The tragedies at Parkland, Las Vegas, and Orlando represent our recent collective experience with trauma purposely inflicted by human beings on innocent children and adults. The purpose of this lengthy blog is to share as much information as we can about post-traumatic reactions and what you can do to buffer yourself and your family from the negative effects of trauma. At this writing we are less than one week after the Parkland killings and only five months past the Las Vegas massacre.
TYPICAL REACTIONS TO EXPECT
There are a number of common reactions that occur after a traumatic life threatening experience. These reactions, although much more intense, often can be grouped into the same four categories that describe our typical stress reactions:
The physical reactions to trauma include the queasy stomach, nausea, sweating, rapid breathing, muscle aches, chills, cold hands or feet, and rapid heart rates. If a person stays in this state of physiological arousal for too long, they may experience other complications such as headaches, diarrhea or constipation, hyperventilation, chest pain, muscular pain, or dizziness. Sleep disruption and loss of appetite are very common. If you have any physical ailments such as a history of stroke, heart attacks, or autoimmune disorder it is recommended that you contact your physician.
The emotional reactions to trauma include differing degrees of anxiety/fear, sadness/depression, anger, grief, guilt, and helplessness. Sometimes the emotions are hard to isolate and identify. Individuals will say that they feel a general sense of being numb or overwhelmed. Although this heightened state of physical and emotional arousal is a “normal” reaction to the traumatic event, much of the counseling effort by professionals is aimed at helping people cope with these emotions in a way that minimizes any risk of long term interference with the person’s life. Simply venting your emotions is not likely to make them go away for very long although this can help vent some powerful feelings, especially anger, that the event occurred.
The cognitive effects of trauma are quite varied. Some of the most common reactions are temporary impairments of our memory, concentration, attention, and problem solving. If we witnessed the event and felt very vulnerable at the time we might have difficulty with flashbacks or nightmares of the event. Intrusive thoughts about the event or issues related to it, worries, hyper-vigilance, and mistrust of others can develop. As we begin to cope with the overall physical and emotional stress, we will often see our general cognitive abilities (e.g., attention, memory, concentration) improve as well. Because it is extremely common to be highly distractible after these traumas, we need to be especially careful in our daily activities since accidents are more likely to occur at these times.
Whenever we have to adapt to a traumatic event, we also have behavioral reactions that go along with the physiological, emotional, and cognitive changes. Some of these behavioral changes are aimed at helping us cope with the events but they may not be effective in the long run. Some people will withdraw socially while others will want to spend time close to their loved ones. Some will avoid anything that increases their anxiety and may have difficulty getting to school or work, or following through on basic responsibilities. Increases in alcohol, drugs use, and cigarette smoking also occur.
Because trauma also can involve the death of close friends or family, grief as an intense sadness can be overwhelming. Crying, agitation, and aggressive behavior can be expected just like being very depressed, anxious, and withdrawn.
Although there are some similarities in our reactions, it is important to remember that we are all individuals and there are differences to be expected. Clearly those who were closest to the danger as in a school or workplace shooting are likely to show the most extreme reactions. If a person is coping with other major losses or problems in their lives, they may have more difficulty coping with the trauma. In spite of all of these differences, there are many things we can do to help us minimize the negative effects of the trauma.
BEGINNING THE COPING PROCESS
If you have experienced a shared trauma such as a school or workplace violence incident, hopefully you have been fortunate enough to talk about the events in a critical incident stress group at school, at work, in your place of worship, or in your general community. By talking to others you have begun the healing process. If you have not had this opportunity the following guidelines should be helpful.
Talk about the event and your reactions.
Even if you do not have a formal group setting, it is important to talk about how you are reacting to the events. Withdrawal and avoidance of others may feel natural in these times, but this will slow your progress if you withdraw too much. Talk to family, friends, co-workers, and other loved ones. It is helpful to hear from others you trust that they have some of the same feelings of vulnerability, anger, and sadness. Sharing your loss or experience with others who have had similar losses can also be quite helpful.
Engage in self-care activities.
Taking care of some of your basic needs will make you more effective in your coping. Try to:
- Get adequate rest and sleep, even though sleep might be normal for a while
- Eat well balanced meals whenever possible
- Drink plenty of non-alcoholic fluids, especially water
- Stay active, exercise if possible – even if it is a brief walk
- Find a way to relax – listening to calming music, taking a warm bath, meditation, etc.
- Distract yourself with some pleasant activities – go to a movie, read pleasant books, watch TV, etc.
