There are two paths after a mass shooting - PTSD or PTG

The Pulse Nightclub Mass Shooting in Orlando was a year ago, yet for some it feels much longer. Why? The human brain reacts to life-threatening trauma differently than it does with daily stressors. Here is a breakdown of the signs/symptoms of the two paths that develop after a community shooting.

First is to notice the dangerous path of Post-Traumatic Stress Disorder, (PTSD), which develops differently in people based on their exposure to the trauma, age, availability of social supports, use of healthy coping skills and previous experiences with trauma. PTSD is a very real and often life-threatening condition that does not improve without intervention.

It can cause a state of intense anxiety, hyper-arousal, or panic which can lead to self-destructive behavior like substance abuse to try and cope with the intensity of overwhelming symptoms.

Not everyone experiencing a traumatic episode will experience PTSD, or experience it the same way. Some people have very intrusive thoughts or flashbacks; while others simply try to avoid all memories associated with the shooting like it never happened as a way to prevent the intense emotions from surfacing, (regretfully this can set them up to experience debilitating emotions in the future). While others go through a cycle of increased arousal, which can intensify and worsen over time.

The symptoms can be quite different for trauma survivors, and all of these emotional or behavioral indicators are normal reactions to having survived a life-threatening event.

“Traumatic reactions are not a sign of being weak, it is a sign of being human.”

The National Center for PTSD (https://www.ptsd.va.gov/ ) lists the most common traumatic reactions as:

• Intrusive memories of the traumatic event
• Bad dreams about the traumatic event
• Flashbacks or a sense of reliving the event
• Feelings of intense distress when reminded of the trauma
• Physiological stress response to reminders of the event (pounding heart, rapid breathing, nausea, muscle tension, sweating)

Sensory stimuli like sight or smell, which can trigger intense traumatic reactions. For a #Pulse survivor it could be the sound of fireworks or the sight of blood, or a song they remember playing in the club when the shooting began.

Some survivors of trauma don’t allow themselves to feel the intense emotions, so they stuff it inside, or try to avoid thinking about it. These individuals report experiencing -

• Avoiding thoughts, feelings, or conversations associated with the trauma
• Avoiding activities, places, or people that remind you of the trauma
• Inability to remember important aspects of the trauma
• Loss of interest in activities and life in general
• Feelings of intense guilt for those who survived
• Feeling detached or estranged from other people
• Feeling emotionally numb, especially toward loved ones
• Sense of a limited future (you don’t expect to live a normal life span, or get married, or have a good job)

PTSD can cause some trauma survivors to continually feel like they are in danger. This flows from the alarm center of the brain called the Amygdala, which is designed to protect us from harm, yet the elevated levels of the stress-hormone cortisol can make it impossible to relax or shut your brain off. This state of hyper-arousal can ripple into work or home life, leading to medical or psychological symptoms like:

• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hyper-vigilance, or being constantly “on guard”
• An exaggerated startle response, or jumpiness when feeling like the situation is unsafe

Untreated PTSD which is internalized can lead to developing depression, or panic attacks that can be quite intense causing a person to be unable to function. Others feel overwhelmed and begin impulsive behavior to escape thinking about the trauma like high-risk relationships, or destructive behavior like substance abuse, while some will slide into aggressive behavior like domestic violence, homicide, filicide or suicide.

PTSD doesn’t get better without some type of intervention and can affect all age groups, including seniors. Here is a quick overview of how PTSD may be affecting your kids -

• Fear of being separated from parent
• Regressing behavior (such as toilet training)
• Sleep problems or nightmares
• Compulsive play in which themes or aspects of the trauma are repeated
• New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters or bad guys).
• Acting out the trauma through play, stories, or drawings.
• Chronic aches and pains with no apparent cause
• Irritability and aggression or moodiness

If you or someone you love have these symptoms of PTSD it is essential to find help because the symptoms won’t get better by themselves, but it can become worse, even to the point of life-threatening behavior. Talk to a medical doctor, counselor, member of the clergy or a trusted family member to being the healing process of recovery, which is available with professional help. Reach out with care and compassion to help those in need, it literally could save their life.

“If you talk through it you can get through it.”

The other path after a community shooting like the Pulse Nightclub Attack is called Post-Traumatic Growth, (PTG) and is quite powerful in rebuilding a sense of unity and community.

This term was first used to describe trauma survivors in clinical research done at the University of North Carolina in 1995 by psychologists Richard Tedeschi and Lawrence Calhoun. They discovered 90% of trauma survivors experienced at least one aspect of posttraumatic growth and resilience, such as deep gratitude or a renewed appreciation for life.

PTG caused these survivors to develop a higher level of functioning than they had prior to the crisis event because of a broader world-view with deeper awareness of themselves and others. They were measured as stronger a year post-trauma then they would have been without having survived the critical incident. This explains community phrases like Boston Strong which appeared everywhere after the Boston Marathon Bombing in 2013 and led to an entire community coming together in a remarkable display of unity and strength that continues to this day.

PTG is more than mental toughness or self-discipline, because it only occurs after growing through the trauma by learning new coping skills, asking for help, relying on others, developing deeper relationships and support systems; all while being mindful that life is a gift to be cherished every day and never wasted on trivial worries from the hassles of daily life.

