On Monday, May 11, the Spanish Pain Society organized a virtual conference to discuss how the COVID-19 pandemic is changing and will change assistance to people suffering from pain.
Among other topics, the importance of the psychological impact that this crisis could have on the general population and, specifically, on people suffering from chronic pain, and health professionals who have been more exposed to contagion during the crisis, was discussed.
Specifically, it was commented that we may see an increase in cases of post-traumatic stress. This is because there are many people who have experienced situations of high emotional impact during the crisis: income in intensive care units, death of patients and loved ones, being exposed to infection, suffering social isolation or lack medical resources, among others.
In this text we want to delve a little deeper into the psychological aspects of post-traumatic stress in order to break with some stigmas and false beliefs associated with this diagnosis.
Before describing what a psychological treatment for post-traumatic stress consists of, there are some considerations to keep in mind:
A traumatic experience does not boil down to death
Events such as having threatened one’s life or personal integrity (for example, a serious injury), being a direct witness of a traumatic experience of others, being aware of a traumatic experience of a close person or being exposed to unpleasant details of a trauma from others (For example, working as healthcare professionals), are also considered traumatic.
Post-traumatic stress symptoms should not be interpreted as personal weakness or something we should feel guilty about
There are many factors that can explain why a person develops more or less intense post-traumatic stress symptoms, such as their genetic characteristics, having been exposed to other previous traumatic events, their learning way, the severity and duration of the traumatic experience, the support received during and after living the traumatic experience, etc.
Blaming yourself only increases your suffering further, and looking like someone weak can cause you to not seek psychological help. However, not all people exposed to highly stressful situations develop post-traumatic stress, nor do they all present the same symptoms and with the same intensity. Therefore, it is perfectly possible that, although you have experienced very stressful situations during this pandemic, you never present serious psychological consequences.
Before starting treatment, it is essential that a professional make a proper diagnosis (a primary care physician, psychiatrist, clinical psychologist, or general health psychologist). Therefore, self-medication should be avoided.
Seeking professional help and sharing concerns with those who are significant to us is not accepting defeat, it is taking a step toward recovery. Although there is still a certain stigma regarding mental health, emotional distress is universal, and normalizing human suffering is essential for seeking professional psychological support to be seen naturally.
In fact, psychological therapy is the treatment with the best evidence, especially in the long term, for managing post-traumatic stress according to scientific clinical guidelines.
What is a psychological treatment for post-traumatic stress?
There are different psychological treatments with proven evidence for post-traumatic stress, among which are Cognitive Behavioral Therapy, Cognitive Processing Therapy, Prolonged Exposure Therapy and Cognitive Therapy.
There is evidence, although not as robust, about other psychological treatments, such as EMDR and Narrative Exposure Therapy. Therefore, we will focus on what we can expect, broadly speaking, from treatment with the four therapies mentioned above that have received the most scientific support.
These are the aspects that are generally worked on in these therapies:
This is a first phase of treatment, in which the psychologist usually shares information that helps to understand and normalize the symptoms and reactions to the lived experience.
The objective of this phase is for the person to understand that some reactions to a traumatic event, such as avoiding thinking or talking about the trauma or even carrying out behaviors as damaging as drinking or taking drugs to avoid feeling emotions in such an intense way, have as Aim to protect ourselves from what we experienced in the short term.
However, these reactions often maintain and worsen symptoms, make it harder for trauma to process healthier and harm our bodies (for example, in the case of alcohol or drug use).
This phase also usually explains what the proposed treatment will consist of.
Cognitive restructuring or processing
The objective in this phase is to identify and modify thoughts that may be maintaining the symptoms of post-traumatic stress such as “the world is an unsafe place”, “it is my fault that this happened”, “it is unbearable to have these emotions”, ” everything is very unfair ”or“ I could not bear that something similar happened to me again ”.
For this, the behaviors carried out so far are normalized to protect us from the lived event but it is explained that these same behaviors may be maintaining the symptoms and the problem in the long term. Also learning to question these thoughts by replacing them with less harmful ones such as “in the world both safe and unsafe things happen, not everything is unsafe”, “perhaps there was some behavior that I could have done differently, but it was hardly my responsibility and being wrong is human “,” although I do not like certain emotions, I can live with them and running away from them will only bring me more problems “,” in life I will live both just and unfair situations, there will be both and I can live with it ” or “although it would be very uncomfortable, I could bear that something similar happened to me again and now I have more resources to face it than before” …
In this phase, the goal is usually for the person to reduce fear of thinking about trauma and increase their control over fear. For this it will be important to differentiate between what can harm (a traffic accident), and what cannot (remember a traffic accident).
Gradual exposure to remembering what happened and to situations / places being avoided (the store or the hospital ward where the stressful event was experienced) is important to gain security, tolerance of discomfort and, ultimately, to give new meaning to what happened in order to have a more satisfactory life.
The goal of psychological treatment for post-traumatic stress is for the person to experience symptoms less intensely and lead as functional a life as possible.
For this, the behaviors carried out so far are normalized to protect us from the event, but it is explained that these same behaviors may be maintaining the symptoms and the problem in the long term.
For this reason, the thoughts that can provoke the maintenance of certain behaviors and emotions must be identified and the patient is asked to expose himself, both in his imagination and in real situations, to memories and situations or places that have been avoided because they are associated to the traumatic experience, provided that these situations or places are not really harmful; for example, in a traumatic memory of a traffic accident, the person would obviously not be exposed to having a traffic accident, but to the memory of it and to walking or driving on the street where it happened.