Coming alongside each other during the unthinkable – trauma experts provide insight into the complex and unique reactions of inexplicable events

Sydney’s weekend event has the nation reeling. For those that have lost loved-ones, and experienced the event in-person, the grief, horror and shock is inexplicable. Many in Australia, even those who weren’t present, have spoken of a sense of utter shock, disbelief and anger; A deep sense of bewilderment and helplessness has been widely shared across the country. Trauma experts have been working to provide not only help to those that have directly experienced events such as these but to educate those in their village as well. Equipping support networks to understand trauma to a further degree is an opportunity to underpin support in the routine. Experts advocate that through education there is an avenue to help, through understanding more of the profoundly complex human experience, and ability to navigate feelings of helplessness. The ‘village’ of support is found to be a critical component in navigating the inexplicable.

Validating experience

The coalition of experts behind the studies and training material, that is used to prepare future clinical leaders in the US, is pulled from thousands of patients in hospital and behavioural health services settings.

One of the most impacting statements that is included in the official training material is that the study and conclusion of the significant sample group “emphasis[es] that traumatic stress reactions are normal reactions to abnormal circumstances”.

First and foremost, for people that have either experienced first hand or part of a wider group who has heard of a traumatic event, feelings of traumatic stress should be seen as normal. For the thousands of Australians who have woken up on Monday maintaining a feeling of “off-ness” as some have put it, of sustained horror and shock, the science affirms this is the normal human reaction to an abnormal event.

For those in the capacity to support those reacting to the news, the experts highlight that affirming the reaction as normal and valid has a key part to play in navigating trauma. Messaging of dismissal and downplaying the relevancy of feeling significant upheaval can be harmful.

Trauma is not one thing

Another element to understand is that, “trauma, including one-time, multiple, or long-lasting repetitive events, affects everyone differently”. The researchers, clinicians, academics and medical staff that contributed to the studies and book on trauma that underpin US expert training are unanimous in this. Trauma does not look one way, it can have expression in many different ways.

For provider leadership, clinical heads and front-line staff, it is critical to understand that the expression of trauma has the potential to be different in each resident, family member, and staff member. Approaching people with an open attitude to see any changes in behaviour after experiencing or even hearing of a traumatic event is important to remain unbiased in spotting any signs of trauma.

“Some individuals may clearly display criteria associated with posttraumatic stress disorder (PTSD), but many more individuals will exhibit resilient responses or brief subclinical symptoms or consequences that fall outside of diagnostic criteria.”

Critically, experts affirm, “the impact of trauma can be subtle, insidious, or outright destructive.” Underpinning the allocation of resources and policies to be able to pivot to meet the needs of residents and staff, particularly after Sunday’s event, to be able to see and observe its impact is powerfully important.

Multiple factors involved

Part of the work of the coalition of experts to build up their trauma training material is to systematise the opening of awareness for clinicians, and to an extent, all members of leadership and front-line staff in being, as they call it, having comprehensive, “trauma awareness”.

They advise clinicians, and all in a position of support, whether that being a loved-one, trusted friend or anyone in a position of safe relationship to understand that how a resident, staff member or simply friend may react to an “abnormal event” will be due to a complicated mix of factors.

They highlight that, “how an event affects an individual depends on many factors, including characteristics of the individual, the type and characteristics of the event(s), developmental processes, the meaning of the trauma, and sociocultural factors.”

For those who are seeking to make sense of the degree of impact after Sunday’s events, the findings display that it is helpful to make space for the profound complexity leading to the feelings that are present.

Wider community is critical

The expert coalition are clear in pinpointing that the strength of the support network, from people someone knows closely, is vital but an ability to help doesn’t stop there. The outpouring of support and decided action, whether that be donating blood or supporting political reform have been found to have a powerful impact to support.

The authors note that, “survivors’ immediate reactions in the aftermath of trauma are quite complicated and are affected by their own experiences, the accessibility of natural supports and healers, their coping and life skills and those of immediate family, and the responses of the larger community in which they live.”

