Brookside Center for Counseling and Hypnotherapy


The Effects of Traumatic Situations on Both Individuals and Emergency Responders

by Maurice Kouguell, Ph.D., BCETS. 

In an article, Antidote for the Psychological Effects of Terrorism: A Rapid,
Biological Technique for Clearing Trauma from Mind and Body
, Judith Swack, Ph.D. writes:

"Since September 11, 2001, have you noticed any of the following symptoms:

If you have any of these symptoms then you have been traumatized to some degree by the terrorist attack on our country. In addition to the direct attack on our country, many people have been traumatized by additional shocks caused by the ripple effect on our economy (such as the loss of jobs and investment money or continued terrorist activity such as the anthrax scare). In one way or another, this attack has affected most of us personally."

Webster's New Twentieth Century Dictionary defines trauma as "an injury or
wound violently produced" and as "an emotional experience or shock which has
a lasting psychic effect." The psychiatric definition as described in the
American Psychiatric Association Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition
includes "the person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (and) the
person's response involved intense fear, helplessness or horror." We observe
that although the trauma, the event itself has ended, the reaction has not.
The memory of the precipitating incident leaves the individual with an imprint, a feeling of being stuck, frozen. Environmental factors will then easily trigger the memory of the incident with its full impact. The incident, the memory, resurfaces and frequently takes such proportions that it becomes real to the victim. Those can become subject to flashbacks, nightmares and may continue to struggle with emotional unrest, fears, and anxiety, very similar in intensity to their initial
reaction to the precipitating event.

It is not possible to estimate how many people have been affected as a result
of the destruction of the Twin Towers in New York. The victims go
beyond the great number of persons whose family members, friends and co workers died on that day, the traumatized people who were in the area or people
who saw the event live or on television. The number does not stop there.
There is, and will continue to be, a ripple effect which will trigger many post traumatic stress reactions. Traumatic stress encompasses the emotional, cognitive behavioral and psychological experience of individuals who have witnessed or have been direct victims of overwhelming events.

Some react to stress by expressing their fears openly. However, it is
reported that the vast majority of traumatized people ''act in.'' They will
turn the terror, the rage, the shame and the guilt inwards. All those bottled
up feelings will, in time, begin to undermine their emotional and physical
health as well as their sense of well-being. Although those feelings are often
translated into physical manifestations, physicians report that they can find
nothing medically wrong with at least eighty percent of patients who seek
their help. A significant portion of these people are probably suffering from
undiagnosed symptoms related to trauma and stress. According to Brown and
Fromm,(1) "events that typically cause PTSD fall into two classes: natural
disasters (tornadoes, earthquakes, volcanic eruptions, storms, floods, fires
and animal attacks); and human aggression (assault, rape, burglary, kidnapping, high jacking, political incarceration, torture and holocaust). These situations are so removed from ordinary everyday experience that even the healthiest of people are ill equipped to cope with them." No two people react to trauma in similar ways. The same event which can be harmful to one individual can be exhilarating to another.

During my tour of duty with the U.S. Army, my entire company was shipped to Korea except for three of us. I was assigned to the Mental Health Unit and the Neuro-Psychiatric Service . I saw several of my "buddies," after their experience in Korea, return to our camp. Some were severely traumatized, experiencing shell shock, some continued to experience flashbacks and some felt great about their
experience during "that police action." Although symptoms of trauma may appear shortly after the precipitating event, others develop over time. The end of a war or a terrorist attack or liberation from a concentration camp does not mean the end of the internal or psychological liberation. So even if one has physical security, one loses emotional security . One may have lost a sense of security, a sense of trust. Sometimes repeated nightmares are reported; at times one may experience startled reactions such as flashbacks. In an interview dated 8/27/97, Dr Yael Danieli (3), states that "everyone is affected for the rest of their
lives. 15 to 35 percent of people are affected seriously …at one point or
another they could be chronically affected for the rest of their lives. They
may be seemingly non affected for a long time but then some reminder will
happen or a change, such as change in life style or aging, can become very
traumatic for survivors of past trauma, as a result of the trauma." It is
important to realize that trauma is not a sickness or a disease. It is a
dis-ease. Some lose the ability to sleep through the night. Should signs
of trauma go on unattended, they could cause pathology.

