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Trauma

A trauma is an event that falls outside the realm of usual human experiences and is very distressing (e.g., evokes reactions of intense fear, helplessness, horror, etc.) These events usually involve a real or perceived threat to your own or someone else's health, life, or well-being. For example, the following is a list of some, but not all, of the many types of traumatic events people might experience: automobile accident, robbery, flood, terrorism. Even though an actual traumatic event may be over, you may still experience some strong emotional or physical reactions. It is very common for people to feel afraid, horrified, helpless, and out-of-control during and after a traumatic event. It is important to note that these reactions are normal, although the circumstances that precipitated the reactions certainly were not normal.

Sometimes reactions to traumatic events may interfere with your ability to function as you normally would. This also is common and normal. However, if these reactions persist and continue to interfere with your ability to function for some time after the event, it is important to seek help from a mental health professional who can recommend appropriate treatment.

Common Reactions to a Traumatic Event
People who have been involved in or have witnessed a traumatic event may experience a range of feelings and reactions. A traumatic event can be defined as any event outside the range of usual human experience which can be experienced as distressing. Examples might include a threat to one's life, a threat or harm to one's friend or loved one, witnessing a death or serious injury of another person, or the destruction of one's home or community due to fire or natural disaster. The definition of "traumatic event" varies significantly as the individual must define what he or she believes is traumatic in their own lives. 

    Initial Symptoms - some or all may be present

    1. Sense of numbing or detachment
    2. Less aware of surroundings ("being in a daze")
    3. Feelings of "unreality" and/or feeling unsure about yourself or your experiences
    4. Inability to recall details of the event

It is important to remember that physical and emotional reactions to traumatic events are considered normal. Many people may experience a brief period in which some or many of the symptoms above are present but will then quickly disappear over time. Sometimes these symptoms persist and it is very important that these individuals seek some assistance for their continuing symptoms. Therapists have found that early intervention produces the best results.

    Persistent Symptoms - some or all may be present

        Reexperiencing the trauma

    • Feeling anxious, jumpy, feeling "on edge"
    • Distressing dreams or nightmares
    • Reliving the event through hallucinations and flashback

        Avoiding associations with traumatic event

    • Avoiding thoughts/feelings of event
    • Feeling numb or detached from others
    • Inability to recall details of the trauma
    • Avoiding similar activities or situations related to the even

        Persisting symptoms of increased arousal

    • Difficulty falling or staying asleep
    • Difficulties' with concentration
    • Feeling the need to be "on guard"
    • Outbursts of anger

        Difficulties in social or occupational functioning

    • Lack of interest in spending time with others
    • Inability to concentrate on job and/or schoolwork
    • Significant changes in your style of dealing with work and/or your relationships with other people

If you experience persistent and distressing symptoms related to a-traumatic event, please seek some assistance such as the individual or group counseling services offered through the Ball State University Counseling Center at 285-1736.

Prepared by: Harry Pepper, Psychology Intern, Ball State University Counseling Center, February, 1996.

Types of Trauma 
Many different events are potentially traumatizing. The determination if an event qualifies as traumatic should be left to participants. Of course, some events like the Oklahoma City bombing create trauma regardless of personal histories. But often, personal experiences, temperament, and recent events can create a buffer to trauma or leave individuals vulnerable to coping in adverse ways. The following are examples of events that often create trauma: 

        Individual events:

    • automobile accident
    • sexual assault/abuse
    • robbery
    • life threatening experience
    • serious physical injury
    • perception of serious threat to self or significant others
    • psychological abuse
    • severe injury or death on one's own child
    • suicide of family member or friend
    • homicide

        Community events:

    • flood
    • earthquake
    • hurricane
    • fire
    • large scale environmental pollution
    • multiple injury/fatality accidents
    • multiple violent crimes or sexual assaults
    • multiple homicides
    • terrorism

Mitchell, J.T, & Everly, GS., (1996). Critical Incident Stress Management: The basic course workbook. Ellicott City, Maryland: International Critical Incident Stress Foundation.

Ball State University's Trauma Response Team
The Trauma Response outreach team at Ball State University's Counseling Center consists of two staff psychologists, and several pre-doctoral and masters-level interns. The purpose of the team is to respond in situations in which there has been a trauma (e.g., death of a student) by helping surviving students, faculty, and staff deal with the event. Through the use of debriefings, dissemination of psycho educational information, and referrals to campus and community resources, the team's goals are to help mobilize coping abilities, restore equilibrium and prevent destructive or negative outcomes.

