Trauma is defined as an experience that overwhelms the brain’s capacity to remain in an organized state.  There are two types of trauma, death-trauma and complex trauma. 

Death related trauma is 911, combat exposure, and rape.  It is exposure to a threat of death and violence so immediate and powerful that it overwhelms the capacity of the brain to remain in an organized state, and the stress-arousal axis of the vagal nervous system-hormonal-limbic-amygdala tracts remain in a hyper-activated stress state following the traumatic exoposure, unable to relax and down-regulate.  Perry and Briere are the top sources in death-trauma.

Complex trauma is child abuse, spousal abuse, and pandemic (also called, Developmental Trauma; van der Kolk).  It is exposure to prolonged fear, anxiety, and stress.  Complex trauma is relationship-based trauma of high-stress/high-anxiety for extended periods of time. Bessel van der Kolk is the top resource in complex trauma.

Pandemic is complex trauma with overtones of death-trauma threat depending on the lethality of the pandemic.  Covid-19 is relatively small in its death-threat anxiety except with vulnerable populations. The impact of Covid-19 pandemic will be less death-related trauma and broader complex trauma throughout the population from disruptions to social bonding, severe economic insecurity, and the loss of a security in a way of life, all for an extended period time in a high-fear, anxiety, and stress laden context.

Sources of Pandemic Complex Trauma

The complex trauma of pandemic has five primary sources.

1.)  Threat to health security.

The lethality of Covid-19 is high but remains in normal-viral range (it’s not the plague with a 60% mortality rate).  However, it is extremely serious for vulnerable populations, compounded by overwhelmed medical systems that increase the traumatic exposure for both the sick patients, their families, and the first-line medical responders.

2.)  Threat to economic security.

The quarantine and social isolation requirements needed to flatten the curve for transmission of a pandemic in order to prevent overwhelming the healthcare system devastates personal, local, state, national, and global economies, bringing them to a standstill.  The surrounding economic insecurities add to immense personal financial insecurity to create for every single individual everywhere a major source of prolonged fear, insecurity, and anxiety, as a major source for the complex trauma of pandemic.

3. Threat to social bonding security. 

Pandemic requires social isolation as the protective response. This is contrary to every fiber in our attachment networks that motivate us to come together in times of threat.  We regulate anxiety and sadness through our attachment networks of social bonding – when in danger, come together.  However, with pandemic we must do the opposite, pandemic preys on us when we are in groups.  For pandemic’s threat we must move apart, we must isolate, and we lose our primary coping of social bonding and social support, adding to the complex trauma of pandemic.

4.  Threat to the stability of the known. 

Pandemic undermines every security we have, routines are entirely lost, the future is completely unknown, financial threats are immensely real and yet the future in unpredictable, and our healthcare system is overwhelmed.  In normal circumstances all of these security sources would be available for trauma recovery, anchoring in the stability and rhythms of routine, the stability of the realistic future expectations to calm anxieties, and confidence in our surrounding social supports.  All of that is lost with pandemic.

5. Threat to family.

For families with elderly or health-vulnerable family members, the death threat of pandemic is personal.  For these families, the threat from pandemic is to a personal family member lost or at risk of death, and this threat does not end anytime, it is now a threat within our families, toughing us personally; our parents, grandparents, brothers, sisters, children, aunts, uncles, our close friends, all face serious and prolonged threat to their health.  Furthermore, parents with children now face enormous family stresses of managing daily child supervision with work responsibilities, and facing terrifying financial insecurity when supporting children on limited financial resources that are now lost and threatened into the future.  The fears of  parents for their family stability is extreme, and their stresses in daily child management increase severely.

Coping Resources Available

None.

Social Resources:  Pandemic requires social isolation.  Normal social bonding coping responses to stress are lost.

Response:  Turn to the Internet to bridge social bonding.  Professional psychology needs to adapt its service delivery to online media – direct telepsychology support and therapy services, informational resources on websites and blogs, Facebook groups led by trauma recovery psychologists addressing the complex trauma of pandemic, informational videos on YouTube for parents, the elderly, and people coping with financial insecurities from pandemic. 

Professional psychology needs to adapt its services delivery modalities and approaches in response to the complex trauma of pandemic – turning to the Internet to break social isolation.

