Taking Care of Others after Trauma

People often worry about how to help others after something traumatic has happened to them. If you happen to be “on the scene” at a traumatic event, you may feel that you don’t know what to do to help others. If someone you know is going through a hard time after a traumatic event, you might worry that you are just “getting in the way” and “intruding”, or that you will say the “wrong thing”.

As a general guide, think about what you would need or want from a friend after a similar traumatic event. How would you want someone to treat your brother or sister if this had happened to them? This may help you figure out how to best support others. Two important things to remember are:

You are not responsible for taking away their pain.
You are not responsible for having the “right answer” to any questions they may ask about the event, why it happened, or what it means.
Generally, people will appreciate your caring presence and your good intentions. Here are some ideas you may find useful if you are trying to help and support someone else after they have experienced trauma.

Do…

If you are on the scene and don’t know the person involved, introduce yourself and offer to assist.

Determine their role in the disaster/traumatic event. Were they a witness, a victim, a relative, or a friend? Are they injured and do they need immediate medical attention? Are they missing a loved one who was involved in the disaster?
If it is safe and appropriate, remove the person from the direct vicinity of a stressful situation and protect them from curious bystanders and the media.
Offer to contact a friend or loved one for them. If appropriate, let that person know where they can meet you.

If you leave a highly distressed person, make sure someone else is there to stay with them. If possible, connect them with a mental health professional on the scene.
If appropriate, inquire about what happened and how they’re doing. Allow them to talk about their experiences, concerns, and feelings if they wish. Don’t force them to do so.

When appropriate, discuss normal stress reactions. Review what you know about normal physical, mental, emotional, spiritual, and behavioral symptoms of trauma. Reassure them that any stress reactions they experience may be normal and will probably pass in time. Recognize that the victim may be shaken and shocked, especially during the first 24 hours after the event. He or she may have trouble concentrating on what you’re saying, so keep anything you say fairly short and simple.

Discuss coping strategies and practical plans for the next 24-48 hours. Help the person focus on this immediate time period. Think about how they are going to do simple things like get home, prepare food and eat, and soothe themselves. Determine who will be with them and who they can call if they feel upset or scared. This can be especially important for people who live alone.

Assist the person in making decisions, if necessary. You may need to make decisions for them. More often it is enough to be with them and provide a rational sounding-board while they make decisions about things like medical insurance, statements to the police, who should be contacted, and what they should be told. Simply being a sensible and calming presence can be an invaluable gift to individuals who are shaken and distressed and who are not sure that they’re doing or saying the right things.

Listen carefully. If it’s someone you know well, don’t be afraid to ask what you can do to be helpful and take your cues from them.

Assist with practical tasks. Help with everyday tasks like cooking, cleaning, and supervising children. These activities can help relieve some of the burden for people who are feeling overwhelmed by life. However, beware of walking in and “taking over” in these areas. Sometimes people who have been through a traumatic event will find things like cooking or spending time with their children the best way to care for themselves.
Don’t…

Don’t assume that the person who’s just experienced a traumatic event is unaffected and thinking clearly simply because they appear calm.
Don’t say something like, “you’re lucky it wasn’t worse”. If the victim expresses this sentiment it’s generally safe to agree with him or her. But remember that some people will feel hurt and annoyed by this statement. Instead, you can express support by simply saying things like, “I’m so sorry this has happened to you,” and “you’re safe now”.

Don’t take their anger or other feelings personally. People who have just experienced a traumatic event may feel overwhelmed by intense emotions, including anger. Sometimes that anger can be directed towards you, even when it seems irrational. This can be hurtful and difficult, but try to stay calm and remember not to take it personally.

If you have been helping someone involved in a traumatic event, don’t forget that you will be impacted by hearing the details of their experiences and being a close witness to their pain, grief, and confusion. Do not forget to review your own coping strategies, and take time to care for yourself after you have spent time caring for other people. For more on this topic see our online training module on Vicarious Trauma.


