Wednesday, November 4, 2009

Anniversary Reactions...

Recently, I taught a brief Chronic Sorrow workshop at a local rehabilitation hospital. When I'd scheduled the talk several months earlier, I had been concerned only with pacing my presentations and not overfilling the work week. (Good self care,

Unfortunately, I had forgotten that September 8th was the anniversary of the day my husband stopped his cardiac medication in order to allow his heart failure to take it's natural course. That day hadn't gone well and he had reacted poorly to the new palliative care medication, losing his pain control and becoming very confused. Rather than beginning a peaceful process of dying at home, as he'd wished, he was taken by ambulance to hospital where he died 3 weeks later. It was a horrible, traumatic day though the wonderful palliative care staff at the hospital worked hard to find the right medication combination and gradually made him both comfortable and oriented again.

I tucked away the memory of that day, (or it was subsumed by the grief of the days, months and years that followed), and I rarely thought about it until I went to the hospital to give the Chronic Sorrow presentation on September 8th. I didn't make the anniversary connection consciously, but my body "remembered" for me, leaving me a little breathless, lightheaded, sad and anxious as I walked through the lobby and causing me to briefly lose my train of thought (a "dissociative moment") during the presentation, itself. Fortunately, I was the only one who noticed and I went home to do some detective work, looking through my old journals until I made the connection between the two September 8th's, in hospital settings, focused on the sorrow of chronic illness. I had had an anniversary reaction.

An increase in distress around the anniversary of a traumatic event is known as an anniversary reaction. They can be mild, as mine was, or they can constitute a more severe reaction with significant psychiatric or medical symptoms. These reactions can involve a few days of mild distress or many weeks of anxiety, anger, nightmares, flashbacks, depression or fear. They can be triggered by specific, conscious reminders of the event or they can seem to come out of the blue. Anniversary reactions may begin days or weeks before the anniversary and may continue for days or weeks afterward.

Common anniversary reactions include:

1. Experiencing increased grief and sadness around the anniversary of the death of a loved one. This may be mild or may extend to clinical depression and suicidal thoughts.

2. Symptoms of posttraumatic stress including:

- Re-experiencing symptoms: Reactivation of the feelings, physiological responses or thoughts that occurred at the time of the event. These may occur as dreams or flashbacks or repeated images of the traumatic event and they may be as vivid on the anniversary as they were at the time of the trauma.

- Avoidance symptoms: Avoiding anything that might remind you of the trauma - people, places, situations.

- Arousal symptoms: Feeling nervous and on edge. Having difficulty sleeping. Feeling more on guard. Being more irritable and jumpy.

3. Panic attacks, specific fears or worry about one's own safety or that of loved ones.

4. Physical symptoms like fatigue, pain, headaches, GI disturbances.

5. Guilt reactions including survival guilt.

As you can see, there is no standard pattern to the symptoms of an anniversary reaction. In most instances, they will vary according to the type of traumatic incident, the personality of the person affected and their previous trauma history.

The good news about anniversary reactions is that they are normal responses to trauma and will usually subside over time. If they don't, they provide us with opportunities to do some deeper healing work that will make us stronger and more resilient in the long run. Doing some trauma therapy can make a significant difference to the distress of anniversary reactions. (It is not uncommon for trauma survivors to wait months or years to ask for mental health support because they are ashamed to admit that they "haven't got over it yet". The fact that we're waiting to ask for help can in itself be an avoidance symptom, a signal that we do actually need the help).

There are some things that we can do to to ease the pain of anniversary times:

- Mark important anniversaries on your calendar so you're not taken by surprise.

- Ask for the support you need at anniversary times - family, friends, or professional support.

- Make specific plans for the anniversary date so you have things other than the memories of the event to occupy your mind. Leave quiet periods to acknowledge your feelings if that helps.

- Honour the memory of loved ones with rituals like lighting a candle, sharing favourite memories and stories, sharing a meal with family or friends, visiting the grave, making a charitable donation, helping others, planting a tree, engaging in an activity your loved one enjoyed or attending a worship service.

- If the traumatic event was one shared in the workplace, consider planning an anniversary ritual or further debriefing that the group can share.

- Engage in activities to reduce your level of arousal - meditation, walks in nature, prayer, breathing practices, pelvic muscle relaxation, guided imagery.

Recovery from a traumatic event takes time. With patience and perseverance and support we can gradually reduce our trauma symptoms (including anniversary reactions) and move on to a life of renewed hope and meaning.

Photo by BigStock Photos

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