It’s no surprise that 2020 was a challenging year — with the pandemic bringing anxiety, grief, burnout, and financial strain to the masses, not to mention other stress-inducing events. Now that we’ve entered Winter 2021, we are currently experiencing a new challenge: navigating the pandemic’s effects at a time that is already difficult for many people. With pandemic fatigue, shorter and colder days, and social isolation, it’s safe to say that this winter hasn’t been an easy season to date for many people. Despite this challenging time, the good news is that we can do things to help us prepare for and cope with the transition into winter. 

Learn to enjoy the outdoors

Nothing is worse than experiencing months of winter when you hate winter. The antidote? Find ways to engage with the outdoors. The cold is an apparent reason why people struggle with winter. I’ve found it’s easier to bear with preparation — investing in warm and comfortable winter wear is a helpful first step, and a hot beverage in hand can make things more relaxing. Taking up a winter sport or activity can also make the outdoors more fun. Why not try sledding with the family on the weekend, try cross country skiing, or try to see the beauty in wintery nature by going for a walk? Trying different activities can also bring variety to your life, which is sometimes lost when we ‘hunker down’ during the pandemic.

Exercise 

With the winter months bringing in higher rates of depression and seasonal affective disorder, finding ways to cope is an essential step in their treatment. While exercise may not be a solution to these disorders, research has shown physical activity to be as effective in treating mild to moderate depression as medication (O’Neal, Dunn & Martinsen, 2000). Winter is when many people want to stay inside watching movies on the couch, and engaging in exercise might feel like a chore. The key is finding an activity you like and ways to make it the most comfortable choice. The best exercise is the one you’ll do, and often, it’s easiest to engage in an activity when it’s a part of your routine (like brushing your teeth). Experiment with a time of day that works best for you. Many people feel most motivated in the morning, and engaging in health behaviours early on in the day can snowball into more health behaviours as your day continues.

Try a little Hygge

‘Hygge’ (pronounced: “hoo – guh”) is an integral part of the Danish lifestyle, encompassing coziness, warmth, and wellbeing through enjoying simple pleasures in everyday life. Though Denmark is known for having intense winters, the hygge lifestyle is a custom that has contributed to making the country amongst the world’s happiest. So how do you incorporate more hygge in your life this winter? Light candles, snuggle under warm blankets, gather some good books, enjoy comforting foods, fit in some quality time to connect with loved ones – what sorts of things will you try? 

Schedule regular social time

Ever find that it’s becoming increasingly more comfortable to be socially isolated during the pandemic? These social distancing regulations make it challenging to spend time with our loved ones in the same way we once did. Many of us can become inclined to isolate; but, isolation can make winter especially difficult considering a time when depressive disorders are most common. Scheduling weekly video calls or socially distanced walks with loved ones helps manage the effects of social isolation. 

Be kind to yourself

When times get rough, it can be tempting to look for someone to blame — and we often direct it to ourselves. While many of us are our own worst critics and often criticize ourselves for instigating change, we may promote the opposite. How can any of us have a positive relationship with ourselves, feel motivated to complete work, or begin a healthier lifestyle if we unceasingly criticize, condemn, nitpick, or hate ourselves? We often speak to ourselves in a way that we wouldn’t talk to our worst enemy–so why say them to the person we’re supposed to have the most connected, intimate relationship with — ourselves? When you’re in the self-critical headspace, try talking to yourself as if you were your own best friend. What would they say? Would they be judgmental or provide a balanced view of the situation? Would they tell you all of the things you’re doing poorly, or would they highlight the positive and how for you’ve come? Would they provide further criticism, or would they soothe the wounds you’ve created for yourself? Remember, all you are ever doing is the best you can, at this moment in time, with the resources you have. That’s the best anyone can ever ask for, given the circumstances!

Seek professional help

Life isn’t simple, especially during a pandemic. Admitting that we need help can sometimes feel complicated. But no matter where you’re at in your life journey, you’re never broken — just stuck. Seeking professional help can be an excellent way to maintain your wellbeing and get support during your most trying times.  Consider contacting the Centre for Interpersonal Relationships (CFIR) if you are seeking therapy services. CFIR is a collective of over 70 clinicians who provide various treatment and assessment services and work with clients of all ages, life stages, cultural, sexual, gender, and romantic orientations. Free consultation and reduced fee options are available, making our services an affordable and accessible option for your therapeutic needs. We hope to be a part of your support network!

