Dealing with direct impact of acute trauma - Part 1

This post is devoted to all people who are directly fighting COVID-19 right now, such as individuals who are diagnosed, patients, medical professionals, or first responders of all kinds.

     I would like to start by stating several basic things:
1) I have a lot of compassion for your situation. I am very sorry that you are between the rock and the hard place right now.

2) Your pain is real and it deserves care and respect.

3) There is nothing I or anyone else can do to fix your pain and suffering; however, there is something you can do to alleviate it to some extent – this is what the post is about.

4) Even though it might feel this way, you are NOT alone; even if it feels that you are fighting for or against the whole world on your own right now, there is at least your internal compassionate witness that is present there with you and, at most, Higher Power (of your understanding). Of course, there are also multiple people around the country and the world, who are experiencing similar struggles.
     In the next two posts, I will review the impact of acute trauma on human brain and nervous system, ways to cope with acute stress during demanding and catastrophic situations, and ways to reduce probability of psychological traumatization, which is often an outcome of an extreme hardship.

Impact of acute trauma

     When we, as human beings, face the situation of overwhelming need and suffering, which is what autonomic nervous systems tend to get overwhelmed and push us out of our regular functioning modes into survival responses. For some people, it means being in the state of hyperarousal (fight or flight response) which manifests in the increase of anxiety or agitation, frenetic energy, difficulties sleeping with possible flight of ideas and difficulty focusing or with tunnel vision and hyper concentration. Maintenance of this state requires a lot of internal resources. It is not sustainable over the long term. However, a lot of first responders, as well as doctors and nurses in critical care, will be functioning in this state for a very long time. For other people, survival mode is associated with the state of hypoarousal (freeze response), which manifests in slowing down of cognitive processes, low energy levels and fatigue, depressed or blue mood, sometimes to the point of feeling paralyzed or disconnected from themselves or others. This is the mode that a lot of ICU patients will be finding themselves in.

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     It is also common for folks to go between these two modes multiple times a week. For example, being in “fight or flight” state at work and then shifting into “freeze” response once off the shift. Living in either one of these states for a long period of time is very taxing for our bodies and our souls. It often leads to us being more traumatized in the end of the catastrophic situations.

     On the level of the brain, when we are outside of our regular nervous system functioning mode, our frontal lobes tend to go offline. They are responsible for us being able to critically evaluate situations and make sound decisions based on facts and data. When we don’t have access to these areas of our brains, we tend to make more mistakes and lapses in judgment. At the same time, amygdala, the area of our brains that processes threats, gets over-activated and pushes us to look at events and people through the lenses of fear and danger. This often results in us being overly reactive and impulsive in our decisions and actions.

     In terms of our psychological and social functioning, the shift into survival mode often leads to us feeling disconnected and alone. Empathizing with ourselves and others becomes a real challenge. We may feel anxious, angry, sad, overwhelmed, guilty, ashamed or a combination of those emotions most of the time. We may become intolerant of other people’s traits, actions, mistakes. We may also develop negative and/or hopeless perspective on the world, future, or our own prospects. It may become difficult to stay embodied, meaning connected to our bodies and aware of our needs. We may struggle with balancing other people’s needs and demands with our own needs.

Coping with acute stress

     When we are in the middle of a critical situation we often need to “collect ourselves” and act. In these circumstances we often have to neglect our own needs. We are often called to do more than we humanely can. How can one cope with those overloading demands? Few suggestions below are not a cure or a magic wand; however, following them may help take some pressure off.

