Responding to Critical Life Events
Originally produced by FEI Behavioral Health, this resource had been distributed by Family Service of the Piedmont. For assistance, dial 336-387-6161 in Greensboro, or 336-889-6161 in High Point.

THE CRITICAL INCIDENT RESPONSE
An incident occurs: it is sudden, random, senseless. It affects not only the victim, but co-workers as well. The incident can shatter your sense of safety and well-being and temporarily destroy your ability to function normally.

This reaction is called "critical incident response." Although individuals will react with different intensities and recover at varying rates, most people will go through some form of the critical incident response, which may be an alternation between two states:

• Numbness. Characterized by withdrawal from others, depression or emotional flatness (not feeling much of anything), the feeling of being "lost in a fog." These signs may be accompanied by problems with concentration on and off the job.
• Hyperarousal. Characterized by irritability, flashbacks to the incident, nervousness, extreme emotions, nightmares, and being easily startled.

It's not uncommon to go back and forth between the two states. You may feel numb for a while, then move into hyperarousal, and back again. Some people may ultimately stay in one of the two states. It's also quite common for the critical incident to rekindle feelings and memories of past events when you felt helpless, shocked, or suffered the loss of someone close to you.

BUILDING WALLS AROUND THE PAIN
When crisis strikes, the normal human tendency is to try to stop the pain. It's normal to build a "wall" around the incident in an attempt to keep it separate from the rest of your life.

The problem with building walls around the pain is that it usually doesn't work. A critical incident causes a reaction, and refusing to think about it or discuss it won't undo the incident.

Even if the pain can be denied for a while, it will push through later--often in the form of increased illness or turnover, decreased productivity or morale, and a breakdown in the normal communication between you and the people you care about.

GETTING OVER THE CRITICAL INCIDENT RESPONSE
The critical incident response is a temporary reaction to a serious event. The most important thing to remember is to avoid walling off the pain. Take advantage of debriefing and/or counseling offered by your EAP to talk about how the incident affected you. If you choose not to seek counseling, talk about the event with people close to you. Understanding the critical incident response, and then making a conscious effort to work through it, will ultimately help you overcome the pain.

CARING FOR YOURSELF PHYSICALLY
In a crisis, do you forget to eat? Do you have to be reminded to get some sleep? Do you revert to old habits, like smoking, or find that nagging physical ailments flare up? If so, you're not alone--all of these are common reactions.

At a time like this, eating a balanced meal or getting your three-times-a-week workout may be the last thing on your mind. But that's precisely why it's important to take care of yourself physically. Emotional upheaval can make you especially vulnerable to physical illness, so good health habits are especially crucial now.

This is not the time to make big changes in your lifestyle, such as quitting smoking or starting a diet. Instead, think in terms of maintenance. Reinforce the good habits you have, and try to minimize the bad ones. Pay special attention to the areas outlined below.

• Stress is completely normal at a time like this. Acknowledge that you're going to feel a lot of unpleasant emotions--sad, angry, out of control, impatient, etc. Learn a couple of relaxation techniques and use them frequently. Try to cut down on responsibilities in other areas of your life until you've had some time to recover from the crisis.
• Sleep is always important--but especially so now, when you're probably not getting enough of it. Nightmares are a common reaction after a crisis, and this can disrupt your sleep. Make sure you allow enough time each night for a full night's sleep. If you have serious difficulty sleeping, and the difficulty lasts for more than a week or so, consult a physician or a trauma counselor.
• Exercise can help clear the cobwebs. Gentle exercises like brisk walking are not only good for the body, but they can have a calming effect on your mind as well. If you are already a regular exerciser, resist the temptation to use exercise as a way to literally "run away" from your feelings. A relaxed exercise session can help combat stress, but an intense, all-out workout every day can sometimes be another way to avoid facing a painful reality. Also, over exercising can easily lead to injury, a problem you don't need right now.
• Smoking is always a health risk. Unfortunately, many ex-smokers become current smokers during a crisis. The act of smoking is often a way to repress feelings and put distance between yourself and a problem. A stressful time like this is probably not the best time to try to quit--but try to avoid using cigarettes as a crutch.
• Alcohol and other drugs may be tempting--but they cause far more problems than they solve. People under extreme stress may tend to "self-medicate" with alcohol, tranquilizers, coffee and other drugs, both legal and illegal. When you're in pain, it's hard to tell how much is too much, so perhaps the best idea is to try to avoid mood-altering substances as much as possible. Instead of a drink, try taking a walk. Instead of pills, try talking to a friend or your spouse.
  
  

COMMON RESPONSES TO TRAUMATIC EVENTS
Although traumas affect people differently, there are some common reactions that you may experience. These signs and symptoms may begin immediately, or you may feel fine for a couple of days or even weeks, then suddenly be hit with a reaction. The important thing to remember is that these reactions are quite normal; although you may feel some distress, you're probably experiencing a normal reaction to an abnormal situation.

Some common responses to critical incidents are listed below.

