Disasters affect many people in different ways. People may die or get hurt and a community may be left with great damage. Learn about common reactions and types of stress that can continue after disasters. There are tips for how to cope in the short- and long-term and when to consider getting help.

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 affect 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 hurricane, 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 hurricane. 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 hurricanes 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 five 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 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 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. Here 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. But 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 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 animals, 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 psychotherapy is a broad term that refers to several specific psychotherapies for PTSD.

“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.

Natural and human-caused disasters affect thousands of people each year. Major adverse events such as these have the potential to cause catastrophic loss of life and physical destruction. They are often unexpected and can leave whole communities in shock.

People who live through a disaster can experience emotional distress. Feelings of anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses to disasters before, during, and after the event. Many people are able to “bounce back” from disasters with help from family and the community, but others may need additional support to cope and move forward on the path of recovery. Anyone can be at risk, including survivors living in the impacted areas and first responders and recovery workers.

Natural Disasters

Natural disasters are large-scale geological or meteorological events that have the potential to cause loss of life or property. These types of disasters include:

• Tornadoes and Severe Storms
• Hurricanes and Tropical Storms
• Floods
• Wildfires
• Earthquakes
• Drought

Severe storms and floods are the most common types of natural disasters reported in the United States. These meteorological events are occasionally preceded by presidential “emergency declarations” requiring state and local planning prior to the event, such as evacuations and protection of public assets. Disaster Distress Helpline staff are available to speak to those who call or text before, during, and after a natural disaster.

Human-Caused Disasters

Examples include industrial accidents, shootings, acts of terrorism, and incidents of mass violence. As with natural disasters, these types of traumatic events may also cause loss of life and property. They may also prompt evacuations from certain areas and overwhelm behavioral health resources in the affected communities.

In the aftermath of the tragic loss of life that occurred on September 11, 2001, the feelings of loss of security and well-being—arguably the most crucial ingredients for leading a happy, healthy life—dramatically affected the citizens of the United States. Disaster Distress Helpline staff are also trained to respond to calls or texts related to these types of disasters.

• Incidents of Mass Violence

Other Incidents of Mass Trauma

Infectious disease outbreaks, incidents of community unrest, and other types of traumatic events can also bring out strong emotions in people.

The outbreak of Ebola affecting several countries in West Africa, with limited reported cases in the United States and other countries, may lead to feelings of anxiety and confusion, even to the point where it can interfere with one’s regular routine. Community upheaval, such as that seen in Ferguson, Mo., can also impact emotional health. News reports and the 24-hour news cycle can make people even more anxious when these kinds of events occur.

Tornadoes are outgrowths of powerful thunderstorms that appear as rotating, funnel-shaped clouds. They extend from a thunderstorm to the ground with violent winds that average 30 miles per hour. Also, they can vary in speed dramatically from being stationary to 70 miles per hour. With a loud roar that sounds similar to a freight train, tornadoes in the United States typically are 500 feet across and travel on the ground for five miles. Every state is at some risk from tornadoes and the severe storms that produce them. These same destructive storms also cause strong gusts of wind, lightning strikes, and flash floods.

Tornadoes can strike quickly with little or no warning, giving those in impacted areas barely enough time to take shelter. Because of the unpredictable nature of tornadoes and severe storms, it’s normal for people to experience emotional distress. Feelings such as overwhelming anxiety, trouble sleeping, and other depression-like symptoms are common responses to these types of disasters. Other signs of emotional distress related to tornadoes and severe storms include:

• Worrying a lot or feeling guilty but not sure why
• Feeling helpless or hopeless
• Thinking that something is going to happen when forecasts for any storm are issued
• Constant yelling or fighting with family and friends
• Having nightmares or thoughts and memories related to the storm

Symptoms of distress may appear before, during, and after a tornado or severe storm and may manifest in the hours, days, weeks, months, or even years after the storms occur.

Who is at Risk for Emotional Distress?

People at risk for emotional distress due to the effects of tornadoes and severe storms include:

• Tornado survivors. People living in impacted areas, particularly children and teens, previously exposed to traumatic, life-threatening situations during a tornado or severe storm are vulnerable to distress.
• Friends and loved ones. It's normal for friends and family members located outside the impacted area to feel anxious about people who are in direct proximity to a tornado or severe storm.
• First responders and recovery workers. These individuals may experience prolonged separation from loved ones (depending on the severity of the tornado or storm) and show signs of mental fatigue.

