Self-Care and Self-Help Following Traumatic Events
Traumatic events can cause people to feel angry, frustrated, helpless,
and afraid. They can also make people want to seek revenge. Studies
have shown that acting on this anger and desire for revenge can
increase feelings of anger, guilt, and distress rather than decreasing
them.
However, there are strong mechanisms that contribute to natural
recovery from traumatic events. Many trauma experts (Staab, Foa,
Friedman) agree that the psychological outcome of our community
as a whole will be resilience, not psychopathology. For most survivors,
symptoms of fear, anxiety, re-experiencing, urges to avoid, and
hyper-arousal, if present, will gradually decrease over time. This
is true not only of communities as a whole facing natural or unnatural
disasters, but also of individuals, such as surivivors of domestic
violence and similar events, eg. stranger rape.
Coping Strategies
There are a number of common strategies that individuals utilize
when coping with extraordinary stress in their lives. These strategies,
while effective at manageable levels of stress, can become unproductive
or detrimental when stress reaches overwhelming or traumatic levels.
It is important to remember that individuals have their own way
of and pace for processing traumatic events, and each individual
must listen to and honor his or her own pace and way. It is suggested
that survivors monitor their reactions and increase the coping strategies
that have worked in other stressful situations.
Research on individuals with positive responses after a traumatic
event indicates that their preferred coping mechanisms are to:
-
When problem-solving, focus on brief time intervals (e.g.,
think only about what the next step is), or focus on a larger
time interval to obtain a less devastating picture of the trauma
(i.e., as one tragic event in a full and meaningful life)
-
Maintain a view of oneself as competent and a view of others
as willing and able to provide support
-
Focus on the current implications of the trauma and avoid
regretting past decisions and actions
(Horowitz, 1986)
The process of converting traumas into growth experiences
has the following characteristics:
-
It is usually done by the individual alone, but confidants
can also suggest new ways of viewing the situation.
-
It usually occurs between 2 weeks and 4 months following the
stressor.
-
It can enhance one’s ability to cope with subsequent
stressors.
-
It usually depends more on an individual's psychological resources
than on the characteristics of the stressor event.
-
It is intuitive, rapid, and sudden rather than being an extended
logical thinking process (i.e., it is characterized by sudden
insight and revelation).
(Finkel and Jacobsen, 1977)
Specific Coping Strategies for Traumatic
Stress and PTSD Symptoms
Positive coping actions are those that help to
reduce anxiety, lessen other distressing reactions, and improve
the situation in a way that does not harm the survivor further.
These types of coping actions improve things not only for today
but for the future as well. Positive coping methods include:
using natural supports and talking with friends,
family, support group and coworkers at your own pace. It is helpful
to follow one's own natural inclination with regard to how much
and to whom you talk.
learning about trauma and PTSD. It is useful
for trauma survivors to learn more about trauma and PTSD and how
it may affect them. Learning how common PTSD is and finding that
these problems are shared by hundreds of thousands of survivors
of trauma can help people with PTSD recognize that they’re
not alone, weak, or "crazy."
talking to other trauma survivors for support.
When survivors are able to talk about their problems with others,
something helpful often results. Through the process of seeking
support from other trauma survivors, the survivor may come to
feel less alone, feel supported or understood, or he or she may
receive concrete help with a problem situation. One of the best
places to find support is in a specially designed support group.
Being in a group with others who have PTSD or have gone through
similar experiences may help a trauma survivor reduce his or her
sense of isolation, rebuild trust in others, and it may provide
an important opportunity to contribute to the recovery of other
survivors of trauma.
talking to a doctor about trauma and PTSD. Part
of taking care of oneself means mobilizing the helping resources
that are available. A doctor can take better care of a patient’s
physical health if he or she knows about the patient’s PTSD
symptoms, and doctors can often refer trauma survivors for more
specialized and expert care.
practicing relaxation methods. These can include
muscular relaxation exercises, breathing exercises, meditation,
swimming, stretching, yoga, prayer, listening to quiet music,
spending time in nature, and so on. While relaxation techniques
can be helpful, they can sometimes increase distress by focusing
attention on disturbing physical sensations or by reducing contact
with the external environment. Be aware that while negative or
painful physical sensations may become more apparent when a person
is relaxed, continuing with relaxation in a way that is tolerable
(i.e., interspersed with music, walking, or other activities)
is, in the long run, helpful in reducing negative reactions to
thoughts, feelings, or perceptions.
increasing positive distracting activities.
