When someone you know has been through a traumatic experience

So far in this blog, I’ve mainly written about those people  – the majority of people – who will be upset and distressed by their experience through the earthquake and aftershocks. However, I thought it would be worth putting up a post that focuses upon those who are, or may be, more profoundly affected in a negative way.

The  Canterbury earthquake was certainly distressing and threatening, and may have been experienced as so intense that it can temporarily disrupt a person’s ability to come to terms with it. Thinking you might die, seeing others injured (or killed – but thankfully not in this case), intense fear, abuse or being forced to do things out of your control are all traumatic experiences. While traumas occur all the time, they only affect to a few people. The reactions of those affected often cause those close to them to be confused and unsure about what to expect or how to help. People who have been traumatised can respond in ways that may seem unusual, make things worse for them or they may be concerned about things that seem unreasonable.

The effects of trauma

A traumatic experience can temporarily shatter basic assumptions about life or other people such as trust, safety, predictability. The feelings caused may be so intense that unlike normal distress, they do not fade with time, but either continue the same or get worse after a while.

People affected by trauma may feel fear even when it is quite safe. They may be constantly on edge and not respond to normal reassurance or opportunities to relax. Their tiredness may continue on for much longer than seems reasonable. They may have periods of appearing numb or detached and not wanting contact. This may be followed later by over-excited behaviour and a need to cling to family or familiar things. They may feel they failed or did the wrong thing at the time (even if this is not true). Usually they remember a combination of very intense fragments of the event that do not go away, combined with important gaps that make them feel uncertain about what really happened.

Recovery from trauma

Most people recover from traumatic experiences, but it usually takes them longer than would be expected for non-traumatic crises. It is common for there to be an initial period of several days with strong emotions of fear or distress, and a constant preoccupation with the events. Many people then feel a need to get back to normal and put it out of their minds. Although this can often be beneficial in the short-term and help recovery from normal crises, it often only postpones problems for people who have been through traumas. Sometimes they can maintain normal routines for some time (although those around them often see that all is not well) and eventually something happens that brings it to the surface again. This can happen months after the event.

The important thing about recovery from trauma is to go back over what happened so the feelings fade and the person can come to terms with the event, realise it is in the past and how they can be safe again. But this has to happen at a time and rate that is comfortable for the individual. Other people are the most valuable support for recovery, but it is often difficult for them to be confident about what to do. Uncertainty and the wish to avoid distress can make those close to the affected person keep away from the experience or from them. It is usually best to ask how you can help and to let them know they can talk if they want to.

Helping someone who has been through trauma

  1. Spend time with the stressed person, without judging or demanding, their recovery will occur in its own time.
  2. Offer support and a listening ear: talking is one of the best things they can do to work things out; but they may need to go over things many more times than you expect. Try to be interested in what they want to say; avoid giving advice or trying to solve the problems. The talking itself is important and helps to make it fade. Remember though, this is likely to happen at their pace, not yours.
  3. Help with practical tasks and chores as this enables more of their energy and time to be given to the recovery process.
  4. Give them time, space and patience: don’t take it personally if at times they are irritable, bad tempered or want to be alone. These are a natural part of the stress response and will pass as they recover.
  5. Don’t try to talk them out of their reactions, minimise the event or say things like “you’re lucky it wasn’t worse,” or “pull yourself together,” or try to get them to look on the bright side; stressed people need to concentrate on themselves at first; they will feel supported if you let them know you are concerned, want to help and are trying to understand. They will see your viewpoint as they recover.


When to seek additional help

Sometimes it is important for people to know when their own recovery activity requires additional help. Personal recovery may need to be supported by specialist knowledge to ensure stress does not linger unnecessarily or lead to later health problems. Stress problems respond rapidly with professional advice and information.

Indications for this are:

  • if recovery has stalled or does not seem to be proceeding
  • if physical or other symptoms are causing concern
  • if there is no one to talk to or relationships are being affected by the stress
  • if there is continuing emotional numbness, depression or anxiety
  • if there is continued disturbed sleep and nightmares
  • if they are unable to handle the intense feelings or physical sensations
  • if they are becoming accident prone or increasing use of drugs and alcohol.

Looking after yourself

Don’t forget that to have a loved one, friend or colleague go through a trauma can be very stressful for you as well and you may find that you have strong reactions of anger that it happened, sadness for them, fear for yourself, changes in how you see life and the world, nightmares or general moodiness. Often the best thing may be to seek support from others for yourself so you can be more available to your loved one for the time it takes them to get over it.