The team has been frequently been involved in consultation after a crisis, to discuss the specifics of a situation and some options for responding (e.g., "one resident was the victim of a crime and members of the floor are reacting in this manner, is this something your team can help with?"). We have also attended informational meetings with students in which residents have been informed about the status of a public event. Typically these meetings are conducted by Residence Life staff and the Trauma Response Team staff are on hand to consult prior to the meeting about specific issues or individuals of concern. We will answer questions or provide some input if it is appropriate. A very fruitful and commonly utilized intervention has been debriefings after traumatic incidents in which staff lead a group discussion for persons impacted by a particular event. These are conducted after distressing occurrences such as after dealing with an attempted or completed suicide, physical assault or injury, sudden death, or arson.

Developmental Training Model
The Trauma Response Team uses a developmental training model to help trainees acquire crisis intervention skills and to maximize the use of these skills throughout the academic year. Initially, the team's senior leaders familiarize trainees with crisis intervention theories and literature, placing particular emphasis on critical incident stress debriefing (CISD). Trainees are encouraged to draw upon their own experiences with crises as well as to observe and learn from the clinical skills of the senior leaders. In addition, role-plays are used to provide trainees the opportunity to practice group crisis intervention skills. The team's initial responses to incidents are coordinated and led by a senior staff member, with at least one masters or doctoral-level student accompanying and assisting by playing a secondary role. As the academic year progresses and trainees have become more skilled, doctoral interns take on primary leadership roles, with masters interns taking secondary roles and the senior staff members serving as consultants.

Debriefings
Critical incident stress debriefing (CISD, J.T. Mitchell, & G.S. Everly, 1983) was first practiced by rescue workers, law enforcement, and military personnel in order to reduce the impact of long-range emotional consequences of traumatic experiences. It has since been broadened to involve citizens affected by critical incidents, not just emergency personnel. CISD has been successfully used to facilitate adjustment after many small scale traumatic incidents and large scale disasters including the 1994 earthquake in Los Angeles and the 1995 Oklahoma City bombing.

Debriefing is not psychotherapy or merely catharsis; it is a discussion of the event, processing reactions, and a review of strategies for coping. CISD is an organized group meeting or discussion about a traumatic event soon after its occurrence (typically within 48 to 72 hours). Early intervention is essential to decrease the potential negative effects of traumatic experiences over the long term. At the meeting, the people who were directly involved in the incident are able to discuss their thoughts and emotions in a controlled, structured, and rational manner. They also get the opportunity to see that they are not alone in their reactions but that many others are experiencing the same reactions. This format is particularly helpful in that only the persons directly affected by the event are involved. Typically, the unique impact of critical incidents leave affected persons feeling that only those that experienced what they did can intimately empathize with their reactions.

How and When to Contact the Trauma Response Team
Students, faculty, and staff at Ball State are encouraged to utilize services of the Trauma Response team. On-going urgent situations are initially managed by Counseling Center staff taking rotating crisis duty. The staff can be reached during office hours at 285-1736, or after hours through our crisis-line at 747-7330. After the crisis has been resolved and it continues to have impact on those closely involved, please don't hesitate to contact the Counseling Center at 285-1736. We are available for consultation and scheduling of debriefings or other interventions as indicated. You may also contact us for further information about our training model.

Surviving a Murder (Joe Abhold, Ph.D. & Caroline Curlin, Ph.D.) 
While each of you probably knew the murder victim in a different way and with a different degree of depth, you have each been dealing with the experience of a loss through a murder -- a particularly difficult type of loss to cope with. Surviving a murder has many elements in common with grieving other losses, but often the reactions are stronger and some reactions are unique.

When you first heard of the murder victim's death, and for sometime thereafter, you may have felt stunned or shocked. Along with this, you may have felt a sense of detachment . . . like you were watching events happen around you but didn't feel as though you were participating in those events.

You may have been really amazed at how life goes on. Frequently, people feel isolated when those around them continue life with a "business as usual" attitude. If others were aware that you knew the murder victim, you may have noticed some of them avoiding you or avoiding the topic of the murder victim's death. This can really intensify the sense of isolation. Additionally, within a short period you may have found that people assume or expect that you are "over it."