Once warnings for tornadoes or severe storms are issued, the risk for distress becomes greater. It's normal to feel unprepared, overwhelmed, or confused, particularly if you are not at home or lack a storm shelter. You may also feel isolated due to telephone or electric power outages, or if you are separated from friends or family members.

Returning to a home, business, school, or place of worship impacted by a tornado or severe storm may cause additional distress, especially if there is structural damage. A temporary or permanent loss of employment may also occur.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain smells or sounds, such as smoke or sirens, can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it's about to happen again. These “trigger events” can happen at any time.

Most people who experience disasters are able to recover quickly, but others may need additional support to move forward on the path of recovery. Finding ways to manage stress is the best way to prevent negative emotions from becoming behavioral health issues.

Hurricanes are types of tropical storms that form in the southern Atlantic Ocean, Caribbean Sea, Gulf of Mexico, and eastern Pacific Ocean. Hurricanes affect millions of people who live along the Atlantic and Gulf of Mexico coasts each year. Parts of the Southwest United States and the Pacific Coast can also experience severe weather associated with hurricanes, which include tornadoes, floods, and heavy winds.

Hurricane Michael in 2018 created life-threatening conditions for residents, including prolonged power outages, storm surges, and municipal service disruptions.

It’s normal for hurricanes to cause people to experience emotional distress. Feelings such as overwhelming anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses before, during, and after these types of storms. Other signs of emotional distress related to hurricanes include:

• Fearing that forecasted storms may develop into a hurricane even when the chances they will are low
• Constant yelling or fighting with family and friends
• Having thoughts, memories, or nightmares related to the storm that you can’t seem to get out of your head

These are just a few warning signs of disaster-related distress. Learn more about warning signs and risk factors for emotional distress related to hurricanes and other disasters.

Who is at Risk for Emotional Distress?

Forecasts for hurricanes and tropical storms can last for days as they take shape. People living in hurricane-prone areas as well as anyone who has struggled to recover from experiences with past storms may be vulnerable to distress before the event occurs. Other people at risk for emotional distress due to these types of storms include:

• Children and teens. After a hurricane, young people may worry that another tropical storm will happen again. They may become overly dependent, have trouble eating and sleeping, or show physical symptoms such as stomachaches and headaches.
• Older adults. Older adults are more likely to need social support to reduce the effects of stress and move forward on the path of recovery. Some older adults may also be dealing with the loss of physical capabilities and possibly independence.
• First responders and recovery workers. These individuals may experience prolonged separation from loved ones (depending on the severity of the storm or hurricane) and show signs of mental fatigue.

Once warnings and evacuation orders are issued, the risk for emotional distress becomes greater:

• You may feel unprepared, isolated, overwhelmed, or confused. Uncertainty about where to go during a hurricane, how to keep your pets safe, or whether you will be able to continue taking any medications can cause emotional distress.
• You may lose contact with a loved one in an impacted area due to power and Internet outages.
• You may experience difficult memories and emotions associated with similar traumatic experiences in the past.
• If you are relocated, being in an unfamiliar environment can be difficult, especially for people with limited physical mobility, economic means, or knowledge of the English language.

Returning to a home, business, school, or place of worship impacted by a hurricane may cause additional distress, especially if there is structural damage. A temporary or permanent loss of employment may also occur.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain smells or sounds, such as smoke or sirens, can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it’s about to happen again. These “trigger events” can happen at any time.

People can experience a wide range of emotions before and after a disaster or traumatic event. There’s no right or wrong way to feel. However, it’s important to find healthy ways to cope when these events happen. Learn about coping tips for dealing with hurricanes, tropical storms, and other types of disasters.

Floods are one of the most common hazards in the United States. They occur when land that is normally dry experiences an overflow of water. Several events cause floods, including hurricanes and tropical storms, failed dams or levees, and flash floods that occur within a few minutes or hours of excessive rainfall.

Although coastal areas are more vulnerable to floods, particularly during hurricane season, they can occur anywhere and can vary in size and duration. Even very small streams, gullies, and creeks that may appear harmless in dry weather can flood.

The physical destruction of a flood can vary, with some carrying away everything in its path, including houses, bridges, cars, and even people who may be trapped or wading in water. Further, the economic loss from hazardous flood conditions can be significant.

