Violence & Trauma

On the anniversary of going through a trauma, some trauma survivors have an increase in distress. These anniversary reactions can range from feeling mildly upset for a day or two to a more extreme reaction with more severe mental health or medical symptoms.

Why do people have anniversary reactions?

The anniversary date itself may trigger a memory. For example, in a case such as the September 11, 2001, attacks, the date serves as a strong reminder. Since people refer to those attacks with the date on which they occurred, it is hard for anyone who knows about that event to go through that day without being reminded of what happened. Triggers may also seem to come from out of the blue around the time of an anniversary. They may happen while you are at work, at home or relaxing.

Anniversary reactions may occur because of the way a traumatic experience is saved in memory. Memories of trauma contain information about the danger that the event involved. The memory helps people be aware of when they should be afraid, how they should look at such situations, how to feel in that situation, and what to think. The trauma memory gives information that may help people stay safe. For example, a memory of a rape might include the information that it’s important to beware of strangers at night and to run away if one comes near. The memory might tell survivors to feel fear in this situation and to think that they are in danger and need help. Such memories may produce strong feelings as well as bodily reactions.

What symptoms go along with anniversary reactions?

Anniversary reactions usually make symptoms that are common reactions to trauma or part of post-traumatic stress disorder (PTSD) get worse:

Reliving the event (or reexperiencing): Perhaps the most common reaction on the anniversary of a trauma is a repeat of the feelings, bodily responses and thoughts that occurred at the time of the event. For example, on the anniversary of a rape, a sexual assault survivor might have unusually intense and upsetting memories.

Avoidance: Another type of PTSD symptom is the avoidance of anything related to the trauma. Sometimes the feelings that are triggered by the anniversary are so strong that people try to avoid events, places or people that are connected to that event. For example, a combat veteran may choose to stay home on Veteran’s Day to avoid parades, fellow veterans and other reminders of military service.

Negative changes in beliefs and feelings: When the anniversary of an event is near, it can lead to sadness. Some people may find it hard to connect with friends and family. Old thoughts of guilt or shame may come back.

Feeling keyed up (or hyperarousal):  A fourth kind of reaction is to feel nervous and on edge. As the anniversary comes, the trauma memory might be so intense that it is hard to sleep or focus on things you need to do. Some people become more jumpy or quick to anger. Others feel like they have to be more on guard.

Around an anniversary, survivors may have panic attacks, be afraid to go certain places, or find that they worry more about safety for themselves and their loved ones. For example, a car accident survivor may avoid getting in a car on the anniversary for fear they will be hit again. Others may have physical or medical symptoms such as fatigue and pain. They may complain of headaches and stomachaches.

A common type of anniversary reaction is feeling grief and sadness on the anniversary of the death of someone close to you. In fact, this is so common that most major religions have special services to support those who feel increased grief at these times. If the reaction is extreme, the survivor may become depressed or even think about suicide. For most people, though, the feelings of sadness at the anniversary do not last more than a brief time.

What becomes clear is that there is not one classic anniversary reaction. The anniversary reaction will differ among trauma survivors. It may depend on the type of trauma, how much time has passed since the trauma or loss, the qualities of that person, or other factors.

What can I do to feel better?

Most people will feel better within a week or two after the anniversary. Over time, the stress symptoms will become less frequent and less severe. You may find it helpful to make special plans for the anniversary day. It can help to have other things to occupy your time besides memories of the event. You may choose to take part in a special activity. Some ideas include

• Visiting a grave
• Donating to charity
• Giving blood
• Helping others
• Spending the day with family

Help is available if the stress response continues. You should contact your doctor or a mental health provider to seek support. It is common for people who did not seek help when they first went through the trauma to feel ashamed that they are still suffering months or years later. The fact that someone did not seek help may itself be a sign that they are avoiding reminders of the trauma. Such behavior can be a signal that the survivor needs the help of a professional.

Source: Department of Veterans Affairs, www.ptsd.va.gov

As the anniversary of a disaster or traumatic event approaches, many survivors report a return of restlessness and fear. Psychological literature calls it the anniversary reaction and defines it as an individual’s response to unresolved grief resulting from significant losses. The anniversary reaction can involve several days or even weeks of anxiety, anger, nightmares, flashbacks, depression or fear.

On a more positive note, the anniversary of a disaster or traumatic event also can provide an opportunity for emotional healing. Individuals can make significant progress in working through the natural grieving process by recognizing, acknowledging and paying attention to the feelings and issues that surface during their anniversary reaction. These feelings and issues can help individuals develop perspective on the event and figure out where it fits in their hearts, minds and lives.

It is important to note that not all survivors of a disaster or traumatic event experience an anniversary reaction. Those who do, however, may be troubled because they did not expect and do not understand their reaction. For these individuals, knowing what to expect in advance may be helpful. Common anniversary reactions among survivors of a disaster or traumatic event include:

Memories, dreams, thoughts and feelings: Individuals may replay memories, thoughts and feelings about the event, which they can’t turn off. They may see repeated images and scenes associated with the trauma or relive the event over and over. They may have recurring dreams or nightmares. These reactions may be as vivid on the anniversary as they were at the actual time of the disaster or traumatic event.

Grief and sadness: Individuals may experience grief and sadness related to the loss of income, employment, a home or a loved one. Even people who have moved to new homes often feel a sense of loss on the anniversary. Those who were forced to relocate to another community may experience intense homesickness for their old neighborhoods.

Fear and anxiety: Fear and anxiety may resurface around the time of the anniversary, leading to jumpiness, startled responses and vigilance about safety. These feelings may be particularly strong for individuals who are still working through the grieving process.

Frustration, anger and guilt: The anniversary may reawaken frustration and anger about the disaster or traumatic event. Survivors may be reminded of the possessions, homes or loved ones they lost; the time taken away from their lives; the frustrations with bureaucratic aspects of the recovery process; and the slow process of rebuilding and healing. Individuals may also experience guilt about survival. These feelings may be particularly strong for individuals who are not fully recovered financially and emotionally.

Avoidance: Some survivors try to protect themselves from experiencing an anniversary reaction by avoiding reminders of the event and attempting to treat the anniversary as just an ordinary day. Even for these people, it can be helpful to learn about common reactions that they or their loved ones may encounter, so they are not surprised if reactions occur.

Remembrance: Many survivors welcome the cleansing tears, commemoration and fellowship that the anniversary of the event offers. They see it as a time to honor the memory of what they have lost. They might light a candle, share favorite memories and stories, attend a worship service or participate in a service project to honor the memory of those who lost their lives

Reflection: The reflection brought about by the anniversary of a disaster or traumatic event is often a turning point in the recovery process. It is an opportunity for people to look back over the past year, recognize how far they have come, and give themselves credit for the challenges they surmounted. It is a time for survivors to look inward and to recognize and appreciate the courage, stamina, endurance and resourcefulness that they and their loved ones showed during the recovery process. It is a time for people to look around and pause to appreciate the family members, friends and others who supported them through the healing process. It is also a time when most people can look forward with a renewed sense of hope and purpose.

Although these thoughts, feelings and reactions can be very upsetting, it helps to understand that it is normal to have strong reactions to a disaster or traumatic event and its devastation many months later. Recovery from a disaster or traumatic event takes time, and it requires rebuilding on many levels—physically, emotionally and spiritually. However, with patience, understanding and support from family members and friends, you can emerge from a disaster or traumatic event stronger than before.

If you are still having trouble coping, ask for help. Consult a counselor or mental health professional. In the workplace, you may be able to get assistance from your human resources department or your company’s employee assistance program.

Source: National Mental Health Information Center, www.nimh.nih.gov

Resolving community conflict will not happen overnight. Building trust  between differing groups or points of view will take time and ongoing effort.

• Don’t rush to judgment. Try to see the situation from multiple points of view.
• Avoid thinking in an “us” vs. “them” way that makes it harder for people to find common ground.
• Be sensitive to the religious, cultural, and social backgrounds of your neighbors and co-workers. Recognize that your own biases and stereotypes may influence how you interact with others.
• Respond to others in your community based on how they behave, not who they are.
• Think about what you say. Avoid using offensive slang or slurs or language that is derogatory toward others.
• Be a role model. Set an example for your children, family, and friends. Treat others as you would wish to be treated.
• Talk to people in your community. Ask them how they are feeling about what’s been going on and listen to their concerns. Ask what changes they think are necessary to resolve the conflict.

Resources

The Culture and Trauma resource kits from the Suicide Prevention Resource Center/National Child
Traumatic Stress Network:  https://www.sprc.org/resources-programs/culture-and-trauma

Stress and Trauma Toolkit for Treating Historically Marginalized Populations in a Changing
Political and Social Environment:  https://www.psychiatry.org/psychiatrists/cultural-competency/education/stress-and-trauma

Fact sheet library on Mental Health Disparities and Diverse populations:
https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts

Source: Empathia, Inc.

Community violence is a complex term that has been used to refer to a wide range of events, such as civil unrest (e.g., riots, shootings, terrorism), workplace violence (e.g., assaults), or other acts of abuse (sexual, physical, or emotional). Mental health professionals often make a distinction between studies on crime-related events in which adults are often the focus and studies on exposure to violence in which children and adolescents are often the focus.

How is community violence different from other types of trauma?

Several aspects of community violence make it different from other types of trauma. Although there are warnings for some traumas, community violence usually happens without warning and comes as a sudden and terrifying shock. Because of this, communities that suffer from violence often experience increased fear and a feeling that the world is unsafe and that harm could come at any time. Although some traumas affect only one individual or a small group of people, community violence can permanently destroy entire neighborhoods. Finally, although some types of trauma are accidental, community violence is intentional, which can lead survivors to feel an extreme sense of betrayal and distrust toward other people.

What are the effects of witnessing or experiencing community violence?

As is the case with other traumas, individuals often experience posttraumatic stress disorder (PTSD) as a result of community violence. PTSD can affect people of all ages.

Children and families: Although some people think that young children are not psychologically affected by exposure to community violence because they are too young to understand or remember the violence, studies have found posttraumatic symptoms and disorders among infants and toddlers. Children’s and adolescents’ risk for developing PTSD increases with the severity of exposure, negative parental reactions to the exposure, and the child’s physical proximity to the community violence.