1.     Protecting your vulnerabilities.
It is important to shield tender and vulnerable sides of you. We all have them, and we all get hurt when they are present in the harsh environments. So, let us focus on several steps of protection. (If you have even a few minutes after you read this article and there is only one practice you can do, I invite you to focus on the next three steps of protection.)
Step 1. Create an internal safe place.
     Simply imagine a place where young and tender aspects of you will be comfortable. It maybe a cabin in the woods, a bungalow on the beach, or a cave in the mountains, or anything else that calls your name. Really develop this place in your mind’s eye so that you can see the colors and experience the smells. Your vulnerable parts can have anything they need for life and comfort in that spot, for example, food, pets, blankets, toys, etc. Now, invite your young and vulnerable sides to come to that place and explain to them that this is a place for them to be when you are in crisis situation, whether it is at your work, in the hospital, in the ICU or somewhere else.
     If you are not a very visual person, you can create a safe place in your body, such as behind your heart or in your gut.
Step 2. Invite your parts to stay in a safe place
     Before you go into a high demand, scary, or crisis situation, invite your vulnerable aspects to go to a safe place and stay there until you let them know it is over. Let them know that they do not have to participate in anything that is about to happen or track anything. They can simply put headphones on and rest or do what they like. Reassure them that adult sides of you can take care of work or crisis and that you will let them know when it is safe to come out.
Step 3. Check in or invite parts out. (very important and makes the whole practice work).
     When you reach respite, whether it is the end of the shift, temporary relief from pain, or any other moment of safety, check in with the parts in a safe place to let them know you remember them and reassure they are not alone. When the situation is over, let the parts know that they can come out of the safe place and join you again. Please, do not simply exile or abandon your younger and vulnerable parts in that safe place. It will be hurtful rather than helpful in the long run.

2.     Checking, keeping, and regaining perspective.
In the midst of chaos, it is very easy to forget simple facts. When you have a moment to breathe, maybe when you are going to the bathroom or before you pass out in your bed, remind yourself:
* the situation is much bigger than you
* you are only ONE person doing the best they can
*it will pass too
*Higher Power (God, Community, Family, whatever calls your name) is there for you and has your back

3.     Hand on the heart – 1 min practice

For the next minute, bring your hand to your heart area, focus on the contact between your palm and your chest, feel the warmth emanating from your hand and say to yourself something like: “I know this situation really sucks. I know it is hard and painful, and I am sorry. I see that you are doing your best. I love you and I accept you just the way you are.” Feel free to modify those phrases so that they sound true and authentic to you. The important thing is that words express validation, understanding, and acceptance of you as a person.

4.     Mindful Movement
It does not have to be anything fancy like a yoga practice or a pilates session. Simply walking down the hall with the full attention to your feet hitting the ground and awareness of your breath is a potent way to bring yourself inside of your body and regulate your brain and your nervous system. Some other ideas here for variety:
* Arm lifts: from standing upright or sitting in the chair with a straight back and an open chest, raise both of your arms on inhalation and release them in exhalation – repeat 5-7 times, using breath as a vehicle for motion.
* Balancing rises: from standing upright, with both of your feet on the ground, rise to your toes extending your arms out on the inhalation, bring your heels to the ground and hands to your heart/chest on the exhalation - repeat 5-7 times, using breath as a vehicle for motion.
* For more one minute movement ideas, visit my YouTube channel at: http://www.youtube.com/c/IrinaDiyankova

     Steps 2-4 are mini practices. Each takes only a minute or two to perform. They can be used individually and multiple times a day to create a moment of regulation and a moment of calm. The more frequently you practice, the more resilience you will create and tap into. There is no need for perfection. If you forget for a day, a week or a month to do those things, you always have a chance in this next coming moment to choose to practice one of them.

5.     Clean the slate
Ideally, we will do it every 24 hours. However, when we are in crisis situations it is not always possible. I suggest that you take a few minutes before you fall asleep or while you are in the shower to release the day (previous 48 hours or week). With every exhalation, release pressure, tension, physical pain, negative thoughts. Ask white light to surround you and bring safety, love, joy, connection, forgiveness or something else your system desperately needs in the moment. Extend compassion to yourself.

      I would like to end part 1 of this post with a brief summary. Crisis situations often push us into survival mode, which can help us deal with life and death.  While it could be useful in a short-term, it really tends to hurt us in a long-term. So, we don’t want to live and function in this mode. I discussed five different strategies that can help shift from survival into regular mode of functioning and provide a needed respite. These strategies are very brief and could be utilized multiple times a day to create mini breaks for the nervous system, brain, and mind. Using these practices on a regular basis may also protect us from a long-term negative impact of acute stress.