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Office of Environmental Health & Safety
The Psychological Preparation for Extraordinary, Stressful, and Traumatic Events 


 

Introduction

                Extraordinary stressful and traumatic events such as fires, floods, or hurricanes have a significant impact on an individual’s physical, emotional, psychological, social, spiritual, and financial well-being. Most of us in eastern North Carolina have a common experience of dealing with the wind, rain, and flooding related to hurricanes.  Regardless of how close we are to the “epicenter” of such an event, it is quite normal and expected that emotional aftershocks can affect us weeks and even months after we have experienced the critical incident. Thus, it is important to try and make “ordinary sense” out of an extraordinary stressful event in order to cope with possible future emotional “triggers” related to the upcoming hurricane season. 

                Information and understanding of the psychological preparation process will support our emotional and psychological well-being by cultivating a caring and safe environment at ECU throughout the upcoming hurricane season. More specifically, the following information is intended to provide ECU staff, faculty, and students with a better understanding of the: (a) immediate and long-term psychological and emotional response to extraordinary stressful events, (b) early warning signs of future critical events and what to look for in terms of the emotional “triggers”, and (c) different prevention and coping strategies to support our emotional and psychological well-being during the upcoming hurricane season. The opening section will provide staff, faculty, and students with general information and assumptions regarding the wide range of human responses experienced during extraordinary stressful events. The section that follows will address specific questions and concerns for different groups (staff, faculty, and students) within the university community.

Assumptions for Survivors of Extraordinary Stressful Events

                There is a tendency to equate extraordinary stressful or traumatic events with other painful events such as losing family, friends, or pets.  Traumatic and enormously painful events vary in their psychological and emotional impact.  While not all painful events are traumatic for the individual some become overwhelming and may require assistance from a professional counselor or a peer-support group. This does not imply that the person is “going crazy” or is “emotionally weak”.  It simply indicates that a particular event was just too powerful for the person to manage emotionally. Whether events are painful or traumatic is a matter of the person’s perception of the event, their coping abilities, and the level of existing support. Consequently, recovery from some critical events may take longer than others. Before reading through this material, it is important to be mindful and take notice of the following common assumptions in dealing with the emotional aftershocks of natural disasters such as eastern North Carolina has experienced.

1.                    Recognize Yourself and Others as Survivors-  Viewing yourself or others as a “victim” of a traumatic, painful, or extraordinary stressful event discounts the person’s survival skills and reinforces negative stereotypes of the person being helpless and dependent.  Although the person may feel like a “victim” of a particular crisis event, a “survivor” is someone who knows how to ask for help and is self-empowered through personal coping abilities.

2.                    Accept the Stress that Accompanies Painful, Stressful, or Traumatic Events as Real and Legitimate for Survivors- Most persons who have been directly involved with a painful, extraordinary stressful, or traumatic event will be physically, emotionally, psychologically, and/or financially affected and will require some assistance. Again, this does not mean that the person is “going crazy” or “emotionally weak”.  Research indicates that between 20-30% of persons directly affected by a traumatic event will require some long term emotional support such as counseling. 

3.                    Survivors Heal at Different Rates- There is no set time limit on when the person “should be emotionally well” again.  Coping with a crisis event depends on the individual’s attitude and perception of the event.  It also depends on the amount of emotional and financial support, as well as other personal issues.

4.                    Preexisting Personal Experiences May Intensify the Person’s Response to a Stressful Event and Hinder Adjustment and Coping Ability- It is important to recognize that when loss occurs, persons who have had prior emotional, physical, financial difficulties, or lack a supportive environment may have a more difficult time coping with a critical event.  An event may actually become an “emotional trigger” for some which can open previous emotional wounds or issues that they previously experienced.

5.                    Primary and Secondary Survivors’ Response to a Crisis May be the Same- Because all reactions are personal and contextualized, a person indirectly exposed to a traumatic event (secondary survivor) may respond at the same level of emotional intensity as those who are directly affected (primary survivor).  Each person must be viewed in terms of their own unique characteristics and socio-cultural environment.