The impact of community violence exposure is not felt by the youth alone. A child’s or adolescent’s exposure to community violence also affects his or her family. Extreme anxiety concerning the child’s health and well-being is a common parental reaction. Resources for parents may be limited, which may lead to frustration and anger. Many parents blame themselves for not protecting their child adequately. They may become overprotective or use punitive discipline in response to their child’s trauma-related acting-out behavior. Relationships among family members can become strained. Parents find themselves having to face the task of reassuring their child while trying to cope with their own fears, especially if there is a chronic risk for future community violence exposure.

Adults: Adults can also experience PTSD following exposure to community violence. In addition to symptoms of PTSD, survivors of community violence often struggle with

• How to build trust again (which includes looking at issues of power, empowerment, and victimization)
• How to find meaning in life apart from the desire for revenge
• How to find realistic ways to protect themselves, their loved ones, and their homes and community from danger
• How to deal with feelings of guilt, shame, powerlessness, and doubt

A final concern regarding the effects of community violence is whether there is a link between witnessing violence and becoming violent, especially in intimate relationships. No studies have determined whether there is a relationship between community violence and domestic violence.

What treatments are available for individuals exposed to community violence?

Rapid, timely, and sensitive care for the community and affected individuals and families is the key to preventing PTSD in the wake of violence. Such care is also the key to reducing violence itself. Mental-health professionals with expertise in community violence can contribute in several ways:

• Help community leaders develop violence-prevention and victim-assistance programs.
• Help religious, educational, and health care leaders and organizations set up relief centers and shelters.
• Work with teachers at children’s schools to provide education, debriefing, and referrals for affected children.
• Provide direct psychological services near the site of violence, such as
• Debriefings
• 24-hour crisis hotline
• Identifying survivors or bereaved family members who are at high risk for developing PTSD
• Getting individuals connected with appropriate continuing treatment

How can community violence be prevented?

Some progress has been made in developing violence-prevention programs. The focus for these programs is prevention of gangs and building conflict-resolution skills in high-risk youths. However, violence prevention programs appear to be more effective if children are engaged early (beginning before age 6) and the program includes intervention in children’s home and school social environments. Programs should also continue to make specific efforts to reduce obvious high-risk behaviors among adolescents, such as gang involvement, heavy drinking, and carrying handguns.

Source: U.S. Department of Veterans Affairs, National Center for PTSD; www.ptsd.va.gov

Summary

This article contains information about some of the signs of grief and anger and provides useful information about how to cope with grief.

It is not uncommon for individuals and communities as a whole to experience grief reactions and anger after an incident of community violence. Grief is the normal response of sorrow, emotion, and confusion that comes from losing someone or something important to you. Most people will experience a natural occurrence of grief after the death of a loved one, but grief and anger can be the result of other types of losses. In situations of community violence, people may experience the loss of their sense of safety, their trust in those who live in their neighborhood, or their trust in local government. The trauma and grief of community violence can be experienced by all involved.

Grief reactions to violence

Often after a death or loss of some kind, many people express feeling empty and numb, or unable to feel. Some people complain that they become angry at others or at situations, or they just feel angry in general, even without a reason.

Some of the physical reactions to grief and anger may include:

• Trembling or shakiness
• Muscle weakness
• Nausea, trouble eating
• Trouble sleeping, trouble breathing
• Dry mouth

People experiencing grief also may have nightmares. They may withdraw socially and have no desire to participate in their usual activities, work, or school.

How long do grief reactions last?

Grief lasts as long as it takes you to accept and learn to live with the changes that have occurred in your community due to the violence and its aftermath. For some people, grief lasts a few months; for others, it may take more than a year. It’s different for each person depending on his or her health, coping styles, culture, family supports, and other life experiences. How long people grieve may also depend on the resilience of the community and the ability of its members to take on roles and responsibilities that will help restore the basic needs of the community, such as getting children back to school and businesses back to working again.

Reactions to community violence in children

Witnessing community violence and death can be traumatic experiences that cause negative mental health outcomes, particularly for children. Close relationships are important to children’s development, and the loss of family or a community member can represent the loss of social capital—the emotional support that enhances their well-being. Children may experience depression, posttraumatic stress, anxiety, aggression, poor academic achievement, hopelessness, and risky behavior. These losses can even affect their capacity for relationships and diminish future expectations.

Tips for helping children cope with grief:

• Allow children co talk about their feelings and to express their grief (e.g. crying, being sad).
• Try to follow the same routines as usual.
• Encourage them to play and laugh.
• Limit exposure to violence on TV news.
• Encourage them to get adequate rest and to eat healthy meals.

What can communities do to cope with their grief?

Often the community needs to come together to honor those who died and find meaning in their deaths in a way that will help everyone in the community recover. People may create a memorial and decide together that this will remind them never to allow such violence in their community again. It may help them be determined to work out their differences in other ways in the future—for example, by forming a community advisory group or identifying a local leader to be their liaison with law enforcement and other government entities.

What can individuals do to cope with their grief?

Talking to others who understand and respect how you feel—family members, faith leaders, people you trust—is a helpful way to ease your grief. Recognize that although you might still have these feelings over a long period, they will likely be less and less intense over time. Make sure to exercise and eat healthy meals. Do the things that you used to enjoy doing, even if you don’t always feel like it. This will help you get back into your routines. Allow yourself to feel joy at times and to cry when you need to.

Even though they may be experiencing grief, some individuals also exhibit positive changes from their experience of loss, such as:

• Becoming more understanding and tolerant
• Having increased appreciation for relationships and loved ones
• Being grateful for what they have and for those in their community who are loving and caring
• Experiencing enhanced spiritual connection
• Becoming more socially active

If you have experienced the death of a friend or loved one—or if you have been exposed to community violence—feelings of grief and anger are a normal reaction. However, if these feelings persist, access the resources below for more information on getting help. If you or someone you know is struggling after a disaster, you are not alone.

Resource

Disaster Distress Helpline
Substance Abuse and Mental Health Services Administration (SAMHSA)
Phone: 800-985-5990
Text: TalkWithUs to 66746
Website: www.samhsa.gov/find-help/disaster-distress-helpline

Source: Substance Abuse and Mental Health Services Administration, www.samhsa.gov

Summary

To cope with survivor guilt:

• Acknowledge feelings of guilt
• Allow time to mourn
• Take positive action
• Seek support
• Stay healthy

Floods, tornadoes, fires, airplane crashes—they happen, and many people survive these calamities. So we start shopping again, check out the movies and meet friends for dinner. But we feel guilty. How can we move on emotionally when so many have died? What if it had been me or someone I loved? What could I have done to prevent it? How can I properly mourn?

These are natural questions for people who went through a traumatic event. We usually associate such “survivor guilt” with war veterans, victims of violent crime, or survivors of life-threatening diseases. But we don’t have to be directly involved in a traumatic event to be affected by it. Many experience a kind of collective survivor guilt after repeatedly viewing images of any disaster. Many of us are unable to come up with a suitable reaction, and thus, a sense of guilt emerges.

Therapists view survivor guilt as a secondary symptom of post-traumatic stress disorder (PTSD) in that it doesn’t come directly from the original experience. It occurs later when a person who was somehow traumatized tries to get back to normal life, only to be sidetracked by such secondary feelings as guilt.

Coping tips

If it goes unchecked, excessive guilt can lead to other problems such as depression, apathy, or generalized anxiety.  We need to remember that guilt is a common reaction to loss and as such, it can ultimately be part of the healing process. These tips can help you cope with guilt:

• Acknowledge that you are feeling guilty. To deal with negative feelings, you must first recognize their symptoms.
• Take time to mourn. Attend a religious or community ceremony or plan your own way to recognize the suffering of others.
• Turn your negative feelings into positive action. Make a contribution, hold a fundraiser, take part in a rally, give blood, or participate in any volunteer action that makes you feel that you are serving the greater good.
• Seek out other people. Isolation worsens guilt, so turn to friends, family, or support groups.
• Keep healthy—eat right, exercise, and get enough sleep. Don’t drown your feelings in alcohol, drugs, or junk food; it will only compound the problem.
• Take advantage of the many organizations offering advice on coping with disasters.

By Amy Fries

©2001-2019 Carelon Behavioral Health

Source: American Psychological Association, www.apa.org; National Brain Tumor Society, ﾓWhat Long-Term Survivors Donﾒt Talk About,ﾔ www.braintumor.org/; The National Center for Post Traumatic Stress Disorder, www.ptsd.va.gov/; National Institute of Mental Health, www.nimh.nih.gov

Summary

• Be gentle with yourself during difficult times.
• Be aware that special days may be difficult.
• Participate in rituals that may provide soothing comfort.

The anniversary of a painful event may cause you to have an increase in stressful feelings. Anniversary reactions can range from feeling mildly upset to more extreme mental or physical health symptoms.

During this time it is important to take care of yourself and to watch out for signs that you need help.

Be aware that special days may be difficult. It’s pretty common for some stress and other emotional responses you had to the original event to come back around anniversary time. Recognizing this fact may help you not to be so hard on yourself. For many people, anniversaries and special days remind them of the impact a disaster has had on them. You may start anticipating the anniversary (or a birthday or other day of special significance in the life of a loved one you have lost) for several days, weeks or even months before. Not having your loved one or friend to share the day, your old home, apartment, neighborhood, job or co-worker—all can be difficult. It’s normal to have fears and concerns about how the anniversary or special day will make you feel.

Don’t worry if you are not experiencing any difficult feelings or emotions. This is normal too. Some people feel increased emotions pre-anniversary while others feel more emotions after the day, or not at all. Just remember that whatever you are feeling is okay. It’s only when your emotions start to interfere with your day-to-day functioning that you may want to consider reaching out for help.

Be gentle with yourself during difficult times. These times include not only the anniversary of the event itself, but other dates that are related, such as birthdays of friends you have lost, anniversaries of your wedding to a spouse you have lost, etc. Treat yourself with the same kindness you give to others.

Participate in rituals that may provide soothing comfort. Whatever those rituals are—exercise; lighting candles; mind and body activities such as meditating, yoga, acupuncture, or getting a massage; going to a movie; sharing a meal; going to a spiritual service; getting together with friends—try doing things that have meaning for you.

Plan activities. It is likely to be more helpful to plan what you are going to do (and with whom) before the special date arrives. Plan your activities so that you know what to anticipate and are not disappointed if something you wanted to do is not possible because you didn’t reserve the place or invite whomever you wanted to be with ahead of time. Don’t set yourself up for disappointment.

