The Rational Basis® of Happiness Podcast

(this is raw unedited text transcribed directly from the audio)

Psychological Trauma

Psychological first aid in cases of trauma - a short interview with Dr. James Campbell

(this is raw unedited text transcribed directly from the audio)

Dr. Kenner: 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. He said, “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 all the fixings and I meandered 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, was totaled, all the windows shattered, but he wore his seatbelt so I’m one of the very lucky ones.

What do you do when you’re in a car accident, a hurricane, a 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? 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 course in traumatic stress and workplace violence. He’s also the author of Hostage: Terror and Triumph. Welcome Dr. James Campbell.

Dr. Campbell: Thank you very much.

Dr. Kenner: Welcome to the show. What are the immediate and short-term consequences of trauma? I mentioned what happened to me, but could you give 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?

Dr. Campbell: Well, for example, there have been several instances where we’ve responded after a sudden death, both in a university setting or a corporate setting. Initially, people are in shock. It’s a little bit like a website that’s gotten too many hits, too much activity – it just slows down – and people are in sensory overload and unable to process.

Dr. Kenner: That’s what explains the slowing down, the numbing? The stunned and bewildered feeling?

Dr. Campbell: Partially. It’s not a perfect metaphor but I think it works.

Dr. Kenner: Psychological overload.

Dr. Campbell: It’s a kind of sensory overload and it’s too much to process. At that time, people really generally need some protection, some support, and someone who is not going to ask too much of them at that moment, other than, “Do you want to sit over here or over there?” That kind of thing.

Dr. Kenner: Very low-level choice making.

Dr. Campbell: Yes. 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 events, a disaster, anything like that, is information. It is the lifeblood of what people want in that context. Just as the story you described, what happened? Where is he? Is he okay?

Dr. Kenner: I had no information. Nothing. He said he was borrowing someone else’s cell phone and gotta go. I was cut off. He was in upstate New York, I don’t even think it was a cell phone, I think it was a regular phone. I don’t even remember. Everything was a blur. My whole life just froze.

Dr. Campbell: Right. That’s a fairly common kind of reaction in those situations, so how to help people through that, just giving them some guidance. Usually giving 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 they want, but you can at least recognize that that’s what they want. Advise them how you’re going to get it, where you’re going to get it, and honor that need. Then they usually feel somewhat reassured.

Dr. Kenner: So that happens with hurricanes. They’ll say, “Stay tuned for the latest updates,” and we do. We all stay glued or if it’s a tornado or a flood.

Dr. Campbell: 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 event, explosion or something in my workplace, well, what happened and is it going to happen again? Is it a perpetrator that’s still out there? What about my job? When do I come back to work? All those kinds of things. What about so-and-so is hurt, where are they? So much need for information. At a time when almost always – I would dare say always – there is lots of misinformation. So it’s a very tricky situation.

Dr. Kenner: And there’s a the rumor mill, that’s what you’re talking about with the misinformation.

Dr. Campbell: Rumor mill that can be destructive. After PanAm 103, there were some parents who 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.

Dr. Kenner: What are you thinking of?

Dr. Campbell: 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 and grief and more distress than would otherwise be warranted. Or another situation I’m aware of where people thought they’re going to be charged criminally when that really is not the case at all, just a rumor that got generated that takes on a life of its own. And creating far more distress.

Dr. Kenner: 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.

Dr. Campbell: Absolutely.

Dr. Kenner: You said some very interesting things in a talk that you gave, that I attended. What to say to someone – and I know you talked about this a little bit – were you hurt? It’s over, you’re safe. But also, what not to say. Could you address that? I think there are things that we all say and then we feel goofy after we say them.

Dr. Campbell: Sure. Usually you would not say, and this is something that counselors and therapists are often trained to say, “How are you feeling?” That’s generally the inappropriate in the first moments or hours after a disaster. You’re not trying to evoke more emotional reaction at that time. Where things like, “Gee, you were lucky,” when people are often not feeling particularly lucky at that time. And it can make you be perceived as being stupid, not with it. Or other things, usually things are said with good intent, like, “It’s God’s will, or there’s some reason for this or don’t cry or calm down.” 

Dr. Kenner: 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.

Dr. Campbell: It’s been a pleasure, thank you.