Author: Elke Van Hoof

Make sure that it’s not a lonely Christmas – for yourself and for others

The corona measures currently in place mean that we are cut off from all meaningful social contact. This can make us feel lonely, which impacts on our resilience. While the festive season is traditionally a time for being together, the end of 2020 threatens to shine the spotlight on our loneliness. Rather than giving in to this feeling, let’s make sure that we have a warm festive season, and keep those we hold dear close.

Loss of resilience

The second lockdown is possibly having even more of an impact than the first, and is sapping the last bit of resilience that we had. The most recent health survey shows that one in five people are prone to depressive thoughts, and almost a quarter are suffering from anxiety. While 35% of the respondents were dissatisfied with the level of social contact in September, this has now grown to 65%.

And, to top this off, we can’t celebrate a normal Christmas, the most important social occasion that we love so much, putting extra pressure on our resilience.

Social relationships are the glue that hold society together

We flourish thanks to our social contacts. Maintaining and preserving our social relationships are important for our sense of well-being. Contact with our families, but happenstance meetings too, ensure that we feel connected to the group, that we feel secure, and that we can motivate ourselves to make extraordinary efforts for others – in this case to comply with the measures in place and help to ‘flatten the curve’.

Of course, loneliness was a problem before corona, but these are just the right conditions that this ugly beast needs to thrive. And this is not without risk: loneliness contributes to the loss of that o so important resilience and functionality and leads to emotional problems.

Our young people in particular need their social contacts and are entitled to their social experimental phase. After all, it is in this important phase that they form their identity and become ready to contribute to society as future adults. This social experimentation phase has been taken from them for many months due to the coronavirus pandemic. Even worse, when our young people display natural behaviour, we wag our finger.

While the coronavirus pandemic has put pressure on our basic need for social contact for many months, we will feel this all the more keenly at Christmas. We all know the rules – or at least we should do by now: a family can have one ‘cuddle contact’ and a single person can have two. That’s the theory, but what does it look like in practice? What if those two cuddle contacts are invited to visit their own families? That means you celebrate Christmas alone.

Create perspective

It is therefore more important than ever to develop an inspiring and engaging narrative, to get through this abnormal festive season in the most resilient way we can. The constant focus on the restrictions to our freedom is demotivating, while an inspiring objective can achieve the opposite. We need to shift the mindset from restriction to a positive message. Covid-19 has pushed us into a dark tunnel, of which we cannot yet see the end. We lack perspective and control, which is why we need to make sure that we don’t give up, but that we create our own perspective in which we can take control. In other words, we need to use our resilience to make it through the corona tunnel and out the other side.

The warmest Christmas

So, what do I propose? We have seen that this pandemic does not follow statistical models. In that case, let’s play the humanity card and form a team of 11 million, in which no-one gets left out.  

To start with, a certain responsibility for this lies with our public services and government bodies. For them the task to provide the population with the tips & tricks that they need, inspiring narratives and distractions from the sometimes-hard reality. The live show ‘Christmas with 11 million’, put together by the normally competing channels Eén, VTM, VIER, La Une and RTL-TVI, is a step in the right direction to unite and motivate the population in this period. We can all build on the feeling of togetherness that this creates, for example by enjoying the programme with family and friends using online tools such as Watchparty.

We also need to organise alternative routes for our single people, our young people and anyone who needs a little relief from the family. An example could be to organise a walk or a torchlight procession on Christmas Day or New Year’s Day (taking the corona measures into account).

Above all, we need to take care of ourselves and each other. Doing something for someone else can contribute to our own happiness. Perhaps we could use the time that we normally spend eating and drinking on Christmas Day to help out in an old people’s home. Or we could talk to someone on the phone who is going through a difficult time or feeling lonely. It’s not much, but it can make a world of difference. Why not give a flower or a home-made meal to someone who is alone this festive season, or post a card through their letter box? However small the gesture, it helps people to feel less alone. However, it is also important to recognise the tipping point in other people, and to make sure that they get the right help when necessary.

