witnessing a tragic event. how does one cope?
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Coping with Traumatic Stress
Ottawa Operational Stress Injury Clinic
Dr. Michele Boivin, Psychologist
Dr. Luis Oliver, Psychologist
Dr. Sarah Bertrim, Psychologist
Mr. Alasdair Gillis, Social Worker
Overview • What is trauma?
• How do people react to traumatic events? – What is a ‘normal’ reaction?
– What are the signs that someone is struggling?
• What is a traumatic loss?
• How do people grieve?
• How can I cope with what I have witnessed?
• How can I help someone else cope?
What is Trauma? • Exposure to actual or threatened death, serious
injury (accident, assault, torture), sexual violation
• Exposure can be:
– Direct
– Witnessed
– Learning of an event that happened to a loved one
– Repetitive exposure to details of the event
DSM-V
Common Reactions to Trauma Thoughts:
• Unwanted thoughts
• Nightmares
• Poor concentration
Emotions:
• Fear and anxiety
• Anger
• Irritability
• Guilt / Shame
• Grief
• Sadness
Physical symptoms: • Insomnia • Changes in appetite • Nausea • Fatigue • Tension • Headache
Behaviours: • Effortful avoidance • Withdrawal • Alcohol or substance use • Checking / vigilance
Prevalence of Trauma vs. PTSD
Natural recovery
• Transient symptoms are normal
• Among those who will recover, symptoms begin to decline within several weeks of the trauma
• Most natural recovery occurs within the first year
• Recovery is associated with reestablishing previous activities
Impediments to natural recovery
– Ongoing avoidance
– Being extra careful /safe
– Trying to push away thoughts & memories
– Distraction / keeping very busy
– Ruminating – thinking and re-thinking
– Vigilance – looking for signs of threat
– Alcohol/medication use
– Giving up enjoyable activities
Traumatic loss Duke University Health System, 2005
• Traumatic death is:
– Sudden, unexpected, or violent
– Caused by the actions of another person, an accident, suicide, natural disaster, or other catastrophe
Common Reactions to Traumatic Loss Duke University Health System, 2005
• Shock: Difficulty accepting the loss really happened, prolonged memories or dreams of the event
• Fear and anxiety: Feeling unsafe during normal activities, worrying about what could happen
• Anger: Feeling out of control / helpless
• Guilt: Regret about what one has done or not done, guilt about surviving / going on with life
What can you do?
Grieving a traumatic loss
• Grief is unique – there is no ‘right way’
• Connect with support systems
• Collective grieving: vigils, spiritual services, recollections of individuals who died
• Individual grieving: Continuing with old traditions or establishing new ones, finding ways to remember, allowing a range of emotions
• Maintain self-care
• Eventually, reengaging in activities
Creating a meaningful legacy
• In the early aftermath this can be difficult to even imagine
• A tragic event can leave us doubting our purpose or question meaning in life
• It isn’t useful to try to find a positive interpretation of the event itself
• In time it can help to find personal meaning from a loss and create a positive legacy
– Ways to make the world better
– Refocusing on values and meaningful activity
Helping traumatized individuals: Strategies for First Responders
• Psychological Debriefing / Critical Incident Stress
Management has been widely applied in these situations
• Available evidence suggests that this method is at best
inert and at worst harmful
• Current best practices suggest Psychological First Aid
and focus on immediate needs for comfort, housing,
medical care etc.
Short Term (first few weeks)
• “Psychological First Aid”
• Safety planning and emergency stabilization should precede psychological factors (Resnick et al, 2000)
• Goal: – Assist individual in feeling connected, validated, safe
– Provide education about signs that would warrant seeking help
– ‘Plant seeds’ rather than initiate long term contact
Litz 2008
Psychological First Aid • Do’s:
– Offer group support
– Offer opportunity for individual meetings for those uncomfortable in group setting
– Review of event (provide basic details of what occurred)
– Offer opportunity to discuss experiences if desired
– Provide information/handouts on trauma, where to obtain care
– Discuss what they could expect from treatment
Helping traumatized individuals: Strategies for Significant Others
Do’s • Listen
• Be available consistently
• Understand & normalize common trauma reactions
• Accept initial coping– (most) anything goes in the first few days
• Encourage use of natural supports over therapy
• Limit exposure to media accounts
Don’ts • Minimize (it will be okay,
they’re in a better place)
• Take control over their wellbeing
• Give advice
• Judge
• Pathologize a normal reaction
• Personalize reactions
Exceptions – When to seek help right away
• Thoughts of harming oneself or someone else
• Excessive alcohol or drug use
• Dangerous/risky behaviours
• Inability to care for oneself or dependents
Risk factors for PTSD
BEFORE:
•Family history
mental illness
•Previous Trauma
•Previous
maladjustment
DURING:
•Perceived life
threat
•Intensity of
emotions
•Dissociation
AFTER:
•Lack of social
support
•Life stressors
•Early
symptoms
When to consider more support
Posttraumatic Stress occurs when we start to organize our lives around the trauma (Briere & Scott)
• Duration - more than one month, most of the time
• Intensity – distress (anxiety, sadness, grief, shame) is significant
• Impairment – relationships, activities, work, self-care
Accessing Resources • Natural supports: family, friends, coworkers, clergy or
community groups, if relevant
• Family physician (referral)
• Employee Assistance Program
• Registered mental health professionals:
– Check college websites for information about psychologists, psychiatrists, social workers
• OSI Connect app: self-screeners, information for professionals, other resources online
Crisis management for Immediate needs • 9-1-1 or Emergency Department
• Mental Health Crisis Line 1.866.996.0991
• Ottawa and the counties of Prescott Russell, Renfrew and Stormont Dundas and Glengarry 613.722.6914
• Leeds & Grenville district 1.866.281.2911
• Pembroke Regional Hospital Mobile Crisis Team 613.732.3675 ext. 8116 or 1.866.996.0991
• Youth Services Bureau 24/7 Crisis Line 613.260.2360 or 1.877.377.7775
Q & A
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