Disaster Mental Health: Trauma-Informed Tools for Better Response

Foreign like to welcome everybody to today's presentation on an integrated and trauma informed approach to disaster mental health. I'm your host, Dr. Donnelly Snipes. Today we're going to review the impact of disasters on all pieces of people's lives. Remember, that stands for physical, interpersonal, emotional, cognitive, environmental and spiritual. We'll enhance understanding of acute trauma reactions during and after a disaster and and identify tools and resources that can be useful for prevent for preventing traumatic injury. Now remember, trauma is when something happens that leaves you feeling unsafe and powerless. Traumatic injury occurs when you never really regain your sense of personal power and safety and it starts affecting your autonomic nervous system, your stress responses, etc. That's when we start looking at PTSD and CPTSD in terms of trauma triage. When I was in graduate school, my doctoral dissertation actually focused on preventing PTSD and complex post traumatic stress in law enforcement. So I did a lot of research and looking and learning and some of the things that came out. Pus and Nader were pioneers in this field. If you want to look up some of their stuff on PubMed, it's just fascinating. But anyway, similarity to the victim is something that can make somebody more likely to have an intense emotional reaction or a more intense emotional reaction. So they may be similar to the victim in the present. For example, they're seeing mothers and fathers and children that are stranded or struggling, and they're a mother of a father or even a child, and they see it. And they may be all the way across the country or in another country, but their heart reaches out because they really can empathize being so similar to that victim. It also could be similarity to the victim from the past. And it doesn't have to be a one for one in order to experience a trauma, a traumatic retraumatization. You don't have to have been through a hurricane before. But if you were experienced a trauma before, remember, trauma leaves you feeling unsafe and powerless. So if you've experienced something that le left you feeling unsafe and powerless, even if it had nothing to do with a natural disaster, it may reawaken those feelings in that person. It may cause some retraumatization. And we do want to be aware of this. We want to recognize in our clients, if you're seeing clients with depression or anxiety or irritability, anger issues, we may want to inquire, you know, is what's going on in Tennessee, North Carolina, South Carolina, Florida right now, is that causing you to feel powerless? I know a lot of us are feeling really Powerless right now and validating how they're feeling because they may be like, I'm living out here in Idaho and I shouldn't be feeling. Well, we feel how we feel. And helping them connect the dots so they can understand why that sense of powerlessness may. May be so overwhelming right now. The proximity to a safe zone is another thing that can make events more traumatic. If it happens in your neighborhood, if it happens in your city, in your town, then obviously that is more traumatic than if it happens, you know, across the world. There's a lot of people that have been posting about Asheville and how they had gotten married there. They used to go there every. Every year for leaf change or. Or whatever. And they have a lot of memories there, and they have a lot of love for that place, and they're just devastated that that place is gone now because it felt. That's part of them. That's part of their memories. And I remember after Andrew, when we would look around, there were not even street signs up anymore. You couldn't even get oriented. And it was devastating to a lot of people because they were supposed to feel safe in their own home. You were, when you visited Asheville for those vacations or whatever, you felt safe there. So bad things weren't supposed to happen there. And recognizing how people's brains kind of work with that, the availability of support, and this is really interesting that in the first 12 hours after a trauma, people are in denial. They have whatever happened, it's fresh in their memory, and they haven't even tried to do anything with it yet. They're just still in the, oh, my gosh, what do I do with this? After about 12 hours, people need to start doing something with it. They may start getting angry. They need to try to start making sense of it. And then after 48 hours, people have identified a strategy to try to manage that distress. Whether it's numbing it, avoiding it, being angry about it. You know, people have different reactions, but they've kind of chosen a path. And they found that the availability of social support within the first 12 hours is extremely helpful to reducing the traumatic injury later on. Somebody that's right there, right after the. The trauma that says, lean on me. I'm here with you. Let's walk together is so important. Somebody that can be there and say, I see you're angry. I can, you know, I. I'm terrified, too. Somebody that can empathize and provide that support is really helpful to helping the. The survivors start feeling safe again, start feeling empowered again, because they've got now, they've got resources, They've got somebody that's helping support them. If it happens in the first 24 hours, that's also helpful. And after a disaster, a lot of times what we're talking about is basic necessities. Think back to Maslow's hierarchy and getting food, getting water, getting shelter, getting. Making sure that your loved ones are safe after. Right after a disaster. That's what people need, is that physical, basic physical safety. And if they get that in the first 12 hours, that's super helpful. If they know that the calvary is coming in, then it's like, okay, you know, I. I just have to stick it out for a few hours, and then somebody will be here to help. I'm not isolated. There will be people to help me do things that I can't do right now. If it arrives in 24 hours, you know, again, we're seeing that the longer help and support, physical, emotional, interpersonal, the longer that help is delayed, the more likely the person is to start perceiving the world as dangerous, perceiving themselves as vulnerable, perceiving themselves as in danger. And I'll just do the last two together. Stressors in the past six months. If they're already worn down, then it's going to be harder to deal with life on life's terms in normal circumstances, let alone during a disaster. And a history of mental illness, trauma, or addictive behaviors. And Pinus and Nader really only talked about mental illness or addictive behaviors. But I think it is so important that we highlight the impact that a history of trauma has. Even if somebody didn't develop ptsd, recognizing that this can reignite those feelings of powerlessness and unsafeness in them is really important. Again, even if they're living in Idaho, they may be thinking, oh, my gosh, what would happen if that happened around here? I don't know if I could survive. Disaster impacts all pieces of