As COVID-19 infection rates decline across the United States and vaccination eligibility expands, many people are looking forward to returning to favorite activities and social connections this summer.
But as we transition to what comes next, according to two Stanford experts on stress and trauma recovery, many people will face new, and likely unexpected, mental health challenges.
Figuring out what aspects of pandemic life to keep or change may be tricky: Some people will jump into new adventures, some will remain cautious and many of us will fall somewhere in between. Whatever the case, the shifts may feel uncomfortable.
"The fact that we acknowledge this as a transition is good because it helps us avoid extreme thinking," said Victor Carrion, MD, who is the John A. Turner Endowed Professor of Child and Adolescent Psychiatry. "We don't go from a pandemic straight back to normal as we knew it before."
Understanding how the brain reacts to stress and trauma can help us take a more intentional approach to our new lives, said Carrion, who directs the Stanford Early Life Stress and Resilience Program. It can also help build resilience, the process by which people adapt productively to hardship.
"We often talk about resilience as a trait, as something you have or don't have, but it's actually a set of behaviors people can learn," said Debra Kaysen, PhD, professor of psychiatry and behavioral sciences. Kaysen is an expert in post-traumatic stress disorder and how people recover from difficult experiences.
Being resilient doesn't mean avoiding distress, she said. Rather, it's normal for people to experience difficult emotions such as sadness, anxiety and stress at the same time that they are putting their resilience into action. There are concrete steps everyone can take to become more resilient, Kaysen added.
The brain on stress
Stress exists on a spectrum, Carrion explained: A little bit, which psychologists call "eustress," is good because it motivates us. Less positive but still manageable are acute stressors, which are short-term, then resolve, and which we can handle without long-term harm. However, stressors that become chronic, as the pandemic has, can cause real problems because some coping strategies may backfire.
"As we've lived in a global pandemic, where there were both real and imagined threats, the behaviors we learned were reinforced, especially for people who didn't get sick," Carrion said. "For example, we might say, 'I didn't get sick because I crossed the street when I saw people on the sidewalk.' Unconsciously or consciously, we may make a connection between the behavior and the outcome even if they were not related."
While crossing the street is helpful during a raging pandemic, it could become maladaptive: We'll feel afraid of others, even as COVID-infection risks decline. "If applied in the wrong scenario, behaviors that were once helpful may become maladaptive," Carrion said. "Still, it may be challenging to give some of these learned behaviors up."
Even worse than chronic stress is traumatic stress. "For most people, COVID-19 on its own is not a traumatic stressor," Kaysen said. "But for some it is, such as people who have lost a loved one, frontline health care workers exposed to high risk of contracting COVID, or overburdened mortuary workers."
How to strengthen the resilience muscle
Fortunately, the experts said, recovery from both chronic and traumatic stress is possible by building resilience.
And that starts with getting positive social support and giving support to others.
"We've been disconnected from extended family and friends, and if we aren't active in restoring those connections, it can remain that way," Carrion said.
Kaysen also recommends identifying coping strategies that you know work for you and practicing them as diligently as you brush your teeth or eat your veggies.
"When we're stressed, we tend to turn inward, isolate and withdraw," Kaysen said. "Often, the first things that go are those that give us joy, because we think, 'That's frivolous.'"
Instead of waiting until you feel like doing something enjoyable, it's better to start restorative activities simply because you know it will make you feel better.
"The reality is we don't have to feel like doing things to do them. Most people don't feel like doing their taxes, but you feel better once you do it," she said.
What if your favorite activities still feel unsafe, or you're anxious about some of them? Carrion suggests listing every activity that worries you, then ranking them from most to least anxiety-provoking. Do what makes you least anxious first -- maybe going to an outdoor farmers' market or hiking with a friend.
"Find something that is still safe but that changes your experience a bit," he said.
Parents of toddlers and preschoolers face special challenges when helping them learn how to cope with post-pandemic life because very young children lack memories from before the pandemic.
Little ones who have felt safe and normal staying home all the time might see no point in putting pants on and getting into the car, and they can be quite stubborn about saying so. "To be fair," Carrion said with a chuckle, "a lot of adults won't want to put pants on and go to the office, either."
Carrion advocates judicious use of bribery: Offer a positive reward to motivate very young children to do something new -- the child's brain makes an immediate connection between the new activity and a positive result. A favorite snack food (a few apple slices, one potato chip), a toy that lives only in the car, or an offer to drive past a child's favorite location ("We're going to see the garbage trucks!") could do the trick.
Finding a path forward
For everyone, Carrion said, it's important to balance acknowledging hard times with building for the future.
"It's a time to grieve for our losses," Carrion said. During the pandemic, people may have lost loved ones, jobs, school experiences and much more. "We cannot avoid it or pretend it didn't happen. We need to reset and move forward."
Also, watch for signs that you or a loved one might need help from a mental health professional, Kaysen said.
"If someone is having trouble functioning as a parent or at work, or is not able to get out of bed or do things that have to get done, it may be time to see someone," she said.
To help focus on the future, Carrion recommends looking for ways to help people in the community around you.
Mentally reframing what we've experienced can help, too. For instance, instead of dwelling on the uncertain timeline of the pandemic, try to focus on how far we've come.
"You can think: 'What if someone told me at the beginning that this would be two years? We've already done one year and now have more scientific knowledge of the disease, plus several effective vaccines,'" Carrion said. "Reconstruct your thinking, not to pretend your negative thoughts aren't real, but to see what competitive positive thoughts can be there to ameliorate them."
Free self-help tools: Kaysen recommends self-help tools created by the VA's National Center for PTSD, for use on their own or as an adjunct to working with a mental health professional. They are free and don't sell or share your data: COVID Coach and Insomnia Coach. She also recommends: PTSD Coach and CBT-I Coach
Photo by Jukan Tateisi