The coronavirus emergency is about to turn to the so-called Phase 2 or to that moment of easing of social restriction measures, which will lead to taking the first timid steps towards the much desired freedom.
Before moving on to imagining the near future of Phase 2, let’s see what the psychological effects of quarantine and how to reduce (Brooks et al., 2020) are according to a scientific article published in The Lancet magazine and social .
The goal of today’s article will be to identify the possible issues people will need to manage and how psychologists can prepare to intervene.
What is quarantine?
Quarantine is the restriction of movements and the separation of people potentially exposed to a contagious disease with the aim of verifying the course of the disease and reducing the risk of contagion. Although its definition differs from that of isolation, understood as separating infected people from people who are not, the two terms are often used interchangeably.
What are its origins?
The word quarantine was first used in Italy in Venice in 1127 as a response to leprosy and later also for the plague . More quarantines have recently been imposed in areas of China and Canada during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak , and in entire West African villages during the 2014 Ebola outbreak .
Why was a review of the consequences of the quarantine requested ?
Quarantine is often experienced as an unpleasant experience for those who suffer it. Separation from loved ones, loss of freedom, uncertainty about illness and boredom can have dramatic effects on people’s mental health. Given the situation we are experiencing, the World Health Organization (WHO) has requested this review, not only to evaluate the impact of quarantine on mental health, but also to identify the factors that can help mitigate its effects.
How was the data collected to evaluate the psychological impact of the quarantine?
The research carried out a review of the psychological impact of quarantine using three electronic databases from which 3166 articles on the subject were found . Of the latter, 24 were included in the study , all referring to studies conducted in ten countries that had been infected with SARS (11 studies), Ebola (five), the 2009 and 2010 H1N1 influenza pandemic (three), Middle East (two) and equine flu (one). One such study involved both H1N1 and SARS.
What did the article review reveal?
Analysis of most studies reported negative psychological effects including symptoms of PTSD , confusion , and anger . For more information on the research data and bibliography. Below, however, we offer a summary of the stress factors during and after the quarantine and the actions that can mitigate the effects taken up in the article.
Stressors during the quarantine
- Duration of the quarantine
Studies have shown that extended periods of quarantine are associated with mental health problems , post-traumatic stress symptoms , avoidance behaviors , and anger .
- Fears of infection
Participants in eight studies reported fears about their own health or fears of infecting others , particularly infecting family members.
- Frustration and boredom
Confinement, loss of usual routine, and reduced social and physical contact with others have often been cited as a cause of boredom , frustration , and a sense of isolation from the rest of the world. The frustration was exacerbated by not being able to take part in normal daily activities, such as shopping for basic necessities or taking part in social networking activities via telephone or the Internet.
- Inadequate supplies
Having inadequate basic supplies (e.g., food, water, clothing, or shelter) during quarantine was rated as a source of frustration and associated with anxiety and anger up to 4-6 months after quarantine.
- Inadequate information
The scarcity of information from the health authorities and the lack of clear and insufficient guidelines on the actions to be taken generated confusion and were experienced as sources of stress also predictive of the development of post-traumatic stress symptoms .
Post quarantine stressors
Financial loss can be a problem during and after quarantine as people find themselves disrupting their professional activities without planning. Furthermore, the effects of economic hardships seem to last for a long time, causing serious socio-economic problems and the risk of developing psychological disorders , anger and anxiety even several months after the quarantine.
Stigma represents an important consequence that can last for some time after the quarantine and the containment of the epidemic. In a comparison of quarantined and non-quarantined health workers , the former were more likely to be stigmatized and rejected by people in their local neighborhoods. For example, participants in several studies reported that they were treated differently: avoiding them, withdrawing social invitations, treating them with fear and suspicion, and making critical comments.
What are the measures that can reduce the risks of a negative impact on people during and post quarantine?
