Post-Traumatic Stress Disorder (PTSD) and How You Feel When Bad Things Happen

We’ve all either supported someone who has experienced a crisis or gone through such an event ourselves. Intense emotions often follow a traumatic incident. Thankfully, although these emotions are often serious, only a very small percentage of people develop post-traumatic stress disorder (PTSD). And the good news is, of those who develop PTSD, many can be helped if given immediate attention.

PTSD is a type of anxiety disorder caused by a significant traumatic event. It is not grief, although that is a normal emotional response to trauma. PTSD anxiety can have a variety of expressions: strong desire to avoid recalling memories of the event, re experiencing the event with intense distress/anxiety, detachment, insomnia, difficulty concentrating and extreme agitation. For a person with PTSD, small things can trigger a disproportionately extreme reaction, like the Chinese saying, “once bitten by a snake, frightened even by a rope.” As pointed out, most people who have experienced a traumatic life event don’t develop PTSD. Individuals who develop PTSD are much more likely to have experienced previous trauma than those who don’t.

There are two categories of trauma that might result in a diagnosis of PTSD. Developmental trauma is recurring trauma (e.g. ongoing abuse), while shock trauma is a one-time event. Of these two types, shock trauma is easier to address. Shock trauma can often be treated much more quickly than developmental trauma.

Regardless of whether your loved one has PTSD, there are some important things to understand as we help them recover from a traumatic event.

How to support someone immediately after a traumatic event

Trauma survivors display one of three general types of reactions: shutting down or becoming over-activated, or bouncing between these extremes. Whatever their reaction, the typical response from their friends and family is a suggestion to quickly “get over” the intense emotions: “Don’t be upset.” “Calm down.” “Take deep breaths.” But these words may have the opposite of their intended effect.

For everyone, empathy is the best way to help them work through intense feelings. After a traumatic event, many people feel ashamed of their feelings. Give your loved ones permission to feel and to notice their feelings. Feeling intense emotions after a shock is absolutely normal, and those feelings should not be suppressed.

The emergency response part of the brain is automatic and quick. In fact, a lot of mental processes occur before we’re even aware of them. In emergencies, we respond without thinking; our automatic emergency response system just takes over. There’s no need to be afraid of emotional signs of activation/agitation. Experiencing these feelings is how we know the body is discharging energy and coming back into balance. These reactions usually subside if you don’t fight them. Resistance often amplifies the reactions. Encourage trauma survivors to observe and accept what is happening in their bodies without judgment.

Additionally, as our nervous systems are recovering from shock, we tend to experience some “aftershock” reactions, such as trembling/shaking uncontrollably, crying/laughing, stomach gurgling, breathing deeply or feeling warm. These reactions are all normal.

Short-term shock support

I had the privilege of working with several brave children who survived the 2008 Sichuan earthquake. In disaster zones, there is a lot of anger. Survivors are feeling a whole host of intense feelings, and their minds are overloaded. One way you can help a trauma survivor is to encourage them to “get outside” their bodies, to focus on things outside their minds. Providing survivors with playful social engagement is more calming than anything. For kids, play and other physical activities are very effective. It’s helpful for people to visually or tactilely focus on something in their immediately space. The following are some examples of instructions I’ve given to patients:

1. Let your eyes move around the room focusing on something they’d like to look at. Don’t think about it too much, just let your eyes move. Have you found something? Focus on that thing. Notice its texture and color. Notice its symmetry and asymmetry.

2. Touch the chair you’re sitting in. Can you feel the texture of the arm of the chair? Feel the cushion under you. Does it feel different from the back of the chair? Do the legs of the chair feel smooth or rough?

Long-term shock support

If the trauma survivor doesn’t seem to be making any progress toward recovering from the shock (usually because the person has suffered a previous traumatic event), see if you can bring in more support resources (friends, family, clergy) as you encourage them to seek professional therapy. I’ve long been studying a type of trauma therapy developed by Dr. Peter A. Levine that is called Somatic Experiencing. This is an approach significantly influenced by recent developments in Neuroscience. Someone suffering from PTSD could benefit greatly from this approach.

How to respond in an emergency

We’ve been talking about how to support people through trauma recovery. Let’s address some practical psychological pitfalls you can avoid while in an emergency.

1) Not everyone reacts the same way in an emergency. The person who is the most calm should take charge. As a side note, inner resilience can be learned. ER doctors are among the most resilient people I know.

2) Don’t be afraid to ask for help. “Macho man” independence in an emergency is needless and unadvised. Know when the situation has spiraled out of control and call for help.

3) Delegate responsibilities. The person who is taking charge should assign tasks to everyone by name instead of giving vague instructions like, “Somebody call emergency!” People need specific instructions during an emergency.

4) In the wake of an emergency, take care of your body. Get ample rest; maintain a good diet; exercise; take time for leisure activities; and process through your sensations/reactions with supportive friends/family (don’t obsess about the event).

5) In the wake of an emergency, DON’T engage in destructive/unhealthy behavior, such as:

a) Excessive drinking
b) Using legal or illegal substances to numb the pain
c) Isolate/withdraw from significant others
d) Stay away from work
e) Be hard on yourself or others
f) Look for easy answers
g) Make major life decisions or changes

Reference:
More information on Somatic Experiencing: www.psychotherapy.net/interview/interview-peter-levine