The Trauma of Hurricane Sandy ...

May there be peace in the midst of the storm

and hope in all the days that follow. 

I've just been watching some of the coverage of the damage wrought by Hurricane Sandy, both in the United States and in Canada, and my heart goes out to everyone affected. I think, particularly, of the first responders and of all those whose work will take them out into the elements and into the path of danger in the days and weeks ahead - also, of all the family caregivers who already experience trauma and loss in their everyday existence and who must now cope an additional layer of traumatic stress. And, of course, there are those who have lost loved ones and homes. And those living with terrible uncertainty regarding loved ones' whereabouts and safety.

We all experience some traumatic events in life but there are ways to keep longterm trauma effects from developing. You can help. I'd like to share with you (with permission) the first two stages of the trauma first aid steps developed by trauma expert, Peter Levine:

First Aid for Adults:

Stage 1:  Immediate Action (At the Scene of the Traumatic Event) 

1.  If life-saving medical procedures are required, that must take precedence.

2.  Encourage a sense of safety. Keep the person warm, lying down, and still, unless they face further danger by remaining where they are. Don't let them jump up and move around, which they might be tempted to do. The feeling of having to do something, to act in some way, can override the essential need for stillness in order to discharge unused fight or flight energy. They may want to deny the magnitude of the traumatic event and might act like they are fine.

3.  Stay with the traumatized person. Assure them that you will stay with them or that help is on the way. When help does arrive, continue to stay with the traumatized person if possible.

4.  Encourage the person to fully experience their bodily sensations. These may include adrenaline rush, numbness, shaking and trembling, feeling hot or chilled. 

5.  Stay fully present. What you do and say can help the person discharge the trauma energy. Let them know it is not only okay that they shake, but it is good, and will help them release the shock. They will get a sense of relief after the shaking is completed and may feel warmth in their hands and feet. Their breathing should be fuller and easier. This initial stage could easily take 15 - 20 minutes.

6.  Don't go it alone.  Get someone to help you process the event afterwards.

Stage 2:  Once the Person is Moved Home, to the Hospital or to a Shelter

1.  Allow time for processing.  Continue to keep the traumatized person quiet and resting until they are out of the acute shock reaction. Traumatized people should always take a day or two off work to allow themselves to reintegrate. This is important even if they perceive that the trauma doesn't justify staying home. This resistance can be a common denial mechanism and defense from feelings of helplessness. A day or two of rest is good insurance.

2.  Allow the emotions to be felt without judgement. The trauma survivor is likely to begin experiencing a variety of emotions, such as anger, fear, guilt, enxiety. There might also be bodily sensations, such as shaking, chills, etc. This is still fine.

For information on the third stage of Trauma First Aid and for more information about healing single event trauma, I would recommend Peter Levine's, Healing Trauma: A Pioneering Program for Restoring the Wisdom of Your Body.

   

Secondary trauma first aid...

My heart goes out to all people suffering the direct effects of the disasters we are seeing on TV this week.

How much the world can change in just a few days. Even though I was fairly sheltered from newspapers, internet and newscasts while I was away, just the conversations of those around me and my own naturally hypersensitive empathic responses were enough to raise my heart rate, increase my respirations and create a buzz of anxiety. (Witnessing trauma triggers old trauma responses.)

The current disasters, to say nothing of the trauma we encounter in our workplaces and caring situations at home, can combine to cause acute secondary trauma responses in our own lives even though we are not actual survivors of the disasters. What can we do to lessen the effects of the trauma we witness?

Here are a few practical tips:

1. Monitor and limit your trauma exposure through TV, the internet, newspapers, and conversations.

2. If you begin to feel anxious, stop and take a few deep breaths and relax your whole body, particularly your pelvic floor muscles, as you breathe deeply, pause, then slowly release your breath through pursed lips. (If a medical condition contraindicates this type of breathing, please make adjustments to meet your own needs.)

3. Take a walk in the fresh air every day.

4. Talk about your feelings with someone you trust to listen respectfully.

5. Draw deeply upon your spiritual beliefs and practices.

6. Do something to help someone else. It will lessen your feelings of helplessness. For example:

- Pray for them or hold them in your meditation.

- Send a donation to a reliable disaster relief organization.

- Send a note of support to someone who is directly affected by the disaster.

- Help someone in your family or neighbourhood - drive someone to a doctor's appointment, visit someone who is shut in, do someone's grocery shopping, spring clean someone's garden, do a new mom's laundry, buy some flowers for a friend who's struggling ...

7. Be close to the people who love and support you - either in person or by email, Skype/iChat or phone.

8. Ramp up your usual self care practices - trust the strategies that have worked in the past.

9. If none of these things help, consider seeing a counsellor who specializes in trauma work. There are a number of short term interventions that could be very helpful in reducing your stress.