The following is a list of symptoms as described by Peter A. Levine, author
of Waking the Tiger:  Healing Trauma. It should be noted that not all of the
following symptoms can be caused only by trauma. The evaluation has to take
into account that the dis-ease is not going away or getting better.

Hyperarousal: Manifested by physical signs such as difficulty in breathing, increased heart rate, cold sweats, tingling, muscular tension, racing thoughts, worry.

Constrictions: The nervous system reacts by constricting both the body and
one's perceptions. This affects the breathing, the body posture and the
muscle tone.

Dissociation: During a life threatening event one experiences a separation of
awareness from physical realities which protects one (act of escalating
arousal). If the precipitating event continues, it protects the individual
from the pain of death and allows him to endure the experience beyond

Denial:  a form of dissociation. Thus one may react as though the event was

Feelings of helplessness, or immobility or freezing. This can be described as
being completely immobilized, paralyzed.

Other symptoms that surface shortly after trauma, although they can surface
later, include:

Hypervigilance: being on guard all the time.
Intrusive imagery such as flashbacks.
Extreme sensitivity to light and sound.
Hyperactivity, restlessness.
Exaggerated emotional and startled reaction to noise, quick movements, etc.
Nightmares and night terrors.
Abrupt mood swings such as rage reaction, temper tantrums, shame.
Reduced ability to deal with stress (easily stressed out).
Difficulty sleeping
Fear of going crazy

Other symptoms include: panic attacks, phobias, anxiety
Mental blankness or spaciness
Avoiding circumstances which remind one of the previous experience
Attraction to dangerous situations
Frequent anger or crying
Mood swings
Exaggerated or diminished sexual activity
Amnesia and forgetfulness
Inability to love, nurture or bond with other individuals
Fear of dying or having a shortened life

The following are symptoms which take longer to develop:
Excessive shyness; Diminished emotional response to make commitments.
Chronic fatigue or low physical energy
Immune system and certain endocrine problems such as thyroid dysfunction
or psychosomatic illnesses - particularly headaches, neck and back problems,
asthma, digestive distress, spastic colon, severe premenstrual syndrome and
eating disorders
Depression, feeling of impending doom
Feeling like the "living dead": detached, alienated and isolated
Reduced ability to formulate plans and carry them through.

The symptoms of the trauma can be present at all times or come and go.
Usually they often grow increasingly complex over time, becoming less and
less connected with the original trauma experience.

How Do People Respond During Traumatic Exposure?

The following emotional, cognitive, behavioral and physiological reactions
are often experienced by people during a traumatic event. It is important to
recognize that these reactions do not necessarily represent an unhealthy or
maladaptive response. Rather, they may be viewed as normal responses to an
abnormal event. When these reactions are experienced in the future (i.e.
weeks, months or even years after the event), they can be joined by other
symptoms (e.g., recurrent distressing dreams, "flashbacks," avoidance
behaviors, etc.), and interfere with social, occupational or other important
areas of functioning, a psychiatric disorder may be in evidence. These
individuals should pursue help with a mental health professional.

Emotional Responses during a traumatic event may include shock, in which the
individual may present a highly anxious, active response or perhaps a
seemingly stunned, emotionally-numb response. He may describe feeling as though he is "in a fog." He may exhibit denial, in which there is an inability to acknowledge the impact of the situation or perhaps, that the situation has occurred. He may evidence dissociation, in which he may seem dazed and apathetic, and he may express feelings of unreality. Other frequently observed acute emotional responses may include panic, fear, intense feelings of aloneness, hopelessness, helplessness, emptiness, uncertainty, horror, terror, anger, hostility, irritability, depression, grief and feelings of guilt.

Cognitive Responses to traumatic exposure are often reflected in impaired
concentration, confusion, disorientation, difficulty in making a decision, a
short attention span, suggestibility, vulnerability, forgetfulness, self-blame, blaming others, lowered self-efficacy, thoughts of losing control, hypervigilance, and perseverative thoughts of the traumatic event. For example, upon extrication of a survivor from an automobile accident, he may cognitively still "be in" the automobile "playing the tape" of the accident over and over in his mind.
Behavioral Responses in the face of a traumatic event may include withdrawal,
"spacing-out," non-communication, changes in speech patterns, regressive
behaviors, erratic movements, impulsivity, a reluctance to abandon property,
seemingly aimless walking, pacing, an inability to sit still, an exaggerated
startle response and antisocial behaviors.