Information and counseling

Counseling with someone trained in trauma is often helpful not only to talk about the trauma, but to give a better understanding about what is happening and how to get over it. Sometimes the person who has had the trauma may not be willing to seek help for a time. In this case it may be beneficial for those close to them to seek professional advice and this often helps them take the step themselves.

I have adapted from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management. I have also compiled a version that you can download here.

Recognising and dealing with cumulative stress after the earthquake

A few days ago, I wrote about how we can sometimes put ourselves into an ’emergency state’ when we try deal with problems and cope with fear after an emergency events like the Canterbury earthquake and subsequent aftershocks.

This short article describes the sorts of signs of stress you may be able to identify in yourself or others if you’ve been in this state of emergency stress for too long, and what you can do about it.

Common stress symptoms

Thinking

  • trouble thinking clearly
  • planning
  • making decisions
  • can’t concentrate or remember details
  • low attention span
  • can’t stop thinking about the issues all the time
  • keep thinking about bad times in the past
  • not speaking clearly, slurring words, forgetting names.

Physical

  • bodily tension, stress and tightness in muscles
  • weak feelings, tiredness, loss of energy and enthusiasm
  • headaches, trembling, sweating, nausea, aches and pains
  • lack of appetite, increased desire for stimulants, sugar, alcohol, tobacco or coffee
  • feeling tired but cannot sleep, disturbed sleep, dreams and nightmares.


Feelings

  • feel detached from things
  • don’t care any more
  • irritable, bad-tempered, impatient and restless
  • unable to relax or keep still
  • feeling overwhelmed
  • everything seems too hard or difficult
  • tearful for no reason
  • easily upset or hurt
  • oversensitive to what others do and say
  • insecure – wanting to stay in familiar places with routines
  • feeling very emotional
  • experience waves of anger or worry that are not reasonable.


Relationships

  • feel others are to blame for stress
  • tendency to get things all out of proportion
  • can’t feel happiness enjoyment or affection for loved ones
  • moody and gloomy
  • feeling sad and hopeless as though the emergency will never end
  • changed relationships with those close to you
  • don’t want to be with family or friends or always need them around
  • have to talk about the emergency all the time
  • feel others don’t understand or don’t seem to care.

Cumulative stress

The same effects can occur if the emergency is not dramatic, but a series of smaller problems that go on for a long time. If it is not possible to unwind and relax between the problems stress builds up. This might apply especially in this case where we can expect the aftershocks to the earthquakes to be going on for some time.

The stress cycle

If stress has been ongoing, a pattern of stress may form. As a result, stress reactions cause more problems and this causes more stress. This is called the stress cycle. Once established, stress can become a lifestyle. Long term stress will undermine health and may cause illnesses. Getting over stress means breaking the stress cycle.

Breaking the stress cycle
Step 1. Recognise you are stressed
People often don’t recognise their own stress because they are too focused on the problems. Listen to others who may see you more clearly than you see yourself.

Step 2. Get to know your stress cycle

Try to see how the stress symptoms cause more stress and put you in the stress cycle.

Step 3. Make a decision to break the stress cycle
Although there are lots of things about your life you cannot change there a real ways some that you can, but you have to decide to do it.

Step 4. Reduce stress activities
Check your routines and life style to see where you can reduce the stress. Where possible stop doing things that keep stress high.

Step 5. Increase relaxation and positive activities
Build activities into the daily routine which break the stress cycle and give you a reward or good feeling, even if only a small one. Put a little effort in to enjoying yourself.

Looking after yourself

There are plenty of things that anyone can do which will help to break the stress cycle and reduce tension. Many simple pleasures will make a big difference to stress. Enjoyment is the best antidote to stress.

Physical

  • Do regular rhythmic physical exercise such as walking, swimming, cycling
  • Make an effort to reduce or at least not to increase your intake of stimulants such as alcohol, tobacco and sugar as they keep the stress cycle going
  • Eat regular, well-balanced meals even if they are small.


Relationships

  • Keep regular contact with people you like to be with
  • Ask for help when you need it, many people enjoy giving help
  • Make time to be with your family or friends
  • Talk to people you trust about yourself and what is happening so you can get it into perspective.

Relaxation

  • Do regular relaxation exercises such as deep breathing, listening to quiet music, meditation
  • Do something about bodily tension such as massage or exercises
  • Rest regularly, even if you can only do it for a short time
  • Try to find something that will make you laugh sometimes.

