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When Civilians Become War Combatants

Protecting healthcare workers from PTSD

Source: Pixabay

Millions of civilian healthcare workers risk their lives on a daily basis simply by going to work to save the lives of others. The novel Coronavirus Disease-2019 (COVID-19) has become this generation’s greatest healthcare crisis. COVID-19 is a global crisis that has already caused many deaths, is expected to cause many more and, frighteningly, has no clear end in sight.

While much attention has appropriately focused on patients who are casualties of the COVID-19 pandemic, there is a need to also focus on the mental well-being of healthcare workers who provide critical, life-saving medical care. These healthcare workers courageously stand on the frontlines of this new war we fight.

I'm a military clinical psychologist, and an essential aspect of my job is to monitor and ensure mental resilience among military warfighters. This includes identifying risk factors that threaten optimal psychological functioning, as well as promoting healthy behaviors that are known to keep service members in the fight.

Mental strength and resilience cannot be underestimated during wartime. War heroes are defined by their mental prowess, not just by their physical stature and the strength of their muscles. Based on this, we should be concerned about the mental wellness of frontline healthcare workers like never before.

Traumatic or stressful life events can trigger a range of responses, from normal stress reactions to the development of more serious mental health concerns. Normal stress reactions are situationally appropriate behavioral responses to a stressful event. Stress reactions and behavioral responses that lead to longer-term functional impairments may indicate psychological maladjustment.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)1 identifies a range of mental health conditions specific to trauma-and-stressor-related disorders, including Post Traumatic Stress Disorder (PTSD), Acute Stress Disorder, and Adjustment Disorder. These conditions are characteristic of an individual’s functional impairment following exposure to a traumatic or stressful event.

It should be stated that being exposed to a traumatic or stressful life event does not automatically mean an individual will develop one of these disorders. It does, however, indicate that individuals exposed to traumatic or stressful life events may be at risk for developing such disorders. This is especially true when considering causal factors such as pre-existing mental health conditions prior to exposure.

In the fight against COVID-19, there are lessons we can learn from military combat.

Frontline healthcare workers may be mindful of the following:

  • Exposure to trauma is inevitable given the nature of your job.
  • Stress reactions to trauma exposure are both normal and expected.
  • Stress reactions to trauma may include symptoms such as helplessness, anxiety, fear, depression, irritability, anger and sleep disturbance.
  • It is important to monitor stress reactions, including onset, duration and severity.
  • If stress reactions are not proportionate to the circumstances or worsen over time, it is okay to seek help from a mental health professional.
  • Ignoring stress reactions can be harmful and may contribute to development of post-traumatic stress (PTS) or post-traumatic stress disorder (PTSD).
  • Staying educated and informed are important, but overconsumption of media exposure may exacerbate stress reactions.
  • Talking about and processing your stressful experiences can be therapeutic and protective.
  • Stress management is critical during this time and includes self-care interventions such as adequate sleep, balanced diet, routine exercise, and geographically distant social connections with extended family and friends.

Family and friends of frontline healthcare workers may be mindful of the following:

  • Providing support to your loved one is critical and necessary during this time.
  • Do not assume you know all the ways your loved one needs to be supported. Instead, ask directly and clarify how you can be helpful during this time.
  • Traditional war combatants are typically exposed to traumatic or stressful events that are difficult to talk about. Sometimes it may be easier for combatants to discuss their difficult experiences with fellow troops, instead of with family or friends. As such, be sensitive to conversations related to your loved one’s work experiences during this time.
  • You may be anxious to learn about your loved one’s experience at work and to talk about these details when they return home. Your loved one may or may not feel comfortable discussing details of their work. Before initiating work-related conversations, ask your loved one if they are comfortable discussing their workday. Accepting their decision about whether to discuss details of their work is one way to offer support and respect boundaries.
  • Encourage meaningful connections with your loved one. Isolating and withdrawing behaviors may be a symptom of post-traumatic stress. While spending time alone is both adaptive and healthy, long periods of isolating behaviors can be problematic.
  • As much as possible, strive to maintain normalcy, consistency and routine schedules within the home.
  • Promote and implement stress-free, fun-filled leisure activities within the home, such as games, arts and crafts, music and film.

Mental health professionals may assist frontline healthcare workers in the following ways:

  • Offer crisis support, including disaster mental health services and psychological first aid.
  • Provide brief education and training on stress, anxiety, trauma and common stress responses.
  • Help to clarify the distinction between normal stress reactions versus more clinically significant conditions like PTSD, Acute Stress Disorder and Adjustment Disorder.
  • Conduct daily check-ins with healthcare workers if serving as a staff member of a hospital or clinical care team. Supportive interventions may include facilitating daily mindfulness-based stress relaxation sessions as brief as 5-10 minutes. This can be facilitated in a variety of formats, including in-person or virtually, as well as conducted prior to shifts, during shift breaks or at the end of work shifts.
  • Encourage help-seeking behaviors. This includes encouraging healthcare workers to seek professional services when needed.
  • Share resources on how healthcare workers may access various levels of support, including professional services.



1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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