For personal reflection…

What are some other ways to support someone who has been through a traumatic event, either at the scene or in the days and weeks after the event? Write down a list of specific things that might be appropriate.
What do you find hardest about supporting people who are going through a difficult time? What feelings and thoughts does it stir up in you?
What are some helpful ways you typically deal with these thoughts and feelings? What else might help you after you’ve spent time caring for someone who is traumatized or grieving?

Taking Care of Yourself after Trauma

Taking care of yourself after traumatic events

When you experience a traumatic event, your body goes into a state of high-alert. It's normal to experience some symptoms of stress and trauma as a result. These symptoms usually subside or disappear with time. However, you can take steps to help your body cope with trauma reactions so that you don’t remain in a state of emergency-preparedness longer than necessary. Here are some suggestions for taking care of yourself in the days and weeks after you have experienced a traumatic event.

Do…

After a traumatic event it may be helpful to:

Review what you know about stress, trauma, and coping. Remind yourself you may be experiencing normal reactions to an abnormal event.
Get some exercise. Moderate to intense exercise within 24 to 48 hours after a traumatic event helps your body use up some of the hormones and chemicals that were released during the event to prepare us for action. This helps restore hormonal equilibrium in your body. However, you should exercise within your normal limits. If you’re not used to exercising, consult your doctor first.

Be extra careful. Avoid tasks and activities that are too demanding or require intense concentration (like balancing a budget or completing intricate or dangerous physical tasks like de-mining). After a traumatic event you may not be able to focus and concentrate normally. Your risk of making mistakes is higher than normal.

Try to maintain a normal, active, and productive schedule. Modify your schedule according to your needs and take into account some of the other suggestions in this list. But, remember that accomplishing some normal and practical tasks (like work or caring for children) may provide structure and normalcy that can be beneficial in the long run.

Allow yourself extra time to accomplish ordinary tasks. Try to maintain a normal routine, but focus on tasks that don’t require a lot of thinking and can be completed in a short time.
Structure your day so that you spend some time alone and some time with others. Spending time with family and friends can be very important and may help you feel less isolated. On the other hand, you should avoid constantly surrounding yourself with people. This can be a way to avoid thinking about what happened.

Give yourself permission to avoid people you find draining and depressing. During the days and weeks following a traumatic event, it is okay to take care of yourself by letting the answering machine pick up the phone for you. Politely tell people that you’d rather talk about something else if you don’t feel like discussing what happened. This is your time to take care of yourself first.

Communicate. It can be helpful to talk about your experiences and reactions with people you know, trust, and like. It can also be helpful to talk with a counselor. Sometimes doing this is easier than sharing distressing details with close family and friends.

Write about your experiences and reactions. Research has shown that it can be therapeutic to write about your experiences and feelings after a traumatic or distressing event.
Help yourself relax by doing things you enjoy. This can include things like reading, writing, physical activity, visiting someplace beautiful, or watching movies.

‘Work’ to relax. Set aside some time to experiment with various relaxation strategies, including therapeutic massage, yoga, progressive muscle relaxation, and warm baths.
Get plenty of rest. Take time to rest even if you can’t sleep. Remember that sleep disturbances and changes in sleeping patterns are common with trauma.

Eat good, well-balanced meals. Eat regularly even if you’re not hungry.
Make decisions about routine daily events. Make decisions about small things like what you will eat for lunch, even if you don’t feel like it. This will help bring back some feeling of control over your life.

Contact a mental health professional. Contact a counselor if you feel especially overwhelmed or in need of some extra support during this time.
Don’t...

There are some coping mechanisms (like alcohol) that can feel very effective at helping you deal with with the immediate pain of trauma. These activities and substances can provide excitement, mood-enhancement, a means of escape, and short-term relief from tension. In the long-run, however, these coping strategies can backfire and actually increase your distress. Other examples of coping strategies that have the potential to become self-destructive include gambling, thrill-seeking, food, rage, excessive spending, sex, deliberate self-harm, overwork, and isolation by withdrawing from the people you care about (Lewis, Kelly & Allen, 2004). After you have experienced a traumatic event, it is wise to be aware of how you use, or abuse, any potentially unhelpful coping strategies.

