Traumatic events include actual or threatened death, serious injury to oneself or another person, or a threat to the personal beliefs of oneself or others. Examples include violent assaults (e.g., sexual or physical assault or mugging), torture, and severe car accidents. Refugees who are fleeing their homes because of war and political problems may suffer from stress related to trauma.
Common Reactions During The Days Following The Trauma
It is common for people to continue to have distressing thoughts, images, and feelings for some days, or even weeks, following the trauma. These reactions are common, and are a sign that the body is recovering from a severe stress. The most commonly reported reactions include:
- Anxiety or fear of: danger to self or loved ones, being alone, being in other frightening situations, having a similar event happen again.
- Avoidance of situations or thoughts that remind you of the traumatic event.
- Being easily startled by loud noises or sudden movements.
- Flashbacks where images of the traumatic event come into your mind suddenly for no apparent reason, or where you mentally re-experience the event.
- Physical symptoms such as tense muscles, trembling or shaking, diarrhoea or constipation, nausea, headaches, sweating, and tiredness.
- Lack of interest in usual activities, including loss of appetite or interest in sex.
- Sadness, feelings of loss, or aloneness.
- Shock or disbelief at what has happened, feeling numb, unreal, isolated, or detached from other people.
- Sleep problems, including getting to sleep, waking in the middle of the night, dreams or nightmares.
- Problems with thinking, concentration, or remembering things (especially aspects of the traumatic event).
- Preoccupation with thinking about the trauma.
- Guilt and self-doubt for not having acted in some other way during the trauma, or for being better off than others, or feeling responsible for another person’s death or injury.
- Anger or irritability at what has happened, at the senselessness of it all, at what caused the event to happen, often asking “Why me?”.
Not everyone will experience all of these reactions, or experience these reactions to the same extent. There may also be other reactions to add to the list. However, in most cases, these symptoms will disappear after a short period of time (i.e., a few hours, days, or weeks).
Acute Stress Reactions
Acute stress reaction is a short-lived condition that develops in response to a traumatic event. The symptoms begin within minutes of the traumatic event and disappear within days (even hours). Symptoms include:
- An initial state of ‘daze’
- Being agitated or over active
- Withdrawing from activities (e.g., from work and socially)
- Anxiety symptoms (e.g. sweating, fast heart beat, blushing)
- Thinking only about what happened
- Feeling disorientated
- Feeling depressed
- Difficulty remembering
How To Deal With An Acute Stress Reaction?
- Safety first! If the traumatic situation is ongoing, get some help to make yourself safe. You may need some help in finding a safe place to stay.
- Talk with someone you trust about what happened. It may be important to seek some professional help, to talk through the facts of what you went through.
- Getting treatment early on may prevent further distress.
- Talking with family and friends may also be good. Support and understanding at a difficult time can be very helpful. You don’t have to face it alone.
- Know that how you are feeling is very normal for someone who has been through a traumatic event.
- Give yourself time. Know that the way you are feeling will not last, and by dealing with the fears and thoughts, you will be able to get on with life. Be kind to yourself.
- Accept that it might take a bit of time to adjust.
- Spend time doing nice things – relaxing, going for walks, visiting beautiful places, seeing friends. Plan to do nice things each day.
- It will be important to confront situations associated with the traumatic event… but do it gradually. You may decide to go back to work, but go just for a few hours at first and then build it up slowly.
- Don’t use drugs and alcohol to cope. They will only make it worse. Try to find other ways to relax
Post-Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a long-lasting anxiety response following a traumatic or catastrophic event. Typically, the person sees a traumatic event such as actual or threatened death, serious injury to oneself or another person, or a threat to the personal integrity of oneself or others. Common reactions during the trauma include feeling helpless, very afraid, or horrified.
PTSD usually develops within 3-6 months of the traumatic event (although sometimes longer) and involves the following:
- Re-experiencing the traumatic event
- Images or flashbacks of the traumatic event (reliving the event)
- Nightmares and disturbed sleep
- Avoiding things that remind you of the event
- Avoiding thoughts and feelings that remind you of the traumatic event
- Difficulty remembering important aspects of the trauma
- Withdrawal from your friends and family
- No interest in normal activities
- Symptoms of increased arousal and anxiety
- Intense arousal and anxiety when faced with reminders of trauma
- Having depressed or irritable mood (and getting angry easily)
- Difficulty concentrating on and remembering other things
- You get easily startled (and feel ‘jumpy’)
Having PTSD can be very difficult and can affect relationships, work, and physical health.
