Understanding PTSD in Uncertain Times

Feeling exhausted? On edge? A little out of sorts? You’re not alone.

More than two years into the coronavirus pandemic, and facing uncertainty around the globe, studies have shown increases in stress and anxiety among U.S. adults, with some experiencing symptoms of post-traumatic stress, or what is being called post-COVID stress disorder.

According to Dr. JoAnn Difede, attending psychologist at NewYork-Presbyterian/Weill Cornell Medical Center, an increase in feelings of moodiness, difficulty sleeping and concentrating, irritability, and anxiety, among other symptoms, is to be expected. Though some people may be more at risk for these symptoms than others, the effects of experiencing or witnessing a traumatic event, whether that be a car accident, severe illness, or any perceived threat to you or a loved one’s life, takes a toll on your nervous system no matter who you are.

The stress and anxiety can be explained in three words: fight, flee, or freeze — activating your sympathetic nervous system, which is your body’s involuntary response to dangerous or stressful situations, causing a cascade of psychobiological events, like changes in cognition, a flood of hormones to boost alertness and heart rate, and an influx of blood to the muscles to prepare the body for action.

Though it’s an evolutionary advantage, Dr. Difede points out, the problem is the body doesn’t always know how to turn off these feelings.

“We don’t know how to dial down the risk,” says Dr. Difede, who is also a professor of psychology in psychiatry at Weill Cornell Medicine. “Our brain continues to look for the enemy.” This can lead to avoidance, increased substance use, intrusive thoughts, flashbacks, and lingering feelings of stress or a sense of vigilance.

Complicating that response is the fact that COVID has been an invisible, prolonged threat.

“Often, a person’s threat is clear to them and they are faced with a choice of what to do, but since the threat of COVID-19 is invisible and society has been facing that threat for so long, your body is constantly preparing to fight, flee, or freeze, perceiving danger literally everywhere,” says Dr. Difede.

For two decades, Dr. Difede has worked to develop innovative treatments for post-traumatic stress disorder (PTSD), including virtual reality exposure therapy, which immerses people in detailed scenarios based on their experiences to help them gradually approach trauma-related memories, feelings, and situations in order to reduce PTSD symptoms. To date, she and her team have treated hundreds of patients, including active military, veterans, burn victims, cancer and 9/11 survivors, as well as firefighters, police officers, disaster rescue and recovery workers, and healthcare workers. Today, as a pioneer in the field, she is spearheading research and focusing on developing treatments for healthcare and other essential workers and COVID-19 survivors facing pandemic-related PTSD. This research includes projects focused on medical music intervention to address sleep disturbances related to PTSD, as well as narrative writing, interpersonal therapy and prolonged exposure therapy, a type of cognitive behavioral therapy to gradually approach trauma-related memories.

She emphasizes that no matter who you are, this has been a uniquely challenging and traumatic time in many ways, compounded by reduced social connection as we retreated into our homes or isolated away from our loved ones for a time to reduce the spread.

“Everyone has the same vulnerability, whether civilian or first responder,” she says. “There’s a dose relationship with trauma, and while health care workers and other front line workers may have had higher doses of trauma, we’re all human and our brains are wired the same way.”

“As humans, we often think that if the problem seems enormous, the solution has to be, and that isn’t really the case,” she says.

Dr. Difede shares her tips on how to prioritize and recover your mental health during difficult times.

Even if your life doesn’t require a schedule, it helps to follow one. It can be as simple as “wake up, make breakfast, and make the bed.” Keeping a schedule is a way to keep yourself grounded when you are feeling distressed.

If you don’t need to be up at 7 a.m. to go to work, that’s OK, but make sure to normalize getting up at a regular hour and going to bed at a regular hour. While an extra dessert or a glass of wine is OK sometimes, avoid overindulging.

Exercise is one of the single best mental and physical things we can do for ourselves because when you exercise, your brain is producing a lot of chemicals to relieve the stress and counteract that sympathetic nervous response. If you are not currently exercising, start simply by taking a walk around your block and build from there.

Whether you like to spend hours by yourself or you need lots of people around, taking time to have social interactions is important. There are challenges if you are still communicating with people over technology, but always try to find ways to make those connections.

The biggest threat to changing your habits for good is becoming overwhelmed and giving up too easily. Set small, realistic goals so that you don’t become frustrated. Try to make a plan and stick with it as best you can. Don’t be discouraged if it takes time to implement new habits. Persistence is key.

There is abundant research on positive psychology and happiness. Showing gratitude and optimism is not only nice to do, it’s good for your health. When you do something nice for someone else, it not only makes them feel good, but it also makes you feel better too.

If you engage your brain in different things, it’s harder to be anxious and harder to think about all of the stressful things. Simple things like reading a book by yourself or with your children can become a helpful habit.

Talk to your doctor. The concept of seeking help for your mental health may seem daunting, but if your doctor told you that you had high cholesterol, you would take the necessary steps to correct it. Think of your mental health in the same terms because it is essential. Don’t discriminate against your brain. If you are feeling symptoms for a prolonged period of time, like difficulty sleeping, a hard time concentrating, or irritability, talk to your health care provider.

You can also take advantage of mental health and mindfulness apps, which can be accessed easily on a computer or smartphone and provide you with some relief.

Give yourself a break. Consider where we are and what we have gone through as a society. As individuals, we can’t create change overnight, but we can appreciate and accept where we are and what we do have. Many people are not exactly where they want to be in life, and the world isn’t always what we want it to be. It’s easier said than done, but accepting that you’re not going to feel good every day is an important part of living.

Learn more about trauma treatment at the Program for Anxiety and Traumatic Stress Studies and find psychiatry and behavioral health services offered at NewYork-Presbyterian.