Here are some things to avoid after a traumatic event (especially during the first couple of days following the event):

Don’t label yourself crazy or weak. Acknowledge that what you are experiencing may be normal reactions to an abnormal event.
Don’t make any big life decisions or changes. Don’t make decisions about things like quitting your job or getting a divorce, especially within the first couple of days or weeks after a traumatic event. You are probably not at your best, and this is not an ideal time to make important decisions.

Don’t increase your use of alcohol, drugs, gambling, smoking, etc. in the days following a traumatic event. These may help you feel better in the short-term, but they will only exacerbate problems (or create new ones) in the long-term.
Don’t use too much caffeine and other stimulants. Your body is already ‘hyped up’, and these substances will only increase your level of arousal.
Don’t try to “just forget” about the event. Don’t try to avoid all thoughts and feelings about the event by working more than usual or doing other things to ensure you stay distracted all the time.

Don’t cut yourself off from the people around you. Even if you don’t talk to them about what happened, spending time with other people can be helpful. Try to spend some of your time with people you like who help you feel safe and anchored in the present.
Don’t watch violent movies or TV shows or read books that are graphically violent. This can trigger distress related to the traumatic event you have just experienced.

Dealing with distress

If you feel distressed, anxious, or agitated, and you aren’t sure what to do to help yourself feel better, here are some suggestions that might help:

Allow yourself to cry.

Write, draw, or use another medium that allows you to express your feelings without putting them into words.

Do a repetitive activity that you find absorbing or soothing. For example, try solitaire, computer games, puzzles, soduku puzzles, gardening, or rocking in a rocking-chair.

Talk to a counselor, trusted friend, or family member.
Read.

Watch a movie.

Spend time outdoors among nature.

Try visualization exercises. For example, visualize putting the distress in a container, closing the lid, and putting it somewhere safe so that you can come back to it at another time. Alternatively, try visualizing yourself in the safest and most peaceful place you know.

Exercise.

Count to yourself and concentrate on feeling your heart beating. After a couple of minutes of this, you may notice that your heart rate slows down and that you feel calmer.

Focus on your breathing, and practice deep-breathing exercises. If you don’t know any, focus on breathing slowly, deeply, and deliberately from your stomach. After a couple of minutes, you may notice that your heart rate is slowing down and that you feel calmer.

Hold an object that’s special to you and that soothes you.
Listen to relaxing music.

Take a warm bath or shower.

For personal reflection…

When you experience distressing emotional states, what strategies do you tend to use to help you cope that could potentially damage your body, sense of self, or emotional functioning (e.g., alcohol, gambling, thrill seeking, rage, food, sex, deliberate self-harm, withdrawing from people you care about, and/or over-work)?
Who do you find easiest and most comforting to be around when you’re feeling isolated and depressed?

What helps you feel better when you’re feeling sad and down? What helps you calm down when you’re upset? Make a list of these activities and keep it somewhere where you can either see it or access it easily. The more distressed you are, the harder it is to remember to take care of yourself properly. Thinking about this in advance means that you will have a number of helpful options to choose from.

Know the Signs of Trauma

People often wonder, “If most trauma reactions are normal and will pass by themselves in time, how do I know when I should seek professional help?”

That’s a good question. On one hand, the reactions you are experiencing may subside by themselves during the days and weeks after an event if you:

Recognize that the trauma reactions seem to be normal responses to abnormal events.
Take some time to care for yourself.
Have supportive people around you.
On the other hand, just like it’s sensible to check in with a doctor when you’ve got a severe case of the flu, talking to a trained counselor after a traumatic event can be very helpful. There are also some trauma reactions that require you to seek help from a mental health professional. To continue with the medical analogy, these severe trauma symptoms suggest that your case of the flu may have been complicated by pneumonia. If you catch pneumonia, you need to see a doctor. And if you experience any of the following severe trauma reactions, you should contact a mental health professional. Likewise, if you observe these signs in someone else who has experienced a traumatic event, you should strongly encourage them to contact a mental health professional.

