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COMMON RESPONSES TO TRAUMA -- AND COPING

STRATEGIES
After a trauma, people may go though a wide range of normal responses. Such reactions may
be experienced not only by people who experienced the trauma first-hand, but by those who
have witnessed or heard about the trauma, or been involved with those immediately affected.
Persons, places, or things associated with the trauma can trigger reactions. Some reactions
may appear totally unrelated.

Below is a list of common physical and emotional reactions to trauma. These are NORMAL
reactions to ABNORMAL events.

Physical Reactions

• Aches and pains like headaches, backaches, stomach aches


• Sudden sweating and/or heart palpitations (fluttering)
• Changes in sleep patterns, appetite, and interest in sex
• Constipation or diarrhoea
• Easily startled by noises or unexpected touch
• More susceptible to colds and illnesses

Emotional Reactions

• Shock and disbelief


• Fear and/or anxiety, expectation of doom and fear of the future
• Grief, disorientation, denial
• Hyper-alertness or hyper vigilance
• Emotional swings -crying then laughing, irritability, restlessness, and
outbursts of anger or rage
• Worrying or ruminating -- intrusive thoughts of the trauma
• Nightmares
• Flashbacks -- feeling like the trauma is happening now
• Feelings of helplessness, panic, feeling out of control
• Increased need to control everyday experiences
• Minimising the experience, concern over burdening others with problems
• Attempts to avoid anything associated with trauma
• Tendency to isolate oneself and feelings of detachment
• Emotional numbing or restricted range of feelings
• Difficulty trusting and/or feelings of betrayal

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• Difficulty concentrating or remembering
• Feelings of shame, self-blame and/or survivor guilt
• Depression

Helpful Coping Strategies

• Reach out and connect with others, especially those with whom you may
share the stressful event
• Cry
• Hard exercise like jogging, aerobics, bicycling, walking
• Relaxation exercise like stretching, massage, swimming
• Humour
• Prayer and/or meditation;
• Listening to or making music and creative arts
• Maintain balanced diet and sleep cycle as much as possible
• Avoid over-using stimulants like caffeine, sugar, or nicotine
• Do something socially active
• Write about your experience – in detail, just for yourself or to share with
others

Unhelpful Coping Strategies

• Avoidance through alcohol, substance abuse or social withdrawal


• Aggressive attitudes or acts
• Acting out though promiscuity, spending or gambling
• Self-harm
• Depressive symptoms
• Excessive worrying
• Displacement of anger

People are usually surprised that reactions to trauma can last longer than they expected. It may
take weeks, months, and in some cases, many years to fully recover. Many people will get
through this period with the help and support of family and friends. If they are unavailable then
finding a group of brothers or sisters who have been through similar experiences will help.

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Topic 2
The Impact of Trauma (Adults)

The word trauma is derived from a Greek Word meaning ‘wound’. Its pure definition is an
event that threatens ones life. The broader definition refers to any physical, sexual, emotional
or spiritual wound that involves threat to ones life or sense of self.

Traumatic events often shatter our assumptions about the world and ourselves. The following
table adapted from Hicks (1993: p.17) outlines the common assumptions that are commonly
shattered as a result of a traumatic experience.

Traumatic events that wound and Traumatic events that don’t make
scare a person challenge the sense challenge the
assumption of assumption of
Invulnerability Rationality
“It can’t happen to me” “The world makes sense”

Traumatic events that seem Traumatic events that change your


unfair challenge the image of yourself challenge the
assumption of assumption of
Morality Identity
“The universe is just” “I know who I am”

Trauma always leaves people changed, either positively or negatively. If the normal trauma
response can be modulated effectively then evidence suggests that change following trauma
can have positive aspects. For example Michael Christopher (2004: 83) outlines the
following positive changes that can occur following a trauma:

1)“The first type of change entails a more integrated sense of self, to be more specific, a
greater competence and resilience when dealing with life’s challenges.
2) The second type of change entails relationships with others, more specifically, closer
relationships with family and significant others, reconciliation of estranged relationships, an
increased ability to protect oneself and prevent abusive relationships, greater altruism,
increased willingness to help, increased sensitivity to others and increased openness to new
behaviours.
3) The third type of change involves a more integrated philosophy of life. That is, the third
type of positive change following trauma includes an increased appreciation of ones
existence, changed priorities, stronger beliefs, a greater sense of meaning, and a whole new
comprehensive perception of reality”

Trauma can be survived and most people will eventually come through a trauma back to full
functioning. The human spirit is resilient. Ernest Hemingway states, “The world breaks
everyone, then some become strong at the breaks”.

