A year of war in Ukraine: Psychological effects and support

Traumatic experiences, such as wars and other disasters, increase the risk of becoming mentally ill. Brigitte Lueger-Schuster, psychotraumatologist at the University of Vienna, shares results from her research and effective exercises for a stable everyday life and support on the website of the University of Vienna.

War increases the risk of developing mental disorders, such as post-traumatic stress disorder (PTSD), anxiety disorders or depression. The results of the 2017 Mental Health Survey show that the recovery from PTSD takes a particularly long time under war conditions. It is expected that Ukrainian citizens who have remained in Ukraine, as well as those who have fled, develop long-term mental problems due to the Russian war of aggression.

Those who had to flee their home had to leave a lot behind: a family, a house, friends, a job, a familiar environment and stable habits. In exchange, they have faced burdensome uncertainty as to what will happen to their family and friends, not knowing how they are doing. Moreover, they are worried about their country’s future, how long will Ukraine exist? What is to come after the end of the war?

The Ukrainians who stayed behind are at risk of bodily harm or even death. Life is dominated by fear, hunger, cold, violence, distress about what the upcoming days might hold, worries about the more vulnerable – the children, the elderly–, but also about the future.

Social belonging as a buffer

Research has proven that war has long-term psychological consequences for both civilians and soldiers. Displaced persons from countries with massive human rights violations suffer from mental illness more often, partly because being forcibly separated from family and friends poses the greatest risk for developing mental disorders. This applies both to the displaced persons/refugees and to those who remained in their country. Social belonging is the main buffer against the effects of massive stress.

Traumatic stress and how to deal with it

Massive or traumatic stress first results in a ‘storm of feelings’, which evokes negative feelings and thoughts and makes coping with everyday life more difficult. Concentration, social belonging, reasonable thinking – they all seem impossible. Life is dominated by negative feelings and thoughts.

Do you feel exhausted and overstrained? Do you sometimes think you are going ‘crazy’? Are you afraid that you might not be able to keep in touch with your family and friends because you have changed so much?

On the basis of the recommendations from the World Health Organization, here are some exercises that can make life a little bit easier:

Exercise 1: Grounding

Start breathing calmly, empty your lungs and then breathe in again very slowly. Stand up only when you start feeling calmer. Now start perceiving your body, i.e. feel every single limb. Then do the following: Stand up, press your feet to the ground, stretch your arms slowly to the side or slowly press the palms of your hands together, and start to focus. What do you see? Pay attention to your surroundings, breathe in and out slowly. What do you smell? Touch your knee or another surface, notice how it feels. Are you feeling a little bit more grounded, more connected to your body and your surroundings? Good, if not – just repeat it.

Even though you are now repeatedly having difficult thoughts and strong feelings, there is still a world out there that you can perceive, in which you are present, even though it is not always a good and beautiful world, but you live in it. Grounding does not dissipate your storm of feelings, but it does help you to feel a little safer until the storm of feelings has passed.

Storms of feelings can last longer or shorter. The longer they last, the longer you should do this exercise. It helps you to be there for others and to be really present, for example. The more you practice grounding and focusing, the easier it will become for you. It is like in sport – the more you train, the better your condition will be.

What should I do if my mind is still occupied with negative thoughts?

Thoughts about home, the war and traumatic situations that you have experienced are recurring again and again, they invade you in a sense, and usually during very inconvenient situations. Unfortunately, this is quite normal for people who are in traumatic situations, and it is also very straining.

Research has shown that we tend to use maladaptive strategies to cope better with these thoughts. We use the term maladaptive to describe an unsuitable strategy that worsens the mental strain, that is not helpful to cope better with the difficult situation.

Shouting, trying to avoid thoughts about it, staying in bed, isolating oneself, drinking alcohol, smoking, taking drugs, blaming oneself, etc. are examples of maladaptive strategies. Are you also exhibiting some of these behaviours? Did they work, or did the thoughts and feelings come back quickly, perhaps even getting worse? Do you also feel these thoughts and feelings in your body? Where?

Exercise 2: Controlling distressing thoughts and feelings

When you are overwhelmed by negative feelings and thoughts, label them and localise them in silence for yourself. These can be a painful memory that is on your mind, or something that is sitting on your chest, like fear of the future. Label these thoughts and feelings in silence and repeat saying the following to yourself again and again: “I notice”. This helps to distance yourself a little bit from these thoughts and feelings. It is thus about what you do with your thoughts. This does not mean that you have to think positively about the world or the war: it is about giving less power to these thoughts and feelings.

The next step is to focus on the here and now, just as you have already practised it. For instance, when one of these thoughts races through your mind you while you are talking to a fellow student or while you are studying, go on with the conversation, further concentrate on the seminar essay or continue learning your vocabulary. But do it consciously, pay attention to where you are and what you are doing. Label the thought and localise it (for example, “Oh, this is homesickness, I feel it in my heart”), and carry on. Yes, a bad thought, a terrible feeling got hold of you, but you labelled it and said to yourself, “I notice that the memory of my flight is in my head, or that the homesickness is in my heart” and, in spite of this, you can then carry on.

At the beginning you may find this exercise difficult, or even strange, but the more you practise, the easier and more normal it will become. This way, you can evade, and even control distressing thoughts and feelings. This exercise teaches you how to regain control of your thoughts and feelings, as well as of your life. It helps you to remain concentrated, present and focused.

Seeking help is a sign of strength

If you practise these exercises, your life will probably become a little bit easier, because you will be able to stay connected with your social environment. You will also be capable of facing your daily tasks and challenges. Please turn to the indicated institutions if these exercises are not helpful even after practising them repeatedly. War and flight are far-reaching traumatic events that have a very strong effect on the mind. Admitting that you need help is a sign of strength.

Related links:

• https://ukraine.univie.ac.at/en/
• “Mein Weg” (my way) – mentoring programme for Ukrainian students (in German)

Sources:

Doing what matters in times of stress: an illustrated guide. Geneva: World Health Organization;

2020. Licence: CC BY-NC-SA 3.0 IGO.

Lindert J, von Ehrenstein OS, Wehrwein A, Brähler E, Schäfer I. [Anxiety, Depression and Posttraumatic Stress Disorder in Refugees – A Systematic Review]. Psychother Psychosom Med Psychol. 2018 Jan; 68(1):22-29.

Morina N, Stam K, Pollet TV, Priebe S. Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies. J Affect Disord. 2018; 239: 328-338