The following may be signs of a severe trauma reaction:

Suicidal thoughts
Feeling as if you might be a danger to yourself or others
Heart palpitations, chest pain, trouble breathing or other potentially serious physical symptoms (contact a physician immediately)
Severe psychological symptoms, including:
Flashbacks
Amnesia
Enduring feelings of unreality and “disconnection from the world”
Feeling completely overwhelmed or paralyzed
Feeling that you cannot handle the intense thoughts, feelings, and bodily sensations alone
A history of mental illness and psychiatric treatment
Substance abuse (e.g., consistently using alcohol or sleeping medication to help you sleep)
Feeling that your emotions are not “falling into place” over time and experiencing chronic tension, confusion, emptiness, and exhaustion
Noticing that your relationships are suffering and/or sexual problems are developing
Driving yourself to stay active all the time to avoid your feelings
How do I find professional help?

Many humanitarian workers live and work in places where contacting a mental health professional is difficult. Begin by contacting the Human Resources department of your employer. They may be able to refer you to an appropriate person or resource.

Do I Need Medication?

Drug therapy generally is not used for the management of daily life stresses such as work- or family-related stress. Stress is a part of life, and we all will experience stress throughout our lives to various degrees, just as we will experience joy, contentment, disappointment, sadness, and other emotions.

However, sudden catastrophic or tragic events and losses can precipitate a temporary severe, often unmanageably high, level of stress. Examples range from the loss of a loved one or relationship to being fired or being a victim of crime. In these cases, doctors often recommend treatment with one of the antianxiety medications or another type of drug. Medications should only be prescribed on a temporary basis for short-term relief of severe stress symptoms. Additionally, stress may worsen symptoms in many people with underlying emotional conditions (such as depression, substance abuse, obsessive compulsive disorder, and other conditions). These people may need to be treated with antidepressants or other medications on a long-term basis to help them manage the effects of stress on their condition.

http://www1.nmha.org/infoctr/FAQs/medicationInfo.cfm


Please use the related Links on this page and the articles on the left of this page for more information.
HELP

Impact of Bullying




What is Bullying ?
Many definitions of bullying will describe it as intimidating, abusive, malicious, offensive behaviour that is intentional, persistent and repeated, directly or indirectly on an individual or group.

In some cases bullying can be covert and subtle, but nevertheless still has the power to exert hurt and distress on the recipient.

Bullying can take many forms, but its aim is always to make the person feel afraid, intimidated or upset.

Most common forms of bullying include:
Physical : pushing , shoving, kicking or hitting
Verbal : name-calling, teasing, insults, humiliation
Emotional: making threats, spreading rumours, excluding, ignoring, undermining
Sexual : ranging from unwanted advances to serious sexual assaults – rape
E-Bullying: sending threatening or upsetting messages or images

Consequences of Bullying Behaviour
Physical Impact
High level of stress and anxiety
Headaches, migraines
Fatigue, exhaustion, tiredness
Sleeplessness, nightmares
Illness – colds flu, infections
Changes in appetite
Increased use of alcohol
Socially isolated by choice or circumstance

Psychological Impact
Loss of confidence and self –esteem
Loss of trust in self and others
Withdrawn and quiet
Hypersensitive and hyper vigilant - constantly on edge
Obsessive thinking – cannot get bullying out of your mind
Psychological ill-health- depression, anxiety, panic attacks
Self-harm
Suicidal ideation
Contributory factor to suicide

Academic Impact
Poor performance and productivity
Absenteeism and poor attendance
Missing deadlines
Lack of concentration
Impaired ability to retain or absorb information
Difficulty in handling equipment
Deterioration in relationships with friends and colleagues
Robs you of time in college

Strategies for dealing with Bullying
Talk about what has happened to you. Remember the bully thrives on secrecy.
Seek help and assistance.

