COMMON RESPONSES TO TRAUMA -- AND COPING STRATEGIES

After a trauma, people may go though a wide range of normal responses. Such reactions may be experienced not only by people who experienced the trauma first-hand, but by those who have witnessed or heard about the trauma, or been involved with those immediately affected. Persons, places, or things associated with the trauma can trigger reactions. Some reactions may appear totally unrelated.

Below is a list of common physical and emotional reactions to trauma. These are NORMAL reactions to ABNORMAL events.

Physical Reactions

Aches and pains like headaches, backaches, stomach aches Sudden sweating and/or heart palpitations (fluttering) Changes in sleep patterns, appetite, and interest in sex Constipation or diarrhoea Easily startled by noises or unexpected touch More susceptible to colds and illnesses

Emotional Reactions

Shock and disbelief Fear and/or anxiety, expectation of doom and fear of the future Grief, disorientation, denial Hyper-alertness or hyper vigilance Emotional swings -crying then laughing, irritability, restlessness, and

outbursts of anger or rage Worrying or ruminating -- intrusive thoughts of the trauma Nightmares Flashbacks -- feeling like the trauma is happening now Feelings of helplessness, panic, feeling out of control Increased need to control everyday experiences Minimising the experience, concern over burdening others with problems Attempts to avoid anything associated with trauma Tendency to isolate oneself and feelings of detachment Emotional numbing or restricted range of feelings Difficulty trusting and/or feelings of betrayal Difficulty concentrating or remembering Feelings of shame, self-blame and/or survivor guilt Depression

Helpful Coping Strategies

Reach out and connect with others, especially those with whom you may share the stressful event

Cry Hard exercise like jogging, aerobics, bicycling, walking Relaxation exercise like stretching, massage, swimming Humour

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Prayer and/or meditation; Listening to or making music and creative arts Maintain balanced diet and sleep cycle as much as possible Avoid over-using stimulants like caffeine, sugar, or nicotine Do something socially active Write about your experience – in detail, just for yourself or to share with

others

Unhelpful Coping Strategies

        Avoidance through alcohol, substance abuse or social withdrawal

       Aggressive attitudes or acts

Acting out though promiscuity, spending or gambling

Self-harm

Depressive symptoms

Excessive worrying

Displacement of anger

People are usually surprised that reactions to trauma can last longer than they expected. It may take weeks, months, and in some cases, many years to fully recover. Many people will get through this period with the help and support of family and friends. If they are unavailable then finding a group of brothers or sisters who have been through similar experiences will help.

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Topic 2

The Impact of Trauma (Adults)

The word trauma is derived from a Greek Word meaning ‘wound’. Its pure definition is an event that threatens ones life. The broader definition refers to any physical, sexual, emotional or spiritual wound that involves threat to ones life or sense of self.

Traumatic events often shatter our assumptions about the world and ourselves. The following table adapted from Hicks (1993: p.17) outlines the common assumptions that are commonly shattered as a result of a traumatic experience.

Traumatic events that wound and scare a person challenge the

assumption of

Invulnerability

“It can’t happen to me”

Traumatic events that don’t make sense challenge the

assumption of

Rationality

“The world makes sense”

Traumatic events that seemunfair challenge the

assumption of

Morality

“The universe is just”

Traumatic events that change your image of yourself challenge the

assumption of

Identity

“I know who I am”

Trauma always leaves people changed, either positively or negatively. If the normal trauma response can be modulated effectively then evidence suggests that change following trauma can have positive aspects. For example Michael Christopher (2004: 83) outlines the following positive changes that can occur following a trauma:

1)“The first type of change entails a more integrated sense of self, to be more specific, a greater competence and resilience when dealing with life’s challenges.

2) The second type of change entails relationships with others, more specifically, closer relationships with family and significant others, reconciliation of estranged relationships, an increased ability to protect oneself and prevent abusive relationships, greater altruism, increased willingness to help, increased sensitivity to others and increased openness to new behaviours.

