Increased the difficulty of psychological reconstruction and rescue after the epidemic.

In order to express the deep condolences of the people of all ethnic groups in China to the martyrs and compatriots who died in the fight against the COVID-19 epidemic, the people of the whole country observed a three-minute silence from April 4 10, when cars, trains and ships honked their horns and air defense alarms sounded. A citizen threw flowers into the Yangtze River on the Wuhan Yangtze River Bridge to express his condolences. Figure /IC

Psychological assistance in the post-epidemic era

Our reporter/Liu

Published in China Newsweek, No.944, April 20th, 2020.

It's already four o'clock in the afternoon, and there is still a long queue in front of the mental health center of Wuhan University People's Hospital. This is April 5, and since the third day of the Lunar New Year, the clinic of the center has never stopped. Every time the number is released one week in advance, it is often robbed in a few minutes in the morning. Liu Zhongchun, director of the center and head of the expert group on psychological crisis intervention for epidemic prevention and control in COVID-19, Hubei Province, said that there will be another free clinic for experts next week.

"Staged acute treatment has ended. In the next two weeks, we will sink into the community, which is the focus of our psychological intervention. Post-intervention needs the leadership of the government and the integration of social forces. It is not enough to rely solely on us. " Liu Zhongchun told China Newsweek.

Compared with SARS and Wenchuan earthquake, this psychological assistance is more organized, but correspondingly, the psychological influence caused by COVID-19 is deeper and wider in space and time. Long-term closed community life and repeated illness make psychological reconstruction and assistance more difficult.

Qingming public sacrifice is the node of social psychology

In Du Mingjun's mind, February 7th is a key node. On this day, Dr. Li Wenliang passed away, and the social mood reached a peak. At that time, the epidemic was the most serious, and the heartstrings of different groups were tense. Panic, anxiety, depression, anger and doubt are common. 65438+1During the period from October 23rd to February 5th, the psychological hotline received 5 14 calls.

The second time with node significance is the public sacrifice day on April 4. In terms of quantity alone, the pressure of the hotline is gradually decreasing. It was received 285 times before March 10 day, with an average of less than 30 times. By the beginning of April, the number of calls received every day had dropped to 20, equivalent to half of the peak period.

After more than two months' ban on singing, the Qingming public sacrifice has calmed many people's psychology, and the public sacrifice mood that has not been responded for a long time has a relieved echo. "This is a dividing line, which gives a good stabilizer to the whole social psychology, and then it will have a better guiding role when individuals bear the grief of families and individuals." Du Mingjun said in an interview with China Newsweek. He is the executive secretary-general of Hubei Psychological Counselors Association, and organized the opening of Hubei psychological hotline on the day when Wuhan closed the city. He is one of the first psychological counselors of Hubei Heart Association to participate in the psychological hotline.

Wuhan has entered the post-epidemic period. If psychological crisis intervention is the main assistance in the early stage, then the focus in the later stage is post-traumatic stress disorder (PTSD) and grief response therapy. Rehabilitation patients, family members of the deceased, medical staff, these special groups need more time for psychological treatment.

In Du Mingjun's view, individuals have internal support systems, and society also has external support systems. When the individual's psychological defense line collapses, society needs to provide more spiritual dams. Sometimes, psychological counselors need to stimulate the internal potential of individuals, but this requires more systematic support from society, including government, community and social forces. Before and after the closure on April 8, Wuhan was gradually recovering, but the community control was still strict, and the understanding of the closure was relatively slow.

Guilt and sadness of survivors

A whole month later, Li Jianguo learned the news of his son's death. Before the outbreak of the epidemic, my son got married once, and after the divorce, he took his daughter to live with his parents. In Li Jianguo's impression, his son is in good health and has never been ill. After being infected with COVID-19 virus, I'm sure I can survive.

Li Jianguo separated her granddaughter from her wife and took care of her son alone. As a result, she was infected. Two people were admitted to the intensive care unit of the hospital. Li Jianguo is on the fifth floor, and his son is on the eleventh floor. The last contact was a phone call when my son was seriously ill. I think I'm dying, so let my father come up quickly. However, he can't get on. When her son was in hospital, she left Li Jianguo's wife's phone number, and she learned the news of his death at the first time.

At that time, Li Jianguo was seriously ill, and his wife fought back her grief and decided not to tell him. A month later, Li Jianguo recovered and learned that his son had passed away. He hid under the bathroom wall and cried. At first, he was angry and felt that his family shouldn't keep it from himself, but later he understood their decision. When he was transferred from the hospital to the rehabilitation station, the car passed by his house, but he still couldn't help it and burst into tears.

On March 3rd1day, 14, my isolation in Li Jianguo expired, and I will return to China the next day. Du Mingjun, a psychological counselor, went to the apartment where the rehabilitation station was located to give him psychological counseling. This is the second psychological crisis intervention of Du Mingjun team in Li Jianguo. They talked for an hour. Li Jianguo confided her heart, wondering if she could bear to go home and see what her son left behind before his death.

In the process of psychological assistance provided by Du Mingjun and his team members, the family members of the deceased in COVID-19 are called bereavement, and what is more special is that in Li Jianguo, relatives are infected with each other, and one party dies and the other party survives. "Survivors will have guilt and remorse in their hearts and feel that they have not taken care of each other. Especially for the elderly, I can't wait to say that it is me, not you. " Du Mingjun told China Newsweek.

