Traumatic events, such as the one we experienced here in Jonesboro, extend beyond normal psychological stressors to the extent that casualties do not have a frame of reference for understanding the event or their own emotional, psychological, and spiritual reaction. This guide equips ministers, church leaders, and concerned Christians with a road map for providing "psychological first aid" and has been helpful to those of us engaged in "first response" counseling here in Jonesboro. However, it is general enough in it's description that it can be applied to a variety of traumatic situations (e.g., natural disasters, accidental death, murder, etc.).

COMMON FIRST EMOTIONAL REACTIONS

   The following is a summary of common emotional responses seen in those impacted by the event. They are often experienced, just as a huge wave crashes against the sea shore, as an overwhelming feeling. Emotional waves come in and out, some staying longer than others, and vary in intensity. It is critical that the helper normalize the range of feelings and prepare the individual for more and different waves. While the following reactions are common, remember that children and adults will respond in a wide variety of ways. It's important to validate their experience and listen with a safe, nonjudgmental attitude.

While the following reactions are common, remember that children and adults will respond in a wide variety of ways.

-- SHOCK and DISBELIEF:
Persons feel stunned by news of the event and are often unable to process the meaning of the new information.

 -- CONFUSION:
Emotions are mixed including sadness, denial, anger, questioning, alarm, fear.

-- GUILT:
Perhaps they know something that they now deem important, but didn't say anything about. Survivors guilt results when someone was hurt or killed and they weren't. Parents might say, "How can I face my friend again, I still have my daughter, but her's is dead."

-- LOSS OF PREDICTABILITY:
Basic assumptions of safety and security are shattered leading to an intense sense of vulnerability, helplessness, and insecurity. "Why did this happen here?" "What's going to happen tomorrow?" "If it could happen to him, could it happen to me / someone else?"

-- INSECURITY and FEAR:
Persons tend to be fearful and scared when they normally feel safe.

-- COMPOUNDED STRESS:
Some people will have other stressful events (e.g., death in the family, parents divorcing, drug use) going on in their life resulting in compounded stress. These people need to be watched closely and checked on frequently.

-- RELIVING PAST TRAUMA:
The current event may resurrect feelings from an event earlier in life that is similar or seemingly unrelated (but the emotional impact is similar). Persons will then have to deal with both events.

-- EXPERIENCING "LAND MINES":
Land mines or "triggers" are those unexpected events, sounds, and occurrences that cause the person to recall this incident or other similar incidents. Landmines usually have intense emotional feelings associated with them that can "flood" (or overwhelm) the individual without warning. Examples include seeing a picture, hearing words or phrases that remind them of something, and smelling certain odors. Most land mines will occur during the first few months. They will taper off as time passes, yet some can and will occur years later.

-- ANGER: Anger may be expressed toward the offender, the victim, God, or others involved in the situation. Often times this comes out initially as blaming the victim (e.g., "How could he have hurt himself!" or "Why did you let him touch you like that, why didn't you say something?")

COMMON PHYSICAL EFFECTS

   Persons will experience physical effects such as loss of appetite, sleeplessness, physical illness, preoccupation with the event, difficulty concentrating (e.g., school or work), poor judgment, mood swings, avoidance of activities or situations connected to the event, and a strong desire to get closer to or distance themselves from loved ones.

FROM IMPACT TO RESOLUTION
It's important for people to know what lies ahead. The following five phases give some predictability to an unpredictable event.

0. Outcry / Shock: This refers to the range of initial emotional reactions and may lead to either denial or intrusiveness.
1. Denial: Blocking the impact is common as is emotional numbing, not thinking of what happened, or avoiding the subject. Some will respond as if the event did not occur ("They say he's dead, but I know they're wrong."). A word of caution about forgiveness: some may demonstrate denial under the guise of quick forgiveness ("Let's just forgive them and get on with our lives.") Forgiveness is a goal, but make sure it's the real thing.
2. Intrusiveness: This often comes in the form of intrusive-repetitive thoughts, images, emotions, and behaviors. Persons may be bothered by preoccupation, nightmares, hypervigilence, and confusion. Intense emotional states can be experienced including rage, major depression, guilt, shame, and anxiety. Children will likely display regression in academic performance and behavior.
3. Working Through: This is the longest period of recovery and will vary in length given the depth of impact on the individual and their family system. This requires that thoughts, feelings, and images of the crisis be identified, expressed, and aired. The grief process includes integrating new "realities" into preexisting assumptions about life and accepting a "new path" for their life. Some people work through naturally on their own, others cannot without outside help. Families also need help coping together and knowing how to support each other.
4. Completion: This occurs when there has been a full integration of the event into the individual's life. They experience restabilization and resolution of feelings. Recalling the event may still bring sadness, or disbelief, but the crisis state and intensity of emotions is diminished.

