You May Have PreTSD. Here's How to Manage It.

Updated: Mar 25

PreTSD isn’t an official diagnosis, but it’s a good descriptor for what many people are experiencing as they wait for infections to spike as a result of the COVID-19 pandemic.


Dr. Alison Block discussed PreTSD in her article last week about doctors and nurses who are struggling with a unique form of anxiety as they prepare to respond to the looming spike in infections. But it’s not just doctors and nurses. People from all walks of life are also describing feelings of anxiety, panic and shutdown in anticipation of what’s to come.

The symptoms are similar to the post-traumatic stress disorder symptoms that many physicians, therapists and healers help clients with every day. They include anxiety or overwhelm, dissociation, and fight-flight-or-freeze.


Understanding PreTSD as a concept is helpful because when we have a name for something, we can investigate it and treat it. In this case, it helps professionals and sufferers understand the mechanisms behind a traumatic response to anticipated events. From there, we can work backward to help people develop tools to manage their symptoms.


If you’re struggling with some of the symptoms described above, I’ve got your back. Below are some tips that I regularly share with patients in my practice who deal with PTSD and anxiety. You can also schedule with me to go in-depth to problem-solve according to your unique biochemical and lifestyle needs (if after trying these techniques you decide you need more help).


Breathe Out

Purse your lips and breathe out as if you’re breathing through a straw, slowly and gently. This will help to reduce the risk of hyperventilation, which is a response to stress that can increase your anxiety. The science behind this is intense, but the concept isn't: The faster and more shallow your breath, the more anxious you feel. The point of "straw breathing" is to slow down the rate of your breathing. This, in turn, slows down your heart rate. It also changes the chemistry of your blood. These physiological changes tell your brain that things are going to be okay.


Breathe out for 10 seconds

Breathe in for 3 seconds

Gently and slowly

Repeat


Within the first few breaths you will feel yourself begin to settle. The point of this exercise is not to completely fill and empty your lungs each time you breathe. Instead, it's to control the rate of your breath. This should feel comfortable and easy.


Ground into Now

Ground into the moment by paying attention to all five senses. Say the following


It is (today's date and exact time)

I am in (city, state, exact location)

I am doing (verb)

I feel (physical sensation)

I smell (scent)

I see (5 objects of different colors)

I hear (sound)


You should feel your breath calm down by the time you name your fifth colored object. This is because you’re forcing your brain to concentrate on something other than your anxiety. Make yourself name at least five things for this really work.


Move

After grounding yourself, go do something else. Something active is best. You can:


Walk

Stretch

Shake your hands out

Workout

Roll an object between your fingers

Scrunch your toes

Dance to your favorite song


Sometimes simply walking into another room is enough to move you out of one headspace and into a new one. The mind-body connection is powerful. You can use your body to help your mind, so do it. It's free, safe and effective medicine.


Connect

People talk about fight-flight-or-freeze a lot, but there's another (healthier) response to trauma called "tend-and-befriend." It's about connection. Studies that suggest looking at another person's calm facial expressions, hearing a calm voice, and even a hug with someone you love can calm your nervous system. This is because our nervous systems evolved using mirror neurons, and still take cues from our environment today about how safe it is to relax.


In my practice we call this tactic "sharing calm". When someone in distress is able to orient to another person's calmness, it helps them center themselves. If you're anxious:


Talk with a calm person

Watch a video of a calm person

Listen to a meditation


For this tip to work, your nervous system has to see or hear the calm person. The main point is to pay attention to the facial expressions and voice on the other end of the video or conversation. Your brain will do the rest of the work. If you can't meet with someone in person, try phone or video chat. If no one is available, a video or recording online is an okay substitute. Dr. Lichtenstein, has free meditations on his website that you can listen to. My favorite is the Lovingkindness Metta Meditation. Sadia's videos are also lovely to watch.

Help Someone Else

Waiting for something awful to happen feels … bad. My advice is, don’t. Instead, focus on creating a meaningful mission / purpose / goal the next few weeks. Fearful of getting sick? Make your mission the opposite -- to stay healthy or, even better, to help others who are suffering. You can also focus on adding joy to your and your love ones' lives. When moments of darkness come you will need those moments of joy to remember. Joy is medicine that transcends time. It's always available to us to look back on, but we have to make the joyful memories first. Do that now.


This method of dealing with suffering comes from a form of therapy called Logotherapy. Dr. Viktor Frankl was a holocaust survivor, psychiatrist and neurologist. His book, "Man’s Search for Meaning," heavily influenced my decision to go to medical school and has made my brand of mind-body medicine what it is today. Frankl's three ingredients for a healthy life were summarized excellently in a recent podcast I listened to. They are:


A project that you need to work on

A redemptive perspective of your suffering

Close, unconditional relationships that accept you as you are


In the short-term sense, these three pillars seem to have little to do with PreTSD, PTSD or anxiety. In reality, we need to change both our minds and our bodies whenever we fully heal. This is why mindfulness, ACT counseling, motivational interviewing and other mind and spirit therapies are part of every naturopathic appointment at my practice. They're incredibly empowering and effective.


Remember It’s Allergy Season

This matters for one reason: histamine. Histamine is an excitatory neurotransmitter that is released in our bodies in response to allergens in the air and in food. It can make you feel like you have anxiety.


Symptoms of high histamine in your body include a faster than normal heartbeat, stuffy / runny nose, watery / itchy eyes, tingling skin, stomach ache, rash, and more. You could have one, all, or none of these symptoms as a result of allergies. Do not let this take you down a rabbit hole of internet research or worry, please.


Instead, if you’re having a day with high anxiety, it's worth heading on over to https://www.pollen.com/ to check the pollen counts in your area.


If they are high, consider the fact that you might just be feeling a little more anxious than normal because of allergies. It could be that simple. If you want to know what you're reacting to, you can schedule an appointment with me or your doctor to run tests to see what allergies you actually have.


Control Your Triggers

If you can reduce your exposure to triggers that knock you off-balance, do it. Limit your consumption of upsetting news to once per day. Get your information from sources like the CDC and WHO that don't rely on triggering fear or anger to get clicks.


Rule Out Underlying Causes

Nutritional deficiencies, blood sugar imbalances and other medical illnesses can make anxiety worse. They can also make it harder to stay grounded when you're triggered by pre or post-traumatic stress symptoms. I can help you identify and address the medical conditions as part of your whole person health assessment. I'm here for you if you need me.


With warmth and wellness,

Dr. Kate


P.S. As always, this article contains helpful info, but no medical advice, so talk to me or your doctor before altering your health routine as a result of what you read. You can schedule with me over at www.doctorkatehenry.com.

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