While complicated, studies have shown that having trusted people around you, that are closely known, as well as being aware that a wider community ‘has your back’, can have a powerful part to play in the navigation through the inexplicable.

The findings showcase that being people alongside someone as they process is highly valuable to understand nuance and not jump to the highest degree of response, which can overwhelm. Within the appropriate policy response to call in licensed and expert medical-psychological staff, whether within a RAC setting, or within a personal setting, the authors note, “although reactions range in severity, even the most acute responses are natural responses to manage trauma— they are not a sign of psychopathology.”

Essentially, the authors highlight that the findings show that while reactions can be substantial, they do not necessitate that a person is removed from reality. Trauma can have monumental impacts, and there remains the possibility that treatment can help the coping and navigation of those feelings into a manageable space. 

This is an important and substantiated piece of hope that science conveys. This is also arguably a deeply human need, to maintain hope, for those impacted, and those that seek to walk alongside them.

Helpful parameters

The authors highlight that, “initial reactions to trauma can include exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion, physical arousal, and blunted affect. Most responses are normal in that they affect most survivors and are socially acceptable, psychologically effective, and self-limited.”

For clinical, front-line staff, understanding behaviour that falls outside of this may be a helpful guide in escalating care, “indicators of more severe responses include continuous distress without periods of relative calm or rest, severe dissociation symptoms, and intense intrusive recollections that continue despite a return to safety.”

What does coping look like

The experts confirm that coping styles may also differ, “coping styles vary from action oriented to reflective and from emotionally expressive to reticent.”

Continuing, “clinically, a response style is less important than the degree to which coping efforts successfully allow one to continue necessary activities, regulate emotions, sustain self-esteem, and maintain and enjoy interpersonal contacts.”

Importantly for those in the village of someone navigating trauma, understanding how to gauge the need for help can be approached through the lens of how much normal everyday activities are impacted.

Being able to go about their day, chat to their usual resident-friends, enjoy their usual foods, to maintain usual conversation, all done inclusive of moments of tiredness, sadness or anxiety but showing a desire to still engage is important.

In a fresh conclusion, the experts articulate, “indeed, a past error in traumatic stress psychology, particularly regarding group or mass traumas, was the assumption that all survivors need to express emotions associated with trauma and talk about the trauma; more recent research indicates that survivors who choose not to process their trauma are just as psychologically healthy as those who do.”

A key take-away that the coalition advocates is for sustained relationships and support, through the continued proximity of human interaction, whether that be in a RAC with front-line staff who have built up connections, or staff relationships with each other. It is in facilitating an environment where someone is known that the key take-away from the authors can be substantiated in practice.

“The most recent psychological debriefing approaches emphasise respecting the individual’s style of coping and not valuing one type over another.”

Critically, after the inexplicable, scientific study reinforces the need for deep, sustained and trusted relationships between human beings. In the direct relationships, as well as the outpouring of wider communities, knowing and being known can have a part to play in navigating the unthinkable. In sitting in spaces of complexity and pain, the unique journey of navigating through trauma can be embarked on by those impacted, and those that will walk beside them. 

Mental Health Australia encourages the use of the following services:

If you are experiencing distress or are seeking mental health support, please contact one of the following services: 

• Lifeline: 13 11 14 or lifeline.org.au
• Beyond Blue: 1300 22 46 36 or beyondblue.org.au
• 13YARN: 13 92 76 (for Aboriginal and Torres Strait Islander people)
• Kids Helpline: 1800 55 1800 or kidshelpline.com.au
• Headspace: 1800 650 850 or headspace.org.au
• ReachOut: reachout.com
• SANE Australia: 1800 18 SANE (1800 187 263) or sane.org
• Suicide Call Back Service: 1300 659 467
• Medicare Mental Health: 1800 595 212 or medicarementalhealth.gov.au

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