MANAGING TRAUMATIC GRIEF AND COPING AFTER NATIONAL CRISES: AfterTalk Weekly

Editor’s note: this post was authored by Bradley University’s Online Counseling Department. It is not only content rich, but the many links are amazingly useful and reliable. 

When a traumatic event occurs, the first emotions we tend to experience are shock and horror. Reality itself may seem to be suspended temporarily, but once we realize the magnitude of the trauma, our shock may give way to grief. As devastating as traumatic grief can be, it’s the first stage in the healing process.

Even our grief has been transformed by the trauma the COVID-19 pandemic has inflicted. Safety measures to prevent the deadly coronavirus have disrupted the normal grieving process in some of the following ways:

• The inability of families and communities to perform the cultural rituals for lost loved ones increases the likelihood of survivors suffering from depression and anxiety.
• Health care workers on the front line of the battle against COVID-19 are often the only people who can be with the victims in their last moments.
• The need to stay separate from family and friends prevents people in mourning from receiving the love and support they need, leading to potentially long-term mental health impacts.

Understanding the connection between unexpected trauma and grief helps mental health practitioners provide the guidance and support that will help families and communities heal from the ravages of COVID-19. Never before has social support and the role of mental health counselors been more needed to help people learn and implement the coping strategies for traumatic grief.

What Is Traumatic Grief?

What is traumatic grief? It’s a reaction to a traumatic event that lasts longer than is typical or that affects the person who is coping after a death or other event more deeply than is typical.

Emotional and psychological trauma strikes people in the aftermath of exceptionally stressful occurrences. Trauma is described as evoking feelings of insecurity and helplessness. People who are traumatized experience a jumble of emotions and memories that may leave them feeling anxious, numb, disconnected or distrustful.

Traumatic grief occurs after an unexpected loss, such as the sudden death of a loved one. The typical grieving process may be accompanied by post-trauma survival mechanisms that could complicate and prolong the healing process. The mechanisms may include fear, fight-or-flight (hyper) responses or freeze (hypo) responses.

How Traumatic Grief Differs from Other Forms of Grief

Grief is an unfortunate but natural part of life. We grieve when we lose a loved one, when a long-term relationship ends and when experiencing other forms of loss. In most cases, the loss is expected or foreseeable, such as the loss of an aged parent to illness. However, when the loss is unexpected, we experience trauma as well as grief, which can interrupt, exacerbate and prolong the usual grieving process. Overcoming traumatic grief often requires counseling from a mental health professional or other professional assistance.

Effects of Traumatic Grief on Individuals, Families and Communities

In the aftermath of a disaster such as the COVID-19 pandemic, most people can return to the way they functioned before the event. However, many people will experience negative feelings and emotions immediately after the calamity. In some cases, the ill effects on the mental health of survivors will persist for an extended period.

Common reactions adults and children experience after a disaster include:

• Having trouble falling or staying asleep
• Feeling sad, depressed, moody, irritable or hyperactive
• Feeling numb
• Feeling tired
• Having trouble eating or overeating
• Having trouble focusing
• Avoiding social contacts and usual routines
• Misusing alcohol or other drugs

Very young children may cling tighter to their parents and caregivers, be frightful or throw tantrums. School-age children sometimes become more combative or isolated; they may struggle with schoolwork.

There are many ways COVID-19 has strained the usual grieving process along with resources communities can tap to mitigate the damage:

• Patient isolation prevents families from saying goodbye to loved ones.
• Funerals and other mourning rituals are disrupted or prevented entirely due to social distancing requirements.
• Mental health professionals haven’t been trained to respond to disasters such as COVID-19, leaving communities unprepared.

Fact sheets and video presentations are available from many sources to help mental health counselors and other health professionals assist clients struggling with COVID-19 issues.

Traumatic Grief Resulting from National Crises

Traumatic grief due to the pandemic is unlike that experienced by people who have lost a loved one in other natural disasters or national crises. Deaths from tornadoes, hurricanes, earthquakes, wildfires and other natural events are typically accompanied by massive damage to property. The full scale of the economic, social and public health damage resulting from the slow-moving catastrophe of the pandemic won’t be known for many years. Communities across the country may respond to the mental health repercussions of COVID-19 for years afterward.

How COVID-19 Impacts Mental Health

The pandemic has affected everyone, but in many cases, the added stress and uncertainty the outbreak has caused has worsened existing mental and physical health conditions. Adults and children can easily be overwhelmed by these feelings. Being concerned about the safety and well-being of our loved ones is natural, but sometimes that worry can get out of control.

In the months after the pandemic struck, 1 in 3 adults in the U.S. experienced symptoms of anxiety or depressive disorder.

• In June 2020, the weekly average of people reporting such symptoms was 34.5%.
• In July 2020, the weekly average was 40.1%.
• From January to June 2019, the weekly average was 11%.

The Challenges of Providing Mental Health Care in Times of National Crisis

Following are some of the challenges faced in combating COVID-19 and other natural disasters:

• The typical adjustment period after the traumatic loss of a loved one is six to 12 months, but anything that interrupts the normal grieving process can extend the adjustment period.
• People can become stuck in the grieving process; this condition is called complicated grief and can lead to depression, post-traumatic stress disorder (PTSD) and other mental illnesses.
• Deaths occurring in intensive care units (ICUs) and other hospital settings are more traumatic for family members — a situation made worse by grieving in environments impacted by COVID-19 restrictions on in-person gatherings.

Strategies for Building Mental Health Resilience During a Crisis

There are many simple ways for people to cope with COVID-19 stress and tend to their emotional health during this time.

• For health care professionals, be aware of the potential for vicarious trauma or compassion fatigue as a consequence of witnessing the trauma and distress from COVID-19.
• For workplaces and businesses, be aware of the symptoms of stress, and communicate health and safety information clearly and frequently.
• For parents helping children and young adults, try to maintain routine and continuity in learning and health care; take every opportunity to make children feel safe and secure.

