Did you know May is Mental Health Awareness Month? 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).
CU Denver community, May is Mental Health Awareness Month, and it is imperative that we talk about mental health and encourage you to “Be Kind to Your Mind” during this traumatic time. 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.
Right now, the world is grieving and mourning 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.
No “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).
Whatever the reaction, it is your reaction. In a recent Gallup Poll, 15% of Americans reported their mental health was suffering due to COVID-19 social distancing. In the same poll, 26% of Americans aged 18 – 44 said their mental health was suffering due to social distancing guidelines, versus only 9% of those 45 –64 years old and 5% of those aged 65 or older (Brenan, 2020).
Furthermore, 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 continues and its impact on mental health grows, we wanted to connect with our CU Denver Community and share information about what you can 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. We will discuss different ways of coping and finding resilience later in this article.
“Grief is hard, and it hurts”
Stress responses are normal in times of turmoil and disaster. 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.
Students are grieving the loss of graduation, a day that pays tribute to years of hard work. Faculty are grieving the face-to-face connection with students and immense changes to their planned curriculum. Staff are grieving the loss of exciting projects and the morale building that comes from sharing a workspace. Grief is hard, and it hurts.
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, which 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?
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! There is 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 with lockdown and wishing things could just get back on track already? These are some of those emotional lows, and we will likely be in this phase for quite some time before we move into the last phase, reconstruction.
Magnified Impact For Some Groups/Communities
We have spoken of the general impact of the pandemic on people. There are, however, some groups/communities for whom the impact will be 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 (e.g., being “less than” or “deserving misfortune”) can wreak havoc on one’s sense of well-being and performance (e.g., stereotype threat). Worse, an individual in this circumstance will experience and “collect evidence” that “justifies” a distorted belief (e.g., “I am deserving of misfortune”), which can unfortunately 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.
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 get new updates and new warnings every day.
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 say 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.
(Adapted from SAMHSA, 2014; Long, 2020)
- Stay informed, but consider limiting exposure to the near constant stream of pandemic news, which can trigger and flood one’s thoughts.
- Self-awareness is an important tool that can be used. Pay attention to how you are feeling and 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.” Examples of cognitive distortions are all or nothing (black and white thinking), and “either this or that” but not something in-between. A common distortion is overgeneralizing, where we take a single event, and see it as a pattern … leading to overly broad conclusions. Another common distortion is magnification (or catastrophic thinking), where we blow things out of proportion. There are other distortions such as “I feel it, therefore it must be true,” or negative filtering (paying attention to only certain types of information), or discounting the positive. If you find yourself having these types of thoughts, you can reflect on them and ask yourself if they are the most plausible explanations/statements.
- Cognitive fusion is where we get entangled with our own thoughts, where a thought can seem like an absolute truth and a rule/command that we need to follow. 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.” It is not a threat or command.
- Behavioral activation is a tool that can be used to improve mood and one’s mental health. It entails a focus on valued and 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. For example, one may not feel like exercising, but if they activate the thought (i.e., work out), they will feel much better.
- When there is so much beyond our control, we can become discouraged. If one can shift their thinking from an “external locus of control” to an “internal locus of control,” one will think about and act on what can be done (and not focus on what one does not have control over).
- Mindfulness and self-care are great ways to maintain or regain our equilibrium. Even brief periods of time (e.g., a few minutes per day) can be effective, and if done regularly, can build wellness “reserves.”
Range of Emotions is Normal
Right now, tending to your mental health and physical health are of equal importance. While we are all receiving daily updates on the physical toll of COVID-19, we are just starting to hear about 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 CU Denver community during this difficult and challenging time.
Want to learn more about Mental Health Awareness Month? Check out these national resources, NAMI(National Alliance on Mental Illness), MHA (Mental Health America) featuring tips for self-care and support, as well as Mental Health Awareness month tool kits and awareness raising campaigns.
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
- Campus Resources for Students: CU Denver Student and Community Counseling Center
- Campus Resources for Students, Faculty and Staff: Health Center at Auraria, Phoenix Center at Auriaria (Interpersonal Violence Advocacy and Support)
- CU Denver Resources for Faculty and Staff: Crisis and Mental Health Resources.
Want to get more involved in creating a culture of mental well-being at CU Denver? We invite you to join our Active Minds chapter by logging in to MyLynx. Faculty, staff and students can email email@example.com to inquire about Mental Health First Aid training and other available mental health training opportunities, or on how to get more involved and help us carry forward initiatives outlined in our CU Denver Mental Health Strategic Plan.
- 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