General Public

Stress

How do I manage stress following a disaster?

Information is available elsewhere on this website on what stress is and how it changes during phases of disaster response. Stress, as we discuss there, is an adaptive and necessary preparation for the work of survival, but becomes a problem when it is excessive in level (that is, too much stress) or when it hangs around past the time when it is needed. In these cases “good stress” turns into “bad stress." Here are some things you can do in conjunction with disasters to lessen stress levels:

Don’t make sudden or drastic decisions. The period immediately following a disaster is not the time to add additional stressors. For example, if your home was destroyed in a fire, focus on the immediate response, such as contacting your insurance carrier, rather than worry about long-term living arrangements.
Do make as many daily decisions (about food and clothing choices, about which radio station to listen to) as possible that will give you the feeling of control over your life.
Structure your time through a routine, to remind yourself that you are normal and having normal stress reactions. Keep your life as normal as possible under the circumstances of the disaster. Routines help both physical and emotional healing. New routines you may want to add (if you haven't already done so) include healthy eating, rest, exercise, and relaxation.
Talk with others as much as you are comfortable. Talking about what is going on reduces the feelings of anxiety, hopelessness and helplessness. Seek out people who care for your and for whom you care. Community gives you strength, courage, and support.
As far as possible, do something every day (even if it’s taking a sponge bath) to make yourself feel good and give yourself a small gift.
Be careful about numbing your immediate experience with overuse of drugs or alcohol. Don’t complicate things further with substance abuse problems.
Within the first 24 to 48 hours, periods of strenuous physical exercise alternated with periods of relaxation will alleviate some of the physical reactions to a stressful situation.
Remember Your Breath: Take deep cleansing breaths and focus on blowing out stress and fear.
Do a short prayer or meditation. Take a moment, if you are able, close your eyes or focus your eyes on something, take several deep diaphragmatic breaths, and repeat a 1-5 word affirmation with each deep breath like "Keep letting go…"
Hold on to something familiar. Put something you love in your pocket, around your neck, or on your wrist. This can be a picture, a cross or medallion on your neck or wrist, beads, a rosary, mala beads, or prayer beads. Some of you may choose to keep a sacred book such as the Koran or Bible or other inspirational text with you. When you get stressed and overwhelmed, stop, touch the object; breathe and repeat a word or phrase that comforts you.
Use progressive relaxation, a technique in which muscle groups are tightened and released while focusing on breathing.
Guided Imagery is a helpful and scientifically based way to manage stress through imagination and self-awareness.
Journaling. Writing down the experience of a disaster can help relieve stress by putting the fear and anxiety out of your body onto paper. People keeping journals in the midst of disasters and disaster recovery tend to experience less stress and more meaning-making.
Soothing and meaningful music and art can lower arousal levels and lessen stress responses.
Memorials and other healing rituals are one way to express and let go of your feelings. Participate in these if you feel they are helping you.

*Please see stress-related sections of this website for additional information on when to seek help.

Web Links

This site provides information from Dr. Patti Levin regarding what you may experience after a disaster. On the left of the page there is a links section with more detailed information.
This Stress Institute site provides advice and tips for reducing stress, such as breath work and prayer. (PDF)
This article is an American Psychological Association website providing useful information about getting help for oneself and one’s family after disaster.

What is traumatic stress?
Stress is a typical, and even adaptive, response to traumatic events such as disasters. The arousal, shock, and denial that we feel in the midst of disasters help us accomplish survival tasks, and also help us keep from feeling overwhelmed. What is important, though, is that we recognize the signs of stress and learn to manage it in such a way that we can continue to function. Here are some helpful facts and tips:

Stress in response to trauma is normal.
It is felt and experienced as a variety of emotions, including confusion, grief, anger, and sadness.
Everyone experiences stress differently, and we experience different stress in response to different disasters. Peoples’ way of experiencing stress depends both on what happened to them and on what meaning they give to those events.
We experience stress differently through different phases of disasters.

This site has suggested the following typical stress response to trauma:

Impact phase: The focus is on survival. Sometimes during this phase people are able to use stress to accomplish meaningful tasks, and other times they respond in a way that is disorganized and stunned. Stressors during this phase include:

Threat to life and encounter with death
Feelings of helplessness and powerlessness
Loss (e.g., loved ones, home, possessions)
Dislocation (i.e., separation from loved ones, home, familiar settings, neighborhood, community)
Feeling responsible (e.g., feeling as though could have done more)
Anger at human evil (It is particularly difficult to cope with a disaster if it is seen as the result of deliberate human actions.)

Immediate post-disaster phase - recoil and rescue: During this phase we begin to recoil from the impact of the disaster, and rescue activities often commence. It is normal to feel stunned, confused, or anxious. Stress responses during this phase may include:

Numbness
Denial or shock
Flashbacks and nightmares
Grief reactions to loss
Anger
Despair
Sadness
Hopelessness

Sometimes, having survived the initial phase of a disaster, people feel a high degree of elation and relief.

Recovery phase: This is a sometimes-lengthy period of adjustment in the return to normal that the community and individuals must go through. It begins as rescue is completed and individuals and communities face the task of bringing their lives and activities back to normal. Much will depend on the extent of devastation and destruction that has occurred as well as injuries and lives lost. It is normal for the emotional and physical components of stress to change during the recovery phase, as the immediate threats to survival are no longer the focus and life starts to ask other questions about meaning and values in the midst of disaster. People may also be hesitant to express distress, concern, or dissatisfaction, feeling they should be grateful for the aid given or because they have suffered less than others have. It should be noted that sometimes emotional reactions may present as physical health symptoms, such as sleep disturbance, indigestion, and fatigue, or they may present as social effects such as relationship or work difficulties.

