By Mark Goulston, MD and Diana Hendel, PharmD 

Healthcare employees on the frontlines of the COVID-19 pandemic face distressing daily circumstances. We all know the many reasons why: long hours on the clock, exposure to extreme levels of death and suffering, and the fact that they risk their own lives to come to work each day. No wonder so many are struggling with anxiety, depression, burnout, and traumatic stress.  

The “just-get-over-it” culture permeating our industry only makes things worse. But the fact is, most healthcare workers can’t just get over the trauma they encounter each time they report for a shift.  

That’s why so many of them are at risk for developing post-traumatic stress disorder (PTSD). Healthcare workers showed signs of PTSD following earlier epidemics like SARS and Ebola. And early research indicates that already it’s happening with COVID-19 as well.  

But there is some good news for healthcare workers: It’s not too late to avoid being impacted long term by traumatic stress or PTSD. Here are some tips to help you circumnavigate the impending PTSD pandemic.  

Acknowledge why you feel so upset these days. There’s a reason (many of them, in fact) that you may be feeling uncharacteristically anxious, panicky, or hopeless right now. You don’t have to dwell on them, but it is important to name the stressors you encounter at your job and to explore why they make you feel the way they do. A few examples:  

• Uncertainty about how much longer the virus will be around 

• Staffing shortages 
• Grieving with and for your patients and their family members 
• Facing too much death too quickly 
• The risk or reality of hospitals reaching patient capacity 
• The personal risk to your own health (and the risk of transmitting the virus to others) 

Trauma is like an unhealed wound. Start thinking of it that way. Imagine an inflamed abscess hidden beneath the surface of the skin. You may forget that it’s there…until you bump it and feel excruciating pain. Only when you drain the abscess and allow it to heal from the inside out can you alleviate the pain. This metaphor of trauma as an unhealed wound that has been sutured too soon is a good explanation of the way unaddressed trauma impacts an individual.  

Learn and watch out for PTSD symptoms. Click here for a comprehensive list of symptoms associated with PTSD. In the meantime, be on the lookout for the main symptoms:  

• Unwelcome or intrusive thoughts 

• Avoiding anything that reminds you of the trauma you have experienced 
• Negative thinking, such as I didn’t do enough to save my patient 
• An on-alert nervous system; it keeps you safe but can cause edginess, exhaustion, and anger 

Practice feeling your feelings using this distress relief exercise. This is an effective way to explore your feelings and your reactions to your feelings whenever an upset of any kind or size occurs. You can use it if you feel triggered by anything reminding you of COVID-19, such as the memory of a deceased patient or the noise of sirens. When a trigger or an upset occurs, go through the following steps:  

1. What just happened?  

1. What did you think when it happened?  

1. What did you feel when it happened?  

1. What does it make you want to do now?  

Take a deep breath. 

1. What would be a better thing to do now?  

1. Why is that better?  

Commit to taking good care of yourself. It’s especially important right now to practice good self-care and develop healthy habits that lay a foundation for wellness. Commit to getting enough sleep, cooking healthy meals that sustain and nourish you, and getting 30 minutes of physical activity several times a week. These practices will nurture your body. But don’t forget to also pay attention to your emotional needs. Spend at least a few minutes meditating or breathing slowly and deeply every day. Also, prioritize activities that bring you pleasure, whether that’s enjoying a good book, listening to your favorite music, or playing with your pet.  

Join a peer-support group (or start one yourself). If your organization does not already have a formal support group, you can make an informal group of your own. This “fire team” can be made up of your fellow trauma survivors who have experienced everything you have gone through. Together, you can process the feelings and emotions you are facing and work toward building resilience.  

Get help from a professional. Sometimes traumatic stress or PTSD requires treatment from a professional. Don’t be ashamed to get help if you need it. Check out your organization’s employee assistance program for a counsellor or request a referral to a therapist that treats traumatic stress. Before committing to a therapist, ask these questions: What approaches do you use to treat PTSD, and do you feel that they will be right for me? What do you think causes PTSD, and what needs to happen for a person to recover from it? How long do you think my therapy will last?  

If you’re a leader, communicate optimism, confidence, and resolve to your team. During the pandemic, leaders should focus on creating a safe work environment while unifying the staff and decreasing uncertainty. Here are three ways to do this.  

• Commit to clear communication. This means providing timely information and clear directions regularly.  

• Listen to your team. You will likely hear some messages of fear, pain, resistance, and maybe even anger. But during an ongoing traumatic experience, it is more important than ever to listen with empathy and compassion.  
• Offer trauma-informed services and resources. Make employees aware of any employee assistance programs, peer-to-peer support groups, and counselling services available to them.  

It may seem as if the pandemic is here to stay forever, but like all things, it too shall pass. Meanwhile, the approaches you develop to process traumatic stress will help you weather the storm and emerge with greater resilience. It takes courage and effort, but you can heal from this or any other trauma and reclaim your life.   

Mark Goulston, MD, FAPA, is the coauthor of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020). He is a board-certified psychiatrist, a former FBI and police hostage negotiation trainer, and the bestselling author of PTSD for Dummies, Get Out of Your Own Way, and Just Listen: Discover the Secret to Getting Through to Absolutely Anyone.  

Diana Hendel, PharmD, is the coauthor of Why Cope When You Can Heal?: How Healthcare Heroes of COVID-19 Can Recover from PTSD (Harper Horizon, December 2020). She is a leadership coach and consultant, former hospital CEO, and the author of Responsible: A Memoir, a riveting and insightful account of leading during and through the aftermath of a deadly workplace trauma. 

For more information, please visit www.whycopewhenyoucanheal.com.