Mental Health Association in New York State

COPING WITH DISASTER AND TRAUMA

See MHANYS Fact Sheet "Helping Children Cope With Disaster and Trauma"
for children and adolescents

Helping yourself cope with trauma
Following a traumatic event, whether it be a natural disaster or of human design, feelings of loss, grief, fear, anger, frustration, anxiety, uncertainty, and helplessness are common reactions. It is important to accept these feelings as a natural response to a traumatic event, but it is also important work through these negative emotions rather than dwelling on them. Follow a comfortable daily routine as much as you are able. Taking such simple steps as getting enough sleep, eating healthful foods, practicing relaxation techniques, and just giving yourself time to readjust can boost your ability to deal with increased anxiety and stress. Reaching out to friends and family, and reconnecting with loved ones to offer and receive support and reassurance are other positive ways to counter negative emotions.

The impact of trauma on mental health
Individuals process traumatic events differently. In the immediate aftermath people may experience shock and denial. Shock refers to the feeling of being in a daze, or too stunned to comprehend fully what has just occurred. Denial is a refusal to acknowledge the extent of the impact a traumatic event has had on oneself, or even to deny it has happened. Shock and denial are common responses, and a normal piece of one's "mental health self-defense" mechanism that protect one from having to confront the enormity of a traumatic experience as it is happening.

In the hours or days following a traumatic event people cope with the situation in different ways. Several factors can affect the degree of the impact of a traumatic event. People who have had a traumatic experience earlier in their lives may find that a new event can trigger a recurrence of negative reactions. People with major life stresses, such as loss of employment, recent death of a loved one, or conflict in the family, occurring shortly before or after the traumatic event may also be at greater risk for negative aftereffects. The duration of the traumatic event, a person's proximity to the event (i.e. did it happen to them, did they witness the event, was a loved one affected by an event that they themselves were not involved in), and the type of trauma can all influence an individual's responses. Studies suggest that human-caused traumatic events take a greater emotional toll. Some people may experience very high levels of anxiety even after the immediate danger has passed. They may become susceptible to panic attacks, or develop phobias that relate to the traumatic event.

Symptoms of acute anxiety in adults may include:

Feeling numb, detached, or emotionally unresponsive
A continuing state of being in shock or in a daze
Feeling detached from oneself or from one's surroundings
Feeling like one is "in a dream", or that events and one's environment is "unreal"
"Blocking out" memories of the event, or an inability to recall aspects of the event
Recurring disturbing thoughts or dreams about the event
"Flashbacks" or having the sense of reliving the event
Feeling emotional distress when encountering a reminder of the event
Avoiding reminders or recollections of the event
Disruptions in sleep
Restlessness
Irritability
Poor concentration
Hypervigilance
Exaggerated startle response
(taken from DSM-IV)

Stress manifests itself in physical symptoms as well. People in the midst of a panic attack can suffer from shortness of breath or feelings of choking, dizziness, trembling, nausea, or they may feel as though they are having a heart attack. When symptoms of acute anxiety persist for longer than several weeks, and anxiety continues to impair one's ability to function in any aspect of day-to-day life, it is important to seek professional evaluation for post-traumatic stress disorder (PTSD). In some cases PTSD may emerge months after the event.

Others may enter a depressed state following a tragedy, even if they initially reacted to the traumatic event energetically.

Symptoms of depression in adults may include:

Feeling sad or empty most of the day, nearly every day
Diminished interest, or lack of interest, in activities, including those previously enjoyed
Changes in appetite, either an increase or decrease
Changes in sleep patterns, either insomnia or sleeping most of the time
Restlessness
Fatigue or lack of energy
Tearfulness, or crying for seemingly no apparent reason
Indecisiveness or an inability to concentrate
Feelings or worthlessness or guilt
Recurrent thoughts of death or suicidal feelings
(taken from DSM-IV)

These emotional and behavioral changes are not necessarily permanent responses to trauma. If you find that symptoms of anxiety and/or depression continue to interfere with your ability to function in life as you did before a traumatic event, consult a mental health professional for an evaluation. Even short-term counseling following a traumatic event can have a beneficial impact. Therapy with a mental health professional and/or participating in support groups can be very effective in helping to deal with emotionally painful and negative aftereffects of tragedy.

