Being involved in a violent encounter does not affect everyone in the same way. At an individual level, some may experience the encounter with few or no psychological consequences, while others will go through the same situation and be emotionally devastated.
This article provides key categories for helping to understand what others are going through and provide solutions to help the person/people.
Concise assessment of the psychological impact of violent encounters
We need to understand that there are many reactions to trauma, including anxiety, depression, somatic reactions, and culturally specific responses. We need not over-focus on whether people meet specific diagnostic categories such as Post Traumatic Stress Disorder.
Distinguish intense but understandable responses to concrete situations from pathological responses. Intense grief should be distinguished from depression. Aches and pains resulting from injury should be distinguished from somatic symptoms expressing anxiety and depression. . Even psychotic symptoms (hallucinations and delusions) may be a brief reactive response to trauma, which will resolve fairly quickly with support, or it may be part of a longer term pattern. Obtaining a history from the victim or their family — when the symptoms first appeared, when the worsen and when the lessen, etc. — is the best guide.
Note that there are many different ways of coping with trauma. Some of these ways may be adaptive. E.g.,
- Fatalism; belief in fate or “karma;” belief “It was meant to be”
- Use of family, community
- Focusing on new dreams or priorities or a sense of mission
- Exerting self-control
Other coping mechanisms are less adaptive and may indicate a need for intervention. For instance,
- Expressing stress in somatic form
- Denial and silence
- Projection; blaming; scapegoating
- Helplessness and dependency
- Dissociation, numbness
Psychological responses to trauma may be confused with physiological responses:
Head injuries can cause brain damage. The person of a brain injury may experience headaches, dizziness, memory loss, difficulty attending or concentrating, sudden outbreaks of crying or anger or laughing, difficulties with vision or hearing or movement, and may express worry that their mind is “broken.” Any of these may occur in the absence of brain injury, as well, but treatment needs of those with physical damage to their brain are quite different from those or people without such injury. Ask the person whether they experienced an injury to the head during the violence (usually involving at least temporary loss of consciousness). Memory loss is a good, although not perfect, indicator, as well. Ask the person whether people say they are forgetful, whether they have been having experiences such as leaving the stove on or forgetting things. Memory can be briefly tested by asking the person to recall three words (e.g., “orange, necktie, 1983) immediately after hearing them and after a delay of three or four minutes. Most people have no trouble with this task.
The effects of violent encounters on mental health
• grief, mourning, depression, despair, hopelessness
• anxiety, nervousness, being frightened easily, worrying
• disorientation, confusion
• rigidity and obsessiveness, or vacillation and ambivalence
• feelings of helplessness and vulnerability
• dependency, clinging; or, alternately, social withdrawal
• suspiciousness, hyper-vigilance, fear of harm, paranoia
• sleep disturbances: insomnia, bad dreams, nightmares
• irritability, hostility, anger
• moodiness, sudden outbursts of emotion
• difficulties concentrating; memory loss
• somatic complaints: headaches, gastrointestinal symptoms, sweats and chills, tremors, fatigue, hair loss, changes in menstrual cycle, loss of sexual desire, changes in hearing or vision, diffuse muscular pain
• intrusive thoughts: flashbacks, feeling one is “re-living” the experience, often accompanied by anxiety
• avoidance of thoughts about the situation and avoidance of places, pictures, sounds reminding the victim of the conflict; avoidance of discussion about it
• problems in interpersonal functioning; increased marital conflict
• increased drug and alcohol use
• cognitive complaints: difficulty concentrating, remembering; slowness of thinking;
• difficulty making decisions and planning
• feeling isolated, abandoned
• “dissociative” experiences: feelings of being detached from one’s body or from one’s experiences, as if they are not happening to you; feeling things seem “unreal;” feeling as if one is “living in a dream”
• feelings of ineffectiveness, shame, despair
• self-destructive and impulsive behaviour
• suicidal ideation or attempts
the “death imprint”: pre-occupation with images of death
• Excessive tiredness
• “Loss of spirit”
• Inability to concentrate
• Somatic symptoms (e.g., headaches, gastrointestinal disturbances)
• Sleep difficulties
Excessive alcohol use, caffeine consumption, and smoking
There are many techniques that can be used such as ‘Critical Incident Stress Debriefing,’ ‘Defusing’ etc…
For this article we will focus on ‘Stress Reduction Techniques’
A “crisis” occurs when a person is faced with a dangerous or other seriously stressful situation for which their habitual problem-solving mechanisms are unsuccessful. Anxiety, fear, guilt and shame, feelings of helplessness or hopelessness, a sense of disorganisation, or anger may result. The conflict itself represents a crisis for most victims, of course. In the days and weeks and months following the violent encounter, additional crises may appear, for victims. Some unexpected incident or simply the buildup of stress over time can constitute the “crisis.”
Crisis intervention is a set of techniques aimed at helping the person in crisis gain control over the crisis situation. A little support and focused help at such a time, aimed at helping the victim to gain control over the crisis situation, may prevent later difficulties. Crisis intervention may be focused on an individual, several people together, or small groups (including a family unit).
The crisis intervention process involves, first, identifying and clarifying the elements of the crisis (the problem or issue or situation); second, developing problem- solving strategies; and third, mobilising the person to act on these strategies.
Simply identifying the elements of the crisis may, in itself, may help the client regain a sense of mastery. Ventilation of feeling and making the person aware that intense feelings do not represent “going crazy” may be helpful, but the flow of affect should be monitored so that the person doesn’t become frightened of losing control and so that his or her thought does not become further disorganised. The subsequent task is to help the person discover solutions, access support networks and resources and concrete services. This may be a very informal process, accomplished in as little as a few minutes, or it may be more formal and may require several meetings.
Stress Reduction Techniques
Violent encounters produce a great amount of stress and anxiety, both immediately and over the weeks and months that follow. A variety of techniques may be useful in reducing stress and anxiety.
Rest and recreation: Both brief periods of rest in the course of the day’s activities and adequate sleep are important. Recreational activities, ranging from card games to watching television to participating in games may be helpful. In part, these serve as a diversion, preventing “ruminating” about the conflict. They also help restore a sense of normalcy and control over one’s life.
Ventilation: Allowing people to talk about their experiences and feelings in both informal and formal settings relieves stress. Repetitive restatements or rumination, however, do not relieve stress and may promote depression, however, and should be discouraged. Divert the discussion on to other topics, provide diversions, or use other approaches to promoting relaxation.
Exercise: Physical activity helps dissipate stress. Provide opportunities for people to get exercise: taking a walk, jogging, engaging in a Krav Maga Self Defence class, engaging in an athletic event, dancing.
Relaxation exercises: Several types of relaxation exercise can easily be adapted for use in disaster settings to help people reduce anxiety and stress. These include breathing exercises, visualisation exercises, muscle relaxation exercises, and combinations of these.
Breathing exercises: The person is taught to breathe in a controlled way, while attending closely to their own breathing.
Visualisation exercises: The person is asked to provide an account of a setting or situation he or she finds very relaxing (e.g., walking in the woods) and is then asked to visualise this scene in a very detailed way. The particular scene to be visualised should be worked out in discussion with the intended user of the exercise.
Muscle relaxation exercises: The person is asked to practice first contracting, then relaxing different muscle groups until the entire musculature is relaxed, while concentrating on the feelings of relaxation in the muscles.
Please note that all of our Krav Maga Self Defence Classes and Courses are based in Manchester