life. Physical, interpersonal, emotional, cognitive, environmental, and spiritual. So let's take a look at the impact of disaster on those pieces. Now, normally I go alphabetically, but after a disaster, as we were just talking about, the first thing that we're really attending to is the environment, the environmental disaster. People. People have a loss of a sense of safety because cities, towns, houses are gone, their cars were parked out front, and their cars are not out front anymore. And that's all very unsettling because they don't know where anything is. They feel like they're kind of in some sort of surreal environment. Now we have an Anticipatory loss of a sense of safety. And I know that, that for me, having gone through hurricanes and tornadoes, it's stressful. And I find myself, whenever we know that there's a hurricane coming our way or a tornado or a potential tornado, I find myself glued to the weather. And is that particularly healthy? No, probably not. But that's one of my ways of trying to feel safe, trying to feel empowered. Knowledge is power. So I figure the more I know, but there's an extreme you can take it to and, and it's important to be able to get that knowledge and then go do something else and then maybe check on the next update. But this anticipatory anxiety, this anticipation of a loss of a sense of safety, if I'm anticipating that the hurricane's going to hit here and there's going to be flooding and blah, blah, blah, I'm already getting ramped up before the suckers even hit. And then post disaster, when you're walking around going, oh my gosh, what just happened? And some people, we're going to talk about survivor guilt later on, but after the disaster, even if it didn't hit you, you're going on Twitter, you're going on social media, Google, wherever you go and surveying the damage. You want to know what happened. And to a certain extent, a lot of times I believe that's people trying to get information that the worst day didn't happen. They're trying to disconfirm their catastrophic beliefs. And I, and I hope that's true, I really do. But for a lot of people going on, and I'm not even on Twitter for the most part right now, especially stuff that has to do with the disaster because I know that it would be too emotionally draining for me to recognize what's going on and know that I can't go help right now. They're still in life saving mode. They're still in rescue and recovery. Loss of housing is another environmental impact. If it you lost a roof, you know, you're worried about rain coming in and they're stressed with that. If you lost your house or you had to leave your house and go to a shelter for evacuation reasons, that creates a whole other set of concerning circumstances. Because you don't have your stuff, you may not have your pets, you are potentially living, sleeping on cots in a gym, surrounded by 50 other people, some who may be sick, some who may not be as altruistic. So you're worried about your stuff getting stolen. There are a lot of concerns that come up when you start cramming 50 or 100 strangers in into one big building. There's a loss of routine and this is especially true. Well, that's not true. I was going to say it's especially true in shelters, but that's not really true. I remember, I don't even remember which hurricane it was. It wasn't a terribly bad one, but when my kids were little, we lost power for about four days. And in terms of hurricane timelines, that's nothing. But when you've got an infant and a 2 year old at home, that's can be kind of stressful without air conditioning, without, you know, all the normal stuff. So your routine gets out of whack. The stuff that you normally do, you. I couldn't take them to the playground, I couldn't take them to other places because the roads were blocked. So the stuff that we normally did got messed up. Without lights, our circadian rhythms got a little bit wonky, if you will, because obviously as soon as the sun went down it was dark outside. And a lot of times we don't pay enough attention to the impact of our circadian rhythms on our moods. And that's really important. When people can't get out of their house, whether it's during the pandemic or after a hurricane or whatever, they have too much time on their hands. And especially if there's no electricity and they can't access the games they used to usually play or whatever, they tend to get into their own heads. And that's when they start thinking and trying to find reasons for this and blaming or feeling guilty or there's a lot of stuff and those critical inner voices may come out, whether it's criticizing the person or criticizing other things. It's important to help people stay busy in the environment. That can be picking up sticks and cleaning up. It can be in shelters. We used to bring in after Katrina, we brought in a lot of board games and card games and things. So people had stuff to do and trying to set it up so everybody felt respected, everybody felt like they had a place. Loss of water and electricity in and of itself is going to make things difficult because you can't very well bathe without water and sometimes you don't have water without electricity, depending on how you get your water. So a lot of things, you know, you think, oh, they're without power, they can't watch tv. Well, that's true, but they also can't maybe can't cook. They also maybe can't bathe. They also maybe can't flush the toilet. Because if they get their water from a well, for example, they may not have access to water for very long. Loss of connectivity is another environmental impact that we don't pay enough attention to. And I, I challenge you to think for a minute. Your mobile device. How would you feel if you were completely disconnected from the rest of the world? You couldn't access your mobile device for 24 hours, let alone a week or two weeks or three weeks. We're so used to constant stimulation. We're so used to being able to get information whenever we want it. Not being able to get it leaves people feeling hypervigilant, scared, and for good reason. You don't. You can't get information about when the calvary is coming or what's going to happen next. There are places in Florida right now we've been hearing about, you know, the Appalachian area right now, which is just devastated. But even places like Columbia County, Florida, last I knew, still didn't have power. And two of the facilities that I used to work at didn't have any. Any types of phone service because the towers were down. They didn't have any water, they didn't have any electricity. So obviously the patients weren't staying there anymore. But there was no ETA on when that would be back up and running again. Loss of jobs and income. If your business gets wiped out by the disaster, then you ain't got a job to go back to. If you are, you know, lots of grocery stores right now, they survived, but the trucks can't get there to bring food to stock the shelves. So those businesses, even though the building survived, those businesses are likely going to close down for a while, and people are not going to know where they're able to get food. They're not going to know when they're going to be able to get food. The people