Helping Give Away Psychological Science/draft:Coping with traumatic events Beruit2020

It can be hard to know what to do in the wake of a large-scale traumatic event. Parents may not know how to talk with their children about what happened. Community leaders may struggle to tell the difference between individuals experiencing normal grief and those showing patterns of behavior that require professional attention. One problem is that people react to trauma in different ways. Another issue is that symptoms of distress can change over time. This page serves as a psychological first-aid resource that describes common reactions in the weeks and months after an incident and provides ways for people to care for themselves and others.

People experience the effects of trauma in different ways depending on their age, life experience, and how long it has been since the traumatic event. Common emotions include: intense grief, sadness, experiencing new fears, feeling angry, and not knowing what to do. There isn't a "right" or "wrong" way to feel. In general, the important thing is to pay attention to changes in mental and physical health and know how to access support that can help with sudden or persistent changes.

The effects of trauma aren't always negative. Some people will experience post-traumatic growth, where after time they find themselves stronger after a intensely negative event. Others may be relatively unchanged months after the trauma. Nevertheless, talking to a mental health professional can help reduce the chances of longer-term problems, particularly if negative feelings continue to disrupt relationships or normal activities, or persist over several months.

= What to expect = Everyone responds to trauma differently. It is normal to experience negative thoughts and emotions, but many people do not realize that physical symptoms can be just as common. In trying to understand how how people may be experiencing effects of trauma, it can be helpful to think about four areas that might affected:

Reactions to Trauma
Not everyone will experience all of these things, but many people will experience some combination of them. The following vignettes give some examples of how people might be feeling and acting in the wake of a traumatic experience.

"Ada, age 8, has just witnessed a shooting at her school. The school has evacuated to a safe location. Although she is eight years old and normally above her reading level, she is incoherent and talking like a baby. Ada is not normally a cuddly child, but when her mother comes to pick her up from school, she becomes very clingy. Ada's mother holds her and reminds her that she is there. Ada's mother gets Ada's little brother's teddy bear from the car, and asks Ada to rock him so that he won't be scared. Ada asks about her friends' safety. While some of them have been located, the whereabouts of some of them are not known. Ada's mother tells her that the police and people in charge are doing their best to make sure that everyone is safe."

After a traumatic event, it is normal for children to regress developmentally or act younger than they actually are. Touch, such as hugs and being held, can be very comforting; however, it is important to ask and respect the child's boundaries. Although children may regress developmentally, it can help them to be in charge of calming down a toy-- a teddy bear, a doll, etc. Given this sort of faux responsibility, they can soothe themselves by soothing the toy. Children may also ask questions that you don't know the answer to or the answer may be too scary for them to process. Without lying make sure to provide answers that are reassuring and put into simple terms. Children can be very black and white and it can be helpful to remind them that the "good guys" are working for their safety.

"Christine, age 16, has just witnessed a shooting at her school. They have evacuated to a safe location. When her father comes to pick her up, she is withdrawn and won't speak when he addresses her. Her father, knowing that she loves music, brings her earphones and asks if they can listen to her favorite songs together. She doesn't want to listen with him, but she puts her earphones in and listens to music. Her father sits beside her."

Adolescents generally understand what has occurred without explanation. They may not wish to talk about their feelings or thoughts directly following the trauma and should not be pressed to do so. Instead if they can be encouraged to engage in a distracting activity, preferably one that they have been known to enjoy, this can help begin the healing process. Simply being beside them can communicate that you are there for them as well as words might.

"Maya, age 7, witnessed a shooting at her place of worship a week ago when she went with her grandmother. Maya has been preoccupied and sharing thoughts that feels it’s her fault, and she doesn’t understand why that man hated her so much. No matter how much her mother seems to remind her that she didn’t do anything wrong, Maya has been difficult to comfort and continually asks her mother these questions. She does not want to go to school, and she has expressed fear over seeing her friends again. She has been having reoccurring nightmares about the shooting and has been asking her mother to sleep next to her."