And so we can be part of a larger whole, do something meaningful and help others to have a warm Christmas. Perhaps the warmest Christmas ever?

Once again, difficult decisions have been made. A new
Corona-wave is flooding us. Once again, we are facing an
uncertain time and we don’t know when it will be over. This
is a huge challenge for our well-being and functioning.

Here you can read the full whitepaper.

Na de lockdown, waar medici ons gedrag bepaalden om de curve van
COVID-19 te controleren, zijn wij aan zet. We krijgen meer
bewegingsvrijheid en daarmee ook direct de verantwoordelijkheid om de
curve verder controleerbaar te houden.
Hoelang? Dat weet niemand. Het is dus vrijheid met randvoorwaarden. Het
nieuwe normaal. Het is dus in ons allerbelang dat we enkele rituelen
installeren

Lees hier de volledige white paper

In a few months time the current global lockdown due to the coronavirus is going to result into a massive outbreak of burnouts and stress related disorders, says professor Doctor Elke van Hoof of the Vrije Universiteit Brussel in Belgium. Half of the world population could be impacted. This is going to come at another great cost, and the world needs to get ready for this next wave now.

BY JOPIE WITZAND

The groups most at risk are women, families with young children, healthworkers, the elderly and those who have a very limited social network. They could suffer from stress, anxiety, anger, irritability, emotional, insomnia, exhaustion, depression, alcohol abuse, self-medication, long-lasting “avoidance” behaviour and post-traumatic stress symptoms. The list is endless and it is going to involve a lot of people. 

Professor Dr Elke Van Hoof is a professor in health psychology and primary care psychology at the Vrije Universiteit Brussel, and serves as an expert for the Superior Health Council of Belgium and the European Parliament.

She bases her predictions on studies and examples of how people respond to extreme situations, ranging from absenteeism in military units after deployment in risk areas, companies that were close to Ground Zero in 9/11 and medical professionals in regions with outbreaks of Ebola, SARS and MERS. 

Elke van Hoof says that in China these expected mental health effects are already being reported in the first research papers about the lockdown, and states that the world needs to prepare for this Corona PTSD pandemic.

Listen to the full interview here:

Billions of people across the globe are currently under some form of government-mandated lockdown. The aim is to curb the spread of the coronavirus and prevent health systems from being overrun. But forcing people to stay at home for weeks or months on end is resulting in unprecedented economic shocks to societies around the world. With unemployment figures accelerating, so too is the debate about how and when to end the lockdowns. Several reports have concluded that social distancing measures can only be withdrawn completely once a vaccine against Covid-19 has been developed and deployed. So, until then how do policymakers balance protecting the health and wealth of citizens? Paul Henley and a panel of expert guests discuss the practicalities of getting people back to work before a vaccine arrives. Widespread electronic tracing of our movements is key to restoring our freedoms, but can that testing capacity be met and will people balk at having their movements tracked? And, in this strange new world, which parts of society will be the first to return to some semblance of normality, which might follow, and which will be transformed beyond recognition?

Listen to the full interview here.

Image: REUTERS/Francois Lenoir

While we’re treating the COVID19 pandemic, we are creating a second epidemic – which we’re ignoring 

Anxiety, stress and PTSD will cause a spike in absenteeism and burnout three to six months after the lockdown ends 

With some 2.6 billion people around the world in some kind of lockdown, we are conducting what is arguably the largest psychological experiment ever. Unfortunately, we already know what it will result in: a second epidemic of burnouts and stress-related absenteeism for the second half of 2020. We are late to address the psychological side of this pandemic, but it’s never too late to act.  

Author: Prof. Dr. Elke Van Hoof, trauma psychologist  

In the mid-nineties, France was one of the first countries in the world to adopt a revolutionary approach for the aftermath of terrorist attacks and disasters. Apart from setting up a medical field hospital or triage post, the French crisis response includes setting up a psychological field unit, a “Cellule d’Urgence Médico-Psychologique” or CUMPS.  