Physical Resources:  Exercise becomes limited, gyms close, yoga studios close, dance, theater, every form of expressive venting of stress is shut down and people enter social isolation at home.

Response 1 Stress Expressive:  Turn to the Internet to develop social groups in physical-expressive activities.  Fitness coaches, yoga instructors, dance instructors, for adults and children, all need to become more active through the Internet to address pandemic. 

Response 2 Reflective Integration:  Professional psychology needs to both support this activation of physical coping resources through the Internet, and then layer in a down-regulatory intervention for anxiety management and coping.  The physical activation and release of stress release can be accompanied by additional instruction in mindfulness training and relaxation techniques to reduce stress and bring a grounded center to the person’s regulatory networks for stress – physical release and relaxation (down-regulation) training – both through the Internet to break social isolation of pandemic.

Response 3: Down-Regulation:  The up-regulatory system is anxiety, the down-regulatory system is sadness.  The high-anxiety, high-stress, high-arousal complex trauma of pandemic requires down-regulation to access the resources of calming, relaxation training, mindfulness, and integration.  This requires the activation and processing of the sadness, grief, and loss surrounding pandemic lost security, lost social contact, lost stability, and a lost way-of-life.  The sadness, grief, and loss from pandemic will need to be opened, expressed, and resolved to access the down-regulatory networks of sadness to counter the hyper-activated up-regulatory system of anxiety and stress.

Financial resources:  During the acute crisis of pandemic’s arrival, financial resources for everyone are strained and lost.  Small businesses shut down, employees are furloughed and laid-off, paychecks stop, sales stop, income stops for many, and for those that maintain their income the general financial insecurity that surrounds them means that they save for insecurity and financial resources are not available as a coping response.

Response:  Saving and carefully managing finances is realistic and important during the social and economic insecurity created by pandemic.  Many will increase their online nurture-buying to cope with anxiety, but that’s not necessarily a good thing. Online purchasing will be important to keep the general economy moving, particularly for businesses that span both brick-and-mortar and online sales.  However, the stresses of pandemic and social isolation may prey on the increased nurture-buying of unnecessary and financially irresponsible nurture-buying purchases by financially insecure people who should apply their limited financial resources in more productive ways.  Financial exploitation of anxiety is a particular concern in a pandemic world of chronic fear and and unresolved anxiety.

Psychotherapy of Pandmic

All current psychotherapy models were developed for in-person face-to-face communication.  While videoconferencing is available through the Internet, there are significant and important differences between in-person and computer-mediated communication.  New models of psychotherapeutic intervention need to be developed that use the unique opportunities available from the Internet, and that do not rely on the interpersonal elements that are lost from the in-person encounter.

Interactive Journaling

Adapting the self-growth activity of journaling for online Internet-mediated therapist-client delivery offers valuable opportunities.  Normally, journal writing is considered a solitary activity, yet text-based communication on the Internet is the norm for social communication.  Extending the text-based medium of the Internet into an interactive journaling format holds unique and promising oppotunities for a uniquely Internet intervention.

Journal entries by the client can be sent to the therapist, who can responded with gentle questioning, eyes-of-the-other responding, attuned support and guidance, drawing the client into the next journal entry.  Journal writing is an established and demonstrated effective approach to trauma recovery, bringing cognitive mediation to otherwise overwhelming emotional-psychological experiences.

Online Group Therapy

Group therapy instruction and skills development is an immensely effective delivery medium, limited in the physical-world by travel and geographic limitations that are not restrictions in cyberspace.  On the Internet, a group can be comprised of people across a geographic regions, virtually anywhere, and attending a group therapy instruction and skills development group is easy to achieve for the participants within the context of their day-to-day schedules.

The differences between in-person (more intense) face-to-face contact of physical-world group therapy and the online social group medium of people in small squares on your computer screen (less intense) require adjustments to the traditional psychotherapy methods of group therapy (Yalom).  Online groups would benefit from a core spine to their structure of skill development and instruction, which is then supported by the interpersonal psychotherapy principles of group therapy (Yalom).

The prolonged exposure to the complex trauma of pandemic will require adaptations and modifications to how professional psychology responds and the delivery systems it uses in its response.  An expanded use of the opportunities afforded on Internet-mediated communications and the need to break the social isolation imposed by pandemic will require expanded discussions of both treatment delivery and models for psychotherapy with the complex trauma of pandemic.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857