who worked there are going to get laid off. And that's. We're already in a financial hardship. And I know I'm spending a lot of time on environmental because invite basically environmental is one of those things. At the base of Maslow's hierarchy of needs, we need to feel we need to get our medical needs net met, have food, have shelter, and then right above that, have a sense of safety. And everything else is going to be negatively impacted. Really recognizing the. The reverberating impact of this disaster, not only on the people who were directly impacted by the flooding, but the truckers and the business owners and the family members of people who lost their homes because they may be, you know, moving back home with mom or something. And that could be in and of itself a stressor to people who were living 400 miles away from it. We can't assume that the only people traumatized were the people in the, in the path. Lack of supplies for individuals or businesses. We talked about that loss of landmarks. It's disorienting when you walk outside and you don't recognize anything. And I talked about Andrew earlier, but not everybody's gone through an Andrew and, or, or a Katrina. When I went back down to Gainesville a couple years ago, the city of Gainesville had built up so much in the last 10 years since I had been there. I couldn't find my way around. It didn't even look remotely like the same place that I had basically grown up in for 20 years. So that can be kind of shocking when you just can't seem to get your bearings and then inundation with reminders and looky lose. Like I said, there are people who right after the disaster may have gone online to hopefully find verification that the worst didn't happen. And then, yeah, they didn't get that. But then there are people who are intentionally going out to find disaster and in order to get clicks and that's not helpful. We don't need to be seeing that crap, quite honestly, because it is traumatizing and it is demoralizing for a lot of people who feel like they want to help but they can't or who did their very best. There was one woman who comment commented the other day on Twitter that people were talking about why the, the people in North Carolina and Tennessee weren't better prepared for, for this once in a lifetime event. And her comment was this was not a once in a lifetime event. This was a never since Noah event. We couldn't have even begun to fathom what would happen. And, and recognizing that being sympathetic and realistic, managing those expectations about what people could have possibly predicted is important. Recognizing now the environment that people are in. There's a lot of chaos. There's a lot of un. Unsureness, unsurity. I don't know what the word is, but my husband and I were looking this morning for places that we could donate to that would make sure that they got the donations of, you know, got the money to an organization that would buy dog food, cat food, human food, water. And in North Carolina there are a couple of places that we can find and I encourage you to check any non profits against Charity Navigator just to make sure they're legit. But in Tennessee there's very little and I was very disheartened. I mean, yeah, North Carolina got. Got it a lot worse than we did. Apparently. I'm just going based on what I'm seeing. But I'm also seeing a lot of frustration because there's a lot of Tennesseans who want to volunteer and want to help, and we don't know how. You can go to the East Tennessee State University ETSU site and find information about volunteering. They do. They are serving as one of the hubs. But I digress. Physically, people who are stressed, which we all are right now, are experiencing increased autonomic nervous system activation, increased HPA axis activation, stress response, whatever you want to call it. We are in fight or flight. Now, we may not be in total fight or flight, but there's this undercurrent of I need to do something. There's this undercurrent of, you know, something's got to be done. We need to mobilize something, something. It's leading to sleep changes in people who are feeling unsafe because of their environment. For people who are worried about the safety of their loved ones who are in an unsafe environment, stress causes changes in the gut microbiome, which alters our chemistry, alters our neurotransmitter balance. People are going to start experiencing GI disturbances. There are a lot of somatic symptoms of stress that come out, especially in the first one to three weeks after a disaster, when people are still focused on physical needs. A lot of times they somaticize their reactions and they have increased pain, they have difficulty sleeping, they have upset stomachs, they get sick easier. And we'll see this a lot in children. Children will have a lot of tummy aches and, you know, may have, you know, diarrhea or something. Sorry, not a pleasant thing to think about. Nutritional status is going to change as it does when we're under stress. It may change because of our choices. We may gravitate toward comfort foods during this time. But even if you are, well, let's stay with choices. Sometimes it's an intentional choice. Sometimes it's availability. The only thing that may be available are ding tongs and ho hos because the grocery stores are closed and you can. The roads are impassable. And it's important to understand how that impacts our gut microbiome and our body's ability to produce neurotransmitters and our body's reaction to that. Our body knows when we're not getting what. What we need, and that further triggers the stress response. Even if you're eating A great diet, if you're stressed, it's probably going through you without being absorbed as effectively. And I'm not going to get too graphic, but understanding that that is going to happen and, and just being compassionate with yourself. People under stress have difficulty regulating their blood sugar and their blood pressure. Stress increases both of those. There's increased pain and illness. Your immune system takes a dive when you're stressed and at about the same time your body loses its ability to effectively reduce inflammation. Cortisol starts losing its ability to act as an anti inflammatory. So we start seeing systemic inflammation which we know is associated with pain as, as well as depression and anxiety. We see increased hypervigilance and that's that feeling like you're on edge, feeling like you've got a scan, feeling like you can't relax and impulsivity. When we are in fight orf flight, we're not in, hey, let's think about it and make the best choice mode. We're in. I'm going, when I am triggered, I'm going to react. We tend to be more impulsive with our words, we with our choices, with our actions. Being cognizant of that is half the battle because then we can recognize our impulsivity and take steps to try to mitigate it, take steps to get support to bounce ideas off somebody else. Helping people regulate their circadian rhythms is going to be really important. This especially true for children, but it's true for everybody. Regulate your circadian rhythms. Try to get seven to nine hours of sleep every