This special feature is co-written by Frank Kim, PhD, director of the CU Denver Student and Community Counseling Center, Kristin Kushmider, PhD, assistant vice chancellor of Health, Wellness, Advocacy and Support at CU Denver, and Katherine Miller, MA., advocacy services program manager at the Phoenix Center at Auraria (PCA).
During this time, it is imperative that we talk about mental health and encourage each person in our community to be kind to your mind.
The COVID-19 pandemic has led to an unprecedented situation for most of us. This crisis embodies many uncertainties, conflicting information and messaging, constant change, and a need to adapt to dramatically different ways of being.
The world continues to mourn the loss of life, loss of livelihood, isolation, and economic instability. We are questioning how we carry out even the simplest of tasks that were taken for granted prior to the pandemic. There are milestones that cannot be celebrated, activities that cannot be engaged in, and people we love who we cannot be with. For many, it has also highlighted the lack of social and economic equality and opportunity, the inherent health disparities that exist, and the lack of accessible resources.
There’s No One Right Way to Respond
All of us will react to the stressors of this pandemic in dramatically different ways, from discomfort to acute stress reactions. Increased feelings of anxiety about the unknown, fear related to one’s own health status and/or the health status of others, and grief for what has been lost are normal reactions to what we are experiencing.
There may be feelings of loneliness and isolation from loss of contact with others, or anger and resentment about others’ behaviors during the pandemic. Boredom or restlessness can set in. There may be a feeling of ambivalence and/or uncertainty about the future.
Some will struggle with a downturn in mood, loss of energy, sleep and appetite disturbance, and a sense of hopelessness. Some will turn to or increase substance use. For those with pre-existing mental health concerns, previously managed symptoms can flare up. Social isolation and disrupted support systems can also lead to acute stress reactions (adapted from SAMHSA, 2014).
In a survey conducted by Active Minds (2020), 1 in 5 college students reported their mental health has significantly worsened under COVID 19, and 80% reported that COVID 19 has negatively impacted their mental health. As the pandemic’s impact on mental health continues to grow, we wanted to share information about what to expect from your emotions as we ride the COVID-19 roller coaster. You may notice different phases of reaction, especially as the pandemic lengthens and one continually strives to adapt to the situation.
Grief Is Hard, and It Hurts
Stress responses are normal in times of turmoil. Because these events are traumatic and not supposed to happen, our brains have to adapt to very atypical situations (ISTSS, 2016). Traumatic experiences also carry the weight of grief. Just as there is no right stress response, there is also no typical grief response. We are grieving numerous losses right now in the wake of COVID-19, including loss of security and safety.
We are also experiencing what psychologist Sherry Cormier calls communal grief, as we all collectively watch systems that we depend on—education, economic, healthcare—destabilize (Weir, 2020). Even if you have not lost a job or a loved one, there needs to be mourning for loss of routine, loss of expectations, and even loss of identity.
While we may feel immeasurable sadness one day, and laugh and feel happy another, grief is ever-present. But grief is natural and necessary. It helps to mourn what we have lost and are losing, while providing a path to move through this collective trauma. It’s OK to allow yourself time to mourn so that you have the capacity to adapt in our changed society.
Disaster Responses in Six Phases
What does all of this mean in the context of a disaster? Because that’s what this pandemic is—a natural disaster. People have been experiencing a range of emotions since the first confirmed case in the United States. This is even more understandable from a disaster mental health perspective, which frames disaster responses in six phases (SAMHSA, 2020).
First, there is the pre-disaster phase, where people are generally feeling fear and uncertainty about how a disaster may impact both their community and themselves. Depending on the type of disaster, fear and uncertainty can be caused by a number of things: lack of security, vulnerability to harm, feelings of guilt that something wasn’t done sooner to prevent more tragedy, and a sense of loss of control.
The second phase is the impact phase, where we see some of the most intense emotional reactions, like shock and disbelief that the disaster is occurring, followed by feelings of self-preservation. Wondering why grocery shelves were bare and you couldn’t find any toilet paper? Blame a collective expression of self-preservation.
Phase three, the heroic phase, and phase four, the honeymoon phase, happen closely together, and quite quickly. This is where the feeling of we’re all in this together comes from. There is a quick call to action and mobilization of resources, as we go into rescue mode. We can make masks! We can stay inside! Howl for healthcare workers! You might have forgotten, but there was a sense of community cohesion in these acts.
This typically fades over a couple of weeks into phase five, disillusionment, where we see the most intense emotional lows. This occurs as our optimism starts to fade, and stress takes over as we begin to recognize our personal limits, and the limits of disaster assistance.
Disillusionment is when we truly realize that, while we may be all experiencing the impacts of a disaster, we are all experiencing them with stark differences. This is the phase that we are in right now. Have you noticed that your fuse is a bit shorter? Do you feel more exhausted by routine tasks than you did before? Are you feeling frustrated and wishing things could just get back on track already? These are some of those emotional lows, and we may be in this phase for quite some time before we move into the last phase, reconstruction.
Magnified Impact for Some Communities
We have spoken of the general impact of the pandemic on people. There are, however, some communities for whom the impact is magnified. These are individuals and groups historically targeted and marginalized due to economic status, race and ethnicity, sexual orientation, gender, age, etc. Differential fatality rates (Scott, 2020) due in large part to health disparities (e.g., African American, Latinx) (Golden, 2020) and economic vulnerability (e.g., lower SES) can dramatically impact these communities. Discrimination based on identity and bias-motivated hate crimes and behavior can adversely affect these individuals, groups, and communities.