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However, if pain is buried or a person fails to process their grief adequately then healing is
blocked and the pain remains. The ongoing pain, (either buried or overtly expressed through
emotions such as anger, resentment, and helplessness) will then negatively impact the person
and often their family and friends.

Most psychological responses that are unhealthy are due to a breakdown in the modulation of
the normal stress response and the specific dynamics of the response will be an interaction
between the individual’s socio-cultural environment and psychological makeup (Christopher,
2004).

Acute Stress Disorder

For a diagnosis of Acute Stress Disorder, symptoms must persist for a minimum of two days
to up to 4 weeks within a month of the trauma. If symptoms persist after a month, the
diagnosis becomes Post Traumatic Stress Disorder

Symptoms include:

• Lack of emotional responsiveness, a sense of numbing or detachment

• A reduced sense of surroundings

• A sense of not being real

• Depersonalisation or a sense of being dissociated from self

• An inability to remember parts of the trauma, "dissociative amnesia"

• Increased state of anxiety and arousal such as a difficulty staying awake or falling
asleep

• Trouble experiencing pleasure

• Repeatedly re-experiencing the event through recurring images and/or thoughts,


dreams, illusions, flashbacks

• Purposeful avoidance of exposure to thoughts, emotions, conversations, places or


people that remind them of the trauma

• Feelings of stress interfering with functioning; social and occupational skills are
impaired affecting the patient's ability to function, pursue required tasks and seek
treatment

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Post-Traumatic Stress Disorder (PTSD)
PTSD is identified as a serious emotional disorder. It can very seriously damage a person’s
normal functioning.
When diagnosing PTSD, psychologists are guided by textbooks, which require certain
symptoms to be present. The following criteria have to be met for a person to have a formal
diagnosis of PTSD. However, it is very important for us to be aware that a person may not
meet all the criteria for PTSD, but still have their life severely affected by trauma. They will
show some of the symptoms.

Criteria for PTSD

1. Trauma

• The person must have been involved in one or more traumatic experiences, or
witnessed them, where either life was in danger or, at least, there was the danger of
terrible injury to someone.
• The person’s response must also have involved intense fear, helplessness or horror.

2. Re-experiencing symptoms
The traumatic event is persistently re-experienced in one or more of the following ways.
• The person keeps remembering what happened and can’t get it out of their mind.
Even if they try not to think about it they remember bits of the trauma – either as
images, thoughts or perceptions.
• They keep having distressing dreams about what happened.
• They have experiences when they feel as if the event is actually happening again and
they are “in it”. These are called “flashbacks”.
• The person reacts with intense psychological distress if they are exposed to “triggers’,
(external or internal) that remind them of the trauma. e.g’s 1. People in Sri Lanka
feeling strong fear when they hear water, even though the tsunami has been over for
many months. 2. People feeling intense fear if they just think about some part of the
trauma.
• The person has physiological reactions when they are exposed to these kinds of
external or internal “triggers”. e.g. 1. Their heart starts to beat fast. 2. They start to
sweat and breathe quickly.

Avoidance Symptoms

People do their best to avoid anything associated with the traumatic experience. This
includes a numbing of their general responsiveness (not present before the trauma), as
indicated by three or more of the following:
• Efforts to avoid thoughts, feelings or conversations associated with the trauma. e.g.
As much as possible they avoid talking about it.
• Efforts to avoid activities, places or people that remind them of the trauma. e.g. As
much as possible they keep away from possible “triggers”.
• Inability to recall an important aspect of the trauma. (It seems like an inbuilt
mechanism sometimes “blocks” from conscious memory some especially horrible
parts of what happened.)

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• Markedly diminished interest or participation in significant activities. e.g. They no
longer feel like meeting people, or going out of the house much.
• Even when they are with other people, they feel disconnected or detached from them.
• They have a restricted range of emotions (e.g. Usually able to feel anger and fear but
not able to have loving feelings).
• They feel their life will be shorter than most (e.g. does not expect to have a career,
marriage, children, or a normal life span).

