The COVID-19 pandemic has universally threatened the building blocks of mental health, well-being, and quality of life, namely, expectations of safety, connectedness, hope, and individual and societal efficacy. Consequently, unprecedently large numbers of individuals are significantly stressed and many are at risk for relapse of mental health problems, exacerbations of existing mental and behavioral health problems, and new onset clinical problems. Because of the scope of the problem, a population-based public health perspective is needed, which in the context of disasters has well-established theories and prevention approaches. Public health approaches to disasters and pandemics focus on preventing subclinical problems from becoming clinical disorders, in comparison to clinical care approaches that focus on treating established disorders. Fortunately, specialty care clinicians who typically think about assessing and treating established disorders have the training and clinical competencies to deliver prevention-focused interventions. This paper is designed to help specialty care clinicians who use cognitive-behavioral strategies to understand the biopsychosocial impacts and resource deficits associated with COVID-19-related stressors and the public health perspective to address them. We also provide ways clinicians can help people who are suffering from significant stress and resource deficits bounce back and regain functioning. We describe psychological first aid, stress management, repeated ecological assessment, writing about stressors, problem-solving, and behavioral activation approaches to assist individuals at risk for enduring stress-linked problems.

BackgroundSymptoms of borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) commonly co-occur. Recent evidence supports the concomitant treatment of BPD and PTSD.MethodsThis study uses a longitudinal cross-lagged panel model to examine BPD and PTSD symptom response in a sample of 110 women undergoing residential treatment for BPD. The naturalistic treatment primarily followed a dialectical-behavior therapy protocol, with individualized integration of other major evidence-based treatments (EBTs) for BPD, including mentalization-based treatment, good psychiatric management, and transference-focused psychotherapy.ResultsA residentially-based integration of treatment approaches resulted in significant reductions in BPD (d = 0.71) and PTSD (d = 0.75) symptoms. Moreover, changes in BPD symptoms prospectively predicted changes in PTSD symptoms (constrained path b = 1.73), but the reverse was not true (constrained path b = 0.05).ConclusionsA naturalistic integration of EBTs for BPD may benefit both BPD and PTSD symptoms even in the absence of PTSD-oriented intervention. Additionally, the attenuation of BPD symptoms may have positive impact on PTSD symptoms.

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This chapter provides an overview of individual and small group–based approaches for prevention and early intervention of posttraumatic stress disorder. Using the Institute of Medicine’s classification system for preventive interventions of mental disorders (universal, selective, and indicated), the chapter describes individual and small group early interventions and reviews the effectiveness of these strategies. Specifically, psychological debriefing, psychological first aid, and psychoeducation have been used with varying degrees of success as selective interventions targeting individuals exposed to trauma. However, there is strong empirical support for using cognitive behavioral therapy as an indicated preventive intervention to help symptomatic individuals in the weeks or months following traumatic exposure. A review of the literature also suggests that future research should explore different modes of delivery and devote more attention to determining the best time to intervene after traumatic exposure.