By Drs Luis Oliver and Michele Boivin

1. Coping with Traumatic Stress
Ottawa Operational Stress Injury Clinic
Dr. Michele Boivin, Psychologist
Dr. Luis Oliver, Psychologist
Dr. Sarah Bertrim, Psychologist
Mr. Alasdair Gillis, Social Worker

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?
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•
•
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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), sexual violation
• Exposure can be:
–
–
–
–
Direct
Witnessed
Learning of an event that happened to a loved one
Repetitive exposure to details of the event
DSM-V

4. Common Reactions to Trauma
Thoughts:
•Unwanted thoughts
•Nightmares
•Poor concentration
Emotions:
•Fear and anxiety
•Anger
•Irritability
•Guilt / Shame
•Grief
•Sadness
Behaviours:
•Effortful avoidance
•Withdrawal
•Alcohol or substance use
•Checking / vigilance
Physical symptoms:
•Insomnia
•Changes in appetite
•Nausea
•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
Duke University Health System, 2005
• Traumatic death is:
– Sudden, unexpected, or violent
– Caused by the actions of another person, an accident,
suicide, natural disaster, or other catastrophe

9. Common Reactions to Traumatic Loss
Duke University Health System, 2005
• 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

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:
Strategies for First Responders
• 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. Do’s
Helping traumatized individuals:
Strategies for Significant Others
•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
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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:
DURING:
AFTER:
•Family history
mental illness
•Perceived life
threat
•Lack of social
support
•Previous Trauma
•Intensity of
emotions
•Life stressors
•Previous
maladjustment
•Dissociation
•Early
symptoms

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

20. Accessing Resources
• Natural supports: family, friends, coworkers, clergy or
community groups, if relevant
• Family physician (referral)
• 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 management for Immediate needs
•
9-1-1 or Emergency Department
•
Mental Health Crisis Line 1.866.996.0991
•
Ottawa and the counties of Prescott Russell, Renfrew and Stormont Dundas
and Glengarry 613.722.6914
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Leeds & Grenville district 1.866.281.2911
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Pembroke Regional Hospital Mobile Crisis Team 613.732.3675 ext. 8116 or
1.866.996.0991
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Youth Services Bureau 24/7 Crisis Line 613.260.2360 or 1.877.377.7775

22. Q&A