References

O’Neal, H. A., Dunn, A. L., & Martinsen, E. W. (2000). Depression and exercise. International Journal of Sport Psychology.

Carolyn Streich, BMus, B.A. is a counsellor at Centre for Interpersonal Relationships working under the clinical supervision of Tracie Lee, R.P. (Registered Psychotherapist). She currently holds a B.A. in Psychology (Honours), and is in her final year of her Masters in Counselling Psychology program (M.Ed) at University of Ottawa.

COVID-19: An existential crisis

Amidst the coronavirus pandemic much concern has been raised regarding its toll on our mental health.  Strategies for managing the inevitable stress inherent in such a crisis are many and readily available on the internet, discussed on television, and in government bulletins. The reach of the pandemic, however, is far deeper than most realize, touching us at a profoundly existential and spiritual levels.  

COVID-19 and the sweeping government actions taken to contain it, have unearthed the “illusion of control” that most of us live under. The pandemic has revealed the apparent fragility and uncertainty of our lives and called into question our sense that we are in control of our destinies. Traditional therapeutic interventions alone may be inadequate to ease our spiritual/existential angst. Turning to spiritual resources can do much to bring peace and provide purpose amidst the pandemic. 

Finding inspiration from the past 

We are not the first to face a crisis of global proportions. Previous generations have lived though world wars, plagues, natural disasters, and much more. Unlike in our modern times, however, the illusion of control was more fleeting in the past, the fragility of life assumed, and dependence on a power greater than themselves more a part of most peoples’ experiences. Looking to stories of heroes’ suffering and being triumphant in the past and learning the spiritual lessons that enabled them to rise above their circumstance and thrive can be a great source of inspiration in these uncertain times. 

Reclaiming our spiritual heritage

We are no different than they with the need to see beyond this momentary crisis.  The fragility of life is every bit as real today as it was then and so is our need for a spirituality that can provide solace and the ability to rise us above our circumstances. Every group of peoples that has inhabited Earth has brought with it a spiritual belief system. Our ancestry not only includes our biological DNA but our spiritual one as well reminding us of our connection to our past, to others, and to God or the spiritual forces find strength in.  These building blocks hewn from millennia of spiritual and religious belief are what have formed the foundation of our moral conscience and the bedrock of the best in human nature. Understanding the transcendent and transformative power of the spiritual convictions that sustained those that came before us can be a catalyst for discovering our own spiritual convictions and a source of strength and solace amidst this current crisis. 

Spiritual resources around us 

Spiritual resources of all traditions abound.  They are readily accessible on the internet, at home in sacred texts, in local faith communities, in pastoral counsellors and in spiritual health practitioners in some mental health services.  Drawing on such spiritual resources can ground our struggle in ageless spiritual traditions and within communities of faith as well as providing a needed adjunct to traditional psychotherapy.  

Prayer and/or meditation

Private and family prayer and meditation can have a great calming and unifying effect.  It has been said that prayer does not change God but rather changes us.  Spending as little as three minutes a day in prayer or meditation can work wonders in grounding and quieting our minds. The effects of pray and meditation are many. They allow us to rise above the chaos of the moment. They calm us creating a sense of safety and security in uncertainty. They unify us drawing attention to our common need amidst discord.  They instill compassion expanding the scope of our concerns to include others outside of our circle. They are restorative allowing us the opportunity for honest expression of our need in a caring and accepting environment. Lastly, they help us realize the limits of our capacity to effect change while reminding us of forces greater than ourselves that can be accessed to work on our behalf.

An attitude of gratitude

Thankfulness is a primary spiritual state of being with tremendous ramifications for mental health. Recounting three blessings each day before going to bed has shown to reap great benefits for maintaining a healthy state of mind.  Being that blessing, can bring a seismic shift away from self-absorption toward compassion for others as well as for ourselves. Looking for the everyday gratitudes that mark our lives can change fatalistic pessimism into hopeful optimism. The scope of gratitude far outweighs that of negativity by opening our hearts and minds to the spirituality that exists everywhere in our everyday experiences and the benevolence that is ours for the asking.   

