• Britt T. Gonsoulin, M.D., M.P.H

Caring for Self and Others in Times of Uncertainty


As part of our focus on Family Mental Wellness, we reached out to Britt Gonsoulin, M.D., M.P.H of Bainbridge Mental Health and Bainbridge Prepares for advise on how parents can practice mental well-being with their kids during the prolonged pandemic. Read on to learn how to empower yourself and those around you by using the The World Health Organization's handy Psychological First Aid mnemonic: LOOK, LISTEN, LINK


Taking care of ourselves and others during a period of prolonged disaster-related stress presents significant challenges. Life has changed. Our mental reserves and bandwidth look different now than they did during the first weeks of this pandemic. In all likelihood, the last 6 months have forced us to reorganize and question our priorities, our routines, and to implement new coping methods. Many individuals and families are becoming accustomed to taking things one day at a time, doing the best they can to navigate a time when uncertainty reigns. And, even with our best efforts, we continue to struggle. And, that’s normal…

In a typical disaster, the period of acute, disaster-related stress is temporary, occurring over days to weeks, sometimes months. Typically, the acute stress phase gives way to a recovery phase. With COVID-19, we face an unprecedented challenge as the “acute” phase of this disaster continues, and will continue, for months, if not years. That means our recovery phase is likely to be prolonged as well. This sobering reality has ushered in an era during which humans have begun to reconfigure their relationships to self, family, and world. Our routines, behaviors, coping strategies, and daily rhythms have been dramatically impacted.

My goal today is to share with you a research-based approach to recognizing stress in yourself and others, adults and children. What I’m speaking of is the practice of providing psychological first aid (or PFA for short). We are all familiar with medical first aid (application of basic medical care that anyone can do). In most scenarios, medical first aid is enough to manage an acute medical issue (an ankle strain, a muscle ache, a cut or a bruise). This is true, as long as you have the right tools for the job!

So, let’s turn our attention to the psychological equivalent of medical first aid, PFA, and what we can do on a daily basis to mend psychological strains and bruises to better care for ourselves and others in the months and years to come. Why learn PFA? Because, if you are NOT able to recognize the signs of stress in yourself and others it will be hard for you to execute the skills necessary to ease that stress or discover new, health-building coping strategies in the long run.

LOOK: RECOGNIZING STRESS IN SELF AND OTHERS

The World Health Organization created a handy mnemonic to assist us in learning/providing Psychological First Aid: LOOK, LISTEN, LINK. We start with the step one: LOOK for signs of stress in self and others, kids and adults.

Let’s study the chart below. It details signs of stress typically seen in adults. Notice that stress reactions occur over a spectrum of physical, emotional, and behavioral realms. Any one person could exhibit a number of symptoms in multiple categories, or just a couple within one area. Stress responses are very person-dependent. Different people show their stress differently. It is well worth your time to familiarize yourself with this chart, discuss it with your family members, and reflect on it daily. Ask yourself, what are my typical signs of stress? What about my spouse or parent or neighbor?



Next, if applicable, take a moment to familiarize yourself with stress reactions in children. Children's stress responses can look different than those of adults. Children are also very susceptible to “catching” the contagious stress of their attachment figures. This is why parents often notice that their child's frustration or anxiety levels seem to mirror their own.



Here, I want to pause and bring up another important point: if children (and adults) are able to “catch” the stress of others, the same is true of the reverse scenario. A person’s calm, connected presence can be contagious too, and it leads to something we call “vicarious resilience.” Vicarious resilience is the ability to strengthen each other psychologically by “infecting” each other with a more calm, connected presence. In a sense, we can insulate each other and our families, neighborhoods, and communities from the toxic effects of stress by finding a calmer place without ourselves. When more and more people in a family or community become skilled at taking care of themselves psychologically, we actually strengthen vicarious resilience and prevent post-traumatic stress disorder, depression, or other anxiety conditions.

The goal of PFA is to prevent disaster related stress responses from becoming chronic. And while it is possible for PFA to address the majority of stress responses, there may be symptoms that require medical care or mental health care by a trained professional. We will talk more about that later.

For now, I encourage you to begin a daily PFA practice of LOOKing to identify signs of stress in self and others.

LISTEN: REFLECT, DON’T FIX

Once we are practiced at recognizing stress in ourselves and others we may reflexively leap into action to “fix” the problem or soothe it away. If this is your tendency, I urge you to take a slow breath, pause, and listen instead.

Why not offer advice to fix or soothe the problem? Because, in the case of disaster-related stress, these stress reactions are NORMAL and expected, not incongruent with the stress at hand. When we have a slow-moving disaster like COVID, these stress responses stretch out over time, wax and wane depending on the week, and become part of the rhythm of our reality.

