The impact of the recent terroristic violence will affect people at all levels of involvement: victims, bereaved family members, friends, rescue workers, emergency medical and mental health care providers, witnesses to the event, volunteers, members of the media, members of the community, the State, the Nation, and the World. Terroristic events can lead to anger, frustration, helplessness, fear, and a desire for revenge. Studies have shown that acting on this anger and need for revenge can increase feelings of anger, guilt, and distress, rather than decreasing them.
However, the mechanisms of natural recovery from traumatic events are strong. Many trauma experts (Staab, Foa, Friedman) agree that the psychological outcome of our community as a whole will be resilience, not psychopathology. For most, fear, anxiety, re-experiencing, urges to avoid, and hyperarousal symptoms, if present, will gradually decrease over time.
There are a number of common strategies that individuals utilize when coping with extraordinary stress in their lives. These strategies, while effective at manageable levels of stress, can become unproductive or detrimental when stress reaches overwhelming or traumatic levels. It is important to remember that individuals have their own way and pace of processing traumatic events, and that each individual mush listen to and honor their own pace and way. A general guideline is to monitor your reactions, and to increase those coping strategies that work for you in other stressful circumstances.
Research on individuals with positive responses after a traumatic event indicates that their preferred coping mechanisms are to:
- Focus on brief time intervals when in a problem-solving mode (e.g., thinking only about what to do next) or focus on extended time intervals to obtain a less devastating picture of the trauma (e.g., as one tragic event in a full and meaingful life)
- Maintain a view of the self as competent and of others as willing and able to provide support
- Focus on the current implications of the trauma and avoid regretting past decisions and actions
The process of “converting” traumas into “growth experiences” has the following characteristics:
- It is usually done by the individual alone, but confidants can also suggest new interpretations
- It usually occurs between 2 weeks and 4 months following the stressor
- It can enhance coping with subsequent stressors
- It usually depends more on individual’s psychological resources than on the characteristics of the stressor event
- It is intuitive, rapid, and sudden, rather than an extended logical thinking process (“sudden insight,” “flash,” “revelation.”)
(Finkel and Jacobsen, 1977)
Specific Coping Strategies for Traumatic Stress and PTSD Symptoms
Positive Coping Actions are those which help to reduce anxiety, lessen other distressing reactions, and improve the situation in a way that does not harm the survivor further and which improves things not only today, but tomorrow and later. Positive coping methods can include:
- Using natural supports and talking with those one is comfortable with – friends, family, co-workers – at your own pace, is strongly recommended. Following one’s own natural inclination with regard to how much and to whom you talk is usually best for the majority of people.
- Learning about trauma and PTSD. It is useful for trauma survivors to learn more about trauma and PTSD and how it may affect them. For those with PTSD, by learning just how common PTSD is, and finding that their problems are shared by hundreds of thousands of survivors of trauma, they can better recognize that they’re not alone, not weak, and not “crazy.”
- Talking to other trauma survivors for support. When survivors are able to talk about their problems with others, something helpful often results. Seeking out support from other trauma survivors, the survivor of trauma may feel less alone, feel supported or understood, or receive concrete help with a problem situation. One of the best places to find support is in a specially-designed “support group.” Being in a group with other survivors of trauma with PTSD may help a trauma survivor reduce sense of isolation, rebuild trust in others, and provide an important opportunity to contribute to the recovery of other survivors of trauma.
- Talking to a doctor about trauma and PTSD. Part of taking care of oneself means mobilizing the helping resources around one. A doctor can take care of physical health better if he or she knows about PTSD symptoms, and doctors can often refer trauma survivors for more specialized and expert help.
- Practicing relaxation methods. These can include muscular relaxation exercises, breathing exercises, meditation, swimming, stretching, yoga, prayer, listening to quiet music, spending time in nature, and so on. While relaxation techniques can be helpful, they can sometimes increase distress by focusing attention on disturbing physical sensations or reducing contact with the external environment. Be aware that while physical sensations may become more apparent when a person is relaxed, continuing with relaxation in a way that is tolerable (i.e., interspersed with music, walking, or other activities) is, in the long run, helpful in reducing negative reactions to internal thoughts, feelings, or perceptions.
- Increasing positive distracting activities. Positive recreational or work activities help distract a person from his or her memories and reactions. Artistic endeavors have also been a way for many trauma survivors to express inner feelings in a positive, creative way. This can be helpful as a means of improving mood, limiting the harm caused by PTSD, and rebuilding a life. It is important to emphasize that distraction alone is unlikely to facilitate recovery; active direct coping with traumatic events and their impact is also important.
- Calling a counselor for help. Sometimes PTSD symptoms worsen and ordinary efforts at coping don’t seem to work too well. The survivor of trauma may feel fearful or depressed. At these times, it is important to reach out and telephone a counselor, who can help the survivor of trauma turn things around.
- Taking prescribed medications to tackle PTSD. One tool that many survivors of trauma with PTSD have found helpful is medication treatment in partnership with their doctor. By taking medications, some survivors of trauma are able to improve their sleep, anxiety, irritability and anger, or urges to drink or use.
- Starting an exercise program. It’s important to see a doctor before starting to exercise, but after getting the OK, exercise in moderation has a number of possible benefits for those with PTSD. Walking, jogging, swimming, weight lifting, and other forms of exercise may reduce physical tension. They may help distract the person from painful memories or worries, and thus give them a break from difficult emotions. Perhaps most important, they can improve self-esteem and create feelings of personal control.
