IN THE AFTERMATH OF HURRICANES RITA AND KATRINA

Our heartfelt sympathy goes out to the countless survivors of Hurricanes Rita and Katrina who have lost loved ones, their homes and possessions, and all that was familiar to them. This Trauma Response E-News provides practical information to assist in your work in supporting and counseling with survivors.

Grief refers to the feelings that are precipitated by loss. The early reactions that we see in grieving individuals occur during a period of "Numbing." Initially, the individual may present in shock. There may be a highly anxious, active response with an outburst of extremely intense distress or perhaps a seemingly stunned, emotionally-numb response.

During this early phase, you may likely observe denial - an inability to acknowledge the impact of the event or perhaps, that the event has occurred. The individual may evidence dissociation, in which he may seem dazed and apathetic, and he may express feelings of unreality. It is not unusual for people to make statements such as, "I can't believe it," "This is not happening," "This has got to be a bad dream," etc. Finally, there may be periods of intense emotion (e.g., crying, screaming, rage, anger, fear, guilt, etc.). Recognize that these kinds of reactions to a traumatic loss are normal responses.

Within hours or perhaps days of the loss, "Yearning and Searching" may be observed. Here, the individual begins to register the reality of the loss. There may be a preoccupation with the lost individual. Symptoms may include, but not be limited to, insomnia, poor appetite, headaches, anxiety, tension, anger, guilt, etc. Sounds and signals may be interpreted as the deceased person's presence.

Within weeks to months following the loss is a period of "Disorganization." Here, feelings of anger and depression are exhibited. The individual may likely pose questions (e.g., "Why did this have to happen?") and evidence periods of "bargaining" (e.g., "If only I could see him just one last time."). Finally, in the months or even years following the loss is a time of "Reorganization." Here, the individual begins to accept the loss - often cultivating new life patterns and goals.

There are no "cookbook" approaches to helping people who are struggling with loss. Perhaps the most important variable is "being there" for the person. Attempt to connect with him using the Acute Traumatic Stress Management model (see www.ATSM.org). Encourage expression of thoughts and feelings without insistence. Recognize that although relatives and friends intend to be supportive, they may be inclined to discourage the expression of feelings - particularly anger and guilt. Avoidance of such expression may prolong the grieving process and can be counterproductive. Allow periods of silence and be careful not to lecture.

When working with grieving individuals, avoid cliches such as "Be strong," and "You’re doing so well." Such statements may only serve to reinforce an individual’s feelings of aloneness. Again, allow the bereaved to tell you how they feel and attempt to "normalize" grief reactions. Finally, don't be afraid to touch. A squeeze of the hand, a gentle pat on the back or a warm embrace can show you are there and that you truly care.

Emotional Responses during a traumatic event may include shock, in which the individual may present a highly anxious, active response or perhaps a seemingly stunned, emotionally-numb response. He may describe feeling as though he is "in a fog." He may exhibit denial, in which there is an inability to acknowledge the impact of the situation or perhaps, that the situation has occurred. He may evidence dissociation, in which he may seem dazed and apathetic, and he may express feelings of unreality. Other frequently observed acute emotional responses may include panic, fear, intense feelings of aloneness, hopelessness, helplessness, emptiness, uncertainty, horror, terror, anger, hostility, irritability, depression, grief and feelings of guilt.

Cognitive Responses to traumatic exposure are often reflected in impaired concentration, confusion, disorientation, difficulty in making a decision, a short attention span, suggestibility, vulnerability, forgetfulness, self-blame, blaming others, lowered self-efficacy, thoughts of losing control, hypervigilance, and perseverative thoughts of the traumatic event. For example, upon extrication of a survivor from an automobile accident, he may cognitively still "be in" the automobile "playing the tape" of the accident over and over in his mind.

Behavioral Responses in the face of a traumatic event may include withdrawal, "spacing-out," non-communication, changes in speech patterns, regressive behaviors, erratic movements, impulsivity, a reluctance to abandon property, seemingly aimless walking, pacing, an inability to sit still, an exaggerated startle response and antisocial behaviors.

Physiological Responses may include rapid heart beat, elevated blood pressure, difficulty breathing*, shock symptoms*, chest pains*, cardiac palpitations*, muscle tension and pains, fatigue, fainting, flushed face, pale appearance, chills, cold clammy skin, increased sweating, thirst, dizziness, vertigo, hyperventilation, headaches, grinding of teeth, twitches and gastrointestinal upset.

Dr. Mark Lerner is a Clinical Psychologist and Traumatic Stress Consultant who focuses on helping people during and in the aftermath of traumatic events. He is the President of the American Academy of Experts in Traumatic Stress (www.aaets.org) and the originator of the Acute Traumatic Stress Management intervention model (www.atsm.org). Dr. Lerner wrote and produced the newly released audio book, Surviving and Thriving: Living Through a Traumatic Experience (www.MarkLernerAssociates.com). He is the Editor and Publisher of Trauma Response, the Academy's official publication, and the author of five books. Dr. Lerner consults regularly with individuals and organizations - where he specializes in the education, training and implementation of Acute Traumatic Stress Management and the development of organizational crisis management teams. Dr. Lerner has conducted numerous interviews, including CNN Headline News, the Los Angeles Times, the Palm Beach Post, Newsweek, Self Magazine, Stars & Stripes, Reuters, the Associated Press and U.S. News & World Report. Most recently, he appeared on Your Morning on CN8, CNN and Dateline NBC. Dr. Lerner lives in New York with his wife and three children.