- When feasible, return to as much normal structure in your day as possible – normalize school, work, and home routines
- Limit exposure to news of the tragedy – stay informed but avoid becoming obsessed with the event; control your social media exposure
Take control of whatever you can.
Feeling out of control is a very unhealthy emotion and can easily lead to anxiety, depression, and potentially dangerous physiological complications. It is important to remind yourself that even though you cannot change what happened or control everything that is scary, you do have a lot of control of other things in your life. Avoid impulsive decisions that you may regret later. It is normal for anyone who is traumatized and has added vulnerability to want to escape or avoid any place that is scary. Other efforts to take control can include participating in memorial services, attending vigils or rallies to support any of your causes, and visiting friends who you know will want to see you.
Minimize other changes or demands in your life.
As discussed previously, significant changes in your life will create more stress. Therefore, it is wise whenever feasible to plan to take on new demands at the right time. This may not be possible after natural disasters like hurricanes or floods where individuals are forced by the nature of the traumatic event to make drastic lifestyle adjustments. In other situations, temporarily avoiding some stressful changes may be helpful. For example, starting a construction project on your house, changing jobs, or moving to a new residence may need to be postponed in order to balance your other stress demands.
Find an active physical outlet to relieve some of the stress.
When the time is right, defusing your physical tension can be helpful. Working out physically, doing work around your house, hitting golf balls, playing tennis or other active sports, are all healthy ways to distract yourself and to defuse your tension. Even going for short walks in your neighborhood can be helpful if more strenuous activity is not feasible. Participating in charitable causes that require physical effort (e.g., Habitat for Humanity) can also be very helpful. If it is difficult to find an active physical outlet, try the mediation and relaxation exercises on this site as a way to defuse your physical tension.
Avoid the quick fixes.
At these times, using alcohol, drugs, or food, or acting out in violent ways may temporarily occur as an easier way to relieve your tension. However, these maladaptive coping methods will cause additional problems in the long run. Again, if you find yourself relying on these methods to cope after a trauma, outside consultation with a professional could be helpful.
OUR EXPERIENCE TELLS US
Healing is gradual after a traumatic event. Generally, it takes a few weeks for things to begin to feel normal – in serious trauma like a school shooting it will take a lot longer. Do not place unrealistic expectations on yourself or your family. Everyone goes at his or her own pace. Normalizing your day to day activities is very important. Major life decisions can be postponed if possible. Our sense of security might not return to its previous levels for a long time. Any further incidents or reminders of our vulnerability will prolong this process.
Use rational thoughts to remind yourself not to overreact. You may find that you are more “edgy” or vigilant and react more strongly to sudden noises or other external stimuli. This is normal after we experience a trauma. However, you need to avoid becoming so sensitive that isolation begins. Maintain all of your positive social relationships.
The biggest challenge is to move beyond the immediate crisis stage when these events occur, and to begin to cope with the event in a positive way. By doing this you may be able to find some relief from the most intense feelings associated with the trauma. Getting actively involved in a cause that is meaningful to you can be tremendously therapeutic. Remember not to expect anyone to make you feel comfortable about your traumatic event. This will not happen. You can, however, find ways to relieve the intensity of your emotional pain and to minimize the impact of these events on the rest of your life.
If the level of distress seems unbearable for too long, consider a consultation with a professional or contact your Employee Assistance Program (EAP) or your school counselors. Sometimes the issues are so complicated that having a professional as a resource will help you handle the stressful events more quickly and effectively. This may be particularly important for those who have a personal history of other tragedies in their lives. In cases where your functioning is impaired or you sense that your heath is at risk, it is advisable to consult with your physician regarding medications.
Many of the recommendations listed above are practical in nature. Following these guidelines can be helpful in buffering yourself and your family from the immediate trauma and its resulting changes in your lives. However, trauma specialists often remind victims and rescue workers that they will be forever changed by these events. Once people experience severe trauma, they cannot perceive the world in the same way that they did prior to the traumatic event. We may see the world as less secure and less predictable. We need to find some way to gain a new and healthy perspective that makes sense to us, and that allows us to function well in spite of any new worries and anxieties. There is no single prescription regarding how to do this. Some will find their answers through self‑reflection and discussions with family and friends. Some may need guidance from their spiritual leaders to accept what happened and move on with life. Still others will find help through therapy to integrate these new experiences into their lives in such a way that the negative impact is minimized. Try to find an approach that fits your personal values and situation.