Reach out to family and friends. There is no need to be alone, and isolation is not helpful. Invite friends or family, or accept their invitations, to participate in rituals or social events, or even just to be in their company. Be with people who understand and accept your feelings.

Talk about how you’re feeling if you need to. Some people need to talk about how their lives have changed. This is normal and may continue beyond the anniversary and special days. Find someone who will listen and understand. And if you prefer to think and talk about the future rather than what’s happened in the past, then that is what you should do. There is no need to talk about distressing events unless you want to.

Do things that might help you with overwhelming emotions. If you are the type of person who likes to exercise or even simply take a walk, make sure to do so around the anniversary time. Try writing in a notebook as if you are telling someone a story, or just write your thoughts down. Maybe write a letter or email to reconnect with people you haven’t seen in a while telling them you miss them or even just telling them how you are doing. Talk to others you trust to understand.

Do what you would like to do rather than what you think you should do. Try not to put the needs of others before your own needs on anniversaries, holidays, and other special days. Each person should spend these days in the ways that will be most helpful to him or her. Trying to make things better for others may result in misunderstandings (“I thought that’s what they wanted to do; they thought it was what I wanted to do.”). Allow for self-care.

Remember, we’re still all in this together.

Source: Substance Abuse and Mental Health Administration, www.samhsa.gov

Your loved one has been through a traumatic incident. What can you do to help support them? Below are several suggestions for offering support and comfort during a trying time.

Listen.

One of the most important needs after a trauma is to talk about the event—and to do so often. Talk about it over and over. It may be difficult for you to hear, or you may get tired of hearing the same old story, but talking is a crucial part of your loved one’s recovery.

Be supportive and sympathetic, but try to avoid overreacting. Your loved one needs to tell their story and not be upset by your reactions. If your loved one tries to shield you from the event by refusing to talk about it, you obviously cannot force them to talk. But, you can encourage openness and listen to whatever else the person wants to say.

Include the whole family in the healing process.

You and your spouse or partner may feel you should protect your children from the upsetting event. But, they’ll undoubtedly know something is wrong. This can be stressful for them too and they may need some help to get through it.

Take care of yourself.

While it is important to be supportive, you also need to take care of yourself. Ask friends and family for help and don’t be afraid to seek counseling for yourself if needed.

Enjoy the little things.

Take time out for your family, have a special meal together or take small outings. Appreciating the little things won’t make the pain go away, but will help in the healing process.

©2011-2021 Workplace Options

The anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain smells or sounds, such as smoke or sirens, can also trigger emotional distress. These and other environmental sensations can take people right back to the event or cause them to fear that it’s about to happen again. These trigger events aren’t associated with any particular day on the calendar and can happen at any time.

What’s more, special occasions like birthdays or holidays can also be difficult for families who have been displaced from their homes due to a disaster. It’s hard to celebrate if you’re facing financial difficulties or living in temporary housing.

Some people start anticipating the anniversary (or special occasion) days, weeks, or even months before it occurs. It’s normal to have fears and concerns about how that day will make you feel. The following tips can help you or a loved one cope with renewed stress as an anniversary approaches or when trigger events suddenly occur.

Be aware that special days may be difficult. It’s common for some stress and other emotional reactions to happen around the anniversary of an event. Simply recognizing that your feelings are normal will help. Dealing with some of your losses and the new realities you’re facing after a disaster can be challenging. Try not to be too hard on yourself.

Be gentle with yourself. Show yourself the same kindness and patience you’d give to others during this time. Allow yourself to feel angry or sad, and recognize that these emotions are natural.

Participate in activities that you enjoy. This may be different depending on the individual. Some people like to reflect in solitude, while others may prefer spending time with family and friends for support. Some of these activities may include singing, prayer, meditation, attending a spiritual service, going to the movies, or just getting together with loved ones to share a meal.

Talk about your losses if you need to. If you want to talk about your losses since the disaster, you can. If you want to talk about the future, you can do that, too. Be sure to share your thoughts and feelings with someone you trust. That can be a friend or family member or a health care professional.

Draw on your faith or spirituality. For many, faith and other spiritual beliefs are a source of strength and comfort every day, and most especially during difficult times. Reach out to your faith adviser, spiritual community or anyone whom you feel comfortable talking with about your beliefs to support and console you.

Accept kindness and help from others. Support from family and friends is essential to healing. It’s often difficult for people to accept help, because they don’t want to be a burden to others or don’t want to appear weak. Allow the people in your life to show their care and concern.

Help others. For some people, volunteering is a healthy way to heal, and they get a great deal of satisfaction from helping others. Some activities can be as simple as donating food, clothing and other items.

Source: Substance Abuse and Mental Health Services Administration, www.samhsa.gov

Disasters and mass violence may cause a wide range of reactions over time. As a result, the types of support an individual or family needs change over time. Most of those who are affected by disaster will recover on their own given some time and help. Yet if someone is still having trouble weeks after the disaster, he or she may need further assistance.

The majority of disaster-affected individuals are likely to do better if they feel–or are helped to feel–safe, empowered to handle the post disaster context, connected to others, and calmer. Those who are optimistic or hopeful also tend to do better. For those who do need help, most can get back on their feet with education, practical help, and simple supportive actions called Psychological First Aid (PFA).

Practical help

A key to recovery from disasters is feeling that you have the resources with which to rebuild your life. The most basic resources include information, food, safety, medical support, and shelter. Other important resources are family, community, school, and friends. In fact, having resources is so important that many programs for disaster recovery focus primarily on providing practical help and building people’s resources.

Psychological First Aid

Those distressed after disaster may benefit from PFA. The core actions of PFA should be based on the most important needs and priorities of those affected by disasters, such as safety, comfort, calming, and practical help. The guide below also includes handouts with information on:

• Understanding post disaster reactions
• Positive ways of coping
• Connecting with social supports
• Links to needed services

PFA guidance: Psychological First Aid: Field Operations Guide was developed by the National Child Traumatic Stress Network and the National Center for PTSD. One aspect of the PFA treatment model is explained in the handout Connecting With Others: Seeking Social Support.

Education to build community resilience

Resilience means being able to recover or bounce back after a disaster. One way to build resilience is through educating yourself about how disasters affect people, how to cope effectively, how to give and receive social support, and how to get further help if needed.

Efforts to reach out and inform the community are sometimes provided by recovery workers, through the media, or on the internet. Education may focus on:

• Reactions to disaster
• Building resilience and positive coping
• Providing support to each other
• Connecting to health and mental health care providers

Many types of healing practices also go into building community resilience. These practices involve communal, cultural, memorial, spiritual, and religious healing practices. Training may be provided to local responders and healers, community leaders, and health providers. These workers are taught to make use of resources that are already in place or that occur naturally after disaster.

Workers try to give survivors knowledge, attitudes, and skills that can be used to build the community. Part of the process also involves grieving the community’s losses and making meaning of the disaster. Other goals include getting back to the normal rhythms and routines of life, and gaining a positive vision of the future, with renewed hope.

Crisis counseling, skill building, and other treatments

Programs and treatments exist for all levels of need after a disaster.

Crisis Counseling Program (CCP): One example is the Crisis Counseling Program (CCP). The Federal Emergency Management Agency (FEMA) supports CCPs for survivors of federally declared disasters. CCPs focus on both those affected by the disaster and the community as a whole.

They provide affected individuals with practical help in coping with their current issues. They serve a full range of children, teens, parents or caretakers, families, and adults. CCPs also help businesses and neighborhoods. They focus not just on those at highest risk for problems, but also on providing resources to make the whole community stronger. FEMA’s Crisis Counseling Assistance & Training Program page gives more information.

Skills for Psychological Recovery (SPR): Skills for Psychological Recovery (SPR) is another model that can often be helpful. The SPR model aims to develop and reinforce those skills that will help affected individuals be more resilient. SPR is usually offered by trained and supervised crisis counselors. Their aim is to provide a safe and comforting relationship within which to help you develop skills that have been found to be related to better recovery following disasters, including:

• Problem solving
• Planning more positive and meaningful activities
• Managing stress and reactions to the disaster
• Engaging in more helpful thinking
• Building healthy social connections

The SPR model, based in part upon PFA, was also developed by the National Child Traumatic Stress Network and the National Center for PTSD, as well as some outside consultants. It was implemented after Hurricanes Katrina and Gustav in the Gulf Coast region.

Trauma-focused treatment for post-traumatic stress disorder (PTSD)

Some affected individuals may still be in distress after PFA, crisis counseling, or SPR. For those in need of more intensive services, research supports trauma-focused psychotherapy for PTSD as an effective treatment following disaster. Trauma-focused psychotherapy is a broad term that refers to several specific psychotherapies for PTSD. (Trauma-focused means that the treatment focuses on the memory of the traumatic event and its meaning.)

Trauma-focused psychotherapies use different techniques to help you process your traumatic experience. For example, some involve visualizing, talking, or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. They usually last about 8 to 16 sessions.

Summing it up

There are a number of different recovery programs after disaster. The goals of these programs are to help those affected and the community to recover. No matter how you are reacting to the disaster, there should be a program to help you. With support, you can build your resources, resilience, skills, and mental health.

Source: U.S. Department of Veterans Affairs, National Center for PTSD. (Updated 2018, September 24). Help for survivors in the aftermath of disasters and mass violence. Retrieved September 18, 2019, from https://www.ptsd.va.gov

Summary

• Talk to the child about the event.
• Limit how much media coverage the child sees.
• Involve the child in planning memorials or helping other victims.

Each year, children experience violence and disaster and face other traumas. Young people are injured, they see others harmed by violence, they experience sexual abuse, and they lose loved ones or witness other tragic and shocking events. Parents and caregivers can help children overcome these experiences and start the process of recovery.

What is trauma?

Psychological trauma is an emotionally painful, shocking, stressful and sometimes life-threatening experience. It may or may not involve physical injuries, and can result from witnessing distressing events. Examples include a natural disaster, physical or sexual abuse and terrorism.

Reactions (responses) to trauma can be immediate or delayed. Reactions to trauma differ in severity and cover a wide range of behaviors and responses. Children with existing mental health problems, past traumatic experiences, and/or limited family and social supports may be more reactive to trauma. Frequently experienced responses among children after trauma are loss of trust and a fear of the event happening again.