Attitudes

  • Accept that it will take time to get out of the stress cycle and keep trying
  • Be careful of accidents – concentration and judgement may be impaired under stress
  • Try to be organised and efficient so you have some time to yourself.

I have adapted from information issued by Queensland Health: Fact Sheets for Psychosocial Disaster Management. I have also compiled a version that you can download here.

Checklist: Common reactions, positive coping, and when to seek help

A new week is with us. So, here’s a heads-up.

Distress is an understandable and normal response to major disasters. Common causes of distress may be related to having been directly at risk from the earthquake and aftershocks, being concerned about family and friends who may be affected, witnessing injuries and distress to others, or being caught up in the panic and confusion that often follows. In addition, feelings and memories related to previous experiences of disasters or other grief and loss may also resurface. Most people experience acute stress during emergency events and most manage with courage and strength. However, sometimes it is only later when the distressing images are recalled that some of the stressful effects start to show.

While most people will manage with the support of family and friends, there are times when extra help and support may be needed. Those who have feared losing loved ones, have been seriously injured, or are highly distressed by the aftershocks, will often need particular support and care. Our communities have a history of coping with uncertain and troubled times with courage and strength.

There are three important things you need to know:

  • normal reactions to this type of emergency
  • positive ways of coping
  • when to get extra help.

Normal reactions to a disaster like this include:

  • shock and numbness, often fear at first
  • horror and grief when the extent of loss is realised
  • frustration, anger, helplessness and even sometimes despair when it all seems too much
  • sometimes fears or old worries may resurface.

These feelings usually settle over the early weeks.

Positive ways of coping may be:

  • supporting one another, especially in the family and in your community
  • providing emotional support – comforting each other
  • carrying out practical tasks – tackling the jobs that need to be done a bit at a time and counting each success
  • sharing your experience and feelings with others – a bit at a time when it is right for you
  • looking after your own and your family’s general health – rest, exercise, food and company all help (being careful not to drink too much alcohol).

Sometimes, post disaster stress can be ongoing and affect your physical and mental health and wellbeing.

It’s time to ask for help if:

  • your sleep is badly affected
  • you feel very distressed, irritable, on edge or agitated much of the time
  • you feel hopeless, despairing, miserable or that you can’t go on
  • you have trouble concentrating, are distracted and cannot do your usual tasks
  • you feel your health is not so good
  • you have recurrent nightmares or intrusive thoughts about the earthquake
  • you have new symptoms or old problems may seem to have returned, eg. breathing, heart and stomach problems.
  • For children, withdrawal, aggressive behaviours, difficulties at school, problems separating from parents or going to sleep may indicate the need for help.

This is just the brief version. If you want more detail about specific topics, check out the other posts on this blog. The home page will have a list of recent posts in the right-hand column. Or you can click here for the fact-sheets at the Ministry of Health. I compiled these too.

Helping adolescents through the Canterbury earthquake and aftershocks: Part One

One week on from the initial earthquake, and hundreds of aftershocks later, it is the weekend. A chance to take stock of what will be remembered as an unforgettable week for a generation of New Zealanders, with considerable uncertainty about what may be yet to come.

But much of the Christchurch CBD is accessible again. All over the region, people will be out and around, surveying their surroundings. Some will take the opportunity to re-connect with others, while others will perhaps take a moment to consider their journey so far, and what they might do next.

One group that can often suffer a little from the lock-down that tends to happen during emergency events are adolescents. All sorts of stuff going on in the life of a modern adolescent – family competes for attention with peer groups, cellphones, games consoles, and generally being out and around and exploring the world. However, under the threat of earthquakes and the aftershocks, people are sometimes enforced to spend a lot of time indoors and in cramped spaces. This weekend might provide a bit of release.

Adolescents involved in crisis and emergency events, may not always show their distress outwardly. As a result, adults may misunderstand their needs or find them unwilling to accept help. Adolescents frequently lose the self-assurance they had when younger, but often gain other types of confidence and abilities. Parents, and adolescents themselves, are confused by their inconsistent behaviour. They can think rationally, but have unstable emotions and may not apply logical thinking to real situations. They need support and independence to learn this. They want to be both close to others and time to be alone as they find new ways of relating to people. To communicate with adolescents, these contradictions have to be understood. Moodiness, depression and insecurity commonly alternate with excitement, happiness and adventurousness.

Whereas children are dependent on parents and live within the family, adolescents are usually proud that they could survive on their own. School, peers, other adults and social or sporting groups are a large part of their support network. They often do not feel the family is the life support system it was in childhood. Parents may feel sidelined, but their importance is no less than before, just different.

