PTSD: National Center for PTSD

What to Expect in the Wake of Disaster

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Disasters may be natural—including fires, hurricanes, ice or snow storms, floods, landslides, and droughts. Other disasters, such as plane crashes, mining or industrial accidents, and chemical spills, are considered "man made," caused by human error, negligence, or mechanical failure. No matter the cause, disasters can have a devastating effect on people who experience them, their loved ones, and communities.

Disasters cause social and community disruption. Transportation, food and water supplies, and communications can be affected. Property damage may be widespread, depending on the particular incident. People may lose jobs located in the affected communities or be unable to get to their places of employment.

But there is also support that comes from going through a shared event. Disasters are experienced collectively and therefore people are connected and can help each other cope.

During the event itself we often hear stories of people putting their lives at risk to help strangers. Following the event, disaster survivors are surrounded by others who can understand what they experienced as everyone is moving through the event at the same time. Support can also come from the public through fundraising efforts and volunteering as outsiders look for ways to help and through FEMA’s practical assistance.

Common Reactions

Given the damage and disruption that can occur after a major disaster, it is not surprising that almost everyone has symptoms in the immediate aftermath. The initial relief to be alive may be followed by distress, fear and anger.

Disaster survivors may find it hard to stop thinking about what happened, have trouble sleeping, or feel keyed up or on edge. For most people those reactions will lessen over the first few weeks after the event. For those who lost a loved one, were injured, or were forced to relocate, those reactions may be more intense and longer-lasting.

Ongoing Stressors

Along with the immediate problems disasters cause, there are additional stressors that can make it difficult to get on with life:

• Days or weeks may pass before evacuees can get back to their homes to even assess the damage.
• Rebuilding takes money, time, materials, and workers—all of which can be in short supply.
• Families may take in relatives while they look for other housing, which can be stressful for everyone.
• People may be out of work if their employers are rebuilding or if they cannot make it to their jobs.
• Parents may have to enroll children in new schools if the family was forced to relocate.
• New physical health problems may need attention and pre-existing health problems can be made worse by stress.

The same type of disaster may also occur many times in a person's life. For example, people who remain in a community that is prone to fires or live in “hurricane alley” have a chance of experiencing the same disaster many times. A strong connection to place can be both a strength and a vulnerability in someone who lives in a community that is prone to disasters.

Long after danger has passed, everyday sights, sounds, and events may serve as regular reminders of the disaster. For example, the sound of fire trucks, high winds, and thunderstorms can serve as regular reminders of memories well after a fire, tornado or flood has occurred.

Coping After a Disaster: Immediate Needs

After a disaster, people's reactions, needs and priorities will vary depending on many factors. When the disaster has caused injury, threat to life, evacuation or displacement, large-scale property damage, separation from loved ones, extreme loss, or perception of ongoing health risks, people may require more psychosocial support because they are more likely to be significantly distressed.

In the immediate aftermath of any disaster, most people have a core set of priorities that are related to 5 key needs:

• Reestablishing a sense of safety
• Regaining control and calm
• Connecting with loved ones and others
• Getting through the crisis
• Feeling hope, optimism, faith, or the belief that things will work out

In general, anything you can do to help yourself or others move towards reestablishing a sense of safety, calm, connectedness, and hope can support recovery. Keep in mind that feelings of distress in the aftermath of disasters cannot be resolved by a single act or a simple fix. But there are some important principles to remember:

• There’s no “right way” to deal with these things. We each need to find the way that works for us, and be patient in applying simple, ongoing strategies.
• Talk when you need to; listen when you can. It sometimes helps to hear the perspectives of other people who share your values and experiences. Take what helps and leave the rest.
• You don’t have to talk when you don’t feel like it. Survivors sometimes do better when they are given space. If you are the loved one of a survivor, respect the survivor’s desire not to talk if that is what they want. Give them space, and check back later.
• Resilience—being able to adapt to what life presents—often means rolling with the punches. Disasters highlight the forces in life that are much bigger than we are, and remind us that there’s only so much we can do.
• Social support is key. Positive social support plays a crucial role in helping people recover from threat, trauma, and adversity. Reconnect with those you feel closest to or reach out to others who have had similar experiences or who are caring and wise.
• Give it time. Resilience means that you bounce back in the time; it doesn’t mean that you never feel the impact of traumatic events. Learning to accommodate (or adjust or adapt to) the things you experience is a continual process.

