'What do we need when responding to Covid trauma? Knowledge, change and action...'

Kate Cairns, 20 January 2022

Maintaining wellbeing in a time of adversity

A global pandemic is a traumatic event. It is likely to affect not only the physical health but also the mental health and wellbeing of the human population. It is therefore essential that we ensure that we understand the impact of trauma and how individuals and whole communities can recover from it. We urgently need to develop trauma-informed practice.

Knowledge is at the heart of trauma-informed practice. In a culture in which information often substitutes for knowledge it becomes vitally important at a time of social adversity to develop an understanding of the nature and importance of a deep knowing that is able to transform our way of being in the world. When we know something it means we have begun to build it into the structure of our brain and nervous system. Information is transitory and shallow. Knowledge is lasting and deep. So what do we need to know?

Trauma

We need to know about trauma, to understand that this is part of being human and affects all of us. There is no us and them in trauma, there is only us. We are mammals, and we have a threat response system like all mammals. This built-in protection against predators has been very successful in humans – sabre-toothed tigers liked to eat humans, they are extinct and we are not. So our threat response system works. Unfortunately this system, which generates toxic levels of stress that change the way our brain and nervous system function, can also lead to injury. Trauma is a word that means injury, and in order to survive as a species in a world that contains predators we have evolved a response which can save our lives but can injure our brains.

We need to know about compassion, and the power of connected relationships to protect us from trauma and to enable us to recover whenever we are injured in this way. Trauma happens when our power to self-regulate and therefore keep stress within healthy limits has been overwhelmed. Fortunately humans are born with the capacity to connect to other humans and benefit from the way their brains and nervous systems are working. So when we are overwhelmed we can connect with someone who isn’t, and their ability to self-regulate will be mirrored in our own nervous system and brain. We are born to connect, mirror and match.

We need to know that when we recover from trauma we are more resilient, that recovery is part of our human development of both individual and community resilience. The research around post-trauma growth is robust and extensive. Understanding that trauma is recoverable and that recovery makes us more adaptive and resilient is an important factor in developing hope and sustaining wellbeing.

There is a vast knowledge base around trauma, but it is also one which connects with our core experience as human beings. So we can quite quickly begin to develop genuine knowledge about trauma, resonating with our own lived experience and that of others around us. And the knowledge we are developing can be soundly based in neuroscience, evolutionary psychology, positive psychology, and the science of human ecology and of community development.

Understanding trauma contributes to stabilisation, the foundation phase of recovery from trauma. To stabilise we need to be in a connected relationship with someone who will co-regulate with us to enable our nervous system to settle from the disruption of toxic stress, and who will help us to make sense of the emotions driving our behaviour and to understand the impact of trauma upon us. Stabilisation results in us feeling safe, feeling emotionally supported and feeling understood. These are the first observable outcomes of recovery from trauma.

Compassion fatigue, moral injury and secondary trauma

When we understand how our nervous system and brain can become depleted and develop fatigue at times of adversity, we become less afraid of our own depletion and more able to explore with authenticity both how we are and what we can do about it. Recent neuroscience has shown that compassion can be cultivated, and that the cultivation of compassion enriches immensely the functioning of the entire brain, but compassion can also be depleted. Times of adversity can lead to bombardment of the neural circuits that support compassion, and like any other neural circuit under excessive pressure, this can lead to fatigue. Compassion fatigue leaves us vulnerable to harm both individually and as communities.

I live with a condition which has fatigue as one of its main symptoms. Polio destroyed a good deal of my neural circuitry when I was two, and now that I am in my seventies my depleted circuits are often fatigued. But much has been learned about fatigue in the last few decades, and using techniques like pacing and structured exercises I am able to live a fulfilling life. When we are living through traumatic events we need to be able to pace ourselves so that we can keep our compassion levels high, and we also need to practise building compassion to keep those circuits strong and active.

When we are able to prevent and manage compassion fatigue we actually enhance our capacity for compassion, even while we are living through adversity. And the work of Professor Richie Davidson and of Professor Dacher Keltner both demonstrate that developing and sustaining our capacity for compassionate action is good for us as well as good for the people who benefit from connecting with us.

Moral injury

Being required to behave in ways which are contrary to our moral code or values presents a threat to our personal integrity and this can injure us, leading to the form of trauma called moral injury. This has been particularly relevant during the coronavirus pandemic, and has been taken up as a concept both by the Royal College of Psychiatrists (March 2021) and by NHS England.

Like all trauma it can lead to either hyperarousal or dissociation, but is particularly likely to leave staff feeling disconnected and switched off. Understanding this has proved helpful to staff, and we also recommend that teams or settings make an opportunity to review together their core vision and values, establishing a baseline for how they can function best in times of adversity and allowing shared grieving over the enforced changes they have encountered in their practice.

Secondary trauma

When we encounter someone who is traumatised our own nervous system and brain experience the toxic stress that they are experiencing because we humans are born to connect, mirror and match. When we are resilient this is an opportunity for us to practise self-regulation, which tones up our nervous system and leaves us even more resilient afterwards. But when we are vulnerable (and every single human being is vulnerable some of the time) we are already in a state of stress, and the extra stress can overwhelm us.

Then this secondary trauma can begin to affect every aspect of life in much the same way as primary trauma does. And of course it will be adding to any burden of injury already present in these turbulent times.

When I was researching for my first book, which explored secondary traumatic stress in people working with children and young people who had been sexually exploited through organised child sexual abuse, I was working with a small proportion of the workforce. But since the coronavirus pandemic secondary trauma is significantly more common among those in this workforce, and we need to understand it in order to prevent it where possible and to ensure that people recover from it when it does affect them. As Professor Siegel says, when we can name it we can tame it.

Change happens when knowledge becomes embodied in us, so that we become what we know. Our brain can absorb and retain a vast amount of information, but our whole being will only absorb and retain knowledge that, for good or ill, will transform our way of being in the world.

Once we become trauma-informed we can no longer perceive the world as we did before. Other people appear to us as vulnerable beings whose behaviour is a sign of the way their brain is working, an indicator that speaks to us of the injuries they may be carrying. Encounters with others are more likely to generate compassionate curiosity than the fear or anger their behaviour might otherwise produce. And we develop compassion towards ourselves, recognising our own vulnerability and discovering respect for our own journey towards compassionate reason.

This embodying of knowledge of trauma contributes to integration, another phase in recovering from trauma. When our whole nervous system and brain work together in an integrated way we become more able to self-regulate, to be emotionally literate and expressive, and to create a clear and coherent narrative. These are the next set of observable outcomes of recovery from trauma.

Action naturally follows change, because when we change we behave differently. We interact in new ways with other people and with the world around us. Trauma-informed practice makes a difference to every aspect of our professional work.

Trauma-informed practice changes what we notice and how we describe this, so observation and assessment become sharp and purposeful. It changes the language we use and the perspective we take on the meaning and progress of our work, so conversations and reports and meetings become opportunities for transformative action. It changes the way we perceive our colleagues and the different organisations and settings in which they work, so that collaboration and shared attention to building communities of support naturally develop.

The action which follows being trauma-informed contributes to adaptation, the third phase of recovery from trauma. As our embodied knowledge translates into daily practice we become more socially responsive, we discover or rediscover our joy in living, and we develop self-esteem based soundly on the difference we can make in daily life. This completes the nine observable outcomes of recovery from trauma: (1) feeling safe, (2) feeling emotionally supported, (3) feeling understood, and developing (4) self-regulation, (5) emotional literacy, (6) clear and coherent narrative, (7) social responsiveness, (8) joy in living and (9) self-esteem.