Resources on Traumatic Grief

• The Disaster Distress Helpline provides links to crisis support services and COVID-19 emergency response information.
• Trauma and Grief resources cover helpful topics, like Will My Child Bounce Back from the Coronavirus Crisis?

What Is Mass Trauma?

Mass trauma occurs when a group of people is affected psychologically after experiencing a shared traumatic event. The impact of the COVID-19 pandemic constitutes mass trauma in that it causes people to feel the world they live in isn’t safe. The outbreak has taken a physical and mental toll on much of the population that hasn’t been infected by the virus, causing symptoms mirroring those of PTSD and other mental illnesses.

How Mass Trauma Relates to COVID-19

The APA states COVID-19 will worsen existing mental health conditions for many people and cause new mental health problems for many others. The organization recommends medical researchers and clinicians prepare mental health diagnostics, prevention and outreach efforts coordinated with local health care providers. The goal is to quickly develop and test interventions for mental distress due to COVID-19.

How Mass Trauma Affects Mental Health

The following are among the conditions that mass trauma and concern about COVID-19 may cause in people:

• People may be on guard or act defensively beyond what would be typical behavior for a given situation.
• People may have more frequent negative thoughts and feelings.
• People may suffer sleep problems and lapses in concentration.
• Children may pick up some of these negative behaviors from their parents or other adults.

Short-Term Impact of Mass Trauma on Mental Health

In the immediate aftermath of mass trauma, all witnesses are likely to experience stress reactions that eventually subside, usually within weeks or months, according to the U.S. Department of Veterans Affairs (VA). However, people with specific risk factors are more susceptible to severe responses, including depression, anxiety and PTSD.

The VA lists the risk factors that may cause serious short-term mental health problems following mass trauma:

• Severity of exposure and proximity to the damage from the disaster
• The presence of preexisting conditions such as neuroticism
• Lack of social support and other social and community resources

Long-Term Impact of Mass Trauma on Mental Health

The type of social isolation and loneliness resulting from COVID-19 restrictions have been linked to increases in mental and physical illnesses, as well as reduced life spans. Mental health risks are also associated with increased worry and stress in older adults. More workers report high stress levels due to potential job loss and income insecurity.

Adapting to and coping with COVID-19 in the long term requires resilience that protects against depression, anxiety, traumatic stress and other mental health conditions. The National Alliance on Mental Illness (NAMI) describes tactics that have proven effective in building mental health resilience:

• Adopt radical acceptance of things that are beyond our control.
• Cultivate realistic optimism by focusing as much as possible on problems that can be solved, such as maintaining social distance and wearing a mask in public.
• When negative thoughts arise, reframe them to highlight a positive aspect, such as gaining the opportunity to think creatively about problems.
• Find small ways to help others, whether family members or strangers, even simply sharing a joke.

Effects of Mass Trauma on Community Health

Following an event that causes mass trauma, the rise in mental illness affects entire communities, not just the people who experienced the event firsthand. Higher levels of PTSD, depression and other mental conditions are reported throughout the impacted community.

The situation is made worse by repeated media reports and social media posts about the traumatic event. The challenge for all communities in protecting the mental health of residents is to make sure resources such as the National Suicide Prevention Lifeline (800-273-8255) are readily available to people in crisis.

How Mass Trauma Affects Children and Vulnerable Communities

A World Health Organization (WHO) survey on the impact of COVID-19 on the provision of mental health services found poor people and other vulnerable populations will suffer the most serious disruptions in the delivery of essential services.

• Poor and vulnerable people are more likely to experience setbacks in their mental health treatment.
• COVID-19 itself is associated with the onset of serious mental and neurological conditions; the disease is most prevalent among poor and vulnerable people.
• Poor and vulnerable people have lost their social support networks and are most susceptible to the economic distress the pandemic has caused.
• COVID-19 has disrupted an estimated 70% of children’s mental health services.

Impact of Trauma on Children

The trauma many children experience as a result of the COVID-19 pandemic will have deep and long-lasting effects on their mental health. Witnessing the death of loved ones and community members lost to COVID-19 is only one reason for concern about the mental health impact of the outbreak on children.

• Children are more likely to witness emotional, physical or sexual abuse or neglect in their homes.
• Children are more vulnerable to economic insecurity, food shortages and homelessness.
• The stay-at-home order has led to teachers, pediatricians and other mandated reporters receiving a 50% decrease in the number of reports of child abuse or neglect.

Vicarious Trauma in Health Care Workers Due to COVID-19

Mental health counselors and other health care professionals have to be aware of the physical and mental risks of treating patients during and after the pandemic. A study found vicarious trauma in health care workers treating COVID-19 patients was lower in nurses on the front line than nurses not on the front line and the general public; the level of pandemic-related vicarious trauma was about the same in the latter two groups.

Symptoms of vicarious trauma include loss of appetite, tiredness, sleep disturbances, irritability, lack of focus, fear and interpersonal conflict. The researchers note most of these symptoms remain relatively minor in affected health care providers. The studies reported in Frontiers in Psychology identified specific groups of health care providers who appear to be at greater risk of vicarious trauma from treating COVID-19 patients. For example, unmarried nurses tend to have fewer severe symptoms of vicarious trauma than nurses who are married, divorced or widowed.

• The higher level of vicarious trauma in nurses not on the front line and the general public is the result of two factors, according to the researchers:
  • Most nurses on the front line volunteered to work in COVID-19 wards and received the psychological preparation to prevent vicarious trauma.
  • Nurses not on the front line and the general public are concerned about COVID-19 patients and the professionals who are caring for them, while nurses on the front line are able to better sympathize with their patients and benefit from their experience with the pandemic.

Resources on Mass Trauma

• The VA’s Resources for Survivors and the Public Following Disaster and Mass Violence features links to information on self-care after disasters and tools for managing symptoms that arise after experiencing trauma.
• Healing Mass Trauma — COVID-19 provides downloadable self-help guides for staying safe and maintaining physical and mental health during the pandemic.

How Do Trauma and Grief Relate to Each Other?

