How Veterans with PTSD Experience the Pandemic
On PTSD and cultivating resilience.
Posted Sep 06, 2020
Every demographic in the U.S. has been affected by COVID-19 in some way, but one that needs particular care and support is veterans with PTSD. Nicole A. Sciarrino is a licensed clinical psychologist at the Ralph H. Johnson VA Medical Center. She also serves as the hospital's Military Sexual Trauma (MST) Coordinator. Sciarrino specializes in the assessment and treatment of PTSD, with an emphasis on sexual trauma; her current research interests are related to identifying risk factors for treatment dropout among veterans with PTSD and intensive treatments for PTSD.
Jamie Aten: How would you personally describe the COVID-19 situation for veterans with PTSD?
Nicole Sciarrino: The COVID-19 pandemic has affected veterans with PTSD both in terms of how they are experiencing symptoms and how they are receiving treatment. PTSD is characterized by a wide range of symptoms, so the variability in how veterans with PTSD are responding to the pandemic is understandable. Some veterans with PTSD are experts in practicing social distancing due to their avoidance symptoms and have reported little change in their day-to-day lives. Others are experiencing the same stressors that most of us are feeling—general distress, fatigue, and being overwhelmed with uncertainty. In addition, some veterans are reporting a worsening of trauma-related symptoms, such as feeling trapped or isolated, increased anxiety when wearing masks, along with fears about safety, trust, and a lack of control. At Ralph H. Johnson VAMC, we have been delivering trauma-focused treatment via telehealth for a number of years. In fact, the majority of our patients are seen via telehealth. When it comes to treatment, the largest change was for veterans who were being seen in-person. With education, increased access to technological resources such as tablets with built in Wifi, and some step-by-step user guidance, the PTSD clinic has been able to successfully convert these veterans to telehealth formats.
JA: What are some ways understanding PTSD during COVID-19 can help us live more resiliently?
NS: Many of the symptoms of PTSD are often adaptive peri-trauma; they are the tools that helped the individual survive the traumatic experience. As a result, PTSD is often thought of as a disorder of non-recovery. The experiences immediately following a trauma are not thought of as problematic “symptoms,” largely because they are adaptive and aid the person in working through what they experienced. For instance, if I am deployed in combat, getting a deep, restful night of sleep may not be adaptive for my survival if the base is frequently being mortared and I need to be alert and prepared to respond.
Going through the COVID-19 pandemic has been a traumatic experience for many of us. Being aware of things such as feeling the need to compulsively check the news to see the latest infection rate or death toll, or being unable to sleep due to worries about COVID-19 can be good indicators that we may not be adequately coping with our fears. One theory about how PTSD develops is that some individuals actively avoid their thoughts and emotions related to the trauma. This can lead to the exacerbation of PTSD symptoms and worsen our ability to function. To increase our resilience during the COVID-19 pandemic, one approach is to “lean into” the experience, connecting with loved ones or therapists and actively processing the ongoing fear and stress related to the pandemic. Checking in with others will also help us remember that we are not alone in these fears. Relatedly, because of the fear and uncertainty associated with COVID-19, many of us are simply living. In order to thrive during the pandemic, we may need to do the opposite of our fear-related urges and actively take steps to engage safely in previously enjoyed activities.
JA: What are some ways people can cultivate resilience amidst this pandemic?
NS: By design, human beings are “pack animals,” programmed to be rewarded when we are social: We can get the same rush of positive feelings from being social as we do when we eat chocolate cake. Because of the necessity for physical distancing during the pandemic, we need to get creative in finding ways for continued socialization in our lives. It is important to reach out to others and stay connected, when we may have taken those interactions for granted before. Platforms like Zoom, Skype, and other video chats (e.g., FaceTime) should not be underestimated. Although these cannot replicate a hug from a friend, they do assist in maintaining our connections and support systems. In addition, there is a lot to be said for the importance of video calls: Body language is a large part of communication, and just talking over the phone does not always provide a good enough substitute.
Just as we have a “pack” mentality, we also tend to be creatures of habit. As such, resilience can be cultivated by considering the ways in which the COVID-19 pandemic has resulted in personal demonstrations of flexibility and adaptability in how we complete day-to-day activities. In my opinion, this is the truest testament of our personal strengths and abilities to survive emotionally, socially, and professionally during these uncertain times. It’s like the Marines say, “Improvise, Adapt, and Overcome.”
JA: Any advice for how we might use what you have learned to support a friend or loved one struggling with a difficult life situation?
NS: We are often our own worst critics and can be incredibly unforgiving of ourselves and our responses to different experiences. It is normal to feel anxious, frustrated, and exhausted when coping with a difficult life situation. In the peri-COVID-19 world, no one has all of the answers and we are all figuring things out as we go along. There is no treatment manual for coping with a pandemic. What I have learned through all of this, and what I try to emphasize to my friends and loved ones is the importance of giving themselves permission to just feel, whatever it is that they are feeling, without judgment. There is no “right” or “wrong” emotion and feelings do not last forever; it is what you do with the emotion that matters. I hope everyone takes the time to process what has been going on and then make a choice to respond to their experiences, while recognizing that even inaction (e.g., sitting on the couch binge-watching various docuseries) is sometimes a perfectly viable choice. I have also learned that even veterans who believe they are “experts” in social distancing are not islands; everyone needs support from time to time. I hope that through all of this we are able to drop our defenses, become more comfortable asking for help, and return to some of our most fundamental life skills—including good self-care.
JA: What are you currently working on?
NS: Prior to COVID-19, our clinic already saw 60% of our veterans through telemental health across South Carolina and Georgia. As a result, a number of our projects are focused on ways that telemental healthcare can continue to improve access to treatment for Veterans with PTSD. Some of our current grant-funded projects include studying the utilization of and satisfaction with telemental health to the home for Veterans with PTSD (PI: Ursula Myers), examining ways that remote psychophysiological measurement can be done with telehealth (PI: Bethany Wangelin), and looking at the impact of COVID-19 on treatment for Veterans with Opioid Use Disorder (PI: Ursula Myers).
Sciarrino, N. A., Myers, U. S., & Wangelin, B. C. (2020). When chaos is the norm: How some veterans with PTSD are continuing to engage in trauma-focused treatments during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0000718