It’s important to remember:

• Children’s reactions to trauma are strongly influenced by adults’ responses to trauma.
• People from different cultures may have their own ways of reacting to trauma.

Commonly experienced responses to trauma among children

Children age 5 and under may react in a number of ways including:

• Showing signs of fear
• Clinging to parent or caregiver
• Crying or screaming
• Whimpering or trembling
• Moving aimlessly
• Becoming immobile
• Returning to behaviors common to being younger
• Thumbsucking
• Bedwetting
• Being afraid of the dark

Children age 6 to 11 may react by:

• Isolating themselves
• Becoming quiet around friends, family, and teachers
• Having nightmares or other sleep problems
• Refusing to go to bed
• Becoming irritable or disruptive
• Having outbursts of anger
• Starting fights
• Being unable to concentrate
• Refusing to go to school
• Complaining of physical problems
• Developing unfounded fears
• Becoming depressed
• Expressing guilt over what happened
• Feeling numb emotionally
• Doing poorly with school and homework
• Losing interest in fun activities

Adolescents age 12 to 17 may react by:

• Having flashbacks to the event (flashbacks are the mind reliving the event)
• Having nightmares or other sleep problems
• Avoiding reminders of the event
• Using or abusing drugs, alcohol, or tobacco
• Being disruptive, disrespectful, or behaving destructively
• Having physical complaints
• Feeling isolated or confused
• Being depressed
• Being angry
• Losing interest in previously enjoyable activities
• Having suicidal thoughts

Adolescents may feel guilty. They may feel guilt for not preventing injury or deaths. They also may have thoughts of revenge.

What can parents do to help?

After violence or disaster, parents and family members should identify and address their own feelings—this will allow them to help others. Explain to children what happened and let them know:

• You love them
• The event was not their fault
• You will do your best to take care of them
• It’s OK for them to feel upset

Do:

• Allow children to cry
• Allow sadness
• Let children talk about feelings
• Let them write about feelings
• Let them draw pictures about the event or their feelings

Don’t:

• Expect children to be brave or tough
• Make children discuss the event before they are ready
• Get angry if children show strong emotions
• Get upset if they begin bedwetting, acting out, or thumbsucking

Other tips:

• If children have trouble sleeping give them extra attention, let them sleep with a light on, or let them sleep in your room (for a short time).
• Try to keep normal routines, for example, reading bedtime stories, eating dinner together, watching TV together, reading books, exercising, or playing games. If you can’t keep normal routines, make new ones together.
• Help children feel in control when possible by letting them choose meals, pick out clothes, or make some decisions for themselves.

How can I help young children that experienced trauma?

Helping children can start immediately, even at the scene of the event. Most children recover within a few weeks of a traumatic experience, while some may need help longer. Grief, a deep emotional response to loss, may take months to resolve. Children may experience grief over the loss of a loved one, teacher, friend, or pet. Grief may be re-experienced or worsened by news reports or the event’s anniversary.

Some children may need help from a mental health professional. Some people may seek other kinds of help from community leaders. Identify children that need support and help them obtain it.

Examples of problematic behaviors could be:

• Refusing to go to places that remind them of the event
• Emotional numbness
• Behaving dangerously
• Unexplained anger/rage
• Sleep problems including nightmares

Adult helpers should:

• Pay attention to children
• Listen to them
• Accept/do not argue about their feelings
• Help them cope with the reality of their experiences
• Reduce effects of other stressors
• Frequent moving or changes in place of residence
• Long periods away from family and friends
• Pressures to perform well in school
• Transportation problems
• Fighting within the family
• Being hungry
• Monitor healing
• It takes time
• Do not ignore severe reactions
• Pay attention to sudden changes in behaviors, speech, language use or strong emotions
• Remind children that adults
• Love them
• Support them
• Will be with them when possible

Parents and caregivers should also limit viewing of repetitive news reports about traumatic events. Young children may not understand that news coverage is about one event and not multiple similar events.

By Jennifer Brick

©2016-2020 Carelon Behavioral Health

Source: American Academy of Pediatrics, “Providing Psychosocial Support to Children and Families in the Aftermath of Disasters and Crises.” Pediatrics, http://pediatrics.aappublications.org/content/early/2015/09/08/peds.2015-2861; “Reactions and Guidelines for Children Following Crisis and Trauma,” Alabama Department of Mental Health www.mh.alabama.gov/Downloads/COPI/GuidelineCrisis.pdf

If caught in a civil disturbance

• If you find yourself caught up in a demonstration, keep to the edge of the crowd where it is safer. Try not to be identified as being one of the demonstrators by keeping well away from the leaders and agitators.
• At the first opportunity, break away and seek refuge in a nearby building, or find a suitable doorway or alley and stay there until the crowd passes.
• When leaving the fringe of the demonstration, just walk away—don’t run, as this will draw attention to you.
• In the event that you are arrested by the police or military, do not resist. Go along peacefully, and contact your embassy as well as your travel-insurance provider to help you resolve your predicament.
• If you are caught up in the crowd, stay clear of glass shop fronts, stay on your feet, and move with the flow.
• If you are swept along in the crush, create a space for yourself by grasping your wrists and bracing your elbows away from your sides. Bend over slightly; this should allow you breathing room.
• If pushed to the ground, try to get against a wall, roll yourself into a tight ball, and cover your head with your hands until the crowd passes.
• Remember to keep calm—the crowd should sweep past in a short amount of time.
• If shooting breaks out, drop to the ground and cover your head and neck. Lie as flat as you can.

Trapped in a car during civil unrest

• Never drive through a crowd.
• If you find yourself in the path of a crowd, turn down the nearest side road, reverse, or turn around and drive away calmly.
• If you cannot drive away, park the car, lock it, and leave it, taking shelter in a side street or doorway.
• If you don’t have time for this, stop and turn the engine off. Lock the doors and remain calm. Be sure not to show hostility or anger.

What to do after an incident

• If it is unsafe to stay where you are, seek a place of safety in a less volatile area.
• If you have suffered injury, seek medical assistance. Report any loss or damage to your property to the police.
• Report your situation or whereabouts to family, friends, or business associates.
• Report incidents to local police, and obtain a report reference. Where applicable, report and claim on your insurance.

©2017-2020 World Nomads

You may be struggling to understand how a shooting could occur and why such a terrible thing would happen. There may never be satisfactory answers to these questions.

We do know, though, that it is typical for people to experience a variety of emotions following such a traumatic event. These feelings can include shock, sorrow, numbness, fear, anger, disillusionment, grief and others. You may find that you have trouble sleeping, concentrating, eating or remembering even simple tasks. This is common and should pass after a while.

Over time, the caring support of family and friends can help to lessen the emotional impact and ultimately make the changes brought about by the tragedy more manageable. You may feel that the world is a more dangerous place today than you did yesterday. It will take some time to recover your sense of equilibrium.

Meanwhile, you may wonder how to go on living your daily life. You can strengthen your resilience—the ability to adapt well in the face of adversity—in the days and weeks ahead.

Here are some tips:

• Talk about it. Ask for support from people who care about you and who will listen to your concerns. Receiving support and care can be comforting and reassuring. It often helps to speak with others who have shared your experience so you do not feel so different or alone.
• Strive for balance. When a tragedy occurs, it’s easy to become overwhelmed and have a negative or pessimistic outlook. Balance that viewpoint by reminding yourself of people and events which are meaningful and comforting, even encouraging. Striving for balance empowers you and allows for a healthier perspective on yourself and the world around you.
• Turn it off and take a break. You may want to keep informed, but try to limit the amount of news you take in whether it’s from the Internet, television, newspapers or magazines. While getting the news informs you, being overexposed to it can actually increase your stress. The images can be very powerful in reawakening your feeling of distress. Also, schedule some breaks to distract yourself from thinking about the incident and focus instead on something you enjoy. Try to do something that will lift your spirits.
• Honor your feelings. Remember that it is common to have a range of emotions after a traumatic incident. You may experience intense stress similar to the effects of a physical injury. For example, you may feel exhausted, sore or off balance.
• Take care of yourself. Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals, get plenty of rest and build physical activity into your day. Avoid alcohol and drugs because they can suppress your feelings rather than help you to manage and lessen your distress. In addition, alcohol and drugs may intensify your emotional or physical pain. Establish or re-establish routines such as eating meals at regular times and following an exercise program. If you are having trouble sleeping, try some relaxation techniques, such as deep breathing, meditation or yoga.
• Help others or do something productive. Locate resources in your community on ways that you can help people who have been affected by this incident, or have other needs. Helping someone else often has the benefit of making you feel better, too. 
• If you have recently lost friends or family in this or other tragedies, remember that grief is a long process. Give yourself time to experience your feelings and to recover. For some, this might involve staying at home; for others it may mean getting back to your daily routine. Dealing with the shock and trauma of such an event will take time. It is typical to expect many ups and downs, including “survivor guilt”—feeling bad that you escaped the tragedy while others did not.

For many people, using the tips and strategies mentioned above may be sufficient to get through the current crisis. At times, however an individual can get stuck or have difficulty managing intense reactions. A licensed mental health professional such as a psychologist can assist you in developing an appropriate strategy for moving forward. It is important to get professional help if you feel like you are unable to function or perform basic activities of daily living.

Recovering from such a tragic event may seem difficult to imagine. Persevere and trust in your ability to get through the challenging days ahead. Taking the steps in this guide can help you cope at this very difficult time.

©2022 American Psychological Association

When a traumatic event or issue happens, it’s easier than ever to immerse yourself in round-the-clock coverage. It can be a racial issue, terrorism, a natural disaster that destroys whole communities, or a new and deadly virus with no cure in sight.

Some TV and radio news programs air 24-hour updates and discussions. But perhaps what has changed the news landscape the most is social media. Online posts make it very easy to find out a lot of news fast—often before it is confirmed or the facts are known. Videos, photos, and news stories can go viral—that is, spread quickly—by being shared on social media sites.

Depending on the event or issue, the news can make you feel helpless and afraid. It can bring out differences of opinion and lead to arguments with friends and family, online or in person. There is such a thing as watching and reading too much news.

How media affects the viewer

When a traumatic or disturbing event happens, how do you stay informed without spinning in an endless cycle of fear and worry?

