What is a traumatic experience? Life is full of stressful changes. Some stressful experiences can be good, such as the birth of a child, some bad, such as financial difficulties. In our everyday language we use the word trauma for many types of stressful experiences. However, traumatic experiences are unique because they specifically threaten us with serious physical injury or death. Common examples include car accidents, rape, assaults, war, fires and man made or natural disasters. Often, traumas caused by people (e.g., violent crime) have additional psychological challenges as compared to natural disasters (e.g., floods or earthquakes). Individuals who witness such dangerous situations or their immediate aftermath may also experience traumatic reactions.
What reactions do people commonly have following a traumatic experience? As we might expect, life-threatening situations will produce a variety of intense and unusual stress reactions in our emotions, thoughts and actions. The most common symptoms of trauma fall into three broad areas: re-experiencing, avoidance and hyperarousal. Other emotions such as guilt, anger, and depression can also commonly occur following a trauma.
Re-experiencing: repetitive, vivid, and intrusive thoughts, images, memories, and sensations about the trauma and its consequences are hallmark symptoms and can create tremendous anxiety. Traumatic images or thoughts may intrude during the day as “flashbacks” or during sleep as nightmares. Other typical thoughts may include: believing you are in danger; believing that you should foresee and control these dangers; believing that you should have somehow been able to do more to stop the event from happening, and that your personality and future are permanently damaged.
Hyperarousal: difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, being hypervigilant, a general inability to unwind and becoming easily startled are common physical symptoms of anxiety that may occur following a trauma. Panic attacks, racing heart and appetite disturbances are also common.
Avoidance: not wanting to be around reminders of the trauma. This may include avoiding some of the people, places and things that remind you of the event or were present at the time, but it can also include avoiding certain conversations, thoughts and feelings. Emotional numbing and a diminished ability to experience pleasure are typical. Some people may forget important aspects of the trauma, report being unable to have loving feelings toward others and may have less interest in carrying on with their daily lives. People may withdraw socially, begin to feel alienated and mistrustful of others and report an increase in conflicts with others. Avoidance can also take the form of strange, almost dream-like, experiences called depersonalization and de-realization. You might feel unreal or disconnected from your surroundings, nearby people or your own body. Alcohol and/or other substances are another method often used to avoid traumatic feelings and memories through “self-medicating.”
An informed understanding of these reactions to abnormal traumatic circumstances is often the beginning of coping with trauma.
How long do traumatic reactions last? Trauma reactions commonly last for several weeks or months before people start to feel normal again. The vast majority of individuals report that they feel better within the first three months. On-going terrorism may produce more prolonged stress because of the continual reminders that the threat of danger is not over. In spite of the normally intense trauma reactions during the initial month, most people are able function relatively well.
Are there ways that I can help myself cope with trauma? There are many ways that people can help themselves cope with traumatic experiences. Research has demonstrated that the use of these strategies may reduce the risk of developing post-traumatic stress, depression and other anxiety disorders. Following is a list of ‘do’s and don’ts’ of coping that may help you in minimizing the impact of trauma on your mental health. +
What things should I focus on doing right now?
What things may be better for me not to do?
- Do keep to your normal routine. Doing so will help you create a sense of normalcy, predictability and controllability, and will make you feel more secure and safe.
- Do turn to your family and friends for support. Research finds that getting support from your family, friends and members of your community can help protect you from the negative effects of trauma.
- Do handle day-to-day conflict appropriately so as to minimize negative encounters caused by the strain, fatigue, and irritability that often follow trauma. For example, if you and your spouse have an argument, take the time to resolve it so that it doesn't add to the stress you are already facing.
- Do find ways to relax. Some people find it helps to exercise, take yoga, pray or meditate. Experiment to find what works for you.
- Do talk about the events, your experiences, losses and feelings with adult members of your family, friends, neighbors and people in the community. Research demonstrates that collective grieving expresses solidarity and facilitates unity and collective action.
- Do find time to engage in leisure and recreational activities. Many people feel guilty about enjoying themselves when they have experienced traumatic events or losses. Getting back to your routine and allowing yourself some enjoyment and distraction is important for your mental health. Feeling guilty about doing so will not only make you feel worse but it will also reduce your ability to cope.
- Do try to be kind to yourself. You may begin to doubt your sense of worth (e.g., no one will love me again) or your ability to cope (e.g., I don't have the strength to go on) because of the trauma you have just experienced. The trauma cannot alter your worth or your ability to cope with life.
- Do confront situations, people and places that remind you of the trauma - repeatedly facing these reminders will reduce your anxiety over time even if your anxiety is temporarily high when you initially face your fears.