Psychology Today points out traumatic grief results from unexpected events, while other causes of grief are foreseeable, such as losing a loved one after a long illness. What is uncertain is the degree of unexpectedness leading to the trauma. Fear plays a greater role in traumatic grief because the event comes by surprise and causes a person’s world to be thrown off its axis.

Differences and Similarities of Grief and Traumatic Grief

Many of the physical and mental responses to grief and traumatic grief are the same:

• Trembling or muscle weakness
• Nausea or loss of appetite
• Difficulty breathing or sleeping
• Feeling empty or numb

However, when trauma complicates grief, a person’s symptoms may include feeling a loss of safety or security. A fixation on the loss can dominate the person’s thoughts. The person may become bitter and envy those not affected by the loss, or may no longer find enjoyment in some favorite activities.

How an Unexpected Death Triggers Traumatic Grief

The four types of problems that may arise after the unexpected death of a loved one include:

• The trauma causes a sense of unreality or leads the person to avoid any reference to the traumatic event.
• The shock of the event postpones the start of the normal grieving process, or conversely, the person becomes stuck in the grief stage and can’t move past the overwhelming feelings of sadness.
• The person becomes angry at themselves or others, magically thinking self-punishment will bring the lost loved one back.
• The person has persistent feelings of fear in anticipation of future traumatic events, sometimes perceiving threats where none exist.

The Connection Between Traumatic Grief and PTSD

People who suffer a traumatic loss are especially susceptible to PTSD. They may also experience panic disorder and depressive episodes that persist long after the usual grieving period. These are among the symptoms of PTSD:

• Anger, tension and irritation
• Heart palpitations, sweating and hyperventilation
• Flashbacks to the traumatic event
• Avoiding any reference to and emotions surrounding the event
• Feelings of guilt or self-blame
• Persistent negative thoughts

What Is Complicated or Prolonged Grief?

Prolonged grief differs from depression in that the person typically becomes fixated on the lost loved one. Also called complicated grief, the condition occurs in about 1 in 10 people who suffer the traumatic loss of someone close to them. If left untreated, the grief can last indefinitely, causing sleeplessness, substance abuse, suicidal thoughts and impaired immune-system response.

How to Distinguish Traumatic Grief from PTSD

While traumatic grief and PTSD share some characteristics, such as disbelief and avoidance behaviors, the two conditions differ primarily in the former’s focus on personal loss.

• Traumatic grief is associated with a deep longing for the lost loved one.
• PTSD is more closely tied to a sense of overwhelming fear and loss of control.
• When a loved one passes away, we lose the neural reward activity the person created, so the sense of loss is due in part to the disappearance of that reward activity.
• When a person experiences trauma, a fight-or-flight response is triggered, causing physical fear responses difficult to overcome.

Resources on Trauma and Grief

• The National Child Traumatic Stress Network features information on the effects of child trauma, interventions and resources for parents and health care providers.
• Federal Occupational Health provides links to resources intended to help adults and children cope with trauma and grief and assist in building resilience to both

Symptoms of Grief

Diagnosing patients who experience symptoms of grief to a greater extent or over a longer period than would be considered typical begins by identifying the symptoms they exhibit or express to caregivers. In particular, complicated grief, which is sometimes called persistent complex bereavement disorder, can have serious consequences for people in mourning and their families.

How Traumatic Grief Symptoms Differ from Other Types of Grief

The symptoms of traumatic grief and other forms of grief are as follows:

• Physical symptoms include headaches and muscle aches, trouble sleeping, weakness, digestive problems, changes in eating habits and frequent illnesses.
• Mental symptoms include guilt, anger, irritability, anxiety, loneliness, melancholy, numbness and detachment.
• People suffering from traumatic grief are more likely to experience complicated grief, which may make them feel angry or bitter, stunned, or in disbelief. They also experience suicidal thoughts, feelings of meaninglessness or constant rumination about the circumstances of the traumatic event.

Symptoms of Traumatic Grief in Children

While children who are suffering grief will experience many of the same symptoms as adults, they may also exhibit distinct changes in behavior:

• Children may cling to adults more, be anxious or feel abandoned.
• Children may experience regression in their development, such as small children wanting to drink from a bottle or use baby talk.
• Children may act out or fall behind in their schoolwork.
• The way children play may change to focus on pretend dying and coming back to life.
• Children sometimes feel guilty during grief, believing the loss is their fault.
• Older children and teenagers may adopt risky behaviors, such as drinking alcohol or taking drugs.

Other Techniques for Identifying People Affected by Traumatic Grief

The APA distinguishes the symptoms of people with prolonged grief from sadness and depression:

• Prolonged grief causes people to be much more emotional.
• Prolonged grief causes people to be preoccupied with memories of the lost loved one and long for the individual intensely.
• Antidepressants don’t improve the condition.

However, prolonged grief shares some symptoms with PTSD:

• Disbelief
• Intrusive images
• Behavior avoidance

Resources on the Symptoms of Grief

• Coping with the Loss of a Loved One offers a guide to identifying complicated grief, including advice for helping people who are grieving.
• The U.S. National Library of Medicine’s bereavement directory including links to information on grief and loss related to COVID-19 and journal articles on prolonged grief disorder.

Coping Strategies for Grief

Recovering from the trauma of losing a loved one requires a platform for examining and understanding what has happened and how the person’s life has changed. Coping strategies for grief are intended to allow people who have suffered trauma to be introspective and thoughtful about their loss. The goal is to channel the flood of emotions that are a natural part of grieving to let thoughts be considered from a different perspective. This helps prevent negative thoughts from looping through the person’s mind.

