Many people have a narrow mental image of trauma: a soldier grappling with PTSD, a hollow-eyed refugee child.
But trauma can also look like someone wearing a face mask panicking during a grocery run.
"Trauma can also just be the result of stressful events, plural, that basically make us feel that we're not safe anymore, that we live in a dangerous world," Marty Martin-Forman, owner of Martin-Forman Consulting, said. "I think that describes COVID-19. We've felt overwhelmed."
It might be hard to accept that you or your child might be dealing with trauma after spending weeks living through the U.S.'s worst pandemic in decades, but learning to recognize and acknowledge trauma is vital to recovery, she said.
Martin-Forman is a licensed clinical social worker and trained trauma-debriefing therapist. Last week, she gave a virtual talk about coping with COVID-19-related trauma.
Most people are familiar with trauma or post-traumatic stress relating to a single catastrophic or awful event, such as a natural disaster, terrorist attack, serious illness or death of a loved one.
In addition to individual stressful events, ongoing stressful situations can also cause trauma: a chronic illness or pain, living in an unsafe neighborhood or facing a months-long pandemic with no end in sight.
"Anything in life can feel like trauma if it's unexpected and we're powerless to prevent it," Martin-Forman said. "The more frightened and helpless we feel, the more likely we are to be traumatized."
However, she said, trauma is not a sign of weakness - in fact, it's a reasonable reaction to a terrible and uncertain situation.
"We are reacting normally to an abnormal set of circumstances," she said. "Feelings aren't bad or good, they just are."
Recognizing trauma
"The first step of getting through trauma is becoming aware of it," Martin-Forman said. "Many people get stuck in denial, and it causes them to not be able to move through."
Trauma manifests differently in everyone, Martin-Forman said. She listed a few common reactions that signify potential trauma:
Shock, denial or disbelief
Confusion, forgetfulness and difficulty concentrating
Feeling disconnected or numb
Isolating yourself socially
Having nightmares, difficulty sleeping and fatigue
Anger, mood swings, agitation and irritability
Aches, pains and muscle tension
A racing heartbeat
Changes in eating habits, or alcohol and drug use
Hypervigilance
Ongoing guilt, hopelessness and sadness
She said she's seen these signs in herself and others around her.
"I don't know anyone I haven't talked to who hasn't felt disconnected from all the normal things," she said. "My daughter and I talk all the time about how we need retail therapy."
The elderly, especially those who already feel disconnected from their families, may be having a particularly hard time, Martin-Forman said. Caregivers should especially watch for changes in appetite.
"One of the things I've done with the elderly in my life, I've said, 'You can make a phone call, you can write a note - you're not helpless. You can give someone a smile. You don't have to go out there in the world to do that,'" she recounted. "They'll come back to me and say, 'Oh, I called my niece who I haven't talked to in years; it was so wonderful.' What that does is combat social withdrawal."
Children going through trauma may show many of the above symptoms, especially difficulty concentrating. Pre-existing behavior problems are likely to get worse.
"Younger kids may regress to earlier behaviors like bedwetting, thumb sucking, all kinds of things," Martin-Forman said. "We go back to what we know, and that's what they're doing."
Children may also develop a fear of letting others get physically close, especially as they take to heart the importance of social distancing.
"We've taught them that for a good reason, but it may be something, as world moves forward, we'll have to help them deal with," she said. "Some of them don't understand they can still hug Mom and Dad."
Moving on
For some people, expert intervention may be necessary to recover from or learn to cope with trauma. Martin-Forman suggested speaking to a counselor or therapist if symptoms persist for more than a few weeks.
"Most of my peers are doing tele-counseling now during COVID-19," she said. "The first step, if you don't know counselor already, is to talk to your family doctor: Many have someone they recommend."
Others might find mental health apps helpful. Many exist, including some targeted at families, and some are free. You can find apps to help you manage an eating disorder, practice mindfulness, track your feelings day-to-day, develop healthy habits and more. Martin-Forman mentioned Calm, Talkspace and Moodpath, among others.
For others, mastering a few new coping skills may be enough.
Get moving, Martin-Forman suggested.
"Trauma disrupts your body functions, your natural equilibrium," she said. "You don't start a 30-minute exercise routine. You start with moving for 10 minutes, three times a day. That's enough to kickstart your system into making endorphins."
Or, try picking up a new project, or an old hobby that makes you feel good. Martin-Forman and her husband are renovating a house.
"I was able to concentrate on that, and it takes me out of myself," she said.
Combatting feelings of isolation is also vital, she said. She recommends finding someone to vent to about your struggles, whether that be a close friend or a member of the clergy.
"Participate in safe social activities," she said. "I've heard about parades, and family picnics with everyone sitting 6 feet apart."
Though novelty can help disrupt the monotony of quarantine, keeping up a routine is important, too - especially for families with children. Make sure to eat regularly and healthfully, and practice good sleeping habits.
"Don't take six naps - get back into the routine you had before this mess," she said.
Keeping your living space clean and pleasant-smelling can also help.
When symptoms spike - your heart is racing, you're crying uncontrollably, or you feel dizzy with anxiety - Martin-Forman recommends sitting down on a chair and gripping it as tightly as you can. Feel how your muscles strain and your knuckles whiten. Try slow, deep breaths: in through the nose, out through the mouth. Or, try six random numbers out loud. The idea is to redirect your mind and physical symptoms.
Helping children
The same techniques can help for children, too; just walk them through the process. Try listening to music together, tasting a favorite treat or smelling a new smell
"Try scents that take you to another place momentarily," Martin-Forman said.
Model coping skills for your children, Martin-Forman said.
"With that anxiety, we're all feeling, we need to think about the example we're giving," she said. "What are we showing about how to deal with this?"
She recommended against trying to keep all pandemic-related information away from your child. With particularly young children, try to explain the situation in age-appropriate terminology.
"When you get to kids about 6-12, the encouragement is to use proper words, because they're going to hear you use it anyway, or hear it on TV," she said. "They might not make connection with words you use to soften the information and what they hear on TV."
For anxious or young children, she suggested limiting their access to the news and being with them when they do watch or listen to the news. Talk to your child about how they're feeling, listen well, let them ask questions and know that it's OK if your answer to a question is "I don't know."
Help your child stay connected with loved ones and friends through video chats, phone calls, emails and letters.
Encouraging your child to keep up with school work and chores is fine, but Martin-Forman recommended against giving the child too many new responsibilities, which can be stressful and frustrating.
"We create these list of things thinking we're doing them a favor," she said. "I'm not discouraging you from giving them responsibility, but how much were you giving them before this? Try to maintain that same level."
Above all, she said, don't guilt yourself or your child for feeling sad or anxious, and don't feel guilty for moving through trauma at your own pace.
"You learn to live with never being the same again," Martin-Forman said. "Once you go through any trauma, and COVID-19 is no different, we are not going to be the same again."