How to manage stress as a crisis responder and when to ask for help

We are in a unique time in world history, one we never actually believed would happen. Daily we hear phrases like “social distancing,” “first responders,” and “shelter in place.” It can leave us feeling uneasy, fearful, and anxiety-driven.

This is the first of a series of articles that will hopefully give some guidance to anyone needing answers, direction, and, most importantly, hope.

Crisis response workers are our modern-day heroes in this COVID-19 pandemic. These men and women include first responders (police, fire, EMTs, military), public health workers (physicians, practitioners, nurses, nurse assistants, technicians, hospital staff, mental health therapists, pharmacists, etc.), and clergy (church pastors, chaplains, pastoral care providers). They are the ones who get up every day and go to work while the rest of the world is mandated to stay at home. They are the ones who are repeatedly exposed to extraordinarily stressful situations day after day, minute by minute, placing them in harm’s way. At the end of a shift, they are expected to return home to their families, ready to do it again the next day… and each day thereafter until the crisis is deemed over.

So how do crisis response workers navigate their responsibilities to their jobs, their families, and their own wellbeing? It’s not easy. And each individual is going to be different and respond different so there is not a “one size fits all” approach. There are, however some things that can be done to bring awareness to these needs.

First, there should be a clear understanding of the challenges crisis response workers face during something like an infectious disease outbreak.

• Increase in care demand. As the news of an infectious disease spreads, more people are going to find themselves with an overall feeling of being unwell. Fear and panic can cause symptoms to appear even when they physically do not manifest. Add to that the people who are actually sick from the disease and you find many more people are presenting themselves for care. In the early stages of an outbreak, it can feel to a healthcare provider, for instance, that they have things under control. Unfortunately, as the disease manifests, an increased number of healthcare workers become sick, causing a larger burden of care upon those who are well.
• The ongoing risk of infection. For any of the essential workers in an outbreak, there is an ongoing risk of becoming infected because of the constant contact being made with a large number of people each day. This can present a deep sense of stress and anxiety for the workers while trying to do their jobs. Add to that, the fear of potentially exposing others including family to the disease.
• Balancing their job and support. Crisis response workers are trained from the very beginning of their respective jobs that they not only have logistical responsibilities but they are also support systems for many people. This is never so apparent than in the midst of a crisis. This is especially true in an infectious disease outbreak for healthcare workers and clergy. In a normal situation, people seek medical answers from medical professionals; spiritual answers from clergy. In a pandemic, this is heightened. The increased number of sick is multiplied by others who are feeling emotionally unwell. It can become very difficult to manage.
• Psychological stress. People who go into a crisis response job are not in it for the money. They are drawn to these professions because of a deep desire to help others. And by helping others, there is a great internal reward. Unfortunately, during a crisis such as a pandemic, the workers can become unequipped to process the emotions they are experiencing. They find themselves on a tightrope of emotions. Most will experience fear, anxiety, insomnia, grief, and exhaustion. But they will try to push those emotions deep inside so they can do their jobs, ultimately creating a worst-case scenario for mental health.

While the challenges are many, let’s focus on the psychological stress of the healthcare worker. Why? Because psychological stress can impact every aspect of a person’s life – physical, mental, and spiritual.

What is stress? Stress is an elevation in a person’s state of arousal or readiness, caused by some stimulus or demand. As stress arousal increases, health and performance actually improve. Within manageable levels, stress can help sharpen our attention and mobilize our bodies to cope with threatening situations. At some point, stress arousal reaches maximum effect. Once it does, all that was gained by stress arousal is then lost and deterioration of health and performance begins (Luxart Communications, 2004).

What does extreme stress look like? It can be different in everyone. First, the brain sounds an alert to the adrenal glands. The adrenals answer by pouring out the first of the major stress hormones—adrenaline—for the classic fight-or-flight response. The fight-or-flight response evolved with the prime directive of ensuring our safety and survival. The pulse begins to race as the adrenaline steps up the heart rate, sending extra blood to the muscles and organs. Oxygen rushes in as the bronchial tubes in the lungs dilate; extra oxygen also reaches the brain, which helps keep us alert. During this stage of the fight-or-flight response, the brain releases natural painkillers called endorphins. This phase, in which adrenaline plays a leading role, is the immediate response to stress (McEwen & Lasley, 2002). When the stress response is active for a long period of time, it can damage the cardiovascular, immune, and nervous systems. People develop patterns of response to stress that are as varied as the individuals (Selye, 1984). These responses simply suggest a need for corrective action to limit their impact (Mitchell & Bray, 1990; Selye, 1984). In other words, changes must be made so stress does not harm you or those around you.

How can you know if you are under stress?

Behavioral

• Increase or decrease in activity level
• Substance use or abuse (alcohol or drugs)
• Difficulty communicating or listening
• Irritability, outbursts of anger, frequent arguments
• Inability to rest or relax
• A decline in job performance; absenteeism
• Frequent crying
• Hyper-vigilance or excessive worry
• Avoidance of activities or places that trigger memories
• Becoming accident-prone

Physical

• Gastrointestinal problems
• Headaches, other aches, and pains
• Visual disturbances
• Weight loss or gain
• Sweating or chills
• Tremors or muscle twitching
• Being easily startled
• Chronic fatigue or sleep disturbances (including vivid dreams/nightmares)
• Immune system disorders

Psychological/Emotional

• Feeling heroic, euphoric, or invulnerable
• Denial
• Anxiety or fear
• Depression
• Guilt
• Apathy
• Grief

Thinking

• Memory problems
• Disorientation and confusion
• Slow thought processes; lack of concentration
• Difficulty setting priorities or making decisions
• Loss of objectivity

Social

• Isolation
• Blaming
• Difficulty in giving or accepting support or help
• Inability to experience pleasure or have fun

(Adapted from CMHS, 2004)

Clearly, crisis response workers are under a great amount of stress on a normal day. But during a pandemic, their stress level is over the top. But there are some strategies that workers can initiate to take care of their mental health during this crisis.