4. Physical Hyper-Arousal Symptoms

It seems like the “Volume Knob” on people’s bodily reactions is turned up higher than normal
and they tend to have physical over-reactions. They need to have two or more of the
following:
1. Difficulties falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulties concentrating.
4. Hypervigilance i.e. constantly looking around them for any signs of danger.
5. Exaggerated startle response.

The duration of the symptoms above must be more than one month for a diagnosis of
full PTSD to be made.

ADDITIONAL NOTES

1. The majority of people who experience a trauma do not suffer from full-blown PTSD.
2. Most people’s trauma symptoms gradually settle down, so that they are not
excessively troubled by them six months after the event.
3. About 20% of people experiencing a severe trauma continue to have distressing
symptoms longer than six months, and these may continue for many years.
4. Symptoms of PTSD can appear soon after the event, but may not appear for years
afterward. Usually they appear within 3 months.
5. If a person has PTSD it does not mean that they are weak.

If PTSD is severe it is a family condition, for all members of the family are affected.

Understanding PTSD

The Brain and Trauma

Brain Stem and Cerebellum: Regulates basic functions such as heart rate and respiration

Limbic System: Emotion is generated in the limbic system. Parts of the limbic system are
involved in trauma. Messages of sight sound and smell converge in the thalamus and are sent
on to relevant structures involved in vision, auditory processing etc. Hippocampus and
amygdala are related to memory storage of traumatic events and strong emotions (e.g., horror
and fear). Limbic system is mostly unconscious.

Cortex and Neocortex: Higher executive functions like thinking, planning, reasoning. These
higher functioning parts of the brain analyse threat messages sent by limbic system and make
decisions regarding the degree of threat, either extinguishing fear response or planning a
course of action.

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Unconscious and conscious fear responses are processed differently. If we can bring what is
unconscious into consciousness then we have access to the higher executive parts of the brain
in the cortex and neo cortex to challenge fears and address problems.

In PTSD the higher executive parts of the brain show diminished function and the emotional
centres of the limbic system show increased function.

Taken from ‘Mapping The Mind’ Rita Carter (1998)

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What are the stages of the grief process?
A loss/trauma experience involves the following five stages of emotional response: (1) denial (2)
bargaining (3) anger (4) despair (5) acceptance.
• These five stages can occur in either the sequence presented or in any variety of
sequence.
• The stages can recur during a loss experience.
• One stage can last a long time, uninterrupted.
• These five stages can occur in either the sequence presented or in any variety of
sequence.
• The loss process can last anywhere from three months to three years.
• These stages of grief are normal and are to be expected.
• It is healthier to accept these stages and recognize them for what they are rather than to
fight them off or to ignore them.
• Working out each stage of the loss response ensures a return to emotional health and
adaptive functioning.
• Getting outside support and help during the grieving process will assist in gaining
objectivity and understanding.

Stage 1. Denial
• We deny that the trauma/loss has occurred.
• We ignore the signs of the trauma/loss.
We begin to use:
• Magical thinking believing by magic this memory will go away
• Excessive fantasy believing nothing is wrong; this trauma is just imagined; when I
wake up everything will be OK.
• Regression believing that if we act childlike and want others to reassure us that nothing
is wrong.
• Withdrawal believing we can avoid facing the losses and avoid those people who
confront us with the truth.
• Rejection believing we can reject the truth and those who bring us the news of our loss
to avoid facing the loss.

Stage 2. Bargaining
• We bargain or strike a deal with God, ourselves, or others to make the pain go away
• We promise to do anything to make this pain go away.
• We agree to take extreme measures in order to make this pain disappear.
• We lack confidence in our attempts to deal with the pain, looking elsewhere for
answers.
We begin to:
• Shop around believing we look for the ``right'' agent with the ``cure'' for our pain.
• Take risks believing we can put ourselves in jeopardy financially, emotionally, and
physically to get to an answer for our pain.
• Doing for others, believing we can ignore our own needs.

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Stage 3. Anger
• We become angry with God, with ourselves, or with others over our pain.
• We become outraged over the costs to overcome our pain.
• We pick out ``scapegoats'' on which to vent our anger, e.g., the doctors, hospitals,
helping agencies, international specialists, etc.
We begin to use:
• Self-blaming believing we should blame ourselves for the trauma.
• Switching blame believing we should blame others.
• Blaming our departed loved ones for leaving us.
• Aggressive anger believing we have a right to vent our blame and rage aggressively on
the closest target.
• Resentment believing our hurt and pain is justified to turn into resentment toward
involved in our loss event.

