Stress, Depression, and Front-line Trauma: Some Tips for Coping

Prepared by the Smithers Institute for Alcohol-related Workplace Studies

The COVID-19 pandemic has forced nearly everyone to drastically reduce face-to-face social interaction and demanded that many others shelter in place for weeks on end. Moreover, many individuals -- including many who never thought they would be out of a job – have been laid off or placed on long-term leave. For these individuals in particular, the stresses of losing one’s job and covering one’s expenses are compounded by stresses of social isolation or the inability to find “alone” time and space while sheltering with others. Finally, first responders and health care practitioners are being confronted by traumatic situations on a daily basis, with no time to decompress or care for themselves.

While for the past 30 years the Smithers Institute at Cornell’s ILR School has focused much of its research on the disease of alcoholism, it also conducts research into the psychological consequences of stress, trauma and workforce disengagement, and has identified strategies for managing such situations and for building resilience. Consequently, we offer the following tips for managing negative emotions that the current pandemic may cause and for preventing or managing work-based traumatic distress.

Managing stress and depression

With millions of people worrying about their health, economic security and future, the COVID-19 virus is a potent stressor, and one that is likely to remain with us for some time. Given its uncertain nature, and unprecedented, far-reaching consequences, it is not the kind of stressor to which people can easily adjust. Rather, between mandatory social distancing and 24/7 news coverage, it has the potential to generate intense and acute negative emotional states manifesting in terms of stress, anxiety or depression. Such negative emotional states, besides being unpleasant, can exacerbate existing mental and behavioral health issues, and make all of us more susceptible to illness. But, there are steps we can take to address and diminish the stressors. Here are a couple:

1. Social distancing means keeping one’s physical space, not social isolation. Sheltering-in-place orders give many of us the time and “excuse” to renew contacts with people we’ve been out of touch with for too long. Build into your daily routine time to maintain and renew relationships by phone or over the internet.
2. Shift your mindset about stress. While exposure to intense stress is associated with a significantly higher likelihood of premature death, research also shows that those who’ve experienced intense stress, but frame it positively (for example, as a challenge), are the least likely to die prematurely. How does one positively frame stress?
   • Acknowledge, rather than avoid, thinking about the stress you’re experiencing. Try to understand what it is about the situation that is generating the emotions that you’re feeling.
   • Understand why those aspects are generating stress for you. Think about the things that you deeply care about and try to identify which of these things the current situation is threatening and how. These are the challenges you face.
   • Engage in problem-focused coping. Focusing on the most significant challenge first, what steps can you take to meet the challenge? Make a list of the possible steps and problem solutions without evaluating them. Then, go through each solution, evaluating the pros and cons. Identify the solution that will best solve the problem. Finally, create and execute your action plan.
   • Stay present in the current moment. Focus on the here and now, rather than on future uncertainties over which we have no control.
3. Exercise. Taking the time to engage in exercise and/or practice a relaxation technique such as deliberate breathing or muscle relaxation can help reduce anxiety and stress.
4. Identify those in need of assistance. Seek out those in your community who may need assistance (e.g., the elderly, homeless), and try to help them. Smithers Institute research indicates that in many contexts, helping others significantly reduces stress.

Managing front-line traumatic stress

While many are feeling the stress at home, there are those who are experiencing extreme stress in the workplace. They include first responders, health care providers and delivery people. These individuals need to put a special emphasis on managing their workplace traumatic stress.

1. Know the symptoms of traumatic distress. There are four main clusters of symptoms:
   • Intrusion symptoms such as nightmare and flashbacks
   • Change in mood such as difficulties feeling positive, negative feelings about oneself or decreased interest in things that were once enjoyable.
   • Avoidance – trying to avoid people or places that might remind you of what happened or avoiding trauma-related thoughts by means of escapist behaviors such as substance misuse.
   • Change in reactivity such as heightened startle response, difficulty concentrating, difficulty sleeping or heightened irritability
2. Don’t delay seeking help. If you experience symptoms of traumatic stress, take action. Don’t assume it will just go away. Indeed, for most people, over time, these symptoms do go away. However, until they do, they can cause secondary difficulties at work and at home, as well as pose a risk to your own physical well-being. Seek assistance by talking about your symptoms with your peers (see no. 3 below), contacting your workplace’s employee assistance program or contacting a mental health professional.
3. Share your experience with peers. It is important to be grounded in the reality of your experience. To do that, make the time to engage in weekly conversations with your peers about what you’ve been experiencing These conversations are critical in helping people work through their exposure to abnormal or threatening experiences. Engaging in such conversation can actually speed up such processing and allow you to develop strategies for dismissing unrealistic threats and controlling actual threats.
4. Get enough sleep. Sleep is an overlooked restorative, and can help manage traumatic stress.

Journal Articles Related to Relevant Smithers Research:

1. Bacharach, S. B., & Bamberger, P. A. (2007). 9/11 and New York City firefighters' post hoc unit support and control climates: A context theory of the consequences of involvement in traumatic work-related events. Academy of Management Journal, 50(4), 849-868.
2. Bacharach, S. B., Bamberger, P. A., & Doveh, E. (2008). Firefighters, critical incidents, and drinking to cope: The adequacy of unit-level performance resources as a source of vulnerability and protection. Journal of Applied Psychology, 93(1), 155.
3. Bamberger, P. (2009). Employee help-seeking: Antecedents, consequences and new insights for future research. Research in personnel and human resources management, 28(1), 49-98.
4. Golan, M., Bacharach, Y., & Bamberger, P. (2010). Peer assistance programs in the workplace. Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice, 1, 169-187.
5. Belogolovsky, E., Bamberger, P. A., & Bacharach, S. B. (2012). Workforce disengagement stressors and retiree alcohol misuse: The mediating effects of sleep problems and the moderating effects of gender. Human Relations, 65(6), 705-728.
6. Vashdi, D. R., Bamberger, P. A., & Bacharach, S. (2012). Effects of job control and situational severity on the timing of help-seeking. Journal of occupational health psychology, 17(2), 206.