Stress in the time of Corona

Lynne Jones

AGENDA• Introductions

• Why do we get stressed?

• How does stress affect our minds and bodies?

• What are the current stresses that we face as

volunteers?

• Is stress a mental illness?

• What are the best ways to cope?

– Helping vulnerable individuals and communities

– Taking care of ourselves

• Frontline workers

• Volunteers at homeLynne Jones 2

1. Why do we get stressed?

The survival functions of fear

• Imagine that you are alone, deep in a tropical forest and a large branch behind you breaks.

• Imagine that the ground beneath your feet and the walls begin to shake violently

• Jot down in the chat your immediate responses under the following headings

– Feelings

– Thoughts

– Behaviours

– Physiological responses

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Responses

• Feelings: fear, anxiety (uncomfortable)

• Thoughts: Appraise the threat: what is that? Is it a tiger? is this an earthquake? Should I run? should I hide?

• Behaviours: flight, fight, freeze, submit, appease, avoid response

• Physiological adaptation:the stress response

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The Fight/flight response…

Humankind’s built in alarm system:

Adrenalin

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When might it be useful to be

anxious?

Write down your ideas

in the chat box

The evolutionary functions of

various forms of anxiety• Predators: flight/fight: survival

• High places: freeze not flight: prevents falls

• Social threats: submission and conform

• Blood and injury: fainting: < blood loss, inhibits further attack

• Anxiety in public places or with strange groups: keeps you close to home

• Sudden traumatic events: heightened memories, avoidance and hypervigilance;

• Nightmares: learning and reorganisation of memory

• Separation anxiety: keeps one connected to those who can protect

• Phobias (conditioned responses to archaic threats- snakes and spiders cf. cars and alcohol)

• Hysterical conversion: signals ‘no danger’ in conflict

• Obsessive compulsive behaviour: avoidance of contaminant or escape through repetitive cleansing

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Red are doing better than

grey squirrels

When red squirrels sniff out the scent of their

predator – the pine marten- they are much

more vigilant than grey squirrels who ignore

the threat and get eatenhttps://www.bbc.co.uk/news/science-environment-51637091

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2. How does stress affect our

minds and bodies?

Physiology of the fight/flight

response

• Increased adrenalin (epinephrine)

• Enhance clotting- deal with wounds

• Glucose release-energy

• Sweating- keep cool, skin slippery

• Decreased saliva

• Pupil dilation- see better

• Hair on end - look bigger

• Rapid breathing >O2,<CO2, run faster

• Cardiovascular changes– Increased heart rate- run faster, fight better

– Blood flow away from skin and gut – muscles: run faster, fight better

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What happens when neither fight

nor flight is possible?

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Protection

• Hair stands on end

• Pupils dilate

• Sweat

• Dry mouth

• Faster breathing

• Faster heart

• Blood away from

GIT

• Blood to muscles

Abnormal feelings

• Odd sensations

• Blurred vision

• Sweat

• Choking

• Cannot breathe

• Palpitations

• Constipation/gut disturbance

• Muscle aches

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Vicious circles in anxiety

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3. Stress in the time of Covid 19

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Brainstorm on current stressors

• Please use chat box to describe things

stressing you out most at the moment?

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Some possible stressorsAffecting refugees

• Fear of illness

• Fears for loved ones

• Fear of violence

• Increased human rights

abuses

• Lack of access to

information/misinformation

• Not enough space

• Soap and water

• Other basic needs

• Stigma

Affecting us

• Fear of illness

• Fears for loved ones

• Fear of violence

• Long way from home

• Lack of access to people

we want to help

• Powerlessness

• Information

overload/misinformation

• Boredom/Frustration

• Self isolationLynne Jones 17

Everyone will have some or all of these

• Tiredness

• Anger

• Sadness

• Numbing

• Disorganization

• Forgetfulness

• Irritability

• Tearfulness

• Poor sleep/nightmares

• Poor concentration

• More phobic and/or obsessional responses

• Physical aches and pains

• No appetite

• Withdrawal

• Feeling overwhelmed

• Cynicism

• Hopelessness

• Apathy

• Lack of self awareness

• >Alcohol/tobacco

consumption

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4. Does that mean I have a

mental illness?

No: acute stress is a normal

reaction to an abnormal

situation

Stress responses vary

• Culture

• Context

• Expectations

• Gender

• Age

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Kosovo, Macedonian border

1999• Kosovar

Fainting

girls

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Hyperventilation

• Fear

• Adrenalin

• Respirations increase

• Chest breathing

• Too much oxygen/too little CO2 (Hypocapnia)

• Chemical imbalance: chest pain, choking feeling, pins and needles, in fingers and round mouth, feeling dizzy, spasm in hands (carpopedal spasm)

• Fear of fear leads to more fear

• Fainting and collapse

• Common in some cultures

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Asian Tsunami 2005

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‘Post Tsunami Distress’

• Sleep disturbance

• Sadness/ tearfulness

• Somatic aches and pains

• Feeling of choking

• Strong visual memories

• Remembering all the time

• Not avoidant- seeking connections with loved

ones/ loved places

• Not necessarily experienced loss

• No marked loss of function

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Haitian earthquake• Large

numbers

presenting

with

palpitations

and a

sensation that

the ground is

still moving,

intense fear

particularly if

asked to go

indoors

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Somatic complaints

• Chest pain, palpitations

• Bodily aches and pains

• Headache

• Gut disturbance

• Odd sensations

• Dizzyness

• Localised pain- to old wounds

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Second World War

• Emphasis on resilience

• 134 patients treated in a London emergency department:

• ‘They were all told that their reaction was due to fear, that that fear was one they shared with all other patients and the first aid workers, and that it was important that they should return to their normal work and resist the temptation to exaggerate the experiences through which they had passed,’

• Reactions ranged from ‘acute emotional disturbance’ to stupor and hysterical paraplegia. All 134 were discharged within twenty four hours and only six needed further treatment over the next nine months.[i]

• [i] Mental reactions to Air Raids, Henry Wilson, Lancet, March 7 1942.