Here are some signs that the anxiety is getting to be too much:

• Thinking about the event or issue all the time
• Getting upset about what will happen
• Trouble keeping up with daily tasks
• Snapping at loved ones
• Getting more tired than usual, yet having trouble sleeping

Too much media exposure can make you feel miserable. How do you take a step back and take care of you?

Tips for adults

Any one event may affect people differently. Some can take the news in stride and move on right away. Others might take the event personally, even if it hasn’t happened to them or to anyone they know.

There is no right or wrong gut reaction to an event or issue, but how you or your loved one responds is key.

Here are some tips:

• Learn about the event or issue. Look for trusted news sources for info, and stick with only one or two of them to get updates.
• Check in with your loved ones to make sure they are OK after an event or issue.
• Keep on task. Try to read or listen to the news when it’s not in the way of your daily routine. Skip catching up on events right before bed.
• Talk with a trusted peer about the event or issue. Family members or friends may make you feel less alone in your concerns. Even if you don’t see eye-to-eye, listen to what they have to say and why.

Tips for children

Kids are curious by nature and will ask about distressing news. Don’t brush the topic off or make it taboo. Kids need to know they have adults to talk with safely about many topics.

• Learn what you can about the matter so you feel comfortable talking about it with your child. This will help you put it in perspective for him or her.
• Talk about plans that are in place to help keep your child safe. Learn about “active shooter,” fire, and other safety drills at your child’s school so you will be prepared to discuss them before drills occur.  
• Look at it from a community standpoint, together. Talk about issues like safety measures at school and why they are vital. Talk about nearby neighborhood crime and why it happens. Don’t assume the issues aren’t going to hit close to home.

Disasters, terrorism, violence, deaths, and problems between races are just a few things kids will want to talk about. Let your kids know that you are willing to have an ongoing and open talk about whatever is on their minds.

The silver lining is that we can find the good that comes out of many awful events. When you’re watching bad situations unfold, look for:

• The volunteers who are helping with the cleanup
• How communities come together
• How people find ways to talk about issues and create positive change
• The proactive groups who is advocating for change
• The grassroots efforts to give aid to those in need

Point these bright spots out to your family, friends, and mostly, kids. Pitch in where you can.

By Andrea Rizzo, M.F.A.

©2016-2019 Carelon Behavioral Health

“Nothing is hopeless, we must hope for everything.”

––Euripides, Greek scholar and playwright

How do we pick ourselves up from the ashes of trauma and tragedy? How do we get through the everyday disappointments and setbacks of life? Hope gives us a reason to go on. First, we need to believe that life will get better, and then we need to nurture a vision of how to make it better. Hope gives us the strength necessary to keep moving in a positive direction, in other words, to persevere.

Hope, in many ways, is more of a feeling than an intellectual effort. In fact, the absence of hope is the deadly emotion despair, which in turn is connected to depression. Since the beginning of recorded time, people have recognized the important role hope plays in survival. Remember the myth of Pandora’s box? The overly curious Pandora opens a forbidden box, thereby releasing a host of evils into the world. But one thing was left in the box, and that was hope. The moral of the story—all is not lost as long as there is hope. 

Hope and success

Hope also plays a key role in achievement. A number of studies have shown that having “high hopes” can help people succeed in many areas of life—school, work, family and sports. In fact, studies have shown that the ability to have and sustain hope plays a bigger role in success than natural talent. Hopeful people have also been linked to better physical, mental and emotional health. There’s also a strong connection between hope and surviving and recovering from a serious illness or injury.

Nature vs. nurture

The jury is out on whether people are predisposed from birth to be positive or negative thinkers, hopeful or hopeless in their outlook. It’s true that how you were raised can affect your ability to ignite and maintain a sense of hope. That said, however, there are ways to nurture the spirit of hope within yourself. For example, if you consciously think positive thoughts and block out negative self-talk, you can start to create a space for hope to grow. To have hope is to have both a plan for the future and a will to carry it out. 

But if you’re not naturally a positive thinker, don’t give up hope. You can build hope as you would any other habit.

• Set goals and draw up a plan to achieve them.
• Envision the future you want. Dream big but have a realistic plan of action to get there.
• Develop skills and talents that help you pursue your goals.
• Be creative when thinking of ways to overcome obstacles.
• Counter negative self-talk.
• Read inspiring stories of others who have achieved or who have overcome setbacks.
• Be grateful for and celebrate the small pleasures and achievements of life.
• Avoid negative things—stories, news, people, movies—that lead to feelings of despair.
• Don’t rush hope. Feeling bad after a terrible experience is natural and necessary. Have faith that hope will return if given room and time to expand. 

“False” hope

Sometimes the word “hope” is confused with fantasies or having “false” or “blind” hopes. False hopes are associated with wishful thinking, in which people sit around hoping for miracles instead of taking steps to make things happen. True hope gives you the strength and energy to persevere in your quest; it ignites the fire that gets you moving, acting, growing and living. 

By Amy Fries

©2006-2021 Carelon Behavioral Health

Summary

• Take steps to prevent workplace violence.
• Recognize and report threats from co-workers or clients.
• Help keep your worksite safe.

We hear about workplace attacks often. You might think workplace violence only involves physical attacks and murder. However, the FBI reports that workplace violence from co-workers or clients often starts with bullying.

In general, workplace violence can be broken down into four types:

1. Crime from outside, such as theft or terrorism
2. Crime committed by a client
3. Crime committed by a co-worker
4. Crime related to domestic violence or stalking

Prevention is always the best policy

Every employee can help reduce the chance that workplace violence will occur.

The first step is to always be aware of your safety at work. That could be as small as making sure the door locks behind you. Or it could be noticing and reporting threatening or strange behavior from a co-worker or client.

The second step is to read your company’s violence prevention policy. Ask Human Resources (HR) about it. Make sure you understand the policy and any parts you need to practice. For example, you may need to know how the alarm system works, or you may need to practice an escape plan.

The third step is to understand that workplace violence often starts with small things. You may notice a co-worker or client making threatening remarks, or you may see a change in behavior in someone at work. Maybe a co-worker has become very angry or sad and has started talking about weapons a lot.

If you notice behaviors that trouble you, report them to your supervisor, HR, or employee assistance program right away. Do not assume that someone else will report it. Your company will keep your report confidential. This is the single most important thing you can do.

Other warning signs from co-workers or clients include:

• Alcohol and drug use disorders
• Complaints of unfair treatment
• Grudges over real or imagined grievances
• Recent purchase of a weapon or talk of weapons
• Violent or suicidal comments
• Threats to workers who are victims of domestic violence or stalking

The FBI says that victims of domestic violence or stalking are more likely to talk to a co-worker than a supervisor. If you think a co-worker may be a victim of domestic violence or stalking, talk to HR.

Try to have the courage to report your concerns. Many times a victim of workplace violence has heard the attacker make threats, but they were too scared to report it.

Help keep the physical worksite safe

It may not be your job to keep doors and lights in working order; but it is everyone’s duty to report problems. For example, if you notice someone propping open a locked entry door, report it. If you notice a broken light in the parking lot, report it.

Other tips include:

• Do not share keys, key cards, or codes.
• Do not prop open doors.
• Keep passwords and codes hidden.
• Follow procedures for allowing visitors and other strangers to enter the workplace.
• Follow all policies related to building and staff security.

By Amy Fries

©2018-2020 Carelon Behavioral Health

A traumatic event, whether an act of violence or terrorism, a disaster, or an accident, turns a person’s life upside down. By definition, this kind of event causes moderate to severe stress reactions. Affecting survivors, rescue workers, and friends and family members of victims directly involved, a traumatic event may also have an effect on people who witnessed it directly or through the media. Whatever the nature of the event, individuals’ experience and reactions to it will be unique to them.

Normal reactions to trauma

Traumatic events have a way of changing a person’s perspective, assumptions, and expectations of life. They can leave people feeling shocked, saddened, and vulnerable. However, it is important to remember that these are normal reactions to an abnormal and unexpected event.

Understanding one’s response after a traumatic event may help an individual cope better. The following are common emotional, cognitive, behavioral, and physical reactions to stress. A person may experience some or all reactions, or additional changes not included on the list. An individual may immediately feel strong emotions or not notice a change until later. Typically these reactions subside within two weeks.

Emotional reactions

• Shock
• Numbness, feeling nothing
• Anxiety, depression, and sadness
• Guilt for being better off than others who survived the event
• Fear of returning to where the incident took place, of another occurrence, of harm to self and loved ones, of being on one’s own or having to leave family
• Uncertainty of feelings
• Feeling lost and abandoned
• Feeling overwhelmed

Cognitive reactions

• Poor concentration or difficulty making decisions
• Confusion
• Memory loss
• Shortened attention span
• Unwanted memories
• Indecisiveness

Behavioral reactions

• Irritability, getting into arguments
• Withdrawal
• Suspicion
• Inappropriate humor
• Loss of interest in family, friends, and daily routine
• Change in sexual interest
• Increased consumption of nicotine, alcohol, and drugs
• Increased or decreased eating

Physical reactions

• Headaches, nausea, stomach pains, tightness in the chest, muscle pain-generally feeling unwell
• Listlessness and feeling tired
• Increased sensitivity to noise or people
• Pounding heart, rapid breathing, edginess
• Loss of appetite
• Tremors
• Disturbed sleep or upsetting thoughts, dreams, and nightmares

There is no simple fix to make things better right away. But there are actions that can help the individual cope better and heal from the traumatic event.

Dos and don’ts—coping strategies

• Understand that everyone reacts differently to trauma. It’s OK if one person’s response is different from someone else’s.
• Give yourself time and permission to feel out of sorts, anxious, or sad. Having gone through an ordeal, people will have good and bad days. That’s part of the healing process.
• Get plenty of rest, nourishment, and exercise (at the minimum, take a walk). Focus on relaxing rather than stressful activities.
• Maintain a usual routine. Make as many daily decisions as possible, encouraging a feeling of control.
• Be more careful around the house and while driving. Accidents are more common after a severely stressful event.
• Express needs and emotions clearly and honestly. Reach out to at least one person who is a good listener and nonjudgmental.
• Accept support and help from caring family and friends. An individual might also want to share feelings with others who have also been affected and check to see how they’re doing.
• Resolve day-to-day conflicts so they don’t build up and add to feelings of stress.
• Help other people in the community as a volunteer. Stay busy.
• Don’t attempt to numb the pain with drugs, alcohol, cigarettes, or coffee.
• Don’t bottle things up. Allowing feelings to come out will help with recovery. Talk, cry, share thoughts, write them in a journal—whatever works.
• Don’t shy away from situations, people, or places that bring back memories of the event.
• Don’t dwell on media reports on the tragedy. Limit time around the sights and sounds of what happened.
• Don’t make big life changes or snap decisions until fully recovered from the event.
• Don’t try to fight recurring thoughts, dreams, or flashbacks. These are normal and will decrease over time.

