1. Mass Trauma Reactions | 1 Dealing with Mass Trauma Reactions First Edition, 2007

2. Mass Trauma Reactions | 2 Objectives of Mass Trauma Reactions  To describe normal reactions to mass trauma  To identify factors that influence individuals’ (and Families’) reactions  To provide tips on how to interact with distressed individuals  To provide guidance on how to help individuals and Families

3. Mass Trauma Reactions | 3 What are Mass Trauma Events?  Two types of mass trauma:  1. Human made (e.g., war, terrorism, transportation disasters)  2. Natural made (e.g., hurricane, earthquake, tornado, flood)  These events expose communities to trauma

4. Mass Trauma Reactions | 4 Individuals’ Exposure to Trauma  Individuals may be exposed to one-time event or ongoing, repeated event  Individuals are exposed to trauma in the following ways:  Physical impact (i.e., injury)  Visual exposure (i.e., witness)  Know someone hurt or exposed to trauma  Media

5. Mass Trauma Reactions | 5 Impact of Mass Trauma Events  When trauma event occurs, individuals experience:  An unanticipated event  Injuries and death or potential threat of injury or death  Personal, community and symbolic loss  A prolonged sense of crisis or lack of control feeling  Additional stressors  As a result, trauma events may create extreme stress, intense fear, feeling of helplessness or vulnerability, and horror

6. Mass Trauma Reactions | 6 Understanding Trauma Reactions  Trauma reactions are individual’s response to stress, fear, vulnerability, and loss  Reactions are multifaceted:  Physical reactions (i.e., physiological)  Emotional reactions (i.e., feelings)  Cognitive reactions (i.e., thoughts)  Behavioral reactions

7. Mass Trauma Reactions | 7 Normal Trauma Reactions PhysicalEmotional/CognitiveBehavioral Unexplained somatic symptoms Feeling jumpy; easily startled Grief/traumatic grief Anger Fear Disbelief/shock Numbing Helplessness Confusion Depression Anxiety Sleep disturbances Nightmares/flashbacks Distrust Loss of confidence in self and others Questioning of beliefs Irritability Withdrawal Increased use of cigarettes and alcohol Increased Family conflict and violence

8. Mass Trauma Reactions | 8 Facts about Trauma Reactions  Can not assume individuals will respond in a particular way  Reactions will vary widely across individuals  Each individual will exhibit a constellation of reactions  Reactions will be intense at first, but may change with phases of trauma event

9. Mass Trauma Reactions | 9 Influential Factors of Trauma Reactions  Circumstances of trauma event  Perceptions about meaning of event  Individual/Family characteristics  Support system and recovery environment

10. Mass Trauma Reactions | 10 Influential Factor: Circumstances of Trauma Event  Type of event – More complex and longer duration of reactions will be seen with:  Intentional human made traumas (e.g., war, terrorism)  Multiple or ongoing trauma  Greater proximity or exposure to trauma event  Nature of loss –  Losses other than death can result in grief or depression  Ambiguous loss situations create stress that can impact Family coping and relationships

11. Mass Trauma Reactions | 11  Temperament  Resources  Culture  Coping style  Past history of trauma and loss  Preexisting stressors  Spirituality and beliefs  Perceptions about meaning of events  Mental illness prior to event Influential Factor: Individual/Family Characteristics

12. Mass Trauma Reactions | 12 Influential Factor: Support System and Recovery Environment  Family  Community:  Community-wide response  Community attitudes and perceptions  Social support (i.e., information disseminated to facilitate problem-solving and development of new social contacts who provide help )

13. Mass Trauma Reactions | 13 Do Trauma Reactions Indicate or Lead to Mental Health Problems?  Nature of individual’s reactions can impact functioning  Cluster of reactions representing Acute Stress Disorder (ASD) or Posttraumatic Stress Disorder (PTSD) symptoms are common  However, most individuals are resilient and PTSD symptoms and other reactions are expected to dissipate over time  A small percentage of individuals will be diagnosed with a psychiatric disorder  When PTSD symptoms or other reactions that impair functioning are left untreated, then mental health problems are more likely to occur  Keep in mind that trauma can lead to personal growth

14. Mass Trauma Reactions | 14 Tips on Interacting with Distressed Individuals  Be compassionate.  Allow individuals to vent. Listen patiently and non- judgmentally.  Allow for diversity in how individuals respond and cope. Accept anger and intense emotions as normal reactions.  Respect religious and cultural beliefs.  If acutely distressed, refer immediately to medical treatment center or mental health provider for psychological first aid.

15. Mass Trauma Reactions | 15 Guidelines on Helping Trauma Victims First Steps  Assist individuals in getting basic needs met.  Help individuals access care and support available from military and community agencies.  Assess stress level and functioning as well as look for strengths to identify at risk. Refer individuals to appropriate agencies as needed.

16. Mass Trauma Reactions | 16 Guidelines on Helping Trauma Victims (continued) General Assistance  Offer reassurance. Encourage optimism.  Encourage self-confidence and point out strengths.  Provide information on effective ways to cope with stress.  Encourage Individual/Family to return to regular routine.  Encourage Individuals/Families to connect with others.  Suggest Individuals participate in projects that help others.  Advise limiting exposure to media coverage of trauma event.

17. Mass Trauma Reactions | 17 Professional Assistance Available Chaplains, Military OneSource, and Medical Treatment Facilities: Social Work Service and Behavioral Health  Provide information on normal traumatic responses and what to expect on road to recovery  Reframe meaning and help balance perceptions and cognitions with facts  Teach communication skills to address relationship problems  Strengthen Individuals’/Families’ problem-solving skills

18. Mass Trauma Reactions | 18 Professional Assistance (continued)  Monitor needs, mental health issues, and functioning  Tailor intervention efforts to particular groups  Provide short term counseling

19. Mass Trauma Reactions | 19 Army Community Service’s Role in Dealing with Trauma  Train unit readiness teams, Soldiers and Families  Provide information and referral assistance  Coordinate additional resources to support the community  At the direction of Garrison Commander set up a Family Assistance Center when a trauma occurs

20. Mass Trauma Reactions | 20 Closing Remarks  Individuals’ intense reactions are the result of experiencing stress, loss, and feelings of vulnerability and helplessness caused by the trauma event  The overall goals in helping trauma victims are to:  Acknowledge individuals’ feelings  Build individuals’ resilience and coping skills  Provide a safe, supportive environment