|Ahead of print publication
Combating COVID-19 stress with psychological resilience
Spandana Devabhaktuni, Suprakash Chaudhury, Daniel Saldanha
Department of Psychiatry, Hospital and Research Centre, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
|Date of Submission||02-Jul-2020|
|Date of Decision||10-Sep-2020|
|Date of Acceptance||21-Sep-2020|
Department of Psychiatry, Hospital and Research Centre, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
“When we are no longer able to change a situation, we are challenged to change ourselves.”
| Introduction|| |
COVID-19 pandemic is likely to be the most widespread pandemic in history, already having infected more than 27 million persons in over 200 countries. Along with disease, disability and death the pandemic are causing global economic devastation. Leaders and entrepreneurs worldwide are under tremendous pressure to keep their systems intact and employees functional. In times like this, it is a double whammy for the workers in health care, now more than ever they are responsible to keep themselves and the patients dependent on them healthy, not to mention their families. The ever present fear of getting infected by the virus has led to an overall diminution of the quality of our lives. Although it is in our very nature to overcome even the most severe of stresses, initial panic and shock can make it difficult even to the most resilient of beings to think clearly and have control over their feelings and actions. Our emotional and psychological response to crises is natural and human, and across the world, a significant proportion of people are going through some form of emotional and financial upheavals.
Current versus past
Mankind faced several health emergencies in the past; COVID-19 infection is not even the first pandemic of this century. In 2002, the SARS pandemic caused by SARS-CoV, a strain of coronavirus, affected nearly 8000 people across 29 countries. Although the mortality rate of SARS is higher in comparison to the current pandemic, Covid-19 appears to be more contagious, leading to a wider spread of the infection and more deaths. Hence, how did we manage to overcome health-care emergencies in the past?
| Resilience as a Concept|| |
Originating from the Latin word “resilire” which means to leap back, resilience essentially describes the quality of recovering from an impact while managing to maintain integrity in its original form. Pioneer resilience researchers attempted to recognize the processes due to which, in the face of adversity, some persons fared well while others did not.
Psychological resilience is the ability to cope efficiently, recuperate from, or adapt well in the face of adversity, trauma, tragedy, threats, or other significantly stressful or challenging life situations. An analysis of the concept of resilience using Walker and Avant method of concept analysis revealed several defining attributes that appeared repeatedly in literature, and the significant outcomes of resilience are effective coping, positive adaptation, and mastery. Adversity is the main antecedent to resilience and is the single most important variable that distinguishes it from other personality traits like ego-resiliency.
Luthar defined resilience as the positive adaptation despite adversity. His two-part construct of resilience, that it is the sum of distinct dimensions: significant distress and adaptation to it is widely accepted., An extensive list of protective factors contributing to resilience has been proposed at individual, family, and social/environment Level. Rutter argued that resilience was not a trait but a dynamic process brought about by the initiation of certain processes in the individual. Including building a positive self-image, reducing the effect of the risk factors, and breaking a negative cycle to welcome new opportunities.
Epigenetic modifications occurring in the backdrop of a significant stressor lead to the changes in gene expression and eventual phenotypic expression. In the past, questions raised upon how the environment influences the nature of a person are now evident when looked through the epigenetic glass. Environmental influences on the human genome are not limited to negative events, research shows, utilizing the resources in his/her environment and one's assets to overcome adversity, provokes sustainable changes in our phenotype leading to resilience. Resilience is an active process involving ongoing adaptive plasticity without external interference.
Steps to build up resilience
A resilient individual is better able to deal with catastrophic situations due to thoughts and actions that they have learned and developed. Therefore, improving resilience in individuals is a priority. Resilience building measures vary from person to person, based on culture, attitude, standards, and inter-personal relations. Some general steps to improve resilience are given below.
Be an optimist
An optimist will focus on the good things in his life, instead of being tormented by things that cannot be controlled. Instead of considering the pandemic as an overwhelming catastrophe think that this too shall pass.
