As a certified registered nurse anesthetist, Christina* is used to working in a high-stress environment. Patients under her care undergo major surgeries, from pre-schedule procedures to emergency interventions, related to trauma or other life-threatening events. Christina prides herself with being able to keep her cool in stressful situations like these; it’s a skill not taught in medical books that patients need from her. But nothing has tested her cool-as-a-cucumber mentality like COVID-19.
Experts in This Article
Alison Block, PhD is a a licensed psychologist and the director of the Health Psychology Center, located in Oceanport, New Jersey. Dr. Block is also the director of the psychosocial curriculum for the Department of Medicine at Monmouth Medical Center, an affiliate of the Robert Wood Johnson Barnabas Health Care System.
David Rubin, PhD is a professor of psychology and neuroscience at Duke University. He has extensively studied memory and PTSD, with the aid of a National Institute of Mental Health grant.
Roxane Cohen Silver, PhD, is a professor of psychological science, medicine, and public health at University of California, Irvine. She specializes in coping with traumatic life events (personal losses and collective traumas), stress, social psychology, and health psychology.
The horrible, heart-breaking stress medical professionals have experienced since March of 2020 has been the subject of many news articles and headlines. Heart-wrenching stories about patients too sick to be saved, and doctors and nurses too overwhelmed with patients that they are unable to properly grieve losses. But for Christina, the stress and anxiety of being a nurse during COVID-19 actually came long before any patients with the disease were under her care.
“Back in March, [my colleagues and I] started getting hourly emails on different changes that were being made due to COVID-19 and everyone started freaking out,” she says. “No one knew what to expect and we were seeing reports out of China and Italy which made us wonder if we even had the right supplies to work safely around potentially positive patients.” She was being bombarded with emails—about changes in how to interact with patients, what to wear, alerts about the increase in cases—all while Christina was trying to perform at her already fast-paced job.
Besides the emails, Christina says supervisors changed work shifts, which added to the stress. And, like many other medical providers across the country, she too didn’t have the protective gear needed, saying there wasn’t an automated external defibrillator (AED) N95 mask that fit her properly available for her to use—despite the emails saying how crucial they were.
“I was getting so stressed out that I was crying in the break room,” she says. And all of this was before anyone with COVID-19 walked through the doors of her hospital. “Anticipating what was going to happen made me feel a new level of anxiety that I’ve never felt before,” she says.
The type of anticipatory stress Christina experienced isn’t limited to front-line workers. Over the past several months, the bad news cycle is seemingly never-ending. Pandemic. Murder Hornets. Police brutality and violence against Black people making headlines day after day. An increasingly hostile election cycle. A prediction of a second COVID-19 wave. It’s no wonder more than one-third of Americans are feeling anxious right now. And for some people, like Christina, that anxiety might be manifesting into something known as pre-traumatic stress.
What is pre-traumatic stress disorder?
“Pre-traumatic stress is an anticipatory type of stress that mirrors post-traumatic stress disorder in its symptoms,” says Alison Block, PhD, a licensed psychologist and the director of the Health Psychology Center in New Jersey. Dr. Block explains that in both cases someone can experience flashbacks, nightmares, severe anxiety, and obsessively think about an event. The difference is, with pre-traumatic stress disorder, the event hasn’t happened yet. “What’s happened to many people during the pandemic is that they’re faced with news of what’s happening constantly, which can cause them to worry about what may happen to them or their loved ones,” she says—in ways that make it hard to function in their day-to-day lives.
Roxane Cohen Silver, PhD, a professor of psychological science, medicine, and public health at University of California, Irvine, says that pre-traumatic stress disorder is not an official psychological disorder in the DSM-5 (the official manual used to diagnose mental health conditions). However, she says that this kind of anxiety has very real symptoms for those who experience it. And it isn’t new to the pandemic, either. “Here in Southern California, every year there is a threat of forest fires. It would be understandable for firefighters to feel anticipatory stress heading into the season,” she says.
Because pre-traumatic stress disorder isn’t officially recognized, there aren’t many studies on it, but one paper published earlier this year did show a link between pre-traumatic stress and worrying about climate change. Climate change is a problem so big and complex that its looming effects can cause some to panic. Another study on pre-traumatic stress disorder dates back to 2014 and focused on Danish soldiers being deployed to Afghanistan. David Rubin, PhD, the co-author of the study, says the soldiers experienced pre-traumatic stress before going to war, anticipating what was to come. They also experienced it again after returning. Slightly different than post-traumatic stress disorder, he says their thoughts focused on what could happen to them on their next tour, not necessarily flashbacks or anxious thoughts about what had already happened.
But Dr. Rubin says pre-traumatic stress disorder can be triggered outside of a war, too. “If someone had stressful experiences at home as a child, they can experience pre-traumatic stress at the thought of going home for the holidays,” he says, citing one example. He adds that the pandemic can make people especially prone. “With the pandemic and then [the death of George Floyd], many people are on edge,” he says. “That contributes to both general anxiety and anxiety in the form of pre-traumatic stress.”
When it’s more than just everyday worries
Again, it’s normal to feel a bit more worried and stressed than usual. (I mean, just look at what this year has been like.) However, Dr. Block says that if those worries and fears become all-consuming and make it hard to function every day, it’s a sign to seek out help from a professional. There are a wide variety of teletherapy options now that are typically more affordable than traditional in-person treatment, including text therapy as well as one-on-one digital sessions and online support groups.
There are also some things anyone can do at home to help better support your mental well-being and protect against stress. Dr. Silver highly advises minimizing how much news you’re consuming. You can still be informed about the world while only checking the news once or twice a day—the bombardment of news alerts on your iPhone may be doing more harm than good.
Dr. Block also recommends reaching out to your support system. “Whatever you’re experiencing, you do not have to go through it alone,” she says. Talking through your fears with family or friends can help—and talking about things completely unrelated to your fears can help, too. Dr. Block also recommends regular exercise and meditation, which are both linked to lowering anxiety and stress.
There’s no denying that life right now isn’t normal—for anyone. But debilitating overwhelm shouldn’t have to be your default. Use this time to check in with yourself, and ask for help when you need it. It’s the first step on the path to healing.
*Name has been withheld.
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