Living through the pandemic may cause varying degrees of trauma: expert

TORONTO — A Canadian expert says that living through the COVID-19 pandemic may cause symptoms of trauma, isolation and “anticipatory anxiety.”

“Psychological trauma can actually be a very common event,” said clinical psychologist at the Centre for Addiction and Mental Health (CAMH) Dr. Katy Kamkar in a telephone interview with CTVNews.ca Saturday. ”Studies have shown that a majority of people have experienced at least one traumatic incident in their life – could be anything from interpersonal violence to a vehicle collision.”

Kamkar, who is the chair of the Canadian Psychological Association in the Traumatic Stress Sector and assistant professor in the department of psychiatry at the University of Toronto, said that the effects of trauma can happen to someone if they witness trauma occurring to others or learn that it has occurred to someone close to them.

The pandemic has caused a collective loss of “normalcy,” routines and certainty about the future. Some have lost jobs, loved ones and connections to friends and family. All of this plays into mental health and trauma, Kamkar said.

“When we refer to a collective trauma, it can be a psychological and emotional reaction to a traumatic event shared between a group of people – but it can sometimes be an entire society,” Kamkar said, noting that collective trauma is a term often applied to regions where people have survived a natural disaster.

Kamkar said during the pandemic the mental health needs of Canadian communities have been on the rise, along with symptoms of depression, anxiety, substance misuse and trauma.

“It hasn’t been just one day, one month, it has been chronic – over a year, concerns about spreading the virus to loved ones and families,” she said. “In a very short period of time, we had to readjust to drastic changes in our routine, we had to create a ‘new normal,’ and we haven’t had to create a new normal two or three times, it’s been constant.”

For those who contract COVID-19, Kamkar said there can be additional traumas ranging from severe medical intervention — like being put on a ventilator or extended hospital stays — to limited communication or presence from family members.

“We’ve seen in the studies about intense medical procedures, like cardiac procedures which require opening of the chest, the increased symptoms of depression, anxiety and post traumatic stress disorder (PTSD) even when people are in recovery,” she said. “Even if a person is recovered and discharged from there can be pain and physical limitations.”

Kamkar said those previous studies are “very relevant” to the COVID-19 pandemic, and challenged the notion that PTSD symptoms only occur in people who are victims of violence crime or war veterans.

“One thing to know about PTSD is that it can be very individualized,” she said, citing the “four clusters” of symptoms.

TRAUMA SYMPTOMS

The first cluster is “experiencing symptoms of trauma,” Kamkar said, which can consist of psychological triggers, nightmares or reactions to reminders of the event. It can also manifest in the avoidance of symptoms and the desire to avoid any reminders of the traumatic event.

The second is the “negative alteration in cognition and mood,” Kamkar said, adding that people may experience “exaggerated and persistent negative beliefs about the self, others or the world,” and seek to self blame or blame others.

The third cluster is when people may have difficulty experiencing positive emotions or “experience diminishing trust in activities they used to enjoy,” she said. Others may experience emotional numbness and feel emotionally distant from others.

The fourth cluster is a state of “arousal.” People experiencing trauma symptoms may have angry outbursts or feel hyper vigilant – constantly on guard for signs of danger or feel “excessively jumpy.” Kamkar said this can play out into difficulty concentrating and sleeping.

Kamkar said generally the symptoms of trauma subside over time, but “if we feel those symptoms increase over time, they create more distress…after one month, they interfere with day-to-day activities and responsibilities.”

Not every symptom of trauma is an indicator of PTSD, Kamkar said, adding that is important to appreciate additional stressors and how they may affect each person.

“Those stressors increase our vulnerability, and become significant predictors in terms of increased risk of a mental health condition,” she said. Additional stressors can be things like employment precarity, poor health, lower socio-economic status and substance misuse.

Another facet of pandemic trauma is something called “anticipatory grief” or “anticipatory anxiety.”

It’s described as a sense of fearful anticipation that there is still more loss to come, whether it be loss of routine, employment, loved ones or isolation.

People experiencing this may feel constantly on edge, (similar to hypervigilance) or feel angry at things they cannot control. Others may feel exhaustion, resigned to the worst case scenario or withdraw and isolate themselves further.

“It’s about anticipation of ‘what are the losses that I might experience?’ So it could be a partner, it could be my companion, it could be my role, my identity, my finances, the wishes that I had in my life,” Kamkar said.

Describing COVID-19 anticipatory grief or anxiety as a ”continuum,” Kamkar said that grief comes not just from the loss of life but “physical injuries, loss of home, finances and routines,” and that much of the pandemic is traumatic because of so much “fluidity” and constant “uncertainty.”

COPING WITH TRAUMA AND THE PANDEMIC

In the face of the third wave of COVID-19, feelings of isolation have never been stronger said psychotherapist Dr. Robin Dhaliwal on CTV’s News Channel Saturday

“I think everyone is just experiencing a lot of COVID-19 fatigue and this time around there is a lot of uncertainty as well,” she said. “I think a lot of people feel very frustrated and angry, especially if they thought that by this time we would be able to go back to some kind of normal, to be able to go on vacation.”

Dhaliwal said that with school closures, children are the “silent sufferers” of the pandemic.

“Unfortunately I would say it has affected them the most…schools closures meant they haven’t been able to see their friends.”

Kamkar said that while the pandemic has been “incredibly challenging,” people have shown an “impressive amount of resiliency,” and that she hopes Canadians continue to learn how to cope better.

“We have the technology in terms of gathering our resources and knowing how to communicate remotely, and now we need to be creative in making meaningful activities,” she said, citing things like online cooking courses or online yoga and meditation instruction.

“If one person feels better, it has a tremendous positive impact on everyone, and if one person is not going well it also has an impact on everyone,” Kamkar said. “As a group, it’s the collective resilience we need to focus on, knowing we’re not alone and come together and maximize our strength.”

Kamkar said people need to know they can reach out and ask for help.

“We need sympathy. We need empathy. We need to normalize our reactions – people are experiencing a wide range of emotional and cognitive reactions [to the pandemic]: sadness, grief, anxiety. We need to show we are not afraid of those symptoms and talk about them,” she said.

Part of coping comes from “self care,” which Kamkar said can start with a balanced diet, stretching and exercise and spending time outdoors – while keeping health and safety guidelines intact.

Dhaliwal said that parents concerned about their children feeling isolated should “expose them to some sort of normalcy,” and take them on errands, get them outside, create new routines, and help them connect with friends virtually.

“Practise self-kindness, don’t judge yourself,” Kamkar said, citing that many feel a measure of self-worth and self-esteem based on their activities.

“We are all human beings, we make mistakes, no one is perfect.”

FINDING HELP

Canadians experiencing mental health crises can visit the Crisis Service Canada site to find resources in their area.

The Kids Help Phone is available 24 hours a day for Canadians aged five to 29. Call 1-800-668-6868 (toll-free) or text CONNECT to 686868, or download the Always There app for additional support.

The Hope for Wellness Hotline is available for all Indigenous people across Canada who need immediate crisis intervention. Call 1-855-242-3310 (toll-free) or connect to the online Hope for Wellness chat.

Hope for Wellness telephone and online counselling is available in English, French, Cree, Ojibway and Inuktitut

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