Pre-Traumatic Stress: What’s Next?
By Siddharth Ashvin Shah, MD, MPH
Founder and CEO
In collaboration with Greenleaf Integrative staff

At our state capitols and in the Washington, D.C. area, countless individuals are coping with what could happen (and what could have happened) between January 6, 2021 and Inauguration Day on January 20. Among our nation’s helpers and protectors, public servants are working particularly hard to manage a crisis and anticipate what comes next, but they may not have a shared vocabulary for the emotional labor entailed by these duties. This is why we are presenting here our spectrum of pre-traumatic stress (ranging from concern to paralysis) to provide both a shared vocabulary and a call for leaders to act with informed empathy for colleagues and employees.

A New York Times headline from January 11th starkly declares “State Capitols ‘on High Alert,’ Fearing More Violence.”  A Florida news outlet emphasized the personal perspective this way: 'It's a fear for my life' | State lawmakers react to potential armed protests at state capitols. From the medical unit of ABC News, clinical fellow Nicholas Nissen, M.D. writes directly and urgently about the The mental toll of the Capitol siege on the American psyche. Nissen’s article is primarily about the after-effects of traumatic events, yet it is important to acknowledge the before effects of possibly horrible events for which we have to prepare, namely, pre-traumatic stress.

We characterize pre-traumatic stress as “stress regarding an impending crisis or danger.” For the period of January 6th-20th, public servants are among the most heavily affected by new exposures to post- and pre-traumatic stress. This means lawmakers and their staff members, law enforcement professionals, election officials, and the many people who support the functioning of our government, including custodial and cafeteria workers. Sadly, not knowing what will happen next, the families, spouses, and partners of all these public servants are also coping with their own dose of pre-traumatic stress. Not to be underestimated is the particularly traumatic dimension of stress when there is no time to process accumulated layers of stressors, including the pandemic.

To illustrate (and normalize) the experience of pre-traumatic stress, I have the permission of one former congressional staffer to share her words that she wrote to another colleague about January 6th:

“Thank you so much for your concern.  I was not there thankfully.  But, like you, after spending the first 15 years of my career in the Congressional complex, those images were highly triggering for me.

Now there are people I know who can’t go back to their offices, or are suffering from headaches and upset stomachs and worse.”

“People who can’t go back to offices.” This could be due to what has already happened: the post-traumatic stress of January 6th, hearing stories of terror, or watching video footage. But it could also be pre-traumatic stress for what could happen and a person’s hope to avoid going through more trauma. It stands to reason that many public servants are along the spectrum of concern, unsettled, and experiencing dread about what could happen. And some even find themselves terrified or paralyzed.

This is a workplace issue because were it not for the specialized roles and places that define their work, public servants would be spared a significant dose of threat and trauma. There is a cost to performing their services for the greater good. In a later article, we will write in more detail on how to cope organizationally with pre-traumatic stress. In the meanwhile, it behooves us to provide something for readers who feel unsettled by diving into this topic. Here is a two minute mind-body meditation from InsightTimer to maintain groundedness and remain situationally aware.

In this article, we wanted to raise awareness to think in tandem about (1) past exposure to trauma and (2) potential future exposures to trauma. Literacy on these two intertwined forms of traumatic stress will help leaders pay better attention to the people under their care. Repeated acknowledgements that people are having physiological and psychological reactions to threat will contribute to collective empathy. We believe mainstream acceptance of these reactions will help leaders and policymakers make better decisions to safeguard public servants from avoidable suffering.