Normal and Extraordinary Stress

                Stress is a part of everyday life and is the result of changes in our emotions, thoughts, body, and natural environment. Stressful events may be viewed on a continuum of good and bad stress.  We may experience “good stress” such as falling in love or getting a job promotion or “bad stress” such as receiving a lower than expected course grade or poor evaluation at work. Most individuals attempt to maintain a state of balance with a normal range of “daily hassles” such as parking problems or being late for work. The way in which you experience and interpret daily stressors or hassles may influence how you respond to future critical events. 

                Stress research has shown that there is a relationship between chronic stress and your immune functioning.  If the stress you experience in your life is chronic, persistent, or cumulative and you are unable to recuperate from daily hassles, you may be at-risk for any number of medical/physical conditions as well as feelings of emotional fatigue.  If this is the case, feelings and emotions that are associated with newly acquired stressful events may be more difficult for you to deal with.

                Everyday hassles and extraordinary stress are different kinds of experiences.  Events that occur outside the normal range of everyday human events are usually experienced as extraordinary stressful or traumatic events.  When the individual is confronted with an extraordinary stressful event such as a hurricane or flood, the ability to cognitively process and respond to such an overpowering sensory experience may be impaired.  Many individuals have little or no coping skills to deal with such events. These events trigger immediate physiological, emotional, and psychological reactions, disrupting the person’s emotional balance. Interestingly, the typical response is to usually attempt to make life “normal” again.

                When adversity strikes and bad things happen to good people it becomes extremely difficult to bring ones’ life back into balance again. We may try hard to make things emotionally normal again for both ourselves and others around us. This reaction to the crisis we have just experienced is actually a loss or grief response.

Response to Extraordinary Stressful or Traumatic Events as Loss and Grief

                We typically deal with traumatic or extraordinary stressful events in the same manner as we have coped with past experiences of grief and loss such as in death, divorce, loss of a job, or our health.  For instance, if we have consistently coped with past crisis by running away from our emotions or detaching ourselves from the reality of the event, chances are that the same behavior will occur in a future event. Avoiding or repressing a crisis event does not provide us with the opportunity to work-through our experience of loss and it is unlikely that we will adjust and grow from the critical and stressful event.

                Victor Frankl, a famous psychiatrist and psychotherapist survived the highly traumatic experience of living in a Nazi concentration camp during World War II.  He states that it is not necessarily the nature of the traumatic event itself that most affects one’s ability to cope with adversity and its consequences, rather, it is one’s own attitude towards that traumatic event.  Many counselors and therapists recognize that the experience of loss is a matter of one’s perception of the critical event.  Some people experience a critical event as a multitude of losses. Feelings of loss are associated with: (a) having control over one’s life or a sense of vulnerability, (b) faith in one’s God or Higher Power, or with other people, (c) a sense of fairness or justice in the world, (d) one’s security and emotional well-being, (e) one’s physical health, and (f) one’s academic future or opportunity for a professional career.  Thus, unresolved loss or ineffective grief resolution compromises current emotional functioning when a new critical event occurs.  This can cultivate a pattern of avoidance that can become firmly entrenched.

Immediate Reactions to Extraordinary Stress and Traumatic Events

                Specific symptoms vary with the individual but may include: neglect of basic health needs, a decrease in physical functioning, grooming, or appearance, impaired academic performance, a lack of concentration and focus in day-to-day activities,  increased number of absences from class or work, emotional detachment, general feelings of anxiousness, or fears about being overwhelmed with daily routine matters.  The person may also experience changes in personality, attitudes, or behavioral changes such as crying, anger, frustration, externalized hostility, denial of the event, constant negativity, the inappropriate use of humor, restlessness, agitation, changes in eating and sleeping habits, and increased use or abuse of tobacco, caffeine, alcohol, or other addictive substances.