According to the authors of the article, the measures to mitigate the impact of the quarantine are:
- Reducing the time of the quarantine
Limiting the duration of the quarantine to a scientifically reasonable period can minimize the negative effect on people. For people already in quarantine, an extension of the latter for example, would risk exacerbating frustration or demoralisation.
- Clear information
People in quarantine often may fear becoming infected or infecting others , and may make catastrophic assessments of any physical symptoms experienced. This fear is a common occurrence for people exposed to a worrying infectious disease and could be exacerbated by inadequate information. Ensuring people have a good understanding of the disease and the reasons for quarantine should be a priority .
- Guarantee of services and supplies
Quarantined families should quickly have sufficient resources for their basic needs . Coordination for resource provision should ideally occur in advance, with conservation and reallocation plans established to ensure resources are not depleted.
- Interventions to reduce boredom and improve communication
Boredom and isolation can cause distress. People in quarantine should be educated on what they can do to avoid boredom and given practical advice on coping and stress management techniques ; be supported in activating the social network to reduce anxiety and prevent the development of long-term distress; put in a position to communicate with one’s family and friends ; have access to an online service run by health professionals who can provide instructions on what to do if symptoms develop and reassure people that they will be treated if they get sick.
- Beware of health professionals
Healthcare workers are often quarantined and this can negatively affect the stigmatizing attitudes of others . It is also possible that healthcare professionals may be concerned about causing shortages in workplaces and doing extra work for their colleagues. Also, being separated from your work crew could develop a sense of isolation . Organizational support has been found to be protective of mental health for health care workers during infectious disease outbreaks.
- Encouragement of altruism
Raising awareness of self-isolation as an action aimed at helping to protect others , including particularly vulnerable ones, can make quarantine an easier act to bear, especially if the safety and responsibility of those who choose this measure for the benefit of others are guaranteed.
What do we at the Italian Center for Single Session Therapy suggest to psychologists?
In a few days people will slowly resume their routines and activities . We already know that this step will be very delicate and stressful . People will be confronted with fears , traumas , mourning , losses and a new and heavy family management . Adults and children will face a great daily challenge.
How can the psychologist respond to new requests?
Being ready to face Phase 2 will also present a great challenge for the psychologist. It will be necessary to be able to respond quickly to people’s requests, also knowing the economic difficulties they will face.
So in this climate, what can the psychologist do if he hasn’t already prepared himself?
At the moment there are two main suggestions:
- Training: this could be the right time to think about training in order to equip yourself with the necessary tools to respond to different people. On the one hand, it will be important to specialize in the topics that will be addressed ( post-traumatic stress , bereavement , anxiety , depression , job loss ), while on the other it will be useful to know new methods and techniques for doing therapy , including short ones such as Single session , useful and effective for dealing with situations that require quick and cost-effective responsesaccessible.
- Remodulation of one’s own way of doing therapy: in this phase we understood that the psychologist will no longer be able to exempt himself from using technology. Some psychologists have already used it before, others have tried their hand at the occasion, but one of the fundamental aspects that we have learned from this experience is that all the tools for remote communication will be needed for some time to come. Therefore the psychologist will have to include them in his baggage and make them an integral part of his professional practice.
The review cited above suggests that the psychological impact of quarantine is large and can last a long time . That doesn’t mean that quarantine shouldn’t be used. The psychological effects of an unopposed spread of the disease could be worse . However, depriving people of their liberty for the public good is often a controversial issue and needs to be handled carefully. While quarantine is indispensable, research findings suggest the need to take every measure to ensure that this experience is as tolerable as possible for people. Are you psychologists preparing for Phase 2 ?
Team Psychotherapist of the Italian Center
for Single Session Therapy
Brooks, S.K., Webster R.K, Louise E Smith, L.E., Woodland, L., Wessely, S., Greenberg, N., Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence, Rapid Review from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30460-8/fulltext
Cannistrà, F., & Piccirilli, F. (2018). Single-session therapy: Principles and practices . Florence: Giunti Editore.