Helping yourself and others following disaster and trauma

Traumatic events are relatively common, with around two thirds of Australians likely to experience or witness an event which threatens their life or safety, or that of others around them. Such events include things like serious accidents, physical or sexual assault, or natural disasters such as bushfires or floods.  Professor Mark Creamer from the Australian Centre for Posttraumatic Mental Health at the University of Melbourne emphasises that most people recover from these experiences with the help of family members and friends without developing mental health problems.

"People who go through a traumatic event may find it hard to cope and it may take a while to come to terms with what has happened," says Professor Creamer. "Emotions such as fear, shock, sadness, guilt, frustration, anger, helplessness and numbness are common in the early days but for most people these emotions will gradually become less intense in the weeks after the traumatic event." 

The good news, says Professor Creamer, is that there are many ways in which those affected by trauma, their friends and family, and health professionals can aid the recovery process.

1. What helps immediately following a traumatic event?

Everyone has their own way of recovering from trauma; there is no standard recipe for how to cope. Assistance in the immediate aftermath of a traumatic event generally involves both practical and emotional support, and ongoing monitoring. This is sometimes referred to as psychological first aid.  Since social support is important in helping people recover, health practitioners generally encourage people affected by trauma to seek the support of their family, friends, and community groups.

Emotional recovery is not something that happens all at once, nor is it straightforward. Associate Professor David Forbes, also from the Australian Centre for Posttraumatic Mental Health, notes that emotional recovery is different from recovering from a physical illness.

"Recovery does not mean that all the pain associated with the experience will disappear," said Dr Forbes. "Rather, it may mean having less intense reactions to stress and reminders of the trauma, an improved ability to manage problems and more confidence in your ability to cope."

2. How you can help yourself

If you have been affected by trauma, there are several things you can do to aid your own recovery. Even if you feel unmotivated and apathetic, try to do some of the things below. They will help you begin to come to terms with the traumatic event and to reduce some of the emotional pain associated with it.

• Recognise that you have been through an extremely stressful event. Give yourself time and space to acknowledge what you have been through and that you will have an emotional reaction to it. Give yourself permission to feel rotten but don’t over-react – it is unpleasant but you can cope with it.
• Look after yourself: get plenty of rest, even if you can’t sleep, and try to eat regular, well-balanced meals. Regular exercise, like walking, cycling or jogging, is very good at reducing the physical effects of stress and trauma; try to do a little every day. Relaxing activities such as listening to music, yoga, meditation, or taking a hot bath may also be of use.
• Cut back or cut out tea, coffee, chocolate, cola and cigarettes. Your body is already ‘hyped up’ and these substances will only add to this. Do not try to numb the pain with drugs or alcohol; this will lead to more problems in the long term.
• Spend time with people you care about, even if you do not want to talk about the event. Contact friends and, if necessary, have someone stay with you for a few hours each day. Sometimes you will want to be alone; that’s ok, but try not to become too isolated.
• Recurring thoughts, dreams and flashbacks are normal. Don’t try to fight them. They will decrease in time. Try not to block them out or bottle up your feelings. Confronting the reality, bit by bit, will help you to come to terms with the experience.
• Be more careful than usual, for example when cooking, driving, or using machinery. Following a trauma, we are more vulnerable to accidents and physical illness.
• Try to resume a normal routine as quickly as possible, but take it easy; do not throw yourself into activities or work in an attempt to avoid the unpleasant feelings and memories. Tackle the things that need to be done a bit at a time and count each success.
• Avoid making any major life decisions, such as moving house or changing jobs, in the period following the trauma. On the other hand, make as many smaller, daily decisions as possible, like what you want to eat or what film you’d like to see. This helps to re-establish feelings of control over your life.
• A traumatic event can have an impact on how you see the world, your life, your goals and your relationships. Giving yourself time to re-evaluate what you think and talking to others about it may help.
• You may wish to provide support to others who have been through similar situations, especially as you start to feel better.