For survivors of a murder, the anger that is felt is typically magnified. In fact, rage may be a more appropriate word. Extreme, intense, angry energy may be felt toward the murderer, as well as toward the injustice of it all . . . the senselessness of murder. Or, you may find that while you aren't enraged, you are feeling irritable. Little things are building up and getting on your nerves.

As we think about the murder victim's death, and the threat of violence that we have all experienced here on-campus and in the community, many people will feel afraid. We are reminded of our own vulnerability. That we could be the victims of violence. That we are not as safe as we would like to believe.

Some people may feel guilty. "Why the murder victim? " or "I should have / could have done something to prevent this." Murder taps into our fear that life is beyond our control, and feeling guilty is our attempt to convince ourselves that we have some control over uncontrollable events.

When death comes in a violent way, we often have visual images of the events as we imagine they occurred. Even if you aren't consciously aware of them, these images may surface in your dreams or daydreams. These images can intensify our feelings and can be very disturbing.

And finally, you may find that you are much more sensitive to murder and violence. When you hear about incidents of violence through the media, your memories of the murder victim will be triggered. You will always be a survivor of murder.

Survivors of murder often struggle with what to do with all these intense feelings. One of the best things you can do for yourself is to share your story . . . what has your experience been? What are your feelings about all of this? What visual images do you have?

If, after this workshop, you would like to talk about these issues further, don't hesitate to reach out to people who are safe to talk to (e.g., each other, close friends/family, clergy, the staff at the Counseling Center). Talking = healing!

How to Deal with a Completed Suicide (Joseph J. Abhold, Ph.D. & Caroline Curlin, Ph.D.)
Dealing with the aftermath of a completed suicide is a very difficult and special kind of grief. Survivors are left with feelings of guilt, sadness, and anger.

Guilt - Very often survivors of a suicide are left wondering what they could have done to help the person who took their own life. Perhaps they saw signs that the person was depressed, upset, or suicidal. If they tried to talk to them, they may feel: "maybe I didn't do enough" or if they talked to them perhaps they feel: "what could I have done better."

The most important thing to remember is that suicide is an irrational act, one that trained mental health professionals often have great difficulty predicting and preventing. You did the best you could in your interactions and the deceased made a choice that you cannot change.

Anger - Survivors of a suicide frequently feel anger at the deceased. "How could they be so selfish to hurt all of us in this way?" is a question often asked. "Didn't they think of their family and all of the people who cared about them?" Anger is a normal part of any stress, but with all of these unanswered questions, it is a common element after a suicide.

It is important to recognize your anger at the deceased, verbalize it, and perhaps clarify it for yourself by writing the deceased a letter or talking to them out loud. It is vital not to focus all of your energy on anger, however, because this will keep you away from another difficult, but very healing reaction to attempted suicide: Sadness.

Sadness - It could also be referred to as pain, sorrow, tearfulness, or hurt, but by any name sadness is the most raw feeling associated with the loss of someone you care about. This intense feelings of sadness is best shared with friends and family who can offer support through this difficult time.

Experiencing this sadness, like experiencing all of the feelings discussed above, will help to move you toward healing. This process will facilitate putting this experience, as difficult as it is, in perspective.

Remember, their attempted suicide was not your fault and if the loss makes you think of harming yourself, please seek help immediately. The Counseling Center offers free and confidential services to students. Call us at 285-1736.

When Safety is Threatened
All of us have a need to feel safe and trusting in our home environments. When this sense of safety is violated, particularly due to an act of another person rather than an accident or natural disaster, individuals react with intense emotions.

Three factors are involved in determining the type of response to personal threat: violence, violation, and volition. VIOLENCE is the degree to which one's threat to safety involves a potentially lethal and injurious act. VIOLATION is the sense of being exploited in a manner over which one has little control. VOLITION refers to the act being a willful and intentional harm. Depending on the degree to which threatening acts are seen as violent, a violation, and volitional, one's responses will be similarly intense.

Individuals react to acts of threat with many differing emotions, including feelings of vulnerability, helplessness, threat, feelings of being out of control, anger, and desire to assign blame and responsibility. Sometimes individuals may be reminded of past occurrences of pain or harm. You may mentally review and revisit these hurts, particularly if the circumstances are similar to the present threat. These reactions are normative and expected. For example, thousands of adults, parents, and children called Red Cross telephone banks after the Oklahoma City bombing. These people were responding to the tragedy of those they did not even know. The callers reported difficulty sleeping, going out of the house, or a change in mood, as well as feelings of fear, anger, and disbelief. A similar or stronger reaction can occur when someone we know, but are not necessarily intimately involved with, is the victim of violence.