In that second triage post, victims and witnesses who were not physically harmed receive first psychological help and are checked for signs that they need further post-traumatic treatment. In those situations, the World Health Organization recommends protocols like R-TEP (Recent Traumatic Episode Protocol) and G-TEP (Group Traumatic Episode Protocol).  

Since France led the way more than twenty years ago, international playbooks for disaster response increasingly call for this approach of building “two tents”: one for the wounded and one to treat the invisible, psychological wounds of trauma. 

Today, in treating the COVID19 pandemic, the world is scrambling to set up enough tents to treat those infected with a deadly, highly contagious virus. In New York we see field hospitals, literally, in the middle of Central Park.  

But we’re not setting up the “second tent” for psychological help, and we will pay the price within three to six months after we come out of this unprecedented lockdown, at a time when we will need all able bodies to help the world economy recover.  

The mental toll of quarantine and lockdown  

Currently, an estimated 2.6 billion people – one third of the world population – lives under some kind of lockdown or quarantine. This is arguably the largest psychological experiment ever conducted.  

And unfortunately, we already have a good idea of what it will result in.  

In late February 2020, right before European countries mandated various forms of lockdowns, The Lancet published a review of 24 studies documenting the psychological impact of quarantine*. The findings offer a glimpse of what is brewing in hundreds of millions of households around the world.  

In short, and perhaps unsurprisingly, people who are quarantined are very likely to develop a wide range of symptoms of psychological stress and disorder, including low mood, insomnia, stress, anxiety, anger, irritability, emotional exhaustion, depression and post-traumatic stress symptoms. Low mood and irritability specifically stand out as being very common, the study notes. 

In China, these expected mental health effects are already being reported in the first research papers about the lockdown.  

In cases where parents were quarantined with children, the mental health toll became even steeper. In one study, no less than 28 percent of quarantined parents warranted a diagnosis of “trauma-related mental health disorder”. (Jokes on the internet are already suggesting that any babyboom resulting from the lockdown will consist entirely of first-born children.)  

In hospital staff that was quarantined, almost 10 percent reported “high depressive symptoms” up to three years after being quarantined. Another study reporting on long-term effects of SARS quarantine among health-care workers found long-term risk for alcohol abuse, self medication and long-lasting “avoidance” behavior. Meaning: years after being quarantined, some hospital workers still avoided being in close contact with patients by simply not showing up for work.  

Reasons for stress abound in lockdown: there is risk of infection, fear of becoming sick, of losing loved ones, as well as the prospect of financial hardship. All these stressors, and many more, are present in this current pandemic.  

The second epidemic – and setting up “the second tent” online 

Already, we see a sharp increase in absenteeism in countries that went into lockdown. People are afraid to catch COVID19 on the workfloor, and avoid work.  

But we will see a second wave of impact in three to six months. Just when we need all able bodies to repair the economy, we can expect a second, sharp spike in absenteeism and burnout.  

We know this from many examples, ranging from absenteeism in military units after deployment in risk areas, companies that were close to Ground Zero in 9/11 and medical professionals in regions with outbreaks of ebola, SARS and MERS.  

In our own research we can see resilience in the (Belgian) population sliding as we go into the third week of the lockdown.  

Right before the lockdown, we conducted a benchmark survey among a representative sample of the Belgian population. In that survey, we saw that 32% of the population could be classified as highly resilient (“green”). Only 15 percent of the population indicated toxic levels of stress (“red”). 

In our most recent survey after two weeks of lockdown, the green portion shrunk to 25% of the population. The “red” part of the population increased by 10 percentage points to fully 25% of the population.  

These are the people at high risk for long-term absenteeism from work due to illness and burnout. Even if they stay at work, research from Eurofound reported a loss of productivity of 35% for these workers.  

In general, we know that the at-risk groups for long-term mental health issues will be the health care workers who are in the front line of this war on the corona virus, young people (< 30) and children, the elderly and those in precarious situations, such als mental illness, disabilities and poverty.  