Stress is reduced by controlling worries
Repetitive thoughts about what might happen or how the situation may worsen if family members fall ill may set off our body's automatic stress response. If persistent, this may result in harmful effects on our bodies. Therefore, it is very important to unearth successful methods to control stress, such as:
- Worries must be quarantined. Designate 30 min daily as “worry time” during which one can spot and deal with each worry as if it were a problem to solve
- Write down your worries and fears. Sometimes, articulating your worries may make help you deal with it or find solutions.
Draw lessons from past experience
Reflect on your past experiences, what helped you and how did you manage to tackle those emergency situations.
Maintain physical fitness
During a pandemic, due to restrictions on outdoor activity, you may switch on to indoor exercises to stretch out tense muscles as well; also find time for relaxation. Eat a healthy diet and ensure adequate sleep.
Set short-term goal and act on them
By advance planning, one can identify specific tasks that will help to achieve the goal. For example, ensuring that the house is stocked with adequate supply of food, medicines, and items of daily use; plan activities that involve the whole family so that everyone is occupied even at home (particularly important if you become isolated). As a result of keeping mind and body active and occupied, there is less time to dwell on fears and worries.
Maintain contact with family and friends
Due to danger of infection during the pandemic, one has to avoid social situations leading to increased isolation. However, one can easily maintain contact with people, by phone, social media, or E-mail. In addition, be in touch with world and periodically collect reliable information about the pandemic. Take information from social media with a pinch of salt.
Do not delay seeking professional help
Contact a professional for help if severe anxiety is interfering with your occupation or other daily activities.
Resilience in communities
Initial work on resilience was focused on individuals. Subsequently, researchers have begun to study resilience as an attribute of entire communities. An individual's response to adversity depends on various factors in his environment, including family, community, and the society at large. The concept of cultural resilience considers how a person's cultural background and values confer them with protection against adversities and that the notion of resilience is not limited to individual characteristics and upbringing alone. In the wake of a pandemic, mental health needs of the population change, and an otherwise resilient population is suddenly left vulnerable. The psychological impact of the pandemic in each population varies from person to person, with some people showing milder reactions as opposed to others who are more severely affected. Identifying the immediate needs and the support that can be given to a fellow human being, with one principle in mind “do no harm,” forms the crux of the psychological first aid (PFA) intervention.
| Psychological First Aid|| |
PFA was first introduced in the mid-twentieth century but gained popularity and became a widely used tool in the post 9/11 era especially for survivors of disaster and extreme events. The recommendations by various health agencies including the World Health Organization (WHO) led to PFA being used as an early psychological intervention to the ones affected by natural or man-made disasters.
PFA is defined by the WHO as “a humane, supportive response to a suffering fellow person who may need support.” It comprises of listening, comforting, helping people to connect with others and providing information and practical support to deal with basic needs.,
What is psychological first aid?
The five essential elements of PFA are safety, calming, connectedness, self-efficacy, and hope. Various interventions have been proposed considering the principles of PFA and were streamlined to suit different target populations. PFA is designed for people exposed to an adverse event and applies to both adults and children. However, while training and delivering PFA, one needs to keep in mind the fact that not everyone who has gone through the event needs or wants PFA. Hence, it is vital to identify the people who would benefit from this psychological intervention.
When is it provided?
PFA can be provided on the first contact with distressed people, which is usually during or immediately after a devastating event. In some cases, depending on how long the event lasted and how severe it was, PFA may be delayed by days or even weeks or may be provided despite ongoing stress.
Administering psychological first aid
As opposed to psychological debriefing, PFA does not place emphasis on a detailed incident review in the first contact, as pressurising people to talk about the distressing event has been found to be counter-productive. PFA aims to provide support and address the immediate needs of the person. These include a sense of safety and connection to another human being who is calm and willing to extend help to meet their basic physical and emotional needs. While taking responsibility to help people in distress, one should act in ways that respect and prioritize the safety, dignity, and rights of the survivors. We often come across survivors who need services beyond the scope of basic PFA. In such cases, acknowledging our limitations and taking the help of others on the team such as social workers, local authorities, and community leaders is beneficial.
