Maintaining Mental Health in the Face of Crisis: Dealing with Post-Traumatic Stress


from Survival Blog:

Many of us have considered how we would provide for our family’s physical needs, including medical care, during a prolonged crisis. Indeed, it would seem foolish to be unprepared for trauma related to accidents, violence, fire, et cetera, when professional medical care might not be available for weeks, months, or more. What most of us don’t think about is the effect that a long-term crisis and/or exposure to traumatic events could have on our mental health. Next to food, shelter, and security, this may seem to be a low-priority concern, but depression and anxiety related to traumatic events can have lasting and highly detrimental effects, ranging from loss of productivity to violence and suicide.

Anxiety Disorders

We may feel that we are tough and hardened to the rigors of even the worst scenarios we can imagine. Many soldiers have felt the same way before entering combat and yet still developed anxiety, depression, and Post Traumatic Stress Disorder (PTSD). Anxiety disorders, such as PTSD, are common in those who face extreme mental stress, as they are related to increased activation in the fear center of the brain.

Not Mental Weakness But How Brains Deal With Intense Fear and Prolonged Stress

These disorders are not a sign of mental weakness but simply the result of how our brains deal with intense fear and prolonged high levels of stress. Typical signs to look for are hyper-vigilance (jumpiness, loss of sleep, increased hostility), intrusive thoughts (inability to stop thinking about traumatic experiences), and recurring nightmares. Along with emotional detachment and depression, these signs are the hallmarks of PTSD. If left untreated, these symptoms can lead to suicidal thoughts and actions, and increase the risk for violent and abusive behaviors towards others.

Not Just Soldiers

Accident survivors and victims of violent crime (especially rape) are commonly diagnosed with PTSD, so it’s not just soldiers who are at risk. It’s not absurd to think that our family members, our friends, and even we might succumb to these problems if things turn out to be as bad as some predict. In a changed world where much of what we’ve taken for granted is gone, even the strongest and most resilient of us could have a tough time coping. This is especially true for children, since they usually don’t deal with change as well as adults. In a TEOTWAWKI scenario, or even in a prolonged crisis, maintaining mental well-being may be as much of a challenge as maintaining good physical health.

Early Action Can Be Very Effective

Fortunately, early action can be very effective in reducing the fear and anxiety caused by traumatic events. Simple and easily implemented measures can help those affected by PTSD to cope with their situation and return to normal functioning. Scores of books and manuals have been written on treatment methods for anxiety disorders and PTSD; more than we have time to go into here.

Intervention That Is Easy To Follow

This essay presents an intervention that is easy to follow and which can provide help to those suffering from PTSD when no professional mental health care is available. The plan is based in Cognitive Behavior Therapy (CBT), which stresses short-term treatment to change thoughts and behaviors, thereby reducing fear and stress. To keep it simple, the plan focuses on two specific areas: exposure therapy and group support.

Exposure Therapy

You’ve probably heard the phrase, “You have to face your fears in order to beat them.” This is the basis of exposure therapy. The goal is to desensitize a person to traumatic events by helping them to face their own fears. One of the methods commonly used is journaling. Writing out a detailed account of traumatic experiences has been proven to lessen their effect, reducing their power to prolong fear and anxiety.

The same idea works for recurring nightmares but with a twist. With bad dreams, the key is to write the dream out, but change the ending to how you would like it to end. Don’t be nice or polite when doing this, but think at a “caveman” level. If someone attacks you in the dream, write out how you would destroy them. Then read this “corrected” dream each night before going to bed. This idea comes from Navy psychiatrist Beverly Ann Dexter, and it’s been proven to work.

Journaling of both experiences and recurrent nightmares is an important aspect of CBT, and it provides a homework-like structure. It is important that journaling be done every day, even if you’re writing the same ideas over and over again. The repetition helps to lessen the effect of intrusive and recurrent thoughts and dreams, and reduces anxiety. It sounds simple, but it works.

Group Support

In addition to journaling, group support meetings also work to help reduce the effects of PTSD. Meetings provide a context for the journal writings, and a small group setting allows a comfortable place for people to read their journal work aloud to others who have experienced the same or similar trauma. This action further cements the exposure process and helps to affirm that these individuals are not alone in their reactions to stress. The writing and reading of journal work together help to promote desensitization to the initial trauma and help to instill resilience to future trauma.

Group meetings provide peer support by allowing people to work through their own problems alongside others who share similar issues. Discussions help people to better understand and cope with their own experiences, and listening to the experiences of others contributes to the exposure therapy aspect of the intervention.

Group Sessions

In group sessions, it is important to have a moderator who oversees the process, allowing everyone time to share their thoughts and journals, while keeping comments from others in line with what is helpful. Statements such as, “You should have…”, or, “I would have done…” don’t have a place in this process, nor does any hurtful or derogatory commentary. Everyone should be focused on helping the rest of the group, even if their approach to problems is different. Some people will be talkative, some shy, and if some don’t want to share at first, that’s all right.

Take time to allow people to read their journal writings, and allow discussion to flow from the topics that come up. Discussion helps to provide support, and shows group members they are not alone in what they’re going through.

Group meetings afford an opportunity to help the greatest number of people in a timely manner. They also help to reduce the stigma commonly associated with mental health treatment, leading to a greater likelihood that people will be willing to seek help for themselves and their family members. Groups typically meet once a week for an hour or so, depending on the size of the group, but meetings can be held more often if needed. A group size of six to twelve often works best, but whatever suits your own purposes is fine. Even if you work one on one with a family member, you can still get results, but the benefits of group support are probably going to be more beneficial and highly recommended.

What You Need for a Group Session

What you will need for a group session includes pads of paper and pens or pencils (not bad things to have anyway), a place to meet, and a mediator. That’s it. Meeting places should be safe and non-threatening, and meetings should be held during a quiet part of the day. Mediators should have an even temperament and a fair amount of patience. It also helps If they have some affinity with the group (for example a teenager or young adult would work best with a group of children), but the best quality is simply the desire to help others get through a tough time. The average CBT session is time-limited, usually lasting no more than eight weeks. Shoot for a six to eight week run of group sessions and see how people progress. You should see good results in this amount of time.

Run Future Group Sessions Consecutively

If anyone still needs help after the group session has run its course, encourage them to take part in future groups. Preparing to run several group sessions consecutively can help those who may need more time and allow people who were initially reticent to seek help another opportunity to participate.

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