Inform about Coping

Inform about Coping (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 77-82)

Goal

Provide information about stress reactions and coping to reduce distress and promote healthy functioning.

Body’s Response to Stress Video

“Disasters can be disorienting, confusing, and overwhelming, putting survivors at risk for losing their sense of competence to handle problems that they face. Feeling as though they can cope with disaster-related stress and adversity is beneficial to survivors’ recovery.” (p.77)

Provide Basic Information about Stress Reactions

If appropriate, briefly discuss common stress reactions experienced by the survivor. Stress reactions may be alarming. Some will be frightened or alarmed by their own responses; some may view their reactions in negative ways (“There’s something wrong with me” or “I’m weak”). You should take care to avoid interpreting this as mental illness; do not use terms like “symptoms” or “disorder.” You may also see positive reactions, including appreciating life, family, and friends, or strengthening of spiritual beliefs and social connections.

Caution: While it may be helpful to describe common stress reactions and to note that intense reactions are common but often diminish over time, it is also important to avoid providing “blanket” reassurance that stress reactions will disappear. Such reassurances may set up unrealistic expectations about the time it takes to recover.

Review Common Psychological Reactions to Traumatic Experiences and Losses

For survivors who have had significant exposure to trauma and have sustained significant losses, education about common distress reactions can be extremely helpful. You can briefly describe to the survivor the reactions explained below, emphasizing that such reactions are understandable and expectable. Inform survivors that, if these reactions continue to interfere with their ability to function adequately for over a month, psychological services should be considered.

There are three types of posttraumatic stress reactions:

• Intrusive reactions are ways in which the traumatic experience comes back to mind. These reactions include distressing thoughts or mental images of the event (for example, picturing what one saw), or dreams about what happened. Among children, bad dreams may not be specifically about the disaster. Intrusive reactions also include upsetting emotional or physical reactions to reminders of the experience. Some people may feel and act like one of their worst experiences is happening all over again. This is called a “flashback.”
• Avoidance and withdrawal reactions are ways people use to keep away from, or protect against, distress. These reactions include trying to avoid talking, thinking, and having feelings about the traumatic event, and avoiding any reminders of the event, including places and people connected to what happened. Emotions can become restricted, even numb, to protect against distress. Feelings of detachment and estrangement from others may lead to social withdrawal. There may be a loss of interest in usually pleasurable activities.
• Physical arousal reactions are physical changes that make the body react as if danger is still present. These reactions include constantly being “on the lookout” for danger, startling easily or being jumpy, irritable or having outbursts of anger, difficulty falling or staying asleep, and difficulty concentrating or paying attention.

Any or all of these three reactions are often prompted by trauma reminders, loss reminders, change reminders, and hardships in contributing to distress.

Trauma Reminders can be sights, sounds, places, smells, specific people, time of day, situations, or even feelings, like being afraid or anxious. Trauma reminders can evoke upsetting thoughts and feelings about what happened. Examples include the sound of wind, rain, helicopters, screaming or shouting, and specific people who were present at the time. Reminders are related to the specific type of event, such as hurricane, earthquake, flood, tornado, or fire. Over time, avoidance of reminders can make it hard for people to do what they normally do or need to do.

Loss Reminders can also be sights, sounds, places, smells, specific people, the time of day, situations, or feelings. Examples include seeing a picture of a lost loved one, or seeing their belongings, like their clothes. Loss reminders bring to mind the absence of a loved one. Missing the deceased can bring up strong feelings, like sadness, nervousness, uncertainty about what life will be without them, anger, feeling alone or abandoned, or hopelessness. Loss reminders can also lead to avoiding things that people want to do or need to do.

Change Reminders can be people, places, things, activities, or hardships that remind someone of how life has changed as a result of the disaster. This can be something like waking up in a different bed in the morning, going to a different school, or being in a different place. Even nice things can remind a survivor of how life has changed, and makethe person miss what has been lost.

Hardships often follow in the wake of disasters and can make it more difficult to recover. Hardships place additional strains on survivors and can contribute to feelings of anxiety, depression, irritability, uncertainty, and mental and physical exhaustion. Examples of hardships include: loss of home or possessions, lack of money, shortages of food or water, separations from friends and family, health problems, the process of obtaining compensation for losses, school closures, being moved to a new area, and lack of fun activities.

Other kinds of reactions include grief reactions, traumatic grief, depression, and physical reactions.

