HOW SMALL ACTS OF CARE CAN ALLEVIATE POST-TRAUMATIC STRESS

Therapist and author, Courtney Armstrong discusses how demonstrating care toward someone after a traumatic event is the best way to aid their emotional healing.

Brain science is finally validating what we intuitively know as therapists: people heal through feeling cared for by others. Whether you receive emotional support from compassionate friends or family members, or an understanding therapist, study after study shows that a caring, compassionate relationship with another human being promotes healing more than any single therapy technique or medication.

In fact, a 2014 study at the University of Exeter demonstrated that just being reminded of feeling loved and cared for reduces the brain’s response to threat. Exeter researchers selected 42 participants for the study. The hooked the participants up to functional magnetic resonance imaging (fMRI) machines that could measure their brain activity as they looked at two sets of pictures. The first set of pictures showed people demonstrating love and affection towards one another. The second featured threatening images and words. The control group in the study was just shown the threatening photographs. Researchers found that the participants who viewed the photos of caring behavior between humans first had reduced activity in the area of the brain that registers threat and were not as emotionally triggered by the threatening images. These results imply that feeling loved and cared for provides a powerful buffer to fear and conditions such as post-traumatic stress.

I witnessed the power of care firsthand when I worked with ‘Vanessa’ (not her real name), a victim of the 2012 movie theater massacre in Aurora, Colorado. Vanessa wasn’t in the Batman movie where the shooting happened, but in a showing of another movie next door. The film had just started when the overhead lights suddenly came on and ushers hurriedly evacuated the audience, including Vanessa and her sister, out of the theater without explaining what was going on.

Vanessa stepped out of a comfortable, air-conditioned movie theater into a parking lot of pandemonium, bloodshed, sirens, SWAT teams, and tears. She tried to find her way through the chaos and almost stumbled over a woman whose pants were covered in blood. The woman had been shot in the leg. Vanessa panicked. She and her sister still didn’t know what had happened. They feared they were in the middle of a gang war and needed to find shelter as soon as possible, or risk getting shot themselves. Yet, they knew this woman needed help and didn’t feel right about leaving her to bleed alone in the street.

Vanessa’s sister agreed to find a first responder who could help them while Vanessa knelt down, held the injured woman’s hand, and let her know her sister was going to get help. The woman squeezed Vanessa’s hand and asked with a weak, raspy voice, “Can you please call my mother?”

The woman began to call out her mother’s phone number as Vanessa fumbled through her purse as fast as she could to find her phone. She managed to get the number punched into her phone and held it up to the injured woman’s ear so she could hear her mother’s voice. Vanessa continued to hold the woman’s hand until the medical team could get to her and thought she would never see or hear from this woman again.

Seven months later, when Vanessa came to me for trauma therapy, she wasn’t as troubled by post-traumatic stress as she was by survivor’s guilt. Vanessa, an occupational therapist, buried her face in her hands and cried, “All I could think to do for the gunshot victim in the parking lot was to sit there and hold her hand. I am in the healthcare field and I felt completely incompetent.”

I put a hand on her shoulder and replied, “Vanessa, you did the perfect thing. You showed her care and compassion in the midst of tragedy and you connected her to her mother.”

Without realizing it, Vanessa instinctively activated the first two conditions of Psychological First Aid:

1) Recreate a sense of safety.

2) Establish meaningful social connections and reconnect victims with loved ones.

These conditions were established after a 2004 landmark study published by Hobfoll et al. that identified 5 essential elements that helped disaster victims avoid or overcome traumatic stress reactions. These 5 essential elements are: safety, calming, connectedness, self-efficacy, and hope.

Sharing this information with Vanessa lifted her spirits a little, but it didn’t alleviate her guilt. What I needed to do was create an experience in our session that would help her realize that the way she demonstrated care toward this woman was extremely valuable.

To accomplish this, I asked Vanessa to retell the story of what happened that day in Aurora as I held her hand and assisted her in remaining emotionally present in the current time and space. When she finished her narrative, she cocked her head to the side and looked at me funny. I asked, “What are you noticing?”

She paused for moment, rubbed her chin and reflected, “It’s weird. I can think back on the event now and it doesn’t seem as scary. Don’t get me wrong, it was an awful thing to happen, but it feels like it’s really over now. It didn’t feel like that before. Do you want to know what’s even weirder?”

“What?” I replied.

Vanessa shook her head and said, “What helped me get through that story was you just sitting with me holding my hand. I mean that really helped me feel better. Can you believe it?”

“Hmm-mm, kind of like the way you held that woman’s hand in the parking lot?” I mused.

Vanessa grinned and said, “Yeah. Maybe I did help her. I hope she is okay.”

A few months later, Vanessa went back to Colorado for a hearing in the case. She was elated when she ran into the woman she had comforted in the parking lot the night of the tragedy. As soon as she saw Vanessa, the woman ran to her and hugged her neck. As they talked about how they’d been doing since the shooting, Vanessa dropped her head in shame, lamenting “I have post-traumatic stress and I wasn’t even shot. I can’t imagine how you’re doing.”

The woman grabbed Vanessa’s hand and said reassuringly, “Vanessa, I’m surprisingly okay. Sure, I’ve had a few nightmares and my leg still hurts at times. And, while I’m not planning on going to movie theaters any time soon, I really don’t dwell on the incident itself. Do you know what replays in my mind instead?”

“What?” Vanessa asked.

Looking tearfully into Vanessa’s eyes, she squeezed her hand and cried, “The kindness of a stranger who held my hand through all that horror. That’s what stands out for me, Vanessa.”

 

Hearing those caring words from the shooting victim herself was the final experience that released Vanessa from her survivor’s guilt and allowed her to move forward with her life.

Demonstrating care toward someone who is in distress is not just a kind thing to do; care is the very thing that can heal them. As Vanessa experienced, it’s not about knowing the perfect words to say, or finding an instant solution to the person’s problem. Simply being able to sit compassionately with a person as they make sense of their experience lightens the darkness and dissolves the walls of isolation where despair and sorrow live.

Despair and devastation can only live in isolation. When we feel love, care, and genuine supportive connections with others, it restores our faith in humanity and belief in the value of life. Coming together with the intention of healing and promoting a positive cause gives us the strength and fortitude to go on, especially after something terrible has happened in our lives.

We live in a world of uncertain times, but what is certain is that we’re all in this together. The media bombards us with threatening images, fearful messages, and the perception that there is danger lurking all around us. Yet, our most powerful weapon against all this danger comes from the softest, humblest place we possess– the bottom of our own hearts.

If you want to learn more about how to help clients who are recovering from traumatic events, my book The Therapeutic “Aha!”: 10 Strategies for Getting Your Clients Unstuck offers advice and tips from my two decades of experience.

I love to read your thoughts, comments and questions; please share your stories of your successes and frustrations when working with traumatized clients in the comments box below.

Finally, if you would like to receive future posts direct to your inbox, you can subscribe to this blog on this page.

Courtney Armstrong
11th June 2015

References

Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BPR, de Jong JTVM, Layne CM, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry 2007; 70:283- 315, discussion 316-69; PMID:18181708; http://dx.doi.org/10.1521/psyc.2007.70.4.283

Norman, L. Lawrence, N. Iles, A., Benattayallah, A., Karl. A. Attachment-security priming attenuates amygdala activation to social and linguistic threat. Social Cognitive and Affective Neuroscience, 2014; DOI: 10.1093/scan/nsu127

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