Trauma - Managing Mental Health Reactions to Major Disasters and Traumas

Common Reactions to Trauma

Traumatic events, and critical incidents are events where one’s life or physical integrity have been threatened or where one has witnessed threat or harm to others. These events are often sudden and unexpected. Such events may include natural disasters (e.g. tsunami, earthquakes and floods), combat and other military operations where one is exposed to contacts with hostile forces or harm to others, vehicle accidents, or physical assault. While many of the people involved in these events may escape physical injury, they are still at risk of developing emotional difficulties. It is common for people who have experienced or witnessed traumatic situations to have very strong emotional reactions. This is true of both those directly threatened and those personnel that have witnessed the event or provided assistance. Understanding normal responses to these critical events can help you in coping effectively with your feelings, thoughts and behaviours after the event.

What happens to people after a disaster or other traumatic event?

Each person reacts differently to these types of events. Some may appear to be largely unaffected, while others may experience significant and strong emotional reactions. Importantly, while many people may have strong reactions in the early stages, most go on to recover well over time with the use of their natural coping strategies and social supports.

There are a range of emotional reactions that are commonly experienced in the early stages after exposure to a traumatic event.

• One type of reaction is shock. Shock is a sudden and intense disturbance of your emotional state that may leave you feeling stunned or dazed. People in shock often have trouble taking in information and responding to the environment. Shock or denial (which involves difficulty acknowledging that something very stressful has happened or not completely understanding the intensity of the event), may have a short term protective role of shielding the individual from the emotional intensity of the event.
  
  Whether in shock or not, personnel may find that they act on "autopilot". When there is an important job to do, they focus on the skills they have learnt in training and getting the job done. This is an important part of completing the job one is trained to do and carrying out one’s tasks effectively. However, it is important to be aware that in such circumstances the individual may experience a delayed emotional reaction after the immediate crisis has passed and tasks are completed.

• Feelings may become intense or unpredictable. You may become irritable and you may experience mood swings. You might be especially anxious or nervous, or feel "down in the dumps", possibly even depressed.

• Thoughts and behaviour patterns may be affected. For example, repeated vivid memories of the event (or "flashbacks") may occur for no apparent reason and can lead to physical reactions such as rapid heart beat or sweating. You may find it difficult to concentrate or make decisions, and you may become more easily confused. Sleep and eating patterns can also be disrupted. You may also begin to avoid certain activities or reminders of the event.

• Recurring emotional reactions are common. Anniversaries of the event, such as at one month or one year, can lead to feelings of depression, anxiety, or guilt. Other reminders such as dealing with people involved in the incident or returning to a similar environment may also trigger upsetting memories. These "triggers" may be accompanied by fears that the stressful event will be repeated.

• Interpersonal relationships often become strained. You may experience greater conflict with family members and coworkers, or you might become withdrawn and isolated.

• Physical symptoms may accompany the extreme stress. For example, headaches, nausea and chest pain may result and may require medical attention. Pre-existing medical conditions may worsen.

How do people respond differently over time?

A number of different factors affect each individual’s response, including:

• The extent of the trauma. Highly threatening and long lasting events, or those involving loss of life and substantial property loss, often take longer to resolve.

• The person's general ability to sustain stress and cope with emotional challenges. People who have coped well with other difficult and stressful circumstances often find it easier to cope with new trauma.

Other stressful events preceding the traumatic experience. The more stress the individual is living with prior to the traumatic event (e.g. personal or health problems), the more difficult he/she is likely to find it to cope with the trauma.

How should I help myself and my family?

• Monitor your level of re-exposure to the event. There is often considerable media coverage of events and it is important that you do not worsen you emotional distress by obsessively watching the coverage.

• Communicate your experiences in a way that is comfortable for you. Talking to family, colleagues and close friends often helps, or you may wish to keep a diary.

• Give yourself time to heal. Anticipate that this will be a difficult time and allow yourself to mourn the losses you have experienced. Try to be patient with changes in your emotional state.

• Ask for support when needed. You may like to approach family, friends, or external support agencies. Often trauma survivors find it beneficial to speak to other people exposed to the trauma.

• Find out about support groups and other health providers. These may include chaplains, psychologists, social workers, or community groups.

• Engage in healthy behaviours. Eating healthy food, avoiding stimulants (e.g. caffeine and nicotine), and getting plenty of rest should help reduce trauma symptoms. If you have ongoing sleeping difficulties, you may find relaxation techniques useful. Avoid alcohol and drugs as much as possible.

• Establish or re-establish routines such as eating meals at regular times and following an exercise program. Returning to work is also a good idea, as long as you return to a manageable workload.

• Avoid major life decisions such as switching careers or jobs if possible. It is difficult to make a well considered decision while under stress, and you may regret these decisions later on.

• Avoid alcohol as a form of self-medication. It is one way to reduce anxiety and avoid negative feelings but it interferes with your ability to sleep and results in the body losing important minerals needed to mange your emotions effectively.

• Keeping busy can help but not to the point that you are too tired to feel anything and this will interfere with your relationships with co-workers, family and friends.

23 September, 2008