‘COVID-19 as an ongoing collective trauma? — How we can respond in a psychologically informed manner’.

04.02.2022: For this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity — Centrepoint, I am back at home after a week working remotely again due to COVID-19 once again hitting our household. Although as I write this blog I am thankfully still negative so far, the potential risk of exposing our ‘frontline’ services to COVID-19, if I carried out face-to-face delivery of reflective practice has meant that I have needed to switch back to a remote delivery format this week. This has been challenging as I have juggled supporting my children with illness / ‘home-schooling’ alongside my PIE role, had to reschedule some planned work and manage the impact on staff engagement (as they naturally prefer a face-to-face format). All of this has affected my psychological well-being and stress levels, even though I am aware that I am fortunate to have a comfortable space to live and work in, and it appears that everyone in the household is on the road to recovery. Therefore, this week has been a reminder that the COVID-19 pandemic is not over, and many of the psychological consequences of this ‘traumatic’ experience are ongoing.

Specifically, I have been acutely aware that I have ‘felt’ different from usual this week. In particular, I have experienced a greater amount of tension and anxiety, that for me I feel in my chest and shoulders. Moreover, whilst my regular daily yoga practice and dog walk helps, it does not sadly eliminate it. As the Psychologist, Bessel van der Kolk noted in the title of his 2015 book, “The Body keeps the Score”, we can keep psychological trauma located in our physical being, and indeed pain or tension in our body is often be a warning sign we are experiencing stress. In addition, my thoughts this week have been predominated by worry and anxiety. Will my family be OK? Will I test positive for COVID-19 too? How can I manage this anxiety so it does not transmit to those around me and make them anxious? Will I get everything done I need to do? I have been ‘hyper-vigilant’ for the threat of COVID-19 in my home, and my behaviours (e.g. cleaning touch points and opening windows repeatedly) have been modified accordingly to try and minimise this threat. My ‘fight or flight’ response, triggered by this threat, has meant I have had higher than usual levels of adrenaline, which are exhausting. Of course, none of this is unusual; in fact, all of this is a ‘normal’ human response to being in a threatening situation even if you are a psychologist!

On reflection, this experience has been a useful reminder of how it must feel if you are a homeless young person coming into a Centrepoint service. Obviously, we are trying to keep our services as COVID-19 secure as possible, but putting the virus aside for a moment, a young person may perceive many different ‘threats’ when they move into a supported accommodation service. Just the novel environment, the changes in staff on different shifts, the peers that they are living amongst, and the uncertainty about their future, could all be viewed as ‘threatening’. Moreover, for many of those homeless young people they already come to Centrepoint with a background of traumatic experiences (e.g. abuse, neglect, domestic violence, fleeing from persecution or danger, breakdown in relationships), that means that they are more likely to be ‘looking out for’ threat in even safer spaces such as our services. When we have previously experienced a traumatic event or experience, our brain chemistry is changed and the brain functions differently — we are in effect ‘primed’ to see danger by being more hyper-vigilant to it in the future. Whilst this has a useful survival or protective function, this constant state of hyper-vigilance is exhausting. Even just for one week, I have experienced this, especially when doing the daily ‘family breakfast Lateral Flow Test’!

Our ‘frontline’ staff in reflective practice sessions in recent weeks have also been reflecting on this sense of exhaustion, having been working now for almost 2 years in this state of hyper-vigilance to COVID-19. Many of them have also experienced their own personal loss related to COVID-19 and like all of us, are still facing many daily challenges related to ‘living with the virus’. This includes the struggle to maintain hope, complicated by the pandemic’s lack of clear endpoint. As I have realised this week, just when you think it is getting close to being over, the ‘threat’ can come around again. Being a psychologically informed environment (PIE) means that we need to continue to be aware of the ongoing impact of COVID-19 on the psychological well-being of both our staff and the young people we support, even if that isn’t always immediately obvious or the pandemic is no longer the top ‘news story’ in the wider media or the government restrictions are being eased.

It is interesting to note that psychologists are now arguing that the pandemic should be treated as a ‘collective trauma’, one shared, albeit in different ways perhaps, by the whole population. Whilst sometimes we think of trauma as a single extreme event such as a car accident or assault (i.e. a Type 1 trauma; Terr, 1991), trauma can also be a repeated exposure to extreme external events (i.e. a Type 2 trauma; Terr, 1991). What both ‘types’ of trauma have in common however is that they are beyond a person’s control and there is nothing we can do to stop them happening. COVID-19 is an invisible airborne virus, which whilst we can try to mitigate its risk (e.g. masks, ventilation, vaccination), we cannot see the ‘threat’ and we cannot eliminate its risk entirely. Perhaps that is why one way of coping with the threat has been to ‘ignore’ or ‘avoid’ it, unless of course it becomes right into our field of vision with a positive COVID-19 test amongst one of our close contacts.

So why should we see COVID-19 as a ‘collective trauma’, what might be the impact on our psychological well-being and how can we continue to deal with it in a psychologically informed way both now and when this pandemic is eventually over? Hirschberger (2018) described ‘collective trauma’ as a mass event, which shatters the fabric of society and brings a crisis of meaning. It is also something that causes a blow to our ‘psyche’. In other words, it breaks through our defence mechanisms, with such brutal force, that we can struggle to respond effectively to it so it can change our sense of self or who we are (Erikson, 1976). Such a ‘collective trauma’ occurs when the same event traumatises a large number of people within some shared time span. In the case of COVID-19, much of this trauma has featured loss (i.e. bereavement, loss of usual activities, loss of social contact) and moreover, much of the usual rituals or ways we cope with loss have not been possible.