Adolescents usually don’t understand these changes although they feel the frustration of them. They need their family to be a trusted home base for their adjustment to painful events, but how much they rely on their family to come to grips with what has happened varies greatly from one person to another.

Adolescents are often more involved in doing things than understanding emotions and may lack words to express important feelings. They handle painful events by distracting themselves. They may be immersed in their own feelings and point of view and not recognize adults’ reactions. They may feel threatened when adults try to be logical about painful experiences and not fully understand what is said until later. But their behaviour often shows they have taken notice even when they don’t acknowledge it. It is important to allow time for them to work things out and not demand immediate feedback. Parents’ own anxiety may make adolescents confused and guilty or cause them to reject the parent’s emotions to protect themselves.

Jump down to Part Two of Helping Adolescents for more.

Helping adolescents through the Canterbury earthquake and aftershocks: Part Two

Continuing on from Part One of this topic, I could talk about the influence of peer groups and all sorts of other things. But, for now, I’ll cut to the chase. Here are some of the behaviours you might see from adolescents as they come to terms with their experience of being under threat with the uncertainty this involves:

These responses are all signs of the stress of coming to terms with crisis. They are normal reactions to abnormal events and should pass with time.

  • excessive concern for others, guilt, anxiety and insecurity
  • sleeplessness or wanting to sleep all the time
  • withdrawal from family, spending increased time alone listening to music or watching TV
  • wanting to be around the family more than before or more dependent on family or other people
  • sudden need for independence expressing feelings like ‘don’t treat me like a child’ and ‘you’re only my Mother’
  • uncooperative, irritable and only concerned with what is important to them
  • bored, listless and dissatisfied unable to cope with responsibilities or duties, reverting to immature or irresponsible behaviour
  • preoccupation with the trauma, wanting to talk about it all the time – or angrily refusing to talk about it
  • more detached from life, the future or interests, and an unwillingness to set goals
  • want to do everything now: they are impatient or intolerant
  • pessimism and cynicism, loss of interest in the future
  • changed values and philosophy of life poor concentration, memory, organisation, planning skills and reduced school performance
  • restlessness, always needing to be doing something or be with peers
  • exaggerated emotional reactions to small problems
  • angry, controlling, assertive and demanding
  • exaggeration or return of previous problems.

If some of this seems contradictory, welcome to the world of adolescence.

Here’s how to help:

  • Give them accurate information about the event and its consequences.
  • Correct any misunderstandings and rumours, but do not burden them with details unnecessary to the overall understanding
  • Encourage them to express emotions and put thoughts into words—if not with you, make sure they talk to someone. Give them the opportunity, but let them go at their own pace.
  • Expressing strong emotions is a natural way to come to terms with crisis. As the emotions subside recovery starts.
  • Suppressed emotions can cause long-term problems. But there are many ways to express, not just through talking.
  • Keep communicating, if they won’t talk about emotions, ask the adolescent what they are thinking.
  • Let them know about your reactions, explain about stress and recovery. Even if they don’t admit it, they do take in what is said
  • Keep telling them you love and care about them no matter what they do or say.
  • If they object to what you are doing, don’t argue, ask them how else you can help.
  • Reassure them about the future, especially that their current distress will pass in time.
  • Make plans to reduce pressure at school or in other activities if they are having trouble coping.
  • Support them to continue their social and recreational activities, to play, explore, laugh, even though the adults themselves may not want to.
  • Maintain routine and familiar activities, ensure life is secure and predictable; minimise change.
  • Keep them informed about how their recovery is progressing and what help is available.

Don’t make this the time to have disputes about normal problems such as work, chores or defiance. Leave this for later or it will be confused with the crisis reactions. The problems usually fade as adolescents recover. If not, the problems will be more successfully worked out later.

Adolescents’ striving for independence, seeking help from peers and adults other than their parents and expressing critical attitudes are all indications of parents’ success in giving adolescents the strength and confidence to become adults. This behaviour needs to be valued and worked with rather than against.

Sometimes, adolescents have a narrower point of view and can accept the earthquake and all it entails in a matter-of-fact way. They may not need their parents as much as parents need them. When this happens parents must continue to be available, but in a different, more detached way and avoid burdening adolescents with their own distress as much as possible.

An event like this also provides adolescents with opportunities for growth and discovery about themselves. With help, adolescents can eventually mature as a result of the experience. They often show strength and resilience that has not been evident before.