We all would like to think that the world is safe, that good things happen to good people, and that bad things happen to other people, "not our friends." When loss occurs these beliefs are challenged and we are forced to deal this reality and associated responses. Such responses might include:

A sense that safety is threatened Increased sense of vulnerability - particularly if one identifies with the victim or has similar past loss The desire to assign blame and responsibility Hypervigilance - looking for threats Anger Sadness Uncertainty about how to respond

Suggestions for Coping
Take action: Particularly if there is a group of people involved, make plans to protect yourself and prevent future harm.

Join with others: The best defense against crime and threat is to join with others to decrease your feeling of isolation and increase your sense of control.

Play it safe: Reduce your risks by employing safe, protective behavior (e.g., always letting someone know where you are, locking your doors, traveling with others).

Talk to friends and supportive others: Venting feelings and gathering support can help reduce your level of fear and anger.

Keep it in perspective: It can be difficult to remain calm and reasonable when a large group of people are reacting in an intense manner. Try to estimate the accurate level of risk involved and the resources available for your protection.

Loss at the Workplace
Working people spend almost 50 percent of their waking hours in their place of employment. Often the relationships that develop between co-workers have an intensity and a life all their own; even when the work relationship is not carried over into their personal lives. Usually co-workers see one another daily, perhaps spending more time with co-workers than at home with significant others. These types of interactions can develop strong emotional connections. Different work relationships may create different feelings, communication patterns, and emotional connections. For example, colleagues working together can develop emotional dependence on one another, particularly when they work together as a team or if work is fed from one to another. Co-workers come to rely on one another, not just for help performing tasks, but for support and understanding. A supervisor can be a mentor, teacher, or friend, which makes this relationship an important one as well. Also, one can naturally have disagreements or anger at a co-worker or supervisor, which could lead to complex feelings of guilt and sadness if something happens to him/her.

Unfortunately, when one experiences loss at the workplace, others might not view this as a valid loss that should precipitate grief. They may reason that co-workers are not loved ones and could underestimate the impact of this loss. The loss of a co-worker or supervisor through death, illness, or his/her leaving the job can create a variety of strong feelings and reactions. Because these losses are not fully recognized by society, there are no clear customs about how to work through the loss. It is important to openly communicate, resolve issues of "how to proceed from here" and to be certain that your emotional needs are met. Grief is a normal process that proceeds from feelings of sadness and pain to healing and wholeness. Below you will find some tips that seem to help this process along. 

    Manifestations of Healthy Grieving

    • Feelings of sadness
    • Oversensitivity to noise
    • Feelings of anger or frustration
    • Disbelief
    • Guilt
    • Confusion or disorganization
    • Anxiety
    • Preoccupation
    • Tightness in chest
    • Sleep disturbance
    • Numbness
    • Appetite disturbance
    • Lack of energy
    • Social withdrawal
    • Dreams of the deceased
    • Absent-minded behavior

    Factors that Inhibit Grieving

    • OTHER LOSSES - Unfinished grief from an earlier loss (not necessarily a loss through death) can awaken and add to the current level of grief.
    • STOICISM - Some believe that they must "be strong" or "put on a good front for everyone else."
    • DENIAL - Others may avoid speaking of the deceased or not attend the funeral.
    • ABUSING SUBSTANCES - Abuse of alcohol or other drugs can shut out the pain temporarily, but creates problems in itself.
    • RUNNING RAGGED - Some individuals keep very busy helping others rather than experiencing their loss.
    • SUGGESTIONS FOR COPING
    • TALK ABOUT IT with those who are similarly affected.
    • VALIDATE YOUR LOSS: if others don't understand, co-workers can supply the validation necessary to deal with effects of sudden change.
    • DETERMINE as a group what issues you are uncertain about and decide how to proceed.
    • CLARIFY any questions about work matters with your supervisor.
Counseling Center
Lucina Hall, room 320
Muncie, IN 47306

Hours: 8 a.m. - 5 p.m., Monday through Friday
Phone: 765-285-1736
Fax: 765-285-2081
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