Recognizing and dealing with traumatic stress

Stress:

Everyone experiences stress. It's a normal reaction to a traumatic event. But relentless stress can drain body and mind. Although it may be impossible to eliminate stress during a crisis, some techniques may help reduce it. These may help victims and families sleep and regain energy and strength and reduce blood pressure, depression and irritability.

Techniques for managing stress:

• Body and mental relaxation
• Positive thinking
• Problem solving
• Anger control
• Time management
• Exercise
• Responsible assertiveness
• Interpersonal relationships

Post-traumatic Stress Disorder (PTSD)

PTSD is a psychological condition that may develop after someone experiences a life-threatening or horrifying situation, such as an unexpected death, severe injury or close call with death. PTSD victims find that they are unable to stop thinking about what happened to them. They may try to avoid people and places that remind them of the trauma or try to push all thoughts concerning the event out of their head.

Signs of PTSD:

• Feeling hopeless about the future, numb, detached or unconcerned about others
• Having trouble concentrating, indecisiveness
• Jumpy or startled easily by sudden noises
• On guard and constantly alert, difficulty relaxing
• Having disturbing dreams/memories or flashbacks
• Work or school problems

Depression

Those who suffer from depression feel down or sad the majority of the time, and often lose interest in activities they once enjoyed. Having low energy, feeling tired, hopeless or desperate are common symptoms. A depressed person may think about hurting or killing themselves.

Self-blame, guilt, and shame

Often people take too much responsibility for something that happens, what they did or didn't do or feel guilty for surviving when others didn't. They may be unnecessarily overly critical of themselves following a trauma.

Suicidal ideation

Trauma can prompt a depressed person to think about hurting or killing themselves. If you believe someone is feeling suicidal, you should directly ask them. This will not put the idea in their head. If they have suicidal plans and the means to carry out those plans, and you feel you are unable to stop them, you should immediately contact a counselor or call 911. Remember, communication is the key to prevention.

National Suicide Prevention Lifeline: http://www.suicidepreventionlifeline.org/ or 1-800-273-TALK (8255).

Anger/Aggressive behavior

After a trauma, people often feel that the situation was unfair and are unable to comprehend why the event happened or why it happened to them. This can cause them to feel frustrated and angry. While anger is a natural and healthy emotion, intense anger and excessive aggressive behavior can cause numerous problems.

Alcohol/Drug abuse

Drinking and drug use is a common inappropriate way people cope with trauma. This may be a quick fix, but it can lead to other problems. Alcohol and drug use provide temporary numbness, but no solutions.

Physical reactions

• Problems eating/upset stomach
• Trouble sleeping
• Exhaustion
• Increased heart rate/breathing
• Headache
• Cold sweats
• Failure to engage in exercise, diet, safe sex, regular health care
• Excessive smoking, drinking, drugs, food
• Worsening of current medical problems

Emotional reactions

• Feeling nervous, helpless, fearful, sad
• Feeling shock, numb, unable to experience love or joy
• A voiding people, places, and other things related to the event
• Loss of intimacy or feeling detached
• Irritability
• Withdrawal, feeling rejected or abandoned
• Distrust of others
• Self-blame

Distressing memories, images, or thoughts

• Remind yourself that they are just memories
• Remind yourself that it is natural to have some memories of the traumatic event
• Talk about them with someone you trust
• Remind yourself that memories will lessen with time

Anxiety or panic

• These reactions are not dangerous
• You are not going to die or have a heart attack
• It is important to focus on your breathing
• Take calm and deep breathes
• As you inhale, slowly count to 4, then exhale while counting to 4, and repeat

Flashbacks

• Keep your eyes open; look around and notice where you are
• Remind yourself where you are, and that you are in the present, while the trauma happened in the past
• Get up and move around
• Tell someone you trust about what is happening
• Remind yourself that this is a common reaction
• Tell your doctor or counselor about the flashback

Trauma-related dreams or nightmares

• If you awaken from a dream in panic, remind yourself that you are just reacting to a dream and not in any real danger
• Get out of bed to reorient yourself
• Engage in a calming activity, like drink a glass of milk or pet the dog
• Talk to someone if possible
• Tell your doctor

Difficulty falling or staying asleep

• Keep to a regular sleep schedule
• A void strenuous exercise before going to bed
• A void using your sleeping area for anything other than sleep
• Avoid using alcohol, tobacco, or caffeine
• Do not lie in bed worrying, instead get up and do something pleasant

Difficulty concentrating

• Slowdown
• Give yourself time to focus
• Write things down
• Break tasks up into to simple chunks
• Determine with a doctor or counselor whether this is a sign of depression

Irritability, anger, and rage

• Take time out to cool off
• Exercise regularly
• Remind yourself that staying angry increases your distress
• Consider taking anger management classes
• If you blow up at someone, find time as soon as you can to apologize and let them know what you are doing to cope

It is important to learn how to cope since recovery is an ongoing process. Recovery doesn't mean the ability to forget tough experiences but the ability to effectively manage trauma-related memories, reactions, and emotions. Recognizing and accepting the impact traumatic situations have, and then taking action to improve things creates a sense of personal power and control.