Physiological Responses may include rapid heart beat, elevated blood
pressure, difficulty breathing*, shock symptoms*, chest pains*, cardiac palpitations*, muscle tension and pains, fatigue, fainting, flushed face, pale appearance, chills, cold clammy skin, increased sweating, thirst, dizziness, vertigo, hyperventilation, headaches, grinding of teeth, twitches and gastrointestinal upset.

* Require immediate medical evaluation


Reprinted from Acute Traumatic Stress Management
by Mark D. Lerner, Ph.D. and Raymond D. Shelton, Ph.D. 2001 by The American Academy of Experts in Traumatic Stress, Inc.

How Can Emergency Responders Manage their Own Response to a Traumatic Event?

Addressing the emergent psychological needs of others during a traumatic event can be a draining experience. Working with individuals who are in acute emotional distress requires an intensity that, for the provider, is both mental and physical. It is imperative that you consider your own state of mind prior to engaging in the provision of ATSM. If you are currently experiencing a time of emotional distress in your life, it would be wise to have another responder assist the victim. In this way, you lessen your chance of becoming victimized yourself by the event. As an emergency responder, you will likely be exposed to the very events that you are called upon to help others. For example, after arriving at an
automobile accident, a police officer had the responsibility of preserving
the scene. While holding back bystanders, he provided psychological support.
Yet he too had seen a gruesome dismembered body on the roadway. As an
emergency responder, you will be exposed to seemingly overwhelming physical
events as well as the psychological impact that these events have on others.
There will be times when you will identify personally or "link with" an
individual with whom you are working-or perhaps with some aspect of the
situation. For example, a young detective was called upon to deliver a death
notification to the parents of a 10 year-old girl. After sharing the news,
she and her partner offered support for the grieving parents. Her feelings of
discomfort shifted very quickly to feelings of being overwhelmed when she saw
a photograph of the deceased child-the girl looked very much like her own

Despite drawing upon a specific strategy that will help you to remain
"professionally detached" (e.g., empathic communication-as described in the
upcoming section, "Provide Support"), powerful thoughts and feelings have a
way of piercing professional detachment. This is a normal response to an
abnormal situation.

If you find yourself feeling emotionally overwhelmed during the provision of
ATSM, try the following:

o Maintain an awareness of your state of mind, as well as your physical
reactions. Consider the effect the person is having on you. Acknowledge to
yourself that your involvement with the individual is creating various
physical and psychological reactions.
o If you find that the discussion is causing you to react physically (i.e.,
rapid heart rate, breathing increase, sweating, etc.) take a slow deep breath
and tell yourself to relax-take a second deep breath and relax. If possible,
separate from the event, grab a cup of decaffeinated coffee, and share your
feelings with a peer.

"High-risk" indicators for Posttraumatic Stress Disorder (PTSD)

o prior exposure to severe adverse life events (e.g., combat)
o prior victimization (e.g., childhood sexual and physical abuse)
o significant losses
o close proximity to the event
o extended exposure to danger
o pre-trauma anxiety and depression
o chronic medical condition
o substance involvement
o history of trouble with authority (e.g., stealing, vandalism, etc.)
o mental illness
o lack of familial/social support
o having no opportunity to vent (i.e., unable to tell one's story)
o strong emotional reactions upon exposure to the event
o physically injured by event, etc.


1-Hypnotherapy and Hypnoanalysis by Brown and Fromm; Laurence Erlbaum
Associates, publishers (pages 262-264)
2- Waking  The Tiger: Healing Trauma by Peter A. Levine and Ann Frederick;
North Atlantic Books publishers (pages 147-148)
3-Healing War's Trauma from an interview with Dr. Danieli, director, group
project for Holocaust survivors and their children aired 8/27/96.

Dr. Kouguell is a diplomate of The American Academy of Experts in Traumatic
Stress. He offers free consultations to individuals and groups related to the
September incident. His website features  extensive resources and self help techniques for individuals affected by PTSD.


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