When someone experiences a potentially traumatic event, it can be hard to know how to offer help and support or what types of coping tools to look for in the aftermath. It is common for people to experience psychological and physiological reactions (fear, sadness, guilt, heart pounding, difficulty sleeping) that range from mild to severe intensity and frequency. Most people will experience a full recovery from these symptoms1, but a small portion of trauma survivors may develop post-traumatic stress disorder (PTSD), depression, and other chronic mental health problems2.

Helping Trauma Survivors Cope

To best help survivors of traumatic events cope, interventions and support systems must focus on helping them adapt healthfully to life post-trauma—before any chronic mental health problems have developed. These types of prevention programs are equally important as treatments to target PTSD and other mental health disorders.

There are several interventions that help trauma survivors cope in the immediate aftermath of a traumatic event.3-5 But little research has focused on learning directly from survivors about their own experiences, including what was or would have been most helpful from their treatment providers and community members.

Survivor Stories

This is what a team of researchers based at the University of Melbourne (Australia) examined6. They interviewed 43 survivors of physical traumas (such as motor vehicle accidents, falls, and physical assaults) and asked two questions:

1. Can you tell me about anything that has been causing you stress or distress since the event that caused your injury?
2. What sort of support do you think has been or would be most useful for helping you with the difficulties you have told me about?

Then they synthesized all the answers and compiled the common themes that emerged. This type of research—hearing directly from survivors—is critically important because it can help mental health professionals better understand their patients' needs in the month or so after an event. It can also inform their efforts to improve existing treatments immediately following a traumatic event. Ideally, interventions of this sort can help alter the trajectory after a traumatic event and prevent the development of PTSD, depression, and other persistent mental health illnesses.

Common Themes of Distress

The survivors in the study discussed a variety of themes. One of the first that emerged was related to the challenges of reduced daily functioning (such as not being able to work or do tasks independently). Another theme was increased relationship and role conflict, such as feeling upset about the perceived burden on others or feeling unsupported or not understood within their social network.

The survivors also spoke about their frustration with the medical care system, especially as it related to poor communication about their trajectory of recovery. They reported that they did not have quality follow-up care or coordination of care after leaving acute treatment settings.

They talked about dealing with uncertainty and hopelessness related to their recovery process. Many were worried about their future and uncertain about the pace of recovery, frustrated it wasn't going as quickly as they had hoped. Finally, they discussed struggles with mental health symptoms, such as feeling generally unsafe and re-experiencing their trauma through nightmares, flashbacks, or intrusive memories.

Helpful and Useful Support

Themes also emerged regarding what the survivors found helpful and useful. The first centered on improving professional support to include more open, direct, and informative communication from their acute-care medical teams while in the hospital about the recovery process and trajectory. They talked about how very helpful it was to receive greater practical assistance, such as help with daily tasks and physical rehabilitation.

They also found it helpful to have increased social support (including practical and instrumental support with daily tasks), along with emotional support and validation for coping with the impact of the trauma and peer support, which involved being connected to other trauma survivors to discuss the recovery process.

The survivors discussed individual coping strategies, including trying to reframe the trauma's effects to include potential positives of increased resilience, gratitude, and a new perspective on living. They also found it useful to work on being positive and hopeful about their recovery process and to accept, rather than avoid, the impact that the trauma has had on them.

Highlights for Now and the Future

This study beautifully synthesizes the stories of trauma survivors and highlights early intervention following a potentially traumatic event. It also points to the value of working with medical teams to have more open, direct, and clear communication with survivors about their recovery, accepting the impact of trauma, and inspiring hope and motivation to take an active role in their recovery process.

It is important to note that this study included only 43 trauma survivors, all of whom experienced severe physical injury. However, the needs of survivors of other types of trauma may be different, particularly those who have survived sexual assault, domestic violence, or military trauma.

Hopefully, researchers will continue to examine these themes in larger samples, as well as how these themes might vary based on diverse cultural, ethnic, and racial identities. And it is important for future research to focus on examining how the themes can be best addressed or included in early interventions to promote well-being in the lives of survivors.

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Sources

1. Bonanno, G. A., Galea, S., Bucciarelli, A., & Vlahov, D. (2006). Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack. Psychological Science, 17, 181–186. http://dx.doi.org/10.1111/j.1467-9280.2006.01682.x

2. Bryant, R. A., O'Donnell, M. L., Creamer, M., McFarlane, A. C., Clark, C. R., & Silove, D. (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry, 167, 312–320. http://dx.doi.org/10 .1176/appi.ajp.2009.09050617

3. Forbes, D., Fletcher, S., Wolfgang, B., Varker, T., Creamer, M., Brymer, M. J., . . . & Bryant, R. A. (2010). Practitioner perceptions of Skills for Psychological Recovery: A training programme for health practitioners in the aftermath of the Victorian bushfires. Australian and New Zealand Journal of Psychiatry, 44, 1105–1111. http://dx.doi.org/10.3109/ 00048674.2010.513674

4. Forbes, D., O'Donnell, M. L., & Bryant, R. A. (2016). Psychosocial recovery following community disaster: An international collaboration Australian and New Zealand Journal of Psychiatry. Manuscript submitted for publication.

5. Dawson, K. S., Bryant, R. A., Harper, M., Kuowei Tay, A., Rahman, A., Schafer, A., & van Ommeren, M. (2015). Problem Management Plus (PM): A WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 14, 354–357. http://dx.doi.org/10.1002/ wps.20255

6. Brand, R. M., Chisholm, K., Terhaag, S., Lau, W., Forbes, D., Holmes, A., & O'Donnell, M. (2017). Understanding the Early Support Needs of Survivors of Traumatic Events: The Example of Severe Injury Survivors. Psychological Trauma: Theory, Research, Practice, and Policy, doi:10.1037/tra0000274

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