- Do recognize that you cannot control everything. Although you should protect yourself from high-risk situations in your environment, acknowledge that every one of us has to accept some measure of risk to live healthy lives.
- Do try and view the future with some measure of optimism. Findings suggest that people who view traumatic situations as time limited, terrible experiences that do not necessarily have negative implications for the future and those who find some elements of personal growth in it, are more likely to recover quickly. By contrast, those who assume that their lives have permanently changed for the worse (e.g., nothing will ever be the same again; my life has been destroyed) are less likely to do so.
- Do believe in resilience of the human spirit. Research finds that a majority of people who have experienced trauma recover on their own within a few months. The odds are in your favor. You are likely to feel better soon.
- Do recognize when you need professional help and do not be afraid of seeking it. There is no reason to suffer on your own. There are plenty of research-based treatments that have shown to be tremendously effective in helping people overcome posttraumatic stress, anxiety and depression.
- Do not repeatedly watch TV news reports. Keeping up with the news is important but repeatedly watching TV news reports will increase your anxiety. The news media tend to present news in an unnecessarily dramatic fashion and tend to catastrophize information. Even worse, TV news media repeatedly show brief clips of horrific images such as the World Trade Center at the moment of impact. Such images are disturbing and research shows that briefly viewing anxiety-provoking images may actually worsen your anxiety.
- Do not suppress your painful thoughts. People who are traumatized often have repeated, intrusive thoughts or images of the trauma that keep playing in their heads. If you find that you are experiencing such thoughts and are feeling anxious as a result, you may have the urge to suppress this anxiety- provoking thoughts and images. Don't. Trying to suppress your thoughts can have the reverse effect. Paradoxically, the more you try to control your thoughts, the stronger they be come.
- Do not overestimate the danger we have experienced and continue to experience. The recency bias states that shortly after the occurrence of a negative event, people tend to seriously overestimate the likelihood of it occurring again. Although the World Trade Center attacks and the current anthrax scares are real, and it is certainly possible that these threats could continue, the probability that any one of us will die from a future terrorist attack is still small. For example, in countries that have been subjected to frequent and prolonged terrorism campaigns, like Israel and Britain, the number of people dying from motor vehicle accidents far exceeds those dying from terrorism. In Israel, more people die from accidents in one year than have cumulatively died from terrorism since independence in 1948!
- Do not make the problem worse than it is already. What has happened is traumatic and there is an increased sense of uncertainty with the ongoing threats, but research shows that individuals who always assume the worst will happen (e.g., we will all die from a terrorist attack) or generalize the threat (e.g., all Islamic countries are out to get us) are more likely to suffer from anxiety and other negative emotions than those of us who are able to assume a more balanced perspective (e.g., some people will die from terrorist attacks, but my personal odds are quite low; some extremists are out to get us but most people and countries have an interest in good relations with us).
- Do not avoid situations or places if the objective risk of danger is absent or low. Research shows that avoidance begets avoidance and increases anxiety in the long run. It will also create a false sense of danger because you will begin to assume that the only reason you are safe is because you are avoiding "dangerous" places. Not so, the probability of risk is low so that you would be safe even if you did not avoid these places.
- Do not engage in unhealthy or excessive escape behaviors (e.g., alcohol, caffeine, online cigarettes, TV, movies) or use excessive forms of distraction (e.g., watching TV or movies all day, distracting yourself from painful thoughts). Although allowing yourself to experience pleasure is important and distracting yourself at times may be useful when stress levels are high, excessive distraction and other escape behaviors may ultimately increase your anxiety in the long run.
- Do not blame yourself for the way you are feeling or reacting (e.g., I must be very mentally unstable if I feel this way). Strong emotions such as anxiety, anger, etc that feel out of control are common when people have experienced trauma, and usually subside naturally. Criticizing yourself will make you feel guilty and ashamed and will only add to the array of negative emotions you are currently experiencing.
- Do not blame yourself for something you feel you should have done or not done (e.g., I should have been nicer to him; I should have gone up to save more people). Blaming yourself cannot change the past and is unfair to you. ‘Monday morning quarterbacking’ is unhelpful and will only compound the problem. Blaming yourself will only add guilt and shame in addition to the anxiety and sadness you are already experiencing.
- Do not discuss every detail of the trauma and world events in detail with young children. See guidelines for how to effectively discuss trauma with children.
- Do not forget to review the "Do list" above when you feel bad. The human spirit is resilient and the odds are in your favor that you will feel better soon. Following these strategies can help maintain your personal resilience.