It is important to realize a survivor can’t avoid, or escape the reality of having endured a traumatic episode, but must grow through it. It is the struggle through the intense emotions, with the help of others and use of mindful coping skills that develops the inner strength of PTG.

Just like how PTSD symptoms can worsen and intensify over time leading to self-destructive behavior; PTG traits will strengthen over time leading to significant growth. There are multiple stories of trauma survivors who are barely recognizable after a major trauma because of their intensity for living life with courage and greater conviction.

“This shooting will not define or destroy us. We are #OrlandoStrong”

The more a person grows through a trauma the more of these indicators and powerful signs of growth you will notice. This psychological resiliency can be developed by adults and children, first-responders and senior-citizens, teachers and students, neighbors and strangers and includes one or all of the following traits of growth.

Here are the key indicators of Post-Traumatic Growth-

1.    A deeper appreciation for life

2.    A changed sense of priorities

3.    Greater sense of purpose and meaning in life

4.    Mental strength and inner-toughness

5.    More connected and closer relationships

6.    Capacity to manage greater levels of pressure

7.    Less complaining over trivial life issues like traffic

8.    Awareness of new possibilities and opportunities post-trauma

9.    Relating to others with deeper empathy

10. Greater optimism and a personal sense of hope

11. Greater social supports and interaction

12. Greater acceptance of reality

13. Improved problem-solving ability

14. Increased ability to manage typical life stressors

15. Elimination or drastic reduction of impatience or frustration

16. Stronger value and gratitude for first-responders and rescue workers

17. Giving up control of things a person can’t control

18. Growing in wisdom and courage for living in the future

19. Broader world-view with the sense that good will triumph evil

20. Development of spiritual insight and inner peace

21. Compassion for the friends/family of victims

22. Determination to endure and survive to reach a place of thriving

23. Acceptance and support of diverse groups of fellow survivors

24. Desire to share insights learned post-trauma with others

25. Greater sense of community and loyalty to community

Clinical research reveals 50-60% of Americans will experience a major trauma in their lifetime like a mass shooting or large scale disaster like Hurricane Katrina, yet only 5-10% will develop the symptoms of PTSD. This is good news for Orlando, and good news for anyone who has endured a major crisis. Trauma doesn’t have to define or destroy you because with supportive coping skills, trusted friends and a sense of purpose you can endure and eventually develop the strength only known by those who understand the power of being Orlando Strong.  

Below is a list of positive coping skills to grow through extreme life pressure. You are invited to share these insights with those you care about who were affected by the Pulse shooting to help them grow through the trauma to develop PTG.

60 Positive Coping Skills to build Resiliency and PTG- Post-Traumatic Growth after a Crisis

Physical:

·        Sleep, (7-9 hours)

·        Sleep rituals- Same time to wake up and go to bed

·        Predictable daily schedule

·        Healthy Diet with Regular mealtimes

·        Hydration throughout day

·        Nutritional supplements

·        Low impact exercise

·        Yoga/Pilates/Stretching

·        Deep breathing

·        Relaxation routines/massage or energizing naps

·        Regular physical checkups, including blood work

·        Medication, (as prescribed by your physician) 

Emotional:

·        Esteem building exercises, especially with photos or images

·        Laughter/Fun/Playtime

·        Face anger, anxiety and apathy directly

·        Journal out negative emotions

·        Let go of painful past memories

·        Say “NO” to bad habits

·        Talk through issues to get through issues

·        Identify and process hurtful emotions

·        Write letters to vent out disappointment, (then tear them up)

Relational:

·        Face relationship issues

·        Voice your needs to others

·        Confront conflict directly

·        Connect with friends/family

·        Share your burdens with others

·        Join a support group

·        Utilize counseling supports

·        Join a hobby group which involves others

·        Say “NO” to manipulative behavior

·        Hugs/affection, (from pets or people)

·        Learn the love language of those close to you and let them know your needs as well 

Behavioral:

·        Daily planning time

·        Utilize organizational planners

·        Short term goals

·        Daily hobbies for enjoyment

·        Creative activities for relaxation

·        Develop victory list of accomplishments

·        Create a bucket list of lifetime goals

·        Reading for personal development

·        “Pay it forward” to do good for others

·        Learn something new everyday

·        Take on new challenges

·        Leave work stress at work

·        Take a training course to gain new knowledge and skills  

Spiritual:

·        Reading for inspiration

·        Meditation

·        Listen to inspirational music

·        Volunteer to help others

·        Forgive those who have wronged you and forgive yourself

·        Attend spiritual development classes to deepen your soul

·        Attend inspirational services

·        Make prayer a regular part of your day

·        Memorize scriptures to inspire and develop your mind

·        Remember, “Things come to pass – not stay”

·        Re-create spiritual peace in quiet places

·        Build spiritual strength through meaningful experiences

·        Attend prayer vigils to experience greater community connection

·        Observe a day of rest

·        Get in touch with nature

·        Visit a bike trail, park, lake, beach or hike a mountain trail

 

About the Author - Dwight Bain is a leading critical incident trauma therapist who leads people through crisis. He is a certified Critical Incident Stress Instructor with the International Critical Incident Stress Foundation in Baltimore working from his office in Orlando, FL. Follow his updates to manage daily stress across all social media platforms @DwightBain