Helping employees after an incident: traumatic stress reactions – looking under the surface

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Published: Friday, 04 August 2017 08:06

Business as usual does not commence once an incident is over and business processes are running normally: the impacts on employees may just be starting. Dr Liz Royle provides some guidance on this difficult area…

Following a potentially traumatic incident in the workplace such as a sudden death, serious accident, violence or ‘near-miss’, the responsibility for identifying those affected, and offering appropriate support, usually falls to line managers and team leaders but just how easy is it for them to recognise where support is needed? When something happens that is distressing, unexpected and shocking, many people will experience a reaction that can be unpleasant, disturbing and potentially overwhelming. However, their internal reaction does not always look the same as what is displayed on the surface.

We are all different.

Following an armed robbery during which employees were threatened with machetes, this group* reacted in seemingly very different ways.

• Alison was visibly distressed. She found it hard to stop crying and kept going through the ‘what-ifs?’ A week later, she’s still tearful and sleeping poorly. Her manager has offered support via the company’s employee assistance programme which Alison has gratefully accepted.
• Kerry was quiet and withdrawn straight after the event. She considers herself a stoic, self-sufficient individual and now says she just wants to forget about what happened and ‘move on’. She looks tired and seems to have lost weight.
• Bill previously served in the Armed Forces and was keen to get on with the job of restoring normal operations. He was seen laughing with police officers at the scene and seemed to revel in the challenge of what had happened. He has been quite snappy with others over trivial issues but this is not entirely out of character for him.
• Julie was, and remains, furious and angrily asks questions about how this could happen. She is looking for someone to blame and demanding security is increased.
• Paul was shocked. He looked pale and clammy and his breathing was shallow immediately after the robbery. He remains easily startled by loud noises and sudden movements. He doesn’t feel safe and is worried that something else is going to happen. He’s certainly not coming back to work in a hurry.

None of these reactions are unusual and, although on the surface they seem very different, they actually have a lot in common if we consider them in terms of the human survival response.

What lies behind the reactions?

During a traumatic event, the brain suppresses feelings as it focuses on dealing with the threat. Emotions that were suppressed at the peak of danger will surface later – Alison’s tearfulness, Paul’s anxiety, Julie’s anger, even Bill’s laughter can all be examples of this venting. It can be helpful to express emotions if it leads to appropriate support and comfort from those around us. For those who are more comfortable with this it can feel like a very natural and healthy reaction. Others may feel an increasing lack of control and fear of overwhelm. Their reaction itself becomes a source of anxiety.

Also during the incident, stress hormones flood the body and prepare people to deal with the danger. It can take some time for levels to reduce and there may continue to be surges of them as people are reminded of what happened. Alison’s sleep is disturbed as her body remains agitated. She’s unlikely to be the only one and Julie’s levels of anger would almost certainly prevent her sleeping well. Kerry may be finding her appetite is disturbed along with her sleep. Paul’s anxiety and exaggerated startle response are very common signs that the brain’s alarm system is still ringing. It’s not unusual for people to remain hyper-sensitive to further threat for some time.

The brain will have taken in a mass of sensory data that needs to be processed and made sense of. Alison found herself thinking about the event when she didn’t mean to and going through the ‘what ifs?’ Julie is trying to regain control through finding a reason for what happened – someone to blame and changes that can be made. Bill is similarly trying to regain his sense of control through action. He probably recognises that this strategy soothes feelings of helplessness and disempowerment that may have been experienced during the incident.

Following a traumatic event, the last thing we want to do is repeat the experience. This may involve avoiding conversations and people associated with it – such as Kerry’s withdrawal – or staying away from places that are associated with danger – such as Paul’s reluctance to go to work. We may also use defences such as Kerry’s denial of a problem, Bill’s gallows humour and keeping busy. In the short term these can help to prevent us experiencing uncomfortable thoughts and feelings.

In reality, there will be a mix of these reactions with differing intensity and duration. For some people, symptoms will be acute and very distressing whilst others will have little or no reaction. We are all individuals with unique histories, present circumstances and interpretations of what happened.

In the majority of cases, the reaction we have will subside over time as we gradually come to terms with the experience and its effects. Good social support and education about trauma reactions are important and both are clinically proven to facilitate this recovery.

The dark side of the trauma reaction

Although mental health professionals emphasise that traumatic stress is a normal part of the human survival response, this doesn’t mean we should become complacent or even ignore it. For many complex reasons, recovery can be delayed or prevented. Symptoms can remain distressingly high, prevent usual functioning and even pose a risk to the safety of individuals and those around them.

Where the stress response remains chronically active, triggered by reminders of what happened, physical ailments may appear or be exacerbated. As sleep and appetite remain disrupted, fatigue sets in and resilience drops.

An inability to process what happened can lead to persistent nightmares, reliving of the event and continuous, unwanted, thoughts about it.
Avoidance can lead to long term sickness, withdrawal from others at a time when their support is crucial and the breakdown of relationships.

The brain must balance thinking about the event in order to make sense of it whilst avoiding becoming overwhelmed by the distressing memory. More hormones may be produced that will numb our feelings and allow us to function. This can however lead to chronic numbing, inability to experience pleasurable feelings and depression.

Severe and chronic trauma reactions are associated with abuse of alcohol or drugs, self-harm and suicide. It’s therefore crucial that those who would benefit from professional support are helped to access this.

