DiLorenzo Pentagon Health Clinic
Civilian Employee Assistance Program (EAP)

When we experience a traumatic event, it can create strong emotional reactions. Many of us continue to experience feelings of helplessness, anger, anxiety, and grief. Some of us may find it more difficult to concentrate or to complete tasks at work. We may feel distanced or misunderstood by friends and family who want us to put the terrible events of that day “behind us.” Some of us may even find we are avoiding things we used to do or places we used to go. Any and all of these reactions can be NORMAL, even months after a traumatic event. Below are listed some common reactions to trauma and some suggestions on how to cope with them. 

Common Emotional Reactions

• Anxiety
• Grief
• Panic
• Uncertainty
• Irritability
• Emotional numbing
• Feeling overwhelmed
• Anger
• Hopelessness 

Common Cognitive (Mental) Reactions

• Poor concentration
• Easily distracted
• Difficulty making decisions
• Memory problems
• Intrusive thoughts and images
• Hyper-vigilance (always on alert)
• Disorientation to time and place
• Poor problem solving

Common Physical Reactions

• Increased fatigue/low energy
• Headaches
• Muscle stiffness or tremors
• Elevated blood pressure
• Nightmares or insomnia
• Nausea
• Chest pain*
• Difficulty breathing* 

* These reactions must be medically evaluated.

Common Behavioral/Social Reactions

• Change in activities
• Avoidance of places or things
• Social withdrawal
• Loss or increase in appetite
• Increased use of alcohol
• Startle reflex intensified
• Restlessness
• Change in communication style
• Change in sexual functioning

Spiritual Reactions

• Doubt
• Loss of direction
• Apathy
• Emptiness

Adapted from International Critical Incident Stress Foundation’s Critical Incident Stress Information Sheet.

There are a number of steps you can take to help restore emotional well-being and a sense of control following a disaster or other traumatic experience, including the following:

Structure your time so you can stay involved with activities you enjoy and on top of responsibilities at home and at work.

Give yourself time to heal. Anticipate that this will be a difficult time in your life. Allow yourself to mourn the losses you have experienced. Try to be patient with changes in your emotional state.

Reach out to others. Ask for support from people who care about you and who will listen and empathize with your situation. Research shows people who rely on strong social supports recover more quickly than those who do not.

Communicate your experience in whatever ways feel comfortable to you — such as by talking with family or close friends, keeping a diary or using another creative art form such as photography, drawing or music.

Engage in healthy behaviors to enhance your ability to cope with excessive stress. Eat well-balanced meals and get plenty of rest.

Exercise on a regular basis. This will help release tension and anxiety. 

Practice good Stress Management. If you experience ongoing difficulties with sleep or anxiety, you may be able to find some relief through relaxation techniques or breathing exercises.

Avoid alcohol and drugs — including caffeine and nicotine. These are bio-genic stressors which will compromise your body's ability to handle stress.

Establish or reestablish routines such as eating meals at regular times. Remind yourself that your feelings and reactions are normal. 

Avoid major life decisions such as switching careers or jobs if possible because these activities tend to be highly stressful.

Monitor your media exposure. Be aware that distressing images in the news and on television can produce or intensify stress reactions. Take control and decide what you really want and need to see, hear and read.

If reactions do not decrease in intensity or frequency over time, seek professional assistance. Contact your doctor or the Employee Assistance Program, at 703-692-8917.

Based on information compiled from the American Psychological Association and Survivor Guidelines.org website.

Some people are able to effectively deal with the emotional and physical demands brought about by a traumatic experience by using their own support system and pre-existing coping mechanisms. It is not unusual, however, to find that uncomfortable reactions persist for others and continue to interfere with daily living. For example, some may have long-term difficult y sleeping or experience flashbacks of the event. Others may feel overwhelming anxiety or lingering sadness that adversely affects job performance and interpersonal relationships.