Common Strategies for Coping with Grief

The following five skills can help people work through the grieving process:

• Eat a healthy diet and drink plenty of water. Even when you don’t have an appetite, preparing simple foods such as soup or tea can bring comfort by feeling familiar.
• Let people know how you feel. It’s common for people in mourning to avoid talking about how they feel, but finding a sympathetic ear can be a therapeutic release.
• Start a journal. If you hesitate to open up to others, express your emotions in a private journal. This helps you mark progress over time and make note of small accomplishments.
• Stay active. Swimming, weightlifting, bicycling and other forms of exercise help relax tense muscles. Even short walks and simple activities such as sweeping the walk can have benefits.
• Try using relaxation techniques. Many people who are grieving find comfort in meditation, prayer and other mindfulness practices. A technique as simple as slow, deep breathing can help calm anxiety or worry.

Explaining the Grieving Process

No two people grieve the same way. The following factors can affect how a person grieves:

• Age
• Beliefs
• Personality
• Support network
• Type of loss

People in mourning must identify behaviors that indicate the need for professional help in overcoming their grief. These behaviors include being unable to maintain a routine, having trouble completing everyday tasks, missing work, incessantly blaming themselves, and feeling worthless or that life isn’t worth living. These feelings aren’t part of the normal grieving process.

Counteracting the Emotional and Physical Symptoms of Grief

These steps can help overcome the physical and emotional effects of the grieving process:

• Changes in a grieving person’s diet can cause digestive problems, so maintaining a healthy diet is important.
• Grieving can affect motor skills, making driving and other physical activities potentially more dangerous.
• The loss of energy accompanying grief can make the person more susceptible to illness.

Sources of Support for Coping with Overcoming Grief

As personal as the grieving process is, no one needs to or should go through it alone. Social support and good eating habits help people recover more quickly from a traumatic loss. The APA recommends five ways for people in mourning to reach out for assistance to help ease their pain:

• Talk about your loss with friends and family to help them understand and remember the person.
• Don’t deny any of the emotions you feel; all of them are part of the normal grieving process.
• Take care of your physical health and make sure others who may be grieving are doing likewise.
• Help others who are experiencing the same feelings; this is one of the best ways to overcome feelings of loss.
• Take every opportunity to celebrate the life and memory of the person you lost.

Family and Friends

The following tips and advice can help family and friends of people in mourning understand the best way to help them through the grieving process:

• Acknowledge the person’s loss and express your concern.
• Give the person a chance to talk about the loss, including how the loss occurred.
• Ask how the person is feeling, but avoid comparing the person’s grief with anyone else’s.
• Accept the emotions the person expresses without judgment or criticism.
• If the person doesn’t want to talk, sitting with the person in silence for a while is OK.

Community Support Services

The American Medical Association (AMA) guidelines for managing mental health patients during COVID-19 recommend planning for increased workloads as the conditions of existing patients are exacerbated and new patients experience symptoms.

• Make sure established referral pathways for patients remain available.
• Find ways to communicate clear messages to patients, explaining how to recognize and respond to symptoms that may be worsened by COVID-19 fears.
• Work with patients to help them normalize stress and understand the feelings are common and treatable.

Social Media and Other Online Services

Consider the following when using social media as part of the grieving process:

• Avoid announcing someone’s loss via social media; although it may be simple and convenient to do so, it can be disturbing for people who learn of the passing in that manner.
• Be conservative in the amount of detail about the death that gets posted to social media to protect the privacy of the person and the person’s family.
• Avoid posting condolences the public can view and comment on; instead, use a private messaging service.
• Get the family’s permission before creating a memorial page for the person.

The Importance of Self-Care for People Who Are Grieving

A personalized self-care plan can help with the grieving process:

• Understand self-care is multidimensional; every day you will feel different from the day before.
• Don’t rush to forget or hold back memories. Take the time to remember and honor the person you lost.
• Whenever the opportunity arises, spend time outdoors, preferably walking or doing other light exercise.

Tips for Facing and Expressing Your Feelings

People who are grieving should make the effort to reach out to friends and family rather than waiting for them to make the call. While it can be helpful to tell them about how you’re feeling, relaxing conversation on nearly any topic can be therapeutic.

In some instances, the best way to communicate how you feel about your grief is by joining a support group or by seeking the help of a mental health counselor. Keep in mind there is no single best way to go about expressing how you feel, so don’t hesitate to experiment until you find the best method for you.

The Importance of Returning to a Daily Routine

The new routine will likely vary in some ways from your previous habits and activities, but it should be designed with your health and well-being in mind. If necessary, make appointments to take part in favorite activities, such as listening to music, reading a book or simply taking a bath. Be sure to include shared activities and visits with friends and family in your new routine.

Encouraging Healthy Habits and Discouraging Unhealthy Ones

A little self-indulgence can help overcome the pain of grieving, but not so much the indulgence becomes a crutch. Grieving requires you to address and process the pain you’re feeling rather than running away from it. Friends, family and co-workers can play important roles in reminding you to maintain a healthy lifestyle despite the pain and sorrow you feel.

Resources on Coping Strategies for Grief

• Coping with a Disaster or Traumatic Event includes links to information about protecting your emotional health in times of crisis, as well as tips for helping children cope with trauma.
• Grief and COVID-19: Saying Goodbye in the Age of Physical Distancing explains how to mitigate the added stress of being separated from loved ones as they are dying from COVID-19.

In Times of Crisis, Look to the Helpers

National traumas are typically associated with a specific date, such as Dec. 7, 1941, or Sept. 11, 2001. The COVID-19 pandemic sometimes feels like it’s happening in slow motion, but the devastation resulting from this ongoing disaster has been made all too real to millions of Americans and tens of millions of people around the world. Grieving after a national crisis the scope of COVID-19 will be widespread, long and painful.

These are the times when our attention naturally turns to the people who are dedicated to the care and comfort of others who are suffering and in need. The work of counselors and other mental health professionals will be needed in the coming months and years more than ever before in our lifetimes.

When a traumatic event occurs, the first emotions we tend to experience are shock and horror. Reality itself may seem to be suspended temporarily, but once we realize the magnitude of the trauma, our shock may give way to grief. As devastating as traumatic grief can be, it’s the first stage in the healing process.