Haitian Earthquake...

My heart goes out to the people of Haiti and to all who wait in an agony of uncertainty for news of loved ones. As the horror of the Haitian earthquake reverberates around the world, two important thoughts come immediately to mind:

First, that the way we can best help to ease suffering in that impoverished, broken but courageous land is to donate as much as we are able to established organizations such as the Canadian Red Cross who are able to make on-the-ground assessments and to purchase, in bulk, what is needed most.

Secondly, that it is important not to create a population of the secondarily traumatized here at home through our over exposure to scenes of injury and devastation in the media. Here are some suggestions for mediating the effects of this exposure:

1. Reduce the trauma exposure wherever possible.

Especially for those who are already trauma survivors, TV coverage of major traumatic events can have a magnetic pull. This is a time to consciously limit your trauma exposure based on your body's responses. If you notice that your heart is pounding, your muscles are rigid and you are holding your breath as you watch TV, that you're becoming frightened about your own safety or irritable with family and friends, that you're sleeping poorly or having intrusive images or nightmares like the ones in the media, it might be time to turn off the tube for a while. (Pacing your exposure before any of these symptoms occur is a good "ounce of prevention" as well).

Keep a particular eye on what your kids are watching and reading. Research shows a positive correlation between children viewing traumatic scenes and the development of PTSD symptoms.

2. Practice exceptional self care.

During a time of shock and horror, there are few things more important than focusing on good self care. Get enough sleep. (I heard a friend say that he'd sat up to 1:00 in the morning yesterday, watching the news.) Eat balanced, low salt, low sugar, low fat meals. Get the stress out of your body with some large muscle exercise. Maintain your spiritual practices. Talk or write about your feelings.

3. Engage in some comforting activities.

Think of things that have helped you to switch from "fight or flight" to "the relaxation response" in the past and do them. Walk in nature. Meditate. Pray. Spend time with children. Gather together with people you love, in person, on the phone, via the internet. Create in this time of destruction. Garden. Knit. Do woodwork. Paint. Write poetry. Cook. Dance. Listen to music. Write music. Chop wood.

Trauma First Aid...

As family carepartners and helping professionals, we are exposed to secondary trauma, or indirect wounding, through witnessing or hearing of the traumatic experiences of others.

Whether we discover a loved one collapsed on the floor after a heart attack, assist a patient suddenly hemorrhaging from his gastrointestinal tract, respond to a serious motor vehicle accident or preside at the funeral of a four year old child, we are vulnerable to secondary traumatic stress. How do we practice good self care in such situations? How do we help ourselves to reduce long term trauma effects?

Peter Levine, PhD,  in his books, Healing Trauma and Waking the Tiger, gives first aid guidelines for helping adults who have experienced traumatic events. From these guidelines, I have drawn the following suggestions:

Stage I:  Immediate Action:

As soon as possible after ensuring the immediate safety of the primary victims and your own safety:

1.  Rest, lying down if possible. (This may go against your natural inclination to "do something" or to deny the impact of the trauma but it is essential to be still so the trauma energy can be discharged from your body.)

2.  Have a trusted person stay with you quietly.

3.  Allow yourself to fully experience your body sensations. These may include adrenalin rush, numbness, shaking and trembling, feeling hot or chilled.

4.  Remind yourself or allow others to remind you that it is not only okay to shake, it is good and will help you to release the shock. You will feel a sense of relief after the shaking is completed and may feel warmth in your hands and feet. Your breathing should be fuller and easier. This initial stage of discharge could easily take 15 - 20 minutes.

5.  Stay quiet and resting until the acute shock reaction is over.

Stage II:  Later

1.  Allow time for processing the traumatic experience. Always take a day or two off work or rest more than usual if you are at home in order to reintegrate. This is important even if you don't perceive your situation to justify staying home or resting. (This resistance can be a common denial mechanism and defense against feelings of helplessness). As Peter Levine says, "A day or two is good insurance".

2.  Allow your emotions to be felt without judgement. You may experience feelings such as anger, fear, guilt, sadness and anxiety. There may also be continuing body sensations such as shaking or chills. This is often the case.

Stage III:  Begin to Access and Renegotiate the Trauma: (Often coincides with Stage II)

1.  Work with someone who understands the body effects of trauma to recall both the direct and peripheral images, feelings and sensations experienced during the traumatic event. Work slowly, one step at a time, to bring up and discharge the trauma energy.

Dealing with a traumatic event at the time that it happens goes a long way toward preventing long term trauma reactions. If you would like to understand more about the importance of processing traumatic events and the physiology behind the process above, I recommend Peter Levine's two books and his CD collection, Healing Trauma.

 (As always, use your own best judgement to assess your particular circumstances before using the guidelines above.)