It’s normal for people to experience emotional distress during a flood. Simply anticipating the possibility of what could be lost or destroyed during a flood can cause people to experience overwhelming anxiety or lose sleep. Other signs of emotional distress related to floods include:

• Feeling helpless or hopeless
• Fearing that forecasted storms may develop into a hurricane, even when the chances they will are low
• Constant yelling or fighting with family and friends
• Excessive absences from work or school
• Having thoughts and memories related to the flood that you can’t get out of your head

Who is at Risk for Emotional Distress?

People at risk for emotional distress due to the effects of floods include:

• Flood survivors. People living in impacted areas, particularly children and teens, previously exposed to traumatic, life-threatening situations during a flood. These people may also have once been displaced.
• Friends and loved ones. It’s normal for friends and family members located outside the impacted area to feel anxious about people who are in direct proximity to a flood.
• First responders and recovery workers. These individuals may experience prolonged separation from loved ones (depending on the severity of the flood) and show signs of mental fatigue.

Once warnings for floods are issued, the risk for distress becomes greater. It’s normal to feel unprepared, overwhelmed, or confused, particularly if you are not at home. You may also feel isolated due to telephone or electric power outages, or if you are separated from friends or family members.

Returning to a home, business, school, or place of worship impacted by a flood may cause additional distress, especially if there is structural damage. A temporary or permanent loss of employment may also occur.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain sounds, such as streaming water or sirens, can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it’s about to happen again. These “trigger events” can happen at any time.

People can experience a wide range of emotions before and after a disaster or traumatic event. There’s no right or wrong way to feel. However, it’s important to find healthy ways to cope when these events happen.

Wildfires are usually triggered by lightning or accidents and often go unnoticed at first. They can spread quickly and are especially destructive if they occur near forests, rural areas, remote mountain sites, and other woodland settings where people live. While not reported as often as floods or tornadoes and severe storms, they, too, can cause emotional distress in people living in affected areas.

Feelings such as overwhelming anxiety, constant worrying, trouble sleeping, and other depression-like symptoms are common responses before, during, and after wildfires. Other signs of emotional distress related to wildfires include:

• Having thoughts, memories, or nightmares related to the wildfire that you can’t seem to get out of your head
• Worrying a lot of the time; feeling guilty but not sure why
• Excessive absences from work or school

These are just a few warning signs of disaster-related distress. Learn more about warning signs and risk factors for emotional distress related to wildfires and other disasters.

Who is at Risk for Emotional Distress?

People living in areas where wildfires often occur, particularly in communities in Arizona, California, Colorado, Utah, and other states, may be vulnerable to emotional distress. People who have struggled to recover from experiences with past wildfires also may experience distress. Other people at risk for emotional distress due to wildfires include:

• Children and teens. After a wildfire, young people may worry that another one will happen again, especially if they witnessed the fire and the loss of their home. Some children may become withdrawn, while others may become agitated and irritable and display outbursts of anger.
• Older adults. Older adults are more likely to need social support to reduce the effects of stress and move forward on the path of recovery. They also may have limited physical mobility and lack independence.
• First responders and recovery workers. These individuals may experience prolonged separation from loved ones (depending on the severity of the wildfire) and show signs of mental fatigue.

Once warnings and evacuation orders are issued, the risk for emotional distress becomes greater:

• You or your loved ones may feel unprepared, isolated, overwhelmed, or confused. Uncertainty about where to go during a wildfire, how to keep you and your loved ones safe, how to care for your pets, or whether you will be able to continue taking any medications can cause emotional distress.
• You may lose contact with a loved one in an impacted area.
• If you are relocated or lost your house to a wildfire, being in an unfamiliar environment can be difficult, especially for people with limited physical mobility, economic means, or knowledge of the English language.

Returning to a home, business, school, or place of worship impacted by a wildfire may cause additional distress, especially if there is structural damage. A temporary or permanent loss of employment may also occur.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain sounds such as sirens can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it’s about to happen again. These “trigger events” can happen at any time.

People can experience a wide range of emotions before and after a disaster or traumatic event. There’s no right or wrong way to feel. However, it’s important to find healthy ways to cope when these events happen. Learn about coping tips for dealing with wildfires and other types of disasters.