The important thing throughout is to turn stress into work, and give ourselves time to heal. Some more things to keep in mind are:

Stress responses tend to change over time in intensity, frequency, duration, and character.
The time it takes for emotional “wounds” to heal varies. Much like the flu, traumatic stress reactions must run their course. No one can deny that this is a difficult experience, but it is important to know the reactions are normal and will ease in time.

Web Links

The Stress Institute has literature and resources on the nature of stress and provides advice for coping with the enormity of a disaster, such as breath work and prayer.

Post-Disaster Stress: When is it normal, and when is it more serious?

Just as physical recovery from a disaster takes time, mental health recovery is a process, not an event. As the immediate post-disaster stress response diminishes, here are some principles to keep in mind:

It is normal to have some intense and unpredictable emotions. You may be more irritable than usual, and your mood may change back and forth dramatically. You might be especially anxious or nervous, or even become depressed.
Thoughts and behavior patterns are affected by the trauma. You might have repeated and vivid memories of the event, called “flashbacks.” These flashbacks may occur for no apparent reason and may lead to physical reactions such as rapid heart beat or sweating. You may find it difficult to concentrate or make decisions, or become more easily confused. Sleep and eating patterns also may be disrupted.
Recurring emotional reactions are common. Anniversaries of the event, such as at one month or one year, can trigger upsetting memories of the traumatic experience. These 'triggers' may be accompanied by fears that the stressful event will be repeated.
Interpersonal relationships often become strained. Greater conflict, such as more frequent arguments with family members and coworkers, is common. On the other hand, you might become withdrawn and isolated and avoid your usual activities.
You may have physical symptoms such as headaches, nausea, or chest pain, and some of your pre-existing medical conditions may worsen due to the stress of disaster recovery.

All of us have a different and somewhat unique timetable for disaster recovery, and there is not one “standard” pattern of reaction to the extreme stress of traumatic experiences.

Personal Factors Related to Severe Distress

Personal experiences and characteristics can influence our way of responding to disasters. Some of these influences include:

Family factors. People who are not living with other family members, who have been exposed to family violence, have a family history of mental illness, and/or have caregivers who are severely distressed by the disaster are more likely themselves to be severely distressed.
Social factors. People who must face a disaster without supportive and nurturing friends or relatives suffer more than those who have at lease one source of such support.
Mental health. Those who had mental health problems (such as depression or anxiety disorders) before experiencing a disaster will be more likely to be severely distressed by a traumatic event.
Developmental level. Although young children, in some respects, may be protected from the emotional impact of traumatic events (because they don’t recognize the threat), once they perceive the situation as dangerous, younger children are more likely to experience severe stress reactions than are older children.
Previous disaster experience. People who have experienced previous threatening and/or frightening events are more likely to experience severe reactions to a subsequent disaster event severe psychological distress.

Normal post-traumatic responses to disaster include:

A concern for basic survival
Grief over loss of loved ones and loss of valued/meaningful possessions
Fear and anxiety about personal safety and physical safety of loved ones
Sleep disturbances, often including nightmares and imagery from the disaster
Concerns about relocation and the related isolation or crowded living conditions
A need to talk, often repeatedly, about events and feelings associated with the disaster
A need to feel one is a part of the community and its recovery efforts

Signs that additional help is needed

How do you know when you or a loved one might need help in healing from the disaster? The following symptoms may indicate a deeper stress or more serious reaction than what is considered "normal" stress. These types of reactions may interfere with the person's day-to-day functioning and could continue indefinitely without outside assistance. Difficulties with any or all of the following:

Disorientation (dazed, memory loss, unable to give date/time or recall recent events…)
Depression (pervasive feeling of hopelessness & despair, withdrawal from others…)
Anxiety (constantly on edge, restless, obsessive fear of another disaster…)
Acute psychosis (hearing voices, seeing visions, delusional thinking…)
Inability to care for self (not eating, bathing, changing clothing or handling daily life)
Suicidal or homicidal thoughts or plans
Problematic use of alcohol or drugs
Domestic violence, child abuse or elder abuse
Overwhelming guilt and self-doubt
Fear of crowds, strangers, or being alone

Some traumatic responses are unique to children

Teachers and parents should be alert to these signs of complicated post-disaster response in children:

Refusal to return to school and "clinging" behavior, including shadowing the mother or father around the house
Persistent fears related to the disaster (such as fears about being permanently separated from parents)
Sleep disturbances such as nightmares, screaming during sleep and bedwetting, persisting more than several days after the event
Loss of concentration and irritability
Startled easily, jumpy
Behavior problems, for example, misbehaving in school or at home in ways that are not typical for the child
Physical complaints (stomachaches, headaches, dizziness) for which a physical cause cannot be found
Withdrawal from family and friends, sadness, listlessness, decreased activity, and preoccupation with the events of the disaster

What to do if you are concerned about your or others’ response to a disaster

Here is a Post-traumatic Stress Disorder self-test that you may want to take to get an idea of how your level of stress compares with that of others. If you have any reason to be concerned about your stress following the disaster, please seek appropriate help. Professional companionship for those affected by a disaster--especially those who have witnessed destruction, injury or death--can help prevent or minimize serious post-traumatic stress disorders. You should consult with your family physician for referral to sources of help with these struggles. Parents who are concerned about their children can ask their pediatrician or family doctor to refer them for an evaluation.