E-Alert - North American Center for Threat Assessment and Trauma Response

COVID-19: Moving Forward with a Caring Approach

March 17, 2020

Note: This is the first of a SERIES of NACTATR™ Communications that will be released as circumstance warrants. As indicated in the work of VTRA™, “The better the data, the better the assessment and the better the assessment, the better the intervention”. As professionals from multiple disciplines across the country, and beyond, are sharing our expertise, we are also learning that the current COVID-19 crisis has some uniqueness specific to our generation especially around more disperse transmission due to modern travel and exponentially higher anxiety due to media and social media coverage.

Purpose of this E-Alert
There has been an abundance of resources for parents, professionals, children and youth surface on various Internet and social media platforms. As such, we wanted to create a growing resource list (see attached) that professionals can feel comfortable providing to parents, staff and others whether you are in a Province/State where school has been cancelled or in one where school is proceeding with caution. There is also a significant traumatic response by many individuals as a result of the unfolding ramifications from possible exposure to COVID-19, to the price many may pay due to social isolation and economic hardship. Also, the fields of Violence Threat Risk Assessment (VTRA™) and Crisis/Trauma Response are inseparably connected. This means that threat-making and threat-related behaviour has already manifest itself in many settings as societal anxiety increases. As noted through the Traumatic Events Systems (TES™) Model of Crisis and Trauma Response, “High-Profile trauma does not necessarily generate many new symptoms in human systems but instead intensifies already existing symptoms”. If families are already stressed and are conflict-ridden then this will intensify the existing dynamics. If there are significant racial tensions in a community this will exacerbate those. Knowledge is power and when we understand our response and that behaviour is somewhat predictable we can also gain mastery through that realization. Therefore, this communication is to also arm our colleagues with some of our expanding insights.

Context
Professionals, parents and caregivers who have not surpassed middle age are experiencing a juncture in the worlds history that feels foreign; that feels as if we are very much out of control. Most of us were not alive (or were very young) during the Cold War and the assassinations of President Kennedy, Dr. Martin Luther King and others. We did not live through a World War or experience a pandemic like the one before us now. To a certain degree our mettle has not been fully tested, especially in Canada and the United States. Yet our children have grown up in the school shooting generation and have watched the Gulf War on TV while many of us, at our children’s age now, were still climbing trees and racing to beat a friend to the home-made swing in the back yard. The 9/11 Terrorist Attacks as well as the polarized political climate of the past four years, coupled with a pandemic feels like our generation of adults is being hit hard. All these types of things have occurred before. Other generations have passed through these things and so will we.

What is different is that our children, because of media in all of its forms, have been perpetually exposed where we (adults) have been more gradually exposed to what has now become non stop traumatizing media coverage. Coverage that activates every human sense that can result in traumatic encoding at the cellular level:

In a climate saturated with social media, everyone by now has been exposed not only to near-hourly updates from news outlets, but also to the reactions of the general public. The result is polarization between those responding traumatically and others whose reactions remain non-to-moderately alarmed. As such, it is necessary to understand the neurology of fear.

Succinctly it is this:
The brain does not react logically when a person is scared. Fear activates the survival instinct (fight, flight, freeze) which occupies a different arena in the brain than does the more sophisticated executive function—where abilities like logic, discernment, and methodical planning exist. What’s more, when an individual feels or perceives that their survival is threatened, the survival response (fight-flight-freeze) will out-pace logic every time. It is hard-wired into the human psyche, as survival is the primary and core job of every human brain.

Adding a layer of complexity to this dynamic, though, are individuals with poor or impaired pre-trauma functioning. We can already accurately predict that these individuals will have a disproportionate reaction to traumatic or fearsome stimuli. Yet, much like the “Pathway to Violence” is heavily nuanced and multi-variabled, so too are individuals’ Pathways to Fear in that fear is subjective. This is why some people manage perceived threats or danger with more (or less) dexterity than others.

Such is the case with the outbreak of a disease. While many are managing this circumstance with balanced discernment from both their brains’ ‘Fear Centre’ and its ‘Executive Function’, others are experiencing a traumatic response—and are reacting from their survival instinct only.

The polarization is occurring at this juncture as the non-or moderately reacting group observe the traumatized—whose behaviors appears to be bewildering, comedic, or even irritating.