WHAT YOU CAN DO: PSYCHOLOGICAL FIRST AID

0. Establish open reliable communication: Let them know it's O.K. to talk about the event and their feelings. Inform them of the facts as best you can. Stay in touch, communicate concern, and follow-up.
1. Normalize their response: Without a framework for understanding, persons need to be reassurred that their reactions are normal given the situation. Talk about how their reaction is similar to others and let them know they aren't going "crazy." "For the next few days/weeks I don't expect you'll feel very good about this, I know I don't. Take your time and we'll work through it together." Explain landmines and tell them to expect some in the days ahead.
2. Dialogue and Debrief: Let them talk about their feelings and concerns, even if they are angry or judgmental in nature. Don't feel the need to agree or "set them straight," just acknowledge the emotion behind the statement. Don't be defensive about the circumstances or the behavior of those involved. Feel free to share your feelings and concerns, after all, you're human, too. This helps to normalize their feelings and makes you a "fellow struggler." Some will benefit from non-verbal expressions of emotion such as drawing, writing, creative works, symbols, and rituals (e.g., releasing a balloon, graffiti wall).
3. Ask what the event means to the person: Initially it is common for persons to focus on the "why?" of the event. Since you may never have a satisfactory answer to that question, try to steer away from "why?" questions to "what" has taken place. Then, be sure to focus on "who" we look to in times of distress. Ask: -- "What does it mean to you that this happened?" -- "How does this effect you or your family directly?" -- "How are you making sense of this?" -- "How do you think God feels / thinks about this?"
4. Establish ongoing contact & support: Call to see how they're doing, don't be afraid to ask. Don't assume that because someone is "handling it O.K.," they really are O.K.
5. God as a source of help! Pray with persons and try to usher them into the presence of God. Find appropriate scripture to share with them as a source of encouragement.

DEBRIEFING IN SMALL GROUPS

   Small groups make for an excellent process time. First, be sure to set some groundrules:

• Safety: make it clear that feelings are safe to express and won't be judged by you or other group members. No one will be critical of your thoughts or feelings;
• Confidentiality: what is said in the group will stay there; and
• Respect: you will respect each members experience, each is deserving of being heard and understood;
• Advice: no advice will be given unless someone asks for a response.

Group Process:

-- Begin and end with Prayer: lots and lots of prayer.

-- Give additional facts when available to help people regain a sense of control.

-- Give information to normalize their emotional reactions.

-- Facilitate listening and understanding about comments.

-- Before soliciting their reactions, set a tone for sharing by sharing your own experience. Be as vulnerable and detailed as you hope they will be. Model for them how and what to share.

-- In a "around the room" fashion, give each person a chance to share:

• where they were when they heard about the event or experienced the tragedy (this will immediately bring emotions to the surface);
• questions about the facts;
• their feelings and reactions (so they can see that others feel similarly); and
• how they are making sense of everything;

-- Give some ideas for coping and encourage them to care for one another throughout this process. Ask them to share what coping strategies they have come up with on their own.

Important Tips for Parents

   Here are some tips for helping you to help your child deal with the crisis:

0. Listen with interest, openness, and acceptance. Encourage them to tell you about their experience. Be prepared for your children to talk sporadically about the tragedy, displaying a need to have small conversations again and again.
1. Spend extra time with them yet balance togetherness with private time or time that isn't oriented around the crisis.
2. Reassure them that they are safe and the Lord will carry them (and your family) through this.
3. Help them with every day tasks and have extra patience as concentration may be difficult.
4. Accept that life will go on and try to maintain a normal routine when possible.
5. Ask, "What can I do to be helpful?"
6. Try to accept their anger or other negative responses with understanding.
7. Acknowledge that family members will grieve and feel differently. Give one another permission to express differing, even opposing emotions.

   This is not the time to argue or be critical. Avoid saying how lucky they are that it wasn't worse and don't push for significant decisions. Symptoms will usually subside and disappear in time without much effort, but persistent difficulties indicate a need for counseling. Do not focus on emotional or behavioral reactions and don't criticize your child because of them. Your children will be vulnerable and hurt for a period of time. If these signs of stress do not begin to lessen within a few weeks, or if they intensify, seek further help. You may not understand what they are going through, but offer your support and love. You probably have a great deal in common with your son or daughter, but allow for differences within the family throughout the grief process. Even though it is upsetting, this is an opportunity to nurture your child's faith. Talk about God, faith, sin, responsibility, forgiveness, and trust. Read Bible passages together (e.g. Psalms), pray, and ask questions of one another. Make God a central anchor