When to seek extra support

Sometimes the stress can be too big to handle alone. If experiencing any of the following, an individual should consider seeking additional support:

• Inability to take care of self or children
• Continuing to feel numb, tense, confused, or exhausted
• Feeling sad or depressed for more than two weeks
• Inability to handle intense feelings, emotions, or bodily reactions
• Continuing to have nightmares and a poor sleeping pattern
• Smoking, drinking, or taking drugs to excess
• Thinking about suicide
• Continuing to make mistakes or have accidents
• Realizing that work performance and relationships are suffering
• Having no one with whom to share emotions, and feeling the need to do so.

Where to go for extra support

• Your physician
• A clergy person
• Your employee assistance program (EAP)
• A mental health counselor
• Local support groups
• A suicide prevention hotline

By Cynthia Sulaski

©2014-2021 Workplace Options

Summary

• They are traditional crimes coupled with bias.
• Hate alone is not a crime, but hurting someone or damaging property in the name of hate is.
• Little hate crime violence is committed by those with a mental health issue.

A hate crime is a crime such as murder or arson coupled with bias. It is the violence of intolerance and bigotry. It is meant to hurt or scare someone because of who they are. The U.S. Congress defines it as “a criminal offense against a person or property motivated in whole or part by an offender’s bias against a race, religion, disability, ethnic origin, or sexual orientation.” Examples include:

• Spray painting a mosque to scare people of Islamic faith
• Shooting members of an African-American church while they pray
• Beating up a transgender person

A hate crime on a larger scale, genocide, is getting rid of whole groups of people.

Hate on its own can start in smaller, more subtle ways such as jokes about race. While hate alone is not a crime, hurting someone or their property in the name of hate is.

Who commits hate crimes?

It may seem like all people who commit violent crimes are one type of person. Yet there are many types of people who commit crimes. There are also different factors that work together to raise someone’s risk of violence. Experts studying violence point to some ideas:

• There may be many genes that join forces to raise the risk of violence.
• Low amounts of a certain brain chemical may be linked to violence.
• Imaging in people who commit violent acts shows poor functioning in parts of the brain that help figure out whether things are dangerous or safe.

In working to learn what drives people to commit hate crimes, experts point to a range of ideas:

• They lack knowledge about and are afraid of people who are different.
• Looking down on others helps boost their self-esteem.
• They have been targeted themselves and think it is OK to do it to others.
• Violence may stem from a self-destructive place, with acts carried out on others.
• People who act out violently may develop thinking that blames others for their problems.

Experts have also worked to understand what drives young people to commit hate crimes. Youth may:

• Use violence to feel powerful or protect themselves
• Feel frustrated and bored
• Learn from others that certain people are to be treated as targets. Often people who are victimized are different than those who did the crime.
• Get caught up in a hate crime without knowing how serious it is. Or, they may blame others for pulling them into poor choices.

Understanding the role of mental health conditions

For some, a mental health issue may raise the risk of violence. But most people with stable mental health conditions do not commit violent acts. In fact, very little of the violence in the U.S. is caused by people with mental health issues. They are more likely to experience violence than to commit it. For those who do have mental health conditions, not getting care is what may lead to trouble with the law.

In the case of substance use disorders, there is a greater risk of violent behavior. Both being on a substance and withdrawing from one can boost violence.

Regardless of whether a person has a mental health or substance use issue, or a combination of the two, recovery can be expected once he seeks help. People can and do recover. There is hope for better health and wellness.

Can hate crimes be prevented?

You may wonder if there are signs that can and should be caught before a crime happens. There isn’t an easy answer to this. Often, pieces are put together after the fact. This doesn’t mean they were easy to spot ahead of time.

Many people believe that there is not enough mental health support. It is true that not intervening when someone is struggling with an illness can lead to problems later on. Yet, not all people who have mental health conditions are at risk of violent behavior. Many others think the root of violent hate crimes in the U.S. has to do with gun control policies. Gun control advocates argue that access to weapons is the heart of the problem.

What you can do is report all incidents involving hate. Whether it seems small or large, report it to the police. This may be an important part of preventing other crimes.

Responding to a hate crime

What can you do if you or a loved one experiences a hate crime? Know that they may feel unsafe, fearful and alone. They may also fear more attacks. If you know someone who has experienced a hate crime, show your support by offering comfort and protection. It is also important to listen. They will need support as they figure out their next steps.

If you have experienced a hate crime, report it to police. No hate crime is too small to talk about. It is important to ask for help. Seek support from:

• Friends and loved ones
• Community and faith groups
• Health care providers and mental health professionals

As a community, there are also steps to take. A community can:

• Pull together allies from local groups, employers and the media to rally against hate.
• Speak up against hate, using media outlets to spread the word.
• Lobby local officials to address hate crimes.
• Teach tolerance at home and work with schools to address hate.

It takes time to heal as an individual and a community. Do not be afraid to seek counseling about your experience or fears. Joining a support group where you can share your experience with others can help provide more support. While hate crimes are hard to cope with, you are not alone.

By Sarah Stone

©2015-2021 Carelon Behavioral Health

Source: Psychiatry, Violence and Mental Illness, May 2008; The Federal Bureau of Investigation, www.fbi.gov/about-us/investigate/civilrights/hate_crimes/overview; The United States Department of Justice, www.justice.gov; The Southern Poverty Law Center, www.splcenter.org; California State University, San Marcos, www.csusm.edu/sjs/documents/Responding-to-Hate-Incidents.pdf; American Psychological Association, www.apa.org/monitor/nov01/hatecrimes.aspx; National Crime Prevention Council, www.ncpc.org

Summary

• Sexual assault can be verbal, visual or anything that forces a person to join in unwanted sexual contact or attention.
• Rape and sexual assault are never the victim’s fault—no matter where or how it happens.

Sexual assault is any type of sexual activity, including rape, that you do not agree to. Also called sexual violence or abuse, sexual assault is never your fault.

What is rape?

The Department of Justice defines rape as “The penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.” This legal definition is used by the federal government to collect information from local police about rape. The definition of rape may be slightly different in your community.

Rape also can happen when you cannot physically give consent, such as while you were drunk, passed out, or high. Rape can also happen when you cannot legally give consent, such as when you are underage.

What does sexual assault include?

Sexual assault can include:

• Any type of sexual contact with someone who cannot consent, such as someone who is underage, has an intellectual disability, or is passed out
• Rape
• Attempted rape
• Sexual coercion
• Sexual contact with a child
• Incest (sexual contact between family members)
• Fondling or unwanted touching above or under clothes

Sexual assault can also be verbal or visual. It is anything that forces a person to join in unwanted sexual contact or attention. Examples can include:

• Voyeurism, or peeping (when someone watches private sexual acts without consent)
• Exhibitionism (when someone exposes himself or herself in public)
• Sexual harassment or threats
• Forcing someone to pose for sexual pictures

What does “consent” mean in sexual assault?

Consent is a clear “yes” to sexual activity. Not saying “no” does not mean you have given consent.

Your consent means:

• You know and understand what is going on (you are not unconscious or blacked out or intellectually disabled).
• You know what you want to do.
• You are able to say what you want to do.
• You are sober (not under the influence of alcohol or drugs).

Sometimes you cannot give legal consent to sexual activity or contact. For example, if you are:

• Threatened, forced, coerced, or manipulated into agreeing
• Not physically able to (you are drunk, high, drugged, passed out, or asleep)
• Not mentally able to (due to illness or disability)
• Younger than 16 (in most states) or 18 (in other states)

Remember:

• Consent is an ongoing process, not a one-time question. If you consent to sexual activity, you can change your mind and choose to stop, even after sexual activity has started.
• Past consent does not mean future consent. Giving consent in the past to sexual activity does not mean you have to give consent now or in the future.
• Saying yes to a sexual activity is not consent for all types of sexual activity. If you consent to sexual activity, it is only for types of sexual activities that you are comfortable with at that time with that partner.

 What is NOT considered consent in sexual assault?

• Silence. Just because someone does not say “no” it doesn’t mean she is saying “yes.”
• Having consented before. Just because someone said “yes” in the past does not mean she is saying “yes” now. Consent must be part of every sexual activity, every time.
• Being in a relationship. Being married, dating, or having sexual contact with someone before does not mean that there is consent now.
• Being drunk or high.
• Not fighting back. Not putting up a physical fight does not mean that there is consent.
• Sexy clothing, dancing, or flirting. Only “yes” means “yes.”

What is sexual coercion?

Not all sexual assault involves a physical attack. Sexual coercion is unwanted sexual activity that happens after someone is pressured, tricked, or forced in a nonphysical way.

Anyone can use coercion—for example, husbands, partners, boyfriends, friends, co-workers, bosses, or dates.

Examples of sexual coercion

How can I respond in the moment to sexual coercion?

Sexual coercion is not your fault. If you are feeling pressured to do something you don’t want to do, speak up or leave the situation.

Some possible responses include:

• “I do like you, but I’m not ready for sex.”
• “If you really care for me, you’ll respect that I don’t want to have sex.”
• “I don’t owe you an explanation or anything at all.”

Be clear and direct with the person coercing you. Tell him or her how you feel and what you do not want to do. If the other person is not listening to you, leave the situation. If you or your family is in physical danger, try to get away from the person as quickly as possible. Call 9-1-1 if you are in immediate danger.

How can I get help after being sexually coerced?

Sexual coercion is a type of sexual assault. Call the National Sexual Assault Hotline at (800) 656-HOPE (4673) or chat online with a trained hotline worker on the National Sexual Assault Online Hotline at any time to get help.

Some sexual coercion is against the law or violates school or workplace policies. If you are younger than 18, tell a trusted adult about what happened. If you are an adult, consider talking to someone about getting help and reporting the person to the local authorities. You could talk to a counselor, the human resources department, or the local police.

What do I do if I’ve been sexually assaulted?

If you are in danger or need medical care, call 9-1-1. If you can, get away from the person who assaulted you and get to a safe place as fast as you can.