Li Jianguo is seventy years old, his son has just turned forty, and his granddaughter is under ten. The white-haired man sent the black-haired man, which made him feel pain. Death was suddenly pushed in front of people, Du Mingjun said, gesturing forward. For many families of the deceased, the last impression in their minds is not the formal farewell at the end of their lives, but the last phone call in the intensive care unit, or the wave of 120 being transferred to the hospital.

Death became breaking news. Therefore, many family members refused to admit the death of their loved ones at first, or did not show sadness. Du Mingjun said that the first step of psychological intervention is to guide the bereaved to accept the facts and vent their emotions, and the second step is to clarify the responsibilities and the guilt.

10% of medical staff will leave psychological trauma.

Recently, doctors and friends I know often come to Liu Zhongchun for psychological consultation. Several cases have happened these days. As the epidemic in Wuhan draws to a close, many medical staff have a chance to rest, and the burden is suddenly removed, but various psychological problems follow, even if they rest, they cannot be alleviated.

Long-term and high-intensity work has caused some people to have the follow-up symptoms of PTSD. They have experienced internal oscillation and will suddenly wake up after a long time. "We have norepinephrine in our bodies, and at the peak of the epidemic, we have a sense of excitement. Just like beating chicken blood, the medical profession has no retreat and can only go up, but this state of excitement is unsustainable. After a month or even two months, we need to rest in time. Otherwise, like a spring, if we lose the elastic limit, we will not be able to recover. Even if we have a rest, we still feel tired. Psychologically speaking, this is a kind of job burnout. " Liu Zhongchun told China Newsweek.

Since the outbreak of the epidemic, Liu Zhongchun has kept close contact with academic colleagues all over the country, and published many articles in cooperation with foreign professional journals, sharing the existing Wuhan experience with medical colleagues at home and abroad.

In an article published in Journal of American Medical Association, they surveyed 1257 medical staff from Hubei and other provinces, and summarized the common psychological symptoms, including stress (50.4%), anxiety (44.6%), insomnia (34.0%) and psychological distress (7 1.0%). Among them, local medical staff in Wuhan are relatively more prone to psychological stress, and women and medical groups with intermediate titles face greater pressure.

There are many sources of stress. Seeing a large number of deaths every day, it is easy to feel out of control. The spreading virus extends to concerns about the safety of yourself and your family. Coupled with the temporary changes in the working environment and content, as well as the isolated state, these have become the source of psychological problems, which require timely crisis intervention, otherwise they may become legacy problems and appear repeatedly after the epidemic.

Li Qiguang from the Department of Psychosomatic Medicine of Shaanxi Mental Health Center is a member of the first psychological aid medical team in Shaanxi. He came to Wuhan with the team on February 24th and was assigned to Wuchang Hospital.

The general medical team mainly pays attention to the psychological needs of patients, but Li Qiguang and his team put 2/3 of their energy into the doctors and nurses in Wuchang Hospital. He still remembers that all the medical staff in Wuchang Hospital were under great pressure and in a bad mood.

Every afternoon and evening, Li Qiguang and his colleagues receive off-duty doctors and nurses in the designated hotel of Wuchang Hospital. There were many people at that time. The five-person psychological assistance team is equipped with psychiatrists and psychotherapists to jointly intervene in the psychological crisis of medical care groups. First of all, the psychologist receives consultation, makes a preliminary judgment on the severity, and then transfers it to the psychotherapist to discuss the specific treatment methods.

General crisis intervention needs 10 to 12 courses of treatment, but in the current special period, the time is limited and the treatment is shortened to 3 to 5 times. Compared with doctors, it is more common that the psychological needs of nursing teams are basically women. They have to deal with tedious work every day and witnessed a large number of deaths.

Psychological obstacles to returning to society

"The people who know the situation best are community workers and volunteers, who play an important role in our psychological intervention. If the consultant is sitting there, no one may come to you and need the help of social workers. " Liu Zhongchun told China Newsweek.

Post-traumatic stress disorder (PTSD) may occur after rehabilitation, and it may recur in the future if it is not relieved in time.

Last week, Du Mingjun received psychological counseling at the rehabilitation station. A young man in his early thirties is very strong, but he has obvious PTSD symptoms. Although his illness gradually recovered, he became irritable and violent, torturing people around him and himself. At the worst, he bit his cheek.

Some fragments of the past often flash in his mind. He said he had died three times. The first time was in the early stage of infection. His symptoms suddenly worsened and he vomited blood. He was taken to the hospital by 120 ambulance, but when he got to the hospital, there was no bed and he had to lie on the ground. His mother banged on the door of the inpatient department. He couldn't bear it, finally gritted his teeth, stood up and went home with his mother.

Then I went to the clinic for an injection. The blood leaked out without firing two shots. These images are imprinted on his mind. After being hospitalized, he thought he could only live for two days at most, but he survived in the end. But those difficult moments after illness will always flash in my mind from time to time and linger.

When Du Mingjun gave psychological counseling to rehabilitation patients, he first confirmed a very important premise with him, that is, these symptoms are temporary and belong to a phased state; Secondly, these emotions should be vented, but at the same time, we must ensure the safety of ourselves and others.

More generally, many patients have a sense of panic about getting back on track. Liu Zhongchun had communication with some patients and grass-roots managers. Some patients who have recovered are reluctant to go back, fearing that they may be discriminated against, that their neighbors are nervous, and that their recovery will affect the health of their families. There are still a few recovered patients ready to go home, but their families are unwilling to pick them up. There are still many uncertainties about COVID-19's cognition, which makes psychological counseling more difficult.