Individuals with prolonged reactions that disrupt their daily functioning should consult with a trained and experienced mental health professional. Your Employee Assistance Program can educate you about normal responses to traumatic events and help you decide whether you need further assistance. They can also help you find a qualified mental health professional. These professionals work with individuals affected by trauma to help them to resolve traumatic stress symptoms and find constructive ways of dealing with the emotional impact. 

How do I choose a therapist? 

Below is a list of questions intended to assist you in choosing a therapist. (You may want to contact your health insurance company first to determine if they have a list of approved providers.)

• 1. What are your credentials?
• 2. What are your specialties?
• 3. What professional organizations do you belong to?
• 4. How long have you been in practice?
• 5. What experience do you have in treating traumatic stress conditions?
• 6. Do you have experience treating victims of disasters?
• 7. How do you approach treatment of traumatic stress conditions?
• 8. What is your fee?
• 9. Do you accept insurance? If so, what kinds?
• 10. Do you accept payment through the Worker’s Compensation program?
• 11. Do you have a sliding fee scale? If so, how is payment determined?
• 12. Do you bill people, or is payment expected at the time of the session?
• 13. How do you protect client confidentiality? Who will have access to my files?
• 14. Has anyone ever lodged a formal complaint against you?
• 15. Have you ever been censured by a professional organization?
• 16. If I were in a crisis, would I be able to reach you? How do you handle crises?
• 17. What is your policy about missed sessions?
• 18. Do you arrange for coverage when you are on vacation?
• 19. Do you think you can help me?
• 20. Is there anything I should know about your services that I didn’t think to ask?

Supervisors are in a critical position to identify employees struggling with the aftermath of trauma. There are still many employees who are struggling to overcome their fear and anxiety from the September 11, 2001 terrorist’s attacks. There are also hundreds of civilians being deployed to Iraq and Afghanistan. These civilians are facing danger and fear like our soldiers in these war zones. Many of them are being exposed to trauma through witnessing bombings, seeing casualties or being located in a “hot” zone. Others are exposed to trauma through the constant drills or hearing the stories of those impacted by combat. One does not need to be on the front line to experience trauma. Additionally, employees may be exposed to traumatic situations in their private lives. Any situation in which you experience intense fear, helplessness or horror can be traumatic, leaving a person with residual reactions. 

You, as a supervisor, can be very helpful as your employees deal with trauma. So often when people experience these reactions, they feel overwhelmed and wonder if they will ever “be themselves” again. They may not understand why they are still having these reactions. You can refer your employees for help and further support. PERS is staffed by licensed mental health counselors specifically trained in working with trauma.

As a supervisor, you may see changes in the employee’s work performance, attitude and behavior. Below are some examples of reactions that you may see in the workplace:

• Feeling out of control — unexpected episodes of tearfulness, panic attacks, flashbacks
• Memory loss or impairment
• Being inattentive to the task at hand that leads to increased accidents and errors
• Increased absences (sick leave, vacation, unexplained absences)
• Deteriorating performance/customer relations
• Withdrawing from usual kinds of peer interactions
• Increasing conflicts with authority figures
• Avoiding performing job activities related to the traumatic event 

Here are some guidelines for working with employees in the aftermath of trauma: 

• Take care of yourself (or you will not be helpful to your colleagues and subordinates).
• Listen carefully and with an open mind to your employees’ concerns.
• Spend time with your staff.
• Offer your assistance and a listening ear, even if they don't ask for help right away.
• Reassure people that they are safe.
• Give those who need it some private time.
• Don't take anger or other negative emotions personally.
• Don't tell employees or co-workers in distress to “be strong,” to “forget it,” or to otherwise suppress their emotions. It can be counterproductive to the healing process.
• Don't tell anyone that they are "lucky it wasn't worse". Most people are not be consoled by these kinds of statements. It may make others feel guilty for the emotions they are experiencing. Instead, let everyone know that you are sorry such an event has occurred and that you want to understand and assist them.
• Don't feel like you have to have all the answers or know exactly what to do. Just being there shows them that you care. (It is okay to ask them what they would like for you to do.)
• Encourage employees whose functioning is compromised to get professional assistance. 

For more information or to speak with a counselor, please call 703-692-8917.