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The following is the second part of the article “Some specifics of stress reactions in times of global pandemic and natural disasters”, published on March 24, 2020:
The crisis we are just going through is generating stress in most people and is an expected increase in the incidence of various forms of stress reactions.
These days, we are all witnessing a series of adverse events, both globally and in our backyard. There is a collective feeling that we were unwanted and suddenly in the role of collateral victim of an evil that left us all unprepared, left us in wonder, changed the tangled ways of everyday life, without anyone asking us anything, asking for permission, or preparing for what is yet to come. In fact, for what we think is coming, since no one is aware and knows the secrets of the future. Despite all the advances in modern science and technology, the nature of its secret is revealed only to the few who spend much of their lives studying its hidden depths.
Never underestimate your own creative potential
Quite unexpectedly, on an early Sunday morning, an earthquake stronger than the five on the Richter scale literally blew us from our sleep. Soon, some of our fellow citizens found themselves on the street, and photographs of the catastrophe that struck our capital began to arrive on our ubiquitous mobile phones. As if that wasn’t enough, there was another disaster, the global COVID-19 pandemic, in full swing. In January 2020, the World Health Organization declared the outbreak of a new coronavirus disease a public health threat of international concern, and in March the COVID-19 infection was assessed as a pandemic. The pandemic, almost overnight, has led to a sweeping change in the world as we know it. Suddenly, we are forced to spend time at home, messages come from all sides about the need and well-being of the home, parents change their daily routine, work from home, we can no longer go to the usual visits to grandparents, all because of the invisible, at the same time distant and ubiquitous enemy COVID -19, and with it all the while still feeling the tremors of the ground, which generates some other fears in us.
The author of this text regularly answers the questions of the type “Doctor, what if the internet and electricity disappears, how then in school / to lectures / colloquiums / we want to have a teleconference with professors in exams?”, All questions that, for now, are not correct and the wrong answers, just a statement that we all, to the best of our ability, retain our composure, prepare ourselves with adequate equipment (always have a backpack or a small suitcase with basic essentials, and today, a laptop for taking important exams through a teleconference is inevitable. ) and that under the circumstances, we respond to the best we can and know at that particular moment. And if the power goes out, they could be supplied with two, three candles, just in case.
The only thing we can do is accept that in these situations there are no universal and easily accessible solutions to these and other problems, but it must be well remembered in advance that something can always be done and taken and that we are never completely helpless, by having a developed human consciousness that always and when it is worst, it retains its creativity, the ability to change established “rules” and even in the worst situations in which, for example, we are faced with the possibility of death of ourselves or our loved ones, it can come up with some creative solution to the problem. You never underestimate your own creative potential.
Such circumstances of a drastically changed everyday life (earthquake + pandemic COVID-19), with the pervasive impression that the world as we know it is losing, affect all people, regardless of age, gender, race. This requires all the extra psychic strength and energy needed to adapt to the new circumstances.
Immediate and acute stress response
After exposure to a stressful and undesirable event, most people experience an immediate stress reaction. It is a normal reaction to an abnormal situation and is different from an acute reaction to stress. With a normal reaction to an abnormal situation, most of us may experience one or more of the following disorders: fear and concern for our lives, health and existence, as well as fear for our loved ones, in children and young people it can often be a fear for parents, friends, grandparents. There is also anxiety, difficulty falling asleep and daydreaming.
Some may experience a loss of appetite, increased appetite, and some may have difficulty eating a craving for a certain type of food, often sweet, fatty and salty. Concentration problems are also possible, as well as exacerbation of pre-existing, chronic health problems. The most dangerous form of immediate reaction to stress as part of the normal reaction to an abnormal situation is certainly the increased craving for cigarettes, alcoholic beverages or other addictive substances.
One may have a stronger, and one milder, reaction when exposed to stress. These reactions do not constitute a clinical entity per se, they are not a psychiatric disorder in the strict sense. They are part of normal human life and are the expected response after exposure to stress for most people. This is why most people do not need the help of mental health professionals because of their immediate stress response, but they are able to adjust themselves, get back in balance, and resume their usual activities.
In some people, depending on the strength of the stressor, the type of trauma as well as their personal predispositions, after exposure to the traumatic experience, an acute reaction to stress may develop.
Acute stress response is defined in the International Classification of Diseases, Tenth Revision, ICD-X and as such constitutes a separate clinical entity. The international code for this clearly defined clinical entity is F43.0, and in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, Fifth Edition, DSM-5, is defined as acute stress disorder.