Coping After a Disaster: Long-Term Needs

Most people who experience a disaster will recover. Having symptoms in the immediate aftermath does not mean that you will have symptoms forever. People who lost a loved one, were injured or became homeless are more likely to have longer-term reactions.

Recovering can take time, and it may require you to learn how to adapt in new ways. What you need in the long term may be different from what helped you immediately after the event. Below are some strategies to help you continue to recover over time.

Strategies for managing ongoing distress

As time moves on, if you still feel distressed or have trouble functioning, it is important to continue with general self-care activities. You may also want include some of the following strategies:

• Safety. To lessen worries, it can help to stay focused on specific routines of day-to-day living.
• Media Viewing. Turn off the television and take a break from social media if watching coverage of the event is increasing your distress.
• Problem-solving. Take an active, problem-solving approach to ongoing challenges by breaking problems into smaller chunks, brainstorming solutions, and planning for simple, achievable steps towards solutions.
• Positive Activities Scheduling. Try to engage in positive, healthy, or meaningful activities. Doing things that are enjoyable, even if you don’t feel like it, can make you feel better.
• Volunteering. Volunteer work may also be a way to find meaning in helping others and building relationships with people who share your interests and values.
• Managing Emotions. Look for positive coping strategies that help you manage your emotions. Listening to music, exercising, practicing breathing routines, talking with others, spending time in nature or with pets, journaling, or reading inspirational texts are some simple ways to help manage overwhelming or distressing emotions.
• Social Support. Spend time with people who give you a sense of security, calm, or happiness, or those who you feel you can support.
• Helpful Thinking. Reframe or divert your attention by practicing acceptance, prayer, or mindfulness. You can also use humor or try to think through the costs and benefits of holding onto negative thoughts or behaviors and then practice more helpful ways of thinking or acting.
• Meaning Making. Reflect positively on people or aspects of life that you may have lost. Try to find meaningful ways to honor that loss, either on your own or through contact with others. You can also shift your expectations about what is considered a "good day," and reconfirm the people, values, and goals in your life that you realize are most important to you.

There is no standard timeline for recovering from a disaster. Depending on how much the disaster impacted you, it may take a long time to feel better. If you can develop your own ways of adapting to ongoing events and situations, you may gain a stronger sense of being able to deal with challenges, a greater sense of meaning or purpose, or an ability mentor and support others in similar situations.

When to Consider Professional Help

If you are distressed, or unable to function well, consider seeking help.

There are competent and caring professionals available who can effectively treat the most common responses to disaster, like depression, anxiety, PTSD, and complicated grief. The most effective treatments give you tools to problem-solve, mourn and make sense of what happened, deal with numbness or intense emotions, and foster resilience. It is a good idea to try meeting with a mental health professional at least once. The sooner you get help, the sooner you will feel better.

For those in need of more intensive services, research supports trauma-focused psychotherapy for PTSD as an effective treatment following disaster. “Trauma-focused” means that the treatment focuses on the memory of the traumatic event and its meaning. Trauma-focused psychotherapies use different techniques to help you process your traumatic experience. For example, some involve visualizing, talking, or thinking about the traumatic memory. Others focus on changing unhelpful beliefs about the trauma. They usually last about 8-16 sessions.

Learn more about Effective PTSD Treatments or compare treatments using the PTSD Treatment Decision Aid.

Tools and Resources to Help

• PTSD Coach Mobile App
  This mobile app has tools that can help you deal with common reactions after disaster, like, stress, sadness, and anxiety. You can also track your symptoms over time.
• Resources for Survivors and the Public Following Disaster and Mass Violence
  Disaster and mass violence may lead to injury, death, and psychological distress. This page links to information to help affected individuals and loved ones deal with distress that may result from these events.