- Starting to volunteer in the community. It’s important to feel like you’ve got something to offer to others, that you’re making a contribution. When you’re not working, it can be hard to get this feeling. One way that many survivors of trauma have reconnected with their communities and regained a feeling of contribution is to volunteer – to help with youth programs, medical services, literacy programs, community sporting activities, and so on.
Negative Coping Actions help to perpetuate problems. They may reduce distress immediately, but short-circuit more permanent change. Actions that may be immediately effective but cause later problems can be addictive, like smoking or drug use. These habits can become difficult to change. Negative coping methods can include isolation, use of drugs or alcohol, “workaholism,” violent behavior, angry intimidation of others, eating, and different types of self-destructive behavior (e.g., attempting suicide). Before learning more effective and healthy coping, most people with PTSD may try to cope with their distress and other reactions in ways that lead to more problems.
Practicing Lifestyle Balance
(Excerpted from: Saakvitne, K. W., & Pearlman, L. A. (ed.). (1996). Transforming the pain: a workbook on vicarious traumatization. New York: Norton).
There are many ways to restore lifestyle balance, and keeping track of and making progress with as many of the following changes is a good way to regain balance after having been exposed to or witnessed cumulative traumatic experiences:
- Eat regularly (e.g. breakfast, lunch, dinner)
- Eat healthily
- Get regular medical care for prevention
- Get regular medical care when needed
- Take time off when sick
- Get massages
- Dance, swim, walk, run, play sports, sing, or do some other physical activity that is fun
- Take time to be sexual–with yourself, with a partner
- Get enough sleep
- Wear clothes you like
- Take vacations
- Take day trips or mini-vacations
- Make time away from telephones
- Make time for self-reflection
- Have your own personal psychotherapy
- Write in a journal
- Read literature that is unrelated to work
- Do something at which you are not expert or in charge
- Decrease stress in your life
- Notice your inner experiences — listen to your thoughts, judgements, beliefs, attitudes, and feelings
- Let others know different aspects of you
- Engage your intelligence in a new area, e.g., go to an art museum, history exhibit,sports event, auction, theater performance
- Practice receiving from others
- Be curious
- Say no to extra responsibilities sometimes
- Spend time with others whose company you enjoy
- Stay in contact with important people in your life
- Give yourself affirmations, praise yourself
- Find ways to increase your sense of self-esteem
- Reread favorite books, re-view favorite movies
- Identify comforting activities, objects, people, relationships, places, and seek them out
- Allow yourself to cry
- Find things to make you laugh
- Express your outrage in social action, letters, donations, marches, protests
- Play with children
- Make time for reflection
- Spend time with nature
- Find a spiritual connection or community
- Be open to inspiration
- Cherish your optimism and hope
- Be aware of nonmaterial aspects of life
- Try at times not to be in charge or the expert
- Be open to not knowing
- Identify what is meaningful to you and notice its place in your life
- Spend time with children
- Have experiences of awe
- Contribute to causes in which you believe
- Read inspirational literature (talks, music, etc.)
When to Seek Help
Several studies have pointed out that following a terroristic event such as the Oklahoma City bombing, many of those in closest proximity to the disaster do not believe that they need help, and will not seek out services, despite reporting significant emotional distress (Meyer, 1991; Sprang, 2000). Sprang lists several potential reasons for this happening:
- A feeling that one is “better off” than those more affected, and therefore should not be so upset.
- Pride, or a feeling that distress indicates weakness of some sort.
- Some individuals may not define services they receive as mental health intervention, especially if unsolicited (lectures, sermons, discussions, community rituals). Indeed, the goal of many disaster mental health workers is to have interventions be a seamless, integrated part of an overall disaster effort, so many may not see these interventions as “mental health” interventions.
- Many individuals are more apt to seek informal support from family and friends, which may not be sufficient to prevent long-term distress in some.
This lack of help-seeking is critical to address, given that of individuals studied who were directly exposed to the Oklahoma City bomb blast, a large portion continued to have active post-disaster psychiatric symptoms six months later (PTSD being the most common, and major depression the second most common disorder (North et al., 1999)).
There may be times when self-help strategies are not effective in reducing the effects of exposure to traumatic stress. Research has shown that some changes associated with exposure to trauma may involve a change in brain chemistry and function, and that the use of antidepressant or other medication is effective in reducing both PTSD and depressive symptoms in individuals who are unable to manage their symptoms behaviorally. Additionally, individuals have also shown partial or full relief from post-traumatic stress symptoms through certain types of cognitive-behavioral treatment. As stated above, seeking assistance from your medical doctor or a mental health professional who is skilled in trauma is recommended if:
· you are experiencing any symptoms that are causing distress, significant changes in relationships, or are impairing functioning at work
· you are self-medicating with alcohol or drugs
· you are unable to find relief with the strategies listed above
Coping with PTSD symptoms and the problems they cause is usually a continuing challenge for survivors of trauma. Recovery from PTSD is an ongoing daily gradual process. It doesn’t happen through sudden insight or “cure.” Healing doesn’t mean forgetting trauma experiences or having no emotional pain when remembering them. Some level of continuing reactions to memories is normal and reflects a normal body and mind. Healing may mean fewer and less intense reactions. But it also means greater ability to manage trauma-related emotions, and greater confidence in ability to cope.
When a trauma survivor takes direct action to cope with problems, he or she often gains a greater sense of personal power and control. Active coping means recognizing and accepting the impact of traumatic experiences, and then taking concrete action to improve things.
National Center for Post Traumatic Stress Disorder (PTSD)