An earthquake is the shifting of the Earth’s plates, which results in a sudden shaking of the ground that can last for a few seconds to a few minutes. Within seconds, mild initial shaking can strengthen and become violent. Earthquakes happen without warning and can happen at any time of year. Certain states are more prone to higher frequency of earthquakes, particularly California, Hawaii, Nevada, and Washington.

Earthquakes are quite common and occur somewhere around the world every day. However, the vast majority are considered minor. The U.S. Geological Survey in 2015 reported more than 3,000 earthquakes in the United States.

Even minor earthquakes that cause little damage and destruction can cause people to experience emotional distress (especially in areas not accustomed to these events). Aftershocks can continue to occur for months afterwards and can be just as stressful.

It’s normal for people to experience emotional distress during an earthquake. Simply anticipating the possibility of what could be lost or destroyed during the event can cause people to experience overwhelming anxiety or lose sleep. Other signs of emotional distress related to earthquakes include:

• Being easily startled
• Having difficulty sleeping or sleeping too much
• Having thoughts and memories related to the earthquake that you can’t get out of your head

Who is at Risk for Emotional Distress?

The following groups are most at risk for emotional distress due to earthquakes:

• Earthquake survivors. People living in impacted areas, particularly children and teens, previously exposed to traumatic, life-threatening situations are especially vulnerable to emotional distress. These people also may have once been displaced.
• Friends and loved ones. It’s normal for friends and family members located outside the impacted area to feel anxious about people who are in direct proximity to an earthquake.
• First responders and recovery workers. These individuals may experience prolonged separation from loved ones (depending on the severity of the earthquake) and show signs of mental fatigue.

Returning to a home, business, school, or place of worship impacted by an earthquake may cause additional distress, especially if there is structural damage. A temporary or permanent loss of employment may also occur.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Sounds such as sirens or the sight of destroyed buildings or cracks in the walls can also trigger emotional distress among earthquake survivors. These and other environmental sensations can take people right back to the event, or cause them to fear that it’s about to happen again. These “trigger events” can happen at any time.

Creating evacuation plans and gathering emergency supplies before an earthquake occurs can give you a sense of control and help you and your loved ones feel more secure in the event of an earthquake.

People can experience a wide range of emotions before and after a disaster or traumatic event. There’s no right or wrong way to feel. However, it’s important to find healthy ways to cope when these events happen.

A drought is a normal, reoccurring weather event that can vary in intensity and duration by region of the country and even by location within a state. Drought occurs when there is lower than average precipitation over a significant period of time, usually a season or more. Other causes of drought can be a delay in the rainy season or the timing of rain in relation to crop growth.

Drought is a slow-moving hazardous event, so the psychological effects of living through this type of disaster are more subtle and last longer than with other natural disasters. Low water availability creates shortages in water supplies that impact various activities and the environment. The impact is even greater as humans place demands on water supplies. Additionally, drought conditions increase the risk of other natural disasters, such as wildfires, and landslides.

Warning signs for emotional distress related to drought may include:

• Feelings of overwhelming anxiety
• Constant worrying
• Trouble sleeping and other depression-like symptoms
• Disputes between people over limited water supplies
• Health concerns related to dust, low water flow, or poor water and air quality
• Financial concerns related to crop failures, low supply and demand of agricultural-related products, or rising food prices

These are common responses to disasters such as droughts, although reactions can vary. Learn more about warning signs and risk factors for emotional distress related to drought and other disasters.

Who is at Risk for Emotional Distress?

Severe and ongoing droughts can have significant economic, environmental, agricultural, health, and social consequences. For example, record high temperatures and very low rainfall in California has resulted in extreme drought conditions since 2012. The drought, considered one of the most severe on record, is crippling California’s water supplies and agricultural industry. Also, the 2012 drought, often compared to the Dust Bowl of the 1930s, impacted 60% of the continental United States and resulted in billions of dollars in agricultural loss.

People at risk for emotional stress due to effects of drought include:

• Farmers, landscapers, garden supply owners, and others working in agriculture and their families. This group already carries a certain amount of stress from working in a business that is dependent on weather or climate conditions for their livelihood. The financial implications of drought can have significant adverse effects as they struggle for economic survival.
• People living in rural or remote areas. These individuals may get water from private wells or poorly maintained municipal systems.
• Older adults. Older adults are typically more prone to heat-related stress and are likely to have chronic medical conditions that change their normal body response to heat.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain sounds such as sirens can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it’s about to happen again. These “trigger events” can happen at any time.

