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Tips for taking a trauma-informed approach to coronavirus (tips 4 and 5)

By Dr Ray Middleton

Hi I’m Dr Ray Middleton, I’m the Workforce Development Lead at FLNG where we are working hard for a better response for people experiencing  complex needs such as mental health, offending, substance misuse and/or homelessness or accommodation needs – those people in our society who often face multiple disadvantage.

Unfortunately, in a pandemic it is the poorest and most socially disadvantaged that fare the worst. I’ve been reflecting on the coronavirus outbreak and the different reactions I, and the people around me, are having to it – in our patterns of thinking, emotions, behaviour and also in our ways of relating with others.

On my learning curve around this pandemic I’ve thought it would help us all to have a trauma-informed approach to how we respond individually and collectively to the coronavirus. So, in the hope of being helpful I’m sharing a series of blogs to share some bitesize #traumainformed tips on how to respond well to this pandemic:

In my last blog (available here) I shared my first three tips. Please read on for tips 4 and 5.  You can also watch a film version of this blog below or by clicking here).

#Traumainformed #coronavirus Tip № 4:

To look after ourselves – to ‘self-care’.

It is vital to keep physically, emotionally and mentally healthy if we are going to maintain a caring role for any period of time during this pandemic. We need to self-care and pace ourselves to avoid burnout. If we allow ourselves to become burnt-out through self-neglect and overwork, then we are not going to be useful for helping others.

People who care for themselves have been shown to be able to maintain caring for others in the long term. We can role model good practice in self-care to those around us.

One way to self-care is by ‘pressing the pause button’ and being reflective and self-aware of our emotional states – such as being tired, confused, annoyed or anxious. During a pandemic it is normal to experience feelings of fear, confusion, anxiety or being overwhelmed at times because this is an unfamiliar threat. Being able to notice and name these feelings role-models to others a self-reflective stance towards challenging life-experiences. Being able to reflect and notice the emotional states we are in and our patterns of thinking can help us to respond better to the challenges ahead. We need some other people around us we can trust to listen with compassion.  If we are going to share how we are feeling and thinking this can make us feel vulnerable. So it is important to think about self-care in a social way, and not in an overly individualistic way. I do need to take responsibility for establishing good habits for looking after myself, but we are social beings and we need to accept care offered by others and if we are working or volunteering for an organisation they have some responsibilities for caring for our wellbeing also. So self-care is a shared social process!

A trauma-informed approach seeks to increase people’s self-care skills in order to reduce the direct negative lasting impact of the traumatic experience and reduce the indirect impact of witnessing other people’s distress, trauma and adversity during the pandemic.

Now the coronavirus means everyone in the world, to varying degrees, is witnessing other people’s distress, trauma and adversity. Witnessing distress could be face to face, such as when giving medical care, or over the phone or witnessing it via news reports and social media. This experience – of witnessing other people’s trauma – is called ‘secondary’ or ‘vicarious trauma’ and can lead to compassion fatigue. Symptoms may include becoming emotionally ‘numb’ or very emotional (‘hyper-aroused’), patterns of negative thoughts, lack of compassion, increased anxiety or depression. These reactions to witnessing other people’s trauma are understandable.  If we ignore them they can result in a poorer service being offered to the people we are trying to help as well as negatively affecting the mental and physical health of staff and volunteers.

Secondary trauma can occur amongst a wide range of professional helping services and volunteers – such as mental health workers, substance misuse workers, housing support workers, community faith-based workers and blue-light responders. We can reduce the impact of secondary trauma through practices such as talking with someone we trust about how we are thinking and feeling on a 1-2-1 or in a supportive group of peers. Some basic trauma-informed training is also likely to help as it introduces some concepts, knowledge and skills around the impact of trauma.

Self-care is about looking after our emotional, physical and mental wellbeing, and we can do this through establishing a balance of good new routines in our life which include:

  • Eating healthy meals regularly
  • Drinking plenty of fluids, but not too much caffeine
  • Avoiding developing unhealthy coping habits (like drinking alcohol excessively)
  • Limiting the amount of media, including social media, you consume
  • Getting up to date information from reliable sources
  • Taking some regular exercise
  • Getting enough sleep and rest
  • Connecting socially with other people and talking about our thoughts and feelings about the virus in order to process and ‘make-sense’ of it, but also talking about topics that are NOT coronavirus and having some fun!
  • Finding meaningful activities to do, which might mean doing new things or hobbies if we have a period of self-isolation, or are working from home.

So, the fourth #Traumainformed #coronavirus tip is:

We need to look after ourselves – ‘self-care’ – because it is vital to keep physically, mentally, socially and emotionally healthy by establishing new healthy habits and routines, if we are going to maintain a caring role in the long run and avoid burnout.

Next we’ll look at;

#Traumainformed #coronavirus Tip № 5:

The research into trauma found positive, healthy relationships are the most important factor helping people cope with, and then recover from, any traumatic experience. This will still be the case with the coronavirus, the responses to it, and its wider impacts on society.

