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Tips on taking a trauma-informed approach to coronavirus

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 going to write a series of blogs to share some bitesize #traumainformed tips on how to respond well to this pandemic:

 #Traumainformed #coronavirus Tip № 1:

Acknowledge to ourselves and others the #coronavirus pandemic is a traumatic event – that it is a threat to our physical and psychological safety and wellbeing which we are all living through together. However, it will disproportionately affect the more vulnerable in our society. On our learning journey it will help to think about “trauma” as both the traumatic event and the reactions to that event (called ‘trauma-reactions’). Trauma stress-reactions are any experience that causes an intense physical and psychological stress reaction, or the lasting effects from harmful or threatening events.

Traumatic events can happen to individuals, such as physical, emotional or sexual abuse, but they can also be events that happen to groups of people. The worldwide coronavirus pandemic is an example of a trauma that is happening to everyone worldwide, but some smaller sub-groups in society are disproportionately affected, such as those who are poorer, people with disabilities, those losing their job and income, or people who are experiencing homelessness, have substance misuse or mental health issues.

The organisation SAMHSA (Twitter @samhsagov) defines trauma as:

“A single event, multiple events, or a set of circumstances that is experienced by an individual as physically and emotionally harmful or threatening and that has lasting adverse effects on the individual’s physical, social, emotional, or spiritual wellbeing.”

The Adverse Childhood Experiences (ACEs) studies have shown people needing mental health, substance misuse and accommodation support have often been exposed to multiple traumatic events in their childhood. Because of these high levels of unresolved trauma this group of people are at increased vulnerability of being re-traumatised and triggered by the current trauma and adversity that the coronavirus is causing.

The ACEs research shows a clear link between high levels of past trauma and the formation health-harming habits which are also public health concerns. This insight led to the development of trauma-informed approaches to help improve the ways we work with people.

So, the first #Traumainformed #coronavirus tip is:

To see the pandemic and our reactions to it through a #Traumainformed lens, understanding trauma as both the traumatic event and our varying reactions to that event.

 #Traumainformed #coronavirus Tip № 2:

There is a wide range of diversity and difference in how people react to traumatic experiences. Two people may have very different reactions and responses to a similar traumatic event. People vary widely in how many traumatic events they experience growing up and during adult life. The severity, frequency and types of trauma experienced varies between people. The younger you are experiencing trauma, the number of traumas and the length of time they went on for all make a difference.

This may help us to understand the wide variation in how people react to a generally threatening experience like the coronavirus. Some people might talk to someone they trust about how they feel about the threat, whilst others do not have another person in their life they feel they can trust, or someone they feel safe to confide in – and so may keep their experience of something threatening traumatic a secret for months, years or decades.

It is important to remember that often people react to trauma in positive ways by processing and making sense of the traumatic incident, maybe by talking it through with someone they trust. In this resilient, healthy, positive reaction to trauma there is no negative ongoing impact on someone’s future life experience.  However, sometimes people react to trauma in ways that form health-harming habits, such as drinking too much or self-harming. These common reactions to trauma can be seen as understandable ways to cope with or survive a threatening situation. However, people can get stuck in these health-harming habits formed to cope with trauma, even after the traumatic threat has passed and become caught in a vicious circle of troubled and troubling behaviour. So there is an increased risk of people forming health-harming habits during this pandemic. One way to reduce the build-up of health-harming habits is to take a trauma-informed approach in how we support people, as we help people to process difficulties in a healthy and resilient way and make sense of their experiences.

So, the second #Traumainformed #coronavirus tip is:

As we relate with others, hold in mind that there is diversity and difference in people’s reaction to a traumatic threat, which likely connects to the extent to which people’s past experiences of trauma is being triggered by current adversity.

#Traumainformed #coronavirus Tip № 3:

People’s ability to deal effectively with and process adversity and traumas in life in a healthy, positive way is called “resilience”. It is helpful to think about resilience in a social way, connected to the social network around someone – those people who can help them cope with and make sense of trauma and adversity – so resilience is not just a capacity inside a person. For example, many people explain how they coped with a traumatic situation was by having someone they could trust listen to them and help them process and ‘make-sense’ of it – making use of positive relationships in their social network. However, not everyone has positive relationships in their life. So our ‘resilience’ to cope with life’s difficulties is connected to the quality of our social network of relationships.  Increasing the positive relationships around ourselves and others in our social network will make it more likely we can process and navigate the difficulties and adversities we face as we make use of our social networks of resources and resilience.

However, a major challenge with the coronavirus pandemic is that the main way to reduce the threat to life is “social distancing” which unintentionally reduces people’s social resilience by making it harder to connect with and support each other as a community. It might be better to call this “Physical Distancing” to encourage social contact during this difficult time. We need to think about how to reconnect people socially, as people are already trying to do, in order to build up our social resilience to make sense of and process this traumatic experience the whole world is living through a pandemic at the moment. The more we do this, the fewer health-harming habits will build up during this time, with long term effects on people and society after the virus has gone. It is vitally important to be creative in how we build these positive social networks in times of community traumas like this because measures taken such as social distancing, working from home and job losses all act to reduce our normal social resilience networks.

People with multiple disadvantages in our society often have high levels of past trauma, as well as needs around substance misuse, mental health and housing. They also tend to have less positive social networks around them and less good quality positive relationships in their life, even before the pandemic, so it is vitally important we help this group of people connect with positive social networks and relationships in creative new ways that keep within the government public health guidance.

So, the third #Traumainformed #coronavirus tip is:

We are part of someone’s social network of resilience when we connect with them as “social resilience” is connected to the quality of relationships within someone’s social network, so improving someone’s relationships within their positive social network increases their resilience to cope with life’s adversities.

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 to do this in our busy working days and nights. So I would encourage us to pause and reflect on these trauma-informed tips:

  1. To see the pandemic and our reactions to it through a #Traumainformed lens, where we understand trauma as both the traumatic event and our varying reactions to that event.
  2. There is diversity and difference in people’s reaction to a traumatic threat, which likely connects to the extent to which people’s past experiences of trauma is being triggered by current adversity.
  3. We are part of someone’s social network of resilience when we connect with them as Social Resilience is connected to the quality of relationships within someone’s social network, so improving someone’s relationships within their positive social network increases their resilience to cope with life’s adversities.

In my next blog I will look at the Five Principles of Trauma Informed Care and how we can increase these through our work.  In the meantime, please do share any reflections 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.