Children’s growing brains are very concerned with finding the cause of things that happen so that they can build schemas, or ways of understanding the world. Also, because children under 7 tend to be very self-focused, they tend to believe that everything that happens in the world is somehow related to them and their behavior. Sometimes after a traumatic event such as a shooting or even a divorce between parents, children can end up blaming themselves. Children need reassuring, simple, and consistent answers to their questions. Children, when experiencing shame and/or fear, may be apprehensive of others close to them, even friends. They will likely need encouragement to reenter routine, but be careful not to force a return to routine too early. Sometimes a professional can be useful in helping decide when your child is ready to resume their routine.

"John, age 14, witnessed a shooting at his place of worship two weeks ago when he went with his parents. He was previously very involved in his religion, but has expressed anger and a lack of desire to go back to his place of worship. He hasn’t been eating very much, and, while he used to be social, he has spent much of this time in his room. He has missed all two weeks of school, and the administration has expressed concern to his parents."

Following traumatic situations, extreme changes in behavior can be indicators of post-traumatic stress. It is important to talk to John and to understand his reluctance to return to a place that previously brought him joy and fulfillment. It is important that any attempt at expressing his emotions verbally be listened to and validated (unless of course he expresses the desire to hurt himself or others). In addition, any attempt to return to activities he previously enjoyed —whether hanging out with a friend or coming out of his room and eating dinner with the family-- should be noted, encouraged, and praised. It could be useful to se itek the help of people John previously respected—whether a religious leader or friend or teacher. Together with John, you, and this person, a plan to help John get back to school could be made. If this does not work, John may benefit from more formal, professional help.

=Positive Ways to Cope= How to cope In response to a traumatic event, it may feel easier to cope by lashing out, self-medicating with drugs and alcohol, or withdraw from others. However, these are unhealthy ways to cope with how you are feeling and will not help you recover in the long-term. Instead, try to engage in the following positive ways to cope:

Talk...or Don’t!

 * Spend Time With Others. It isn’t necessary to talk about what happened. Just spending time with friends, family, and other survivors can be helpful
 * Communicate What You Need. If you aren’t ready to talk, it is OK to let others know that they can be supportive just by spending time with you
 * Wait Until You Are Ready. It is up to you to decide when you are ready to talk about the event, even if others want you to talk about it.

Ready to talk?

 * Let Others Know. Let those close to you know that you are ready to talk about your experiences.
 * Be Selective. Think about who would be best to talk to. This might be someone who you trust or who you think will provide the most support.
 * Don’t worry. It is OK to talk about your experiences with other people. While it is important to consider the emotions of the friends and family who are providing support, it is also true that people who care about you will want to listen.
 * Remember. Feeling strong emotions is completely natural and it can be very helpful to express these emotions.

Getting Help and Support
It can be hard to admit that you need help and support, but both of these are critical aspects to recovering from a traumatic experience


 * Get Support Early. Getting support early is likely to reduce the negative impact of the traumatic event
 * Reach Out. Your friends and family are a great place to start. Moreover, counselors, doctors, nurses, and coaches are all professionals that are in the business of helping others. Even if their role has nothing to do with what you’re going through, they might be able to offer support and help connect you with services that could benefit you. It never hurts to ask!
 * Consider Using a Crisis Hotline. Crisis hotlines are often used as the first point of contact for those looking for information and support. Trained staff and volunteers can help with problem-solving and connecting you to the resources you need. Call and text options are available.
 * Crisis Call Center
 * Crisis Text Line
 * Join a Support Group. Talking with other people who were affected by the same or a similar event can be especially helpful. Start here.

Additional Ways to Cope
There are many well-supported ways to cope with trauma in a positive and constructive way


 * Try a New Activity. Trying a new activity or hobby can help broaden your social circle and introduce new, positive experiences into your routine.
 * Volunteer. Helping others can be a powerful way of feeling connected.
 * Stick to a routine. Developing a routine and sticking to it while you are recovering from trauma can help make life feel more like normal. When developing this routine, make time for activities than you find enjoyable and comforting.
 * Try Relaxation Techniques. Relaxation techniques can help you slow down and focus your thoughts and feelings, which may feel fast and confused at times after a traumatic event.
 * Strategies for self-care & relaxation
 * Breathing techniques
 * Audio recordings for meditation
 * Yoga-based relaxation
 * Alternatives to meditation relaxation

=When to Seek Professional Help= Sometimes, it is necessary to get help from a mental health professional who is trained to assist those who have experienced a trauma. Although it is normal to experience significant changes in functioning after experiencing a trauma, 'if you still have trouble coping several months after the event or if you feel you would benefit from talking to someone with expertise', find a mental health professional who can help.