If you have been physically assaulted or raped, there are other important steps you can take right away:

• Save everything that might have the attacker’s DNA on it. As hard as it may be to not wash up, you might wash away important evidence if you do. Don’t brush, comb, or clean any part of your body. Don’t change clothes, if possible. Don’t touch or change anything at the scene of the assault. That way the local police will have physical evidence from the person who assaulted you.
• Go to your nearest hospital emergency room as soon as possible. You need to be examined and treated for injuries. You can be given medicine to prevent HIV and other sexually transmitted infections and emergency contraception to prevent pregnancy. The National Sexual Assault Hotline at (800) 656-HOPE (4673) can help you find a hospital able to collect evidence of sexual assault. Ask for a sexual assault forensic examiner. A doctor or nurse will use a rape kit to collect evidence. This might be fibers, hairs, saliva, semen, or clothing left behind by the attacker. You do not have to decide whether to press charges while at the hospital.
• If you think you were drugged, talk to the hospital staff about being tested for date rape drugs, such as Rohypnol and gamma hydroxybutyrate (GHB), and other drugs.
• The hospital staff can also connect you with the local rape crisis center. Staff there can help you make choices about reporting the sexual assault and getting help through counseling and support groups.
• Reach out for help. Call a friend or family member you trust, or call a crisis center or hotline. Crisis centers and hotlines have trained volunteers and counselors who can help you find support and resources near you. One hotline is the National Sexual Assault Hotline at (800) 656-HOPE (4673). If you are in the military, you may also call the DoD Safe Helpline at (877) 995-5246.
• Report the sexual assault to the police: Call 911. If you want to talk to someone first about reporting the assault, you can also call the National Sexual Assault Hotline at (800) 656-HOPE (4673). A counselor can help you understand how to report the crime. Even though these calls are free, they may appear on your phone bill. If you think that the person who sexually assaulted you may check your phone bill, try to call from a friend’s phone or a public phone.
• Write down the details about the person who sexually assaulted you and what happened.

How can I get help after a sexual assault?

After a sexual assault, you may feel fear, shame, guilt, or shock. These feelings are normal. But sexual assault is never your fault. It may be frightening to think about talking about the assault, but it is important to get help. You can call these organizations any time, day or night. The calls are free and confidential:

• National Sexual Assault Hotline, (800) 656-HOPE (4673). You can also chat with a trained hotline worker on the National Sexual Assault Online Hotline.
• National Domestic Violence Hotline, (800) 799-SAFE (7233) or 800-787-3224 (TTY)

Each state and territory has organizations and hotlines to help people who have been sexually assaulted.

How can I help someone who has been sexually assaulted?

You can help a friend or family member who has been sexually assaulted by listening, offering comfort, and not judging. Reinforce the message that she or he is not at fault and that it is natural to feel angry, confused, or ashamed—or any combination of feelings.

Ask your loved one if she would like you to go with her to the hospital or to counseling. If she decides to report the crime to the police, ask if she would like you to go with her. Let her know that professional help is available. Let her know about the hotlines to call and talk to someone.

Source: Office on Women’s Health, U.S. Department of Health and Human Services, www.womenshealth.gov/publications/our-publications/fact-sheet/sexual-assault.html#

Public and private institutions and individual citizens use social media to spread essential disaster-related messages to the masses in real time. The rapid rise of social media activity after major disasters has not only grabbed the attention of federal and local government officials, but led to an increase in social-media training efforts among emergency management staffs nationwide. Shortly after Hurricane Sandy in 2012, the Federal Emergency Management Agency (FEMA) reported that more than 20 million Sandy-related Twitter posts (tweets) were sent despite cell phone outages during the peak of the storm.

Stay connected

A common fear associated with disasters is being separated from loved ones and unable to contact them. If you have access to a mobile device (smartphone or tablet) or a computer, social media platforms are among the quickest ways to tell family and friends you are safe and out of harm’s way, or if you need help or emergency assistance.

The power of social media often goes beyond where the actual disaster takes place, setting off a chain reaction of encouragement and support from friends, family, and concerned strangers alike. In some instances, disaster survivors have been connected to resources they needed because others outside of the affected areas “retweeted” or reposted their original pleas for help.

Google Person Finder is a web application that allows individuals to post, search, and reconnect with friends and family in the aftermath of natural or human-caused disasters. The American Red Cross offers a similar online registration called Safe & Well. If disaster strikes, you can add yourself to the database to let family and friends know that you are safe, and you can search registered loved ones to find out their status.

Institutions share important information faster

Many people rely on social media to receive timely, important information when a disaster takes place:

• Government agencies share vital information with the public, such as disaster updates, contact information, shelter locations, and other useful resources.
• Utility providers communicate with customers, respond to reports of power outages and water use restrictions, and share restoration updates.
• First responders and volunteers use social media to directly speak with the public and to mobilize, assess, and prioritize the needs of the community.
• Educational institutions, such as colleges and universities, send alerts to students, faculty, and parents about when and where to take shelter (during natural disasters) or to go into a lockdown mode (during a mass shooting).

Institutions, civic organizations, and individual community members have used social media to instantly spread important information regarding

• Availability of supplies
• Sources for medical assistance and counseling services
• Status of businesses
• Power outages
• Road closures or areas to avoid

For incidents of mass violence, like a shooting or act of terrorism, alerts via text message and social media from local law enforcement inform those in danger and the community when lockdown modes have been lifted. These kinds of alerts also warn others nearby to stay away.

Source: U.S. Department of Health and Human Services,Substance Abuse and Mental Health Services Administration; www.samhsa.gov

Summary

• Ask questions to understand what the child is asking.
• Be honest, but not too detailed.
• Follow up a few days later.

Talking to a child about complicated issues such as racism, sexual orientation, terrorism, war, domestic or sexual violence, or natural disasters is one of the hardest jobs parents have, but it has to be done.

If your child hasn’t been directly affected or hasn’t asked you questions

You should still talk to them. If you can have a conversation about something hard that hasn’t affected your child, it opens the door for them to come to you later if something does. It also helps them make sense of what they may hear from classmates or see on television or social media.

Gauge what level of exposure your child has. Kids talk to each other and overhear adults talking about traumatic issues. You can say something like, “There was a horrible thing that happened far away in ____________. What do your friends say about it?”

Talks, about specific events or difficult subjects, can happen at any age. They should be geared toward the child’s age and level of understanding.

For example, to talk about something like racism or other forms of hatred, you can begin by discussing bullying. Say something like “I know your school has a bullying program. What is bullying like at your school?” This allows for you to say “Sometimes people get bullied because of the color of their skin, their religion or who they love. Sometimes that can happen in school and sometimes outside of school. Sometimes people who have different colored skin than us are not treated the same way.”

When a child is young, the talks can be general: “How do we make friends and treat people?” If the child is older, the talks can be more specific: “What happens is what you are seeing in the news right now.”

If your child brings up a difficult topic for discussion

Be honest with them, but don’t overshare. You can do this by asking a question in return. For example, if they say, “A boy in my class was being teased for being ‘girly’.” You could ask, “How do you feel about that?” or “What do you think about that?”

If they start with a question, answer in a way that is simple or feels appropriate to the child’s age and understanding. Then follow up with another question.

For all conversations

Spare children any gory details. Don’t overshare. If your discussion is over their heads, they will fill in the blanks on their own which may not be good. Be sure to think about the kinds of things they are learning. Consider what you talk about on a regular basis.

Children understand things differently at different ages. For example, a 4-year-old doesn’t understand what death is. They may ask, “When is Grandma coming back?” “Is Grandma sad?” Be honest. Don’t tell them something like, “Grandma is taking a long nap in the ground.” Keep answers developmentally appropriate like, “Grandma’s body got hurt and stopped working. The doctors tried to fix it, but they couldn’t.”

When children talk about a subject such as terrorism, it is not so much about that event. What they really want to know is:

• Are we safe?
• Are we OK?
• Can this happen to us?

Listen to what is the child is asking. What are they really concerned about?

Focus on the positive. Point out who the helpers are in the situation. Help children feel prepared by going over emergency plans with them.

Children need to hear that the trauma is not their fault. They need to hear that their trusted adult believes them. This is especially true for children who disclose sexual abuse.

Following up

Circle back to the talk a few days later: “I know we had a difficult conversation. I’m proud of how you handled it. Do you have any questions?”

Watch for behavior changes after a talk about a difficult subject that has been stressful for the child. A few signs could be:

• More withdrawn, having more temper tantrums or being more irritable
• More problems with their friends
• Not wanting to do things they enjoyed in the past
• Changes in appetite and sleep habits
• Not wanting to go to school
• Changes in attention
• Harder time completing homework or doing chores
• Little kids “playing” it out or talking about it a lot
• Regression with dressing or potty-training
• More secretive

If you are worried, ask for help. School counselors, a local mental health office and your child’s pediatrician are good places to go for advice.

Why it’s important

You don’t know what your child might want to talk to you about but doesn’t because they are afraid. These types of talks let them know it’s OK to talk to you.

If you start the talks with, “There’s nothing you tell me that’s going to get you in trouble,” a child is less likely to keep worries to themself.

One of the best predictors of how well kids recover from stress is how safe they feel. Parents who turn off media coverage and talk to their children can help them feel secure.

By Jennifer Brick

©2016-2021 Carelon Behavioral Health

Source: Kathryn (Katie) Bauman, LCSW, Strong Fathers, Durham, NC; Dr. Robin Gurwitch, Clinical Psychologist, Duke University Medical Center

Summary

• Look for a real event to provide an opener.
• Start the habit of discussing these tough issues as early as possible.
• Don’t worry about having all the answers—seek help from someone you trust.

Reports of catastrophic violence in a school may cause you and your children much anxiety. When you’re concerned for your children’s safety, how can you help them address their fears of being safe at school?

Should I bring it up?

Regardless of any actual threat to your child’s safety, they are likely aware of school violence and may fear for their safety. If you don’t talk to them about it, they may rely on other sources for information, such as television, movies, the internet or friends — sources that may not provide them with the facts or values that you can provide.

When should I bring it up?

If you’re unsure of the right time to start a discussion about school violence, look for a real event to provide an opener. For instance, after watching a news report on school violence, ask your child how they feel about the issue. It’s also important to talk about the subject more than once, giving your child time to think about their feelings between discussions.