What is an acute stress response
Acute stress response and acute stress disorder are not synonymous with the normal response to an abnormal situation that occurs as an expected response to stress in most people, but are clearly defined clinical entities and are diagnosed by a doctor’s office or an adult psychiatrist as well as child and adolescent psychiatrist. The aforementioned clinical entity is often subject to psychiatric expertise, while a normal reaction to an abnormal situation is not a psychiatric entity, but rather a transient emotional distress.
In order to be diagnosed with an acute stress response according to the International Classification of Diseases or Acute Stress Disorder according to DSM 5, important conditions must be met:
It is important to point out that even a less stressful event, psychosocial stress, can be a trigger for emotional difficulties, which, if they become permanent, can turn into real psychiatric disorders. The causal importance of such events is not always clear and often depends on the individual characteristics of the person, such as age. Children are more vulnerable to such events and are more likely to respond to some of the true psychiatric disorders after exposure to psychosocial stressors compared to adults.
In contrast, life events that cause an acute reaction to stress in the majority of the population must have a catastrophic note that threatens man directly, here and now, leading to a position of helplessness and are perceived as such from the position of all people, regardless of age, gender, education and their own inherent vulnerability to stress. In other words, we all unfortunately have a “right” to be diagnosed with an acute stress response over our lifetimes.
An acute stress response is a transient disorder that develops in people who are not suffering from other serious mental illness, as a reaction to extreme physical and mental stress. Individual vulnerability and susceptibility to stress play an important role in the onset and severity of an acute stress response. Vulnerable, sensitive people, as well as young people and especially children, are more vulnerable and less resistant to stress. In some circumstances, some women may be more vulnerable to acute stress, though this does not in any way exclude the male gender from vulnerability to stress.
Symptoms of an acute reaction to stress include the initial state of “shock”, with the possible existence of a degree of narrowing of consciousness and attention, an inability to grasp one’s own pulses. Disorientation may also occur when very heterogeneous behavioral manifestations are possible, which may also be of great forensic importance.
An acute reaction to stress may be accompanied by excessive activity to the level of hyperactivity or certain withdrawal from the environment, even to the level of complete icing and absence of any activity. Often, though not always, as part of the acute stress response, disturbances are present which are also present in the immediate stress reaction, eg increased anxiety on the psychic plane or through somatic equivalents of elevated anxiety in the way of subjective feeling of rapid heartbeat with objectively greater numbers of heart rate, increased sweating, redness of the skin, sensation of rapid and shallow breathing, impaired concentration, etc. The acute stress reaction occurs shortly after the effect of the stressor, lasting from a few days to a maximum of one month.
Pandemics and natural disasters
During the current COVID-19 pandemic, some persons or a possible and entire population are in isolation, self-isolation and some in quarantine. We have limited contacts, we are in uncertainty and we are all a bit shy about our own infection or the infection of those we have been in contact with (it is objectively difficult to assess who is infected and there are no symptoms; everyone can be a healthy, asymptomatic virus carrier). On the other hand, COVID-19 sufferers suffer severe symptoms, some are at risk of life, their families worry, some will lose family members. People who are in any way exposed to the possibility of corona virus infection can be exposed to social stigma, which, as in a vicious circle, increases their suffering and isolation. At the same time, we are witnessing changes in the working functioning of parents, teachers and most of the people we know. We participate in changes in the way we study, take exams, study online, take important exams through teleconferences, all without prior preparation and announcement. Adults think about get security. No one is protected from the issue of economic sustainability. In all of this, we are also exposed daily to various misinformation and bombastic pandemic headlines, all of which increase insecurity and anxiety. Ultimately, the daily lives of all of us changed.
It is already clear for the reasons described above that the global pandemic COVID-19 has all the characteristics of a terrifying, globally dangerous event that threatens the potentially very unfavorable changes of our beloved everyday life. Because of all this, we can rightly consider the COVID-19 pandemic a traumatic event that can result in a variety of stress reactions in humans, from a normal reaction to an abnormal situation to post-traumatic stress disorder on the opposite side.
A stronger earthquake is a natural disaster and in itself is a catastrophic event that directly and significantly endangers the individual, can result in human casualties and material damage, and leave survivors with a bitter sense of helplessness and as such can in most directly exposed people, especially children and youth, lead to acute reactions to stress.
In addition to the acute stress response and the normal reaction to an abnormal situation, other forms of post-traumatic stress disorder, adjustment disorders, and many delayed or late effects of trauma can be other consequences of acute, very intense but also chronic psychosocial stressors.
How can we help ourselves and others in changed circumstances?
It is important in these times of crisis to protect ourselves, but also to be supportive of others. The best way to protect ourselves first and foremost is to be well informed. The key information and recommendations of the National Civil Protection Headquarters and the World Health Organization should be given due attention and trust and respected. It is recommended to reduce exposure, ie to reduce reading or listening to content that increases anxiety, and especially to avoid unverified and sensationalist media coverage of the pandemic. It can be helpful, for example, to limit news coverage to twice a day. That way it will be better to distinguish facts from mere rumors.
It is necessary in the present conditions when staying at home is the best possible choice in order to protect one’s and others’ integrity, to take active care of one’s health, to take care of preventing the disease through regular hygiene of both body and soul. These include exercising regularly within the limits of one’s own abilities, a few squats a day may be sufficient, it is essential to maintain any physical activity and movement. It is advisable to stretch, to practice abdominal breathing. Who does not have an obligation of isolation or quarantine, it is advisable to stay in nature, but with the avoidance of social contacts, in accordance with the recommendations of the National Headquarters. It is necessary to maintain sleep hygiene by going to sleep at about the same time and sleeping in a piece of six or seven hours. Nutrition choices are also important. However, energy consumption has now been reduced and it is recommended to avoid “empty calories” in the form of refined carbohydrates, sweets, snacks, junk food and the like. Five meals a day, three main meals with two smaller meals, are recommended, with the recommendation that the last meal be at least two hours before bedtime. It is advisable to avoid excessive consumption of energy drinks, coffee and maximum avoidance of alcohol, drugs and other addictive substances.
It is essential to maintain communication and relationships with other people through modern-day technology (online communication and video communication via Whats App, Viber, Instagram, etc.), which is also a way of avoiding social contacts to reduce the possibility of spreading the disease. Talk about how you feel, if you notice that an activity is helping you, it is a noble gesture to share it with others. It is a universal recommendation that we always respect and appreciate other people, strive to be kind, although it is human in times of crisis to show some inappropriate behaviors to reduce tolerance for frustration. But there is no excuse for rudeness and sobriety. Therefore, it is a reason to admire ourselves if, in these difficult times, we are able to maintain our composure and suppress undesirable behavior towards those around us
In the field of emotions, it is important to try to identify your own emotional states and, if possible, to share it with your loved ones. The better we recognize and speak about our emotions, the easier it will be to deal with them. Expressing emotions is not a sign of weakness and in such crisis situations it is essential to maintain mental health. Share your feelings with you close people, rely on each other, give yourself comfort, warm words and hope.
All of the recommendations described will help to recover and restore vitality and energy faster.
Attention must be paid to one problem that may arise in situations of overload, such as our present situation. In such conditions, it can easily happen to people who are completely healthy and without any emotional disturbance, so-called “thinking errors” or “thinking distortions”. When that happens we can start interpreting situations as through a certain mental filter, in the way of black and white thinking, we can think eg “we are not equipped and we will all die” / “we are a modern country, we are super equipped and no one will die”, maybe there are also catastrophic thoughts such as “I sneezed, I must have a virus” or “it’s an earthquake, no help.” There are also possible generalizations in thinking that “all earthquakes are very dangerous, if it is happened again we will die”. These missteps are detrimental as they further complicate emotional responses to stress, and may exacerbate symptoms of stress exposure.
Since these are overstated interpretations, most of these conclusions are certainly wrong, and if some of them are even only partially correct, they are neither useful nor functional because they make the negative emotional states of fear, worry and anxiety stronger and thus lead to distortions of perceptions of reality, thus making us more vulnerable to possible new stresses and more susceptible to manipulation.
That it is a mistake in thinking, we will most easily recognize by changing our emotional state. When we notice that we are suddenly starting to feel differently than usual, our moods are deteriorating or we are starting to feel worse, we need to pause for a moment, pay attention to the thoughts and feelings that linger in our consciousness. Then, when we have captured thoughts that disturbed our emotional equilibrium, we need to ask ourselves if this is true and what is the evidence that reinforces such thoughts, in support of the truth. We should also ask ourselves if such an opinion is of any help to us. If we eliminate or reduce such distortions of thought, we will more realistically experience the situation we are in, lessen excessive emotional reactions and feelings of exhaustion.
These recommendations are not a substitute for the help of mental health professionals. Suspicion of disorders from the stress spectrum requires contact with a family physician and, where appropriate, a psychiatrist and psychologist. An acute stress reaction often requires short medication with anxiolytics. Most stress spectrum disorders can be most successfully treated with a combination approach, psychotherapy with pharmacotherapeutic treatment with anxiolytics and antidepressants, while it is sometimes advisable to introduce mood stabilizers and antipsychotics for more complex disorders. At times when we feel overwhelmed by anxiety, fear, or other negative affective states, it is always advisable to seek the help of mental health professional.
Written by: Dijana Staver, MD, Specialist Psychiatrist
Disclaimer: This is unofficial translation provided for information purposes. Zagreb Child and Youth Protection Center can not be held legally responsible for any translation inaccuracy.