What Treatments Work For PTSD?
Getting better means that the trauma stops terrifying you. For this to happen you will have to face your fears, and be able to talk about what happened. You don’t have to do this all at once. You need to talk about what happened in increasing detail, and to deal with the upsetting feelings, so that you can get on with your life. The aim is to face the fears and the terrible memories so that they no longer intrude in your life.
Cognitive Behavioural Treatment
- Education and information about the symptoms of PTSD, the role of avoidance and the influence of thoughts and fears
- Anxiety management, such as slow breathing and relaxation
- Exposure to trauma-related stimuli
- Changing thoughts and fears about the traumatic event
Education and information
It is important to know that your feelings and symptoms are normal. You have been through a traumatic event and your body and mind will need some time to understand what has happened.
Strategies can be used to decrease your arousal level, if it is too high. This will hopefully increase your sense of control and safety, and help you to face difficult memories and triggers associated with the trauma. A few important tips:
- Exercise regularly, and eat a well balanced diet with regular meals.
- Slowing your breathing
- Hold your breath for 6 seconds (time it)
- Breathe in and out every 6 seconds
- Say relax under your breath as you breathe out
- Stop after a minute or when your anxiety drops
- Practice slow breathing for one minute 4 times a day then it will be easy to use when you need it
Exposure to trauma-related stimuli
It is important to gradually face the situations and memories that you may have avoided. It is best to seek the help of a professional trained specifically in providing cognitive behavioural treatment of PTSD to start to face your fears. Exposure can be both in your imagination and in real life (e.g. thinking of visiting the place where the accident occurred, and actually visiting the place).
Often people will have unhelpful, and perhaps even incorrect, memories of the traumatic event. It is important to start to think about what happened in a realistic way, and to think about some of the beliefs you may have that are making the traumatic memories difficult to deal with. This can be very hard to do. An experienced therapist, trained in cognitive behavioural therapy, will be able to help you to confront these thoughts and beliefs in a gradual manner.
Some antidepressants may be helpful in dealing with PTSD. Studies have shown mixed results. Improvement has been shown with antidepressant drugs. Benzodiazepines such as Valium may give some temporary relief from your symptoms, but are addictive and you will end up needing bigger doses to get the same effect. They are not recommended for long-term use. Medication alone may not be as good for you as taking medications and seeing a therapist trained in cognitive behavioural therapy (CBT).
How Do I Get Help?
Start by talking to your local doctor. Another option is to contact your local community mental health centre and speak to a professional. If you have been sexually assaulted, most cities and towns will have a sexual assault or rape crisis centre that you can visit. Your local phone book should help you to find the closest centre. If your trauma is war-related, Veteran Affairs in your area may be the best place to seek help. Many universities offer treatment for trauma through their psychology or psychiatry department. Professional bodies for psychologists and psychiatrists may be able to help you find the care you need.
A few websites that may be helpful include:
Helpful Hints For Family And Friends
- Spend time with the traumatised person and reassure them that they are safe.
- Offer support and listen to them, even if they haven’t asked for help.
- Don’t take it personally if they want to be alone sometimes. Don’t take their anger or other problems personally – they are part of the normal response to trauma.
- Tell them that you are sorry the event happened, and you want to understand and assist them.
- If you were involved in the event also, try to spend some time talking about what occurred with the other person/people. Try to express how you feel about what occurred, and about how you are feeling now.
Children’s Reactions – Coping With Disaster And Trauma
Children may also experience psychological reactions to a traumatic event. They react to scary events in many different ways, and there is no typical or normal reaction. Younger children, in particular, may find it very hard to understand what has happened to themselves, their parents, or siblings. Like adults, they will have strong feelings. Unlike adults, they may not be able to tell you how they are feeling, and instead will express their feelings through their behaviour. When a family member experiences a trauma, everyone in the family is affected. It will take time for the family to adjust as they try to understand the reactions of other family members, and may have to learn to relate to each other in new ways.