Actually, all this should surprise no one, as the insights on the long-term damage of disasters have been accepted in the field of trauma psychology for decades.  

Source: Beverly Raphael (1986). When disaster strikes.  

But while the insights are not new, the sheer scale of these lockdowns is. This time, ground zero is not a quarantined village or town or region. Today, a third of the global population is dealing with these intense stressors.  

We need to act now to mitigate the toxic effects of this lockdown.  

What governments and NGOs can and should do today 

It helps that there is broad consensus among academics about the psychological care following disasters and major incidents.  

A few rules of thumb: 

1. Make sure self-help interventions are in place that can address the needs of large affected populations 

2. Educate people about the expected psychological impact and reactions to trauma if they are interested in receiving it. Make sure people understand that a psychological reaction is normal.  

3. Launch a specific website to address psychosocial issues.  

4. Make sure that people with acute issues can find the help that they need 

In Belgium, we recently launched “Everyone OK”, an online tool that tries to offer help to the affected population. Using existing protocols and interventions, we launched our digital self-help tool in as little as two weeks.  

There is no need to reinvent the wheel.  

When it comes to offering psychological support to their populations, most countries are late to react – as they were to the novel coronavirus. But better late than never.  

References 

• Brooks et al. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet; 395: 912–20 
• Eurofound (European Working Conditions Survey, 2016: Job quality in Belgium: https://werk.belgie.be/nl/nieuws/een-analyse-van-de-jobkwaliteit-belgie-2015?id=45604 
• IASC (2020) Briefing note on addressing mental health and psychosocial aspects of COVID-19 Outbreak- Version 1.1 
• Jalloh MF, Li W, Bunnell RE, et al. (2018) Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015. BMJ Glob Health;3 

• Jones, David. (2020). History in a Crisis — Lessons for Covid-19. New England Journal of Medicine. 10 
• Qiu J, Shen B, Zhao M, et al. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry 2020; 33 
• WHO (2020) Mental Health and Psychosocial Considerations During COVID-19 Outbreak 

Prof. Dr. Elke Van Hoof is a clinical psychologist and an authority in the fields of stress, burn-out and trauma. She is a professor in health psychology and primary care psychology at the Vrije Universiteit Brussel, and serves as an expert for the Superior Health Council of Belgium and the European Parliament. She is the founder of Ally Institute.  

(* We use “quarantine” and “lockdown” interchangeably here, as they both refer to the “restriction of movement of people who have potentially been exposed to a contagious disease”. This is different from “isolation”, which is the separation of people who have been diagnosed).  

Publication on World Economic Forum

WHAM. BAM. COVID-19 has uprooted all of our lives. The impact of
the virus is everywhere, both in our private lives and our professional
situation.

Read the full whitepaper here.

We’ve been taken by surprise by an invisible enemy: COVID-19. We’ve
been inundated by a tsunami. When such an unexpected, serious
and unpredictable situation hits us it induces a state of heightened alertness. This alertness serves a purpose viz. to identify hazardous
situations and get ourselves to safety or adapt to the new reality.

Read the whitepaper here.

A new age is dawning. Children are working from home, as are their parents. Our daily routines are being uprooted.

So how best to organise and adapt to this new situation? Why is it important to regroup and organise?

It is important to avoid additional negative pressure. Without a clear structure we become overstimulated because everyone interrupts everyone else and does as they please. At the same time it is important to give direction and offer perspective. In other words, make a planning that gives you a clear view of what the immediate future has in store. Of course, we wouldn’t want everyone to just lie about because that’s bad for our health.

Read the full whitepaper here.

Elke Van Hoof is a professor at the Vrije Universiteit Brussel (VUB) and teaches health and medical psychology as well as clinical psychological interventions. She is best known for her work on stress, burn-out, sensory-processing sensitivity, and return-to-work. She embodies a unique combination of business expertise, psychology and academic research.