Psychological support encompasses both verbal and nonverbal cues, a caregiver is trained for these situations not to talk too much, allowing for silences and being aware of both their words and body language such as facial expressions, eye contact, hand gestures, etc.
Encouraging and helping people identify and use their positive coping strategies, while avoiding negative strategies will help them feel stronger and regain a sense of control. Some positive coping strategies include getting enough rest, eating regular meals and staying hydrated, connecting with family and friends, discussing problems with someone they trust, indulging in relaxing activities, exercising regularly, and finding ways to help others in the community. Suggesting people to avoid or cut down negative coping strategies such as abuse of alcohol or other substances, sleeping excessively, working without taking breaks, and avoiding social interactions. It is important to end a PFA interview on a note of hope. Inform the person about other services that are available in the area what help they can obtain from these services.
| Utility of Psychological First Aid in Covid-19 Pandemic|| |
Utilizing PFA in the COVID-19 pandemic is critical in alleviating the escalating mental stress due to the massive impact of the pandemic on the diverse aspects of social and economic activities.,, The increasing morbidity and mortality across the planet implant feelings of terror, dread, and vulnerability in not only the affected persons but the population at large. During the earlier Ebola pandemic, the WHO found PFA to be very useful in decreasing reduce nervousness, horror, anxiety, and panic in the population living in Ebola affected areas in Sierra Leone and Liberia. Both nongovernmental organizations and international organizations can complement the role of the government agencies to preserve and protect the health of individuals.
The first step in obtaining the benefits PFA is to make available trained staff in hospitals and trauma centers to manage the acute anxiety induced by the pandemic.,, Based on the skyrocketing rates of infection, a large number of trained personnel are going to be required to deliver PFA to merely the infected patients. Undoubtedly, there is also intense fear of COVID-19 among a large number of uninfected people which will require the availability of a far larger number of people trained in PFA. Innovative teaching models such as train-the-trainer and just-in-time models should be utilized to quickly enhance the supply of trained workforce adept at providing PFA and psychological intervention to people in the new environment.
Sensitizing and training the available medical and paramedical staff on stress management through PFA will greatly help them to manage their own stress but also their patients in coping with stressful events, such as quarantine and physical distancing in workplaces and homes. Availability of enormous number of persons adept in administering PFA among health workers, recovered COVID-19 patients, and lay persons will broaden PFA's access and efficacy in managing psychological trauma resulting from the COVID-19 pandemic. It is important to mention here that the requirement of psychological intervention will continue and may even increase after the COVID-19 pandemic is contained. The vast majority of health-care workers are not equipped to manage psychological stress and will not be able to manage the psychological toll after the pandemic. Teaching PFA skills by short-term courses will assist people psychologically, thereby decreasing agony and anguish not only in health-care workers but the population at large.,,
| Concluding Remarks|| |
The more we aspire, at both individual and institutional level to make our experience of the current pandemic a story of hope, the more likely we are to overcome the present hardship and look forward to a brighter future. It makes the present bearable and instils in us a sense of purpose. While resilience and the benefits of resilience training are important for the entire society, it is particularly beneficial to high risk industries, such as the health-care workers or first responders. PFA, a tried and tested model of psychological intervention after a disaster, is additionally useful in managing distress in areas affected by pandemic. It is a simple, quick, and efficient means of helping people with high psychological distress following traumatic events. PFA by decreasing apprehension, encouraging coping and increasing resilience, may counteract the expected postpandemic increase in psychiatric morbidity. Basic training in PFA is imperative not only to deal with the current situation but also to deal effectively with future disasters.,
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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