Although many people are eager to return to “normal” living, the COVID-19 pandemic has already left an indelible mark on the collective psyche of people all over the world. In most cases, this has not involved direct illness or loss of life to networks of families or friends. However, the pervasive fear of severe sickness and death to ourselves and or the people we love has created vigilance, social distancing and isolation, concerns or actualized fear of economic ruin, and disruptions in daily routines in almost every domain of life. In other words, there is a global backdrop of trauma that colors every person’s experience of the world and of themselves. These are the ingredients that often mix together to produce traumatic stress symptoms. For those individuals who have witnessed the horrific illnesses and deaths related to COVID-19, post-traumatic stress disorder (PTSD) may already be present with reminders everywhere and ongoing and further risk of traumatization ahead.
It is hard to know how to best intervene to promote resiliency and recovery given the rapidly changing “nowness” of this trauma. Trauma-focused CBT psychotherapies that emphasize processing trauma memories and beliefs typically assume that the person(s) no longer face immediate risk of further traumatization. None of us can know for certain how long the risk of COVID-19 will last or who among us might contract the illness or to what extent it will impact our health. Thus, there isn’t yet a post-trauma window that we can safely assume is over. What then do we do amidst all of this fear and confusion?
Behavioral activation strategies are well suited to this particular type of context. Behavioral activation psychotherapy has its roots in behavioral models of depression but has more recently been applied to trauma and PTSD conditions, addiction, chronic pain, and anxiety disorders. At its core, behavioral activation relies on reinforcement and learning principles to change behavior as a means of changing our mental and emotional well-being. But more than simple behaviorism, Behavioral activation has evolved into a psychotherapy approach that facilitates one’s identification of personal value, pleasurable activities, and ways to make meaning out of our life and begin to plan ways to approach (or continue or resume) enacting these parts of our lives to help guide us toward our personal goals and improve our quality of life. Goal setting with a commitment to concrete goals, along with time management, and pacing strategies are used within behavioral activation to create and sustain momentum forward.
Behavioral activation is particularly well suited to the current pandemic situation because it relies on pragmatic adaptation and problem-solving to help us re-engage in the important parts of life while staying flexible as to what that looks like. There may be people who have immediate and basic needs, such as finding employment or housing. Behavioral activation principles can help identify concrete steps one might take towards resolving these challenges, breaking down bigger tasks (e.g., apply for a job) into smaller components (could you spend 30 minutes each morning reviewing job postings) while also promoting self-care and reinforcement (after 30 minutes, making oneself a cup of coffee while listening to a favorite song). Persons who value health and exercise have been forced to reconsider ways to maintain their routines. There have been online postings of people running marathons around their backyard or developing fitness communities via social media. If values of faith and community are central features to a person’s religious practices, but travel or official restrictions present a challenge to attending in-person services, Behavioral activation would promote the brainstorming of ideas on how one might enact these values in some alternative forms. Are there online services? Are there ways to reach out to other members of the faith community to share expressions of faith and support others to do the same?
None of this is rocket science. It is a simple, intuitive approach to managing challenging and shifting situations. However, this type of approach is consistent with many principles of psychologist first aid, identifying priorities, anchoring energies toward the continuance or resumption of routines, encouraging connection with social support, and focusing on personal spiritual and personal values to guide these efforts. Yet, the simplicity of behavioral activation belies how difficult it can be to maintain our lives in the midst of upheaval. Seeking out someone who can support our efforts (e.g., a loved one or caregiver) or even a coach (e.g., a therapist) will increase the likelihood that we get our lives back on track.
