Research In Action

As a member of the CHOP Violence Intervention Program team, I work with youth ages 8-18 injured by peer violence to help them physically and emotionally recover. When we initially meet youth, we utilize validated tools to learn more about a child’s experience of potentially traumatic events (PTE) and corresponding symptoms. One item on these measures asks if a child has ever experienced a natural disaster. Although we have rarely had anyone endorse this question, I fear that we are all experiencing one right now.

It is important we acknowledge that for many of our families, COVID-19 clearly meets the criteria that defines trauma: a subjective reaction to an event that creates the real or perceived threat of death and overwhelms one’s ability to cope. Our daily way of life has been interrupted, and each day we are flooded with media reports detailing the spread of the disease. The cumulative impact is profound as we face a global crisis.

Mitigating the Impact of Trauma

When we identify a PTE, the most important thing for us to determine is if the event is over or ongoing. When an event is ongoing, our first intervention is to plan for safety – by considering the cause of the threat and how we can mitigate that cause. That is exactly what we are all doing as part of our global safety plan – physical distancing, stocking up on food stores, cancelling travel plans, and washing or sanitizing our hands.

However, these universal safety plans stop short of mitigating the threat to our own emotional health. Physical distancing is contrary to what we need to overcome stressful times. We have to think more broadly and holistically. When we safety plan with our youth, we ask them: “Who can you call if you need help? Who is available as a support to you emotionally? What activities can you do that help reduce anxiety?” We plan for those and we write them down, serving as a way to exert control when our emotional response interrupts our rational thoughts and memory.  During this time, we can also ask these questions of ourselves. We can embrace the real value of technology and foster support in our communities through phone and video connection.

Taking Back Control

We know that trauma interrupts the ability to exert power in our lives. Here are some things that we can do to enhance our sense of control:

• Write down a safety plan, focusing on what we can control and letting go of what we cannot
• Embrace our social support systems, calling on those we love to fill our need for connection, comfort and distraction
• Practice healthy boundaries by avoiding the overconsumption of news media and endless updates
• Use relaxation and mindfulness techniques, like deep breathing, progressive muscle relaxation or guided meditation, to quiet our bodies and stay focused on the present
• Remember these techniques can also include exercise, yoga, cooking, cleaning, or laughing with a friend

Here are some of the emotional-regulation techniques in the toolbox that we offer youth in our program.  These also work for us, as adults and helpers, during times of high anxiety:

• Recognize your own emotions: Practice identifying feelings, understanding their intensity, and noticing how they can manifest in the body
• Practice turning your emotions up and down, like you would with your favorite song or a loud TV commercial
• Acknowledge how your thoughts and feelings can direct or misdirect what you say and do
• Examine your thoughts and look for errors and distortions. Have you made a mountain out of a molehill? What evidence is there to support that catastrophic thought? Are there more options than the two we have laid out in black and white?
• Consider that a thought is not a fact; observe it – and then release it, watching it float by like a leaf on a river.

We, as adults, need to practice these skills ourselves and teach our children how to connect with their bodies, feelings, and thoughts. To teach them the value of social connection in ever changing times.

I encourage us all to take a breath and carefully observe ourselves at this stressful time, noticing our thoughts, feelings and body sensations. We can only safety plan using currently available information. We can use our skills to enhance our sense of control. We can question our catastrophic thoughts and use relaxation techniques to calm them. We can reach out to others and use empathy to guide our words and actions. And of course, we can wash our hands.