Behavior Patterns of Coping

Shock and Denial - "No, it can't be true!"

Often people need to use this phase to cushion the pain of the loss. It is accompanied by numbness, disbelief, and feelings of surrealism. Except for a rare few, people do not need to be confronted and will come out of the denial phase by themselves.

Anger - "Why me?" "Why him/her"

This anger may be directed at the person who died, an event, or other people. It is important to let the grievers experience their anger without being critical or judging whether the anger is appropriate.

Bargaining - "Yes, it is true, but ... "

This is the beginning of acceptance. The need here is to let the mourners make the agreements that they need with God, with the person who died, or with others. On their own, people will decide, when they are ready, if these promises can be fulfilled.

Depression - "Yes, it has happened to me."

The mourning process is being worked through. The mourners begin to separate emotionally, and may accept offerings of support. Usually, the grievers reject offers of reassurances.

Acceptance

This is not a resignation, but an acceptance of the realities, and the need to pick up the pieces and move on.

Negative coping actions increase problems. These are short-term solutions that will later become detrimental and hard to change, and include isolation, workaholism, violent behavior, unhealthy eating, smoking, and alcohol and drug use. Some people with PTSD try to cope with their distress in ways that lead to more problems because they aren't informed about positive and healthy coping methods.

Negative coping methods include:

Alcohol or drug use

These may block painful memories, increase social confidence or induce sleep, but they often cause more problems. Alcohol and drug use have a risk of dependency and can increase anger, isolation and suicidal tendencies.

Social isolation

Isolation allows survivors to avoid situations that may cause anger, irritability and fear, but it creates major problems. The loss of social support, friendship and intimacy may increase depression and anxiety.

Anger

By keeping people away, anger may get rid of upsetting situations, but will also drive away positive relationships in a person's life.

Avoidance

A voiding the problem may help to control distress, but it will prevent the survivor from learning how to cope with the trauma in a positive way.

Education

When survivors learn to recognize what upsets them, they are in a better position to cope with PTSD. Understanding that PTSD is common and knowing that there are hundreds of thousands of others going through the same thing shows survivors that they are not alone or weak.

Talk to another person for support

With support from others, survivors may feel less alone and more understood. They may receive concrete help for a particular problem. Survivors must carefully choose their support people and clearly ask for what they need. It is often better to talk to a professional counselor because they are more likely to understand trauma and its effects than family or friends. A support group may lessen the feeling of isolation and reinforce trust.

Talk to your doctor or professional medical person

Your doctor will be better able to care for your physical health if aware of PTSD and may refer you to specialized help.

Finding A Therapist

When looking for a therapist, ask family and friends if they know anyone they would recommend who has expertise in trauma treatment. You can also:

• Contact your family physician for a recommendation
• Call your local state psychological association
• If you work for a large organization, contact human resources to find out if they provide mental-health services or make referrals

Practice relaxation methods

Relaxation methods include breathing exercises, stretching, yoga, meditation, swimming, jogging, spending time in nature and listening to quiet music. On the other hand, relaxation initially may increase distress by focusing on disturbing sensations or reducing contact from external forces. Continuing with relaxation techniques in a way that is tolerable, such as interspersing it with music, walking, or other activities, helps reduce negative reactions to thoughts, feelings, or perceptions.

Increase positive distracting activities

Positive work or recreational activities help to distract a person from their memories. While it is not a long-term solution, it is effective as a first step or short-term remedy. Artistic endeavors are also a great way for those suffering from PTSD to express themselves in a creative way.

Contact a counselor

If PTSD symptoms start to worsen, and coping doesn't seem to help, it is important to contact a counselor.

Take prescribed medication

Prescribed medication can be extremely helpful in improving sleep, and decreasing anxiety, depression, anger, irritability, and urges to drink or take drugs.

Call about treatment or joining a PTSD support group

Taking the first step can be difficult especially if the victim feels that nothing will help, but taking positive action creates a feeling of great relief.

Increase contact with other survivors of trauma

The best source of understanding and support are other survivors of trauma. Increasing contact with other survivors can reverse the process of isolation and distrust in others.

Reinvest in personal relationships with family and friends

Making an effort to reestablish an important relationship can help survivors reconnect with others.

Start an exercise routine

Exercise in moderation may distract those with PTSD from negative reactions and will increase their self-esteem and sense of personal control.

Starting to volunteer in the community

It is important for survivors to feel that they are contributing to the community. One way to reconnect with the community is to volunteer. This may reverse feelings of hopelessness and negative views of the world.