While it may be unrealistic to expect that one's life will ever "be the same" again, it is entirely possible to regain a normal life and greatly improve one's ability to deal with stress and trauma.

Helping someone who has experienced trauma
Accept that a person who has experienced a traumatic event needs to process the experience on his/her own terms at his/her own pace. However tempting it may be to try to "fix things" or to tell someone to "get over it," that only adds unhelpful pressure, and may make the person reluctant to express distressing emotions. Sometimes the best thing one can do to help is to follow the piece of advice that goes, "Don't just do something, stand there!" Be patient; allow them the time they need to deal with their feelings. Be supportive. Be a non-judgmental listener and allow them to discuss their experiences and feelings without interrupting or telling them what you think they should do to get better. It is all right, however, to discourage someone from engaging in harmful behavior, such as trying to numb pain through consumption of alcohol or drug use, and to encourage them to seek counseling when appropriate.

When a traumatic experience involves the death of a loved one, the survivor will usually go through stages of bereavement and mourning. Sometimes the nature of the tragedy, such as with the September 11th attacks, involves the death of people whom the survivor may not have known or been close to. They may still be touched, perhaps quite intensely, by a sense of loss. They may feel guilty for having survived when others did not, or may feel guilt over things one had to do in order to survive. Allow the survivor time to mourn. It takes time to work through grief and all the other emotions, such as sadness, anger, betrayal, that accompany a major loss. A survivor of a traumatic event may feel loss for intangible things; the loss of security, the loss of peace of mind, loss of potential opportunities. Even though loss of life may not be the case in these situations, it is important to recognize and respect that coming to terms with any significant loss requires time to mourn and grieve. Patience, understanding, and compassion are the best things you can provide for someone going through the healing process after a loss.

Other resources
When disaster strikes, agencies such as your local Red Cross and Salvation Army can provide or direct people to services including mental health counseling.

Following trauma or disaster your local Mental Health Association, county mental health agency, or mental health helplines can refer you to mental health resources in your area. Look in the yellow pages of the phone book under 'Mental Health Services'. Victims of crime, rape, or domestic violence should contact their local crime victims group, rape crisis center, or domestic violence organization for assistance in locating counseling.

A directory of New York State county mental health agencies is available on the Internet at http://www.clmhd.org/about/countydirectory.aspx. A directory of MHA affiliates in New York State is available at http://www.mhanys.org/affiliates on the Mental Health Association in New York State, Inc.'s website.

The American Psychological Association operates a referral line at 1-800-964-2000 which connects callers with the state psychological association referral network in their area. In New York State the number is (518) 437-1050.

Further information on anxiety and stress disorders are available through a number of organizations, including:

National Mental Health Association - http://www.nmha.org, 1-800-969-NMHA (1-800-969-6642)
National Alliance for the Mentally Ill - http://www.nami.org, 1-800-950-6264
Anxiety Disorders Association of America, Inc. - http://www.adaa.org, (301) 231-9350

The following online resources were consulted in putting together this factsheet:

"Managing Traumatic Stress: Tips for Recovering From Disasters and Other Traumatic Events" http://www.apa.org/helpcenter/disaster-tips.aspx - American Psychological Association

"When Disaster Strikes..." http://www.psych.org/Resources/DisasterPsychiatry/APADisasterPsychiatryResources/WhenDisasterStrikes.aspx - American Psychiatric Association

"Post Traumatic Stress Disorder" http://www.nami.org/helpline/ptsd.html - National Alliance for the Mentally Ill

"Post-Traumatic Stress Disorder" http://www.nmha.org/infoctr/factsheets/34.cfm - National Mental Health Association

See other Information Center Fact Sheets.

The Mental Health Association in New York State, Inc. is a 501(c)(3) not-for-profit organization, with 33 local affiliate MHAs serving 54 counties. MHANYS is working to ensure available and accessible mental health services for all New Yorkers.