First, you must meet your basic needs. Be sure to eat, drink, and sleep regularly. Becoming biologically deprived puts you at risk and may also compromise your ability to care for those around you who are depending upon your alertness. Try to eat healthy, limiting foods that make you feel sluggish. Drink lots of water while limiting soft drinks, caffeinated beverages, and alcoholic drinks. Don’t forget to take your medications properly and exercise when you can. A brisk walk outside can do wonders for your mental and physical health.

Take breaks. In other words, don’t neglect to take a sabbath. Everyone needs to take time away from the frontlines. Even Jesus took time away to rest from the constant needs of the people. The world will not implode if you step away briefly. Breaks can vary from a few moments while on duty to a full day. Give yourself a rest from tending to the needs of others. Whenever possible, allow yourself to do something unrelated to work that you find comforting, fun, or relaxing. Taking a walk, listening to music, reading a book, or talking with a friend can help. Some people may feel guilty if they are not working full-time or are taking time to enjoy themselves when so many others are suffering. Recognize that taking appropriate rest leads to proper care of others after your break. As I have said many times, you cannot pour into others when you are empty.

Connect with colleagues. Talk to your colleagues and receive support from one another. Infectious outbreaks can isolate people in fear and anxiety. Tell your story and listen to others’ stories. We were created to be in community with other people. A quarantine goes against our very nature. But it’s necessary in order to save lives. This does not mean you have to isolate yourself emotionally. Share your heart. 

Contact family and loved ones, if possible. They are an anchor of support outside your work. Sharing and staying connected may help them better support you.

Respect differences. Some people need to talk while others need to be alone. Recognize and respect these differences in yourself, those you are helping, and your colleagues. It’s very easy to compare ourselves with others and how each of us is dealing with the situation at hand. Don’t fall into that trap. You are uniquely you and that is enough. Respect each other’s differences.

Stay updated. This one is difficult because the other part of it is to limit media exposure. Clearly, we need to know what the latest in efforts, government mandates, and recommendations are. Unfortunately, these things can be hidden within negative and fear-driven messages. Rely on trusted sources of information. Participate in meetings to stay informed of the situation, plans, and events. But try to limit social media, television, and other forms of news delivery. The more you can limit these, the better for your mental health.

Self check-ins. Monitor yourself overtime for any symptoms of depression or stress disorder: prolonged sadness, difficulty sleeping, intrusive memories, hopelessness. Talk to a peer, supervisor, or seek professional help if needed. Prolonged intense stress without proper care can lead to Post Traumatic Stress Disorder.

Honor your service. Remind yourself that despite obstacles or frustrations, you are fulfilling a noble calling—taking care of those most in need. Recognize your colleagues—either formally or informally—for their service. Let them know you appreciate them.

Develop a buddy system. While you are often the best at determining your mental health level, sometimes crisis response workers can bury their own needs so deep they fail to recognize warning signs within themselves. During a crisis, have a “buddy” whom you trust to bring to you concerns about your behavior or self-care. And then listen! As a care “buddy”, be bold in your approach but also do it in love. If you notice your colleague withdrawing, speaking in negative talk constantly, hopeless, without spiritual support, isolating, angry, or changing dramatically in appearance, it is imperative that you bring it to their attention, as well as potentially their supervisor or family. And as always, gaining the advice of a mental health professional is important.

And finally, pray. The biggest issue that crisis response workers report is their feeling of being out of control. The truth is, within a crisis such as a pandemic, there is little that is within your control. Focus on what you can control – your actions and your reactions. You cannot control others. You cannot control the amount of work there is. You cannot control the length of time the crisis continues. But you can control your response. And that begins with prayer. God tells us from the beginning of time that He is with us, He hears us, and He answers us. Praying for the peace of mind, clarity, patience, rest, and trust can give you balance in the midst of the chaos. If you are praying for how you can fix this situation, you are setting yourself up for more stress. Trust that God is God and you are one of His instruments in this battle but you are not His only instrument. He is calling upon all of us to do this work so that our land is healed.

God appeared to Solomon that very night and said, “I accept your prayer; yes, I have chosen this place as a temple for sacrifice, a house of worship. If I ever shut off the supply of rain from the skies or order the locusts to eat the crops or send a plague on my people, and my people, my God-defined people, respond by humbling themselves, praying, seeking my presence, and turning their backs on their wicked lives, I’ll be there ready for you: I’ll listen from heaven, forgive their sins, and restore their land to health. From now on I’m alert day and night to the prayers offered at this place. —2 Chronicles 7:12-15

References:

Adapted from “Psychological First Aid,” the Center for the Study of Traumatic Stress at http://www.centerforthe studyoftraumaticstress.org and used with permission.

Center for Mental Health Services. (2004). Mental health response to mass violence and terrorism: A training manual. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

Luxart Communications. (2004). The quick series guide to stress management. Ellicott City, MD: Chevron Publishing.

McEwen, B. S. & Lasley, E. N. (2002). The end of stress as we know it. Washington, DC: Joseph Henry Press.

Mitchell, J. T. & Bray, G. P. (1990). Emergency services stress: Guidelines for preserving the health and careers of emergency services personnel. Englewood Cliffs, NJ: Prentice Hall.

Selye, H. (1984). The stress of life (Rev. ed.). New York: McGraw-Hill.