Psychological first aid in cases of trauma ~ a short interview with Dr James Campbell
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I can remember getting a phone call from my son who said, "Mom, my car slipped." And I said, "Okay, so you'll be here a little later." We were meeting during Thanksgiving, and he says, "No, Ma, my car flipped. It's been totaled. I've got to go. See you later." Now, I want to tell you that was during Thanksgiving. I did not see him that Thanksgiving. I thought he had died. In that moment, I was totally, totally paralyzed, numb. I was with the rest of my family members, and I was supposed to go shopping to get the turkey and to get all the fixings, and I mean, I entered through that store in a total daze. Now, luckily, he's one of the lucky people who walked away when his car did flip on ice. It was totaled, all the windows shattered, but he wore his seat belt. So I'm one of the very lucky ones. Well, what do you do when you're in a car accident, a hurricane or tornado, a flood, or you're dealing with the aftermath of a house fire, a robbery or something on a massive scale, like 9/11, or maybe something work-related, like a layoff? What can help you cope better psychologically? Well, with me today is Dr. James Campbell. He's the Rhode Island coordinator for the American Psychological Association and the American Red Cross Disaster Response Network, and he's a frequent consultant to corporations regarding crisis response and threat of violence. He's the director of the University of Rhode Island Counseling Center, and he teaches courses in traumatic stress and workplace violence. He's also the author of "Hostage, Terror, and Triumph." Welcome, Dr. James Campbell.
Thank you very much. Yeah, welcome to the show. So what are the immediate and short-term consequences of trauma? I mentioned what happened to me, but could you give like a scenario that you've been in, and tell us what you've observed in a situation where people are in desperate need of first aid?
Well, for example, it's really been several instances, say, when I responded after a sudden death, both in a university setting or corporate setting, and initially, people are in shock. A little bit like, you know, a website that's gotten too many hits, too much activity; it just slows down, and people are just in sensory overload and unable to process. So
that's what explains the slowing down, the numbing, the stunned and bewildered feeling.
Well, partly, it's not a perfect metaphor, but I think it works—psychological overload. It's a kind of sensory overload. It's too much to process, and at that time, people really, generally need some protection and some support, and someone is not going to ask too much of them at that moment, other than, you know, do you want to sit over here or over there, kind of thing, right? So
very low-level choice making, yeah,
this is not typical psychotherapy. This is structuring the environment a little bit, responding to concrete needs. One of the things that people most want, typically, after a traumatic event, a disaster, or anything like that, is information. It is the lifeblood of what people want in that context. Just as the story you describe: "What happened? Where is he? Is he okay?" I
had no information, nothing. He said, "I'm borrowing somebody else's cell phone. Gotta go," right? And I was cut off. He was in upstate New York, where,
I guess you—I don't even think it was a cell phone.
I think it was a regular phone. See, I don't even remember. Everything was a blur. Yeah, my whole life just froze,
right? And that's a fairly common kind of reaction in those situations. And so to help people through that, which is giving them some guidance, usually giving them information in small bits and repeating it, because, again, they won't be able to take it in all at once. Also, you typically, in those situations, don't have all the information that they want, but you can at least recognize that that's what they want. Advise them how you're going to get that information, and honor that need. Then they usually feel somewhat reassured.
So that happens with hurricanes. They'll say, "Stay tuned for the latest updates," right? And we do, we all stay glued. Or if it's a tornado or if it's a flood,
and after a disaster, we stay tuned. "What's the government doing? What's the president doing, the governor and so forth? And what's going to happen next?" Or if it's an explosion or something in my workplace, well, you know what happened, and is it going to happen again? Is a perpetrator still out there? What about my job? When do I come back to work? You know, all those kinds of things. What about so-and-so? Was hurt? Where are they? There is so much need for information at a time when almost always—I would dare say always—there is lots of misinformation. And so it's a very tricky situation, and
there's a rumor mill that goes on. That's what you're talking about with the misinformation.
Yeah,
the rumor mill that can be destructive to Pan Am 103. Some parents were notified that their children had died when they were not on the plane. There's always misinformation in the fog of a disaster, the chaos, and that's a real challenge to manage and has important mental health implications, obviously. Yeah,
what are you thinking of?
Well, I mean, obviously, if someone is given misinformation about the safety or death of a loved one, that is going to be extremely upsetting and provoke anger, grief, and more distress than would otherwise be warranted. Or another situation I'm aware of where people thought, "Oh, they're going to be charged criminally," when that really was not the case at all, but it was just a rumor that got generated. That takes on a life of its own and creates far more distress. You know, when
I hear you talking about that,
I think that one of the key problems with trauma is that it has the potential to affect your long-term life premises—your most fundamentally held ideas about yourself. I'm able to cope or not cope. It can affect your view of the world. This is no longer a safe place. I know I felt that after 9/11 for a short period of time. It can affect your views of others. I can't trust the government. I can't trust other people after the war or something. It can affect profound, fundamental ideas that you hold, which are all pervasive in your life. So I know that that's the type of psychological damage that can set a person up for an anxiety disorder, for depression, for post-traumatic stress disorder, and it's very, very damaging. You said some very interesting things in a talk that you gave that I attended: "What to say to someone," and I know you've talked about this a little bit where you heard it, "It's over, you're safe."
But also, what
not to say? Could you address that? Because I think there are things that we all say, and then we feel goofy after we say that. Okay,
sure. Usually, you would not say, "Hey,
I gotta interrupt this because we've got to pay some bills. 30 seconds, that's it. A very quick ad, and then Alan will be back.
Romance. Oh, I wish guys knew more about what we want from a relationship. Boy, I wish I knew more about what I want. Where's that ad I saw? Here it is: "The Selfish Path to Romance," a serious romance guidebook. Download chapter one for free at selfishromance.com and buy it @amazon.com. Hmm. The Selfish Path to Romance, that is interesting. What
Not To Say? Could
you address that? Because I think there are things that we all say and then we feel goofy after we say that. Okay,
sure. Usually, you would not say—and this is something that, you know, counselors, therapists are often trained to say—"How are you feeling?" Exactly. Generally, being appropriate in the first moments or hours after a disaster, you're not trying to evoke more emotional reaction at that time. Or things like, "Gee, you were lucky," when people often are not feeling particularly lucky, and it can make you be perceived as being stupid, not with it. Or other things—usually things are said with good intent—like, "You know, it's God's will," or "There's some reason for this," or "Don't cry" or "Calm down." But "calm down" really irritates me. If I'm feeling agitated, I feel totally invisible. If someone tells me to calm down—listen, I can see that we're right at the end of time right now. So I want to thank you so much for joining us, Dr. James Campbell, and I look forward to talking with you again sometime. Oh, it's been a pleasure. Thank you. And that's so good to remember that "calm down" is not the thing to say when someone's feeling real anxious and in a crisis. I was going up Mount Washington, actually, with a group of people, and I was feeling some anxiety because I was smelling some smoke in the car, some burning rubber. And I said, "Oh my God, you know, maybe we should pull over and let things cool down." And somebody said to me, "Calm down. It's not a problem." And it would have been much better if they said, "Yeah, I smell it too," which everyone did. And I think it's only X, Y, Z, and I will pull over in a little bit. That would have been much better than saying, "You know, relax, what's your problem?" And now I have a second problem.
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