Five principles have been found to be present in the kind of relationships that help people heal from trauma. These principles were used to form the basis of ‘trauma-informed care’. They are to act in relationships in ways that increase people’s; Safety, Empowerment, Choice, Collaboration, and Trust (Trustworthiness).

So this tip is simply to press the pause button and reflect on what we are doing, and answer this question:

To what extent is what I am doing increasing people’s;

  1. Safety
  2. Empowerment
  3. Choice
  4. Collaboration, and
  5. Trust?

And also ask,

Could I respond in a better way that increases one of these principles?

Reflecting and finding ways to increase these five principles can create a trauma-informed culture, which in turn can enable and encourage social resilience, healing and recovery. Trauma-informed care is an asset or strengths-based approach based on a reflective response to the impact trauma has on people. It does this by prioritising physical, psychological, relational and emotional safety.

In this approach increasing safety is prioritised for both for the person being offered help and the volunteers or staff offering support – safety is not just for the people we are offering help to. One very practical way to increase safety is by helping someone without a home to access a home with a front door that locks. We can see this in the U.K. at the moment as local authorities try to find places for rough sleepers in hotels. Feeling safe is not only about physical safety, it is also about relational safety. A way to increase relational safety is by maintaining good healthy boundaries in our relationships so the other person feels we are trustworthy, reliable and consistent in what we offer and the way we offer to help.

However, we all need to learn about how to take reasonable and responsible risks in life, so it is important not to excessively take power away from people and try to control them when trying to increase their safety during this pandemic – we do not want to give people the message that we think they are not capable of making choices for themselves.

Empowering people involves seeing them as people with capacities who have skills and can learn new skills. For example, empowering someone could involve helping and encouraging them towards trying some new habits and establishing routines, such as exercising daily or eating healthily as well as helping someone access income to buy healthy food.

Increasing people’s choices is another way to empower people, but this is currently challenging as public health measures have reduced people’s choices dramatically.

Another trauma-informed principle is to work collaboratively with people. This means avoiding thinking we are taking care of people who are dependent on what we have to offer, and instead seeing people as actively and collaboratively working at their own journey through life with some help from others. We strive for mutuality in a collaborative relationship, where power is shared. At one, unusual, end of the spectrum we are sometimes completely passively receiving care, for example if we are unconscious in intensive care. But at any stage moving away from that passive state there is the opportunity to involve people collaboratively in the help we are offering them, so it becomes a mutual relationship of trust. As far as possible we want to increase people’s collaboration in the help we are offering.

The ACE’s studies (which I talked about in my last blog) showed us that often people with complex needs have more than the average amount of unresolved trauma in their past. This means those facing multiple disadvantages in our society will be disproportionately affected by this coronavirus, partly as the current adversity will trigger past unresolved traumas.

The reason a trauma-informed approach creates opportunities for survivors to rebuild a sense of control and empowerment is because often the original traumas involved having relatively little power, or others exercising power-over them. This can make people very sensitive to, or triggered by, authority figures, who have, or appear to have, power-over them. They may see us as an authority figure even if we do not see ourselves that way. Thus surviving traumatic periods of our life, and the subsequent journey of recovery often involves increasing someone’s sense of power and control over their own choices in life.

The fifth trauma-informed principle is building and then increasing Trust through our relationships, which means increasing our trustworthiness. We can do this in simple ways by being reliable, not overpromising things we cannot really do, maintaining our boundaries, being honest, genuine, admitting mistakes and saying sorry when appropriate. People with past trauma have often had their trust in people broken, so it is healing to form a relationship with someone trustworthy and so help restore someone’s ability to trust another human being.

So, the fifth #Traumainformed #coronavirus tip is to:

 Act in ways that increase people’s;

  1. Safety
  2. Empowerment
  3. Choice
  4. Collaboration, and
  5. Trust

Remember, a trauma-informed approach encourages us all to ‘press the pause button’ and Reflect on the impact trauma has on ourselves and others – and say how we might Respond better if we held this Reality in mind – sometimes called the ‘Three R’s’ as a way to remember this in our busy working days and nights. So I would encourage us to pause and reflect on the two trauma-informed tips we have just covered:

#Traumainformed #coronavirus Tip № 4:

We need to look after ourselves – ‘self-care’ – because it is vital to keep physically, mentally, socially and emotionally healthy by establishing new healthy habits and routines, in order to maintain a caring role in the long run and avoid burnout.

 And

 #Traumainformed #coronavirus Tip № 5:

 Act in ways that increase people’s;

  1. Safety
  2. Empowerment
  3. Choice
  4. Collaboration and
  5. Trust

I read SAMHSA’s TIP 57 in preparing this blog and would highly recommend it if you want to read more.

In my next blog I will share six skills we can all practice to be validating with people when they are expressing their distress or confusion during this challenging time for us all.

In the meantime, please do share this blog, and any reflections you have on these tips by joining our conversation on Twitter or emailing me at Ray.Middleton@fulfillinglives-ng.org.uk.

Please also take a look at my short film below explaining a little more about these tips: