Pre-Traumatic Stress

You imagine what might happen. You imagine not being able to handle it. And before the event has arrived, you are already feeling the stress.

In Episode 313, healthcare workers in our community brought this experience to my attention. It was March 2020, and they were facing the uncertainty of the pandemic. One nurse described the panic before the storm as pre-traumatic stress.

They were dealing not only with what was happening, but with the anticipation of what might happen. I wanted to explore how we could use our minds in that uncertainty without denying the fear.

My recommendation was to give the imagination room for both sides: the frightening possibility and the possibility that we have strength, skill, and resilience to meet it.

Anticipation creates an experience now

You may know how much pleasure comes from anticipating a vacation. Sometimes looking forward to it feels as wonderful as being there.

The same capacity works in the other direction. Imagining something terrible can create fear now, before the circumstance exists.

Some of the healthcare workers described waiting to see what would happen, whether people would get sick, and whether there would be enough supplies. The waiting itself was emotionally exhausting.

Their brains were creating images of a possible future and responding to those images in the present.

Recognizing that process helps you see the distinction between what is happening and what you are imagining.

Don’t attack yourself for the thoughts that arrive

One description of this stress included intrusive, involuntary images of future events. The word involuntary matters.

Your brain is looking for what might startle or threaten you so it can protect you. It offers frightening thoughts. Beating yourself up for having them adds another problem.

You can understand why your mind goes there without believing every prediction it makes.

Uncertainty makes the absence of control feel especially clear. We never know everything that is coming, but we don’t always pay attention to that fact.

When we are forced to consider it, our imaginations can quickly fill in the unknown with the worst possibility.

Responsibility and worry are different

People sometimes believe worrying is necessary to protect themselves. If they stop worrying, they think they will stop taking action.

But you can be responsible, educated, careful, and protective without using worry as the fuel.

In the episode, I emphasized following protective guidelines while recognizing that fear isn’t the requirement for doing so.

The distinction matters because worrying ahead of time isn’t the same as taking a useful action. You can examine what needs to be done and do it without demanding that you feel scared first.

We can also collaborate and try to understand each other instead of using our energy to blame or criticize people whose actions we don’t understand.

Let the fear be there—and offer an alternative

One thought I heard repeatedly was that people wouldn’t be able to handle what was coming.

Given what they were seeing and imagining, I understood why that thought was there. I didn’t want them to brush aside the possibility or pretend they weren’t afraid.

In this situation, I recommended allowing the imagination to go to the difficult possibility while recognizing that it was imagination.

Then I recommended giving equal time to the alternative.

If you spend twenty minutes imagining the worst case, spend twenty minutes imagining that you could handle it. Picture yourself being strong, capable, and able to contribute.

The point isn’t knowing which future will happen. You don’t know that yet. The point is noticing that your mind has been treating one imagined possibility as though it is the only one.

Find a thought that includes both truths

You don’t have to replace fear with a sentence you don’t believe.

You can recognize that you are afraid and resilient. You can be worried and capable. You can be exhausted and skilled.

Those combinations helped some of the physicians and nurses I was coaching. They knew they were scared. They also knew they had skills. Becoming a doctor had already required resilience.

Including both let them experience something more balanced than sheer terror.

Use words that feel true to you. You cannot pretend your way to peace. The thought needs a grain of truth you actually believe.

Ask what else is true alongside the fear. What can you do? How can you be your best right now? How can you allow what you feel without shutting down?

Put the thoughts on paper

Write down all the scary thoughts. Don’t edit them into something you think you should be feeling.

Then separate the thoughts from the facts. Notice which sentences describe what is happening and which predict what will happen.

Recognize how those predictions create feelings in the present.

Next, look for equally believable thoughts that help you feel capable, strong, or resilient. Explore the possibility of getting sick and the possibility of not getting sick. Explore not knowing what will happen rather than insisting the feared outcome is certain.

Let yourself feel the difference as you move between those thoughts. You aren’t lying to yourself or denying the risk. You are opening your mind to more than one possibility.

Use the imagination for strength, too

The same imagination that creates stress ahead of time can create an experience of capability ahead of time.

You can picture fear and also picture how you might meet it. You can acknowledge exhaustion and also recognize the skills you bring. You can be human and scared while still contributing.

Pay attention to how you are using your mind. Don’t spend all its energy convincing yourself you can’t handle a future that hasn’t happened yet.

Make room for the fear. Then make room for your strength. Both deserve airtime as you decide who you want to be in the moment you are actually living.