It will happen to some of us. In a long career away from home something that causes physical or emotional injury – or creates the fear that we will be killed or hurt – may happen to us or to someone we know.
The injury might not be direct. Those of us who work with distressed populations may be fine for years, and one day see a suffering child or read of a community we know receiving a blow, and find ourselves overwhelmed and unable to cope.
This kind of “critical incident stress” (or “trauma injury”, if it has a long lasting impact), whether direct or vicarious, is an occupational hazard. It is an injury we may get as a result of our work, just as a sprain or break is an injury an athlete may incur. And as with any injury, we are better for understanding it and knowing how to heal from it.
In the previous note we examined what we can do to help someone else. In this one we will consider our reactions and what to do, if something happens to us.
Timing: Each of us will react differently. There is no ‘right’ or ‘wrong’ way to react to a traumatic event. For some, a reaction will be quick and intense. For others, a reaction may be delayed for days or weeks. Our circumstances will have an impact. Existing stress from other sources might increase our response. Responsibility for colleagues or others who are injured might delay our own reactions.
Physical responses: During an incident we may feel frozen and have a racing heart. Right after, we may experience shaking, crying, nausea, sweating, weakness or other symptoms. Later, it is common to lose appetite, to have sleep problems including disturbed dreams or insomnia, and fatigue. Because stress affects our immune systems, we may be more vulnerable to colds and flues. If such things happen, know that these reactions are normal, and will pass.
Emotional responses: Numbness is a common initial emotional reaction. It helps deal with the immediate challenges. Later, it is normal to experience a tumble of emotions. We may feel insecure, depressed, betrayed, angry and even guilty about things we tell ourselves we could or should have done during or after the event. There may be a feeling of grieving, for the loss of our sense of safety and security.
Time may have slowed during the event, a reaction which helps us react in survival mode. After, we may find ourselves worrying a lot, or suspicious and fearful of others. We may have problems concentrating, become forgetful, or find it hard to make decisions. We may get stuck in loops of replaying the event and judging our own or others’ responses. We might worry that all of this is a sign that we are ‘losing it’. Although our reactions feel scary, they are normal… and they will diminish with time. Even without professional support, most people who experience a critical incident scare will return to a normal state within four to six weeks.
After the stress of a serious incident we may continue to act irritably, or want to withdraw or be easily startled for some time. We may be hyper-sensitive to what others say and do. We may find ourselves needing physical contact – and not wanting sex. Whatever our unique reaction, it is normal – and we will move beyond it, with time and the support of others.
What can we do?
Remember what we know about stress and coping. We are having normal reactions to a difficult circumstance.
Be with others. We may need quiet time – and we will need people who care about us. We have to let them know what we want, whether it is to talk, or to be quietly with them, to be held or to have something to eat. Feel comfortable in asking for support. Others will be grateful for the chance to help.
Talk about our reactions with someone we trust. If it is hard to talk about them at this time, write letters or a journal. Remind ourselves that having these reactions is normal and that they will gradually pass.
Drink lots of liquids – and limit alcohol and stimulants like coffee, which can stimulate or depress our feelings in an unhelpful way. Eat food that is both comforting and healthy. Our body needs our support.
Don’t force ourselves to do a lot for a few days – and accept opportunities to do things that let us focus on something other than the event. Exercise is important and will help avoid or recover from depression and anger. Rest also, even if we find it hard to sleep.
Avoid making big decisions until our reactions have moved towards normal and our judgment is more balanced.
Understand that colleagues and friends may be having a hard time dealing with what we went through and may not know how best to support us. Some of their comments may not feel helpful – but aren’t intended to hurt. Establish boundaries if needed, and avoid people who are not helpful.
If we are worried about our reactions or if we are still acutely upset after four to six weeks, talk to a professional. There are many helpers who have experience with stress and trauma, and they can help.
Post Traumatic Stress Disorder (PTSD) is a longer term condition that can develop for some people who have been exposed to a deeply frightening or life-threatening situation. Although many people who experience a critical incident may have reactions that will pass in weeks or months, some will have symptoms that last much longer, and should consult a professional about their concerns. The strategies that help people with PTSD may also be helpful for anyone experiencing shorter term reactions to critical incident stress. For suggestions on dealing with anxiety, flashbacks, sleep and dream issues and others, check the website of the National Center for PTSD.