Prime Minister John Key gives good counsel

I think Prime Minister John Key made some very helpful statements yesterday regarding how some people are reacting to the earthquake and subsequent aftershocks and how they might get help. Here is some of the quote:

Prime Minister John Key is calling on those still residing in Canterbury to consider seeking counselling to deal with the stress of the earthquake and continuing aftershocks.

Speaking to RadioLIVE’s Marcus Lush this morning Mr Key said that the “compounding increase in anxiety that is taking place because of the aftershocks” only became clear to him upon visiting the region to assess the fallout of Saturday’s quake.

“People are living in slightly damaged houses, so they’re thinking ‘I’m living in a damaged structure, I’m fearful of another earthquake’ and of course they’re getting really upset, and that’s really one of the reasons why we’re asking people to reach out and get some counselling,” said Mr Key.

Do you notice how he doesn’t talk about trauma?

He talks about anxiety and getting really upset.

Mr Key is getting good advice (or he knows this himself, possibly).

Talking about trauma is not very helpful, and it is not true for the majority of people either. In this post, I point out how research predicts that most people who are living through this unfolding event will be OK. They may have some ups and downs and some wobbles along the way, the dominant story is resilience for the majority, particularly if they have supportive friends, families, clubs , societies, church groups, and voluntary or government-sponsored groups standing strong beside them. Trauma symptoms affect the minority but we of course need to ensure that we can identify and help these people early on in the piece.

Mr Key gets this.

Talking about trauma turns people off from looking for help. However, anxiety and uncertainty will be all too common. This is just a normal reaction to a highly unusual and sometimes frightening set of events. Getting good information about why people are feeling, thinking and behaving like they are, that they are not alone in experiencing this, and that there are concrete things that can be done, along with caring, compassionate people (sometime professionals) around to help them work through what they need to do – this is what Mr Key is getting at.

People to hear their story, when they’re ready.

At their own pace.

Those people are around – you might already know them.

Just don’t let anyone rush you.

Taking care of yourself when you’re trying to help others

If you’re in Canterbury, or elsewhere in New Zealand and are trying to look after the needs of those affected by the Canterbury Earthquake, there are a few pointers to bear in mind to help you you and others well, and safe from potential harm.

Let’s start with the positives:

DO

Promote SAFETY
Help people meet basic needs such as food and medical assistance.

Promote CALM
Provide accurate information about the situation and listen to those who want to share their feelings and stories.

Promote CONNECTEDNESS
Help people to contact their loved ones and keep families together.

Promote HOPE
Acknowledge the difficulty of the situation and remind people that the responders are doing all they can to help.

Promote SELF-SUFFICIENCY
Give practical suggestion on what people can do.

Now, the things to avoid:

DON’T

Don’t force people to share their stories.

Don’t say everything will be OK.

Don’t tell people what and how they should feel.

Don’t tell people how they should have acted earlier.

Don’t make promises that cannot be kept.

Don’t criticise services in front of those who are in need of them.

Remember there is no right or wrong way to feel and react to a disaster. You also need to remember that whether you’re working or volunteering to help others, if you don’t keep yourself safe and well, you won’t  be able to do it for very long, and you may even do yourself harm. Here are some tips you might find useful to keep yourself as well as you can.

TAKING CARE OF YOUR BODY

Get enough sleep and rest. Eat healthily. Exercise as much you can – rhythmic activities like walking, running, and swimming. Avoid drugs and excessive drinking and smoking.

TAKING CARE OF YOUR MENTAL HEALTH

Learn about normal and abnormal reactions to disasters. Don’t ignore your own emotions. Know when to seek help. Do things you find relaxing.

TAKING CARE OF YOUR SPIRITUAL SELF

Make time to reflect. Meditate. If you find it helpful, pray. Find spiritual connection or community.

INCREASING YOUR RESILIENCY

Do something that will help you to regain a sense of control. Focus on your strengths and positive coping skills.

REACHING OUT

If you feel overwhelmed reach out. Do not be afraid to accept help.

REMAINING ACTIVE

Go back to your normal activities as soon as it feels comfortable to do so.

MANAGING YOUR WORKLOAD

Maintain a healthy balance between your work and rest. Take breaks and time off. Prioritise your tasks.

REDUCING YOUR STRESS

Do things you find comforting: exercise, read, listen to music. Be with people whose company you enjoy. Practice stress reducing exercises.

I’ve adapted these points from the from the New York City Department of Health and Mental Hygiene, Office of Mental Health Disaster Preparedness and Response. I hope you find them useful.