Let go and Let God

Recognizing and accepting our fragility and lack of control of our lives can be a tremendously liberating experience as we, as they say, “let go and let God.” Finding a spiritual anchor that can give both hope and security amidst this everchanging COVID crisis, can provide peace and purpose within the pandemic.

Dr. Marjorie Swarthout, C.Psych. is a Registered Clinical Psychologist at CFIR Ottawa. Prior to receiving her doctorate in counselling psychology, she had nearly 15 years of experience and extensive training as a psychotherapist and multifaith spiritual heath practitioner. 

Marjorie has been a been a university guest lecturer and conference presenter exploring issues of spirituality in mental health care.

Existential thinking has boiled to a crescendo for many since the first pandemic began. “What is my purpose?” “What does everything mean?”; there’s no shortage of questions keeping people awake at night. In the last installment of the three-part ‘Mind-Body-Wellness Sessions’ series, Tracie Lee, M.A., R.P. (registered psychotherapist at Centre for Interpersonal Relationships – Ottawa) and Stephanie Karlovits, (founder and CEO of EPIC Fitness + Lifestyle ) share insights on supporting your physical and/ or psychological well-being by managing persistent existential thought patterns. Breathe deep, get present, and listen in now:

We’re back with another episode of ‘Mind-Body-Wellness Sessions’ part 2 of 3! In this segment, Tracie Lee, (registered psychotherapist at Centre for Interpersonal Relationships – Ottawa) and Stephanie Karlovits, (founder and CEO of EPIC Fitness + Lifestyle – Ottawa) talk about how coping with the pandemic has been affecting so many of us mentally and physically. There are ways to feel better, and in this video, this amazing duo of wellness professionals tells us what we need to know.

We love it when great insights come together! Tracie Lee, (registered psychotherapist at Centre for Interpersonal Relationships – Ottawa) and Stephanie Karlovits, (founder and CEO of EPIC Fitness + Lifestyle) recently recorded a 3-part mini-series called ‘Mind-Body-Wellness Sessions.’ The series explores ways to make psychological and physical wellbeing a priority in our day to day living, and why it matters.

In episode 1, Tracie and Stephanie discuss why it’s often essential to integrate the mind and body, especially during challenging times. Check it out!

“I just need to get over it and not let it bother me” or “I don’t think talking about this will help” are responses I often hear in my clinical work. Such reactions are often from men who have, or are currently experiencing emotional and psychological hardships. Challenges can range from concerns such as work-related stress, relational difficulties, trauma, anxiety, and depression. Another source of mental health stress for men (often less noticeable) is trying to maintain societal expectations and stereotypes of what it means to be masculine. Such harmful stereotypes often depict men as never being vulnerable, not acting or behaving in emotional ways, and solving their problems independently. This perspective can often begin in childhood when children are told “boys don’t cry,” and the ongoing societal pressure for men to remain ‘strong’ and not admit they are struggling.

Due to such beliefs and ideas, men are much less likely to seek support or treatment. This reasoning may help explain why men have lower rates of diagnosed depression; however, suicide rates are three to four times higher in men compared to women. Knowing this, how do we help men reach out for support?

Firstly, we need to be aware of the signs of mental health difficulties. Men and women may experience the same mental health conditions at various times, although men might show different signs and symptoms. Rather than seeking treatment for a specific condition such as depression, men are more likely to engage in maladaptive coping behaviours including turning to alcohol or drug use. Depression in men can also be characterized through anger and irritability in addition to expressions of sadness. Knowing how men might show signs of mental illness and the associated risk factors is required to seek or encourage support.

Secondly, it is crucial to be aware of the harmful stereotypes associated with the idea of masculinity, which serves as a barrier for men in seeking help. As human beings of all genders, we experience emotions, which at times might be complex and challenging to organize and make sense of on our own. Expressing emotion or vulnerability does not equate to weakness. As humans, we are a social species, and we thrive collectively. Discussing our difficulties with others and having a support system help to provide a sense of relief and understanding.

Lastly, it is essential to remember that you are not alone. If you are struggling emotionally yourself or are concerned about someone, know that you are not alone in experiencing such difficulties, and you do not bear the load in silence. Whether its offering support to someone by listening, talking to a family member or friend, or reaching out to a therapist who you can build a non-judgemental and trustworthy relationship with, knowing you are not alone is a vital step in finding support.

