Making sense of disaster

Many people feel distress in the aftermath of disaster. For most, the distress will settle in the days, weeks and months after the disaster, and the recovery process is facilitated by their use of adaptive coping strategies and by engaging with family, friends and local support networks. The strategies people employ to support their recovery varies from person to person, as does the time taken to recover, and it is important that health practitioners do not interfere with naturalistic recovery processes. However, health practitioners should be alert to circumstances in which disaster-impacted individuals report that their distress remains intense, or becomes worse with time. Listen also for indications that individuals are thinking about the disaster (or its aftermath) in snap shots, often focusing only on the most distressing or upsetting aspects of the disaster. Focusing on snapshots instead of the whole experience contributes to feeling “stuck”, and prevents distress from fading. Also be alert to the possibility of the development of frank mental health disorders, and either employ routine clinical assessment strategies and treat appropriately, or refer to a general practitioner or specialist mental health practitioner for assessment and ongoing support.

Provide psychoeducation

Encourage understanding of the importance of making sense of disaster experiences. Terms such as “processing”, “sorting through”, “organising” and “coming to terms with” can be employed. There are two goals. The first is to reduce reliance on avoidant coping by encouraging opportunities to engage with the memory and to sit with associated thoughts and feelings. The second goal is to reduce focus on the most distressing “snap shots” of the disaster by putting all of the pieces or fragments of memory relating to the event together and in sequence. Both often occur naturalistically during everyday conversations and moments of personal reflection. By better organising memory fragments, thoughts, feelings and reactions to the disaster, or other troubling events/situations, the overall memory becomes clearer and more structured, and interpretations of the event can become more balanced, or less distressing or frightening. Making sense of disaster in this way can support a broader recovery process.

Where individuals find the process of recalling disaster events overwhelming and respond with a persistent pattern of avoidance, more structured opportunities for engagement can be encouraged, and taking opportunities to write about the disaster experience is often helpful. It is important that disaster-impacted individuals understand that starting the process of writing about their experience in detail can temporarily increase distress. The steps below provide guidance about how to approach a writing task step by step.

Commence the writing task

Encourage the individual to choose a distressing memory, troubling or upsetting issue to write about. This might relate to the disaster itself (e.g., seeing the house burn down; trying to find the kids when it was time to go), or it could be something that has happened subsequent to the disaster (e.g., engaging with contractors to rebuild house; negotiating with work to return to work; losing livelihood as result of fires) or something else that is troubling them (e.g., dealing with a neighbour).

In writing about their experiences, there are a number of aspects to the process that may be helpful to consider:

1. Ask the individual to commence their writing in a quiet location free from distractions. If they are not a confident writer, then they can also record their story on a voice recorder (like the ones found on mobile phones).
2. In selecting the memory or issue they wish to write about, ask the individual not to focus only on facts but also their thoughts, feelings, worries, reactions or what they have found most distressing about the event or experience.
3. Where new details become apparent, or changes to the sequencing of events becomes obvious encourage the writing of multiple transcripts on separate occasions, and to continue with the process until the memory feels “complete” and “organised”.
4. Encourage the individual to look for a broader context and to include details even if they feel peripheral.]
5. Encourage participants to re-read their written story on multiple occasions, and explain that this will help them to process what has happened and become less distressed when they think about it.
6. Let them know that they can take a break from writing if they need to and then return to it later on.
7. As re-writing or re-reading continues, encourage reflection on what the experience means to the individual now
8. At the conclusion of each writing activity, if distress remains high, advise individuals that they may benefit from the use of distress management strategies such as controlled breathing, here and now grounding techniques or progressive muscular relaxation. Scheduling a pleasant activity such as a walk, craft work or meeting a friend after conclusion of the writing task may also be helpful.
9. Finally, reinforce that the written story is for the individual alone, and is confidential. No one gets to read the written material unless the disaster-impacted individual requests it.

‘Processing’ disaster events takes time. Changes in meaning and reductions in distress do not occur quickly, and evidence of those changes can be difficult to recognise. Writing about disaster events may also prompt individuals to talk more about their experiences, thoughts, feelings and reactions. Health practitioners may themselves be sounding boards for that process, or they may encourage individuals to engage with others during this time. It is helpful to remember that social connectedness is an important predictor of outcome. Health practitioners should also be alert to the possibility of worsening mental states, and be prepared to refer to general practitioners or specialist mental health providers as necessary.

Recommended reading list:

• Janoff-Bulman, R. (2010). Shattered assumptions. Simon and Schuster.
• Resick, P. A., Monson, C. M., & Chard, K. M. (2016). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Publications.