Long-term Reactions to Extraordinary Stressful and Traumatic Events

                If the above symptoms persist for more than one month these may be emotional and psychological warning signs.  The person would be advised to seek help from a professional counselor. Individuals affected by long-term critical events may exhibit some of the following reactions which include, but are not limited to the following: sustained or persistent thoughts and overt behaviors of hopelessness, helplessness, sadness, or suicide ideation, significant decrease in routine day-to-day activities, extreme restlessness or motor agitation, substance abuse behaviors, chronic sorrow or depression, feelings of anxiety or being overwhelmed with routine daily hassles, or a decrease in immune functioning, and overall intense psychological distress such as persistent, recurrent, and intrusive thoughts about the event. Persons may also experience any number of “trigger” events such as rain, water, wind, or thunderstorms which may be stimuli that could re-traumatize the individual. In the most severe cases, persons may be suddenly acting on feelings as if they were experiencing the event for the first time.

Stages of Adjustment and Coping

                There are a number of stage models to choose from in the literature concerning the person’s adjustment and coping with extraordinary stressful and traumatic events. It is important to realize that all stage models of adjustment and coping are theoretical and the sequence of reactions may vary with the individual. Most persons do not reach the theoretical endpoint of “adjustment”.  Individuals may regress to an earlier stage or skip one or more stages altogether. It is implied that successful transition through the phases of adaptation and adjustment should produce increased psychological growth and healthy coping mechanisms.

                Be mindful that in the initial stages of adjustment and coping, denial or repression may be used consciously or unconsciously by the person as a coping strategy or survival mechanism.  Thus, denial of an extraordinary stressful event may be important so the individual can continue with a daily schedule of classes or work. Denial loses its usefulness and becomes pathological however, when it operates as a total avoidance mechanism or when it interferes with the processing of therapeutic or relevant information.

The following is a parsimonious description of predictable stages of adjustment individuals may experience when confronted with extraordinary stressful or traumatic events.

Initial Stage: includes physical shock and panic-type reaction (e.g., psychomotor disturbances, hyperventilation), numbness, and disorientation.  As the hours and days pass, individuals may progress to certain levels of psychic shock, disbelief, and anxiety. 

Middle Stage: includes a range of emotions such as anger, rage, externalized hostility, denial, fear, panic, sorrow, depression, grief, confusion, frustration, internalized anger, self-blame, and guilt.

Final Stage:  includes a reconnection with family, friends, and daily routine. Persons reestablish trust and have increased feelings of security.  Despite a “roller-coaster” of emotions, the person develops a realistic/cognitive recognition of the extraordinary or stressful event and cultivates positive coping and support mechanisms that will eventually lead to a level of adjustment similar to that which is expected prior to the event.                                                     

Emotional Triggers and Prevention Strategies

                Survivors of extraordinary and stressful events typically spend a lot of time and energy avoiding the feelings, thoughts, and activities that are associated with the critical event. This is a normal response to extraordinary stressful events that may have affected the individual in significant ways.  Some avoidance of past crisis events may be important as a coping strategy.  However, too much emotional avoidance, or suppression, may result in a numbness or a dissociation from the cognitive and emotional experience of past stressful events.

                Research has shown that negative intrusive thoughts from past traumatic events are quite common and occur in about 80% of the general population. Persons that grieve a loss in their lives will often harshly pass judgment on their own feelings of selfishness, guilt, or irrationally believing that they are going “crazy”, or they are acting “unchristian-like”.  However, actively avoiding or suppressing unwanted negative thoughts, emotions, and memories as a means to create psychological health in one’s life, may actually contribute to a magnification of negative emotional responses and thoughts.  Thus, dealing with the psychological and emotional impact of a critical incident early-on, will ultimately benefit the individual in healing. It is therapeutic to verbalize one’s thoughts and emotions associated with a past event.

                Remembering negative critical events is oftentimes a very painful process.  This process sometimes triggers unwanted emotional responses that may be too uncomfortable for the individual, if explored early-after a critical incident.  However, there comes a time when it feels right for the person to talk about past events that have been painful or extraordinarily stressful. Verbalizing feelings and asking for support from family, friends, or a professional counselor is a healthy, therapeutic, and preventative approach that will assist the individual move towards adjustment. Keeping a personal journal or making a scrapbook of past events can also be helpful.                  Stress is often created by negative beliefs and self-talk as well as distorted  “catastrophic” thinking.  Cognitively restructuring or learning to reframe negative thoughts into more positive thoughts can facilitate adjustment and coping with future events.

