What are normal stress reactions in the wake of disaster?
Most disaster survivors (children and adults as well as disaster
rescue or relief workers) experience normal stress reactions after
a traumatic event. These reactions may last for several days or
even a few weeks and may include:
Emotional reactions (shock, fear; grief; anger; guilt; shame;
feeling helpless or hopeless; feeling numb; feeling empty;
diminished ability to feel interest, pleasure, or love)
Severe anxiety (debilitating worry, extreme helplessness,
compulsions or obsessions)
Severe depression (loss of the ability to feel hope,
pleasure, or interest; feeling worthless)
What aspects of disaster are especially traumatizing?
Certain aspects of disaster are particularly likely to be
traumatic. The following are likely to put survivors at risk for
severe stress symptoms and lasting PTSD if the survivor directly
experiences them or witnesses them:
Life threatening danger or physical harm (especially to
Exposure to gruesome death, bodily injury, or dead or maimed
Extreme environmental or human violence or destruction
Loss of home, valued possessions, neighborhood, or
Loss of communication with or support from close
Intense emotional demands (e.g., rescue personnel and
caregivers searching for possibly dying survivors, or interacting
with bereaved family members)
Extended exposure to danger, loss, emotional/physical
Exposure to toxic contamination (e.g., gas or fumes,
Which individuals are at risk for severe stress responses?
Some individuals have a higher than typical risk for severe
stress symptoms and lasting PTSD, including those with a history
Exposure to other traumas (e.g., accidents, abuse, assault,
combat, rescue work)
Chronic medical illness or psychological disorders
Chronic poverty, homelessness, unemployment, or
Recent or subsequent major life stressors or emotional strain
(e.g., single parenting)
Disaster stress may revive memories of prior trauma and may
intensify preexisting social, economic, spiritual, psychological,
or medical problems.
What are the priorities for helping disaster survivors?
Helping disaster survivors, family members, and emergency rescue
or disaster relief personnel requires preparation, sensitivity,
assertiveness, flexibility, and common sense.
The first priority is to be a team player by respecting and
working through the site chain of command. Being a team player
also means pitching in to provide basic care and comfort to
survivors and workers.
A close second priority is to make personal contact in a
genuine way with survivors and rescue workers. Listen; don't give
advice. Ask the survivors how they and their children are doing
and find out what you can do to help. If they need it, provide
them with food, beverages, practical supplies (e.g., clothes,
blankets, sunscreen, magazines, writing implements, telephone),
and a comfortable place to sit.
A third priority is to help them "defuse" by encouraging them
to tell their story. Ask: "Have you ever been through anything
like this before?" "How's it going finding a place to stay and
getting the assistance you need?" "Is there anyone I can help you
get in touch with?" "What do you find yourself remembering most
since this all happened?" "Where were you when this started?"
"What are your top three main concerns for the next few hours or
A fourth priority is to carefully assess the risk factors and
symptomatic problems for PTSD or other health problems. Identify
and set up referrals for the persons or families most likely to
be in need of further care.
What are the goals of mental-health providers in response to a
The goals of on-site mental-health care in the wake of disaster
Protect. Help preserve survivors' and workers' safety,
privacy, health, and self-esteem.
Direct. Get people where they belong; help them to organize,prioritize, and plan.
Connect. Help people communicate supportively with family, peers, and service providers.
Detect. Screen, triage, and provide crisis care to those
at-risk for severe problems.
Select. Refer people to health, spiritual, mental-health,
social, and financial services.
Validate. Use formal and informal educational opportunitiesto affirm the normalcy and value of each person's reactions,
concerns, ways of coping, and goals for the future.
What are the recommended interventions in the wake of a
People have their own pace for processing trauma. It is
important to convey to them that they should listen to and honor
their own inner pace.
People should be encouraged to use natural supports and to
talk with friends, family, and co-workers - at their own pace.
They should follow their natural inclinations with regard to how
much and with whom they talk.
If someone wants to speak with a professional in the
immediate aftermath period, it would be helpful to:
Listen actively and supportively, but do not probe for
details and emotional responses. Let the person say what they
feel comfortable saying without pushing for more.
Validate normal, natural recovery.
Conclusions drawn from outcome studies of Psychological
Debriefing (PD) are mixed. Overall, the conclusions do not confirm
the efficacy of a one-session intervention shortly after the
trauma. Psychological Debriefing does not necessarily decrease
psychological disturbances after a trauma. Some studies found
that, in the long run, a single session of psychological debriefing
may hinder natural recovery. Accordingly, we do not recommend
intervention in this initial aftermath period. If people do present
to clinics or counselors requesting help, single-session contact
should be avoided. In these instances people should be scheduled
for 2-3 visits over 2-6 weeks.
For those who have previously experienced traumatic events,
subsequent traumatic experiences may stir up memories and
exacerbate symptoms related to previous traumas. Thus, some
people will feel like the most recent trauma is opening old
wounds. These symptoms should also be normalized and are likely
to abate with time. It may be helpful to ask people what
strategies they have successfully used in the past to deal with
trauma reactions, and encourage them to continue using these
Individuals who continue to experience severe distress that
interferes with normal functioning after three months are at
higher risk for continued problems. These individuals should be
referred for appropriate treatment.
The construct "Protect, Direct, Connect, Select" was
developed by Diane Myers, unpublished manuscript.
See last Reviewed/Updated Date below.