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A trauma-informed response to covid-19

By Iain Boag

Humans are incredibly adept at coping with stress and uncertainty – our nervous systems are primed to direct us to safety, capable of quickly shifting gears, readying our bodies and minds to respond effectively to threat and danger.

Over the recent months we will all have felt that heightened state in some form or other, and reacted differently – we might have become more vigilant, slept or eaten more, drunk more alcohol, or slept less. For some people this surge of (possibly dysfunctional) safety-making behaviour might have taken the form of rational problem-solving, for others a strong urge to talk things through. Some people might have denied they were affected, still others feeling a stoic determination to face things head on.

Each of us cope in different ways, borne from a lifetime of learned behaviour, of struggle and success, and no one way is the right way.

There is however a truth about human bodies – we are not designed to live with chronic uncertainty or stress, our lives are supposed to be a series of ebbs and flows. Our physiology yearns for calm and consistency – we create this for ourselves at home, and, in a nutshell, this is what we are all trying to achieve for our service users in our work as well.

A defining aspect of complex trauma is the feeling of uncertainty – of not knowing when a threatening situation will end. We can, generally, tolerate great stress if we can see an end in sight – research shows that after a deeply distressing single event such as an earthquake or terrorist attack only around 15% of people will need any ongoing psychological help.

A defining aspect of the recovery process from trauma is having the space to share the trauma story – to feel a sense of communality, acceptance, and recognition.

The ongoing nature of the covid-19 epidemic places us, individually, as a community, and as an organisation, in a unique situation. There is no obvious end in sight, and yet we’re all in it together. The cause and the cure in convergence, indelibly bound.

In our work we are used to hearing stories of individual trauma and adversity, however in this case the story is not just happening to someone else, it’s happening to everyone. We are collectively feeling the communal narrative flex and twist in a way we have never done before. The fact that we are all facing the same changes and uncertainty, that our entire country – and indeed world – is facing the same challenge gives us rare opportunity to reflect together on how we cope as a community, and to respond with shared purpose.

For us to do this successfully requires us all to be open, accepting and connected. To welcome others’ reactions even if they do not reflect our own, and to choose to incorporate the current incongruence into our collective story.

A message that shines through Trauma-Informed work is that people are able to change, and this is also true of our social fabric – our responses to events are driven by our past experiences in the context of our current environments, and they affect each other.

As our collective story progresses we can draw from our successes in the face of threat to increase our resilience – individually and collectively – and use the ‘new normal’ as an opportunity to enact positive change.

Rather than hoping that things will ‘bounce back’, a facet of true resilience is the ability and drive to ‘bounce forward’ – to draw from experience and to use it as a point of growth.

The ongoing experience of Covid-19, as we regroup after the first wave and look towards the next phase, asks us, as support workers, to reflect and create a narrative plaited from the shared experiences of the team members and service users – the so-called ‘lived experience’ usually used to describe the clients’ story becoming a communal stream – we are all going to be Covid-19 veterans, together.

The Psychologically Informed Environment (PIE) approach is a practical tool we can use to help us negotiate the coming weeks of reflection, and, undoubtedly, further spikes of stress and difficulty.

The central premise of the PIE framework is that the relationships we build are the key tools for change. As traditional supportive systems stutter and fail, we can draw from this core tenet and have confidence that we carry within us the skills to help people feel safe and cared for, simply through our urge to reach out and connect.

The framework also asks us to use reflective practice to examine our actions and situation. Never before has there been such a need to take a collective breath and consider how we can best support each other and our service users over the next phase of this epidemic – by looking both back and forward. Reflection gives an opportunity to celebrate success and frame distress, these, flip sides of the same coin, borne from a determination to not let the people we work with down.

Moving forward, we can use the PIE framework as a foundation to build new practices on – as an operational tool to help us ensure our environment is as supportive as possible. Critically, this does not mean making a space perfectly welcoming, currently a likely impossibility, rather it emphasises honest appraisal, that we should stay aware of how the environment might impact our clients – of how a more clinical experience, full of masks and more intrusive infection control, might make people feel, and therefore react. Could these safety-making interventions increase feelings of isolation or frustration? If so, how can we find ways to best mitigate these distressing feelings.

The PIE principles and trauma-awareness asks us to work as a community. The polyvagal theory – a therapeutic model that looks at how our autonomic nervous system and stress responses affect our behaviour – suggests we, as individuals and as a group, need to address 3 elements to successfully feel settled. These are context, choice and connection.

If we reflect and contextualise our experience as a group; recognise we all react differently but hold the same values and goals; and strive for connection within our teams and with our service users, then we will create a new-normal that is resilient, caring, accepting and flexible. These assets will allow us to negotiate and adjust to any future eventuality – uncertain or otherwise.


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