Yet these behaviors are none of those things. Driven by their basic survival instincts, the traumatized are engaging in reactions that are classic (and predictable) fight-flight-freeze responses to a perceived threat. Consider the fight response of purchase-hoarding items like hand-sanitizer and toilet paper in order to combat the bacteria of the disease. Or the flight response of pulling their children from school where no instances of COVID-19 have even been reported. These individuals are not lacking intelligence, as many online criticisms would have them described. They are scared—their brains are responding in such a way that every human brain is designed to do when faced with threat: they are fighting, fleeing, or freezing.

In Canada, the major world traumas mentioned above did not occur on our soil so it was easier to psychologically distance from them but this pandemic has directly impacted us and now we can watch other country's tragedies and assume they will be ours in due course. Yet the panicked human response is more predictable than the course of this virus. The first principle of crisis response is model calmness but that is not achieved by simply telling someone to be calm. We all need context, perspective and a plan. The following is a simple dichotomy to bring perspective to our current circumstance.

Analogy: Big Picture, Little Picture, and Littlest Picture of All
Big Picture for professionals, parents and caregivers is the global picture which we can observe but do very little about. The more emotional energy expended on absorbing other nations trauma, the less we have for ourselves and those we are responsible for. Some of you are originally from or have family from the most impacted countries, and seeking information and contact from there may be more important to you. No matter what the circumstance, seeking out direct information from family via Facetime and other chat forms is generally good but Internet and media sources need to be vetted properly. For those of you who have less ties abroad, you should limit watching ongoing dramatized coverage.

Tip 1: Accessing media sources that show pictures, videos and others telling emotionally laded stories can deplete your own emotional reserves. Your body can feel when your brain is overloaded so take turns with other adult family members and friends when reviewing news. When leading in a high-profile crisis response, TES trained professionals are counselled to have colleagues not on the ground review media representations of the current crisis and verbally report to shield crisis response personnel on the ground from being exposed to additional traumatic stimuli: Families can do the same.

Tip 2: Bookmark in advance reputable websites that upload text only to inform and not content to inflame an undo emotional reaction such as pictures and videos that activate multiple senses. Most government sponsored websites are written non-emotionally which helps to keep us grounded in the cognitive domain where there is far greater self-control. Little Picture is the family and community around us where we can take turns helping and being helped by each other (Open System). A principle of crisis response borrowed from the family therapy field is that “two people can absorb more anxiety than just one” and therefore “three people can absorb more anxiety than just two”. Sometimes families, friends and colleagues (children and youth) default to the same individuals for support when they are stressed and in a crisis. But oversaturation with one person will begin to lose its’ effect on the one receiving the support and may leave the helper feeling ineffective and overwhelmed themselves. Often a new conversation with someone we respect or care about but do not see that often can interrupt that pattern of communication for good where a change of human scenery can be profound. Reconnect with other supportive individuals!

Tip 3: Adults and children alike can have a friend or family member who seems a little wiser than the rest! For instance, just talking on the phone with a favorite aunt or uncle who models calmness by nature may reinforce what the parent is saying to their child but is received as more credible because it lacks the emotional intensity from the immediate family relationship. Parents should encourage their children to talk to healthy others but let the healthy others know in advance that a call is coming so they can be prepared.

Tip 4: Adults (Parents and Professionals) who need to talk should likewise not interact with the same adult family member or colleague all the time but reach out to others including those that maybe you can be helpful to as well. Sometimes the call is supportive to us the caller and sometimes we find ourselves unexpectedly supporting them. Taking turns caregiving is a remarkable way to feel empowered by seeing that we are contributing.

Littlest Picture of All is our children who we can lead! Model calmness and help them learn where they have power and control to protect themselves and help others. We learned from the terrorist attacks on 9/11 that many young children were becoming overwhelmed because they were absorbing the adult’s anxiety around them. To the surprise of many professionals, they were discriminating between all the televised violence they saw in regular TV and movies and the “reality” of the attacks they were now seeing through the adults emotional and behavioral responses. They rightfully interpreted that the adult responses meant “we are at risk”. The same applies for this pandemic except our children and youth do not just have parent and caregiver responses but the responses of adults in the media and the steady stream of social media responses to add to the confusion.

Tip 5: Parents and caregivers need to talk with their children and use some of the resources attached to this communication as a support for how to do that.