Positive recreational or work activities help distract a person
from his or her memories and reactions. Artistic endeavors have
also been a way for many trauma survivors to express feelings
in a positive, creative way. These endeavors can help improve
a person’s mood, limit the harm caused by PTSD, and can
help a person rebuild his or her life. It is important to emphasize
that distraction alone is unlikely to facilitate recovery; active,
direct coping with traumatic events and their impact is also important.
calling a counselor for help. Sometimes PTSD
symptoms worsen and ordinary efforts at coping don’t seem
to work very well. If the survivor of trauma feels fearful or
depressed, it is important that he or she reach out and telephone
a counselor, who can help the survivor turn things around.
taking prescribed medications to tackle PTSD.
Many people with PTSD have found that by taking medications they
are able to improve their sleep, anxiety, irritability and anger,
or urges to drink or abuse drugs.
starting an exercise program. It’s important
to see a doctor before starting to exercise, but after getting
the OK, exercise in moderation will potentially benefit those
with PTSD in a number of ways. Walking, jogging, swimming, weight
lifting, and other forms of exercise may reduce physical tension.
These activities may also help distract the person from painful
memories or worries and thus give them a break from difficult
emotions. Perhaps most important, exercise can improve self-esteem
and help people feel that they have some control in their lives.
volunteering in the community. It’s important
to feel like you have something to offer to others and that you
are making a contribution. When you’re not working, you
may not feel that you are contributing anything worthwhile. One
way that many survivors of trauma have reconnected with their
communities and regained a feeling of connection and importance
is to volunteer: to help with youth programs, medical services,
literacy programs, community sporting activities, and so on.
Negative Coping Actions help perpetuate problems.
They may reduce distress in the short term, but in the long-term,
negative coping actions may short-circuit more permanent change.
Actions that may feel immediately helpful but that can cause later
problems include things like smoking or using drugs. These habits
can become difficult to change. Negative coping methods can also
include isolation, workaholism, violent behavior, angry intimidation
of others, unhealthy eating, and self-destructive behavior (e.g.,
attempting suicide, self-harming, etc). Before people with PTSD
learn effective and healthy coping methods, they may try to cope
with their distress and other reactions in ways that lead to more
problems.
Practicing Lifestyle Balance
(Excerpted from: Saakvitne, K. W., & Pearlman, L. A. (Eds.).
1996. Transforming the pain: A workbook on vicarious traumatization.
New York: Norton).
There are many ways to restore lifestyle balance, and keeping track
of and making progress with as many of the following changes is
a good way to regain balance after having been exposed to or witnessed
cumulative traumatic experiences:
Physical Self-Care
- Eat regularly (e.g. breakfast, lunch, dinner)
- Eat healthily
- Exercise
- Get regular medical care for prevention
- Get regular medical care when needed
- Take time off when sick
- Get massages
- Dance, swim, walk, run, play sports, sing,
or do some other physical activity that is fun
- Take time to be sexual--with yourself, with
a partner
- Get enough sleep
- Wear clothes you like
- Take vacations
- Take day trips or mini-vacations
- Make time away from telephones
Psychological Self-Care
- Make time for self-reflection
- Have your own personal psychotherapy
- Write in a journal
- Read literature that is unrelated to work
- Do something at which you are not expert
or in charge
- Decrease stress in your life
- Notice your inner experiences -- listen to
your thoughts, judgments, beliefs, attitudes, and feelings
- Let others know different aspects of you
- Engage your intelligence in a new area, e.g.,
go to an art museum, history exhibit, sports event, auction,
theater performance
- Practice receiving from others
- Be curious
- Say no to extra responsibilities sometimes
Emotional Self-Care
- Spend time with others whose company you enjoy
- Stay in contact with important people in
your life
- Give yourself affirmations, praise yourself
- Find ways to increase your sense of self-esteem
- Reread favorite books, re-view favorite movies
- Identify comforting activities, objects,
people, relationships, places, and seek them out
- Allow yourself to cry
- Find things to make you laugh
- Express your outrage in social action, letters,
donations, marches, protests
- Play with children
Spiritual Self-Care
- Make time for reflection
- Spend time with nature
- Find a spiritual connection or community
- Be open to inspiration
- Cherish your optimism and hope
- Be aware of nonmaterial aspects of life
- Try at times not to be in charge or the expert
- Be open to not knowing
- Identify what is meaningful to you and notice
its place in your life
- Meditate
- Pray
- Sing
- Spend time with children
- Have experiences of awe
- Contribute to causes in which you believe
- Read inspirational literature (talks, music,
etc.)