Even our grief has been transformed by the trauma the COVID-19 pandemic has inflicted. Safety measures to prevent the deadly coronavirus have disrupted the normal grieving process in some of the following ways:

• The inability of families and communities to perform the cultural rituals for lost loved ones increases the likelihood of survivors suffering from depression and anxiety.
• Health care workers on the front line of the battle against COVID-19 are often the only people who can be with the victims in their last moments.
• The need to stay separate from family and friends prevents people in mourning from receiving the love and support they need, leading to potentially long-term mental health impacts.

Understanding the connection between unexpected trauma and grief helps mental health practitioners provide the guidance and support that will help families and communities heal from the ravages of COVID-19. Never before has social support and the role of mental health counselors been more needed to help people learn and implement the coping strategies for traumatic grief.

What Is Traumatic Grief?

What is traumatic grief? It’s a reaction to a traumatic event that lasts longer than is typical or that affects the person who is coping after a death or other event more deeply than is typical.

Emotional and psychological trauma strikes people in the aftermath of exceptionally stressful occurrences. Trauma is described as evoking feelings of insecurity and helplessness. People who are traumatized experience a jumble of emotions and memories that may leave them feeling anxious, numb, disconnected or distrustful.

Traumatic grief occurs after an unexpected loss, such as the sudden death of a loved one. The typical grieving process may be accompanied by post-trauma survival mechanisms that could complicate and prolong the healing process. The mechanisms may include fear, fight-or-flight (hyper) responses or freeze (hypo) responses.

How Traumatic Grief Differs from Other Forms of Grief

Grief is an unfortunate but natural part of life. We grieve when we lose a loved one, when a long-term relationship ends and when experiencing other forms of loss. In most cases, the loss is expected or foreseeable, such as the loss of an aged parent to illness. However, when the loss is unexpected, we experience trauma as well as grief, which can interrupt, exacerbate and prolong the usual grieving process. Overcoming traumatic grief often requires counseling from a mental health professional or other professional assistance.

Effects of Traumatic Grief on Individuals, Families and Communities

In the aftermath of a disaster such as the COVID-19 pandemic, most people can return to the way they functioned before the event. However, many people will experience negative feelings and emotions immediately after the calamity. In some cases, the ill effects on the mental health of survivors will persist for an extended period.

Common reactions adults and children experience after a disaster include:

• Having trouble falling or staying asleep
• Feeling sad, depressed, moody, irritable or hyperactive
• Feeling numb
• Feeling tired
• Having trouble eating or overeating
• Having trouble focusing
• Avoiding social contacts and usual routines
• Misusing alcohol or other drugs

Very young children may cling tighter to their parents and caregivers, be frightful or throw tantrums. School-age children sometimes become more combative or isolated; they may struggle with schoolwork.

There are many ways COVID-19 has strained the usual grieving process along with resources communities can tap to mitigate the damage:

• Patient isolation prevents families from saying goodbye to loved ones.
• Funerals and other mourning rituals are disrupted or prevented entirely due to social distancing requirements.
• Mental health professionals haven’t been trained to respond to disasters such as COVID-19, leaving communities unprepared.

Fact sheets and video presentations are available from many sources to help mental health counselors and other health professionals assist clients struggling with COVID-19 issues.

Traumatic Grief Resulting from National Crises

Traumatic grief due to the pandemic is unlike that experienced by people who have lost a loved one in other natural disasters or national crises. Deaths from tornadoes, hurricanes, earthquakes, wildfires and other natural events are typically accompanied by massive damage to property. The full scale of the economic, social and public health damage resulting from the slow-moving catastrophe of the pandemic won’t be known for many years. Communities across the country may respond to the mental health repercussions of COVID-19 for years afterward.

How COVID-19 Impacts Mental Health

The pandemic has affected everyone, but in many cases, the added stress and uncertainty the outbreak has caused has worsened existing mental and physical health conditions. Adults and children can easily be overwhelmed by these feelings. Being concerned about the safety and well-being of our loved ones is natural, but sometimes that worry can get out of control.

In the months after the pandemic struck, 1 in 3 adults in the U.S. experienced symptoms of anxiety or depressive disorder.

• In June 2020, the weekly average of people reporting such symptoms was 34.5%.
• In July 2020, the weekly average was 40.1%.
• From January to June 2019, the weekly average was 11%.

The Challenges of Providing Mental Health Care in Times of National Crisis

Following are some of the challenges faced in combating COVID-19 and other natural disasters:

• The typical adjustment period after the traumatic loss of a loved one is six to 12 months, but anything that interrupts the normal grieving process can extend the adjustment period.
• People can become stuck in the grieving process; this condition is called complicated grief and can lead to depression, post-traumatic stress disorder (PTSD) and other mental illnesses.
• Deaths occurring in intensive care units (ICUs) and other hospital settings are more traumatic for family members — a situation made worse by grieving in environments impacted by COVID-19 restrictions on in-person gatherings.

Strategies for Building Mental Health Resilience During a Crisis

There are many simple ways for people to cope with COVID-19 stress and tend to their emotional health during this time.

• For health care professionals, be aware of the potential for vicarious trauma or compassion fatigue as a consequence of witnessing the trauma and distress from COVID-19.
• For workplaces and businesses, be aware of the symptoms of stress, and communicate health and safety information clearly and frequently.
• For parents helping children and young adults, try to maintain routine and continuity in learning and health care; take every opportunity to make children feel safe and secure.

Resources on Traumatic Grief

• The Disaster Distress Helpline provides links to crisis support services and COVID-19 emergency response information.
• Trauma and Grief resources cover helpful topics, like Will My Child Bounce Back from the Coronavirus Crisis?

What Is Mass Trauma?

Mass trauma occurs when a group of people is affected psychologically after experiencing a shared traumatic event. The impact of the COVID-19 pandemic constitutes mass trauma in that it causes people to feel the world they live in isn’t safe. The outbreak has taken a physical and mental toll on much of the population that hasn’t been infected by the virus, causing symptoms mirroring those of PTSD and other mental illnesses.