PHYSICAL REACTIONS

• Insomnia/nightmares
• Fatigue
• Hyperactivity or "nervous energy"
• Appetite changes
• Pain in the neck or back
• Headaches
• Heart palpitations or pains in the chest*
• Dizzy spells*

EMOTIONAL REACTIONS

• Excessive jumpiness or tendency to be startled
• Irritability
• Anger
• Feelings of anxiety or helplessness
• Guilt

EFFECT ON PRODUCTIVITY

• Inability to concentrate
• Increased incidence of errors
• Lapses in memory
• Increase in absenteeism
• Tendency to overwork

For each symptom, note the:

DURATION. Normally reactions will grow less intense and disappear within a few weeks.

INTENSITY. If the reaction interferes with your ability to carry on your life normally, you may wish to seek help.

*If you experience these symptoms, see a physician.

If you are concerned that your response is too intense, or is lasting too long, please seek a qualified trauma counselor.

Whether you choose to seek counseling or not, the following tips can help you keep your life in order while you experience the critical incident response:

• Maintain as normal a schedule as possible, but don't overdo it. Cut out unnecessary "busyness" and don't take on new projects.
• Acknowledge that you may be operating below your normal level for awhile.
• Structure your time even more carefully than usual. It's normal to forget things when you're under stress. Keep lists, and double-check any important work.
• Maintain control where you can. Make small decisions, even if you feel that it's unimportant or you don't care. It's important to maintain control in some areas of your life.
• Spend time with others, even though it may be difficult at first. It's easy to withdraw when you're hurt, but now you need the company of others.
• Give yourself time. You may feel better for awhile, then have a "relapse." This is normal. Allow plenty of time to adjust to the new realities.
  
  

HOW CO-WORKERS CAN BE SUPPORTIVE
What can you do when a co-worker is affected by a critical incident? You may feel awkward or embarrassed. You may have your own feelings about the incident that are difficult to resolve. Most of all, you may simply feel that you don't know what to say. The tips below may help you formulate a response that shows your co-worker that you care and want to be supportive

• Acknowledge the event. Pretending that nothing happened may seem like the easiest thing to do, but it won't help affected individuals recover. You may want to acknowledge the event with a kind gesture.
• Don't ask questions; just listen. Asking detailed questions about what happened usually comes across as ghoulish and intrusive. If your co-worker wants to talk about the event, just listen. He or she may repeat the details many times; this is often an important part of healing. But if he or she is not yet ready to talk about it, don't push.
• Offer long-term emotional support. It takes longer to recover from a critical incident than most people realize. For instance, a year might seem like enough time to "get over it;" yet the first anniversary is often very difficult for people.
• Offer practical support. Instead of the catch-all, "If there's anything I can do...", offer to do specific things such as give rides to and from work, run errands, pick up part of their workload (check with the boss first), or other favors.
• Watch for signs of abnormal reactions. Behavior that would usually be considered strange is quite normal at a time like this: irrational anger, crying spells, a period of seeming to be okay followed by a relapse, etc. But if your co-worker seems to be seriously disturbed, if the symptoms go on for weeks, and if he or she is not in counseling, then the manager may need to get involved.
  
  

HOW FAMILY MEMBERS CAN BE SUPPORTIVE
Your spouse or other loved one has been through a critical incident. What can you do to ease the pain? Below are several suggestions for offering support and comfort during a trying time.

• Listen, listen, listen. One of the most important needs after a critical incident is to talk about the event--often, to talk about it over and over. It may be difficult for you to hear about, or you may get tired of hearing the same story, but talking is a crucial part of your loved one's recovery. Be supportive and sympathetic, but try to avoid overreacting. Your loved one needs to tell their own story, not to be upset by your reaction. If your loved one tries to shield you from the event by refusing to talk about it, you obviously can't force them to talk. But you can encourage openness and listen to whatever else the person wants to say.
• Don't encourage your loved one to quit work. After a crisis, emotions run high. It's easy to rush into an unconsidered action, such as quitting a job. While it may be difficult for your loved one to face going back to work, returning to work may actually be the best way to recover from the crisis. Work can provide the company of others who have been through the same thing; but by quitting the job, the person may fail to face the event and work through the emotions. Also, by quitting, your loved one will not be able to take advantage of any counseling on the job.
• Include the whole family in the healing process. Both you and your spouse may feel that you should protect your children from an upsetting event. But they'll undoubtedly know something is wrong. If you try to hide the truth from them, the kids may think that they are somehow to blame. This can be a stressful time for them, too, and they may need some help to get through it.
• Watch for signs of strain in your relationship. Marital problems are common after a critical incident; don't assume you just need to be "more understanding." If you decide to seek counseling, call your employee assistance professional.
• Take care of yourself. You have your own responsibilities, and now you may also feel responsible for keeping your loved one and your children from feeling too much strain. While it's important to be supportive, you also need some support yourself. Ask friends or family members for help, and don't be afraid to seek counseling for yourself.
• Enjoy the little things. Even after a personal tragedy, there are things to be grateful for. Take time out for your family and for your spouse. Have a special meal together, or take a small outing. Appreciating the little things won't make the pain go away, but it will help in the healing process. While it may be difficult to enjoy yourselves at a time like this, it's important to strengthen your bond with the people you love.