COVID-19 Rehabilitation from PTSD, Anxiety and Stress

Studies on mental health in many previous disease outbreaks have shown that many individuals exposed to life-threatening diseases can also experience longer-term psychological aftereffects such as PTSD, anxiety and depression that extend far beyond the active infection.

During these periods of prolonged stress and uncertainty, many changes can occur in the brain and to the immune system. While some individuals can become more susceptible to stress and others will become more resilient.

What we are seeing with long term exposure to COVID-19 stress, is that even some of the most resilient people can still experience trauma-related mental health issues.

“There may also be features unique to COVID-19 and its pandemic status that exacerbate its psychological impact, such as being isolated from family during and after hospital admission. Failure to deal with this immediately could lead to serious long-term mental health difficulties.”

Dr Bloomfield (UCL Psychiatry UK)

Not unsurprisingly there is no uniform approach in South Africa to managing the mental health states of COVID-19 survivors. Most patients self-refer to their GP for a prescription mediation which will have a knock-on effect of its own. A number of COVID-19 private support organisations have formed that voluntarily help COVID-19 trauma survivors.

Posttraumatic stress disorder (PTSD), anxiety and stress are very common mental health conditions that can be created by significant trauma events.

Recovery Direct is one of South Africa’s private trauma care centres with a dedicated counselling team specifically here to support the resolution of these many psychologically traumatic events in peoples lives.

While the focus on COVID-19 patient care is presently the worlds foremost objective. The pandemic has also created an “emotional tsunami” that will require suitable care to help with mental health symptoms of COVID-19 survivors.

Each person is unique and has their own responses to trauma. however here are some of the more common symptoms of PTSD that a person may experience in one format or another.

• Flashbacks or feelings like the event is happening over again
• Nightmares of terrifying events or of the event itself
• Loss of interest in daily life and activities
• Feelings of being emotionally numbed and detached from other people
• Sense of a not leading a normal life
• Intense feelings of distress when reminded of a COVID-19 related events
• Physical reactions to reminders of trauma including nausea, pounding heart, sweaty hands
• Invasive, upsetting memories of a specific tragedy or
• Avoiding specific activities, feelings, thoughts or places that remind you of the trauma
• Difficulty remembering important aspects of a trauma event

These traumatic experiences are not limited to COVID-19 survivors but may include that of their family members or anyone in front line exposure to the disease such as health care workers or anyone directly or indirectly experiencing PTSD symptoms as a result of COVID-19.

Symptoms include persistent intrusive thoughts, persistent avoidance of activities, negative thoughts or moods, and increased reactivity or avoidance when associated with the traumatic event. Mostly avoidant behaviours where clear decision making is clouded by overtones of anxiety or depression.

PTSD is a common psychological response to a wide variety of traumatic events that may include anything that causes significant wars, disasters, relationship issues, physical/emotional abuse, road accidents, severe illness, critical loss (relationship, security, career, limb etc).

In the case of COVID-19 the constant stream of media, or loss of incomes, lockdown stress, and a board range of anxiety and stress based circumstances directly connected to COVID-19 are KNOWN to cause many PTSD based symptoms.

Left untreated, patients with PTSD live in the shadows of their trauma and become more susceptible to adopting new coping mechanisms that can become problematic to their wellbeing.

For the mind to “overcome” trauma events can take 36 months (With the counselling support) and 64 months (Without counselling support). The problem is that trauma can become most destructive in those 36 or 64 months in regards to relationships, social, occupational, or other important areas of life.

Infectious disease epidemic and PTSD

Exposure to infectious disease epidemics results in a particular type of psychological trauma, which could be categorized into three groups.

1. The first is directly experiencing and suffering from symptoms and traumatic treatment. For example, dyspnea, respiratory failure, alteration of conscious states, threatening of death, tracheotomy, etc. are major trauma of patients with severe COVID-19.
2. The second is witnessing of patients who suffer from, struggle against and die of the infectious disease, which has a direct impact on fellow patients, family members of patients, or people who directly provide aids and care for the patients.
3. The third is experiencing the realistic or unrealistic fear of infection, social isolation, exclusion, and stigmatization. This directly affects patients, family members, care and help providers, or even the general public.

While many mental health conditions will decline out after the COVID-19 pandemic, many of the symptoms of PTSD can continue a lot longer and as a society, we need to be mindful that these events are linked to the fallouts of trauma.

1. Increased divorce rates
2. Substance use disorders
3. People using prescribed medications
4. Anxiety and depression

Most epidemiological studies indicate the survivors reported the highest prevalence of PTSD, followed by victim families, medical professionals providing care to patients with infectious diseases, and others.

Early psychosocial care is PTSD always the recommended  

Doing What Matters in Times of Stress: An Illustrated Guide is a stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. A few minutes each day are enough to practice the self-help techniques. The guide can be used alone or with the accompanying audio exercises.

Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances.