DR. MARK LERNER
Empowering People Through Challenging Times
What is Traumatic Stress?
What is Posttraumatic Stress Disorder (PTSD)?
How Do People Typically Respond During a Crisis?
21 Things You Can Do While You're Living Through a Crisis
When It’s Time for a Mental Health Professional
A Personal Message for All Caregivers
What is Traumatic Stress?
Traumatic stress refers to our feelings, thoughts, actions, and our physical and spiritual reactions when we are exposed to, or witness, events that overwhelm our coping and problem-solving abilities. These events are often unexpected and uncontrollable. They compromise our sense of safety and security, and leave us feeling insecure and vulnerable. Traumatic stress is a normal response to an abnormal event.
What is Posttraumatic Stress Disorder (PTSD)?
PTSD refers to the development of certain symptoms following a traumatic event. Events that trigger PTSD are experiencing, witnessing or being threatened with serious danger to your own or another person's life or physical integrity. The traumatic event that triggers PTSD causes intense feelings of fear, helplessness and horror. People who are diagnosed with PTSD find themselves re-experiencing the event, avoiding stimuli associated with the event, and experiencing symptoms of increased arousal. The disturbance causes significant distress or impairment in social, occupational, or other important areas of functioning. Certainly not everyone who is exposed to a traumatic event develops PTSD. By reaching people early, during times of crisis, we can ease their emotional pain, keep them functioning and lessen the likelihood of chronic and debilitating traumatic stress disorders.
How Do People Typically Respond During a Crisis?
A crisis is the human response to an event, or series of events, that overwhelms our coping and problem solving abilities. There’s no standard pattern in which people respond during a crisis. Some of us respond immediately, while others may experience a delayed reaction, sometimes months or even years down the road. Some people’s reactions may last for a long period of time. For others, traumatic stress reactions are short-lived.
The following reactions/responses are frequently experienced during times of crisis It’s important to recognize that these reactions do not necessarily represent an unhealthy response. Rather, they may be viewed as normal responses to an abnormal event.
If these reactions continue to be experienced in the future and are joined by other symptoms (e.g., recurrent distressing dreams, flashbacks, avoidance behaviors, excessive jumpiness, etc.), and interfere with social, occupational or other important areas of functioning, a stress disorder may be present. Consideration should be given to consulting with a mental health professional.
Emotional Responses may include:
• shock
• denial
• dissociation
• panic
• fear
• aloneness
• hopelessness
• helplessness
• emptiness
• uncertainty
• horror
• terror
• anger
• hostility
• irritability
• sadness
• depression
• grief
• guilt
Cognitive Responses to traumatic exposure are often reflected in:
• impaired concentration
• confusion
• disorientation
• difficulty in making a decision
• a short attention span
• suggestibility
• vulnerability
• forgetfulness
• self-blame
• blaming others
• lowered self-esteem
• thoughts of losing control
• hypervigilance
• perseverative thoughts of the traumatic event
Behavioral Responses may include:
• withdrawal
• “spacing-out”
• non-communication
• changes in speech patterns
• regressive behaviors
• erratic movements
• impulsivity
• a reluctance to abandon property
• seemingly aimless walking or pacing
• an inability to sit still
• an exaggerated startle response
• antisocial behaviors
Physiological Responses may include:
• elevated blood pressure*
• difficulty breathing*
• shock symptoms*
• chest pains*
• cardiac palpitations*
• rapid heart beat
• muscle tension and pains
• fatigue
• sleep difficulty and disturbing dreams
• fainting
• flushed face
• pale appearance
• chills
• cold clammy skin
• increased sweating
• thirst
• dizziness
• vertigo
• hyperventilation
• headaches
• grinding of teeth
• twitches
• gastrointestinal upset
*These require immediate medical evaluation.
Spiritual Responses to a traumatic incident often include:
• anger and a distancing from God
• withdrawal from attending religious services
or an uncharacteristic involvement in
religious community activity
• feelings that faith practice (e.g., prayers,
scriptures, hymns, worship, communion) is
empty and without meaning
• a questioning of one’s basic beliefs and anger
at clergy
21 Things You Can Do While You're Living Through a Crisis
1. Take immediate action to ensure your physical safety and the safety of others. If possible, remove yourself from the event/scene in order to avoid further traumatic exposure.
2. Address your acute medical needs. If you’re having difficulty breathing, experiencing chest pains or palpitations, seek immediate medical attention.
3. Find a safe place that offers shelter, water, food and sanitation.
4. Become aware of how the event is affecting you (your feelings, thoughts, actions and your physical and spiritual reactions).
5. Know that your reactions are normal responses to an abnormal event. You are not “losing it” or “going crazy.” It’s okay not to be okay, right now.
6. Speak with your physician or healthcare provider and make him/her aware of what has happened to you.
7. Be aware of how you’re holding-up when there are children around you. Children will take their cues from the adults around them.