night. Good quality sleep. And again, if you're staying in a shelter, that may not be possible, but do the best you can. Because sleep deprivation and circadian rhythm disruption contributes to a cascade of mental health and physical health problems. We can make sure that people have access to the best of our ability to nutritional snacks and water. Water's so important and I didn't put heat on here. I should have. In my playlist on disaster mental health, we talk, I have a video that talks about how people who are on certain medications may have difficulty regulating their, their body temperature. People who are on antidepressants, for example, have difficulty regulating their body temperature. Whereas people on antipsychotics, for example, if they're, the blood level of the antipsychotic gets out of balance because the person is either dehydrated or over hydrated, then they're going to start having breakthrough symptoms and we need to be conscious of this because in a lot of the places that are still rebuilding, still without power, potentially without water We've got people on medication and it's hot, it's hot and it's humid. We see increased substance misuse during this time. Some people are trying to numb it out, some people are trying to relax, being cognizant of this and trying to find alternative strategies to deal with it. Am I real thinking realistically people aren't going to use substances heavily during this time? No, I, I'm realistic. But being aware of it and helping each other remain mindful of how we're coping with stress is important. People are going to have more injuries. You're out there cleaning up sticks or debris or whatever. You're probably moving in ways you haven't moved before or overdoing it. Being aware of that and pacing yourself. Went through this with my mother in law a few days ago and it's important. If you haven't been doing that kind of activity, all right, fine, go out and do it for an hour and take a break. And then if you still feel pretty good after lunch, go out and do it for another hour and take a break. If you feel good tomorrow, maybe you can do an hour and a half at each time. But you want to build up to it so you don't shock your body and end up in a lot of pain and potentially injuring yourself. I guess I did put dehydration and heat stress here. When we become dehydrated, it impacts our cognitive functioning. It registers in our body as a threat, so it triggers our HPA axis. Our body's going, I can't survive without water, I need water. Which increases anxiety and irritability. We know that people are tend to be more irritable and more impulsive when they're under heat stress. In terms of the emotional impact of disaster, anger and fear are normal responses to threat. That's fight or flee people. This is an abnormal event. They don't know what to do with this. Anger and irritability with others usually has less to do with the other person and more to do with your sense of powerlessness. A lot of times we get mad at people because they're not doing what they want we want them to do. And that's our way of trying to regain control of our environment. So it's less about them and it's more about our sense of powerlessness. Tolerating the distress that we're experiencing and diverting the energy to productively work toward what's important in each person's rich and meaningful life and embodies their values is essential if you fancy yourself A compassionate, giving, helpful person. If those things are important to you, then using your energy to exemplify those behaviors right now, which can mean being patient with others who are totally irritable. Fear, anger and anxiety, why do we have it? For safety of ourselves. You know, we're worried about our own safety and, and our kids and our, and our pets and our loved ones. We're worried about that right now, even if we're not in it. We had some family members that were in the Appalachian region, and it took a couple of days before we were able to make contact with them. So there was undercurrent of anxiety. We really wanted to know what was going on. We didn't, you know, and recognizing fear, anxiety and anger, that's your fight orf flight response. Your body, your brain is telling you you feel vulnerable for some reason, or somebody you love is you think is vulnerable and you want to protect them. That's all it's saying. It doesn't mean that person is, you know, in danger. It means you. You are concerned that that might be just like that smoke alarm. And people are anxious about the future. What's going to happen? How long will it take to rebuild? How am I going to pay my bills? You know, the list goes on. We could just hypothesize all those questions. And when we're working with people who are experiencing distress, we need to have them just, you know, put out there all those things, dump all those things that they're thinking. And I've had ex good experiences, like in shelters using a whiteboard. And people just shout out or say out the things that they're worried about, the things that they're concerned about. And we start putting them all out there, and then we start tackling them one by one, evaluating their probability based on the facts in context, identifying resources to help them get the answers they need, identifying strategies to address those problems. And there can be a lot of anger at others for not understanding or being callous. And I'll just leave that there. Well, no, I won't. When we communicate online, there is a phenomenon called disinhibition, where people will often say things online they would never say to your face because they know it's not right to say. They feel emboldened online. And if you haven't been through an experience like this, you may not understand, which is fine. However, it can feel very invalidating when people are just suddenly telling us what we should or shouldn't be doing. And, and when people are telling us what we should or shouldn't do. They're taking our power. They're taking our power. Instead of saying, if I were in your position, I would do this, this or this, that doesn't take my power. That tells me what you would do. When you're telling me what I should be doing, you're giving me orders, then that's taking my power. And I've already lost enough power already, thank you very much. Grief. Remember the grieving process. Denial, anger, depression, and eventually acceptance. We're going to go through these things and including acceptance back and forth. It's not a linear process. And once you reach acceptance doesn't mean that you're not going to go back and get angry or depressed again. Preparing people for that is important. During the disaster, people experienced a ton of losses and I can't possibly list all of them here, but some of them are a loss of safety. We talked about that. A loss of people or animals and, and whether they recognize whether they know that person is deceased or whether they're just incommunicado, it's still anxiety provoking, it's still a loss. But when they find out that you know that person or animal is gone, then there's a grieving process. Loss of houses, landmarks and towns. Yes, it's stuff. And stuff can be rebuilt, but