Most people who experience disasters are able to recover quickly, but others may need additional support to move forward on the path of recovery. Finding ways to manage stress is the best way to prevent negative emotions from becoming behavioral health issues. Learn about coping tips for dealing with drought and other types of disasters.

Incidents of mass violence are human-caused tragedies that can impact whole communities and the country at large. These types of disasters, which include shootings and acts of terrorism, often occur without warning and can happen anywhere.

These violent acts typically target defenseless citizens with the intent to harm or kill. They can instill feelings of confusion, fear, and helplessness in survivors. Incidents of mass violence disturb our collective sense of order and safety, and may even impact those with no personal connections to the event.

Because of the unpredictable nature of these types of disasters, it’s normal for people to experience emotional distress. Feelings such as overwhelming anxiety, trouble sleeping, and other depression-like symptoms are common responses to incidents of mass violence. Other signs of emotional distress related to incidents of mass violence may include:

• Feeling numb or like nothing matters
• Feeling helpless or hopeless
• Worrying a lot of the time; feeling guilty but not sure why
• Feeling like you have to keep busy
• Excessive smoking, drinking, or using drugs (including prescription medication)

Symptoms of distress may appear before, during, and after such an event and may manifest in the hours, days, weeks, months, or even years after they occur. These are just a few warning signs of disaster-related distress. Learn more about warning signs and risk factors for emotional distress related to incidents of mass violence and other disasters.

Who is at Risk for Emotional Distress?

People at risk for emotional distress due to the effects of incidents of mass violence include:

• Survivors. Injured victims as well as bystanders in close proximity to the event are especially at risk for emotional distress.
• Friends and loved ones. It’s normal for friends and family members located outside the impacted area to feel anxious about people who are in direct proximity to an incident of mass violence.
• First responders and recovery workers. These individuals may experience prolonged separation from loved ones during the incident and show signs of mental fatigue.
• Community members. People who live the area surrounding the event may experience emotional distress.

If a terror alert, lockdown notice, or other warning is issued via television, radio, social media, or text alert systems, the risk for emotional distress becomes greater. It’s normal to feel unprepared, overwhelmed, or confused, particularly if you are not at home. You may also feel isolated if you are separated from friends or family members.

Remember, too, that the anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain sounds such as sirens, or large crowds, can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it’s about to happen again. These “trigger events” can happen at any time.

Most people who experience disasters are able to recover quickly, but others may need additional support to move forward on the path of recovery. Finding ways to manage stress is the best way to prevent negative emotions from becoming behavioral health issues. Get coping tips for dealing with emotional distress related to incidents of mass violence and other types of disasters.

If you live in an area hit by a disaster, it is likely you will have an emotional response. There are risk factors that make it more likely you will have ongoing reactions after a disaster. There are also factors that make it more likely you will recover. Resilience factors are things that help you "bounce back" after a traumatic event. Learn about risk and resilience factors and how they affect your ability to cope with disaster.

Every year, millions of people are affected by both human-caused and natural disasters. Disasters may be explosions, earthquakes, floods, hurricanes, tornados, or fires. In a disaster, you face the danger of death or physical injury. You may also lose your home, possessions, and community. Such stressors place you at risk for emotional and physical health problems.

Stress reactions after a disaster look very much like the common reactions seen after any type of trauma. Disasters can cause a full range of mental and physical reactions. You may also react to problems that occur after the event, as well as to triggers or reminders of the trauma.

Risk Factors

A number of factors make it more likely that someone will have more severe or longer- lasting stress reactions after disasters:

Severity of exposure

The amount of exposure to the disaster is highly related to risk of future mental problems. At highest risk are those that go through the disaster themselves. Next are those in close contact with victims. At lower risk of lasting impact are those who only had indirect exposure, such as news of the severe damage. Injury and life threat are the factors that lead most often to mental health problems. Studies have looked at severe natural disasters, such as the Armenian earthquake, mudslides in Mexico, and Hurricane Andrew in the US. The findings show that at least half of these survivors suffer from distress or mental health problems that need clinical care.

Gender and family

Almost always, women or girls suffer more negative effects than do men or boys. Disaster recovery is more stressful when children are present in the home. Women with spouses also experience more distress during recovery. Having a family member in the home who is extremely distressed is related to more stress for everyone. Marital stress has been found to increase after disasters. Also, conflicts between family members or lack of support in the home make it harder to recover from disasters.

