How do people typically respond to traumatic stress? What is the best way to support someone in a traumatic crisis? Johan Cullberg, a Swedish professor in psychiatry, may have some of the answers.
What is a traumatic crisis?
People may experience a traumatic crisis if they have experienced a trauma such as a sudden, unexpected and terrible experience. There are many examples of traumatic experiences, e.g. illness, death, torture, accidents, divorce and so on. All these life experiences may evoke feelings of loss and despair, and they can be so extreme that not even a person’s normal defenses are enough to deal with them.
Most people will have experienced at least one traumatic event by the age of 45. Only a small number of people who have experienced a traumatic event actually develops Posttraumatic Stress Disorder (PTSD). Instead, they get through their crisis more or less successfully.
A traumatic crisis makes it difficult to do everyday activities or tasks: small things that once were done automatically now seem overwhelming. Traumatized people typically undergo some of the same psychological processes, in which they try to find meaning and equilibrium.
Reactions to traumatic stress
The following symptoms are common reactions to traumatic events (Wainrob & Bloch, 1998):
- Disbelief and emotional numbing
- nightmares and other sleep disturbances
- anger, moodiness, and irritability
- forgetfulness
- flashbacks
- survivor guilt
- hypervigilance
- loss of hope
- social withdrawal
- increased use of alcohol, and drugs
- isolation from others
Stages of a traumatic crisis
Johan Cullberg has described a four-stage model of a traumatic crisis in one of his books from 1971. In this book, he also describes how we should respond to someone in a crisis, depending on the stage the person is in. The stages are not clear-cut. The stages serve as a framework for understanding a typical course of traumatic crisis, and this is why it is useful.
The stage model shows a scenario where a person gets through all four stages successfully, but we should note that some people get stuck (e.g., people with PTSD may never get to stage 3 and 4). Also, people experience each stage at different time points, but they do it chronologically from stage 1 to 4.
Stage 1: Chock
In stage 1, feelings are chaotic. You may feel empty, left and isolated, and reality feels unreal. The reaction is sometimes characterized by immobilization, restlessness or acting-out behaviors. The body is likely to react with tensions, headache, stomach ache, nausea, tremor, and rapid heart beat.
Stage 2: Reaction
In stage 2, you may feel grief, despair, anger and meaninglessness. You have realized that the trauma was a real experience. You may want to find out why it happened, and who the guilty person was. Feelings like “why me?” and “what have I done wrong?” are common. This stage is also characterized by acting-out behaviors or the exact opposite, i.e. introversion. The bodily symptoms are tensions, muscle pain and restlessness.
Stage 3: Coping
In stage 3, you begin to cope with feelings of loss and disappointment. You begin to get used to your “new” situation, and you accept what has happened. You begin to resume how you once lived and you try to look forward. You may still re-experience the traumatic event, and feelings of anxiety, fragility and an absent mind are common psychological symptoms.
Stage 4: Orientation Towards the Future
In stage 4, you have accepted what has happened, and you begin to orient yourself towards the future. Your everyday routine has been reestablished and it works for you. You may still feel moments of emotional pain, but these moments are just transient. You are able to talk about the traumatic event without becoming too upset. You have integrated the traumatic event into your life history, and you realize it is a part of your life experience. You have found equilibrium in your life.
The best way to support a person in a traumatic crisis
Sometimes we avoid persons in traumatic crises because we don’t know how to support or respond to them. This is, however, not the best way to do it. Here are some of the ways to support a person in a crisis and to promote his or her personal strength.
The traumatized person needs to get through all of the four stages of the crisis successfully so that it does not turn into a chronic crisis. We can try to help a person get through these stages. If a traumatized person does not get enough (emotional) support, then it is difficult for him or her to overcome the trauma.
- In stage 1, the best way to show one’s support is to be there for him or her physically. You may help with everyday tasks so that the traumatized person feels safe and comforted.
- In stage 2, you need to listen to the person’s grief. Remember to be open and non-judgemental. All emotions are true and need to be acknowledged and understood. You may still help with everyday tasks, i.e. tasks that appear overwhelming to the traumatized person.
- In stage 3, you need to listen actively to the words of the traumatized when he or she re-experiences the traumatic event. You may begin to ask curious questions and suggest strategies that can help the person to overcome difficulties.
- In stage 4, the traumatized person is now oriented towards the future so you may support him or her by giving advice, instructions or support. There are new choices and decisions to be made so tell him or her what you think about them – emphasize the pros and cons.
The support we give to people needs to fit where they are in their lives or crisis. In the first two stages of a crisis, it is important just to be there and listen. As the person progresses through the stages, he or she may benefit from suggestions.
It is therefore important to be aware of where the person is in his or her crisis. The sooner we realize that a person is in a traumatic crisis, the better we are to support him or her getting through it.