stuff also has memories attached to it. And stuff is also how we orient and ground ourselves. Stuff like houses help us feel safe. And when we don't have that sense of safety, we feel unsafe and powerless. There's a loss of a faith in government. How could they not have planned for? Why did they not maintain XYZ roads or bridges or dams? Where's the help when we need it? Why are they not using XYZ Resource? These are all things that before I got off Twitter, I was seeing with regularity. People are feeling powerless. People are feeling abandoned again, going back to their prior experiences, whether it was a natural disaster or something else, it. If people experienced the trauma of abandonment before, this may be retraumatizing them, reawakening some of those feelings that are fueling their, their fury and their grief right now. And there's also going to be eventually a loss of a sense of support when relief agencies pull out. Inevitably, relief agencies leave before people are feeling completely grounded and ready for them to leave. And generally the exit process is sudden instead of saying, all right, y', all, we're going to be leaving in 30 days, we're going to be leaving in three weeks, we're going to be leaving in two weeks. It's just, hey, we're going to be leaving at the end of the week, so take advantage of whatever you need to now. And people can feel, again, very abandoned and let down. Blame is a common issue when trying to make sense of what happened. There's anger at others for failing to do something they should have. Like, plan for dam failures, clear out underbrush in the case of fires, have an emergency plan in the case of a family who, you know, may not have prepared for this kind of an emergency or doing something they shouldn't have, like if somebody goes out to assist in the recovery process and they get injured now they can't work, or worse yet, they're, you know, killed or driving into flood areas. I shouldn't have done that, but I did anyway, and their consequences. And blame, again, is anger. It's just a different word for anger. Blame is, I'm angry at you for doing this or not doing this. And it's how we're trying to figure out how to make sense of what happened. We talked, oh, gosh, decades ago when the stuff came out about not blaming victims. We need to refrain from blaming victims. Well, why do we blame victims? Behavior is communication. When we notice victim blaming, a lot of times it's that person's way of trying to make sense of why that happened and help themselves feel safe. This person did this, which is why this happened. I don't do that, therefore I am safe. Victim blaming is a way that people try to feel different than less similar to the actual victims in order to stay safe. Guilt is anger at yourself for not doing something you should have done. You should have evacuated when, you know they told you to, or you should have moved your car. My aunt lives in Safety harbor, and she said they must have lost two dozen houses to evs in people's garages exploding during the. During the flooding. So somebody may feel guilty about that. You know, we could have, you know, made it if the house wouldn't have caught fire. Anger at yourself for doing something you shouldn't have, like yelling at your loved one. You know, we're all sort of stressed right now, and we tend to be more impulsive, and we may yell at people, we may misdirect our anger, and then we may feel guilty about it. Or you may be reflecting and, and feeling guilty for buying a house in the path of that destruction in the first place. Using cognitive tools to evaluate the facts in context can be really helpful. When you bought the house, using the facts in context at that time, could you have even remotely fathomed what was going to happen? And generally the answer is no. Helping people process their anger. Anger, feeling of threat, feeling of powerlessness. Helping people learn from the situation can't change it. We can learn from it and figure out how to stay safe in the future and then eventually maybe get to the point of forgiving themselves. Forgiveness may take a while. Survivor guilt and trauma is when people have guilt for having. When others don't have. You feel guilty for feeling safe. You feel guilty for not have been. Not have been. For surviving, I can't speak today for surviving the tornadoes, for example, people I worked with a few years ago. When the tornadoes came down, I40 here in Tennessee, one side of the road was just decimated, and literally the other side of the road was fine. And the guilt, the survivor guilt that those people experienced was just immense anger at not being able to help. And a lot of us are going through that right now. We want to go help. And we know, you know, the hotels are already filled with rescue workers. We can't go there. But we're still angry that we can't figure out something to do to help. We want to regain some control. We want to try to feel like we've got some power in this situation. Similarly, anger at the. A lack of a coordinated effort, and this is true in every disaster from Andrew to Helene and everything in between that I've been a part of the effort doesn't seem to be very well coordinated. And survivors can feel angry about it, but they can also feel guilty. I should have said something. I should have done something to help my town plan better. I shoulda, coulda, woulda. And then we get depression and burnout. And this is actually kind of modified from my research with emergency responders. But people will go into helping after a disaster, the recovery process. We're optimistic. I'm going to go there. I'm going to be able to help. I'm going to make a difference. I'm going to feel better. I'm going to, you know, save the world. And they get there and they go in like a steamroller. It's like, all right, I'm not making the. Making the changes or helping in the way that I thought I was going to. So now I'm taking control, and they start being argumentative and overly independent, and they're just steamrolling. I'm going to do what needs to be done. I don't care what you say about it, which we know is not helpful. Please don't do that. Well, they do. They follow directions, and it doesn't help. Then they go in like a steamroller and it's still not fixing everything. And notice I say fixing everything. Then people start getting exhausted and irritable. They start feeling powerless, hopeless, helpless. They may continue to push through that and then they hit that wall of apathy and burnout. We need to be excruciatingly sensitive to first responders, to people who are working in churches, to people who are doing outreach of any sort that of these symptoms because it's likely that left unchecked they're going to burn themselves out because that's all they know how to do. They, they keep giving, they keep hoping that if they do one more thing then it'll fix things and, and then they get burned out and they're no good to anybody. Cognitive changes after a disaster, sleep, emotional distress, circadian rhythm disruption and nutrition related changes all lead to cause issues with brain fog. Difficulty with short term memory, difficulty