Stress Management

STRESS, TRAUMA AND RECOVERY

By Deborah S. Kaufman, LCSW

Reactions to extreme stress and trauma are individual and varied. However, there are common themes by which the individual experiences can be organized, understood and eventually, treated and healed.

WHAT IS NORMAL STRESS?

To understand the range of human response to trauma, it is useful to start with a description of normal stress. While many people think stress is negative – something to be avoided if at all possible, it is best to view stress as neither negative nor positive. Stress is simply a normal, and even necessary part of life. In fact, a person without any stress would not be able to carry out any of life’s functions. This is because stress is the organism’s natural response to any demand made on the mind-body system. The demand can be as common as walking to the door to answer a knock from a visitor or as extreme as increasing adrenaline to enable a person to run into a fire to carry a child to safety. The latter is an example of the fight or flight response to perceived danger.

In the course of day-to-day living the process is fairly automatic, we perceive a demand, we respond to it and then we return to a state of balance or homeostasis. However, when the demand is excessive or the person is too challenged physically or emotionally to respond, then the system is in a state of distress – which is the negative association of stress. Levels of distress vary in intensity depending on the “stressor.”

THE EFFECTS OF SURVIVAL

Driving down I-75, one week post Hurricane Charley in August 2004; I saw a highway lamp folded in half with the top touching the ground somewhere between Port Charlotte and Punta Gorda. I was reminded how the forces of nature are stronger than we are. Many people had recently experienced these forces in a life altering way. They came face to face with their own vulnerability and mortality in a powerful and frightening manner. These hurricane victims were experiencing the effects of multiple losses. They survived the violence of nature gone wild with tremendous threat to their personal safety. This experience falls into the category of high intensity distress and trauma and can contribute to their developing PTSD (Post-traumatic stress disorder). According to statistics provided by the National Center for PTSD, approximately 7.8% of Americans age 15 to 54 will suffer from PTSD. Women are twice as likely as men to develop the condition. The statistics for children are harder to pinpoint; however girls are cited as 2-3 times more likely than boys to develop PTSD (3-15% for girls as compared to 1-6% for boys) with much higher rates for children and adolescents recruited from atrisk samples. These include children that have been exposed to community violence, family violence, sexual assault or sexual abuse.

PTSD is a psychiatric diagnosis that can only be made be a trained professional; however, it is helpful to recognize the symptoms to consider seeking professional help. The most common symptoms are:  Exaggerated startle response  Recurrent and intrusive distressing recollection of traumatic event  Recurring nightmares pertaining to the event  Hallucinations  Intense psychological distress at exposure to stimuli that resemble or symbolize the event  Physiological reactions to exposure to stimuli that resemble or symbolize the event  Sleep difficulties  Irritability or angry outbursts  Difficulty concentrating  Hypervigilence

HOW TO TREAT PTSD

Treatment for PTSD must include an initial assessment and treatment plan by a mental health professional. This is followed by education about the symptoms and effects of PTSD, developing coping skills and ultimately some reliving of the event in the safety of the therapy environment. Commonly used therapeutic approaches for PTSD are:  Cognitive-behavioral therapy (CBT). This involves working with cognitions or beliefs to change emotions, thoughts and behavior. An aspect of CBT that is specific to trauma treatment is called “exposure therapy.” This is where careful detailed imagining of the event, combined with relaxation techniques, helps reduce the emotional impact of the memories.  Eye Movement Desensitization and Reprocessing (EMDR). This treatment combines elements of CBT and exposure therapy, with eye movements, sounds and tactile stimulation to create a shift of attention from side to side. This is known as bilateral stimulation. As with the relaxation techniques in CBT, this stimulation can reduce the emotional impact of the memories.  Psychopharmacology (medications). Medications can alleviate symptoms of anxiety, depression and insomnia, and may be helpful for some trauma survivors.  Group therapy. Sharing in the healing process with others who are similarly affected can be very beneficial for trauma survivors.

OTHER MENTAL HEALTH PROBLEMS

It is important to note that some trauma survivors do not develop PTSD but do suffer from other related mental health problems like depression, anxiety or substance abuse. These people can also benefit from professional psychiatric and mental health services. In addition, since PTSD does not show up immediately following a trauma like living through Hurricane Charley, there are other distress symptoms to address. Critical Incident Stress Debriefing is a therapeutic intervention for people who have suffered trauma. This process is used with groups of trauma survivors in the initial days after the event. Survivors are invited to share their experiences and talk about the associated thoughts, reactions and symptoms. It is followed by education about taking care of themselves and how to begin the journey towards recovery. Some suggested ways to take care of yourself are:  Limit your intake of substances such as alcohol, caffeine and nicotine that interfere with relaxation  Drink plenty of water  Eat natural foods such as fruits, vegetables and whole grains  Simple moderate exercise like walking, bike riding or swimming can help the body and mind return to a more relaxed state  Talking with close friends and loved ones who have experienced the event with you can help demystify the experience  Avoid movies or books with upsetting themes that are reminiscent of the trauma  Engage in enjoyable, relaxing activities

HELP YOURSELF AND YOUR CHILDREN

The effects of a major traumatic event can be especially frightening for children. The most important component to helping your child through a traumatic experience is to take good care of yourself and your child simultaneously. Communicate through your words and your actions that it is okay to be upset. It is also helpful to know that if you are able to put the event in perspective, chances are your child will follow your lead. Try to maintain as much of your usual routine as possible under the circumstances. Be a bit more available than you would normally be. Emphasize whatever positives are available without minimizing any one’s experience.

Revised from an article printed in the Vitality section of the Sarasota Herald Tribune September 2004