Coping Strategies

                Persons that have been involved, either directly or indirectly with the flooding, death, and destruction caused by Hurricane Floyd, or other disasters, have a common core of experience with family, friends, co-workers, and the community-at-large. The following strategies are recommendations to begin or continue the adjustment process.

Coping Strategies for Survivors

1. Allow time for yourself to transition back into your day-to-day routine such as school or work.

2. Identify friends and family members that may be “at-risk” physically, psychologically, or  emotionally.

3. Be familiar with the resources available in your community that will support recovery.

4. Support your peers and allow them to talk about their loss and reinforce their positive steps towards recovery.

5. Focus on the routine things that you are able to do, as well as some positive things that you have done in the past.

6. Establish ongoing support and contacts with friends and family members.

7. The most important resource you have is one another!

Strategies for Co-Workers, Friends, and Family to Support the Survivor

1. Be an active listener for the survivor but do not get “hooked” into the role of counselor.

2. Identify when the survivor is emotionally overwhelmed and suggest professional help.

3. As difficult as it may be for you, allow and invite the survivor to talk about their feelings of loss or fear of future critical events.

4. Establish regular contact with the survivor to ensure that the person is safe and social and has emotional support.

Strategies for Teachers and Supervisors to Support the Survivor

1. After the survivor has been through a crisis, it is likely that the person will have a difficult time focusing on studies or work. Allow the survivor time to transition back to day-to-day school or work routine. Take a “time-out” from your regular structure for an “emotional check-in”with the survivor.  You may want to begin class or the work-day by allowing the survivor(s) to ventilate  feelings concerning a recent past extraordinary stressful experience. Verbalizing thoughts, feelings, or emotions has therapeutic benefits.

2. Be sensitive to the emotional needs of the survivor(s) in class or during work. While you are not (and do not need to be) a professional helper, you can offer to be a good listener.

3. Familiarize yourself with, and promote educational or wellness-type campus resources among survivors.  Be aware of students or employees who may be “at-risk” for additional emotional or psychological stress.

4. Be aware that you may also be experiencing some stress-related symptoms related to dealing with the survivor’s emotional aftershocks.  Also, be mindful that secondary stress is a natural artifact of just being around or overhearing the survivor’s stories of extraordinary stressful experiences.

5. Emphasize the survivor’s strengths by reinforcing positive aspects of current functioning or productivity level.

Resource List

American Counseling Association (ACA) {a comprehensive list of materials and links to multiple helping resources} www.counseling.org               

Davis, M., Robbins Eshelman, E., & McKay, M. (1995). The relaxation & stress reduction workbook (4th ed.). Oakland, CA: New Harbinger Publications.

 Follette, V.M., Ruzek, J.I., & Abueg, F.R. (1998). Cognitive-behavioral therapies for trauma. New York: Guildford Press.

Kushner, H. (1981).  When bad things happen to good people. New York: Avon Books.

McKay, M., Davis, M., & Fanning, P. (1997). Thoughts & feelings: Taking control of your moods and your life. Oakland, CA: New Harbinger Publications.

 Mitchell, K.R., & Anderson, H. (1983). All our losses, all our griefs: Resource for pastoral care.

Philadelphia: Westminster Press.

Mitchell, J.T., & Everly, G.S. (1996). Critical incident stress debriefing: An operations manual for the prevention of traumatic stress among emergency services and disaster workers. Ellicott City, MD: Chevron Publishing.

 National Organization for Victim Assistance (NOVA).

 Rando, T.A.  (1984).  Grief, dying, and death. Champaign, Il.: Research Press.

Authored by:

Mark A. Stebnicki, Rh.D., CRC, LPC, CCM,Associate Professor, Director of Graduate Program in Rehabilitation, Counseling Department of Rehabilitation Studies, School of Allied Health Sciences, East Carolina University