Jane Moffett, PhD is a psychotherapist specializing in the treatment of trauma and traumatic loss. Earlier this year, in the Spring, she participated in a webinar for the Rhode Island Episcopal Clergy addressing concerns about the coronavirus pandemic and offering insights into how we can help those in need. While we mourn the loss of so many, within our country and around the world, this pandemic has also plunged us into a period of economic devastation with millions of unemployed Americans facing homelessness and hunger. Compounding the trauma is the uncertainty of the upcoming presidential election: both the process and the outcome. And, as the Black Lives Matter movement continues to call out racial injustice and the need for radical change in our nation, we simultaneously must grapple with the disproportionate loss of life and the increased risks Covid-19 has on Black Americans. Many of us are at a loss of how to deal with these compounding traumas.

This month, WVFC has been presenting Dr. Moffett’s three-part series on the pandemic (See Adapting to Changes in our Work and Personal Lives and Trauma and Battle Fatigue). In this week’s post, A Pandemic Self-Care Tool Kit, Dr. Moffett expands on the ways we can care for ourselves and others, including how to cultivate peace of mind during the work day, prioritizing emotional self-care, and practices that can help grieving family members and friends. 

I understand that these posts may cause anxiety for some of you. It is normal to want to have a lovely summer and many may want to avoid more talk of the pandemic, the economic crisis, and the many other issues that American citizens are dealing with. If these posts are too much at this moment, save them for another time. No one really knows what to say or how to write about these painful experiences in a way that will resonate for everyone. We hope that you recognize that we at WVFC are making our best effort to be part of a national conversation — one that will help us collectively find a way forward. 

We welcome and are thankful for Dr. Moffett’s contribution to WVFC during this unprecedented time in American history. 

—Dr. Pat 

A Pandemic Self-Care Tool Kit

By JANE MOFFETT, LCSW-R, PH.D., S.E.P

Practical Considerations for Peace of Mind

Bookend your day: Working at home, the days can flow together. If you are working from home, it is helpful to have a defined workspace, organized in such a way as to feel separate from the rest of your home. We don’t end the day by leaving the office and commuting home. Consider a way to mark the clear end of your day. 

Calming hypervigilance: In another era, someone who was troubled might take a break by sitting back from their desk, lighting, a cigarette, and looking out the window. If you think about it, they were breathing in and out deeply, and taking a moment for reverie. Simple breath works to turn off your survival smoke alarm and calm your nervous system.  Most of us have learned breathing techniques from various sources. What we may not have been taught is the importance of the out-breath. The exhale part of the breath cycle activates the parasympathetic nervous system, stimulating relaxation. You can figure out how long to exhale by experimenting. Try your longer exhale, maybe 7 counts, and shorter inhale, maybe 3 counts first. Repeat it a few times. Emphasizing the exhale, shortening the inhale. Modify this as it suits your needs.

Structure is important (especially if you are subject to depression): If you are in a transitional time, and your days are more open ended, think about creating some structure. If you are working a lot, be sure to include mini-breaks in your day. 

Sleep: Everything has changed, and there is an underlying anxiety about what is coming. With the effects of hypervigilance, increased work demands, and possible family stressors, you may not be sleeping well. Further, the stress hormones I mentioned earlier, adrenaline, cortisol, and norepinephrine, also make it harder to sleep. You might make time for an internet free hour before bed – unplugging from the news and stimulation to let your nervous system settle. If these steps don’t work, it may not be a good idea to tough it out. There are non-addictive sleep medications that are safe. Consider speaking to your doctor about one to use a few nights a week. Sleep deprivation can lead to depression, trouble focusing, eating issues, and irritability. 

So much emphasis now is placed on socialization through drinking. Monitor your alcohol and other drug use. If you are worried about an increase, you may have a problem. While alcohol is a great release for some, it can cause fitful sleep and lead to a low grade depression the next day.  

• Be aware if you are drinking more than usual.
• If you cannot take a 5 day drinking holiday you may have a problem, 
• Be honest with yourself about how you are feeling in the morning – is the wine from last night making you feel unwell?
• Pay attention to whether you might be uncomfortable with your behavior after drinking. 
• While it is hard to acknowledge that something that can relieve stress and loneliness can also be harmful, consider other ways to relax.
• If you don’t want to give up drinking, there are good programs for drinking moderation. 