3) The third type of change involves a more integrated philosophy of life. That is, the third type of positive change following trauma includes an increased appreciation of ones existence, changed priorities, stronger beliefs, a greater sense of meaning, and a whole new comprehensive perception of reality”

Trauma can be survived and most people will eventually come through a trauma back to full functioning. The human spirit is resilient. Ernest Hemingway states, “The world breaks everyone, then some become strong at the breaks”.

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However, if pain is buried or a person fails to process their grief adequately then healing is blocked and the pain remains. The ongoing pain, (either buried or overtly expressed through emotions such as anger, resentment, and helplessness) will then negatively impact the person and often their family and friends.

Most psychological responses that are unhealthy are due to a breakdown in the modulation of the normal stress response and the specific dynamics of the response will be an interaction between the individual’s socio-cultural environment and psychological makeup (Christopher, 2004).

Acute Stress Disorder

For a diagnosis of Acute Stress Disorder, symptoms must persist for a minimum of two days to up to 4 weeks within a month of the trauma. If symptoms persist after a month, the diagnosis becomes Post Traumatic Stress Disorder

Symptoms include:

Lack of emotional responsiveness, a sense of numbing or detachment

A reduced sense of surroundings

A sense of not being real

Depersonalisation or a sense of being dissociated from self

An inability to remember parts of the trauma, "dissociative amnesia"

Increased state of anxiety and arousal such as a difficulty staying awake or falling asleep

Trouble experiencing pleasure

Repeatedly re-experiencing the event through recurring images and/or thoughts, dreams, illusions, flashbacks

Purposeful avoidance of exposure to thoughts, emotions, conversations, places or people that remind them of the trauma

Feelings of stress interfering with functioning; social and occupational skills are impaired affecting the patient's ability to function, pursue required tasks and seek treatment

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Post-Traumatic Stress Disorder (PTSD)

PTSD is identified as a serious emotional disorder. It can very seriously damage a person’s normal functioning.

When diagnosing PTSD, psychologists are guided by textbooks, which require certain symptoms to be present. The following criteria have to be met for a person to have a formal diagnosis of PTSD. However, it is very important for us to be aware that a person may not meet all the criteria for PTSD, but still have their life severely affected by trauma. They will show some of the symptoms.

Criteria for PTSD

1. Trauma

The person must have been involved in one or more traumatic experiences, or witnessed them, where either life was in danger or, at least, there was the danger of terrible injury to someone.

The person’s response must also have involved intense fear, helplessness or horror.

2. Re-experiencing symptoms

The traumatic event is persistently re-experienced in one or more of the following ways. The person keeps remembering what happened and can’t get it out of their mind.

Even if they try not to think about it they remember bits of the trauma – either as images, thoughts or perceptions.

They keep having distressing dreams about what happened. They have experiences when they feel as if the event is actually happening again and

they are “in it”. These are called “flashbacks”. The person reacts with intense psychological distress if they are exposed to “triggers’,

(external or internal) that remind them of the trauma. e.g’s 1. People in Sri Lanka feeling strong fear when they hear water, even though the tsunami has been over for many months. 2. People feeling intense fear if they just think about some part of the trauma.

The person has physiological reactions when they are exposed to these kinds of external or internal “triggers”. e.g. 1. Their heart starts to beat fast. 2. They start to sweat and breathe quickly.

Avoidance Symptoms

People do their best to avoid anything associated with the traumatic experience. This includes a numbing of their general responsiveness (not present before the trauma), as indicated by three or more of the following:

Efforts to avoid thoughts, feelings or conversations associated with the trauma. e.g. As much as possible they avoid talking about it.

Efforts to avoid activities, places or people that remind them of the trauma. e.g. As much as possible they keep away from possible “triggers”.

Inability to recall an important aspect of the trauma. (It seems like an inbuilt mechanism sometimes “blocks” from conscious memory some especially horrible parts of what happened.)

Markedly diminished interest or participation in significant activities. e.g. They no longer feel like meeting people, or going out of the house much.

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Even when they are with other people, they feel disconnected or detached from them. They have a restricted range of emotions (e.g. Usually able to feel anger and fear but

not able to have loving feelings). They feel their life will be shorter than most (e.g. does not expect to have a career,

marriage, children, or a normal life span).