The psychologist David Trickey (c.f. Trauma Council / Anna Freud Centre) has also noted that trauma can be understood as a ‘rupture in meaning making’, so that the way you see yourself, the way you see other people and the way you see the world can be shocked and radically changed, and you may experience feelings of helplessness. The ongoing COVID-19 pandemic has certainly highlighted this to all of us, although as noted above this type of sustained trauma may not be a new experience for the majority of the homeless young people we support at Centrepoint. Moreover, whilst our individual responses to trauma may vary from individual to individual, perhaps dependent on how much support or resources we have to process and deal with it, trauma itself does not discriminate.

COVID-19 has effected the entire population, even those who may not have caught the virus have lived through the ‘fear’ of catching it (particularly pre-vaccine and if you were working on the ‘frontline’) and it has had a massive impact on our daily personal and professional lives. For example, it is common to hear comments from those I speak to about how they feel that ‘time’ has been distorted over the past couple of years as usual social events that mark the passing of time (e.g. holidays) have been curtailed. However, our environment, unlike other mass trauma events such as war, has not obviously changed. It still looks the same, everything looks ‘normal’, yet it now framed as a space fraught with the physical danger of an invisible virus. This in a way again mirrors the trauma that many of our homeless young people have experienced, such as violence and abuse behind ‘closed doors’ or the experience of sleeping rough somewhere that for us is just an ordinary shopping street but for them is a place full of risk and danger.

Decades of psychological research on the impact of ‘collective trauma’ has highlighted that there are often significant mental health consequences for exposed individuals, ranging from short-term anxiety and impacts on sleep and weight gain, to longer-term post-traumatic stress disorder (PTSD) and depression (Norris et al, 2002; American Psychological Association, 2020). However, we need to be mindful that for those individuals who have already experienced early childhood trauma and adversity (such as the homeless young people we support); there is an association with more difficulties coping with subsequent stressors and a greater likelihood of subsequent distress, functional impairment and lower life satisfaction (Seery et al, 2010). As we have sometimes seen in our supported accommodation services, those who already have unprocessed traumatic experiences may be more prone to a negative response to a further trauma such as COVID-19 (i.e. challenging behaviours, refusal to abide by COVID-19 guidance, high levels of anxiety or avoidance).

Taking a psychologically informed approach to deal with the ongoing collective trauma of COVID-19, that perhaps (certainly to me this week!) can feel somewhat never ending, is therefore critical to maintaining our psychological well-being. Of course, once it is ‘over’, psychologists have argued that the whole population will need to address this ‘collective traumatic experience’ in some way through memorial, remembrance or restitution. In addition, it will be important that a shared narrative of this experience or ‘new meaning-making’ of what has happened over the past couple of years is created. In the meantime, some psychologists (e.g. Thompson et al, 2017; Garfin et al, 2020; Silver et al, 2021) have noted that one aspect of ‘coping’ is to limit our exposure to the trauma as far as possible. For example, limiting the constant stream of information we can access via the 24 hour media, which can cause further ‘vicarious trauma’. Moreover, continuing to prioritise our own self-care (as well as encouraging it in those we support) will help us manage to get through each day.

‘Collective trauma’ is also noted to be a shared experience of helplessness, disorientation and loss amongst a group of people (Castelloe, 2020). However, this can also give rise to a shared identification or narrative that can help us to reconnect with those around us (i.e. as we start to return to offices and workplaces, see more of friends and family). Therefore, speaking about our COVID-19 traumatic experiences in a safe place with others who have had similar experiences can be very helpful in order to allow us to process it and understand we are not alone. Indeed, this is the reason why group therapy or peer support groups can be such an effective psychological intervention (Yalom, 1985). Work by psychologists in organisations such as the Red Cross post natural disasters has also shown that communal gatherings, community-based resources and social networks can bring about recovery and healing, and maybe even allow individuals to begin to thrive in response to stress (Silver et al, 2021).

This importance of relationships, as per a PIE, was found in one study from Israel that looked at the psychological impact of the ongoing war in that region (Holmes et al, 2020). This research found that communities with higher community integration, strong social networks and support, and sufficient resources to deal with the aftereffects had less vulnerability to developing post-traumatic stress disorder (PTSD). Effective interventions included creating opportunities for connection with others though activities (e.g. exercise, arts-based, life-skills); simple things that we can replicate in our own lives as well as within our homeless services to help the young people deal with their past traumatic experiences. Moreover, psychologists have also noted the role of good leadership relationships — for more details see the previous PIE blog here on PIE informed leadership in a post COVID-19 world: https://drhelenmiles.medium.com/psychologically-informed-leadership-in-a-post-covid-19-world-a7738dc8c0ab. A recent study carried out in the UK National Health Service (NHS) also highlighted the important role of leadership. This research found significant associations between the extent of support from leaders and staff involvement in decision-making and work pressure, which impacted upon outcomes for both staff and clients.

Finally, it is worth highlighting that not everything post trauma is negative. Whilst it can take time to ‘heal’ and trauma often leaves a lasting imprint on us, a research study by Tedeschi & Calhoun (1996) found that for many people it was possible to experience a transformational shift following a traumatic experience. New strengths, skills and resilience can develop when we can view ourselves as ‘survivors’, particularly if we are able to take back some power and control in our lives. Often such experiences can help us to be more compassionate towards others and may perhaps lead us to be more grateful for the ‘small’ things in our lives. This pandemic will end, this challenging week is almost over for me, and the homeless young people in Centrepoint will get the support they need to move on from their previous aversive experiences to #changethestory. Hopefully, in all of these examples as per a PIE, there will be the opportunity and space for reflection, growth and learning to turn these negative experiences into something more positive for the future…