Healthy food is important. We also know that skipping meals and eating food higher in sugar can increase depression. If you are on the go, treat yourself at the grocery store to healthy snack packs, portable fruit, and good quality protein.

Emotional Self-Care

Knowing your response style to danger will help you take better care of yourself in unsettling situations. 

• Are you a fighter, do you withdraw and need extra space, or do you  go deep inside? 
• Many of us have a combination of these reactions.
• If you tend toward fight, watch for unexpected flares of anger or irritability. 
• If you tend towards flight or freeze, you may need to make an extra effort to stay present and engaged.
• It may be important for you to verbalize that you need some extra time: “May I think about this and get back to you later today or first thing in the morning?”

Try reframing mistakes, not as failures, but as part of the process of mastering the pandemic learning curve. Some of our best learning comes out of making mistakes. It is how we repair those mistakes that makes all the difference.

Watch for shame. If you don’t know Dr. Brene Brown’s work on shame, vulnerability and empathy, this is a good time to listen to her Ted Talk “Dr. Brene Brown on The Power of Vulnerability.” If we are too hard on ourselves, we can be immobilized by painful shame. Further, we miss an opportunity to fashion a more suitable response by asking for feedback. 

Make time for “face to face” time with family and friends. Contact with close family and friends is just as important as food. 

• Research by Dr. Steven Porges tells us that it is very important during the pandemic to see the faces of people we love, and hear their voices. He has a short Youtube: Dr. Steven Porges on Face to Face Social Engagement. 

• For introverts it may be tempting to text and email. But make some time for Facetime or Zoom connections.
• For extroverts it may be hard to tolerate long periods without human contact and the opportunity to process life events with someone special.

Touch is so important, but we are missing simple contact through touch: handshakes and hugs.  There are two trauma therapies that use touch for emotional self-regulation. 

• EMDR: Laurel Parnell is the Director of the Parnell Institute, a training institute for trauma treatment called EMDR. She originated a technique called the butterfly hug, using the EMDR concept of bilateral stimulation. Google “Butterfly Hug: A Simple Grounding Technique,” you will find guided relaxations using touch. 
• EFT: The Emotional Freedom Technique, uses meridian points on the head, sternum, and hand to relieve stress, anxiety, fear, depression, and help with insomnia. Brad Yates uses humor, and adds warmth to his guided demos. He offers a guided YouTube on help with sleep: “Tapping in a Good Night’s Sleep with Brad Yates.” 

Death and Dying : The Lack of Completion 

One of the cruelest aspects of Covid-19 is that people are dying alone.  Family members are being denied access to their dying loved ones in the most heart-rending ways. In our current environment, funerals are limited to a very small group. We know that this adds to the family’s grief,  complicating the resolution of guilt feelings which can accompany a loss. 

Practices to Help People with Completion

There are few practices that may help grieving family members, or those suffering from shock trauma.  Reactions to devastating loss and extreme stress can be divided into two categories. The first are people who keep talking, almost looping – going over and over the experience – this is a form of the fight response. So, you might see anger mixed into the despair. The second group are people who are lost inside themselves with grief – a variation of the flight and freeze response. And they may have trouble speaking.

Two strategies that may help process grief are completion and titration.

Completion:  When someone is not able to be with a dying family member to provide comfort and to say goodbye, they often need to “complete” the experience.  Invite the person to tell you what happened from start to finish.  Are there things they wished they could have done or said?  If the bereaved person cannot speak much, suggest they write a letter to the person who has died, saying all the things they want them to know. Offer to help them write that letter, and/or can ask if they would like to  meet again to think about the letter together.

Titration: This leads to titration, pacing the telling of the narrative slowly so the person can integrate what you have to offer. A simple question can slow someone down. For example: How are you feeling now as we talk?  Look for ways to build in pauses, to give the other a change to process and reflect as they are speaking.

Leading with the Negative: When some people are in a lot of pain, they can lead with the negative: anger, resentment, and blame. This can be off-putting, but for some it is a part of the process of grieving. However, if it doesn’t shift over time, there may be further work to be done.

Addendum:

Compassion and patience are crucial tools that are sometimes hard to access as we are all coping with stress and uncertainty at the moment. Remember to keep reaching out for support.