When to Seek Help
Several studies have pointed out that following a traumatic events
many of those involved do not believe that they need help and will
not seek out services, despite reporting significant emotional distress
(Sprang, 2000). Sprang lists several potential reasons for this:
-
Some people may feel that they are better off than those more
affected and that they, therefore, should not be so upset.
-
Some may not seek help because of pride or because they think
that distress indicates weakness of some sort.
-
Some individuals may not define services they receive as mental-health
intervention, especially if such intervention is unsolicited
(e.g., lectures, sermons, discussions, support groups, community
or church rituals).
-
Many individuals are more apt to seek informal support from
family and friends, which may not be sufficient to prevent long-term
distress for some.
There may be times when self-help strategies are not effective
in reducing the effects of exposure to traumatic stress. Research
has shown that exposure to trauma may result in a change in brain
chemistry and function. Research has also shown that the use of
antidepressant or other medication reduces both PTSD and depressive
symptoms in individuals who are unable to use behavioral techniques
to manage their symptoms. Individuals have also experienced partial
or full relief from posttraumatic stress symptoms when using certain
types of cognitive-behavioral treatment. As stated above, it is
recommended that you seek assistance from your medical doctor or
from a mental-health professional who is skilled in the treatment
of trauma if:
-
You are experiencing any symptoms that are causing distress,
are causing significant changes in relationships, or are impairing
functioning at work
-
You are self-medicating with alcohol or drugs
-
You are unable to find relief with the strategies listed above
Coping with PTSD symptoms and the problems they cause is usually
a continuing challenge for survivors of trauma. As stated above,
those who are able to convert traumas into growth experiences are
often able to do so through sudden insight or revelation.
For those who develop PTSD, however, recovery is an ongoing, daily,
gradual process. It doesn’t happen through sudden insight
and there isn’t a quick cure. Healing doesn’t mean that
a survivor will forget the trauma experiences or have no emotional
pain when remembering them. Some level of continuing reaction to
memories is natural and reflects a normal body and mind. Healing
may mean that reactions will occur less often and be less intense.
Healing also means having a greater ability to manage trauma-related
emotions and having greater confidence in one’s ability to
cope.
When a trauma survivor takes direct action to cope with problems,
he or she often gains a greater sense of personal power and control.
Active coping means recognizing and accepting the impact of a traumatic
experience and then taking concrete action to improve things.
Seeking Help
Where to get help:
Listed below are some ways to find help. When you call, tell whomever
you speak to that you are trying to find a mental-health provider
who specializes in helping people who have been through traumatic
events and/or who have lost loved ones.
-
Call your doctor’s office or ask friends if they can
recommend any mental-health providers.
-
If you work for a large company or organization, call the Human
Resources or Personnel office to find out if they provide mental-health
services or make referrals.
-
Call your local refuge or Women's Aid branch to ask about
local support groups or counselling services.
-
Contact your local mental-health agencies or family doctor.
(The National Center for Posttraumatic Stress Disorder has a
fact sheet with information on how to talk to your primary care
physician about trauma and PTSD. )
(excerpted and modified from the National Center for PTSD Fact
Sheet: Self-Care and Self-Help Following Disasters',. Full text
available at http://www.ncptsd.va.gov/facts/disasters/fs_self_care_disaster.html
)
Please also check out the National
Center for PTSD website!
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