How to Cope with the Effects of Critical Incident Stress

A critical incident is a relatively sudden, untimely and unanticipated event or situation which is outside the range of usual human experience and which evokes unusually strong emotional reactions which have the potential to interfere with one's ability to function at the time the situation arises or later.

Many people experience a critical incident at some stage of their life. Examples of traumatic events in the wider world include disasters, floods, bushfires, foundering of a vassel, plane crash war; violent public incidents- shootouts, hostage-taking; other traumatic events could include suicides, murder of a friend or colleague, unexpected death, being assaulted, mugged or raped. Sometimes a trauma may be experienced indirectly, eg as a bystander, or where friends or family are victims.

This leaflet is designed to help you to understand the typical reactions of others who have been in traumatic situations. It will give you some guidance in taking care of yourself so that recovery can be facilitated.

At the time of the incident you may have felt stunned or frozen, or felt that your sense of time was distorted or your perceptions very focused. You might have been angry, anxious or frustrated. Physical responses could have included nausea, rapid heart beat or muscular tension. Afterwards it is common to feel numb, in shock, unable to believe what occurred. Gradually the impact of the incident is felt, and the numbness wears off. At this time, you may experience intrusive thoughts of the incident, sleep is often disturbed, perhaps with nightmares, or you may experience flashbacks where aspects of the event recur in imagination so vividly, you feel as if you are reliving the trauma. Self-doubts and what if's? are common. All reactions are part of your body's efforts to come to terms with what you have experienced, part of the natural process to recovery. Talking to people that understand, whether friends, family, partner, counsellors, chaplains, colleagues or fellow survivors helps process the incident and provides emotional relief.

Remember

• People react differently to traumatic events. They also progress through the effects of critical incident stress at different rates. Symptoms experienced may vary.
• Accept your own feelings and reactions to the incident as well as those of others. There is no wrong or right way to feel or think. Your reactions are valid.
• Most people do the best that they can at the time of a critical incident. It's natural for you to feel that you could have done something to lessen the impact or prevent the incident. This is probably unrealistic. Don't take too much responsibility for the incident or the way it went. Don't be too harsh on yourself.
• You have experienced or witnessed a traumatic event which no doubt will affect you in some way. Be aware that symptoms may develop. Be alert to the signs of critical incident stress in your general functioning.

Symptoms usually begin immediately or soon after the trauma. Sometimes symptoms are delayed for a period of months or in some cases even years after the incident although avoidance symptoms might have been present during this period.

Common effects

• Nightmares
• Insomnia
• Flashbacks
• Intrusive thoughts about the incident; what if's?
• Difficulties in concentration and memory
• Regression to earlier behaviours
• Apathy, no energy
• Inability to feel
• Decreased sexual interest, impotency
• Outbursts of aggression
• Irritability
• Violent impulses
• Hostility, rage
• Anxiety
• Startle reactions; hyperalertness
• Restlessness
• Shock or denial
• Numbness
• Fear
• Guilt
• Grief
• Feelings of detachment from others
• Sadness, depression
• Mistrust
• Phobias
• Avoidance of reminders of the incident;
• Avoidance of people or places connected to the incident

Effects on Attitudes

A heightened sense of concern for the well-being of loved ones

Feelings of hopelessness and a sense of loss of control of one's life

A sense of a foreshortened future Loss of trust in others, or in a God

Loss of a sense of self as a worthwhile person; as invulnerable and immortal.

A sense that the world has changed; that it is not just or fair.

Common concerns seem trivial

Physical Responses

• Nausea, vomiting
• Dizziness
• Heart palpitations
• Shaking, trembling
• Diarrhoea
• Muscular tension, headaches, aching
• Neck and back pain
• Chest pain (check with your GP)
• Menstrual dysfunction
• Difficulty of breathing, shortness of breath
• Fatigue
• Rapid heart beat
• Sweating
• Loss of appetite
• Frequent low grade infections

People may be more vulnerable to the effects of traumatic experiences when exhausted, tired or sick; when the incident triggers memories of a traumatic event in the past; when the event

• Involved violent deaths
• involved the death or injury of a child
• the circumstances were horrifying; or involved characteristics that particularly affected you
• was a major disaster
• involved many casualties
• involved others you are close to
• involved severe injuries to victims, eg mutilations, burns
• involved a personal threat to life or when other critical incidents have been experienced recently; or other major stressors are active in one's life or when there is no effective support unit, eg family or friends.

• Remember that these reactions will lesson in time; they are normal reactions to extreme stress.
• Keep, or return to, your usual routine as much as possible. Structure your time.
• Talk to family and friends; share your feelings and your concerns. This helps the healing process.
• Don't have rules about your progress, just go with how you feel.
• Avoid over-use of alcohol and drugs.
• Get some exercise or relaxation daily.
• Do something pleasant for yourself from time-to-time.
• Take some time and space to work through the event.
• Sometimes jotting down thoughts helps to process your experience cognitively as well as emotionally.
• Delay making major decisions or life changes at this time; however making smaller day-to-day decisions increases your feeling of control over life.
• Keep up some social contact.
• Eat regular, balanced meals even if you don't feel hungry.
• Memories of what you have experienced will fade with time. Don't have unrealistic expectations that they will disappear early.
• Check on friends or colleagues who shared the experience with you. You may be having a good day and can be supportive. They can do the same for you at another time.
• Remember, you are not going crazy.
• Remember, help is available if you find that you are feeling too much pain.
• Remember that there is always hope, and that the world is waiting for you to get back into it.

How loved ones and friends can help

It can be extremely distressing to watch a loved one experience reactions to a traumatic event. Feelings of helplessness may result, and you, yourself, may become stressed. There are a few things you can do to alleviate the response of your loved one, and your own feelings of concern.

• Try to understand what your loved one has experienced and how it has affected him/her.
• Remember, with time, care and support, these reactions should subside and usual patterns of behaviour resume.
  Realise that your loved one will feel dreadful at times.
• Be there to listen when your loved one wants to talk; expression of emotion helps the healing process.
• Have patience, reassure them you are there whatever they may need.
• Encourage them to maintain normal work and social routines.
• Encourage them to participate in a sporting or relaxation activity.
• Understand that your loved one may want to be alone sometimes, to reflect on what he/she has experienced.
• Encourage your loved one to seek help if symptoms do not subside within a few weeks, or if certain symptoms seem to get worse, or significantly inhibit their usual functioning.
• Seek help yourself if you feel the need to talk, or are uncertain or over-whelmed by the situation.

When to seek help

• If numbness persists and you continue to feel detached from life.
• If you feel overwhelmed by intense emotions or physical symptoms.
• If your relationships are deteriorating as a result of your experience.
• If you are abusing alcohol or drugs.
• If nightmares or flashbacks persist.
• If intrusive thoughts persist and are discomforting.
• If you cannot get on with the job after a reasonable period.
• If you are unable to discuss, express or share your experiences, perhaps because you have no social supports.

Where to seek professional help

The University of Sydney Counselling Service
Telephone: 02 9351 2228
Email: counsell@stuserv.usyd.edu.au

- Community Mental Health Teams
- Area Crisis/Extended Hours Service
(See the front section of the Telstra White Pages , 'Where to find Mental Health Services')

Information prepared by Wendy McCartney for the Counselling Service, University of Sydney.