Offering support to those affected

Research over many years consistently shows that

• Stigma leads to suppression and denial of a problem;
• Those who most need help are least likely to seek it;
• In the general population, less than half of people with mental health symptoms seek treatment. In high risk organizations such as the emergency services this can be around 30 percent, meaning 70 percent do not access support.

Many people can’t relate to having a problem – they just don’t see themselves as ‘that kind of person’ and / or don’t believe that counselling or psychotherapy would help. This inevitably means that symptoms will be hidden and may take several weeks, months or even years to surface.

The earlier scenarios are typical of many people’s reactions to a traumatic event but determining who needs support is complex. What happens on the surface doesn’t always reflect the internal picture. Who would you be most concerned for? In reality, we all make judgments based on what we observe. And we all try and portray an image that we believe is socially acceptable!

Often the immediate response following an incident is to check how people are and offer help to those who request it or appear outwardly distressed. Many are not ready to accept help at that point and get forgotten as life moves on. It is estimated that around 15 percent of serious trauma reactions will be delayed. Most of us are familiar with the concept of delayed grief. Often individuals put their grieving on hold as they support others, avoid feeling the pain or get busy with practicalities. For some, it may be years before that grief is triggered perhaps by a lesser loss and suddenly it’s all coming out. It can become harder to ask for help the longer it takes. There is an expectation that everyone has moved on.

There may be a subtle, chronic deterioration as the person struggles ever harder to contain what is happening on the inside. This subtle deterioration may mean that changes are not attributed to a particular event and people become ‘the problem employee’.

A bad attitude
If someone threatens us, the human instinct is to fight or flee, resulting in the associated emotions of fear or anger. Sometimes it’s not possible to direct our righteous anger at the real cause of an incident. Perhaps the perpetrators are unknown or not yet apprehended. In such cases, it’s not unusual for the organization or managers to have the focus projected on to them – as in Julie’s case. This anger may come out more subtly through a ‘don’t care’ attitude or general irritability, mistrust and cynicism. The first real indication may be someone becoming the subject of complaints about performance or attitude. Ironically, we often feel least inclined to help those who make our own lives difficult!

Poor performance
Chronic trauma reactions can lead to fatigue and physical ailments which in turn can lead to poor sickness records. Persistent lateness may be caused by lack of sleep and general fatigue may be viewed as a lack of motivation or apathy. There may be a real disinterest in work. Traumatic events often mean that life has been turned on its head and personal values are reassessed. Particularly if we have felt our lives were at risk, we can wonder what the point is of sales targets and mission statements. High levels of stress hormones have a direct impact on our ability to focus, concentrate, remember and make decisions. This may lead to accidents and errors or a perceived sloppiness and disregard for work.

Poor assessment of risk
When our alarm system has failed to reset correctly, we may over-estimate risk. Just as Paul continues to feel danger is present, so the police officer is more likely to shoot a suspect or a prison officer use extreme methods of retaining a prisoner. Trauma breeds more trauma. The other side of this changed attitude towards risk is the reckless behaviour fuelled by ambivalence about life that is often seen in severe trauma reactions. It ranges from driving too fast, being promiscuous, taking unnecessary risks, drug and alcohol abuse right through to suicidal and homicidal ideation.

Not a team player
There will inevitably be an impact on how we relate to others if we do not address a trauma reaction. Going back to our employees from the example – their different coping styles have the potential to cause friction. Kerry’s withdrawal may extend to her colleagues and she may brush off their attempts to talk to her. Paul may feel overwhelmed by Julie’s anger, Bill frustrated by Alison’s tearfulness, with Alison feeling in turn unsupported by Bill. Controlling behaviour may be seen as bullying, particularly if the person has become more irritable or snappy. On the other hand, the alarm system encourages us to continually look for threat from others and this can generalise into perceptions of being bullied.

This isn’t to say that trauma lies behind every problem in the workplace!

But where there has been a traumatic event, we should be vigilant to the possibility of less obvious symptoms. Often help is only sought when the individual reaches a personal crisis and is no longer able to contain the reaction but the clues are usually there in hindsight as the reaction has been ‘leaking’ out.

Managing the psychological impact of a traumatic incident requires a good awareness and the commitment to spending time considering employees’ welfare. This must come from the top down especially in high risk environments. A cultural commitment to doing it properly needs to be made. If managers are already under time constraints to restore operational functioning it is all too easy to miss the less obvious signs until they have created a whole new crisis of their own. When organizations only consider a small range of reactions in a short range of time – usually those visibly distressed in the first week – then they are truly paying lip service to the issue.

*All names changed.

The author

Dr Liz Royle is an international author and speaker with substantial experience of the strategic management of trauma and proactive and responsive interventions for high risk organizations. Her professional experience of trauma was cemented during her time as senior welfare officer for Greater Manchester Police providing 24/7 critical incident interventions to police officers, developing post-incident procedures and managing responses to major incidents such as line of duty deaths and multiple fatalities. She was the lead person for the European Society for Traumatic Stress Studies (ESTSS) Managing Trauma in the Uniformed Services task force for eight years. Since leaving the police service in 2004, she took her skills and knowledge into the private, corporate and voluntary sectors. Dr Liz Royle has written trauma support policies for city councils, police forces and security companies and provided strategic and crisis response support to organizations affected by acts of terror, natural disasters, deaths, violence and serious accidents.

Dr Liz Royle will be speaking at BCI World in November.

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