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Helping Others Through a HEALTH CRISIS

by Mark D. Lerner, Ph.D.

Chairman, The National Center for Emotional Wellness

During a health crisis, physical and safety needs must be the priority. Physical illness can destroy lives. However, traumatic stress can ultimately destroy many more.

Traumatic stress disables people, causes disease, precipitates mental disorders, leads to substance abuse, and destroys relationships and families. In organizations, traumatic stress can lead to communication breakdowns, a decrease in morale and group cohesiveness, workplace tension and conflict, excessive absenteeism, employee sabotage, an increase in workers’ compensation and disability claims, employee litigation, an inability to retain effective personnel, and ultimately, a decrease in productivity.

Caregivers can expand their repertoire of helping skills—beyond the physical and safety needs of people, and raise their level of care.

During a crisis, sights, sounds, smells, tastes and physical touch are indelibly etched in peoples' minds. They repeat over and over again, they “play back” in one's experience as disturbing “movies,” and they lead to uncomfortable and overwhelming thoughts. These stimuli are the precipitators of debilitating traumatic stress disorders.

The fact of the matter is that whatever we are exposed to, whatever we focus on during peak emotional experiences, will stay with use forever. However, in the same way that negative stimuli are etched in peoples' minds during a traumatic experience, so too can a positive information.

During a health crisis, we turn to physicians and other healthcare providers. Many of us turn to our spiritual leaders. Others present at a therapist’s office where an educational process begins. People tell their stories, expose themselves to their painful feelings, and learn about traumatic stress.

We shouldn’t wait for people to experience months, and sometimes years, of emotional pain and dysfunction. If what we focus on during a peak emotional experience stays with us forever, let's seize this opportunity!

One doesn't need an advanced degree in mental health in order to provide timely information and support. In fact, the best help during a health crisis is often rendered by people who take the time to listen and say the “right things” at the “right time.” However, one must know what to say and do. Traumatic experiences, by their very nature, compromise one's ability to think clearly and often leave people feeling a loss of control. By having a plan, caregivers can be prepared and responsive.

Beyond recognizing and understanding traumatic stress, those who help others must be equipped with a practical strategy.

Following are five basic elements (Acute Traumatic Stress Management: Lerner):

1. Connect

During a health crisis, introduce yourself and let people know your role (e.g., “My name is Angela. I’m a nurse.”). Begin to develop rapport by making an effort to understand and appreciate his situation. A simple question such as, “How are you doing?” may be used to engage the individual. Use appropriate non-verbal communication (e.g., eye contact, body turned toward him, a gentle touch, etc.). Recognize that during a challenging experience, individual reactions may present on a continuum from a totally detached, withdrawn reaction to the most intense displays of emotion (e.g., uncontrollable crying, screaming, panic, anger, fear, etc.). During a health crisis, you may find yourself working to connect with not only the patient, but also his loved ones.

2. Ground

Once you have established a connection, you can begin to "ground" the individual. Encourage him to “tell his story” and attempt to orient him by discussing facts regarding his illness or injury (e.g., “I understand that it’s common to have feelings of numbness”). Address the circumstances at a cognitive, or thinking level. While one should not discourage the expression of emotion, attempt to focus on the facts in the here-and-now, and help the individual to know the reality of the situation. Oftentimes, his “reality” may be seriously clouded due to the nature of the situation. Remember, a crisis can overwhelm an individual’s coping and problem-solving abilities. Assure the individual that he is now safe, if he is. He may still be “playing recordings” of aspects of his situation over and over in his mind. By reviewing facts, you may disrupt “negative cognitive rehearsal” (i.e., repetitive, potentially destructive thinking), help the individual to function, and help him to deal with the circumstances at hand.

3. Support

Factual discussion will likely stimulate thoughts and feelings. This is often the time when individuals who are living through a health crisis need the most support. However, in reality, it’s also the time when many people look the other way. Many individuals feel terribly unprepared to handle others’ painful thoughts and feelings. Oftentimes, they fear that they will “open a can of worms” or “say the wrong thing.” Generally, a reasonable attempt to help others is preferable to avoidance.

Attempt to understand and respect the uniqueness of the individual—the thoughts and feelings that he’s experiencing. Strive to “give back” a sense of control that has been “taken from” him by virtue of his experience. Support him, and allow him to think and feel. When faced with a health crisis, many people will experience an overwhelming sense of aloneness and withdraw into their own world. Make a respectful effort to “enter that world,” and to help the individual to know that he is not alone and that his unique perception of his experience is important. Never attempt to talk a person out of a feeling (e.g., “Don’t be scared, you'll be fine.”). Communicate an appreciation of the other person’s experience. Attempt to understand the feelings that lie behind his words (or perhaps actions) and convey that understanding to him.

4. Normalize

While you are attempting to support an individual by giving him the opportunity to express his thoughts and feelings, begin to normalize his reactions. This is an important component when communicating with people who may be feeling very alone. Experiencing a cascade of emotions, or perhaps a lack of emotional reactivity, may cause him to feel as if he is “losing it” and perhaps, “going crazy.” Normalizing and validating an individual’s experience will help him to know that he is a normal person trying to deal with an abnormal event.

It’s important that you do not become sympathetic and over identify with the situation with statements such as, “I know what it feels like.... When I was....” Rather, you should attempt to normalize and validate the individual’s experience with statements like, “I see this is overwhelming for you right now... facing an illness like yours would be hard for anyone to handle.”

An important component of the normalization process is to begin to educate the individual by helping him to know how people typically respond to challenging life experiences. Discuss traumatic stress—the normal response to an abnormal event.

5. Prepare

A final strategy to help others during a health crisis is to begin to prepare the patient for what lies on the road ahead. It's is helpful to 1) review facts about the illness, disease or injury, 2) bring the person to the present, and 3) describe likely events in the future. Continue to normalize the individual's reactions.

Try to avoid using statements like “Everything is going to be okay,” or that “Everything is going to work out.” These kinds of “band-aid” statements may only serve to minimize an individual’s feelings and cause him to feel misunderstood. Instead, focus on listening and being there. It's generally not what people say that helps others the most. It's what they don't say.

The Power to Overcome!

There's a lot of talk today about helping people who are living through challenging experiences to become more resilient. Resiliency is defined as the ability to bounce back, to restore oneself. A health crisis changes us. Our goal should not be to bounce back and become the way we were if there's potential for us to grow through our experience.

We all have the power to overcome—the innate ability to harness painful emotional energy, and use that energy to propel us to cultivate a mission and live with a new sense of purpose.

It's critical to understand that what we think about will become our experience. And while we may be grappling with physical discomfort or pain, depending upon the nature of our crisis, we may be able to use this uncomfortable energy productively. We can think of ourselves as moving from victim to survivor and, ultimately, thriver.

While we’re working to cope with an illness or injury we can ask ourselves, "How would I ideally respond to my condition?" While this is a hypothetical construct, changing daily, weekly, even monthly it helps us to become goal-oriented.

A health crisis is a powerful force; a force that can disable us, or enable us, by bringing new meaning, purpose and hope into our lives.


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