On Oct. 1, 2017, 64-year-old Stephen Paddock opened fire from his room far above the Mandalay Bay Resort and Casino in Las Vegas into crowds at a country music festival below. In 10 minutes, he killed 58 people, injured more than 850 people and left the country in shock. For those survivors and their families, the effects of this traumatic event fare still palpable.
We spoke with Victor Baumgarten, Ph.D., a licensed clinical social worker at Intermountain Psychiatry and Counseling – St. George (Utah) about what it takes to heal and how social workers can aid survivors.
What some symptoms of post-traumatic stress disorder (PTSD)?
PTSD can develop following a traumatic event or a series of traumatic events and can be experienced by those who experienced the trauma and those who witnessed it. People can also develop PTSD because of what their loved ones experienced and from repeated secondary exposure. Therapists and even the public can develop PTSD from second-hand exposure.
Also, at its most fundamental, PTSD occurs in response to an event or series of events that we are unable to cognitively assimilate or accommodate. An event that is dissonant to our cognitive schema can cause a PTSD response in the victims and witnesses and their loved ones, as well as those who are exposed to repeated detailed accounts of the event.
Treatment for PTSD is usually straight-forward when dealing with a situation the individual can’t assimilate or accommodate. When the traumatic event has been accommodated in a dysfunctional way, the PTSD becomes much more complicated and difficult to treat.
The symptoms of PTSD fall into four categories: re-experiencing, avoidance, negative cognitive and affective symptoms, and arousal/reactivity symptoms.
- Re-experiencing symptoms are more than just having bad memories of the event. Re-experiencing can include recurrent distressing nightmares, flashbacks in which the person feels or acts like they are back in the traumatic event, and intense psychological and physical reactions to triggers.
- Avoidance involves making deliberate efforts to avoid internal and external triggers.
- Negative cognitive and affective symptoms most often appear as emotional numbing and distancing, but it can also include anhedonia (the inability to feel pleasure), dissociative amnesia, self-blame and a constricted affect.
- The arousal symptoms most often appear as insomnia, irritability, hyper-vigilance and an exaggerated startle response.
Finally, and this is really the distinguishing factor, the person is distressed by these symptoms and are having significant impact on how they are functioning socially, academically, at work, or in other areas of their life.
How can social workers help someone suffering from PTSD?
Traumas and the accompanying PTSD fall into two basic categories: simple and complex. Generalist providers can have success treating the former using fundamental talk therapy strategies. Helping the patient therapeutically talk through what they experienced can be enough for many patients.
Complex cases require more specialized training. This would include traumas that were repeated or experiencing a series of traumas. It also includes PTSD in which the individual has adopted dysfunctional world views and ingrained beliefs because of their trauma(s).
Providers need to be honest with themselves and with their patients and avoid trying to practice beyond their training and expertise. Evidence-based PTSD treatments include cognitive processing therapy, prolonged exposure, and trauma-focused EMDR.
Is being a witness to a mass shooting something a person ever recovers from?
Yes and no. It really depends on what “recover” means. If we’re talking about recovering our life before the event happened, then the answer is no because that event is now part of your experience.
If recovering means living a healthy, normal life, then the answer is a resounding YES. That doesn’t mean being free from the memories of what happened. There may always be reminders of what happened, and we may carry physical, emotional and psychological scars, but we can live a healthy life despite those things.
When would survivors need to seek therapy?
Following exposure to a traumatic event, most people will have some of the PTSD symptoms described earlier. Most people will experience a natural recovery in the days and weeks following the event, with symptoms decreasing in frequency and intensity over time.
Seeking help is appropriate when any of the symptoms become debilitating, distressing, or hamper our functioning. That could range anywhere from not being able to sleep to being short with family members to not being able to go out in public. If anything related to the trauma is getting in the way of normal life, get help, whether it’s right after the trauma or many years later.
How can someone heal from such trauma?
There is a lot of truth to the cliché that “time heals all wounds.” Time is one of the most important factors in healing. Often, “watchful waiting” can be an appropriate response.
But just like some physical injuries, some psycho-emotional injuries need more than just watchful waiting and may require medication and therapy. Healing from an injury doesn’t necessarily mean returning to our previous baseline. Sometimes pain lingers, and sometimes we have scars and functional limitations. Healing is about living the healthiest life we can with what has happened to us.
PTSD is a common part of our vernacular. There is an anti-thesis to post traumatic stress that we don’t talk much about. Trauma does not necessarily result in post-traumatic stress. The goal of therapy is to move from post traumatic stress to post-traumatic growth.
What are some signs that survivors should look out for?
We can distill the signs down to two factors: time and energy. If we are spending too much time or too much energy dealing with our reaction to the event, we may need help. How much is too much? That’s subjective, and sometimes we need to trust our family and friends to help us know if we’re spending too much time or energy on it.
Will the anniversary of this event be a trigger for years to come?
It can. The severity of the event and our proximity to the event will impact how significant that date is to us. The anniversary of traumatic events may become significant to us. It’s up to us, however, if these anniversaries are focused on our trauma and victimization or if they are focused on memorializing loses and focusing on our resilience.
Victor Baumgarten, Ph.D., is a licensed clinical social worker at Intermountain Psychiatry and Counseling – St. George in Utah.