Bullies can be devious and you may need support.

Keep a written account of everything that happens to you. Be clear about the facts of each incident

Keep copies of e-mails, memos letters etc. sent to you. When confronted bullies tend to deny what they do.

Be informed on anti-bullying policies and procedures. Know your rights. When in doubt seek expert advice.

If you choose to confront the bully do so in a planned and assertive way. Bring someone with you, choose the time and place carefully

Focus on the behaviour, state how it has affected you and request clearly what you want changed.

Keep a written account of this interaction for further reference.

The first thing to know if you suffer from such incidences is that you are not alone. Many laws have been passed to support you in both the workplace and educational institutions. Feel free to contact me and take your time going through the articles on this site and the links attached.


FEAR! Useful or Just Scary

Is Fear Useful, or Just. . . Scary?
By Daniel Robin

How do you now deal with fear at work? This article pinpoints the types of fear that cause needless suffering, and advocates workplaces that consistently maintain an "absence of threat."


For better or for worse, we all bring our personal history to our workplace relationships. Many of us learned "fear tactics" from our parents, who, with good intentions and limited options, used threats to get us to obey their authority. This just doesn't work. When such authority is imposed at work, it not only destroys morale, but left unaddressed, breeds office politics, CYA, turf wars, entrenched negativity. . . reinforcing a cycle of mistrust.

In many workplaces, this unfortunate pattern begins when employees are afraid to ask questions or shy away from asserting their truth. Pride and trust are undermined, and relationships turn sour. So what are we dealing with here? Are there different "types" of fear: some you can count on (like feelings of apprehension during a performance review) while others are indicative of a broken process ("I can't speak up; they'll fire me!")?


Is There Anything Good About Fear?

Surprisingly, many executives quietly (perhaps unconsciously) assume that fear is "good" -- or inadvertently cause fear in others in an attempt to motivate. Think about it. If you wanted something done and encountered resistance, certainly one way to "inspire" action is to highlight the consequence of not doing it, making that more distasteful than the resistance. And will that work?

Make no mistake: externally imposed fear is not an effective motivational tool. Though it may yield short-term gains, it usually backfires. This practice, part of the legacy of traditional hierarchies, prevents people from doing their best. A study of 580 companies by the American Quality Foundation found that imposed fear is simply destructive. . .it either inhibits or causes overreaction such as knee-jerk resistance. Speak up about it and interrupt the cycle.

Whose Motives are These?

Instead of extrinsic motivation, when you have a goal that involves other people, demonstrate leadership by tapping into the vast ocean of intrinsic motivaters. Guess what? People are already motivated, and wise leaders need only harness that already exists. If you get resistance, tap into and understand that, too. People are far more likely to go the extra mile when they see a genuine concern for employee well-being -- not the often heard "You'd better. . . or else. . . and that's final."

On the other hand, fear that comes from within you -- such as a concern that you might not meet a deadline you voluntarily agreed to -- produces discomfort or anxiety and if it doesn't cause overwhelm, will inspire action.

Manageable, self-imposed fear acts as the fuel for change or improvement. It propels us forward and helps us move through stuck points or avoid hazards. It is a natural part of learning. But if I'm concerned about being judged or penalized or fired. . . I'm not going to learn, and I might not even hang around, let alone perform well.

So if we can fully commit to building a workplace culture where externally-imposed fear is headed for extinction, we'll all win.

What Can Be Done To Handle Fear?

First: Acknowledge what you don't want. Second: Decide if there's anything you need to do to prevent that downside. Third: If so, formulate a plan to handle it; if not, find a way to live with (come to terms with) the downside -- even if it never comes to pass, at least you'd know you could handle it if necessary.

Let your response to fear teach you what it's like to be fully present. Help the leaders understand the impact of their behavior. By the way, do remember to breathe!