Balanced Living Special Edition

Special Edition - Responding to the Boston Marathon Explosions

The pair of explosions that struck the 2013 Boston Marathon have left tragedy and heartbreak in their wake. What was a community event that attracted runners and onlookers from across the globe was instantly transformed into a grim and unfortunate reminder that our world is not always a safe place.

The resources collected in this newsletter are specifically focused on helping those impacted by this event cope with what has happened. From recommendations for how to address very serious topics with children to providing support for friends, loved ones, and anyone touched by this tragedy, these articles help to create a positive foundation for care and recovery.

Coping with a Traumatic Event

people embracing

What Is a Traumatic Event?

Most everyone has been through a stressful event in his or her life. When the event, or series of events, causes a lot of stress, it is called a traumatic event. Traumatic events are marked by a sense of horror, helplessness, serious injury, or the threat of serious injury or death. Traumatic events affect survivors, rescue workers, and the friends and relatives of victims who have been involved. They may also have an impact on people who have seen the event either firsthand or on television.

What Are Some Common Responses?

A person’s response to a traumatic event may vary. Responses include feelings of fear, grief, and depression. Physical and behavioral responses include nausea, dizziness, changes in appetite and sleep pattern, and withdrawal from daily activities. Responses to trauma can last for weeks to months before people start to feel normal again.

Most people report feeling better within three months after a traumatic event. If the problems become worse or last longer than one month after the event, the person may be suffering from post-traumatic stress disorder (PTSD).

What Is PTSD?

Post-traumatic stress disorder (PTSD) is an intense physical and emotional response to thoughts and reminders of the event that last for many weeks or months after the traumatic event. The symptoms of PTSD fall into three broad types: re-living, avoidance, and increased arousal.

  • Symptoms of re-living include flashbacks, nightmares, and extreme emotional and physical reactions to reminders of the event. Emotional reactions can include feeling guilty, extreme fear of harm, and numbing of emotions. Physical reactions can include uncontrollable shaking, chills or heart palpitations, and tension headaches.
  • Symptoms of avoidance include staying away from activities, places, thoughts, or feelings related to the trauma or feeling detached or estranged from others.
  • Symptoms of increased arousal include being overly alert or easily startled, difficulty sleeping, irritability or outbursts of anger, and lack of concentration.

Other symptoms linked with PTSD include: panic attacks, depression, suicidal thoughts and feelings, drug abuse, feelings of being estranged and isolated, and not being able to complete daily tasks.

What Can You Do for Yourself?

There are many things you can do to cope with traumatic events:

  • Understand that your symptoms may be normal, especially right after the trauma.
  • Keep to your usual routine.
  • Take the time to resolve day-to-day conflicts, so they do not add to your stress.
  • Do not shy away from situations, people, and places that remind you of the trauma.
  • Find ways to relax and be kind to yourself.
  • Turn to family, friends, and clergy for support and talk about your experiences and feelings with them.
  • Participate in leisure and recreational activities.
  • Recognize that you cannot control everything.
  • Recognize the need for trained help, and call a local mental health center.

What Can You Do for Yourself?

Children may struggle with a traumatic event in ways very similar to adults. Knowing what you can do to help a child recover is important when helping him/her rediscover a sense of normalcy. Try these steps:

  • Let your child know that it is okay to feel upset when something bad or scary happens.
  • Encourage your child to express feelings and thoughts without making judgments.
  • Return to daily routines.

When Should You Contact Your Doctor or Mental Health Professional?

About half of those with PTSD recover within three months without treatment. Sometimes symptoms do not go away on their own or they last for more than three months. This may happen because of the severity of the event, direct exposure to the traumatic event, seriousness of the threat to life, the number of times an event happened, a history of past trauma, and psychological problems before the event.

You may need to consider seeking professional help if your symptoms affect your relationship with your family and friends, or affect your job. If you suspect that you or someone you know has PTSD, talk with a health care provider or call your local mental health clinic.

Centers for Disease Control and Prevention (CDC) ©2013


Trauma Affects Relationships

Trauma survivors with PTSD often experience problems in their intimate and family relationships or close friendships. PTSD involves symptoms that interfere with trust, emotional closeness, communication, responsible assertiveness, and effective problem solving.

  • Survivors may experience a loss of interest in social or sexual activities, they may feel distant from others, and they may be emotionally numb.
  • Partners, friends, or family members may feel hurt, alienated, or discouraged because the survivor has not been able to overcome the effects of the trauma, and they may become angry or distant toward the survivor.
  • Feeling irritable, on guard, easily startled, worried, or anxious may lead survivors to be unable to relax, socialize, or be intimate without being tense or demanding. Significant others may feel pressured, tense, and controlled as a result.
  • Difficulty falling or staying asleep and severe nightmares may prevent both the survivor and partner from sleeping restfully, which may make sleeping together difficult.
  • Trauma memories, trauma reminders or flashbacks, and the avoidance of such memories or reminders can make living with a survivor feel like living in a war zone or like living with the constant threat of vague but terrible danger.
  • Living with an individual who has PTSD does not automatically cause PTSD, but it can produce vicarious or secondary traumatization, which is similar to having PTSD.
  • Reliving trauma memories, avoiding trauma reminders, and struggling with fear and anger greatly interfere with a survivor's ability to concentrate, listen carefully, and make cooperative decisions. As a result, problems often go unresolved for a long time.
  • Significant others may come to feel that dialogue and teamwork are impossible.