Instead of trying to fix signs of stress with quick reassurance or advice, I encourage you to engage in more ACTIVE LISTENING. Active listening is one of the most important relationship/life skills a person can learn. I repeat: active listening is one of the most important relationship/life skills a person can learn. Why emphasize this twice? Because, if there is one thing I hope a person will take away from an introduction to PFA, it is that active listening is at the heart of interpersonal connection. Our nervous systems generally calm down and unwind in the presence of someone who is actively listening.

So, what exactly is active listening? It is the practice of observing not just what a person says (the content), but also their body language, their tone, etc.

It is immersing oneself in the whole experience of what someone is saying, including imaging what they must be feeling. Active listening involves being patient (not butting in, allowing silence), being neutral (nonjudgmental), asking questions to express curiosity, reflecting back what you hear a person say. Examples of active listening would include saying things like “that’s tough, I’d like to hear more about what you just said,” or “the things you’re feeling sound difficult and challenging,” or “It sounds like you don’t know what to do, I’m right here...let me know if there’s something I can do.”

Think about a time in your own life when you needed to “vent” to someone. In that moment, a good active listener would sense your need to be heard, reflect back to you what they hear you say, and offer connection in the form of a understanding presence. If, instead, that person minimized your concerns, offered their advice, or proposed “solutions” to your “problem” you may have become more irritated in the end.

Step two of providing Psychological First Aid is to actively listen with a calm, compassionate presence.

LINK: CONNECT PEOPLE WITH GOOD RESOURCES AND COPING

Once you are able to see and hear about a person’s stress reactions you are in a better place to connect them with resources. Step 3 of PFA is to LINK, or connect, people to things that will provide positive mental support. In other types of disasters, like earthquakes or hurricanes, “linking” may take the form of supplying a person with a snack, a warm blanket, a bottle of water, or a clean pair of clothes. These are examples of helping people get their basic needs met. Addressing needs for food, clothing, or shelter go a long way to mitigating acute stress in these scenarios.

Beyond helping ourselves and others get those basic needs being met, PFA teaches us to engage in healthy coping strategies to manage stress reactions. This is where we can make a greater impact during COVID-19. It goes without saying that we all cope in different ways, sometimes adaptive ways and sometimes not. We know that engaging in adaptive coping strategies for ourself and others promotes resilience and improved long term mental and physical health outcomes. The same cannot be said of non-adaptive coping, unfortunately. Take a look at this chart and compare adaptive vs. non-adaptive coping strategies. Ask yourself, what are adaptive coping methods I can used to support myself? What can I encourage my loved ones to do?

Adaptive coping

  • Moderate exercise

  • Good nutrition

  • Social connection (virtual or in-person)

  • Playing games

  • Watching a favorite show

  • Listening to music

  • Journaling

  • Meditation

Non-adaptive coping

  • Excessive alcohol consumption

  • Excessive exercise

  • Isolation

  • Denial

  • Blame

  • Risky behaviors

  • Drug use

  • Avoidance

Exh. 3 Coping strategies

If we see someone engaged in non-adaptive coping we may first seek to better understand their state of mind and gently encourage more adaptive coping. Adults modeling adaptive coping behaviors for their children will also help children to internalize those strategies.

In addition to encouraging positive coping methods, PFA encourages us to be aware of community resources and share that information with those who may benefit. Raising Resilience and BainbridgePrepares.org are great starting points for those seeking to benefit from or share resources during this time.

The biggest challenge we face in weathering the psychological effects of COVID-19 is its enduring nature. It asks us to maintain a daily, if not hourly, practice of PFA, which is no small task. The intention, mindful awareness, and resolve to continue such efforts, day after day, takes an incredible amount of stamina. But, if practiced and allowed to guide our life choices in the short term, it can prevent the development of long lasting stress-related disorders, strengthen families, and build life skills that will create resilience now and in the future.

Be sure to give yourself and your loved ones protected time to unwind, connect, and engage in good coping behaviors. Like any skill, this takes practice. If you or someone you know demonstrates severe symptoms that don’t respond to PFA interventions described here, or demonstrate a potential danger to themselves or others, it is important to seek help from a professional (a primary doctor or mental health professional). [For a list of mental health resources, visit our Parent Support Resources page]

In summary, caring for our basic psychological needs during uncertain times is paramount to sustaining a non-traumatizing response to disaster-related stress. Starting with ourselves and those closest to us, we begin to empower ourselves and our communities by building vicarious resilience when we follow the LOOK, LISTEN, LINK mnemonic.

For more information about PFA and Skills for Psychological Recovery, please visit https://bainbridgeprepares.org/category/psychological-first-aid/. Parents can find video presentations there and on the Raising Resilience Video Library page discussing how to best care for children during COVID, which may be of particular interest to those reading this article.

Britt Gonsoulin, M.D., M.P.H.

I am a dual-trained medical doctor and public health worker practicing in Kitsap County. I have experience in Disaster Mental Health Responses, promoting personal and community resilience in the city of Bainbridge Island. I also practice General Adult Psychiatry and Collaborative Care Psychiatric Consultation.

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