In recent years, many disaster response experts and mental health researchers have switched their focus from looking exclusively at at-risk populations in the aftermath of an emergency to asking, “What are the protective factors?” “What situations, experiences, or personal traits help people to come through a traumatic incident with greater resilience?” First, let’s clear what we mean when we use the word “resilience” in this context.

Resilience: a definition

Bonanno (2004) has defined adult resilience as…

“The ability of adults in otherwise normal circumstances who are exposed to an isolated and potentially highly disruptive event such as the death of a close relative or a violent or life-threatening situation to maintain relatively stable, healthy levels of psychological and physical functioning as well as the capacity for generative experiences and positive emotions” (pp. 20-21).

While researchers admit that controlled studies to date have not conclusively shown all of the factors which may support a hardy response to adversity, there are nevertheless some factors which are widely held to be negatively correlated with PTSD and other post-disaster mental disorders, seeming to confer an aura of protection on survivors:

  • An optimistic outlook and positive expectations
  • Having coping skills gained from previous distressing events and experiences
  • Receiving good social support from others
  • Possessing emotional stability
  • Being a disaster worker in environments that are less horror-filled and/or more rewarding
  • Relatively light loss of resources
  • Being provided with basic resources (food, water, shelter, emotional support) early on
  • Having a strong moral belief system or spiritual holding
  • The ability to return to “normal” life (i.e., reduce disruption) relatively sooner
  • Having the opposite situation to the factors named above as creating potential for being at-risk
  • Having a strong sense of cultural/racial identity

(Seligman, 1992; Carbonatto, 2009; Australian Red Cross and Australian Psychological Society, 2010; (Tummala-Narra, 2007; The Professional Counsellor, 2011)

Recognising the symptoms of trauma

Many mental health and other professionals in private practice have travelled to disaster destinations to offer their skills in the acute phase of a crisis, meaning in the days following events such as Hurricane Katrina, the Boxing Day tsunami of 2004, or the 2008 Chinese earthquake in Sichuan province. One common thread running through their reports is that helping out in a disaster is vastly different than sitting with people in the calm confines of a consulting room.

One way in which this is especially true is that there is not an orderly line-up of people waiting their turn to see the doctor/therapist/counsellor at a prescribed appointment time. In fact, in a field setting, all of that is turned on its head, and the volunteer — whether a “professional” in regular life or not — is often tasked with searching out those who would receive assistance. Several helpers have commented that that aspect of field work is quite challenging, so it is crucial to know: how might you — possibly a seasoned mental health professional, or possibly not — go about recognising when someone is experiencing the symptoms of trauma?

Every emergency or traumatic experience is unique, and so are the myriad reactions that the survivors have. All of these stress reactions are possible:

  • Physical symptoms (for example, shaking, headaches, feeling very tired, loss of appetite, aches and pains)
  • Crying, sadness, depressed mood, grief
  • Anxiety, fear
  • Being “on guard” or “jumpy” (hypervigilance)
  • Worry that something really bad is going to happen
  • Insomnia, nightmares
  • Flashbacks or scenes from the disaster coming back intrusively to mind
  • Irritability, anger
  • Impulsiveness (especially for adolescents, who may take unwarranted risks)
  • Guilt, shame (for example, for having survived, or for not helping or saving others)
  • Confused, emotionally numb, or feeling unreal or in a daze
  • Appearing withdrawn or very still (not moving)
  • Not responding to others, not speaking at all, being “shut down”
  • Disorientation (for example, not knowing their own name, where they are from, or what happened)
  • Not being able to care for themselves or their children (for example, not eating or drinking, not able to make simple decisions) (WHO et al, 2011; Ruzek et al, 2007)

Some people may only be mildly distressed or not distressed at all. Most people will recover well over time, especially if they can restore their basic needs and receive support, such as help from those around them and/or Psychological First Aid. However, people with either severe or long-lasting distress reactions may need more support than Psychological First Aid alone, particularly if they cannot function in their daily life or if they are a danger to themselves or others.

Note: It is vital to make sure that severely distressed people are not left alone. It may be up to you as the mental health professional to try to keep them safe until the reaction passes or until you can find help from health personnel, local leaders or other community members in the area.

This article was adapted from Mental Health Academy’s “Psychological First Aid” course.

References

  • Australian Red Cross and Australian Psychological Society. (2010). Psychological First Aid: An Australian guide. Victoria, Australia.
  • Carbonatto, M. (2009). Back from the edge: Extraordinary storeys of survival and how people did it. Auckland, New Zealand: Cape Catley, Ltd.
  • Ruzek, J., Brymer, M., Jacobs, A.K., Layne, C., Vernberg, E.M., & Watson, P.J. (2007). Psychological First Aid. Journal of Mental Health counselling 29 (1), January, 2007, 17 — 49.
  • Seligman, M. Learned optimism. Random House: Australia, 1992.
  • The professional counsellor (2011). Critical incident counselling. The professional counsellor, 2 (2011), 1 — 9. Copyright: The Mental Health Academy Pty, Ltd.
  • Tummala-Narra, P (2007). Trauma and resilience: A case of individual psychotherapy in a multi-cultural context. Journal of Aggression, Maltreatment, & Trauma, 14, 205-225. In Warchal, L. R., & Graham, L.B. Promoting positive adaptation in adult survivors of natural disasters. Adultspan Journal, 2011 10 (1), 34 — 51.
  • World Health Organisation, War Trauma Foundation and World Vision International (2011). Psychological first aid: Guide for field workers. WHO: Geneva. Retrieved from: hyperlink.