COUNSELING 101 Coping After a Crisis In the wake of a crisis almost everyone is hurt and confused, but some are at risk of developing long-term consequences. Quick, effective intervention can help alleviate these people’s pain. BY STEPHEN E. BROCK AND KATHY COWAN STOCK PHOTO IMAGE ntil recently severe trauma Although principals are primarily term difficulties that can significantly reactions were most com- concerned with understanding and impair their daily functioning. Some Umonly associated with veter- meeting the needs of students, they will be at risk of developing PTSD, ans or survivors of major catastro- also must pay attention to the the most common and devastating phes, not the young people filling potential effect of a crisis on staff of the clinical anxiety disorders our nation’s schools. Generally, members, particularly those who are that are triggered by psychological when a student or a staff member serving as crisis caregivers for their trauma. The exact size of this coped with the psychological after- students. minority will depend on the type math of a tragedy, they did so with- and severity of the event because out the involvement—or responsi- Range of Reactions some events—especially acts of bility—of school personnel. But Anyone, regardless of psychological human violence—are more trau- educators have come to recognize strength, can be initially affected by matic than others. Although only a that schools play a critical role in exposure to an event that causes trained mental health professional any crisis response and care system fear, helplessness, or horror. can diagnose and treat PTSD, edu- serving children and youth. This is Symptoms can be emotional, physi- cators can help minimize potential- true whether dealing with an act of cal, cognitive, and social and inter- ly serious consequences of the violence on campus, an accident personal and vary significantly in disorder by recognizing warning involving a serious injury or loss of severity and duration. Strong reac- signs, identifying high-risk stu- life, a natural disaster, or terrorism. tions, such as anxiety or anger, can dents, and providing appropriate For the most part, schools have be normal and usually are not debil- interventions and referrals. done an admirable job of improving itating. With time, most people are crisis support in terms of planning, able to recover from the psychologi- What Is PTSD? prevention, and ensuring physical cal effects of a traumatic experience. PTSD is a characteristic set of safety during and immediately after According to the National Institutes symptoms resulting from “exposure” an event. An essential part of this of Mental Health (2002), a “sensible to a “traumatic stressor” (American effort, however, is the ability to rec- working principle” in the immediate Psychological Association, 2000). ognize and respond to the mental aftermath of a traumatic event “is to The kinds of stressors most likely to health effects of a crisis—including expect normal recovery.” result in PTSD include death, seri- such serious disorders as posttrau- A minority of children and ous injury/harm, and other threats matic stress disorder (PTSD). adults, however, will develop long- to physical integrity. Exposure is defined as directly experiencing or Stephen E. Brock is a nationally certified school psychologist and school psychology witnessing a traumatic event or trainer at California State University–Sacramento. Kathy Cowan is director of learning about an event being communications for the National Association of School Psychologists (NASP). This experienced by a family member, article was written in cooperation with NASP. close friend, or another loved one. JANUARY 2004 9 C OUNSELING 101 This explains why a number of play or representations in art or the particular vulnerabilities of the people developed PTSD after writing that reflect the trauma. They individuals involved. September 11 although they were may also be more disruptive in class, not directly affected by the attacks: express the belief that they will not Risk Factors They knew someone close who had live to adulthood, believe that cer- Usually exposure to a traumatic died or they “experienced” the catas- tain omens foretell traumatic events, event is not sufficient in itself to trophe on television. and exhibit such physical symptoms generate PTSD in most people. The general symptom categories as headaches and stomachaches. Certain factors put specific individ- of PTSD are persistent reexperienc- uals at greater risk for developing ing of the traumatic stressor, persist- How Common Is PTSD? the disorder. A fatal school bus acci- ent avoidance of reminders of the The lifetime prevalence of PTSD dent may not cause PTSD in most traumatic event, emotional numb- among adults is slightly less than of the students involved but might ing, and persistent symptoms of 8% and among children and adoles- trigger it in the student whose father increased arousal. PTSD is different cents slightly more than 10%. recently died in a car crash. Being from a more “typical” traumatic Females are two times more likely