Survivors of childhood sexual and physical abuse and survivors of rape, domestic violence, combat, terrorism, genocide, torture, kidnapping, and being a prisoner of war often report feeling a lasting sense of terror, horror, vulnerability, and betrayal that interferes with relationships.

  • Survivors who feel close to someone else, who begin to trust, and who become emotionally or sexually intimate may feel like they are letting down their guard. Although the survivor often actually feels a strong bond of love or friendship in current healthy relationships, this experience can be perceived as dangerous.
  • Having been victimized and exposed to rage and violence, survivors often struggle with intense anger and impulses. In order to suppress their anger and impulsive actions, survivors may avoid closeness by expressing criticism toward or dissatisfaction with loved ones and friends.
  • Intimate relationships may have episodes of verbal or physical violence.
  • Survivors may be overly dependent upon or overprotective of partners, family members, friends, or support persons (such as healthcare providers or therapists).
  • Alcohol abuse and substance addiction, which can result from an attempt to cope with PTSD, can destroy intimacy and friendships

In the first weeks and months following a traumatic event, survivors of disasters, terrible accidents or illnesses, or community violence often feel an unexpected sense of anger, detachment, or anxiety in their intimate, family, and friendship relationships. Most are able to resume their prior level of intimacy and involvement in relationships, but the 5-10% who develop PTSD often experience lasting problems with relatedness and intimacy.

Yet, many trauma survivors do not experience PTSD, and many people in intimate relationships, families, and friendships with individuals who have PTSD do not experience severe relational problems. People with PTSD can create and maintain successful intimate relationships by:

  • Establishing a personal support network that will help the survivor cope with PTSD while he or she maintains or rebuilds family and friend relationships with dedication, perseverance, hard work, and commitment
  • Sharing feelings honestly and openly with an attitude of respect and compassion
  • Continually strengthening cooperative problem-solving and communication skills
  • Including playfulness, spontaneity, relaxation, and mutual enjoyment in the relationship

National Center for PTSD (NCPTSD) ©2013


Tips for Talking to Children in Trauma

Children are just as affected as adults are by a disaster or traumatic event. Some may be affected even more, but no one realizes it. Without intending to, we, as parents, may send our children a message that it is not all right to talk about the experience. This may cause confusion, self-doubt, and feelings of helplessness for a child. Children need to hear that it is normal to feel frightened during and after a disaster or traumatic event. When you acknowledge and normalize these feelings for your children, it will help them cope with their experience and move on.

Following exposure to a disaster or traumatic event, children are likely to show signs of stress. Signs include sadness and anxiety, outbursts and tantrums, aggressive behavior, a return to earlier behavior that was outgrown, stomachaches and headaches, and an ongoing desire to stay home from school or away from friends. These reactions are normal and usually do not last long. Whether your child is a preschooler, adolescent, or somewhere in between, you can help your child by following the suggestions below.

Preschooler

  • Stick to regular family routines.
  • Make an extra effort to provide comfort and reassurance.
  • Avoid unnecessary separations.
  • Permit a child to sleep in the parents' room temporarily.
  • Encourage expression of feelings and emotions through play, drawing, puppet shows, and storytelling.
  • Limit media exposure.
  • Develop a safety plan for future incidents.

Elementary-Age Children

  • Provide extra attention and consideration.
  • Set gentle but firm limits for acting out behavior.
  • Listen to a child's repeated telling of his/her trauma experience.
  • Encourage expression of thoughts and feelings through conversation and play.
  • Provide home chores and rehabilitation activities that are structured, but not too demanding.
  • Rehearse safety measures for future incidents.
  • Point out kind deeds and the ways in which people helped each other during the disaster or traumatic event.

Preadolescents and Adolescents

  • Provide extra attention and consideration.
  • Be there to listen to your children, but don't force them to talk about feelings and emotions.
  • Encourage discussion of trauma experiences among peers.
  • Promote involvement with community recovery work.
  • Urge participation in physical activities.
  • Encourage resumption of regular social and recreational activities.
  • Rehearse family safety measures for future incidents.

It is important to remember that you do not have to "fix" how your child feels. Instead, focus on helping your child understand and deal with his or her experiences. Healing is an evolving state for most children, but some may need professional help.

If signs of stress do not subside after a few weeks, or if they get worse, consider consulting a mental health professional who has special training in working with children. In time, and with help, your children will a return to health.

Substance Abuse and Mental Health Services Administration ©2012


Additional Resource

As an additional resource to help you, a friend, or a loved one understand the silent impacts of post-traumatic stress disorder, here’s a special booklet prepared by the National Institute of Mental Health. Use this resource to better understand what steps you can take and what options are available to assist in the recovery related to this tragic event.

Post-Traumatic Stress Disorder

The National Institute of Mental Health (NIMH)