Age

Adults who are in the age range of 40-60 are likely to be more distressed after disasters. The thinking is that if you are in that age range, you have more demands from job and family. Research on how children react to natural disasters is limited. In general, children show more severe distress after disasters than do adults. Higher stress in the parents is related to worse recovery in children.

Other factors specific to the survivor

Several factors related to a survivor's background and resources are important for recovery from disaster. Recovery is worse if you:

• Were not functioning well before the disaster.
• Have had no experience dealing with disasters.
• Must deal with other stressors after the disaster.
• Have poor self-esteem.
• Think you are uncared for by others.
• Think you have little control over what happens to you.
• Lack the capacity to manage stress.

Other factors have also been found to predict worse outcomes:

• Bereavement (death of someone close)
• Injury to self or another family member
• Life threat
• Panic, horror, or feelings like that during the disaster
• Being separated from family (especially among youth)
• Great loss of property
• Displacement (being forced to leave home)

Developing countries

These risk factors can be made worse if the disaster occurs in a developing country. Disasters in developing countries have more severe mental health impact than do disasters in developed countries. This is true even with less serious disasters. For example, natural disasters are generally thought to be less serious than human-caused. In developing countries, though, natural disasters have more severe effects than do human-caused disasters in developed countries.

Low or negative social support

The support of others can be both a risk and a resilience factor. Social support can weaken after disasters. This may be due to stress and the need for members of the support network to get on with their own lives. Sometimes the responses from others you rely on for support are negative. For example, someone may play down your problems, needs, or pain, or expect you to recover more quickly than is realistic. This is strongly linked to long-term distress in trauma survivors.

After a mass trauma, social conflicts, even those that have been resolved, may again be seen. Racial, religious, ethnic, social, and tribal divisions may recur as people try to gain access to much-needed resources. In families, conflicts may arise if family members went through different things in the disaster. This sets up different courses of recovery that often are not well understood among family members. Family members may also serve as distressing reminders to each other of the disaster.

Keep in mind that while millions of people have been directly affected by disasters, most of them do recover. Human nature is resilient, and most people have the ability to come back from a disaster. Plus, people sometimes report positive changes after disaster. They may re-think what is truly important and come to appreciate what they value most in life.

Resilience Factors

Human resilience dictates that a large number of survivors will naturally recover from disasters over time. They will move on without having severe, long-lasting mental health issues. Certain factors increase resilience after disasters:

Social support

Social support is one of the keys to recovery after any trauma, including disaster. Social support increases well-being and limits distress after mass trauma. Being connected to others makes it easier to obtain knowledge needed for disaster recovery. Through social support, you can also find:

• Practical help solving problems.
• A sense of being understood and accepted.
• Sharing of trauma experiences.
• Some comfort that what you went through and how you responded is not "abnormal."
• Shared tips about coping.

Coping confidence

Over and over, research has found that coping self-efficacy - "believing that you can do it" - is related to better mental health outcomes for disaster survivors. When you think that you can cope no matter what happens to you, you tend to do better after a disaster. It is not so much feeling like you can handle things in general. Rather, it is believing you can cope with the results of a disaster that has been found to help survivors to recover.

Hope

Better outcomes after disasters or mass trauma are likely if you have one or more of the following:

• Optimism (because you can hope for the future)
• Expecting the positive
• Confidence that you can predict your life and yourself
• Belief that it is very likely that things will work out as well as can reasonably be expected
• Belief that outside sources, such as the government, are acting on your behalf with your welfare at heart
• Belief in God
• Positive superstitious belief, such as "I'm always lucky."
• Practical resources, including housing, job, money

Summing It Up

Disasters can cause both mental and physical reactions. Being closer to the disaster and having weak social support can lead to worse recovery. On the other hand, being connected to others and being confident that you can handle the results of the disaster make mental health problems less likely. Overall, human beings are resilient, and most survivors will recover from the disaster. For those with higher risk factors, self-care and seeking help are recommended.

No matter how well you have prepared, you might feel dazed or numb after going through a disaster. You may also feel sad, helpless, or anxious. In spite of the tragedy, you might just feel happy to be alive.