concentrating, difficulty problem solving, low frustration tolerance, increase negative perceptions. You're gonna people start seeing the glass as half empty and seeing the people as a dollar short and a day late. Increased ruminations and intrusive thoughts. All of these are expected. When we have those physical and environmental changes, what can we do? Educate people about brain fog, that difficulty to think clearly. Encourage them to be compassionate with themselves and give themselves a little bit more time for short term memory. Have people write things down. You ain't going to remember squat right now, so write things down. Even if normally you've got a great memory because of the stress reaction, the chemicals in your brain, you're not going to remember things as well, so write them down. Concentrating. Break things down into smaller chunks. Instead of expecting somebody to focus for an hour, give them 10 minutes. And, and this is especially true with children and, and adolescents who are trying to go to school or trying to learn. It's going to be a struggle for a lot of them right now. Difficulty with problem solving. This is true for a lot of people. It could be the problem of I just blew a fuse in my house and I need to figure out how to reset the breaker and I can't remember where the breaker is or something. Things that normally wouldn't be a big problem suddenly start feeling like overwhelming barriers to recovery. Encourage people to reach out for support. Encourage people to take a step back and write things down. Breaker blew a fuse in the house. Okay, that's the problem. Now think back to last year, the last time you blew a fuse. What did you do? Once people start getting back into their wise mind and out of their emotional mind. They're often able to connect with that experience and go, oh yeah, I remember there's a breaker box for some unknown reason down in the one car garage. Okay. So that anchoring can be really helpful. Low frustration tolerance. Encourage people to minimize things that are going to cause their frustration right now because it's not the time to challenge your skills For a lot of people. Recognize when people start giving up too soon or feeling like they just can't do it, you know, forget it, I'm not even going to try. That in and of itself is a symptom, for example, of ADHD and other things. And it's going to be worsened under stress. But for people who generally have a good frustration tolerance, it's still going to be a problem. And we need to be sympathetic and empathetic and encouraging of people. If they say, you know, I just, I can't, I can't, I just, it's too hard. All right, let's take a break instead of trying to push through or okay, so let's take a break and, and until you can down regulate a little bit. And then we'll come back and we'll start breaking this task down into something that's more manageable. Encouraging people, helping people break tasks down. Increased negative perceptions is normal. When we're in fight or flight, our, our brain notices the threats and ignores the positive. Encouraging people to turn their attention to the positive, to balance it out. Yes, there's the gray skies and the crappy stuff over here, and there's also these things that I am grateful for or these things that are going at least okay today. We're just trying to balance it out so we don't feel so lopsided. To the powerlessness and increased ruminations and intrusive thoughts. People deal with those in a lot of different ways. Recognizing the impact of sleep deprivation in increasing these thoughts. Some people will write them down and put them in an envelope and say, not going to give it any more attention. Some people will just talk back to those ruminations and intrusive thoughts and say, I'm not thinking about that. Literally. They may plug their ears and go, la la la la la. Some people may start singing a song so they're not even thinking about it anymore. So they ignore the thought. And other people may argue back with it for a minute and say, you're wrong. This is what's going on right now. People handle ruminations and intrusive thoughts differently. So find a strategy that works for you. Environmental stressors, psychological changes, changes in our cognitive perceptions and our ability to think clearly. And emotional distress leads to impatience, irritability, blaming, mind reading, distrust of others, and potentially activation of insecure attachment or separation anxiety, especially in children. Recognizing these interpersonal changes is important because during this time, we need social support. We need secure attachment. Impatience is me getting angry that you're not doing something. Right now I feel out of control, and I want to try to control a situation. It's behavior, behaviors, Communication. If I'm irritable, that means I'm angry, that is, or feeling unsafe, and I want to try to change it. That's my behavior communicating my feelings. Blaming. We already talked about helping people reflect on, you know, what's prompting this behavior right now, and how can I help you get more grounded can be helpful, but also just understanding what it's coming from and sometimes just letting it roll off your back. If somebody's impatient or irritable with you, empathizing with them and just let it roll. Mind reading is when during a disaster, people start saying, well, I know you're judging me, or they expect others to know what they need. Well, you knew I was going to need water or, or whatever. And that's. This is one of those cognitive distortions or thinking errors that we need to pay close attention to or it's going to start causing divisions in relationships. And we need to provide an environment for the adults as well as the kids that is consistent, attentive, responsive, encouraging, and safe. So when people start acting up, when we start seeing some unwanted behaviors, we need to back up and ask ourselves, is this environment supporting safety? Is it consistent? Are we being attentive to our own needs as well as each other's needs? Are we being responsive, or are we just trying to ignore it and plug on? Are we being encouraging? And are we making sure that people feel safe expressing their concerns in a healthy way? Spiritually? People often experience a sense of disconnection after a tr. After a disaster. Nobody can understand what we just went through. And in large part, there's, yes, there. There's some element of truth to that. If you haven't been through what that person just went through, you may not be able to fully understand, but you can try to empathize and be willing to empathize. And then nobody can understand is often a reaction to. You don't even want to try to understand you. You can't conceptualize this. And that could be the person's way of saying, I can't conceptualize this. I can't even understand what I went Through a sense that nobody cares because the calvary didn't immediately show up or, or because the social media is being dismissive or negative or whatever. And then there's people who feel disconnected from their higher power. They're like, where was my higher power when all this was going on? There may be a sense of