Edgar Prudco is a therapist at the Centre for Interpersonal Relationships (Toronto) and works under the supervision of Meg Aston-Lebold. Edgar is completing his Masters degree in Clinical Psychology at the Adler Graduate Professional School. He supports individual adults and couples to deal with difficulties related to emotion (e.g., depression, anxiety, anger), the effects of trauma, loss & grief, conflict resolution, and relationship functioning.

As the possibility of business and recreation gradually reopening becomes more of an imminent reality, many of us will face the opportunity to step out into the outside world again, into closer contact with other live (not-virtual) human beings, for the first time in months. 

Despite many social media narratives that celebrate this possibility, the actual emotions we might face as such opportunities become realities might be a lot more complex than that.

When COVID-19 initially hit, we fell suddenly and unexpectedly into a full-blown crisis. As with any onset of crisis, it is common and even likely to feel emotions like anxiety, worry, panic, overwhelm, and fear.

And as long as we continue to live in this crisis, especially as food, work & income, and housing remain uncertain for so many, we can expect these emotions of anxiety, worry, panic, overwhelm and fear to stay present. 

Everything inside of us is mobilizing—body and mind—to meet these threats that we face, and to survive them. 

Now that we are a couple of months into the pandemic, I am seeing some clients in my psychotherapy practice who are beginning to enter into the next phase of emotions. Since we’ve now had some time to start absorbing a bit of the new reality, and certainly, as we anticipate returning to work, the main emotions we are feeling are expected to shift. Increasingly, I anticipate seeing more people with emotions like depression, chronic boredom & under-stimulation, frustration, hopelessness, helplessness, and despair.

As we continue to take in more of what we have been experiencing, we are going to feel more of the weight of it all, and at times that weight is likely to feel quite heavy. 

So, what can you do to support yourself through these current and upcoming emotional experiences? For me and the way that I practice psychotherapy, the answer comes back to ‘connection.’ 

Firstly, it is essential to maintain—or build—connection to yourself. Once or twice per day, for 15 or 30 or 60 seconds at a time, stop and check-in with yourself. Notice what is happening in your thoughts and feelings, and even in your body. Notice your breath, notice your bodily sensations, and check in on them at various moments and throughout the following days because they are likely to fluctuate. 

Self-monitoring, in this manner, can help you to feel grounded in yourself and your experiences. It can also help you to identify when you need help—and this leads to a second point: we also need to be maintaining connection to others. 

If you find yourself struggling or feeling unwell, try to reach out. Of course, you can always reach out to a psychotherapist, and you can also reach out to a close friend or family member who might intently listen to you, or else might help you problem solve, depending on what you need. 

You can also try going for a walk to give your thoughts some space, or write them out, or even audio record them for yourself. In any of these cases, reaching beyond yourself to outwardly express what you are thinking and feeling can help you release some emotional burden, and so can help you to feel a little better. 

Secondly, as you are reaching out to others, do not forget that you can probably assist others, too; there can be a mutual exchange of support. Sometimes all someone might want is to be heard, and even in times when we feel we have nothing left to give, just existing next to someone alongside their experiences can bring great relief. The relief is mutual, as we benefit from a dose of feel-good chemicals in the brain when we connect with and help others. 

One final thought on emotions in this next stage of the pandemic: sometimes we can forget that it is absolutely possible to feel many different things, including stress and hopelessness, and even gratitude, or any other mix of emotions, all at the same time. These feelings can co-exist together.

If we can hold on to this thought, maybe we can make even just a tiny bit more space for the feelings of connection and groundedness. 

Take good care.

Reesa Packard, M.A., Ph.D., R.P. is an Associate and registered psychotherapist at CFIR (Ottawa). She has a doctoral degree from the Saint Paul School of Psychotherapy & Spirituality and works in private practice as a registered psychotherapist. She works with clients hoping to develop a more integrated sense of self as a means to well-being and meaningful, lasting transformation. Reesa is also involved in the teaching and supervision of psychotherapists-in-training and advanced knowledge through research in her specialty fields.

Coping with acute stress

Note: The sympathetic nervous system is the part of the nervous system that is responsible for activating the fight or flight response (i.e., acute stress response) and preparing the body for the necessary activity to protect itself from actual or perceived danger. The parasympathetic nervous system is the part of the nervous system that is responsible for recuperation and is important in feeling safe and calm.