3. How you can help your loved ones

If you have a friend or family member who has been affected, you can help by:

• Recognising that they have been through an extremely stressful event. They may need time and space to acknowledge what they have been through. You can help by offering practical support with things like caring for children or grocery shopping.
• Offering to keep track of the news and to inform them of new information so that they do not feel the need to monitor it continuously. While it is important for people to keep informed of the facts, it is not good to focus too much on media accounts of the event.
• Encouraging them to re-establish normal routines as quickly as possible; this helps to restore a sense of order and control in their life. Help them to start with small daily goals and to recognise each success. Equally, don’t allow them to throw themselves back into activity as a way of avoiding unpleasant feelings or memories; encourage them to slow down.
• Helping them to think through decisions, but don’t make decisions for them. Advise them to avoid making any major life decisions in the period following the trauma.
• Encouraging them to think constructively about their lives. Help them to plan things that they want to do and to acknowledge their success in coping so far. For example, ask questions such as: "Are there any things that you think would help you to feel better, anything that I can get for you or do for you? Do you have any concerns or problems that we could sort out together? What have you done in the past to make yourself feel better when things got difficult?"

Your friend or family member might want to talk to you about their experience or feelings. Try to listen. If possible, choose a time and place to talk where you won’t be interrupted and when neither of you is rushed or tired. You might want to reassure the person that emotional pain is to be expected after such events. Even when coping well, things can be hard.

Professor Creamer says that talking itself may be painful and the person may get upset. "But this is a natural part of coming to terms with trauma," he says. "Don’t feel that you have to make the distress go away. If it seems like the person has had enough, you could offer to continue another time."

Listening is very important, but sometimes it is hard to know how to respond. Don’t feel that you have to say ‘the right thing’; there is no right thing to say but here are a few pointers:

• Listen intently if they talk to you about their experience. Try to work out why they wanted to tell you each particular piece of information. Try to put yourself in their shoes. Don’t interrupt, offer examples from your own life, or talk about yourself. Try to avoid offering simple reassurances like "I know how you feel" or "It’s all going to be ok".
• Gently encourage them to talk, or to continue talking, by asking leading questions like: "Would it be helpful to talk about what happened? What are the main things worrying you at the moment? You’ve had a rough time, how are you going? How is (Fred) going?"
• Respond with statements like: "It’s really tough to go through something like this; This is such a difficult time for you; Sometimes situations like these can be overwhelming and it’s hard to see a light at the end of the tunnel."
• After listening to what the person has told you, you can show them that you understand by reflecting what they said or re-phrasing the information they gave you. You might start your response with something like: "You seem really…; It sounds like…; Did I understand right that you…; No wonder you feel…"

If the person doesn’t want to talk about the experience or their feelings, don’t force it. Just try to be with them and focus on practical help, and other topics of conversation. Let them be alone for awhile if that’s what they want. However, it is a good idea for them not to get too isolated and to have some company for some part of each day.

4.  What are posttraumatic mental health problems?

While the majority of people will come through the worst of their post trauma difficulties within the first fortnight or so, some people will face ongoing problems. Posttraumatic mental health problems include a range of reactions to a traumatic event, including anxiety, depression, posttraumatic stress disorder (PTSD), and risky alcohol and drug use, as well as difficulties with relationships, work, or study. These problems do not only affect the individual, but can have a significant impact on family, friends, and carers.

5.  When to get further help

With the support of their family and friends, most people will recover and will not need professional help. However, it may be necessary to seek further assistance if initial distress has not reduced after two weeks; if an individual feels highly anxious or distressed; has reactions to the event that are interfering with home, work or relationships; or is thinking of harming themselves or someone else. 

Dr Forbes says that GPs are a good first port of call. "They can determine if there is a problem, what the best approach might be, and provide referrals to mental health professionals such as psychiatrists, psychologists and social workers if need be," he says.

For more information, see Disaster Recovery: Psychological First Aid.

(Source: Australian Centre for Posttraumatic Mental Health: February 2009)