Adults Coping with Trauma: An Expert Perspective

Saturday, January 12, 2008

Adults Coping with Trauma: An Expert Perspective


By: Daniel S. Weiss, PhD

The psychological challenges that confront us when we are exposed to catastrophic or traumatic stress can be seen in our faces and postures almost immediately. During the recent terrorist events, hands covered mouths or eyes and faces were averted from the scene. Voices said "Oh no!!", "This can't be real", and "I don't believe it." These actions and utterances are common responses to traumatic stressors. They are the mind's automatic attempt to integrate and assimilate the brutal and initially unbelievable reality of a traumatic event, into a familiar psychological world.




Psychology's Lost its Balance
Most of us function with certain assumptions about the world and our surroundings. We assume that our worlds are safe and predictable. Exposure to traumatic stressors like the events of September 11th, or an earthquake or a flood, rudely punctures this psychological bubble of invulnerability. Our normal assumptions are ruptured, and our understanding of the "rules" of daily living are shocked and upset. The term "upsetting" is apt, because not only do we experience strong emotions in these times, we actually lose our balance psychologically. This loss of stability and psychological equilibrium are what we aim to regain as we experience the waves of emotions in the weeks and months that follow our exposure. Exactly what each of us feels will be different, but there are clearly commonalities.

One important point to know and to remember is that the natural, common, and normal reactions that you experience may feel quite painful and may make you wonder if your mind is playing tricks on you. In the vast majority of cases, your reactions are normal, even if they are very strong and upsetting.




The Reactions to Trauma
There are three kinds of experience that most people have after witnessing or being involved in a traumatic event.

Intrusion
Most disturbing to many are the vivid visual images that intrude into conscious awareness without any particular trigger. Termed "intrusive phenomena" these include experiences such as bad dreams or nightmares, anxiety or fear when exposed to reminders of the trauma, painful thoughts about what happened, and, in extreme cases, losing track of the present and feeling like what happened is happening again. These intrusive phenomena are part of the process of incorporating the distressing change in what reality is, into our world view.

Avoidance
It is also common to turn away from traumatic events and avoid coming to grips with what has happened. The avoidance can take the form of social isolation, not thinking or talking about the traumatic event, or less adaptive activities such as using alcohol or drugs to avoid painful thoughts and feelings. Frequently our own protective defenses take over, and we just feel numb.

The natural course of coming to terms with a traumatic event involves oscillating between intrusion and avoidance. We flip back and forth over the course of minutes as well as over the course of days and weeks. We think we are doing better but then we experience another wave of grief or sorrow or fear. The episodic nature of the intrusion and avoidance is to be expected and is just a reflection of the process of trying to regain psychological balance.

Hyperarousal
The third natural response to trauma is hyperarousal, and comes from the "fight or flight response", which is part of our evolutionary heritage. Those who are personally involved in a tragic event commonly experience continuing hyperarousal. This is manifest in disturbed sleep, trouble concentrating, being easily startled, and being overly watchful, on guard, and jumpy. The hyperarousal response makes sense from the perspective of natural selection-those who stayed alert and on guard after danger threatened were more likely to survive and reproduce than those who put their head back down into the sand.




Thematic Concerns
After the recent tragedies in New York, Pennsylvania and Washington DC, you may have heard a number of the following refrains:

"I feel so sad and bad for those who perished." "I'm worried that things are never going to be the same." "I'm frightened for the safety of my children-what if something else happens?" "I feel so powerless." "I want to do something, anything, to help." "I never thought that something like this could happen." "I am so enraged and furious, I'm beside myself." "My troubles feel so small in comparison, I feel guilty about asking for help." "I just had to talk to people, to tell them how I felt."

The primary task for each person who has lived through a traumatic event is to come to terms with what it means to him or her. We bring different life histories and experiences to bear, and we will not all have the same reactions. Grief, guilt, loss of control and helplessness, rage, fear, and anxiety about the event, are all common reactions after exposure to trauma.

Moreover, our main concerns may shift with the passage of time, after things have settled down, or with new information. Helplessness may turn into anger for one person, while for another the desperate need for revenge morphs into sadness and an overwhelming sense of loss and isolation. Thus, just as intrusion and avoidance oscillate and change, the preoccupations can be volatile, changing rapidly or changing more gradually.

Some mental health professionals present processes like grieving or coming to terms with trauma as following a set sequence of phases or processes. And though there are common themes, and typical symptoms and reactions to trauma, there is no universal course that recovery follows. It is important, consequently, to be comfortable with being at whatever place you find yourself, and to not be alarmed if others around you are at a different place.

Coping Techniques
One of the best ways to cope with the effects of trauma is to do something that most of us find we want to do naturally-tell our story to others who want to listen.

Communicate
Talk to those who want to and are able to listen. Be aware that there will be times when others aren't able to or don't want to listen. Similarly, listening to others will help you cope-both listening and telling bring people together, let them feel understood, and counter feelings of isolation and alienation, feelings that may easily arise after trauma. Help others if helping doesn't deplete you-but be sure to take care of yourself so you can effectively help others.

Protect yourself from information overload
Another way to cope is to turn away from the information overload periodically-turn off the television or radio, and stop surfing the Internet for the latest bulletin. Our need for information is driven by our need to regain a sense of control, but when the world is still rocking, real control is not yet available.

Be prepared for future catastrophe
Make preparations to be better prepared for future catastrophes or disasters-this is an arena in which authentic control is available. For example, for those who live in earthquake country, work out a plan to have an out-of-state point of contact, so when local phones are down, scattered family members can each call and give a location update.

Avoid 'escapist' behavior
Finally, avoid alcohol, drugs, or immersion in work as a way to distract yourself from the traumatic feelings. Better to deal with the painful feelings as they happen than to put them aside.




Seeking Professional Help
Time is the great healer for those exposed to trauma. If your reactions intensify with the passage of days and weeks and months, or your reactions simply don't begin to remit, then it is wise to consider seeking professional help from a mental health expert. In the early days and weeks after the event, medication for help with sleep can be immensely restorative-but consult a physician before taking sleeping pills.

Posttraumatic stress disorder
Those with the most intractable and severe symptoms following trauma suffer from posttraumatic stress disorder, which can be diagnosed only after at least one month post trauma.

Research in the field has shown that those with a history of prior trauma, prior adjustment problems, or extremely strong emotional reactions during and immediately after the trauma are at somewhat higher risk for posttraumatic stress disorder than others, but the increased risk is not substantial.

Some of my own work has shown that those whose reactions during and immediately after the trauma were characterized by stark feelings of unreality, palpable disconnection from bodily sensations, a sense of watching what was happening to them as if it were a movie or play, or a profound chaos and disorganization, are also at somewhat increased risk for a more difficult recovery.

Nonetheless, this same research has also shown that the vast majority of those exposed to traumatic events eventually regain their balance psychologically and move forward in the world-albeit a world that is forever different from the world they knew before the tragedy occurred.

Acceptance of the fact that the world will never be quite the same after a trauma is the most critical task of coming to terms with the trauma