4. Physical Hyper-Arousal Symptoms

It seems like the “Volume Knob” on people’s bodily reactions is turned up higher than normal and they tend to have physical over-reactions. They need to have two or more of the following:

1. Difficulties falling or staying asleep.2. Irritability or outbursts of anger.3. Difficulties concentrating.4. Hypervigilance i.e. constantly looking around them for any signs of danger.5. Exaggerated startle response.

The duration of the symptoms above must be more than one month for a diagnosis of full PTSD to be made.

ADDITIONAL NOTES

1. The majority of people who experience a trauma do not suffer from full-blown PTSD.2. Most people’s trauma symptoms gradually settle down, so that they are not

excessively troubled by them six months after the event.3. About 20% of people experiencing a severe trauma continue to have distressing

symptoms longer than six months, and these may continue for many years.4. Symptoms of PTSD can appear soon after the event, but may not appear for years

afterward. Usually they appear within 3 months.5. If a person has PTSD it does not mean that they are weak.

If PTSD is severe it is a family condition, for all members of the family are affected.

Understanding PTSD

The Brain and Trauma

Brain Stem and Cerebellum: Regulates basic functions such as heart rate and respiration

Limbic System: Emotion is generated in the limbic system. Parts of the limbic system are involved in trauma. Messages of sight sound and smell converge in the thalamus and are sent on to relevant structures involved in vision, auditory processing etc. Hippocampus and amygdala are related to memory storage of traumatic events and strong emotions (e.g., horror and fear). Limbic system is mostly unconscious.

Cortex and Neocortex: Higher executive functions like thinking, planning, reasoning. These higher functioning parts of the brain analyse threat messages sent by limbic system and make decisions regarding the degree of threat, either extinguishing fear response or planning a course of action.Unconscious and conscious fear responses are processed differently. If we can bring what is unconscious into consciousness then we have access to the higher executive parts of the brain in the cortex and neo cortex to challenge fears and address problems.

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In PTSD the higher executive parts of the brain show diminished function and the emotional centres of the limbic system show increased function.

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Taken from ‘Mapping The Mind’ Rita Carter (1998)

What are the stages of the grief process?

A loss/trauma experience involves the following five stages of emotional response: (1) denial (2) bargaining (3) anger (4) despair (5) acceptance.

These five stages can occur in either the sequence presented or in any variety of sequence.

The stages can recur during a loss experience. One stage can last a long time, uninterrupted. These five stages can occur in either the sequence presented or in any variety of

sequence. The loss process can last anywhere from three months to three years. These stages of grief are normal and are to be expected. It is healthier to accept these stages and recognize them for what they are rather than to

fight them off or to ignore them. Working out each stage of the loss response ensures a return to emotional health and

adaptive functioning. Getting outside support and help during the grieving process will assist in gaining

objectivity and understanding.

Stage 1. Denial

We deny that the trauma/loss has occurred. We ignore the signs of the trauma/loss.

We begin to use:

Magical thinking believing by magic this memory will go away Excessive fantasy believing nothing is wrong; this trauma is just imagined; when I

wake up everything will be OK. Regression believing that if we act childlike and want others to reassure us that nothing

is wrong. Withdrawal believing we can avoid facing the losses and avoid those people who

confront us with the truth. Rejection believing we can reject the truth and those who bring us the news of our loss

to avoid facing the loss.

Stage 2. Bargaining

We bargain or strike a deal with God, ourselves, or others to make the pain go away We promise to do anything to make this pain go away. We agree to take extreme measures in order to make this pain disappear. We lack confidence in our attempts to deal with the pain, looking elsewhere for

answers. We begin to:

Shop around believing we look for the ``right'' agent with the ``cure'' for our pain. Take risks believing we can put ourselves in jeopardy financially, emotionally, and

physically to get to an answer for our pain. Doing for others, believing we can ignore our own needs.

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Stage 3. Anger  We become angry with God, with ourselves, or with others over our pain. We become outraged over the costs to overcome our pain. We pick out ``scapegoats'' on which to vent our anger, e.g., the doctors, hospitals,

helping agencies, international specialists, etc.