Grief Reactions will be prevalent among those who survived the disaster but have suffered many types of losses, including the death of loved ones, and loss of home, possessions, pets, schools, and community. Loss may lead to feelings of sadness and anger, guilt or regret over the death, missing or longing for the deceased, and dreams of seeing the person again. More information on grief reactions and how to respond to survivors experiencing acute grief reactions can be found in the section on Comfort.

Traumatic Grief Reactions occur when children and adults have suffered the traumatic death of a loved one. Some survivors may stay focused on the circumstances of the death, including being preoccupied with how the death could have been prevented, what the last moments were like, and who was at fault. These reactions may interfere with grieving, making it more difficult for survivors to adjust to the death over time. More information on traumatic grief reactions and how to respond can be found in the section on Comfort.

Depression is associated with prolonged grief reactions and strongly related to the accumulation of post-disaster adversities. Reactions include persistent depressed or irritable mood, loss of appetite, sleep disturbance, greatly diminished interest or pleasure in life activities, fatigue or loss of energy, feelings of worthlessness or guilt, feelings of hopelessness, and sometimes thoughts about suicide. Demoralization is a common response to unfulfilled expectations about improvement in post-disaster adversities and resignation to adverse changes in life circumstances.

Physical Reactions may be commonly experienced, even in the absence of any underlying physical injury or illness. These reactions include headaches, dizziness, stomachaches, muscle aches, rapid heartbeat, tightness in the chest, hyperventilation, loss of appetite, and bowel problems.

Once the survivor is able to better understand their own stress reactions, they may be prepared to discuss healthy and unhealthy ways of coping with the reactions they are experiencing.

Provide Basic Information on Ways of Coping

The aim of discussing positive and negative forms of coping is to:

• Help survivors consider different coping options
• Identify and acknowledge their personal coping strengths
• Think through the negative consequences of maladaptive coping actions
• Encourage survivors to make conscious goal-oriented choices about how to cope
• Enhance a sense of personal control over coping and adjustment

You can discuss a variety of ways to effectively cope with post-disaster reactions and adversity.

Adaptive coping actions are those that help to reduce anxiety, lessen other distressing reactions, improve the situation, or help people get through bad times. In general, coping methods that are likely to be helpful include:

• Talking to another person for support
• Getting needed information
• Getting adequate rest, nutrition, exercise
• Engaging in positive distracting activities (sports, hobbies, reading)
• Trying to maintain a normal schedule to the extent possible
• Telling yourself that it is natural to be upset for some period of time
• Scheduling pleasant activities
• Eating healthful meals
• Taking breaks
• Spending time with others
• Participating in a support group
• Using relaxation methods
• Using calming self talk
• Exercising in moderation
• Seeking counseling
• Keeping a journal
• Focusing on something practical that you can do right now to manage the situation better
• Using coping methods that have been successful for you in the past

Maladaptive coping actions tend to be ineffective in addressing problems. Such actions include:

• Using alcohol or drugs to cope
• Withdrawing from activities
• Withdrawing from family or friends
• Working too many hours
• Getting violently angry
• Excessive blaming of self or others
• Overeating or undereating
• Watching too much TV or playing too many computer games
• Doing risky or dangerous things
• Not taking care of yourself (sleep, diet, exercise, etc.)

Teach Simple Relaxation Techniques

Breathing exercises help reduce feelings of over-arousal and physical tension which, if practiced regularly, can improve sleep, eating, and functioning. Simple breathing exercises can be taught quickly. It is best to teach these techniques when the survivor is calm and can pay attention. It may also be helpful for family members to prompt each other to use and practice these techniques regularly. The handout, Tips for Relaxation (Appendix E), can be provided to reinforce the use and practice of relaxation techniques. Helpful demonstrations of relaxation techniques such as diaphragmatic breathing and progressive muscle relaxation are included below.

Demonstration of Diaphragmatic Breathing

Demonstration of Progressive Muscle Relaxation

Some other educational and empowerment resources may be useful for individuals experiencing stress reactions. When Terrible Things Happen describes common adult and adolescent reactions, and positive/negative coping. Parent Tips for Helping Infants and Toddlers; Parent Tips for Helping Preschool-Age Children; Parent Tips for Helping School-Age Children; Parent Tips for Helping Adolescents; and Tips for Adults are for adults to help themselves and their children.