“How do I know if I need trauma therapy?” A common question from Parkland shooting survivors

After consulting with numerous people directly and indirectly affected by the shooting at Stoneman Douglas High School in Parkland, FL, a common question has been raised around whether or not to seek treatment for psychological trauma.  This question involving the need for treatment following traumatic exposure has come not only from teachers, staff, students, and families, but also from therapists and school officials making assessments and referrals.  Due to the clear importance this has for the welfare of individual victims as well as the Parkland community as a whole, I will attempt to answer the question below.

A number of mental health professionals have been assertive in their position that a victim’s post-traumatic stress symptoms are normal and that we don’t want to shame them by suggesting they go to therapy, thereby sending the message that there is something wrong with them.  I agree that these symptoms are very normal reactions to a very intense and overwhelming situation and that it is important for individuals to understand this.  The process of normalization needs to occur as well as education on what they can expect to experience going forward.  What about those who say that “grieving the death(s) of loved ones is a process and that nature should just take its course over time without trying to push clients toward more-rapid healing”?  I partially-agree, however would point out the difference in this situation for many – that there is a loss and a trauma.  This can perhaps be described by one expert as ‘complicated grieving’ (Kessler, 2017) and ‘traumatic grief’ by others (Shear & Smith-Caroff, 2002).  I wonder if the grieving process could even begin if an individual’s brain and body are still stuck in the trauma and in perpetual fight or flight.  I have also been hearing people spread the unfortunate misconception that PTSD is a lifelong condition and that one must just learn to live with it.  This notion is far outdated and creates an inaccurate and misinformed belief in society that perpetuates suffering.  The truth is that PTSD is a very treatable condition and symptoms can be reduced significantly or even eliminated altogether and people can return to the state they were prior to the traumatic event.  If there are safe and effective, evidenced-based, early interventions that can clear away the traumatic memories and reduce an individual’s disturbing symptoms quickly, then shouldn’t these be provided without delay?

Over time, most people with traumatic stress symptoms immediately following an event will have a spontaneous remission of symptoms without any psychological treatment at all.  Only about a third of individuals go on to develop the full criteria for the diagnosis of PTSD (van der Kolk et al., 2007).  However, this does not mean that two-thirds of individuals are left unscathed.  Many won’t progress to the full PTSD diagnosis but may still have  debilitating traits, while others who don’t have any of the common PTSD reactions such as hypervigilance, flashbacks, etc. may go down a different road and develop substance use disorders and addictions, mood disorders, and panic attacks.  It is widely accepted that numerous psychopathological conditions have origins based on trauma.

The costs of trauma are quite high not only for the individual victim but for their families and society as a whole.  If you know someone who has been traumatized you can witness in them the devastating suffering that is caused by post-traumatic stress (read last week’s post for more details on what the Parkland survivors are reporting).  And what about the secondary problems that arise from not sleeping well or having the difficulty concentration and attention that causes lost productivity and an inability to learn?  How can a traumatized mother or teacher perform the vital parenting and educating roles that require individuals to be calm and present?  What about the chronic re-experiencing of trauma that happens through self-victimization or when victims become perpetrators and create cycles of violence through the generations?  It reminds me of the sayings, “we repeat what we don’t repair” and “hurt people hurt people.”  Unresolved trauma can cause problems on a physical level as well (McFarlane, 2010).  Chronic stress on the HPA axis and autonomic nervous system creates a wear and tear on the body over time and can cause immunosuppression and a variety of other physiological concerns.  PTSD is associated with a variety of somatic complaints such as hypertension, unexplained physical pain, irritable bowel syndrome, chronic fatigue, hyperlipidemia, coronary heart disease, and obesity.  The implications for treatment (or not treatment) are clear.

Our knowledge about the cumulative nature of trauma suggests a great need to intervene early to prevent the layering effect of dysfunctionally-stored trauma memories and subsequent problems down the road.  If a trauma is left untreated, the processes of kindling and sensitization occurs where an individual has a progressively greater degree of reactivity over time through reminders of the event as well as repeated exposure to traumatic events.  In fact, many Parkland victims who have a history of prior, unresolved traumatic experiences are noticing that their past is starting to creep to the surface, no longer able to be contained and as if this was the “straw that broke the camel’s back”.

The truth is that there are safe, efficient and effective trauma treatments such as Eye-Movement Desensitization and Reprocessing (EMDR) that can effectively clear away debilitating unprocessed trauma memories thereby reducing or eliminating distressful symptoms and potentially preventing the development of PTSD or other mental health conditions.  If you notice your problems persisting after several days or weeks and are having a hard time sleeping, feeling jumpy and on-guard, difficulty controlling your emotions, anger and aggression, having disturbing intrusions (images, memories, body sensations, smells, sounds), a thin window of tolerance for ‘holding it together’, difficulty concentrating, or desperately trying to avoid even thinking of the event, my recommendation would be to talk with a professional who is trauma-informed and up-to-date on the current research and treatment guidelines and can talk with you about your symptoms.  There are several organizations that are providing pro bono therapy from quality clinicians and can provide appropriate assessment and recommendations.  If you’re experiencing difficulties following the Parkland shooting that have not subsided after a few days, it can’t hurt and can only help to consult with a professional who can ask the right questions and provide therapeutic options.  The Southeast Florida Trauma Recovery Network is available to help with pro bono EMDR therapy services (Please see next week’s post on EMDR as an evidence-based early intervention trauma treatment).  Working closely with us, the Professionals United for Parkland (PU4P) organization is also available and is providing a limited number of no-cost sessions to anyone impacted by the shooting.

Brian Gong is the co-founder and coordinator of the Southeast Florida Trauma Recovery Network (TRN) which is providing pro bono EMDR therapy to those individuals directly impacted by the Parkland shooting.  For more information or to request no-cost trauma therapy, please visit: www.southeastfloridatrn.org

Kessler, D. (2017, October). David Kessler on Grief and Grieving.  Presented at a continuing education workshop in Fort Lauderdale, FL.

McFarlane, A. C. (2010). The long-term costs of traumatic stress:  intertwined physical and psychological consequences. World Psychiatry, 9(1), 3–10.

Shear, K. M., & Smith-Caroff, K. (2002). Traumatic Loss and the Syndrome of Complicated Grief. PTSD Research Quarterly, 13(1).

Van der Kolk, B., McFarlane, A. C., & Weisæth, L. (2007). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York: Guilford Press.