It is not unusual to have bad memories or dreams. You may avoid places or people that remind you of the disaster. You might have trouble sleeping, eating, or paying attention. Many people have short tempers and get angry easily. These are all normal reactions to stress.

Sometimes the stress can be too much to handle alone. Some people have long-term problems after a disaster, including

• Post-traumatic stress disorder
• Depression
• Self-blame
• Suicidal thoughts
• Alcohol or drug abuse

If your emotional reactions are getting in the way of your relationships, work, or other important activities, talk to a counselor or your doctor. Treatments are available.

Many people find it hard to resist news of traumatic events, such as disasters and terrorist attacks. As awful as it is to watch and read about, many still cannot turn away. Why is this kind of news so hard to resist? Some say it is because people are trying to inform themselves to be prepared in case of future disaster or attacks. Others say that people are watching and reading news in an effort to understand and process the event. Still others say the media is trying to draw you in with exciting images almost like those from an action movie. Whatever the reason, we need to understand the effects that this type of news exposure may have.

Watching Traumatic News Is Related to Stress

Research tells us there is a link between watching news of traumatic events, such as terrorist attacks, and stress symptoms. It could be that watching television of the event makes people worse. It could also be that people who have more severe stress reactions are the ones who choose to watch more television about the event. Here are some examples that show the link:

• Research after the September 11th, 2001, terrorist attacks found that in the first few days, adults watched an average of eight hours of television related to the attacks. Children watched an average of three hours of television related to the attacks. Older teens watched more than younger children. In both children and adults, those who watched the most coverage had more stress symptoms than those who watched less.
• The Oklahoma City bombing was also widely covered in the news. In adults, watching bomb-related news did not relate to increased PTSD symptoms. On the other hand, children who watched more bomb-related news did have more PTSD symptoms. Of note, for most Oklahoma school children in the weeks after the bombing, the bulk of their television viewing was bomb-related. Links were seen between PTSD symptoms and bomb-related television for children who did and did not lose a close family member in the bombing.
• In Israel, those who watched television clips of terrorism reported feeling more anxiety than those who watched clips that were not related to terrorism.
• Adults who lost close friends or family in the Mount St. Helens tragedy said that the news coverage made it harder for them to recover. Adults who only lost property said that the news neither hurt nor helped them.
• Children from Kuwait had increased PTSD symptoms after viewing gruesome televised images of violence and death related to the Gulf War.

It is still unclear why this relationship exists. Media might both hurt and help those who experience trauma. Having news media present is sometimes a burden on family members. For example, the media may show their personal grief on television. Also, watching news about a trauma may make the victims feel even more helpless. It may fix even more firmly in their minds the images of death and damage.

Positive Role of the Media

Although there may be negative effects, clearly the media plays a vital role after a disaster. The media provides needed information and alerts. Media outlets can direct the public to services for victims and their families. They are a resource for the community. They can also be a source of hope. In some ways, being involved with the media might give survivors a sense of power. This could help offset their feeling helpless after the trauma.

Recommendations about Viewing

You may want to limit the amount and type of news you are viewing if you:

• Feel anxious or stressed after watching a news program
• Cannot turn off the television
• Cannot take part in relaxing or fun activities
• Have trouble sleeping

Some useful tips include:

• Do not watch the news just before bed.
• Read newspapers or magazines rather than watching television.
• Inform yourself by talking to other people about the attack.

Children

The research with children shows even more clearly that watching too much trauma-related television can be harmful. Here are some tips for dealing with children and media exposure:

• Be aware that children in the household may be exposed to traumatic images. It is common for a television to be on for several hours a day in an American household. Adults should be aware of how much news a child is viewing. This may occur even if no adult has decided that the child can watch trauma-related news.
• Parents should talk with the child about what they are seeing on the news. For example, children who watched news about the September 11th attacks may have seen the first plane crash into the building over and over again. These children may have needed it explained to them that they were seeing one single crash that happened on one day, not multiple crashes.
• Put the news into context. Explain that:
  • There are many good people who will do their best to keep them safe if something bad happens. Focus on the firemen and rescue teams and not just on the attack.
  • The news often tells us bad things that happen in the world. Most of the time, though, the country is safe. Most people who fly in airplanes land safely on the ground and have no problems at all.
• Invite children to talk. Above all, parents need to allow and even invite children to ask questions. Children may have misplaced fears after watching a news report. This may be because they did not understand something. If the child shares those fears or asks questions, parents can help explain and comfort. Parents can tell the child that a lot of people are working hard to make things safer for the future.
• Limit the child's news viewing. Some parents do not allow young children to watch the news at all. If news viewing is allowed, experts suggest that parents watch the news WITH their children. Also, if a child seems to be watching too much trauma-related news, the parent can direct the child to other more positive activities.