There are many strategies we can learn and strengthen to help us tolerate and reduce the intensity of acute distress. It is important to note that we do not want to make the emotion “go away” as this will likely initiate less adaptive coping strategies, such as repression, denial, avoidance, and escape distraction. When coping with a distressing emotion, I encourage people to learn to tolerate some level of that emotion (i.e., within a “window of tolerance”), while also engaging in and using strategies to help reduce the intensity of that emotion. It is important to keep in mind that learning to tolerate emotion is a valuable skill and through practicing distress/emotional tolerance, we allow the emotion to rise and fall and, ultimately, run its natural course; while tolerating the emotion, we can “listen” to the emotion as it provides valuable information about what might be happening in the environment. Also, it is important to remember that all emotions are temporary. 

The following are a few examples of strategies that can be used to help reduce the intensity of a distressing emotion and bring it to a level that is tolerable; the goal of the following strategies is to help reduce nervous system activation (i.e., sympathetic nervous system) and increase parasympathetic nervous system function:

1. Intense exercise: 3-5 minutes (or more) of intense exercise (i.e., enough to elevate your heart rate) will help to burn off anxious or distressing/unpleasant energy which is pent up and activating the sympathetic nervous system. This will help the body to regulate (allowing for the onset of the parasympathetic nervous system).
2. Recovery-oriented relaxation strategies: there are a variety of activities and strategies that can be used within this domain and I encourage you to think about activities that help you experience a sense of ease and relaxation. Furthermore, encourage you to reflect on experiences that’ll allow your body to experience muscle relaxation to help reduce pent-up muscle tension.

• Progressive muscle relaxation: this strategy uses repetitive tension and release movements in various muscle groups to help reduce muscle construction patterns induce muscle relaxation.

• Diaphragmatic breathing: at any point when we are experiencing an unpleasant or distressing emotion, I encourage people to take stock of their breathing an attempt to slow their breathing down using deep, diaphragmatic breathing techniques. In doing so, feedback loops to our brain provide information and indicate that we are calmer and safer than the brain is interpreting. Deep breathing by itself may not be enough to reduce the intensity of the emotion we are experiencing, especially if the emotion is 8-10/10, with 10 being more intense. I encourage people to include deep breathing while using another strategy.

• The “dive” technique: I use and recommend a modification of this strategy, which includes using a Ziploc bag full of cold water and is placed over the eyes, including the undereye area. There is a nerve that runs underneath the eye that, when cold, activates the parasympathetic nervous system.

• Listen to calming music: Our nervous systems are acutely attuned to sounds from the environment. When we intentionally play music that is calming, we are providing a message to our nervous system that we are safe.

• Use heat to induce muscle relaxation: Acute and chronic stress responses involve muscle tension. Using heat will facilitate muscle tension release and relaxation, in turn, sending information to the brain that you are relaxed and safe.

3. Mindfulness: The regular and intentional practice of mindfulness meditation can help develop our cognitive resources of attention allocation in order to more swiftly let go of distressing thoughts and sensations. As well, mindfulness helps create greater awareness of our bodies and minds (i.e., flow of consciousness). As we expand our intentional practice of mindfulness exercises into our greater daily experience, we allow ourselves to become more present in each moment, letting go of past and future thoughts and feelings, and creating “space” for in-the-moment experiences of cultivating contentment, joy, and ease.

Tip:  Finding it difficult to find time to engage in the above? Or single strategies not as effective as you would like? Try “doubling” or “tripling” up on the above strategies to send multiple signals to the brain that the body is calm/relax and safe. I encourage you to add deep breathing to all activity!  

Coping with chronic stress

There are many ways to cope with acute stress and chronic stress that can be applied at various times in our lives when acute and chronic stressors are present. I often encourage people to first take stock of their “foundations.” 

The Five Pillars to Wellbeing

1. Sleep
2. Nutrition
3. Exercise/Movement
4. Enjoyable activities (that bring you a sense of contentment, joy, and ease)
5. Social connection 

By taking stock of these five “pillars,” we can start to make small, manageable changes to our foundation, which in turn, will provide us with ample physical and mental resources to facilitate our ability to cope with acute and chronic stress. It is important to note that during times of chronic stress, we often experience destabilization related to one or more of the above pillars; as well, when we get “busy,” we often reallocate time away from the above activities, which further perpetuates and exacerbates the impact of the chronic stress/distress. As such, I strongly encourage people to dedicate time (i.e., create “protected time”) each and every day to ensure maintenance of the above pillars.