Psychologically, for these communities, current trauma and stress can activate prior experiences with oppression. This process can be quite unconscious and implicit in nature.
Once activated, less conscious and distorted beliefs (the feeling of being “less than” or “deserving misfortune”) can wreak havoc on one’s sense of well-being and performance. Worse, an individual in this circumstance may begin to collect evidence that justifies a distorted belief, which unfortunately can reinforce and perpetuate erroneous self-beliefs.
There is also a “just-world fallacy,” (Earnshaw, 2020) where we implicitly believe that bad things happen to bad people. This could erroneously be applied to people who are infected with the COVID-19—this fallacy would assume that those infected with the disease did something wrong to deserve it.
But that’s simply not how transmission of a virus works. As we have learned by now, anyone can catch this virus.
Ambiguity Is Our New Normal
While this all may provide context, it doesn’t change the feelings. The fear and uncertainty are still present, and it’s important to acknowledge those emotions. Things are not business as usual, and we may not know what usual looks like anytime soon. There is a lot of ambiguity as things are changing quickly. We continue to get new updates and cautions.
Normalcy is something that we crave in a circumstance where it is unclear what that means. Ambiguity can feel extremely disempowering and sometimes paralyzes us to feel as though we can’t act. It’s a lot to oscillate between just stay positive and everything will be fine to I feel afraid all the time and there is nothing that I can do about it. It’s dangerous to stay on either end of the spectrum too long.
Give yourself permission to feel this range of emotions. These responses are normal, and it can be powerful and affirming to name the emotions that you are experiencing (Weir, 2020). Naming emotions may also help to better identify which coping strategies will work best for you.
- Stay informed, but limit exposure to the constant stream of pandemic news.
- Pay attention to how you are feeling and monitor your self-dialogue. Many times we react to our thoughts, but sometimes these thoughts are based on faulty assumptions that we make, leading to cognitive distortions.
- Cognitive fusion is where we get entangled with our own thoughts, where a thought can seem like an absolute truth. A healthier process is cognitive defusion, where we can observe our thoughts for what they are—just thoughts—and we can recognize that they may or may not be true.
- Behavioral activation is a tool that can be used to improve mood and mental health. It entails a focus on meaningful activities and becoming more active and involved in life. Simply put, just do it. This activates the brain and importantly allows one to experience positive events.
- When there is so much beyond our control, we can become discouraged. If you can shift your thinking from an external locus of control to an internal locus of control, you will think about what can be done and focus less on what you cannot control.
- Mindfulness and self-care are great ways to maintain equilibrium. Even a few minutes a day can be effective.
A Range of Emotions Is Normal
Tending to your mental health and physical health are of equal importance. We are still uncovering the mental and emotional effects of this pandemic. The range of emotions individuals are experiencing is normal under the current circumstances.
If your emotions are overwhelming you or you feel paralyzed by fear, anxiety, sadness, or are having thoughts of harming yourself or others, please reach out for help. Seeking support for your mental well-being is as important as reaching out to your doctor for help with injury and illness.
Below are resources and tools available to support the mental well-being of our community:
Are you struggling now? Do you need mental health support? Here are national, local, and campus-specific resources:
- National Resources: NAMI COVID-19 Resource Guide, National Suicide Prevention Line, Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC) Stress and Coping, National Domestic Violence Hotline, National Sexual Assault Hotline
- Local Resources: Colorado Crisis Centers and Hotline, Community Mental Health Centers in Colorado
- Resources for Students, Faculty, and Staff: CU Denver Student and Community Counseling Center, Health Center at Auraria, Phoenix Center at Auriaria (Interpersonal Violence Advocacy and Support), Crisis and Mental Health Resources.
- Active Minds (2020). The Impact of COVID-19 on Student Mental Health. https://www.activeminds.org/studentsurvey/
- Brenan, M. (2020). Americans Say COVID-19 Hurting Mental Health the Most. Gallup. https://news.gallup.com/poll/308420/americans-say-covid-hurting-mental-health.aspx
- Earnshaw, V. (2020). Don’t Let Fear of Covid-19 Turn into Stigma.
- Golden, SH. (2020). Coronavirus in African Americans and Other People of Color.
- International Society for Traumatic Stress Studies. (2016). Mass disasters, trauma, and loss. Retrieved from https://istss.org/ISTSS_Main/media/Documents/ISTSS_MassDisaterTraumaandLoss_English_FNL.pdf
- Long, L. (2020). Coping Skills for COVID-19: Resiliency while Socially Distant.
- Power Point presentation, University of Kansas Medical Center.
- Scott, D. (2020). Covid-19’s devastating toll on black and Latino Americans, in one chart.
- Substance Abuse and Mental Health Services Administration. (2020). Phases of disaster. Retrieved fromhttps://www.samhsa.gov/dtac/recovering-disasters/phases-disaster
- Substance Abuse and Mental Health Services Administration (2014). Taking Care of Your Behavioral Health: Tips for Social Distancing, Quarantine, and Social Isolation During an Infectious Disease Outbreak. SAMHSA HHS Publication No. SMA-14-4894.
- Weir, K. (2020). Grief and COVID-19: Grieving our bygone lives. American Psychological Association. Retrieved from https://www.apa.org/news/apa/2020/04/grief-covid-19