The impact of the terroristic violence on September 11, 2001
will affect people at all levels of involvement: victims,
bereaved family members, friends, rescue workers, emergency
medical and mental-health care providers, witnesses to the event,
volunteers, members of the media, and citizens of the community,
the country, and the world. Terroristic events can cause people
to feel angry, frustrated, helpless, and afraid. Terrorism
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.
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
1
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)
2
Specific Coping Strategies for Traumatic Stress and PTSD
Symptoms
Positive coping actions
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,
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 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
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). 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 terroristic
event such as the Oklahoma City bombing, many of those in closest
proximity to the disaster do not believe that they need help and
will not seek out services, despite reporting significant
emotional distress
3. 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, community
rituals). Indeed, because the goal of many disaster
mental-health workers is to have interventions be a seamless,
integrated part of an overall disaster effort, those who
receive these services may not recognize them as mental-health
interventions.
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.
It is critical to address this hesitance about seeking help
given that a large portion of the individuals who were directly
exposed to the Oklahoma City bomb blast continued to have active
postdisaster psychiatric symptoms six months after the
bombing. (PTSD was the most common disorder, and major
depression was the second most common disorder
4).
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. Check this
website regularly for updated information on how to get help. We
will be listing more ways to get help as they become
available.
For veterans
VA medical centers and Vet Centers provide veterans with
mental-health services that health insurance will cover or that
costs little or nothing, according to a veteran's ability to
pay. VA medical centers and Vet Centers are listed in the phone
book in the blue Government pages. Under "United States
Government Offices," look in the section for "Veterans Affairs,
Dept of." In that section look for VA Medical Centers and Clinics
listed under "Medical Care" and for "Vet Centers:
Counseling and Guidance," and call the one nearest to where you
live. On the Internet, go to
www.va.gov/ and look for the VHA
Facilities Locator link under "Health Benefits and Services," or
go to
www.va.gov/rcs.
For non-veterans
Some local mental-health services are listed in the phone book
in the blue Government pages. In the "County Government Offices"
section for the county where you live, look for a "Health
Services (Dept. of)" or "Department of Health Services" section.
In that section, look for listings under "Mental Health." In the
yellow pages, services and mental-health professionals are listed
under "counseling," "psychologists," "social workers,"
"psychotherapists," "social and human services," or "mental
health." Health insurance may pay for mental-health services and
some are available at low cost according to your ability to
pay.
For anyone
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.
If you are a member of a Health Maintenance Organization
(HMO), call to find out if mental-health services are
available.
Call the National Center for Victims of Crime's toll-free
information and referral service at 1-800-FYI-CALL. This is a
comprehensive database of more than 6,700 community service
agencies throughout the country that directly support victims of
crime.
Contact your local mental-health agencies or family physician.
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.
References
1.
Horowitz, M.J. (1986).
Stress-response syndromes: A review of posttraumatic and
adjustment disorders.
Hospital and Community Psychiatry, 37(3), 241-249.
2.
Finkel, N.J., & Jacobsen, C.A.
(1977). Significant life experiences in an adult sample.
American Journal of Community Psychology 5(2),
165-175.
3.
Sprang, G. (2000). Coping strategies
and traumatic stress symptomatology following the Oklahoma City
bombing.
Social Work and Social Sciences Review, 8(2), 207-218.
4.
North,
C.S., Nixon, S.J., Shariat, S., Mallonee, S., McMillen, J.C.,
Spitznagel, E.L., & Smith, E.M. (1999). Psychiatric disorders
among survivors of the Oklahoma City bombing.
Journal of the American Medical Association, 282(8),
755-762.