Coping with Pandemic Stress

1. Use gentle avoidance. Often psychologists help people to limit their use of avoidance as this is often driven by anxiety and leads us to be unable to engage in activities that he might otherwise enjoy. However, in some contexts, such as this pandemic, I encourage people to practice gentle avoidance regarding some aspects of activity and knowledge consumption.

• Limit media consumption: The key here is to find reliable sources of information where you can stay informed about the procedures and guidelines to keep you safe. Additional information beyond this may contribute to and perpetuate anxiety.

• Avoid discussing events: Although it can be helpful at times to discuss the pandemic and associated changes with friends and family, people can get swept into “anxiety spirals,” which worsen the acute/chronic stress impact and can maintain anxiety beyond the conversation. Also, misinformation can be shared, and in the context of high anxiety, it is easier to believe misinformation and become more fearful or paranoid. 

• Keep things in perspective: Speaking with reliable sources can help us keep information in perspective and help to abate and let go of anxiety-driven thoughts/beliefs (e.g., catastrophizing). Remember, if people are bringing up topics of conversation regarding the pandemic that provoke intense feelings of anxiety/distress in you, it is ok to set boundaries and ask the person to not bring up said conversations with you.

2. Stay connected. Remember, we are social creatures and we thrive off of social connection, regardless of our place on the introversion/extroversion scale; the difference here is the frequency and intensity of social connection. Although phone and video connections do not provide the same sense of connection as in-person connection, it is important to stay connected to friends and family. Isolation, especially if living alone, can become very dangerous to our mental wellbeing. Without external sources of support, emotion-driven thoughts/beliefs can take hold and we start to believe them more strongly. 

• Keep things in perspective: Speaking with reliable sources can help us keep information in perspective and help to abate and let go of anxiety-driven thoughts/beliefs (e.g., catastrophizing). Remember, if people are bringing up topics of conversation regarding the pandemic that provoke intense feelings of anxiety/distress in you, it is ok to set boundaries and ask the person to not bring up said conversations with you.

• Use social connection as a source of adaptive distraction: Talk about topics that bring you contentment, joy, and ease! Share information about books/literature, movies/TV shows, and/or other hobbies and enjoyable activities. You may even wish to reminisce by sharing fond memories.

• Remember that life will go on: It is important to acknowledge/validate that the pandemic and associated changes is difficult; however, because we cannot control the pandemic, it is not helpful to wallow or become preoccupied with the difficulty. Remind yourself and your family/friends that life will continue and try to anchor yourself to something hopeful in the future (e.g., a trip, a goal, an activity).

3. Movement/Exercise: Whatever the type of movement, try to incorporate some form of movement on a daily basis, whether it be walking, stretching, or a formal workout routine. Our bodies are meant to move and, as a result of self-isolation protocols, we are not moving as much as we have before. 

If you are having difficulty coping with acute, chronic, or pandemic stress, I encourage you to reach out to a professional (psychologist or psychotherapist) who can assist you in developing and strengthening your coping skill repertoire, as well as address other contributing factors to the maintenance of your symptoms. 

Dr. W. Rylie Moore, C.Psych., is a clinical psychologist & neuropsychologist at CFIR’s Toronto location and he has published academic articles in peer-reviewed journals and book chapters. As a requested presenter at numerous national and international academic conferences, Dr. Moore has spoken on topics related to gender dysphoria, LGBT2QA advocacy, psychological assessment, executive functions (cognitive abilities that could be described as the CEO of the brain), stuttering, and bilingualism. In his therapy practice, he works with clients to understand what is happening for them in its larger context, including past experiences and their social world. 

Reesa Packard, R.P., Ph.D. (Associate at CFIR – Ottawa) was on the airwaves with 1310News’ Sam Laprade! The two shared an engaging discussion about managing mental health throughout the pandemic and beyond. This conversation is one you don’t want want to miss.