If you have young children, start the habit of discussing these tough issues as early as possible. Studies show that children who start talking with their parents when they’re young continue to do so when they’re older, instead of relying so heavily on peers and other outside influences for answers.

What should I say?

If you’re like many parents and feel you don’t know what to say, seek help from your family doctor, member of the clergy, school or other parents. But don’t worry about having all the answers. It’s OK to admit that you don’t know something. That provides a great opportunity to research the solution together.

Often your child just needs to share their concerns and isn’t really looking for solid answers. Listen to their fears. They may share your own fears. Don’t attempt to downplay them. Instead, discuss them honestly using language that your child will understand. Most importantly, assure them that you will do your very best to help keep them safe.

©2000-2019 Boston College, Center for Work and Family

Talking with children about violence can be hard, but it’s often the best way to help. Adults avoid talking to children about violence for many reasons. Have you thought any of the things below? If you have, you aren’t alone:

• “I don’t know what to say.”
• “I’ve tried to talk about it, but my child won’t listen.”
• “I feel uncomfortable.”
• “I’m scared to bring it up.”
• “I’m embarrassed.”
• “It might make things worse.”
• “It’s not a big deal.”
• “It’s over now. Why talk about it?”

It’s OK to have these thoughts, but don’t let them stop you from talking to a child who may have seen or been hurt by violence. Talking is the first step toward healing. Sure, you may not know exactly what to say. You may feel uncomfortable, but you can do your best. Here are some ways to get started:

• Take a deep breath. Talking about violence is tough.
• Try to get more comfortable by talking to someone you trust first. That person can help you plan what you want to say to the child.
• If you were hurt by the same violence the child saw or experienced, tell yourself that it’s OK to feel upset when you remember what happened. It’s scary for the child, too. Once you start talking, you may feel better.
• Begin with an opening question, asking the child what he or she thinks happened and how he or she feels about it.
• Don’t assume you know what the child experienced, even if you were there when the violence happened. Children often perceive violence very differently than grownups do. Don’t try to correct the child. Listen.
• Be patient. Don’t push it if it seems as if the child doesn’t want to talk or listen. You can try again later.

Sometimes, a child needs more help than you can give.

Children may be so upset by what has happened or what they have seen that nothing you can do will help. In those situations, you should find a trained professional. A psychologist, social worker, or school counselor can help the child talk about what happened. The professional can also help you find the actions or words to help very young children who are not able to talk about their experiences.

Seeing a mental health professional is a good idea when a child does one or more of the following for longer than one month:

• Has frequent nightmares or trouble sleeping
• Withdraws and doesn’t want to play with other children
• Has angry outbursts
• Has nausea, headaches, or other physical illnesses
• Loses or gains weight
• Has problems at school
• Feels intensely anxious
• Avoids people, places, or things that remind him or her of the event
• Seems depressed or hopeless
• Gets involved with alcohol and other drugs
• Gets in trouble with the law or takes dangerous risks
• Constantly worries about what happened

Getting professional help will keep the child’s problems and worries from getting worse—although the symptoms may not disappear immediately. If you believe a child needs professional help, talk to a trusted adult, such as the child’s pediatrician, teacher, school counselor, spiritual leader, or coach, about finding an appropriate mental health professional.

For a variety of reasons, many people are reluctant to seek help for mental health problems. However, not getting professional help for a child who needs it could hamper the child’s normal growth and development. Protecting the child’s mental health is as important as caring for his or her physical health. Getting help early can help the child cope better and prevent additional problems.

Hotlines

When you call one of the hotlines listed here, you’ll talk to a trained counselor who will connect you to the help you need. Also, contact the employee assistance program (EAP) for more resources and to see what additional benefits you may be entitled to.

VictimConnect (National Center for Victims of Crime Help Line)
855-4VICTIM (855-484-2846)
https://victimconnect.org

National Domestic Violence Hotline
800-799-SAFE (800-799-7233)
800-787-3224 TTY
Available 24 hours a day, 365 days a year https://www.thehotline.org

Childhelp National Child Abuse Hotline
800-4-A-CHILD (800-422-4453)
Available 24 hours a day, 365 days a year https://www.childhelp.org

Source: U.S. Department of Justice (DOJ), Office of Justice Programs (OJP), Office of Juvenile Justice and Delinquency Prevention (OJJDP). (n.d.). Healing the invisible wounds: Children’s exposure to violence (pp. 7ﾖ9, 23). Retrieved August 22, 2019, from https://www.ojjdp.gov

While the media (television, radio, print, and the internet) can help inform and educate you and your children about recent events, such as terrorism or shootings, media coverage unfortunately also has the potential to upset and confuse. As parents, you can protect your children by helping them understand media coverage while limiting their exposure to distressing images.

The impact of media coverage will be different depending upon whether you are a family who:

• Has loved ones in the affected area
• Has been affected by a recent loss or trauma in the past
• Is not directly threatened but is viewing news about the impact of this event on others (individuals killed, injured, or suffering)

Understanding media exposure

Media coverage can produce increased fears and anxiety in children. The more time children or teens spend watching coverage of the tragic events, the more likely they are to have negative reactions. Keep in mind that:

• Graphic images and news stories of chaos, injury, and death are especially upsetting to children.
• Very young children may not understand that the coverage and repetition of images of the events is a replay. They may think the event is continuing to happen or is happening again.

What parents can do to help

Limit your children’s exposure to media coverage:

• The younger the child, the less exposure she or he should have.
• You may choose to eliminate all exposure for very young children.
• Play or watch their favorite shows or movies instead.
• Consider family activities away from television, radio, or Internet.

Watch and discuss with children and teens:

• Watch what they watch.
• Discuss the news stories with them; asking about their thoughts and feelings about what they saw, read, or heard; and correct any misunderstandings or confusion.
• Ask older children and teens about what they have seen on the Internet or what they have heard through social media technologies (text, Facebook, Twitter), in order to get a better sense of their thoughts, fears, concerns, and point of view.

Seize opportunities for communication:

• Use newsbreaks that interrupt family viewing, or use newspaper and web images, as opportunities to open conversation.
• Be available to talk about children’s feelings, thoughts, and concerns, and reassure them of their safety and of plans to keep them safe.

Monitor adult conversations:

• Be careful of what you and other adults say about the recent event or the media coverage in front of the children.
• Remember that children often listen when adults are unaware and may misunderstand what they hear.

Let your children know about successful community efforts:

• You may want to share positive media images, such as reports of individuals helping those in need.
• Reassure your children and teens that many people, organizations, and governments are working to help the people. This will give them a sense that adults are actively taking steps to protect those who are currently suffering.

Educate yourself:

• Learn about children’s reactions to traumatic events.
• For more information, see the National Child Traumatic Stress Network website.

When your family is part of the story

Know your limits:

• Decide if it is a good idea for you or your children to talk to the media. While it’s natural to want to tell your story, the media may not be the best place to do so.
• Think about what you are willing and not willing to discuss. You have the right to set limits with reporters.
• Ask the reporter for the purpose of the story and its content.

Protect your children:

• Make sure the reporter has had experience working with children in the past.
• Talk it over with your children before they are interviewed. Assure them that there are no wrong answers.
• Let them know they can say no to any question, and they can stop the interview at any time.
• Be present when your child is interviewed. Stop the interview if he or she becomes upset or distressed in any way.
• After the interview, discuss the experience with your children. Praise them for doing a great job, and listen carefully to any concerns they have.
• Prepare your children that the final media story may be very short or may be edited in ways that do not reflect their experience.

Source: National Child Traumatic Stress Network; www.nctsn.org

Summary

• Return to work as soon as possible.
• Set aside time to grieve or feel your emotions.
• Take advantage of available resources.

Everybody has had a bad day at work and not wanted to return. But after a co-worker has died, or there’s been a serious accident or other disturbing event, those feelings are more serious. An inability to cope at work can affect a person’s livelihood.

How can someone return to his job? How can he be successful at it?

Returning to work

Scared or not, it is recommended that you try to return to the job soon after the event. The idea might make you feel uncomfortable, and being there might be uncomfortable. However, getting back into the routine of work could help the feelings of fear, self-doubt or anxiety lessen.

That is the best-case scenario. Returning to work might increase anxiety, but you won’t know without trying.

Ways a person might be affected once he returns

• Anxiety in the presence of the location, activity, or people
• Inability to stop thinking about the event or person(s) involved
• Sleep disturbance lasting more than a few nights
• Irritability with family or co-workers
• Social withdrawal
• Difficulty enjoying activities

These signs shouldn’t be disregarded. Not sleeping well, especially, can be the beginning of a worse reaction.

The longer a person tries to “grin and bear it,” the worse the negative feelings can get.

Tools to manage anxiety

• Talk about it. It is best if there is someone at work who can be supportive. Since it happened there, that person might have the best understanding. You can also talk to trusted friends and family so you’re not shutting yourself off. If talking about it makes you more anxious, limit the conversations. Yet, someone at work should know you’re having a hard time. It shouldn’t be kept secret.
• Change something. A small change in the work environment might make the job feel new. Put a new picture on the wall. Wear a different item of clothing or jewelry. Take breaks at different times. Get reassigned to a slightly different activity.
• Set aside time to reflect. See if a memorial or special space can be created at work. People can go to that space, plaque or object and focus on it. If a person gives themself a certain block of time to remember the person or feel the emotions, it is less likely to spill over into other parts of their day.
• Practice self-care. Exercise helps whether it is before or after work. During work, try to get out of your chair if you sit a lot. Do stretches. Take a short walk. Practice abdominal breathing or short meditative techniques. Major life decisions should be postponed during this time.
• Slow down. If you can, slow your task down by doing one simple step at a time. Say each step as you do it: “I can reach for the switch and not be hurt.” “I can work the lathe and not be hurt.” Take one step at a time so you can see how safe you are. Be gentle with yourself by lowering your expectations for high performance or perfectionism.

If the tools above don’t help you feel comfortable or the feelings of grief and anxiety get worse or don’t lessen over time, speak to your manager or someone in human resources to see what options are available to you. You may be able to take time off while you seek help, have support group opportunities within your workplace, or have sessions with a mental health professional.

By Jennifer Brick

©2016-2021 Carelon Behavioral Health

Source: Elizabeth M. Johnson, MA, Health Educator, Outside the Mom Box; Dr. John Farber, Clinical Psychologist