When should I consider professional help for my symptoms? When symptoms are severe enough during the first month to impair social or occupational functioning, Acute Stress Disorder (ASD) may be diagnosed. If these more immediate and disruptive patterns last beyond one month, the syndrome is called Post-Traumatic Stress Disorder (PTSD). Approximately half of those who have post-traumatic symptoms will recover within 3 months. The likelihood that you will continue to experience these symptoms beyond three months depends upon a variety of factors. For example, direct exposure to the traumatic event, the seriousness of the threat to life, amount of times trauma was experienced, a history of past trauma, psychological difficulties prior to trauma are all factors that may increase the likelihood that your symptoms will not abate on their own with time. Sites such as www.istss.org describe these responses and may further help you in understanding what you are going through. Visiting www.nimh.nih.gov will provide more detailed discussion of various possible problems. Because there are so many things that can affect the severity of a person’s reaction to trauma, the estimates of how many people develop PTSD vary widely, from as little as 3% to as much as 75%. Anyone who believes they may have ASD or PTSD should seek help beyond speaking with family members. Referrals can be obtained from friends, family physicians or professional agencies such as the Academy of Cognitive Therapy. Though the more obvious symptoms of PTSD or ASD certainly warrant seeking out professional help, one should not hesitate to secure it even if the symptoms seem less severe. Questions, concerns or the desire to speak freely with someone other than family are equally good reasons to seek help.
What kind of treatment should I look into? The types of treatment one may seek will depend on many factors including the elapsed time since the traumatic event. An excellent site summarizing the scientific literature on these issues may be found at www.ncptsd.org. The site www.apa.org also provides information on a range of types of psychological treatment available today.
Can you tell me a little about Cognitive Therapy? Cognitive Therapy (CT), is a research-based type of psychotherapy, that has demonstrated promising results with acute and post-traumatic stress as well as other problems that might be set in motion by trauma. Cognitive therapy has been shown to be effective in treating individuals with post-traumatic stress disorder and has also been shown to work in preventing onset of post-traumatic stress disorder. When used preventatively, cognitive therapy appears to be best applied two to four weeks after the event, at the earliest, and with at least three to four sessions of work with a therapist. When used as a treatment for individuals who have already developed post-traumatic stress disorder, cognitive therapy is generally administered over a four to six month period. Depending on the individual and the severity and complexity of the problem(s), the length of treatment may very well be longer. The positive results of CBT also hold for individuals with a chronic history of trauma. Greater amounts of elapsed time since the trauma does not seem to lessen its effectiveness. Cognitive therapy generally aims to help people see themselves and their worlds more adaptively by modifying the distorted or unhelpful ways of thinking that have been linked to problems in emotion. The therapist tries to help the individual view trauma and their reactions to it, in ways that are more helpful and balanced. For example, after such an event, people may begin to see the world as a dangerous place or in other excessively negative ways. This keeps the sense of current threat alive and increases anxiety. Assumptions of safety or trust are often shattered. They may also think of themselves as unable to cope with the feelings that have resulted or may criticize themselves for this reason. Cognitive therapy modifies these unhelpful patterns of thinking, and in doing so, helps people experience less anxiety and improved functioning over time. The memories of trauma can also be fragmented, with many individuals reporting an inability to recall significant aspects of the trauma coupled with persistent, recurrent thoughts of the trauma. These thoughts are often triggered by a wide range of situations or events linked to the trauma and may create tremendous anxiety. Consequently, people try to escape these thoughts and feelings because they are so frightening. Unfortunately, escaping only makes the anxiety worse because the person keeps reacting as if the events were still happening and does not learn that new situations may not be fraught with danger. Cognitive therapy helps the person learn new ways of handling these distressing moments. In the process, individuals begin to assign more balanced meaning to the event and what followed. They also learn new skills for handling their emotions and begin to view themselves in less negative ways. The fact that the trauma occurred cannot be changed, of course, but the therapy helps to minimize it’s negative effects in the long run. A visit to www.academyofct.org will provide a complete list of certified cognitive therapists, all of whom have met rigorous standards for competency in CBT.
Are there other professional services that may be helpful? Grief counselors, pastoral counselors, social workers and psychiatric nurses are just some of the other professions who are working in the area coming to be known as traumatology. Each group usually has accrediting bodies that certify the training and skills of their members. If possible, try to secure this information before you seek help from them. Be sure to ask about specialty and experience in working with trauma. This type of work can be some of the most challenging for professionals. A supervised base of experience is critical. Visit your particular state, provincial or national licensing board site for qualified practitioners.