To learn more about how clinicians at CFIR can help you online or by phone, go to www.cfir.ca

During this unparalleled novel coronavirus pandemic, the majority of the global population has been instructed to practice social distancing and stay at home. However, front line workers have no choice but to continue serving the public during this critical time. These workers include, but are not limited to, hospital staff, nurses, physicians, police officers, firefighters, paramedics, and many more. Under normal circumstances, society relies on these individuals for our wellbeing and understands the importance of protecting their mental health. However, in the context of COVID-19, our collective reliance on and heartfelt gratitude for this population is highlighted. Thus, it is incumbent upon us as mental health professionals and as a society to care for the specific mental health struggles these individuals will face during this devastating time. These individuals are knowingly exposing themselves and their loves ones to the virus to serve the public. Taking this risk comes with its own set of mental health challenges that I will speak about, drawing from a psychological understanding of how chronic exposure to trauma affects individuals.

Isolation 

Front line workers understand that their job requires them to be exposed to events outside of the average person’s experience, including having to work to protect the public in a state of global crisis. At the same time, the rest of the world is social distancing. This exposure creates isolation as many front line workers live with a sense that others do not understand what they go through and that people around them are concerned with “more trivial” issues. This sense of isolation can lead to further disconnection from loved ones during a time when front line workers need support. Additionally, feeling isolated can result in their apprehension to raise their challenges with loved ones, operating under the assumption that they will not be understood. Thus, a deep sense of shame and alienation about one’s internal struggles can ensue, furthering isolation, and helplessness.

Disconnecting from Difficult Emotions 

As front line workers are taking risks to their own (and loved ones’) safety and security, they must adopt coping strategies to manage their own painful emotions of fear, powerlessness, sadness, and more. These strategies may include suppression, dissociation, and avoidance and are, to a certain extent, standard in response to trauma and crises to maintain functioning. While these mechanisms are necessary to allow front line workers to perform heroic acts of bravery, there are detrimental effects to chronic use of these coping strategies. These damaging effects involve operating on “autopilot,” as if one’s survival is continuously threatened, lack of engagement in the present moment, being indifferent, withdrawn, or cutoff. Moreover, the complex emotions engendered during times of crisis do not get processed in a healthy way that allows for constructive meaning to be made. Further, enduring chronic trauma increases the risk of substance use and other forms of self-destructive behaviour.

The Effects of Chronic Stress Response 

Unfortunately, front line workers will also suffer from the chronic activation of anxiety associated with always being in “fight or flight” mode. The persistent activation of this kind of psychological stress also has harmful physical and mental effects. Such effects include: 

• destabilization of mood, 
• distorted perceptions of events, 
• hyperarousal of the nervous system, (resulting in elevated blood pressure, heart rate, physical tension, and stress hormone production) 

Moreover, nervous system dysregulation results in increased difficulties with primary bodily rhythms, such as sleep, appetite, digestion, body temperature, sexual desire/arousal, and energy levels. These detrimental psychological and physical effects of chronic stress levels make it even more difficult for front line workers to cope and less capable of accessing their baseline levels of resilience.

Supporting Front Line Workers During the Pandemic 

At CFIR and in the broader community, we are enormously grateful for the sacrifices front line workers are consistently making daily during this global crisis. CFIR clinicians are skilled in providing trauma related-care and assisting family members of front line workers. Collectively, we can support front line workers by increasing our awareness of the specific challenges they have and will endure and letting them know that mental health support is available to them. We also recognize that, particularly at a time like this, front line workers need to be confident that the world around them is ready and able to provide much-needed care and support. If you are a front line worker during the COVID-19 pandemic, you are not alone—we see you, we value you, and there is support for you!  

Tracie Lee, M.A. (Ed)., R.P. is an Associate at CFIR (Ottawa).  She provides psychotherapy to adults and couples who are experiencing issues related, but not limited to, anxiety and depression, self-esteem, interpersonal and couple relationship functioning (e.g., divorce/separation, infidelity, intimacy issues, family issues), sexuality, body image concerns, personality disorders, identity issues (e.g., professional, gender, sexual), suicidal ideation or self-harming, trauma and domestic abuse, and workplace and school functioning (e.g., burnout, workplace stress, performance). She recently spoke with CBC News Ottawa co-host, Adrian Harewood, about the psychological effects of COVID-19.