Anger is a normal stage. It must be expressed and resolved; if it is suppressed and held in, it will
become "Anger in" leading to a maladaptive condition of depression that drains our emotional
energy.

Stage 4. Despair
• We become overwhelmed by the anguish, pain, and hurt of our loss; we are thrown into
the depths of our emotional response.
• We can begin to have uncontrollable spells of crying, sobbing, and weeping.
• We can begin to go into spells of deep silence, morose thinking, and deep melancholy.
We can begin to experience:
• Guilt believing we are responsible for our loss.
• Remorse believing we should feel sorry for our real or perceived ``bad past,'' deeds for
which this loss is some form of retribution or punishment.
• Loss of hope believing that because the news of our loss becomes so overwhelming
that we have no hope of being able to return to the calm and order our life held prior to
the loss.
• Loss of faith and trust believing that because of this loss we can no longer trust our
belief in the goodness and mercy of God and mankind.

We need support to assist us in gaining the objectivity to regroup our lives. If we are not able to
work through our despair, we risk experiencing events such as physical or mental illness, suicide,
inability to cope with the aftermath of our trauma, rejection of those who experienced the
trauma, detachment, and poor relationships.

Stage 5. Acceptance
• We begin to reach a level of awareness and understanding of the nature of our loss.
We can now:
• Describe the terms and conditions involved in our loss.
• Fully describe the risks and limitations involved in the treatment or rehabilitation for
the loss involved.
• Cope with our loss.

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• Test the concepts and alternatives available to us in dealing with this loss.
• Handle the information surrounding this loss in a more appropriate way.
We begin to use:
• Rational thinking believing we are able to refute our irrational beliefs or fantasy
thinking in order to address our loss from a rational perspective.
• Adaptive behaviour believing we can begin to adjust our lives to incorporate the
changes necessary after our loss.
• Appropriate emotion believing we begin to express our emotional responses freely and
are better able to verbalize the pain, hurt, and suffering we have experienced.
• Patience and self-understanding believing we can recognize that it takes time to adjust
to the loss and give ourselves time to ``deal'' with it. We set a realistic time frame in
which to learn to cope with our changed lives.
• Self-confidence believing, as we begin to sort things out and recognize the stages of
loss as natural and expected, that we gain the confidence needed for personal growth.

We can be growing in acceptance and still experience denial, bargaining, anger, and despair.

To come to full acceptance we need support to gain objectivity and clarity of thinking. It is often
useful to gain such assistance from those who have experienced a similar loss. For example,
groups of parent who have experienced the death of a child or who have had a child with a
developmental disability.

Peer support from strangers is often the best way for a person to deal with the grieving process.

Acting out behaviours


Survivors of traumatic events often engage in risky and self-destructive behaviours. They do
so in a desperate attempt to avoid the painful emotions they experience as a result of the
trauma, or an attempt to deny the trauma and its consequences.

• Alcohol or substance abuse


• Gambling or irrational purchases
• Promiscuous and/or unprotected sex
• Self-mutilation
• Assault behaviours
• Self deprecating speech and performance
• Stealing
• Eating disorders
• Social withdrawal

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Depression

Depression is a mood noted by a negative view of self, the world and the future.
It is characterised by: sadness; discouragement; low self-esteem; inferiority; guilt;
indecisiveness; irritability; loss of interest in hobbies, family, friends; loss of motivation; poor
self image; appetite changes; sleep changes; loss of sex drive; concerns about health; suicidal
impulses

Depression is often characterised by negative thinking and distorted perceptions:


Filtering: Looking at only one part of a situation to the exclusion of everything else.

Polarised Thinking: Involves perceiving everything at the extremes, as either black or white;
all or nothing, with nothing in between.

Overgeneralisation: Reach broad, generalised conclusions based on one piece of evidence.

Mind Reading: base assumption and conclusions on your ability know other people’s
thoughts.

Catastrophising: You turn everything into a catastrophe, always expecting the worst-case
scenario.

Personalisation: You interpret everything around you in ways that reflect on you and, often,
your self worth.

Control Fallacies: Entails feeling either that the events in your life are totally controlled by a
force outside of yourself or that you are responsible for everything.

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