Traumatic Stress/Crisis Intervention Techniques and Tips
Mark Gorkin, MSW, LICSW, “The Stress Doc” ™
This “how to” guide highlights key questions and concepts, illustrative vignettes and intervention strategies for understanding and responding supportively and therapeutically to individuals grappling with post-traumatic effects after Tuesday’s “Day of Terror.” In this abbreviated version, the areas outlined are: Prologue: Key Crisis Concepts, A) Current Bio-Psychosocial Assessment, B) Post-Traumatic Coping and Problem Solving.
Prologue. Key Crisis Concepts
Definition: Crisis is a heightened state of emotional vulnerability that produces an acute, time-limited need to regain a sense of psychic control and mind-body equilibrium, that is, to reduce the profound tension and return the person to some pre-crisis level of adaptation. However, in a crisis state, by definition, one’s usual coping mechanisms are not proving sufficient. Sustained tension and hypervigilance are creating cracks in one’s natural and conditioned defensive shield. Emotional memories of other traumatic or crisis events as well as generalized angst and depression, come flooding up to consciousness.
Here lies the double-edged – “danger” and “opportunity” – nature of crisis. Immediately there is often confusion or disorientation, from both the immediate threat, loss, or challenge submerged in former or unfamiliar pain. A heightened vulnerability and sense of threat may challenge the person to move beyond habitual ways of responding. With sufficient support and encouragement, a person may allow himself to become more dependent on others, to reach out for resources and or experiment with new or improved methods of problem solving. Conversely, lacking support or ashamed of displaying neediness, an individual in crisis may regressively withdraw or turn to escapist behavior and other dysfunctional adaptations.
1. Explain that crises are time-limited, that is, usually within one to six weeks, a person will regain a state of mind-body equilibrium. However, the ongoing war status, the possibility of more terrorist strikes or counterattacks to American reprisals means many individuals will ebb and flow through heightened tension if not crisis states.
2. Fortunately, there is a learning curve. Effective coping with an initial crisis sequence often helps prepare an individual for positively responding to and for managing subsequent crises or trauma effects.
A. Current Bio-Psychosocial Assessment
1. How is the person functioning now in his or her various roles and relationships? How calm, agitated, lethargic, sad or withdrawn does he or she appear? How appropriate is the overall emotional expressiveness and mood stability?
2. How does it compare with the person’s initial reaction on Sep. 11, 2001?
3. Is the individual fixated on a particular image or memory, e.g., people jumping from the WTC, the building crumbling, being trapped in an inferno, airplane passengers becoming part of a guided missile, etc? When the timing is right, explore the personal significance of these images for the individual.
4. What feelings are most uncomfortable for the person to experience and publicly express?
a) Some may be afraid of revealing anger as they believe it will lead to out of control rage and a greater sense of helplessness
b) Some may be ashamed of crying in public for others will judge them as weak or needy
c) Some may feel guilty for being survivors or for having escaped the most brutal consequences
5. If the individual is a parent, close relative or guardian of a child, encourage the person to:
a) speak of any anxieties he or she may have for a child’s welfare
b) explore how children are reacting to: 1) the events, 2) the coping patterns of the significant adults around them and 3) the coping behavior of peers?
c) reassure parents that if they overreact emotionally with a child to a mundane event, e.g., yelling loudly when the child leaves the milk out on the kitchen table, there’s always opportunity to soothe any wounds. The parent can subsequently explain that the child was not the cause of the hyperreaction; the parent is under more stress than usual in this crisis period
Remember, to some degree, in such a national catastrophe everyone is grappling with post-traumatic effects. Stress symptoms include:
a) generalized anxiety or helplessness, impending doom; preoccupation with what will happen next?
b) loss of concentration; racing thoughts
c) eating or sleeping disturbance; abusing alcohol and drugs
d) feeling numb or unpredictably weepy; sudden crying
e) somatic stress, e.g., headaches, muscle tension, rise in blood pressure, etc.
f) loss of interest in previously enjoyable activities, roles and relations
6. How was the person coping with day to day responsibilities and stressors in the days, weeks and months before the day of national trauma? Determine if any previous stress or hazardous events are enhancing the post-traumatic reaction.
B. Post Traumatic Coping
1. Strive for Realistic Control. Discourage the person from trying to achieve an absolute sense of control of his or her external environment, as this will invariably leave one feeling more at risk. The Serenity Prayer is also relevant here:
Grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.
2. Seek Sources of Support. Are there supportive/nurturing resources available at home, at work, through church, with friends – in person, over the phone, on the Internet; is there an online or offline support group available?
3. Take Some Concrete Action Steps. Encourage the person to focus on two or three actions steps that would help the individual feel a small but significant degree of enhanced safety and security. For example, one woman stated that getting a gas mask for her and her cat and stocking up on bottled water would help her feel better. (I declined asking what the cat would think of her plan.)
4. Explore the Need for Counseling. Let people know about the counseling option. If in the next few weeks, the person feels stuck in one of the grief stages or the post-traumatic symptoms are not subsiding, professional guidance is indicated.
5. Communicate Optimism. Reaffirm that post-traumatic stress is natural, that crisis can heighten a person’s problem-solving capacity, enhance a person’s communal circle of support and that the grief process may be a catalyst for potent healing and growth producing energy.
As I once penned: Whether the loss is a key person, a desired position or a powerful illusion each deserves the respect of mourning. The pit in the stomach, the clenched fists and quivering jaw, the anguished sobs prove catalytic in time. In mystical fashion, like Spring upon Winter, the seeds of dissolution bear fruitful renewal.
Some questions and answers to help us all in these traumatic times…Practice Safe Stress.