Common Kids’ Reactions
Some common reactions from your child may be:
- Being scared, especially at night or when away from parents
- Being clingy and more dependent than usual
- Your child may show ‘babyish’ behaviour that they have grown out of
- Your child may have nightmares and have trouble sleeping
- Wetting the bed
- Having aches and pains
- Your child may be more naughty than normal
- Your child may be grizzly and whinging
- Your child may have tantrums and do things to get attention from you and others
- Your child may not be doing as well as normal at school
These problems are all normal reactions to an abnormal event that has touched the lives of the whole family. It is important not to get angry and blame the child for this behaviour.
How To Help
Like adults, most children’s reactions go away with time. Parents and other adults can help the child recover in many ways:
- Keep talking – about what is happening, how family members feel, and what they need from each other. This helps stop children from feeling alone, isolated, and misunderstood.
- Reassure them that they are safe and will be cared for.
- Listen and talk to them about the experience. Honest, open discussion is best as the unknown is often more frightening than the reality for children. Even very young children know that something is going on and, again, the reality is easier for them to deal with than the unknown.
- Some children will need extra encouragement or special attention, especially at bedtime.
- Allow kids to express how they feel. Feelings are part of the healing process. Support the child and allow them time to work through it.
- Do things as a family and make sure time is kept for fun and rewarding times together. Shared fun carries a family through many hard times.
- Keep family roles clear. Don’t allow your child to have too much responsibility for too long, even when they want to care for an upset parent. It is just as important not to become too overprotective of your child after a trauma. Try to understand if they can’t do things for a while, like going to school, or helping at home, but talk about how they will get back to normal activities as soon as possible.
Like adults, most children will adapt and grow through crisis with the love and support of their family and friends. However, if the child’s reactions are particularly severe or prolonged, or if you have other concerns about the way that your child is reacting to a traumatic event, do not hesitate to contact someone who is trained to assess the situation and advise you.
Immediately After The Event
- Make sure you are with people. Do not go home to an empty house – ask a friend or relative to stay with you.
- Talk about the incident with others. Talking will help you get over the reactions.
- Remind yourself that the event is over and that you are now safe.
- If possible, get some physical exercise. This will help to burn off some of your tension and anxiety.
- Avoid alcohol, sedatives, or sleeping pills (they will only dull the experience and not allow you to deal with your feelings properly).
- Restrict stimulants (such as tea, coffee, chocolate, cola, or cigarettes) because you do not want to make your body even more agitated than it already is.
- Try to eat something, even if you do not feel like eating.
- If you cannot sleep, do not lie in bed, tossing and turning – get up and do something until you feel tired.
How To Handle The Next Few Days
- Remind yourself that your reactions are a normal result of trauma and will pass in time.
- Try to get back into your normal routine as soon as possible. You may need to gradually introduce yourself to tasks that seem difficult.
- If you feel uncomfortable, scared, or anxious, take some long, slow breaths and remind yourself that you are safe, and that the trauma is over.
- Make sure that you are doing things that are relaxing and enjoyable – be kind to yourself.
- Continue to talk to your family, friends, and colleagues about the trauma. This will help you to get over your feelings. Even if you feel a bit distant from other people, do not reject their support. Do not be afraid of your feelings.
- Work on your general stress levels by ensuring that you have adequate sleep, a good diet and regular exercise. Practise relaxation to help reduce nervous tension.
- Drive more carefully, and be more careful around the home and with machinery. Accidents are more common after severe stress.
- Allow yourself time to deal with the memories. You will need commitment and patience. There may be some aspects of the experience that will be difficult to forget.
- If your reaction continues to seriously disrupt your life, please talk to your clinician.
Managing Loss Or Bereavement
The experience of grief after loss is one common to human beings. The most intense grief usually follows the death of a loved person, perhaps because death is so final and we feel a great sense of loss. While what follows will concentrate mainly on bereavement, similar reactions occur in many different types of loss, e.g., breakdown of a relationship, loss of a pet, a job, a lifestyle, a limb. The intense feelings experienced after loss are a normal, healthy part of the healing process and will result eventually in learning to live with the loss. For some, however, difficulties in working through the process may result in depression.