Unlike, the terrorist attacks of 9/11, where many of us were observers only, there are things we can do to protect ourselves and others from this ongoing crisis. Teaching individual, family, and social responsibility to children empowers them to help stop the spread of the virus by hand washing, proper coughing techniques, social distancing and being responsible for younger siblings. Whether adult or child, human beings feel more grounded and in control when they are in possession of knowledge they believe is true and when they are serving others. Our children need to be able to express their fears and concerns as well and then be lifted up again with continued knowledge and service. This will be a circular process as time goes on and the weight of crisis settles on our families, communities and countries as a whole.

What we are seeing out of many children and youth is everything from natural anxiety to the beginnings of symptoms similar to the stages of grief and loss:

Denial
Anger
Bargaining
Depression
Acceptance

This is predictable but parents and professionals alike must be mindful that whatever level of emotional strength and functioning a child was experiencing prior to the real effects of the pandemic (i.e. school closure, job loss, sport and academic scholarships in jeopardy, etc.) will be the springboard for their initial response and the foundation for recovery. In other words, some children were already angry because of parental divorce, a personal trauma or other struggles. Some children were already burdened with an anxiety or depressive disorder or other clinical condition that may be now exacerbated.

Critique of the phrase “Model Calmness.” Those of you who are trained in the Traumatic Event Systems (TES™) Model know that the first principle of crisis response is “model calmness.” But I also qualify that “everyone deserves a good melt down every now and then!” What that means is, adults are not supposed to be relentlessly serene: If the walls feel like they are crumbling down around them, it is ok to acknowledge “this sucks!” Families that cannot be open about how they are really feeling, run a high risk of becoming traumatically closed. Everyone can have a bad day or a momentary masterful blow out that helps to ventilate the frustration that can often help you to quickly re-regulate. As a trained Family Therapist, I am telling you it is ok for our children to see that we are human. However, parenting with wisdom, even in a crisis, is where we use our own stress to show we can all be worried but we can also recalibrate. A mother, father, parent or caregiver who exposes their tears of pain or fear (whether they wanted to or not) can descend to their lowest and then climb the next mountain with relative ease. Moving through a large-scale crisis is not a straight line of recovery; it is instead “peaks and valleys." Therefore, parents be kind and forgiving to yourselves and then do the same for your children.

Short Online Informational Videos to be Released
Both VTRA™ and TES™ are about responses to violence, threat and trauma through a human systems lens. However, that lens was born out of my early training in Family Therapy as well where the focus was not just on individual pathology but family system and society generated-trauma as well. Therefore, my colleagues and myself are releasing short online informational videos addressing the emotional and traumatic responses we are seeing and expect to see with specific interventions related to the current pandemic. The first will be aired Monday, March 23, 2020 with a link that will be provided in an E-Memo that will be sent that day.

Special Note to my Colleagues Across North America
As you become aware of trends and insights you feel we at NACTATR can support through these videos and upcoming Podcasts please let us know. The work of VTRA and TES has grown because of our collective learning and ongoing collaboration. Bless your hearts!

J. Kevin Cameron, M.Sc., R.S.W., B.C.E.T.S., B.C.S.C.R.
Board Certified Expert in Traumatic Stress
Diplomate, American Academy of Experts in Traumatic Stress
Executive Director, North American Center for Threat Assessment and Trauma Response
Special Thanks to the NACTATR Team for your help in the development of this and our forthcoming Alerts.
Online Resources

Self-Assessment

Alberta Gov’t: Online Self-Assessment Tool (COVID-19)

Resources – Parents – Talking to your Children about COVID - 19

Anxiety and Depression Association of America: How to Talk to Your Anxious Child or Teen About Coronavirus

The Conversation: How to talk to your kids about COVID-19

National Association of School Psychologists: Talking to Children About COVID-19 (Coronavirus): A Parent Resource

NASP: Countering COVID-19 (Coronavirus) Stigma and Racism: Tips for Parents and Caregivers

Kids Health: Coronavirus (COVID-19): How to Talk to Your Child

World Health Organization: Helping children cope with stress during the 2019-nCoV outbreak

Child Mind.org: Talking to Kids About the Coronavirus

New York Times: 5 Ways to Help Teens Manage Anxiety About the Coronavirus

International OCD Foundation: Here are some tips specifically for parents of youth with OCD: