*You dodged the bullet, now you need to deal with the emotional damage*
The enormous amount of stress that results from any sort of traumatic experience frequently causes a cascade of potentially damaging emotional responses. These include feelings of loss, grief, fear, anger, frustration, anxiety, uncertainty, and helplessness. Short-term difficulty coping with the emotional fallout of a traumatic experience is a completely normal response to an abnormal situation. Typically, it can take up to six months to completely adjust. When a person fails to adjust during this time period, post traumatic stress disorder is the usual label. This article is not designed to provide a complete guide to the treatment of PTSD. This is just a basic guide to help avoid it.
Letís start with defining a few terms.
What is Trauma?
Trauma is a startling or shocking experience that has a lasting effect on mental and/or physical health. It typically occurs when a person feels overwhelmed, powerless, and in fear of their life.
What is Shock?
Shock refers to the feeling of being in a daze, or too stunned to comprehend fully what has just occurred.
What is Denial?
Denial is a refusal to acknowledge the extent of the impact a traumatic event has had on oneself, or even to deny it has happened.
While experiencing a traumatic event, shock and denial are common responses, and a normal piece of one's "mental health self-defense" mechanism that protect one from having to confront the enormity of a traumatic experience as it is happening. It is only when these responses continue after the event and interfere with a personís ability to manage their life, that they become maladaptive.
There are two components to a traumatic event, the objective and the subjective. It is the subjective experience of the objective events that constitutes the trauma and each person will respond differently. Two people could undergo the same noxious event and one person might be traumatized while the other person remained relatively unscathed. In addition, the specific aspects of an event that are traumatic will be different from one individual to the next. When you are helping a person that has experienced a traumatic event, it is important to keep this in mind. Sympathetic, supportive and attentive listening skills are vital.
There are several factors that can effect how a person responds to a traumatic event and how long it may take them to recover. These include:
In the hours, days and weeks following a traumatic event, different people will respond in different ways but there are several broad categories of reactions to expect. These include, but are not limited to, acute anxiety, and depression.
Symptoms of acute anxiety in adults may include (taken from DSM-IV): Feeling numb, detached, or emotionally unresponsive; A continuing state of being in shock or in a daze; Feeling detached from oneself or from one's surroundings; Feeling like one is "in a dream" or that events and one's environment are "unreal"; "Blocking out" memories of the event, or an inability to recall aspects of the event; Recurring disturbing thoughts or dreams about the event; "Flashbacks" or having the sense of reliving the event; Feeling emotional distress when encountering a reminder of the event; Avoiding reminders or recollections of the event; Disruptions in sleep; Restlessness; Irritability; Poor concentration; Hypervigilance; Exaggerated startle response.
Symptoms of depression in adults may include (taken from DSM-IV): Feeling sad or empty most of the day, nearly every day; Diminished interest, or lack of interest, in activities, including those previously enjoyed; Changes in appetite, either an increase or decrease; Changes in sleep patterns, either insomnia or sleeping most of the time; Restlessness; Fatigue or lack of energy; Tearfulness, or crying for seemingly no apparent reason; Indecisiveness or an inability to concentrate; Feelings of worthlessness or guilt; Recurrent thoughts of death or suicidal feelings.
Physical symptoms of stress can also manifest and be very distressing. People in the midst of a panic attack can suffer from shortness of breath or feelings of choking, dizziness, trembling, nausea, or they may feel as though they are having a heart attack. Lack of sleep and proper nutrition can make a person more susceptible to these attacks.
Tips for adults dealing with their own trauma.
Talk: Try to find words to describe your reaction and share them with someone you trust. If you can't talk with someone, write in a journal or diary. Go over the event as many times as you need to until the power of the emotional response subsides.
Cry: Recognize the value of tears. They are a natural reaction of men, women, and children to internal stress. They remove unhealthy stress-related toxins from the body.
Be Active: Limit television, radio, internet, video games, etc. Go for walks. Become involved in activities helping others. Take up yoga.
Be kind to yourself: Recognize that your mental abilities may be impaired and donít beat yourself up over any mistakes you may make. Pamper yourself if you can. Utilize your spiritual resources. Try to establish a regular schedule.
Tips for helping children cope
Be calm: Children mirror the reactions of their parents and caregivers. It is fine to share feelings of sorrow, which can encourage the children to express their own sadness. However, express your more intense reactions such as horror and outrage with other adults, outside the presence of the children.
Encourage them to talk: This helps reduce their confusion and anxiety related to the trauma. Respond to questions in terms they can comprehend. Reassure them repeatedly that you care about them and that you understand their fears and concerns. Answer questions truthfully but do not give more information than is requested. Donít be surprised if the same questions are asked repeatedly. Watch for symptoms of depression and anxiety.
Organize play sessions: In general, play can help relieve tension but it can also be therapeutic. Children will often re-enact the traumatic experience in play or artwork. When they do this, encourage them to talk about their play, or artwork and the associated feelings.
Establish a regular schedule: Regular times for meals, bedtime and other activities provide a sense of security and normalcy for children. Limit television and other non-active forms of entertainment. Encourage children to become involved in helping with projects as much as their age or skill level allows.
Be non-judgmental: It is normal and beneficial for children to cry. Some children may regress to behaviors more typical of a younger child. Increased discipline is not the answer to these changes in behavior.
Tips for helping other adults cope with trauma
Listen and encourage them to talk: The power of speech can not be overestimated when coping with trauma. The value of good listening skills is nearly immeasurable. Remain calm while still showing sympathy to their emotional state. Demonstrate that you understand and care by using active listening skills when appropriate. Donít be surprised or irritated if they seem to be repeating themselves. Repetition is the key to robbing traumatic memories of their emotional punch.
Be patient: Remember that everyone heals at their own pace. Refrain from offering advice on what they could have done differently or on how to "fix" things. It is okay, however, to verbally discourage harmful behavior such as trying to numb pain through consumption of alcohol, drug use, or any other form of self injury.
Reach out to them: Many times, survivors of a traumatic experience will isolate themselves. Try to get them involved in activities with other people. Even when they donít want to talk, sometimes just being with others can be healing.
Allow for and encourage mourning: This is especially important if the traumatic event involved the loss of a loved one. Expect the usual stages of bereavement, plus the likelihood that the survivor will be feeling guilty that they survived. Even when there is no loss of life, survivors still need time to mourn the loss of intangibles like a sense of security, peace of mind, or opportunities.
If the maladaptive coping strategies typical of trauma continue for more than a couple of months or worsen in severity, professional help should be sought if at all possible. There are medications that can help lessen the physical manifestations of anxiety and depression that can be coupled with individual and group treatments. Left untreated, the adjustment problems following a traumatic event can develop into a full blown case of PTSD. The treatment for this is similar in many ways to what has been outlined above but more involved.
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