How Mass Trauma Relates to COVID-19

The APA states COVID-19 will worsen existing mental health conditions for many people and cause new mental health problems for many others. The organization recommends medical researchers and clinicians prepare mental health diagnostics, prevention and outreach efforts coordinated with local health care providers. The goal is to quickly develop and test interventions for mental distress due to COVID-19.

How Mass Trauma Affects Mental Health

The following are among the conditions that mass trauma and concern about COVID-19 may cause in people:

• People may be on guard or act defensively beyond what would be typical behavior for a given situation.
• People may have more frequent negative thoughts and feelings.
• People may suffer sleep problems and lapses in concentration.
• Children may pick up some of these negative behaviors from their parents or other adults.

Short-Term Impact of Mass Trauma on Mental Health

In the immediate aftermath of mass trauma, all witnesses are likely to experience stress reactions that eventually subside, usually within weeks or months, according to the U.S. Department of Veterans Affairs (VA). However, people with specific risk factors are more susceptible to severe responses, including depression, anxiety and PTSD.

The VA lists the risk factors that may cause serious short-term mental health problems following mass trauma:

• Severity of exposure and proximity to the damage from the disaster
• The presence of preexisting conditions such as neuroticism
• Lack of social support and other social and community resources

Long-Term Impact of Mass Trauma on Mental Health

The type of social isolation and loneliness resulting from COVID-19 restrictions have been linked to increases in mental and physical illnesses, as well as reduced life spans. Mental health risks are also associated with increased worry and stress in older adults. More workers report high stress levels due to potential job loss and income insecurity.

Adapting to and coping with COVID-19 in the long term requires resilience that protects against depression, anxiety, traumatic stress and other mental health conditions. The National Alliance on Mental Illness (NAMI) describes tactics that have proven effective in building mental health resilience:

• Adopt radical acceptance of things that are beyond our control.
• Cultivate realistic optimism by focusing as much as possible on problems that can be solved, such as maintaining social distance and wearing a mask in public.
• When negative thoughts arise, reframe them to highlight a positive aspect, such as gaining the opportunity to think creatively about problems.
• Find small ways to help others, whether family members or strangers, even simply sharing a joke.

Effects of Mass Trauma on Community Health

Following an event that causes mass trauma, the rise in mental illness affects entire communities, not just the people who experienced the event firsthand. Higher levels of PTSD, depression and other mental conditions are reported throughout the impacted community.

The situation is made worse by repeated media reports and social media posts about the traumatic event. The challenge for all communities in protecting the mental health of residents is to make sure resources such as the National Suicide Prevention Lifeline (800-273-8255) are readily available to people in crisis.

How Mass Trauma Affects Children and Vulnerable Communities

A World Health Organization (WHO) survey on the impact of COVID-19 on the provision of mental health services found poor people and other vulnerable populations will suffer the most serious disruptions in the delivery of essential services.

• Poor and vulnerable people are more likely to experience setbacks in their mental health treatment.
• COVID-19 itself is associated with the onset of serious mental and neurological conditions; the disease is most prevalent among poor and vulnerable people.
• Poor and vulnerable people have lost their social support networks and are most susceptible to the economic distress the pandemic has caused.
• COVID-19 has disrupted an estimated 70% of children’s mental health services.

Impact of Trauma on Children

The trauma many children experience as a result of the COVID-19 pandemic will have deep and long-lasting effects on their mental health. Witnessing the death of loved ones and community members lost to COVID-19 is only one reason for concern about the mental health impact of the outbreak on children.

• Children are more likely to witness emotional, physical or sexual abuse or neglect in their homes.
• Children are more vulnerable to economic insecurity, food shortages and homelessness.
• The stay-at-home order has led to teachers, pediatricians and other mandated reporters receiving a 50% decrease in the number of reports of child abuse or neglect.

Vicarious Trauma in Health Care Workers Due to COVID-19

Mental health counselors and other health care professionals have to be aware of the physical and mental risks of treating patients during and after the pandemic. A study found vicarious trauma in health care workers treating COVID-19 patients was lower in nurses on the front line than nurses not on the front line and the general public; the level of pandemic-related vicarious trauma was about the same in the latter two groups.

Symptoms of vicarious trauma include loss of appetite, tiredness, sleep disturbances, irritability, lack of focus, fear and interpersonal conflict. The researchers note most of these symptoms remain relatively minor in affected health care providers. The studies reported in Frontiers in Psychology identified specific groups of health care providers who appear to be at greater risk of vicarious trauma from treating COVID-19 patients. For example, unmarried nurses tend to have fewer severe symptoms of vicarious trauma than nurses who are married, divorced or widowed.

• The higher level of vicarious trauma in nurses not on the front line and the general public is the result of two factors, according to the researchers:
  • Most nurses on the front line volunteered to work in COVID-19 wards and received the psychological preparation to prevent vicarious trauma.
  • Nurses not on the front line and the general public are concerned about COVID-19 patients and the professionals who are caring for them, while nurses on the front line are able to better sympathize with their patients and benefit from their experience with the pandemic.

Resources on Mass Trauma

• The VA’s Resources for Survivors and the Public Following Disaster and Mass Violence features links to information on self-care after disasters and tools for managing symptoms that arise after experiencing trauma.
• Healing Mass Trauma — COVID-19 provides downloadable self-help guides for staying safe and maintaining physical and mental health during the pandemic.

How Do Trauma and Grief Relate to Each Other?

Psychology Today points out traumatic grief results from unexpected events, while other causes of grief are foreseeable, such as losing a loved one after a long illness. What is uncertain is the degree of unexpectedness leading to the trauma. Fear plays a greater role in traumatic grief because the event comes by surprise and causes a person’s world to be thrown off its axis.

Differences and Similarities of Grief and Traumatic Grief

Many of the physical and mental responses to grief and traumatic grief are the same:

• Trembling or muscle weakness
• Nausea or loss of appetite
• Difficulty breathing or sleeping
• Feeling empty or numb

However, when trauma complicates grief, a person’s symptoms may include feeling a loss of safety or security. A fixation on the loss can dominate the person’s thoughts. The person may become bitter and envy those not affected by the loss, or may no longer find enjoyment in some favorite activities.

How an Unexpected Death Triggers Traumatic Grief

The four types of problems that may arise after the unexpected death of a loved one include:

• The trauma causes a sense of unreality or leads the person to avoid any reference to the traumatic event.
• The shock of the event postpones the start of the normal grieving process, or conversely, the person becomes stuck in the grief stage and can’t move past the overwhelming feelings of sadness.
• The person becomes angry at themselves or others, magically thinking self-punishment will bring the lost loved one back.
• The person has persistent feelings of fear in anticipation of future traumatic events, sometimes perceiving threats where none exist.

The Connection Between Traumatic Grief and PTSD

People who suffer a traumatic loss are especially susceptible to PTSD. They may also experience panic disorder and depressive episodes that persist long after the usual grieving period. These are among the symptoms of PTSD:

• Anger, tension and irritation
• Heart palpitations, sweating and hyperventilation
• Flashbacks to the traumatic event
• Avoiding any reference to and emotions surrounding the event
• Feelings of guilt or self-blame
• Persistent negative thoughts

What Is Complicated or Prolonged Grief?

Prolonged grief differs from depression in that the person typically becomes fixated on the lost loved one. Also called complicated grief, the condition occurs in about 1 in 10 people who suffer the traumatic loss of someone close to them. If left untreated, the grief can last indefinitely, causing sleeplessness, substance abuse, suicidal thoughts and impaired immune-system response.

How to Distinguish Traumatic Grief from PTSD

While traumatic grief and PTSD share some characteristics, such as disbelief and avoidance behaviors, the two conditions differ primarily in the former’s focus on personal loss.

• Traumatic grief is associated with a deep longing for the lost loved one.
• PTSD is more closely tied to a sense of overwhelming fear and loss of control.
• When a loved one passes away, we lose the neural reward activity the person created, so the sense of loss is due in part to the disappearance of that reward activity.
• When a person experiences trauma, a fight-or-flight response is triggered, causing physical fear responses difficult to overcome.

Resources on Trauma and Grief

• The National Child Traumatic Stress Network features information on the effects of child trauma, interventions and resources for parents and health care providers.
• Federal Occupational Health provides links to resources intended to help adults and children cope with trauma and grief and assist in building resilience to both.

Symptoms of Grief

Diagnosing patients who experience symptoms of grief to a greater extent or over a longer period than would be considered typical begins by identifying the symptoms they exhibit or express to caregivers. In particular, complicated grief, which is sometimes called persistent complex bereavement disorder, can have serious consequences for people in mourning and their families.

How Traumatic Grief Symptoms Differ from Other Types of Grief

The symptoms of traumatic grief and other forms of grief are as follows:

• Physical symptoms include headaches and muscle aches, trouble sleeping, weakness, digestive problems, changes in eating habits and frequent illnesses.
• Mental symptoms include guilt, anger, irritability, anxiety, loneliness, melancholy, numbness and detachment.
• People suffering from traumatic grief are more likely to experience complicated grief, which may make them feel angry or bitter, stunned, or in disbelief. They also experience suicidal thoughts, feelings of meaninglessness or constant rumination about the circumstances of the traumatic event.

Symptoms of Traumatic Grief in Children

While children who are suffering grief will experience many of the same symptoms as adults, they may also exhibit distinct changes in behavior:

• Children may cling to adults more, be anxious or feel abandoned.
• Children may experience regression in their development, such as small children wanting to drink from a bottle or use baby talk.
• Children may act out or fall behind in their schoolwork.
• The way children play may change to focus on pretend dying and coming back to life.
• Children sometimes feel guilty during grief, believing the loss is their fault.
• Older children and teenagers may adopt risky behaviors, such as drinking alcohol or taking drugs.

Other Techniques for Identifying People Affected by Traumatic Grief

The APA distinguishes the symptoms of people with prolonged grief from sadness and depression:

• Prolonged grief causes people to be much more emotional.
• Prolonged grief causes people to be preoccupied with memories of the lost loved one and long for the individual intensely.
• Antidepressants don’t improve the condition.

However, prolonged grief shares some symptoms with PTSD:

• Disbelief
• Intrusive images
• Behavior avoidance

Resources on the Symptoms of Grief

• Coping with the Loss of a Loved One offers a guide to identifying complicated grief, including advice for helping people who are grieving.
• The U.S. National Library of Medicine’s bereavement directory including links to information on grief and loss related to COVID-19 and journal articles on prolonged grief disorder.

Coping Strategies for Grief

Recovering from the trauma of losing a loved one requires a platform for examining and understanding what has happened and how the person’s life has changed. Coping strategies for grief are intended to allow people who have suffered trauma to be introspective and thoughtful about their loss. The goal is to channel the flood of emotions that are a natural part of grieving to let thoughts be considered from a different perspective. This helps prevent negative thoughts from looping through the person’s mind.

Common Strategies for Coping with Grief

The following five skills can help people work through the grieving process:

• Eat a healthy diet and drink plenty of water. Even when you don’t have an appetite, preparing simple foods such as soup or tea can bring comfort by feeling familiar.
• Let people know how you feel. It’s common for people in mourning to avoid talking about how they feel, but finding a sympathetic ear can be a therapeutic release.
• Start a journal. If you hesitate to open up to others, express your emotions in a private journal. This helps you mark progress over time and make note of small accomplishments.
• Stay active. Swimming, weightlifting, bicycling and other forms of exercise help relax tense muscles. Even short walks and simple activities such as sweeping the walk can have benefits.
• Try using relaxation techniques. Many people who are grieving find comfort in meditation, prayer and other mindfulness practices. A technique as simple as slow, deep breathing can help calm anxiety or worry.