8. Try to obtain information. Knowing the facts about what has happened will help you to keep functioning.
9. If possible, surround yourself with family and loved ones. Realize that the event is likely affecting them, too.
10. Tell your story. And allow yourself to feel. It’s okay not to be okay during a traumatic experience.
11. You may experience a desire to withdraw and isolate, causing a strain on significant others. Resist the urge to shut down and retreat into your own world.
12. Traumatic stress may compromise your ability to think clearly. If you find it difficult to concentrate when someone is speaking to you, focus on the specific words they are saying and work to actively listen. Slow down the conversation and try repeating what you have just heard.
13. Don’t make important decisions when you’re feeling overwhelmed. Allow trusted family members or friends to assist you with necessary decision-making.
14. If stress is causing you to react physically, use controlled breathing techniques to stabilize yourself. Take a slow deep breath by inhaling through your nose, hold your breath for five seconds and then exhale through your mouth. Upon exhalation, think the words “relax,” “let go,” or “I’m handling this.” Repeat this process several times.
15. Realize that repetitive thinking and sleep difficulties are normal reactions. Don’t fight the sleep difficulty. Try the following: eliminate caffeine for four hours prior to your bedtime, create the best sleep environment you can, consider taking a few moments before turning out the lights to write down your thoughts, thus “emptying” your mind.
16. Give yourself permission to rest, relax and engage in non-threatening activity. Read, listen to music, or consider taking a warm bath.
17. Physical exercise may help to dissipate the stress energy that has been generated by your experience. Take a walk, ride a bike, or swim.
18. Create a journal. Writing about your experience may help to expose yourself to painful thoughts and feelings and, ultimately, enable you to assimilate your experience.
19. If you find that your experience is too powerful, allow yourself the advantage of professional and/or spiritual guidance, support and education.
20. Try to maintain your schedule. Traumatic events will disrupt the sense of normalcy. We are all creatures of habit. By maintaining our routines, we can maintain a sense of control at a time when circumstances may lead us to feel a loss of control.
21. Crises present opportunities. Cultivate a mission and purpose. Seize the energy from your experience and use it to propel you to set realistic goals, make decision and take action.
When It’s Time for a Mental Health Professional
It’s very common for people to ask when it’s necessary to turn to a mental health professional for help. Following are four basic indicators that will help you to know if you’ve experienced more stress than you can handle yourself, or with the help of your friends and loved ones:
1. Persistent suicidal or homicidal thoughts.
It’s not unusual for us to experience thoughts of non-existence, or thoughts of harming ourselves or others, particularly during a crisis. However, if these thoughts persist, and you begin to think of how and when you may act on your thoughts, pursue professional help immediately. Don’t give yourself the chance to act impulsively.
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2.An inability to care for yourself
You’re withdrawing from people, not eating, not sleeping, not taking care of your basic needs. Any one of these or a combination of several is an indication that it’s time to pursue professional help.
3. Ongoing painful symptoms
If you’re experiencing ongoing physical pain or discomfort, speak with your doctor. In the same way, if you’re experiencing ongoing painful feelings, such as panic attacks or depression, speak with a mental health professional.
4. Abuse of substances
If you’re turning to alcohol, tranquilizers or sleeping pills on a regular basis, or if you’re using drugs to “self medicate,” see a professional who can offer healthier and more effective solutions. If you don’t know of a particular mental health
practitioner, turn to your doctor, a hospital or perhaps your spiritual leader, for a referral.
A Personal Message for All Caregivers
Firefighters race into buildings, into the smoke and flames, ultimately to save lives. In the same way, I feel compelled to rush into the heat of emotions. It’s my conviction that there’s a critical opportunity to reach and help people, early on, during the most painful and challenging times in their lives. Here’s a message that I would like to leave for all caregivers who choose to help others during times of crisis....
Years ago, I was warned by an esteemed psychologist never to build a clinical practice around, or specialize in working exclusively with, people in crisis. He explained how the stress of helping others, during intensely emotional times, would be too overwhelming for anyone.
Because of my belief that crises present unique and powerful opportunities for people to grow, I chose not to heed my colleague’s warning. Instead, I immersed myself in helping people to live through and overcome adversity. I chose to focus on the healing process and the hope and potential of empowering people to look beyond today and live their dreams! This is my mission and purpose, and I’ve never found it to be overwhelming.
And another thought. There’s nothing magical about what we say or do with people during times of crisis. In fact, it’s generally not what we say that helps people the most, it’s often what we don’t say. Let’s remember that we are not experts in solving other people’s problems. No one has the right to question another person’s beliefs or to tell them how they should feel. Instead, we should strive to become experts in helping people to find the answers within themselves. We should try to give back a sense of control that their experience seems to have taken away.
Let’s support people during their crisis and help them to look beyond adversity ... toward their blessings and their unique potential.
Take care of you.
practical information