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Phases of psychological response in COVID-19: A preliminary heuristic

George S. Everly Jr, PhD, Albert W. Wu, MD, MPH, James B. Potash, MD, MPH


Objective: To explore the putative phases of the psychological response to disaster: preimpact, impact, heroic, honeymoon, disillusionment, and recovery, and make recommendations for corresponding interventions.

Conclusions: Disasters such as the COVID-19 pandemic are often characterized by chaos and uncertainty. As a result, public health disaster planning and response represent formidable challenges. Although disasters can result from a wide array of hazards, regardless of the agent at work, they may follow a rather predictable trajectory of psychological phases. A heuristic of those phases can provide an opportunity for a more organized disaster mental health response and more efficient utilization of scarce resources.


COVID-19, pandemic, psychological impact, phases, mental health response

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Raphael B: When Disaster Strikes: A Handbook for the Caring Professions. New York: Basic Books, 1986.

United Nations: COVID-19 and the Need for Action on Mental Health. Geneva: United Nations, 2020.

Jameton A: Nursing Practice: The Ethical Issues. Englewood Cliffs, NJ: Prentice-Hall, 1984.

Dean W, Jacobs B, Manfredi RA: Moral injury: The invisible epidemic in COVID health care workers. Ann Emerg Med. 2020; 76(4): 385-386.

Williams RD, Brundage JA, Williams EB: Moral injury in times of COVID-19. J Health Serv Psychol. 2020; 46: 65-69.

Myers D, Wee D: Disaster Mental Health. New York: Brunner- Routledge, 2005.

Quanrantelli EL: The need for clarification in definition and conceptualization in research. In Sowder BJ, Lystad M (eds.): Disasters and Mental Health. Washington, DC: American Psychiatric Association, 1986.

Box GEP, Draper NR: Empirical Model-Building and Response Surfaces. New York: John Wiley & Sons, 1987.

Johns Hopkins University and Medicine Corona Virus Resource Center: New cases of COVID-19 in world countries. Available at Accessed October 28, 2020.

Terpstra T: Emotions, trust, and perceived risk: Affective and cognitive routes to flood preparedness behavior. Risk Anal. 2011; 31(10): 1658-1675. DOI: 10.1111/j.1539-6924.2011.01616.x.

Busch IM, Moretti F, Mazzi M, et al.: What we have learned from two decades of epidemics and pandemics: A systematic review and meta-analysis of the psychological burden of frontline healthcare workers. Psychother Psychosom. 2021; 1: 1-13.

Lai J, Ma S, Wang Y, et al.: Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020; 3(3): e203976. DOI: 10.1001/jamanetworkopen.2020.3976.

Green BL, Solomon SD: The mental health impact of natural and technological disasters. In Freedy JR, Hofoll SE (eds.): Traumatic Stress: From Theory to Practice. New York: Plenum Press, 1995.

Norris FH, Friedman MJ, Watson PJ, et al.: 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry. 2020; 65(3): 207-239.

Flynn BF: Psychological aspects of disasters. Renal Fail. 1997; 19(5): 611-620. DOI: 10.3109/08860229709109027.

Vlahov D, Galea S, Resnick H, et al.: Increased consumption of cigarettes, alcohol, and marijuana among Manhattan residents after the September 11th terrorist attacks. Am J Epidemiol. 2002; 555(11): 988-996.

Hall BJ, Tucker JD: Surviving in place: The coronavirus domestic violence syndemic. Asian J Psychiatr. 2020; 53: 102179. DOI: 10.1016/j.ajp.2020.102179. PMID: 32480357; PMCID: PMC7246009.

Brahmi N, Singh P, Sohal M, et al.: Psychological trauma among the healthcare professionals dealing with COVID-19. Asian J Psychiatr. 2020; 54: 102241. DOI: 10.1016/j.ajp.2020.102241. PMID: 32634708; PMCID: PMC7305901.

Solomon Z, Shklar R, Mikulincer M: Frontline treatment of combat stress reaction: A 20-year longitudinal evaluation study. Am J Psychiatry. 2005; 162: 309-314.

Flynn B: Mental Health All-Hazards Disaster Planning Guidance. DHHS Pub. No. SMA 3829. Rockville, MD: Center for Mental Health Services, SAMHSA, 2003.

Ruzek JI, Young BH, Cordova MJ, et al.: Integration of disaster mental health services with emergency medicine. Prehosp Disast Med. 2004; 19(1): 46-53.

Schoenbaum M, Butler B, Kataoka S, et al.: Promoting mental health recovery after Hurricanes Katrina and Rita: What can be done at what cost. Arch Gen Psychiatry. 2009; 66(8): 906-914.

McCabe OL, Everly GS Jr, Brown LM, et al.: Psychological first aid: A consensus-derived, empirically supported, competency-based training model. Am J Public Health. 2014; 104(4): 621-628.

Everly GS Jr, Beaton RD, Pfefferbaum B, et al.: Training for disaster response personnel: The development of proposed core competencies in disaster mental health. Public Health Rep. 2008; 123: 13-19.

Institute of Medicine: Ready and Resilient Workforce. Washington, DC: National Academies Press, 2014.

Wu AW, Connors C, Everly GS Jr: COVID-19: Peer support and crisis communication strategies to promote institutional resilience. Ann Intern Med. 2020; 172(12): 822-823. DOI: 10.7326/M20-1236. PMID: 32251512; PMCID: PMC7146593.

Everly GS, Wu AW, Cumpsty-Fowler CJ, et al.: Leadership principles to decrease psychological casualties in COVID-19 and other disasters of uncertainty. Disaster Med Public Health Prep. 2020: 1-10. DOI: 10.1017/dmp.2020.395. PMID: 33087209.

Watson C, Toner ES, Shearer MP, et al.: Clade X. A pandemic exercise. Health Secur. 2019; 17(5): 410-417. DOI: 10.1089/hs.2019.0097.

Everly GS Jr, Lating JM: The Johns Hopkins Guide to Psychological First Aid. Baltimore: Johns Hopkins Press, 2017.

Edrees H, Connors C, Paine L, et al.: Implementing the RISE second victim support programme at the Johns Hopkins Hospital: A case study. BMJ Open. 2016; 6(9): e011708. DOI: 10.1136/bmjopen-2016-011708.

Everly GS Jr, Mitchell JT: Critical Incident Stress Management. Baltimore, MD: Chevron, 1997.

Norris FN, Friedman MJ, Watson PJ: 60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research. Psychiatry. 2003; 65(3): 240-260. DOI: 10.1521/psyc.

Everly GS Jr, Mitchell JT: Critical Incident Stress Management: A Review. Ellicott City, MD: ICISF, 2017.

Moran D, Wu AW, Connors C, et al.: Cost-benefit analysis of a support program for nursing staff. J Patient Saf. 2020; 16(4): e250-e254.

Dzau VJ, Kirch D, Nasca T: Preventing a parallel pandemic—A national strategy to protect clinicians’ well-being. N Engl J Med. 2020. DOI: 10.1056/NEJMp2011027.



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