved one
- Witnessing or experiencing violence
- Seeing death or dead bodies, including while at work
- Natural disasters
- Arson or house fires
- Domestic violence
- Terrorism or mass violence
Is COVID-19 a traumatic event?
COVID-19 experiences may qualify as a traumatic event if they involved actual or possible death or serious injury you directly experienced, witnessed, or learned of occurring to a close loved one. Similar to other medical conditions, the diagnosis of COVID-19 alone does not qualify as a traumatic event. The illness must occur under traumatic circumstances including significant life threat.
Examples of experiences related to COVID-19 that would qualify as traumatic events include:
- experiencing significant life threat due to severe respiratory distress
- exposure to severely ill and dying COVID-19 patients as a first responder
- having exposure to COVID-19 without adequate personal protective equipment (PPE)
- being a family member or close personal friend of someone who experienced extreme anxiety, panic, fear, or death during severe respiratory distress.
What factors influence our experiences of these events?
Stressful and/or traumatic events do not occur in a vacuum. While emotional reactions (e.g., fear, helplessness, horror) to a traumatic event are not currently part of the DSM-5 definition of a traumatic event (i.e., what mental health professionals use to diagnose PTSD), some individuals do experience significant emotional reactions. There are various factors that influence how an event is experienced by a particular individual. Contextual factors may impact how events are experienced and may ignite survival-based behaviors (i.e., defense cascade) that indicate that an event is perceived as traumatic. There are many contextual factors that may influence the experience of traumatic events. Some examples include:
- Individual identities (e.g., race, gender, sexual orientation)
- Proximity to trauma
- Cumulative trauma burden
- Media exposure (e.g., high-profile violent acts)
- Prior personal experiences
- Directly experiencing trauma
A continuum of automatic, survival-based behaviors activated in response to danger or the perception of danger. Behaviors may be described as fight, flight, or freeze. The freeze response, for example, involves an immediate stilling of all movement, vigilance to the threat, and preparation for active fight or flight response.
What are some unique influences of the COVID-19 pandemic on trauma survivors?
The COVID-19 pandemic has presented unique challenges that may impact how stressful and/or traumatic events are experienced. Individuals with PTSD may experience particular difficulty identifying healthy ways to manage emotions associated with these unique challenges during the COVID-19 pandemic. Consider the following:
- Unpredictability. Many aspects of the COVID-19 pandemic were (and continue to be) difficult to predict. Trauma can often lead individuals to see others and the world as unpredictable and threatening – believing that personal suffering will continue, or negative outcomes will preside for the foreseeable future. These thoughts may be reinforced by the COVID-19 pandemic and can impact one’s ability to use internal and external resources effectively.
- Uncertainty. Many aspects of daily life became uncertain at the onset of the COVID-19 pandemic. As the months passed, information was often uncertain or unreliable, rules were sometimes inconsistent, and even world leaders could not clearly identify next steps. The COVID-19 pandemic brought much uncertainty that was often unresolved for long periods of time. Particularly for trauma-exposed individuals, uncertainly can increase feelings of stress, anxiety, and powerless.
- Uncontrollability. For many, it felt like their circle of influence became smaller and smaller as the COVID-19 pandemic continued. Further, it underscored the frustrating truth that we can control our own behavior, but not the behavior of others. With many distractions and positive coping mechanisms taken away due to social distancing procedures, chronic worrying over uncontrollable events may have increased and become disruptive.
What helps us recover from stressful or traumatic events?
While we still have much to learn about what contributes to natural recovery, the factors outlined below are thought to aid in this process. While the availability of some of these factors may be impacted by the COVID-19 pandemic, some have sought creative ways to implement these factors with social-distancing practices in mind.
- Social support, including:
- Staying connected with friends, people who care about you, and those who are available if you need them.
- Being able to talk about stressful and/or traumatic events, and your reactions to it, with supportive people who avoid reacting in unhelpful ways.
- Getting back to your life, including:
- Returning to your routine or finding creative ways to implement structure during your day for activities such as work or school, household chores, and sleep.
- Not avoiding safe reminders of the stressful and/or traumatic event.
- Making meaning of what happened, including:
- Finding helpful and realistic ways to fit stressful and/or traumatic events into the way you think about yourself, other people, and the world.
- Noticing patterns of negative thinking or other unhelpful thoughts that may get in the way of making meaning. Look for examples of ways that you coped well.
What is helpful to know about professional help?
Many times, people recover from stressful and/or traumatic events on their own and with the help of their support systems. Sometimes, professional help is needed. If you feel that you have not been able to recover within one month following a traumatic event, visiting a mental health professional is recommended. Most benefit from evidence-based treatments. You can learn about the treatments that work for PTSD, which may develop following traumatic event(s), on the National Center for PTSD website.
To find a mental health professional, you can use online therapist directories, call your doctor or insurance company, or ask other people you know for recommendations. ISTSS also has a directory of mental health professionals. Once you find someone, be sure to ask them if they have expertise in helping people who have experienced stressful and/or trauma events and whether they offer evidence-based treatment options.
If you are already seeing a therapist or decide to see a therapist in the future, you can show them this fact sheet so that they can learn about the resources that have been created for therapists that work with trauma survivors. This includes the ISTSS PTSD Prevention and Treatment Guidelines. These guidelines were released in 2019 and describe the state of the evidence on ways to prevent and treat PTSD.
Where can I get more resources?
For more information, visit the ISTSS Public Resources page. There, you will find links to many of our public education products, briefing papers, and affiliated resources.