purposelessness because the person thinks, you know, everything that I've worked for for so long was destroyed. So what, what was the point? What was the point in all that? And an inability to make sense of what happened and find comfort in a power greater than self. You know, I'm not able to rely on anybody else. I can't find meaning for what happened. And I. I don't know how I'm ever going to feel safe again is kind of what we're talking about here. Basic tools physically help people establish a routine to set their circadian rhythms. Work diligently to try to improve sleep hygiene so they can get seven to nine hours a night. Teach physical relaxation strategies and vagus nerve strengthening in order to help people down regulate that. Vagus nerve is your main down regulator. I've got videos on that, on the YouTube channel if you want to look at that. For kids, blowing bubbles with bubble stuff or blowing bubbles with bubble gum can help trigger that vagus nerve and that relaxation response. Singing really loudly, karaoke, whatever you want to do, that can also trigger the vagus nerve. Not everybody's down with yoga and, or meditation or those sorts of things. So there are options out there. Healthy diet, minimizing excessive caffeine use. I know people are going to use it, but minimizing it. Caffeine is a diuretic and that's going to contribute to dehydration. Even though you're drinking flu fluid, it's actually causing more fluid loss. Take medications as prescribed. Since your brain is not on the same routine. Set an alarm on your mobile device. You know, hopefully you have enough power for that. Or if you've got an analog clock, set an alarm so you remember to take your medication interpersonally. Be mindful of your needs, your thoughts, wants and needs of self and others. What is my kid needing right now? What is my loved one needing right now? Have empathy and compassion for self and others. And remember, don't expect mind reading. Ask for what you need the more stressed people worry. Or angry box where they write down their, their fears and their anxieties or what they're angry about. And they put it in this box so they can come attend to it when they have time. But it's not something that they're constantly mulling over. Engage in behavioral activation. Do things that encourage happiness, patience, and gratitude. And we don't want to push this on a lot of people right now. Make sure they're getting their physical needs met first. But at some point, we want to start encouraging people to remember things that made them happy cognitively, as I mentioned, encourage people to write things net down and not rely on their ability to remember. Get second opinions before you do something. Because we, we do tend to be impulsive. Should I do this right now? Or what's, what's your thought about doing this? And. And try not to make huge decisions if you don't have to see the big picture. Noticing the good and the bad. Set small goals. Not by the end of the day, I need to have this done. No small goals. Smaller. Much, much smaller. What can I do right now in the next five minutes, in the next 30 minutes to move toward this goal? Small goals. Talk back, restructure or ignore intrusive thoughts. Environmentally, maintain a schedule. Recognize trauma triggers. Create safety and help people create safety. If you're one of those people who needs some quiet time to get grounded, then make sure there's a quiet space where you're staying. If you're in a shelter, make sure there's a quiet space for people who need that grounding time. In terms of organization, people like me who are J's, don't do well with chaos and disorganization. Trying to keep the environment as organized as possible can be really helpful for some people. But don't overdo it where you're over organizing, you know, have bins, have areas, not necessarily, you know, intricate filing systems. And encourage people, at least right now, to do what they can once they're physically safe, to do as much as they can, to stay busy and out of their own heads until we can kind of start getting a handle on things in one hour. We couldn't possibly cover all of the impacts and interventions for after a disaster. It's vital to recognize how the powerlessness, unsafeness, and feelings of abandonment of prior traumas can be triggered during a current disaster. Consistently being present for yourself and others, helping them feel safe, expressing their distress and learning to tolerate it is a big part of disaster recovery. Because we can't make this distress go away. We can't just, you know, count to 10 and all of a sudden it's going to be fine. It's going to suck for a while. And helping people learn how to tolerate that distress and work towards their rich and meaningful life is going to be really important. Are there any questions? I appreciate everybody being here with me today and I'm sending you thoughts of safety, health and power. I will see you next week. Lisa. It's always good to see you. Hope is important, and what gives people hope is going to be different. And I've done entire groups on that. How do you develop hope? Hope is the belief that things are going to get better or could get better. So how do you nurture that belief? Hope When I plant. I'm a gardener. When I plant a plant in the garden, I. I do what I need to do and I water it. I do my part and I hope that it sprouts. Does it always sprout? No. But I feel hope knowing that I've done my part and that by doing my part, I've given it every chance to actually succeed. How do you support people with too much time on their hands? I would encourage them to get involved in something and that may not be cleanup. That may be crossword puzzles. That may be playing with their dog. Our my husband's grandparents are in their 90s right now and they ain't going to be going out and doing cleanup. That's not safe or healthy. But they've got a lot of time on their hands and it's important to find activities that they enjoy that can help them stay busy so they're not ruminating about what happened or what's going on or what could happen next week. How does disaster trauma build on previous trauma, such as abandonment trauma? If people felt abandoned in the past, whatever that trauma was that caused them to feel abandoned in the past, in the current situation, when they are expecting or needing hope and resources. And those that hope and resources or help and resources don't come fast enough or sometimes at all, then they feel abandoned again and. And it reopens that wound. It reignites some of those beliefs they had about the untrustworthiness of other people. And it's important to recognize the difference between this situation now and my perceptions based on the facts in context and the prior situation. Sometimes there's a lot of similarities, sometimes there's not. But it's important to evaluate it because if people continue to have experiences that compound their sense of or their belief that people will abandon them, that's going to increase their trauma and their sense of unsafeness and powerlessness. For someone who's experienced multi multiple disaster traumas, it certainly could result in