Witnessing a Tragic Event: How does one cope?


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By Drs Luis Oliver and Michele Boivin

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  • Traumatic events are common:
    National Comorbidity Survey (NCS; Kessler et al, 1995):
    Men: 60.7%
    Women: 51.2%
    National Women’s Survey (NWS; Resnick et al 1993): 69%
    PTSD is less common:
    Lifetime prevalence rates 8%
  • Not taking things or people for granted,
  • The Cochrane Collaboration is an international not-for-profit and independent organization whose purpose is to disseminate information about evidence-based care. It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. The Cochrane Collaboration was founded in 1993 and named after the British epidemiologist, Archie Cochrane
    We want to help, but our desire outstrips our science – what PD has to offer does not appear useful
  • Think Maslow’s hierarchy of needs…
  • Review of event is designed to provide survivors and loved ones with information to reduce confusion, misinformation etc.
  • Witnessing a Tragic Event: How does one cope?

    1. 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. 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. 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. 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. 5. Prevalence of Trauma vs. PTSD
    6. 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. 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. 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. 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. 10. What can you do?
    11. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 • Leeds & Grenville district 1.866.281.2911 • Pembroke Regional Hospital Mobile Crisis Team 613.732.3675 ext. 8116 or 1.866.996.0991 • Youth Services Bureau 24/7 Crisis Line 613.260.2360 or 1.877.377.7775
    22. 22. Q&A