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Profile
Ms Clarissa Sammut Scerri is a Counselling Psychologist and UKCP accredited Family Therapist. She is a member of the Maltese Psychological Association and a lecturer at the University of Malta.
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Those of us who watched these terrifying scenes on the news, of people fleeing for their life in darkness may have shuddered at the fate of these people and what they must be going through psychologically, physically and emotionally. They were re-experiencing such traumatic events in a relatively short space in time, during a time too when recovery and resettlement to “normal” life have been painstakingly slow given the extent of the devastation of the disaster. The events of Monday night might have triggered the memories of the death and destruction that happened a few months before, resulting in re-experiencing some of the physical, emotional and cognitive reactions experienced after the traumatic event had occurred.
What are some of these traumatic stress reactions? How do traumatic experiences affect people? Perhaps we associate traumatic experiences with natural disasters such as earthquakes or flooding. However, other common traumatic experiences which can include being physically attacked, being in a serious accident, being in combat, suffering through terrorist act, being sexually assaulted, and being in a fire also can provoke traumatic reactions in people.
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It is important to note that stressful events of daily life such as divorce or financial crises, although stressful to the persons involved and which may lead to adjustment problems, do not have the same impact as a traumatic event. According to the DSM IV R, a traumatic event is such, when the person has experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury or a threat to the physical integrity of self and others and the person‘s response involved intense fear, helplessness or horror. (In children, this could be expressed by disorganised or agitated behaviour).
When children and adults go through traumatic experiences, it is normal to experience the following stress reactions for several days after the initial shock subsides: feelings become intense and sometimes unpredictable, one may become more irritable than usual and one’s mood can change back and forth. One may become especially anxious or nervous or depressed. Thoughts and behaviour patterns are also affected by the trauma. One might have repeated and vivid memories of the event. Such flashbacks may occur for no apparent reason and may lead to physical reactions such as rapid heart beat or sweating. Persons may also feel confused, disoriented and indecisive, and sleep and eating patterns may also be disrupted. Physical symptoms may also accompany the extreme stress. Persons may feel tense, tired and may have headaches, nausea and chest pain and may require medical addition. Pre-existing medical conditions may worsen. Interpersonally, people may notice that they are increasingly irritable, want to stay isolated or feel rejected and abandoned. Relationships may become strained and possibly greater conflict might occur with family members and colleagues.
Such reactions are actually normal reactions to abnormal situations. Such stress reactions in the emergency and early post-traumatic incident event are highly common as the survivors and their families accurately recognise the grave danger that they are in. Generally, many people recover fully from even moderate stress reactions between 6 to 16months and although these stress reactions may seem “extreme”, and cause distress, generally they do not become chronic problems. Persons need to realise that there is not one standard pattern of reactions to the stress of traumatic experiences. Some people respond immediately, while others have delayed reactions. Some who have suffered from trauma are energised initially by the event to help them with the challenge to coping, only to later become discouraged or depressed.
From a psychological point of view, traumatic events impact us so because the events are so abnormal to normal day to day living. Traumatic incidents shatter our assumptions that the world is a safe place and challenge our perceptions of the world , of how and why things happen. More so, when disasters are inflicted by humans as opposed to natural disasters, our life philosophies, including our values and moral principles may be called into question as we encounter the cruelty persons can intentionally inflict upon others. Our spiritual experiences, our belief in God and/or our notions of hope, faith, love, gratitude can also be disrupted by traumatic events. We can struggle to find a source of hope, for ourselves and our loved ones.
Traumatic reactions and traumatic events may happen to anyone, including competent, healthy strong and good people. People who react to traumas are not going insane and having symptoms after a traumatic event is not a sign of personal weakness. Mental health workers, emergency personnel, clinicians or therapists who work closely with survivors of traumatic reactions are also prone to experiencing such symptoms. Specialised training in this area, supervision and giving importance to self care and one’s relationships of loved ones help mediate some of the factors that may lead to traumatisation.
Since trauma survivors have these upsetting feelings and reactions when they are reminded of their trauma, they may often act as if they are in danger again and have avoidance symptoms. They might get overly concerned about staying safe in situations that are not truly dangerous. They might also want to avoid thinking about the trauma or avoid any reminder of the traumatic event. Some survivors are aware that they are avoiding reminders but at other times, people do not realise that their behaviour is motivated by the need to avoid reminders of the trauma. Actually, re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience. These symptoms are automatic learned responses to trauma reminders and trying to avoid thinking about the trauma and avoiding treatment for trauma-related problems may keep a person from feeling upset in the short term but avoiding seeking help can mean, that in the long term, trauma symptoms may persist.
What can persons who have experienced a traumatic incident do to help themselves? How can family and friends help? In general, most people who go through traumatic events are not familiar with how trauma affects people. They may not understand what is happening to them. They may think that the trauma is their fault, that they are going mad and may turn away from friends and family who do not seem to understand. For this reason, it is important that trauma survivors inform themselves of the effects of traumatic experiences on themselves and also on their families. It is important for them to remember that survivors and their families also have their strengths, interests, commitments, relationships with others and past experiences that were not traumatic. These are all important factors for the recovery process from a traumatic experience.
The percentage of those exposed to traumatic stressors who then develop Posttraumatic Stress Disorder (PTSD) can vary depending on the nature of the trauma, and other risk and adverse factors, with prevalence rates ranging from 4 – 5% in the case of natural disasters to a rate of 28% in the case of mass shooting
According to the US National Centre for Post traumatic stress Disorder , a substantial amount of research shows that an adult ‘s risk for psychological distress will increase as the number of the following factors increase: female gender, age of 40 – 60 years old, little previous experience or training relevant to coping with traumatic events, ethnic minority, low socio-economic status, children present in the home, for women, the presence of a spouse, especially if he is significantly distressed, psychiatric history, severe exposure to the disaster, especially injury, life threat, extreme loss, living in a highly disrupted or traumatized community and secondary stress and resource loss. Research also show that although at the time of the traumatic event, many people feel overwhelmed with fear and dread, most trauma survivors will be upset for several weeks after an event but will recover to a variable degree without treatment.
If symptoms endure for more than one month and one feels that his or her quality of life has been seriously compromised, it is important to seek help from a psychologist trained in the area who would be able to guide the person concerned to the appropriate services for treatment. Family members of a traumatised person should find out as much as they can about PTSD and get help for themselves even if their loved one does not seek treatment. Family members can encourage the survivor to inquire about therapy but they should not pressure or try to force their loved one to get help. They should let their loved one know that they are willing to listen if the survivor would like to talk about his or her trauma but again he or she should be forced beyond what feels comfortable.
Recovery from traumatic stress and from PTSD is an ongoing, daily, gradual process. It does not happen through sudden insight or “cure” but involves a multi-pronged approach. In addition to seeking the help of a therapist for support and for someone to talk to, survivors have also found it helpful to practice relaxation methods such as physical exercise, spending time in nature or meditation, taking prescribed medication through a psychiatrist and increasing activities that the persons concerned find pleasurable such as engaging in artistic endeavours. Other positive lifestyle changes include: increasing contact with other survivors of trauma, refraining from alcohol and drug abuse and also starting an exercise program.
Healing does not mean that a survivor will forget the traumatic experience or have no emotional pain when remembering. Some level of continuing reaction is normal, which reflects a normal body and mind. Recovery may lead to fewer reactions and reactions that are less intense. It may also lead to manage trauma-related emotions and to greater confidence in one’s ability to cope.
Ms Clarissa Sammut Scerri is a Counselling Psychologist and UKCP accredited Family Therapist. She is a member of the Maltese Psychological Association and a lecturer at the University of Malta.
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