ptsd. There's no doubt about it. And it, it would meet the Definition, clearly. Now, ptsd, remember, isn't diagnosed right away. First you have the normal stress reaction. Then you have what we diagnose as acute stress disorder for the first few weeks. And then if it hasn't resolved after that, then we consider a diagnosis of ptsd. But, yes, people can experience traumatic injury from this situation because they don't regain a sense of trust in others. They don't regain a sense of safety or personal power to keep themselves safe. Bob, I will be editing this and uploading it as soon as we're done here, so it will be available on demand. Yes. Hello, Roller girl. Good to see you. For those of you who are still hanging in, this is not going to be obviously part of your CEU class because I couldn't have anticipated the questions that would come. But I am here to answer any questions about disaster, mental health, disaster recovery, trauma, anything that you want to ask. I will stick around as long as my voice holds out. Thanks, N.W. i think that's one of the mugs that I got back in the day when A and W root beer used to have actual stores, kind of like Dairy Queen does now. And you'd be able to go into the A and W and get root beer floats. That's how. That's how old that is. But y' all know I like my cups big. How can we help people from falling into the victim mindset? Empathize with them first. If they are feeling powerless, if they are feeling helpless and recognize the impact that you can have in their life, Let them know that you're there for them and you want to help support them, you want to help them survive, you want to help them move forward in this trauma and be encouraging instead of minimizing. A lot of times when somebody's feeling like a victim, we want to say, oh, you know, yeah, this stuff is going against you. But look at all the stuff you've got going for you. And that minimizes their feelings, that minimizes their grief, that minimizes their loss. So explore it with them. Explore what their losses were. Hear how they're feeling disempowered, hear how they're feeling victimized. Because until you figure out what things are causing them to feel powerless and victimized, you can't help them figure out a strategy to move forward and encourage them to come up with the strategy. What is it that you think would help you feel a little more empowered? What is it that you think would help you feel safer right now? What can I do to help you feel more empowered or to get through the day or however you want to put it. It's good to know that A and W still exists. Bridget. I remember going there with my, with my grandmother when I was like 8, 10 years old. So. What other questions? Oh, brain spotting for trauma, emdr, brain spotting. There are several psychophysiological interventions that we can use to help people cope with and integrate trauma when they get to that place. And that's probably going to be super in need and super helpful in the coming months. Right now, a lot of people are again, still trying to get, get their physical needs, their safety needs, their medical needs met. Do remember if you had somebody that was on medications, whether it's thyroid medications or mental health medications, they may need to be adjusted if the person continues to be stressed for a while and a while. I can't tell you how long that is, but the autonomic nervous system will adjust. So their thyroid meds, blood pressure meds, antidepressants, antipsychotics may need to be adjusted in response to the neurological changes that they're undergoing as a result of the disaster trauma. Encouraging people, again, not to rely solely on a medication to help them cope with this, and helping them recognize how they're using their skills and tools to survive and encouraging them. A lot of times in the shelters, one of the things that was effective was talking with parents and, and caregivers who were there with their kids about what was going on with the kids and how the kids were acting out, how the kids were irritable, how the kids were blah, blah, blah, and saying, okay, well, let me hypothesize about some of the reasons why this may be happening, and let's try to brainstorm some strategies. What might you be empowered to do to help Johnny cope with his irritability or his restlessness right now? And even though, you know, maybe parent was exhibiting the same behaviors as they started to help their child, they were also modeling the stress management behaviors and the distress tolerance behaviors that we wanted them to be teaching little Johnny. And so we kind of got a twofer out of it, which was helpful. A lot of times after a disaster, people have difficulty looking at their own behaviors or addressing their own behaviors or hearing any feedback about their own behaviors that's they feel like that's taking away their power. You're being critical or something. And that's the last thing we want to do. And a lot of people want to help their children or somebody else's children, or they want to help their neighbor who is struggling. And we can help them learn tools that they can teach their neighbor. But again, by teaching, they're also learning. Yes, fine. I have a video that talks about the HPT axis, the hypothalamus, pituitary, thyroid axis. But basically the short version of it is when we're under chronic stress, our stress response alters our nervous system. And it doesn't only affect our adrenals, it also affects our gonadal hormones and our thyroid hormones. So people who are under chronic stress or who have CPTSD very often also have hypothyroid. Any of you who are still listening, please remember to like the video that, that does definitely help. And share the video with pastors, with community outreach workers, with anybody who might benefit from it. If you're out there on the West Coast, I know you weren't impacted directly by this hurricane, but it could be reigniting trauma for people who were have lived through the fires and the earthquakes and other things that y' all have had in the past. I haven't stayed up with my news awareness right now, so I'm really hoping you don't have anything else going on at the moment. Mudslides. Oh, yeah, y' all have your. Your own set of calamities and catastrophes that are just heartbreaking to watch. And, and people who've lived through those may be, you know, really struggling because with their empathy, it's. It's just still so raw for them. Oh, that's so cool, Roller girl, that your grandparents owned an A W. I guess all those kind of migrated to the, to the west. I don't think we have any over here on the east side of the country anymore. Emotional Freedom Technique, that was the other one I was trying to think of. Emdr, brain spotting and Emotional Freedom Technique are all really helpful interventions that a trained therapist can help walk you through. I appreciate everybody for being here and I will see you tomorrow. I suppose we will do another live tomorrow at 12 o'. Clock. It's just a live Q A, not a. Not a CEU course, but I'm trying to do what I can until we get called up to be able to actually go over to North Carolina and East Tennessee to help out.