aware of the more powerful predic- event response (i.e., a normal tors of PTSD can help school per- response to abnormal circumstances) sonnel and parents identify students by the duration and intensity of the School counselors who are potentially more vulnerable. symptoms. They must last for at Physical and emotional proximi- least one month and cause signifi- are staunch ty to the traumatic event. The clos- cant disruption to the individual’s er people are to a traumatic event, daily life. For example, following a student advocates the greater the likelihood that they school-related traumatic event a stu- will develop PTSD. Proximity dent or a staff member may be who work closely includes both direct personal expo- unable to return to the building. sure to the event (physical proximi- with teachers and ty) and relationships with crisis vic- Different Ages, Different tims (emotional proximity), particu- Symptoms administrators to larly when the victim is killed. Not PTSD symptoms of adolescents ensure students’ surprisingly, crisis victims, especially closely resemble those of adults. those who were physically injured, Teenagers with PTSD may become welfare and are at greatest risk. more aggressive, start fights, or Subjective perceptions of the behave irrationally. They may have protect their rights. traumatic event. The individual’s trouble sleeping, participating in subjective impression of the traumat- class, and completing assignments ic event can be more important than or lose interest in cocurricular activ- the event itself. Simply put, those ities and friends. They are also at than males to develop the disorder. who develop PTSD perceive trau- increased risk of substance and The rate of PTSD after any specific matic events as extremely threaten- alcohol abuse, reckless behavior, event varies greatly depending on its ing. Those who do not view an and suicide. type and intensity. Sudden, human- event as threatening (no matter how Younger middle school students caused disasters involving assault, horrific others may judge it to be) and children may display a different injury, physical threats, or fatalities are unlikely to develop PTSD. This pattern of symptoms. Specifically, can be particularly traumatic, as are is why the demeanor of teachers and their anxieties can be more general- unusually intense and long-lasting other staff members is important ized than those of older individuals experiences. In addition, PTSD during and after a crisis. The reac- whose symptoms are much more seems more likely to develop in tions of trusted adults can help shape clearly linked to the traumatic event. young people if the perpetrator of a students’ subjective perceptions of a For example, they may display gen- violent act is a trusted adult. It is traumatic experience, particularly for eralized fear of strangers; separation important to keep in mind, howev- middle level students. anxiety; and sleeping difficulties, er, that virtually any traumatic expe- Family and social factors. including frightening dreams that rience has the potential to cause Students who no longer live with a do not necessarily reflect the stres- PTSD among some victims, given nuclear family member, are exposed sor. They may engage in repetitive the right set of circumstances and to family violence, have a family his- 10 P RINCIPAL L EADERSHIP PSYCHOLOGY 101 CASE STUDY tory of mental illness, or live with caregivers who have PTSD are more Assessing the Risk for PTSD likely to develop PTSD themselves. A local gang, in response to the beating of a fellow gang member by a student at In addition, the absence of close your high school, has come on campus. A fight breaks out in the student parking lot peer friendships, access to positive between the gang and the student’s friends. A 15-year-old gang member is hospital- adult models outside of the family, ized with a stab wound, and one of your students is killed by a gunshot wound to the head. A teacher was in the immediate area and tried to intervene; she was or connections to prosocial organi- hospitalized with a serious stab wounds but is expected to live. zations or institutions (such as schools) increases vulnerability. How Traumatic Is the Crisis Event? Mental health and trauma The situation described in this case study is obviously extreme and very rare, but it history. A preexisting mental illness illustrates many of the principles of assessing the risk for PTSD. This event involves violence that has resulted in death and injury and likely generated feelings of intense influences the development of fear, helplessness, and horror within the school community. This is the type of event PTSD. Students who had mental that is likely to be highly traumatic and generate symptoms of PTSD among sur- health problems (such as depression vivors, witnesses, and friends of the victims. This situation would probably require or bipolar disorders) before experi- comprehensive crisis intervention from the school, which may include crisis interven- encing the trauma are more likely to tion team members who are not typically a part of the school staff.