Inside Out, Outside In

What we bring to the world, and what it brings to us

How Adults Cope Under Boston Marathon Lockdown Stress

Managing Emotions in a Most Difficult Time

Co-author: Steven Schlozman, MD

 

Over the past week we have focused on helping kids through the terrorist situation in Boston. This is only natural, since we worry more about children, their fragility, and how the events will impact their lives. As adults we always think of them first. Maybe this is human nature, survival of the species or just plain love.

 But adults have their own share of fears, anxieties, and needs during massively stressful times. What are some of the ways disasters and war-like situations affect us and what can we do to help ourselves?

 Sadly learning from the disasters we have witnessed over the last 25 years in America and around the world – from 9/11, to the families witnessing the Oklahoma City Bombing, to the survivors of Katrina, to the Israeli families who were displaced during the scud missile attacks during the Gulf War we have learned quite a lot about the promotion of adult resilience.

 But what makes this situation TERRIBLE? It is OUR neighborhood, our city, our home. We felt safe. And now we are scared and disrupted. Boylston Street will never be the same, and many of us feel violated.

 

 What can we prevent as a consequence of disasters?

 Humans respond to life and death situations with the fight or flight response – that is they experience normal fear, physical symptoms of anxiety (stomach upset, jitteriness, rapid heart rate, extreme vigilance) and a wish to be in a safe place. But even if safe, excessive fear verging on panic can feel awful. Physical symptoms such as headache, muscle spasm, tremor, heartburn, or even chest pain are not uncommon. We startle at the slightest sound or change in the environment.

 Some feel depressed, hopeless, and develop a kind of pessimistic, catastrophic thinking in which most things are taken as signs of doom and gloom. Others long for getting outside, feeling trapped, isolated. Still others cannot remember things, keep track of time or just feel lost. In these moments, it is sometimes hard to function – to do daily activities, take care of kids, or focus on work.

 These are signs of acute stress and are really very common. Usually the pass as the stress is relieved. Hopefully in the Boston situation this will not be long. But in some situations, like Katrina, it is quite different, as the stresses of homelessness, lack of food, medical care, and extreme social isolation just continue on and on.

 

What can adults do to cope with our current stress:

 Adults under massive stress in times of disaster or war respond to the following kinds of experiences:

 

1.Adults need support from other close adults, e.g. spouse, family member, friend

2. Family cohesion: stay close to others, kids, spouse others. Do things together – play, especially cook!

3. Community cohesion: This includes religious, spiritual or other community groups.  Try to stay connected even at a distance, calling, texting, using social media.

4. Ability to process events, both emotionally and cognitively: Techniques may be specified for each: Get in touch with your emotions, and think of ways you have settled them in the past; and be careful of exaggerated or catastrophic thinking. This will be over soon. In general, use logic over emotion!

5. Self-reflection and awareness is key: be aware of your current state. Monitor yourself.  

6. Self-care that is physical: sleep, good diet, exercise

7. Meditation or Yoga is helpful

8. Music or other means of soothing

9. Distractions like hobbies, activities

10. Work if you can!

11. Be careful about use of substances. They will not help in the long run!

12. Vulnerability with pre-existing psychiatric conditions, losses, PTSD. If you suffer from any of these, remember what has helped in the past; and that event will pass soon, but you may be more vulnerable in the short-run.

13. Be a helper! Just as Mr. Rogers said for the kids, you need to feel like you are doing something productive for home, friends, and community. Email, text or soothe others around you.

 

 Under lockdown some of these may be done, but the isolation may be eliminated by:

1. Contact with friends, community leaders using phone, texting

2. Making plans for after this is over: hope for the future.

 

Conclusion:

 Don’t let this get you down. Think of the first responders and how heroic they were in such a stressful time. They saved lives. You will get through this, but remember that it takes more than you alone to get through it. And you will!

Previously posted on CommonHealth: Reality and Reform. www.commonhealth.wbur.org

Eugene Beresin, M.D., is Professor of Psychiatry at Harvard Medical School.

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