The stiff upper lip…

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Acute stress in

children

• May present with a wide variety of symptoms

– somatic symptoms such as pain;

– behavior disturbance, regressive behavior, increased clinginess,

– bedwetting

– sleep disturbances

– nightmares and night terrors

– phobiasLynne Jones 29

Covid 19 Will some anxiety related behaviours have survival value?

• Phobias

– Social anxiety

– Agoraphobia

– Germ phobia

• Obsessional compulsive rituals

– Cleaning

– Checking

– Avoidance

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5. How can we help others

and ourselves?

Care4Calais volunteers at work in the camps. Photograph: Kim Willsher

How to help-class exercise

• Briefly identify an upsetting experience

that you have had in recent years: ( a

bereavement, accident, natural disaster…

• In the chat box list the top three things that

helped in the first week after the event

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What helped?

• Having people you love around you

• Having information

• Feeling safe

• Not having to worry about basic necessities like food and water and shelter

• Being treated with dignity

• Being treated with compassion

• Being listened to…..

• Legal assistance

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This is what some people call

psychological first aid

LOOK, LISTEN, LINK

– LOOK: Assess needs and concerns

– LISTEN: without pressuring the person to talk

– LINK: Help the person to address immediate,

basic physical needs including safety

– Help people connect to services, family, social

supports and accurate information

– As far as possible, help protect the person from

further harm.

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Helping the most vulnerable

• Address basic needs: food, shelter

WATER, SANITATION, HYGIENE,

• Provide information in an understandable

accessible form

• Provide means for social connection when

physically distanced or isolated

• When these things are not possible:

ADVOCACY FOR ALL THE ABOVE

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Frontline workers

• Up to date, accurate information about risks

• Safe working conditions: (masks, gloves, change of clothes)

• Adequate space to withdraw from the working situation

• Space for ventilation as appropriate and desired

• No compulsory psychological debriefing

• Sleep

• Proper diet

• Physical exercise

• Connect to receive support from significant others

• Time away from the field

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Volunteers at home

• Explanation: understanding sources of stress- being informed but NOT overloaded

• Sleep

• Proper diet

• Structure to your day

• Physical exercise

• Distraction

• Regular social contact while maintaining distancing

• Opportunities for altruism: Local mutual aid, advocacy for international situation

• Distraction

• Symptomatic relief: rebreathing, AMT

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Sleep is not a luxury

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How to help get more sleep

• Address environmental causes where possible (e.g noise)

• Explain that insomnia is common after recent exposure to extreme stressors.

• Sleep hygiene

– Stop caffeine

– Increase physical exercise

– Remove all technology from sleeping area at night

• Relaxation and stress management techniques help in older children and adults

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Reducing stigma (from WHO)

• COVID-19 has and is likely to affect people from many countries, in

many geographical locations.

• When referring to people with COVID-19, do not attach the disease

to any particular ethnicity or nationality. Be empathetic to all those

who are affected, in and from any country. People who are affected

by COVID-19 have not done anything wrong, and they deserve our

support, compassion and kindness.

• Do not refer to people with the disease as “COVID-19 cases”,

“victims” “COVID-19 families” or “the diseased”. They are “people

who have COVID-19”, “people who are being treated for COVID-19”,

or “people who are recovering from COVID-19”, and after recovering

from COVID-19 their life will go on with their jobs, families and loved

ones. It is important to separate a person from having an identity

defined by COVID-19, in order to reduce stigma.

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Should we debrief?

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Psychological Debriefing

Psychological Debriefing involves promoting

some form of emotionalprocessing/catharsis

or ventilation by encouraging the

recollection/ventilation/reworking of the

traumatic events

AIMS:

1. Reduce psychological distress

2. Prevent the development of mental

disorders at a later dateLynne Jones 43

WHO recommendation

• WHO issued a recommendation against the universal

use of psychological debriefing in 2003 and updated and

retained this recommendation in 2012: Psychological

debriefing should not be used for people exposed

recently to a traumatic event as an intervention to reduce

the risk of post- traumatic stress, anxiety or depressive

symptoms. WHO Guidance 2012. Available at:

http://www.who.int/mental_health/mhgap/evidence/resou

rce/other_complaints_q5.pdf;

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What has worked for you?

Please put additional ideas in the

chat box

Some poor coping strategies

• Alcohol

• Drugs

• Risk taking

• Ventilation of feelings on colleagues and beneficiaries

• Overeating

• Not eating

• Belief in being indispensable

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Exercise: Stress management

• Let's relax . . .

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Take home lessons: personal

• Give yourself time

• Take days off, exercise

• Find some beauty in the natural world every

day

• I am not indispensable

• Not wishing to talk =/= denial

• Wishing to talk=/=weakness

• Coping methods differ

• Listen to what your friends and colleagues tell

you re how you are doingLynne Jones 48