Coping with Traumatic Stress

Ottawa Operational Stress Injury Clinic

Dr. Michele Boivin, Psychologist

Dr. Luis Oliver, Psychologist

Dr. Sarah Bertrim, Psychologist

Mr. Alasdair Gillis, Social Worker

Overview • What is trauma?

• How do people react to traumatic events? – What is a ‘normal’ reaction?

– What are the signs that someone is struggling?

• What is a traumatic loss?

• How do people grieve?

• How can I cope with what I have witnessed?

• How can I help someone else cope?

What is Trauma? • Exposure to actual or threatened death, serious

injury (accident, assault, torture), sexual violation

• Exposure can be:

– Direct

– Witnessed

– Learning of an event that happened to a loved one

– Repetitive exposure to details of the event

DSM-V

Common Reactions to Trauma Thoughts:

• Unwanted thoughts

• Nightmares

• Poor concentration

Emotions:

• Fear and anxiety

• Anger

• Irritability

• Guilt / Shame

• Grief

• Sadness

Physical symptoms: • Insomnia • Changes in appetite • Nausea • Fatigue • Tension • Headache

Behaviours: • Effortful avoidance • Withdrawal • Alcohol or substance use • Checking / vigilance

Prevalence of Trauma vs. PTSD

Natural recovery

• Transient symptoms are normal

• Among those who will recover, symptoms begin to decline within several weeks of the trauma

• Most natural recovery occurs within the first year

• Recovery is associated with reestablishing previous activities

Impediments to natural recovery

– Ongoing avoidance

– Being extra careful /safe

– Trying to push away thoughts & memories

– Distraction / keeping very busy

– Ruminating – thinking and re-thinking

– Vigilance – looking for signs of threat

– Alcohol/medication use

– Giving up enjoyable activities

Traumatic loss Duke University Health System, 2005

• Traumatic death is:

– Sudden, unexpected, or violent

– Caused by the actions of another person, an accident, suicide, natural disaster, or other catastrophe

Common Reactions to Traumatic Loss Duke University Health System, 2005

• Shock: Difficulty accepting the loss really happened, prolonged memories or dreams of the event

• Fear and anxiety: Feeling unsafe during normal activities, worrying about what could happen

• Anger: Feeling out of control / helpless

• Guilt: Regret about what one has done or not done, guilt about surviving / going on with life

What can you do?

Grieving a traumatic loss

• Grief is unique – there is no ‘right way’

• Connect with support systems

• Collective grieving: vigils, spiritual services, recollections of individuals who died

• Individual grieving: Continuing with old traditions or establishing new ones, finding ways to remember, allowing a range of emotions

• Maintain self-care

• Eventually, reengaging in activities

Creating a meaningful legacy

• In the early aftermath this can be difficult to even imagine

• A tragic event can leave us doubting our purpose or question meaning in life

• It isn’t useful to try to find a positive interpretation of the event itself

• In time it can help to find personal meaning from a loss and create a positive legacy

– Ways to make the world better

– Refocusing on values and meaningful activity

Helping traumatized individuals: Strategies for First Responders

• Psychological Debriefing / Critical Incident Stress

Management has been widely applied in these situations

• Available evidence suggests that this method is at best

inert and at worst harmful

• Current best practices suggest Psychological First Aid

and focus on immediate needs for comfort, housing,

medical care etc.

Short Term (first few weeks)

• “Psychological First Aid”

• Safety planning and emergency stabilization should precede psychological factors (Resnick et al, 2000)

• Goal: – Assist individual in feeling connected, validated, safe

– Provide education about signs that would warrant seeking help

– ‘Plant seeds’ rather than initiate long term contact

Litz 2008

Psychological First Aid • Do’s:

– Offer group support

– Offer opportunity for individual meetings for those uncomfortable in group setting

– Review of event (provide basic details of what occurred)

– Offer opportunity to discuss experiences if desired

– Provide information/handouts on trauma, where to obtain care

– Discuss what they could expect from treatment

Helping traumatized individuals: Strategies for Significant Others

Do’s • Listen

• Be available consistently

• Understand & normalize common trauma reactions

• Accept initial coping– (most) anything goes in the first few days

• Encourage use of natural supports over therapy

• Limit exposure to media accounts

Don’ts • Minimize (it will be okay,

they’re in a better place)

• Take control over their wellbeing

• Give advice

• Judge

• Pathologize a normal reaction

• Personalize reactions

Exceptions – When to seek help right away

• Thoughts of harming oneself or someone else

• Excessive alcohol or drug use

• Dangerous/risky behaviours

• Inability to care for oneself or dependents

Risk factors for PTSD

BEFORE:

•Family history

mental illness

•Previous Trauma

•Previous

maladjustment

DURING:

•Perceived life

threat

•Intensity of

emotions

•Dissociation

AFTER:

•Lack of social

support

•Life stressors

•Early

symptoms

When to consider more support

Posttraumatic Stress occurs when we start to organize our lives around the trauma (Briere & Scott)

• Duration - more than one month, most of the time

• Intensity – distress (anxiety, sadness, grief, shame) is significant

• Impairment – relationships, activities, work, self-care

Accessing Resources • Natural supports: family, friends, coworkers, clergy or

community groups, if relevant

• Family physician (referral)

• Employee Assistance Program

• Registered mental health professionals:

– Check college websites for information about psychologists, psychiatrists, social workers

• OSI Connect app: self-screeners, information for professionals, other resources online

Crisis management for Immediate needs • 9-1-1 or Emergency Department

• Mental Health Crisis Line 1.866.996.0991

• Ottawa and the counties of Prescott Russell, Renfrew and Stormont Dundas and Glengarry 613.722.6914

• Leeds & Grenville district 1.866.281.2911

• Pembroke Regional Hospital Mobile Crisis Team 613.732.3675 ext. 8116 or 1.866.996.0991

• Youth Services Bureau 24/7 Crisis Line 613.260.2360 or 1.877.377.7775

Q & A