While many of us try to cope with the immediate effects of the COVID-19 pandemic and process the trauma, anxiety, and global loss, recent research might help guide the way forward. Many of the feelings brought on by COVID-19 are not new, especially for vulnerable populations that might face frequent life-threatening events but continue to fight for life’s possibilities. We can learn coping strategies from those who have experienced trauma and those who work with trauma survivors. This painful period in history provides an opportunity to better understand the importance of trauma-informed care and to apply what we have learned on a larger scale.
In the past few decades, research has influenced an important movement toward trauma-informed care. That’s a term that has gained relevance and acceptance recently, but what does it really mean? Trauma-informed care is broadly defined as practices that promote a culture of safety, empowerment, and healing, and that encourage support and treatment of the whole person, rather than treatment of individual symptoms or specific behaviors. Trauma-informed care initially shifted the focus from, “What’s wrong with you?” to “What happened to you?” In recent years, this approach has expanded to include asset-driven strategies such as healing-centered engagement, a framework that goes one step further toward empowering survivors. Under this framework, the lens shifts from, “What happened to you?” to “What is right with you?” Focusing on trauma can make people feel defined by it, as opposed to being reminded of the things that make us strong and that we can make possible. Healing-centered engagement emphasizes individuals’ strengths and resilience, recognizing the impact of trauma without minimizing it.
Perhaps the most significant goal of trauma-informed care and healing-centered engagement is simply acknowledging trauma in ourselves and others—it is common and yet often unrecognized or buried. Recognizing trauma, and how it connects to what we are experiencing, enables us to respond and move forward. The more we can do this now, the more we can move toward the shared resilience necessary to meet the challenges we face today.
The ongoing crisis management that is part of the current pandemic is all too familiar to families that have faced trauma and adverse childhood experiences (ACEs)—including violence, abuse, and neglect. Before COVID-19, many were already coping with symptoms and emotions that come with crisis situations, including hypervigilance (a sense of being on high alert) and an overarching feeling of dread. Survivors of trauma also may experience emotional numbing and avoidance of triggers—reactions that many more people are now experiencing in the context of COVID-19. These experiences can make it difficult for individuals to see beyond the present and more likely to fear the worst.
Anxiety and biological stress responses, which might be new experiences for some as a result of COVID-19, already affect many families in the United States and abroad:
- A 2019 report by the Centers for Disease Control and Prevention found that 61 percent of adults in the sample of 25 states reported experiencing at least one type of ACE, and one in six experienced four or more ACEs.
- A recent World Health Organization study found that the estimated total annual costs attributable to ACEs were $1.33 trillion a year ($748 billion in North America and $581 billion in Europe). These data demonstrate the reach of trauma on a large part of the planet, as well as the significant costs.
- Although trauma affects all demographic groups, it disproportionally affects women and people of color, who are at a greater risk of experiencing four or more ACEs. This is similar to evidence on the impact of COVID-19 on racial and ethnic minority communities.
Given the high prevalence of ACEs and trauma before the pandemic, understanding what can be done to help is critical. In addition, COVID-19 is taking a toll on frontline health care workers and first responders. The emotional demands of this work can exhaust a person’s capacity to be involved with and responsive to the needs of service recipients, particularly for individuals who have not identified or addressed their own ACEs. Trauma may resurface for those caring for people experiencing traumatic stress reactions triggered by the pandemic.
Being trauma informed can reduce high rates of burnout and emotional fatigue. This includes training providers to recognize trauma, screening for trauma in ways that reduce stigma, providing culturally relevant services, and offering peer-based supports. Although access to these services is now limited or simply not available, especially in under-resourced communities, one thing we can do is understand the great needs out there—the need to recognize the variety of modalities offering relief and healing for traumatic stress; the need for more resources to support healing in communities that were vulnerable before the pandemic; the need for resources to support frontline health care workers experiencing unprecedented stress; and the need for more training, support, and resources for behavioral health providers who are tackling the emotional and psychological impacts of COVID-19.
Multiple studies have also linked traumatic childhood experiences with a greater chance of lifelong physical health problems that include lung, heart, liver, and autoimmune diseases. This issue cuts across mental and physical health and underscores the importance of trauma-informed practices in health care delivery. Anxiety and stress lower our immune system defenses at this sensitive time. Focusing on core components of resilience such as adequate sleep, good nutrition, regular physical activity, and active relaxation are more critical now than ever before.
Addressing trauma and fostering resilience also require creating a sense of safety and connectedness, which is being threatened during this pandemic. Combating physical isolation by reaching out through phone and videoconferencing can help. Since this began, our inclination to wait for the so-called right time to call people we care about has diminished.
The scale and the suddenness of loss we are starting to experience are in themselves a traumatic experience. One thing is clear: this crisis did not develop in isolation, and the solution likewise will need to be a collective one. Gaining awareness of trauma facilitates empathy, and through empathy, healing and resilience occur. If we can meet this call for empathy on a global scale, we can process our collective grief and begin to heal.