The recent attack in downtown Ottawa has deeply affected our city. We have a powerful desire to stay strong as individuals and as a community yet we are all human so it is natural to feel fear, anxiety and loss after this type of event. Recognizing this, The Royal held a special info session on coping with trauma. Presenters: Dr. Jakov Shlik, Clinical Director, Operational Stress Injury Clinic and Anxiety program, The Royal Michelle Antwi, Operational Stress Injury Clinic, The Royal Katie Bendell, Operational Stress Injury Clinic, The Royal

1. Dealing with fear and anxiety:
How to feel «Ottawa strong»
October 29, 2014
Dr. Jakov Shlik, Clinical Director; OSI Clinic & Anxiety Program
Michelle Antwi, MSW, RSW; OSI Clinic
Katie Bendell, BA, PhD Pending; OSI Clinic

2. Overview
• What is trauma?
• How do people react to traumatic events?
– What is a ‘normal’ reaction?
– What are the signs that someone is struggling?
• What is a traumatic loss?
• How do people grieve?
• How can I cope with what I have witnessed?
• How can I help someone else cope?

3. What is Trauma?
• Exposure to actual or threatened death, serious injury
(accident, assault, torture), or sexual violence
• Exposure can be:
– Directly experienced
– Witnessed in person
– Learning of an event that happened to a loved one
– Repetitive or extreme exposure to details of the event
DSM-V

4. Common Reactions to Trauma
Thoughts:
•Unwanted thoughts
•Nightmares
•Poor concentration
Emotions:
•Fear, anxiety
•Anger, irritability
•Guilt, shame
•Grief, sadness
Behaviours:
•Effortful avoidance
•Withdrawal
•Alcohol or substance use
•Checking / vigilance
Physical symptoms:
•Insomnia
•Changes in appetite
•Fatigue
•Tension
•Headache

5. Prevalence of Trauma vs. PTSD

6. Natural recovery
• Transient symptoms are normal
• Among those who will recover, symptoms
begin to decline within several weeks of the
trauma
• Most natural recovery occurs within the first
year
• Recovery is associated with reestablishing
previous activities

7. Impediments to natural recovery
• Ongoing avoidance
• Being extra careful /safe
• Trying to push away thoughts & memories
• Distraction / keeping very busy
• Ruminating – thinking and re-thinking
• Vigilance – looking for signs of threat
• Alcohol/medication use
• Giving up enjoyable activities

8. Traumatic loss
• Traumatic death is:
– Sudden, unexpected, or violent
– Caused by the actions of another person,
an accident, suicide, natural disaster, or
other catastrophe
Duke University Health System, 2005

9. Common reactions to traumatic loss
• Shock: Difficulty accepting the loss really happened,
prolonged memories or dreams of the event
• Fear and anxiety: Feeling unsafe during normal
activities, worrying about what could happen
• Anger: Feeling out of control / helpless
• Guilt: Regret about what one has done or not done,
guilt about surviving / going on with life
Duke University Health System, 2005

10. What can you do?

11. Grieving a traumatic loss
• Grief is unique – there is no ‘right way’
• Connect with support systems
• Collective grieving: vigils, spiritual services, recollections of
individuals who died
• Individual grieving: Continuing with old traditions or
establishing new ones, finding ways to remember,
allowing a range of emotions
• Maintain self-care
• Eventually, reengaging in activities

12. Creating a meaningful legacy
• In the early aftermath this can be difficult to even imagine
• A tragic event can leave us doubting our purpose or
question meaning in life
• It isn’t useful to try to find a positive interpretation of the
event itself
• In time it can help to find personal meaning from a loss
and create a positive legacy
– Ways to make the world better
– Refocusing on values and meaningful activity

13. Helping traumatized individuals:
first response strategies
• Psychological Debriefing / Critical Incident Stress
Management has been widely applied in these situations
• Available evidence suggests that this method is at best inert
and at worst harmful
• Current best practices suggest Psychological First Aid and
focus on immediate needs for comfort, housing, medical care
etc.

14. Short Term (first few weeks)
• “Psychological First Aid”
• Safety planning and emergency stabilization should
precede psychological factors (Resnick et al, 2000)
• Goal:
– Assist individual in feeling connected, validated, safe
– Provide education about signs that would warrant seeking
help
– ‘Plant seeds’ rather than initiate long term contact
Litz 2008

15. Psychological first aid
• Do’s:
– Offer group support
– Offer opportunity for individual meetings for those
uncomfortable in group setting
– Review of event (provide basic details of what occurred)
– Offer opportunity to discuss experiences if desired
– Provide information/handouts on trauma, where to
obtain care
– Discuss what they could expect from treatment

16. Helping traumatized individuals:
Strategies for significant others
Do’s
•Listen
•Be available consistently
•Understand & normalize common
trauma reactions
•Accept initial coping – (most)
anything goes in the first few days
•Encourage use of natural supports
over therapy
•Limit exposure to media accounts
Don’ts
•Minimize (it will be okay,
they’re in a better place)
•Take control over their
wellbeing
•Give advice
•Judge
•Pathologize a normal reaction
•Personalize reactions

17. Exceptions – when to seek help
right away?
• Thoughts of harming oneself or someone else
• Excessive alcohol or drug use
• Dangerous/risky behaviours
• Inability to care for oneself or dependents

18. Risk factors for PTSD
BEFORE:
•Family history
mental illness
•Previous Trauma
•Previous
maladjustment
DURING:
•Perceived life
threat
•Intensity of
emotions
•Dissociation
AFTER:
•Lack of social
support
•Life stressors
•Early symptoms

19. When to consider more support?
Post traumatic stress occurs when we start to organize
our lives around the trauma (Briere & Scott)
•Duration - more than one month, most of the time
•Intensity – major distress (anxiety, sadness, grief)
•Impairment – relationships, activities, work, self-care

20. Accessing Resources
• Natural supports: family, friends, coworkers, clergy or
community groups
• Family physician
• Employee Assistance Program
• Registered mental health professionals:
– Check college websites for information about
psychologists, psychiatrists, social workers
• OSI Connect app: self-screeners, information for
professionals, other resources online

21. Crisis help for immediate support
• Distress Centre Ottawa and region; dcottawa.on.ca
– Distress Line 613-238-3311
– Tel-Aide Outaouais 613-741-6433 or 1-800-567-9699
– Mental Health Crisis Line (Ottawa) 613-722-6914
– Mental Health Crisis Line 1-866-996-0991 Akwesasne,
Prescott-Russell, Renfrew, Stormont-Dundas-Glengarry
• Youth Services Bureau 24/7 Crisis Line
– 613.260.2360 or 1.877.377.7775

22. Q & A