We begin to use:

Self-blaming believing we should blame ourselves for the trauma. Switching blame believing we should blame others. Blaming our departed loved ones for leaving us. Aggressive anger believing we have a right to vent our blame and rage aggressively on

the closest target. Resentment believing our hurt and pain is justified to turn into resentment toward

involved in our loss event.

Anger is a normal stage. It must be expressed and resolved; if it is suppressed and held in, it will become "Anger in" leading to a maladaptive condition of depression that drains our emotional energy.

 Stage 4. Despair We become overwhelmed by the anguish, pain, and hurt of our loss; we are thrown into

the depths of our emotional response. We can begin to have uncontrollable spells of crying, sobbing, and weeping. We can begin to go into spells of deep silence, morose thinking, and deep melancholy.

We can begin to experience:

Guilt believing we are responsible for our loss.

Remorse believing we should feel sorry for our real or perceived ``bad past,'' deeds for which this loss is some form of retribution or punishment.

Loss of hope believing that because the news of our loss becomes so overwhelming that we have no hope of being able to return to the calm and order our life held prior to the loss.

Loss of faith and trust believing that because of this loss we can no longer trust our belief in the goodness and mercy of God and mankind.

We need support to assist us in gaining the objectivity to regroup our lives. If we are not able to work through our despair, we risk experiencing events such as physical or mental illness, suicide, inability to cope with the aftermath of our trauma, rejection of those who experienced the trauma, detachment, and poor relationships.

Stage 5. Acceptance

We begin to reach a level of awareness and understanding of the nature of our loss.

We can now:

Describe the terms and conditions involved in our loss. Fully describe the risks and limitations involved in the treatment or rehabilitation for

the loss involved. Cope with our loss. Test the concepts and alternatives available to us in dealing with this loss. Handle the information surrounding this loss in a more appropriate way.

We begin to use:

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Rational thinking believing we are able to refute our irrational beliefs or fantasy thinking in order to address our loss from a rational perspective.

Adaptive behaviour believing we can begin to adjust our lives to incorporate the changes necessary after our loss.

Appropriate emotion believing we begin to express our emotional responses freely and are better able to verbalize the pain, hurt, and suffering we have experienced.

Patience and self-understanding believing we can recognize that it takes time to adjust to the loss and give ourselves time to ``deal'' with it. We set a realistic time frame in which to learn to cope with our changed lives.

Self-confidence believing, as we begin to sort things out and recognize the stages of loss as natural and expected, that we gain the confidence needed for personal growth.

We can be growing in acceptance and still experience denial, bargaining, anger, and despair.

To come to full acceptance we need support to gain objectivity and clarity of thinking. It is often useful to gain such assistance from those who have experienced a similar loss. For example, groups of parent who have experienced the death of a child or who have had a child with a developmental disability.

Peer support from strangers is often the best way for a person to deal with the grieving process.

Acting out behaviours

Survivors of traumatic events often engage in risky and self-destructive behaviours. They do so in a desperate attempt to avoid the painful emotions they experience as a result of the trauma, or an attempt to deny the trauma and its consequences.

Alcohol or substance abuse Gambling or irrational purchases Promiscuous and/or unprotected sex Self-mutilation Assault behaviours Self deprecating speech and performance Stealing Eating disorders Social withdrawal

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Depression

Depression is a mood noted by a negative view of self, the world and the future. It is characterised by: sadness; discouragement; low self-esteem; inferiority; guilt; indecisiveness; irritability; loss of interest in hobbies, family, friends; loss of motivation; poor self image; appetite changes; sleep changes; loss of sex drive; concerns about health; suicidal impulses

Depression is often characterised by negative thinking and distorted perceptions:

Filtering: Looking at only one part of a situation to the exclusion of everything else.

Polarised Thinking: Involves perceiving everything at the extremes, as either black or white; all or nothing, with nothing in between.

Overgeneralisation: Reach broad, generalised conclusions based on one piece of evidence.

Mind Reading: base assumption and conclusions on your ability know other people’s thoughts.

Catastrophising: You turn everything into a catastrophe, always expecting the worst-case scenario.

Personalisation: You interpret everything around you in ways that reflect on you and, often, your self worth.

Control Fallacies: Entails feeling either that the events in your life are totally controlled by a force outside of yourself or that you are responsible for everything.

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