If you are experiencing some of the following symptoms more than a month or two after the event, it would be beneficial to make an appointment with a mental health professional :


 * Click here for the HGAPS List of Where and How to Find a Therapist

=Resources for People Close to Survivors=

When someone goes through a traumatic event, they experience a variety of emotions and reactions. Here are some ways you can help those you care about:
 * Reaching out
 * Ask them about how they are doing, or if there is anything they need help with . Offer to spend time with them. If they refuse or don’t respond the first time, let them know that you are there for them by reminding them that you care.
 * When talking, remember to be judgement-free, patient, and positive
 * Everyone copes with trauma differently. There is no “right” way to cope, nor is there a “wrong” way.
 * Some individuals may take longer to return to their usual self than others. Being positive and showing support helps them know that they will be okay and are able to rebuild their lives.
 * Seek professional guidance:
 * If someone you know becomes withdrawn or engages in troubling behaviors, it is okay to admit that you are unable to provide them with the help they need. If you are worried about someone’s safety, do not be afraid to ask for outside assistance. Even if they may not want to see a professional, talking to someone else may help you offer them better support.

Sometimes, our efforts to help may cause more harm than good. Here are some ways to help avoid doing that while still remaining supportive.
 * Do not be surprised at their reactions. Each individual responds and copes differently. For some, this may involve not following their routine or avoiding certain places and activities. Do not pressure them to be “normal”, and focus on remaining supportive.
 * Focus on the individual and their experiences. Sharing your own experiences may not always help, as they can discourage your loved one from talking about theirs. Listen to them, and voice your support. Be empathetic and share your condolences. If you want to share advice or personal stories, ask them if it is okay for you to do so.
 * Do not avoid the topic. For some people, speaking about their experiences helps them process what has happened to them. If their disclosure affects you, it is okay for you to seek out support for yourself.

Supporting Your Child After Trauma
=External Resources=


 * Psychological First Aid
 * Click here for a Psychological First Aid Field Operations Guide
 * Click here for the Dos and Don'ts of Psychological First Aid
 * Click here for more information about Psychological First aid (in Spanish, en Español)
 * Click here for more information about Psychological First Aid (in Mandarin Chinese)


 * Resources for Parents and Caregivers
 * Click here for parent guidelines on helping youth deal with the aftermath of a recent shooting
 * Click here for tips on helping young children with traumatic grief
 * Click here for tips on helping school-age children with traumatic grief
 * Click here for a comprehensive list on how to help young children heal after a traumatic event
 * Click here for a guide on talking to children about death and attending services


 * Resources for Clinicians
 * Click here for a fact sheet on traumatic stress and children with developmental disabilities.
 * Click here for a fact sheet on traumatic stress in deaf children
 * Click here for a paper on addressing the trauma treatment needs of children who are deaf or hard of hearing and the hearing children of deaf parents
 * Click here for a fact sheet on homeless children with trauma
 * Click here for resources in dealing with LGBTQ issues and child trauma


 * Resources for Communities
 * Click here for what to do if you have experienced community violence (for children under 18)
 * Click here for information about the psychological impact of a recent shooting event
 * Click here for tips on how to help youth after community trauma (for educators)
 * Click here for information on how to be a community leader in the wake of a traumatic event
 * Fact sheets and information about dealing with traumatic events
 * Click here for information in Spanish (en Español)
 * Click here for information in Mandarin Chinese

=Want to help others?=

Donate
These organizations were recommended in this article in the Washington Post:

Lebanese Red Cross

• UNICEF
UNICEF is helping salvage what is left of the medical supplies and vaccines that were stored at the port (where the explosion happened). UNICEF partners are offering counseling to children and families affected by the blast. Donate here.

• U.N. World Food Program
Lebanon imports most of its food (85%+) percent of its food, according to the U.N. World Food Program, and most of that arrives by sea. The explosion damaged the largest port, as well as destroying the silo with the national grain reserve; thus food shortages are expected. The UN World Food Program is assembling food packages, delivering flour to bakeries, and providing basic emergency food assistance. Donate here.

Volunteer
= References =