Understanding Trauma

[This article written by me was published in the Workplace Options Global Connections newsletter in April 2014 http://www.workplaceoptions.com/global-connections/spring-2014/global-connections-spring-2014-featured_1.html ]


Traumatic events can take many different forms, including an accident, a sudden death, a workplace incident, a suicide, an assault, violence, or an act of terrorism. But no matter what form these events take, they tend to come out of the blue, and are often shocking and unexpected. An incident doesn’t have to cause physical injury for it to be traumatic. Traumatic events show us how fragile life is and how little control we have, which can leave us feeling saddened and vulnerable.
It is important to remember that these reactions are completely normal. They are simply a normal person’s way of coping with an abnormal and unexpected event. Normal reactions to trauma can manifest as feelings of numbness and detachment; anxiety, depression, and sadness; guilt for being better off than others or for surviving an event; regret or shame for not reacting as one would have wished; bitterness or anger at what happened, whoever caused it to happen, or the injustice and senselessness of it all; a sense of “why me?”; fear of returning to where the incident took place or of a similar event happening again; fear of oneself, or loved ones, being harmed or left alone; or worry about breaking down or losing control.

Each person’s response to a traumatic event can be different and personal. It is, therefore, important for people to be psychologically prepared and strong by living balanced lifestyles (with enough exercise, nutritious meals, and adequate sleep) and maintaining contact with a primary social support system. Knowing one’s own personal triggers also helps in being prepared and bouncing back after the event.

Physically, normal reactions to trauma can manifest as headaches, nausea, stomach pains, tightness in the chest, muscle pain, generally feeling unwell, listlessness, increased sensitivity to noise or people, pounding heart, rapid breathing, edginess, loss of appetite, increased dependency on smoking, drinking, drugs, and more. Behaviorally, normal reactions to trauma are an inability to concentrate or make simple decisions; impulsive actions or searching for quick fixes; irritability, anger, or violence; disturbed sleep or upsetting thoughts, dreams, and nightmares; loss of interest in one’s family, friends, and daily routine; changes in sexual interest; and loss of confidence.

As counselors, it is important that we take opportunities to normalize responses. Employees may need to spend time talking to each other while processing the event. It is normal to want to share thoughts, feelings and reactions following a traumatic incident. Taking the opportunity to talk to colleagues gives a sense that one is not alone and that one’s reactions are normal.

After a traumatic incident clients may feel that the world is a dangerous place, and it will take some time for them to recover their sense of equilibrium. Individuals may experience three stages of crisis reactions to varying degrees:

• Stage 1 is dominated by emotional reactions including shock, disbelief, denial, or numbness. Physically, clients may experience a fight-or-flight survival reaction in which the heart rate increases, perceptual senses become heightened or distorted, and adrenaline levels increase to meet a real or perceived threat.
• Stage 2 is the impact stage, where they may feel a variety of intense emotions, including anger, rage, fear, terror, grief, sorrow, confusion, helplessness, guilt, depression, or withdrawal. This stage may last from a few days to a few months.
• Stage 3 is the reconciliation stage, in which they try to make sense of the event, understand its impact, and through trial and error, reach closure so that the traumatic event does not interfere with their ability to function and grow. This stage may be a long-term process.

While it is difficult to predict how an incident will affect any given individual, several factors influence the intensity of the trauma experienced. These include the duration of the event, the amount of terror or horror the individual experienced, the sense of personal control (or lack thereof) the individual had during the incident, and the amount of injury or loss the individual experienced (i.e. loss of property, self-esteem, physical well-being, etc.). Other variables include the person’s previous victimization experiences, recent losses such as the death of a family member, and other intense stresses. Counselors must encourage individuals to seek regular ongoing support if they:

• Cannot handle their intense feelings, emotions, or bodily reactions.
• Continue to feel numb, tense, confused, or exhausted.
• Feel sad or depressed for more than two weeks.
• Continue to have nightmares and a poor sleeping pattern.
• Keep making mistakes or have accidents.
• Are smoking, drinking, or taking drugs in excess.
• Are suffering in their performance or in their relationships.
• Have weak social linkages and no person or group with whom to share their emotions, and feel the need to do so.

Dos and don’ts in supporting clients who have faced trauma

• Understand that everyone reacts differently to trauma, so don’t question why someone is reacting in a particular way.
• Give time and permission to feel out of sorts, anxious, or sad. It’s part of the healing process.
• Encourage clients to look after themselves, taking time out to rest, sleep, eat, think, and care for self.
• Ensure clients try to maintain their regular routine as much as possible and make daily decisions which will give them a feeling of control over their lives.
• Caution clients to be more careful around the house and to drive more carefully. Accidents are more common after severe stress.
• Help clients to express their needs and emotions clearly and honestly, and keep regular contact so that they can give you feedback on how they’re doing.
• Encourage them to spend time and share feelings with others who care and not to isolate themselves.
• Don’t let them bottle things up. Nudge them to allow their feelings to come out by talking, crying, sharing their thoughts, or writing them in a journal. Let children who are affected talk about their emotions and express themselves in games and drawings.
• Remind clients that they are the same people that they were before the event.
• Remind them that there is light at the end of the tunnel.
• Reiterate that support is available, if they find things difficult.
• Discourage them from numbing the pain with drugs, alcohol, cigarettes, or coffee. These will create more problems in the long term.
• Don’t force exposure to the reality. Advise them to limit their time around the sights and sounds of what happened. Don’t dwell on TV, radio, or newspaper reports on the tragedy.
• Discourage them from making big life changes or snap decisions until they are sure they have fully recovered from the event.
• Don’t let them fight recurring thoughts, dreams, or flashbacks. These are normal and will decrease over time.