Explaining the Grieving Process

No two people grieve the same way. The following factors can affect how a person grieves:

• Age
• Beliefs
• Personality
• Support network
• Type of loss

People in mourning must identify behaviors that indicate the need for professional help in overcoming their grief. These behaviors include being unable to maintain a routine, having trouble completing everyday tasks, missing work, incessantly blaming themselves, and feeling worthless or that life isn’t worth living. These feelings aren’t part of the normal grieving process.

Counteracting the Emotional and Physical Symptoms of Grief

These steps can help overcome the physical and emotional effects of the grieving process:

• Changes in a grieving person’s diet can cause digestive problems, so maintaining a healthy diet is important.
• Grieving can affect motor skills, making driving and other physical activities potentially more dangerous.
• The loss of energy accompanying grief can make the person more susceptible to illness.

Reaching the Stage of Acceptance and Remembrance

In the last stage of grief, people who are grieving allow feelings of sadness, anger, regret or depression. They have reached the point of understanding their emotions and have accepted their new world. Unfortunately, not everyone who grieves can reach the acceptance and remembrance stage due to being unable to get past one of the stages, like anger or depression.

Sources of Support for Coping with Overcoming Grief

As personal as the grieving process is, no one needs to or should go through it alone. Social support and good eating habits help people recover more quickly from a traumatic loss. The APA recommends five ways for people in mourning to reach out for assistance to help ease their pain:

• Talk about your loss with friends and family to help them understand and remember the person.
• Don’t deny any of the emotions you feel; all of them are part of the normal grieving process.
• Take care of your physical health and make sure others who may be grieving are doing likewise.
• Help others who are experiencing the same feelings; this is one of the best ways to overcome feelings of loss.
• Take every opportunity to celebrate the life and memory of the person you lost.

Family and Friends

The following tips and advice can help family and friends of people in mourning understand the best way to help them through the grieving process:

• Acknowledge the person’s loss and express your concern.
• Give the person a chance to talk about the loss, including how the loss occurred.
• Ask how the person is feeling, but avoid comparing the person’s grief with anyone else’s.
• Accept the emotions the person expresses without judgment or criticism.
• If the person doesn’t want to talk, sitting with the person in silence for a while is OK.

Community Support Services

The American Medical Association (AMA) guidelines for managing mental health patients during COVID-19 recommend planning for increased workloads as the conditions of existing patients are exacerbated and new patients experience symptoms.

• Make sure established referral pathways for patients remain available.
• Find ways to communicate clear messages to patients, explaining how to recognize and respond to symptoms that may be worsened by COVID-19 fears.
• Work with patients to help them normalize stress and understand the feelings are common and treatable.

Social Media and Other Online Services

Consider the following when using social media as part of the grieving process:

• Avoid announcing someone’s loss via social media; although it may be simple and convenient to do so, it can be disturbing for people who learn of the passing in that manner.
• Be conservative in the amount of detail about the death that gets posted to social media to protect the privacy of the person and the person’s family.
• Avoid posting condolences the public can view and comment on; instead, use a private messaging service.
• Get the family’s permission before creating a memorial page for the person.

The Importance of Self-Care for People Who Are Grieving

A personalized self-care plan can help with the grieving process:

• Understand self-care is multidimensional; every day you will feel different from the day before.
• Don’t rush to forget or hold back memories. Take the time to remember and honor the person you lost.
• Whenever the opportunity arises, spend time outdoors, preferably walking or doing other light exercise.

Tips for Facing and Expressing Your Feelings

People who are grieving should make the effort to reach out to friends and family rather than waiting for them to make the call. While it can be helpful to tell them about how you’re feeling, relaxing conversation on nearly any topic can be therapeutic.

In some instances, the best way to communicate how you feel about your grief is by joining a support group or by seeking the help of a mental health counselor. Keep in mind there is no single best way to go about expressing how you feel, so don’t hesitate to experiment until you find the best method for you.

The Importance of Returning to a Daily Routine

The new routine will likely vary in some ways from your previous habits and activities, but it should be designed with your health and well-being in mind. If necessary, make appointments to take part in favorite activities, such as listening to music, reading a book or simply taking a bath. Be sure to include shared activities and visits with friends and family in your new routine.

Encouraging Healthy Habits and Discouraging Unhealthy Ones

A little self-indulgence can help overcome the pain of grieving, but not so much the indulgence becomes a crutch. Grieving requires you to address and process the pain you’re feeling rather than running away from it. Friends, family and co-workers can play important roles in reminding you to maintain a healthy lifestyle despite the pain and sorrow you feel.

Resources on Coping Strategies for Grief

• Coping with a Disaster or Traumatic Event includes links to information about protecting your emotional health in times of crisis, as well as tips for helping children cope with trauma.
• Grief and COVID-19: Saying Goodbye in the Age of Physical Distancing explains how to mitigate the added stress of being separated from loved ones as they are dying from COVID-19.

In Times of Crisis, Look to the Helpers

National traumas are typically associated with a specific date, such as Dec. 7, 1941, or Sept. 11, 2001. The COVID-19 pandemic sometimes feels like it’s happening in slow motion, but the devastation resulting from this ongoing disaster has been made all too real to millions of Americans and tens of millions of people around the world. Grieving after a national crisis the scope of COVID-19 will be widespread, long and painful.

These are the times when our attention naturally turns to the people who are dedicated to the care and comfort of others who are suffering and in need. The work of counselors and other mental health professionals will be needed in the coming months and years more than ever before in our lifetimes.

About Bradley University

Established in 1897, Bradley University is a private, independent institution of higher learning located in Peoria, Illinois. Inspired by our founder, notable philanthropist Lydia Moss Bradley, we pursue excellence in teaching, research, scholarship and service, and we celebrate leadership, integrity, diversity and collaborative learning. Today, we offer an impressive array of more than 130 undergraduate, graduate and continuing education programs across five colleges. Widely respected for our outstanding faculty and student-centered approach to learning, we’re able to provide the resources of a large public university—but with the personalized attention of a small private college. With more than 65,000 alumni worldwide, we are full of promise to become one of the nation’s best comprehensive academic institutions.

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