Community Forum: After the crash – a survival guide

This week’s writer is Matthew Kimble, a licensed clinical psychologist and associate professor of psychology at Middlebury College. He teaches courses on psychological disorders and psychological trauma and has a National Institute of Mental Health-funded clinical research program that investigates how psychological trauma changes the way individuals look at their world.
This past Saturday morning, an SUV careened into the crowd at the Bristol Soccer Jamboree, injuring three adults and two children. By all reports, one of the victims was a child who was pinned under a vehicle. In an instant, a beautiful and promising Saturday morning had been shattered.
Unfortunately, the effects of the accident may go beyond those who were directly injured. There were those who watched the whole scene unfold. Others who stumbled upon the chaos that ensued in an attempt to help. And those who got a terrifying phone call explaining that that they would need to greet their loved one, not at the door, but at the emergency room.
It’s likely that scores in our community remain deeply affected by the incident. So what now?
For those who experience a traumatic event, like that which occurred on Saturday, the psychological responses can be wide-ranging. There is no one reaction to this type of event. Intrusive memories, rumination, depression, emotional numbing, irritability, nightmares, jumpiness, difficulty concentrating and poor sleep are common. In children, one can additionally see an increase in aggression as well as violent themes in their art and their play.
These experiences, if short lived, are an absolutely normal response to an abnormal event. Most people when experiencing such a trauma show a disruption in their normal functioning for a period of time. How long that disruption occurs is usually related to how severe their exposure was; those who were injured for example are likely to experience psychological symptoms longer than those who came upon the scene later to help.
The reassuring news is that most people, with time, recover. Through their own support networks, resilience, and coping skills, it is estimated that four out of five individuals do not suffer long-term negative consequences from these types of experiences.
In the meantime however, these experiences can leave friends and loved ones at a loss about how to help. In more severe cases, it leaves one feeling impotent in the face of significant and fast-moving changes to someone they’ve known their whole life.
What can you do to be of help? The evidence suggests that the number-one predictor of recovery from these type of experiences is appropriate social support. In this case, it means being willing to listen but not intrusive. It might mean cooking a meal, or providing a ride to a medical appointment or a counselor. In general, you want the individual to know that you are there for them without dictating how you will be there for them.
In my course on this topic at Middlebury College, my bullet points on this issue are:
•  Give resilience a chance.
•  Be available, but not intrusive.
•  Provide practical support.
•  Neither encourage nor discourage treatment in the early months. Let them decide.
•  Keep a watchful eye out for prolonged problems.
In the majority of individuals, symptoms after an accident will subside in the first days and weeks after the trauma. However, for a subset of people the symptoms do not go away and in some cases worsen. If natural recovery does not seem apparent in the next three to six months, then it becomes very important to encourage treatment before dysfunctional patterns in thinking and behavior become entrenched. Typically, if the symptoms have not relented after six months, the symptoms are not going to go away without intervention.
The good news is there are excellent treatments (particularly to singular events like the witnessing of a motor vehicle accident) for individuals who have developed a chronic response to the trauma. The most reliable approach involves “memory work” or “flooding” from either a psychodynamic or cognitive-behavioral perspective. The common denominator of this type of work is the active processing of the memory so that the associated negative emotions disappear.
And remember … if the individual does not recover naturally, it is important that they know that it not their fault. Some individuals recover quickly and others eventually require treatment. Why this happens in some but not others is one of the million-dollar questions in psychological science. The most damaging thing you can do is tell someone to “just get over it.” If they could, they would.
There are excellent resources available to survivors and their friends and families. A good place to start is www.istss.org, a nonprofit organization dedicated to the research and treatment of traumatic stress. 

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