Sadly, it is true that most reported news is bad news. We don't hear about the planes that land safely every day. Children need to be reminded that what they see on the news does not reflect the way things are most often in our country.

School shootings can erode the sense of safety and security people usually feel. This is true at both an individual and community level. These sudden, tragic events challenge our need to see the world as orderly and controllable. People in the affected communities are forced to adapt to extreme loss or disruptions to their lives. Even those who live far away may find themselves feeling fear, anger and loss.

There are elements that research tells us are related to people doing better through adverse situations. With these 5 elements, you can choose the actions that can help you and your family better cope after a school shooting:

• Increase sense of safety
• Increase calming
• Connect with each other
• Build personal and family competence
• Foster hope

How to Apply the 5 Elements

You can modify these elements based on many factors, including the level of disruption in your life and the age of children in the home. Using them as a guide can help you create your own ways to help your family cope.

Pick some of the following ideas within each of these 5 elements or develop your own. Using them can help your family work through the challenges you are facing. If anyone is having a very hard time and needs more help, know that there are resources available to support recovery.

Increase sense of safety

When families don't feel safe it can feel overwhelming. School shootings can result in an ongoing sense of being threatened, so it is important to increase your sense of safety. It is helpful to give consistent safety messages to your family, such as:

• "We will get through this together."
• "No matter what happens, we will do what we need to do to take care of each other."

Some people feel safer by becoming involved in change efforts, activism or community programs that increase safety. For others, it may be more important to focus on what is in their capacity to control, even if those things seem like small actions.

Increase calming

School shootings can cause anxiety. People may have trouble thinking clearly or sleeping soundly. It is important to help yourself and your family find ways to take breaks and calm down, even momentarily.

• Offer simple calming strategies such as slowed, even breathing, talking through concerns, finding distractions (with books, videos or anything that can take your mind off what is happening), and taking short breaks.
• Try noticing and naming your feelings. Ground your attention by focusing on what you can see, feel and hear in the current moment.
• Understand that feelings such as sadness, anxiety and fear are common and that it's okay to talk about them.
• Think about limiting activities that trigger anxiety—such as checking the news—even if you think they are helpful.

Do your best to let family know that their well-being is one of your priorities. Keep to a routine. Structure helps younger children know what to expect and can be calming. Consider scheduling into your day shared activities that have meaning for your family.

Connect with each other

Be dedicated about connecting with loved ones within and outside the immediate family. Include family members who don't live in your home to make the circle wider.

Build personal and family competence

There are many ways to build competence and develop skills that can help you get through your current challenges. For instance, involve the family in a problem-solving approach to challenges, where you talk through problems; break them down into smaller chunks; brainstorm creative solutions together; negotiate the solutions that will work best for everyone; and take small, steady steps towards your goals.

Role-model competence. Demonstrating patience with yourself will show your children how to do the same. Just being your best self—whatever that best self is in that moment given the circumstances—will inspire others. As you strive to do your best remember to keep your expectations realistic. A crisis can make it hard to keep up our usual standards in what we think, feel, or do. You may need to adapt your expectations of what a good day is, and of what you demand from yourself.

Foster hope

It is natural that families may be scared, in shock, angry, sorrowful or discouraged following school shootings. This is particularly true for those in the communities where the violence took place. Focusing on the ways you and your family are safe or strong can help to foster hope. You can also discuss positive things that you see others doing, ways you believe that the situation will become better with time, or ways in which you are grateful. Ask others in your life to share how they have maintained hope or seen things from a more hopeful perspective. Highlight that many people are working hard to keep schools safe and help people recover.

Many people turn to their values or beliefs as a way to make meaning or raise hope in a difficult time. For some, that might mean helping others or engaging in protest and activism. Others who have faith in a higher power spend more time in activities that foster those beliefs, like prayer, meditation, reading or reflection. Researchers have found that resilient families share open communication about feelings, engage in group problem-solving, make meaning in the face of adversity, share their hopes in overcoming challenges, encourage each other, and work to tolerate uncertainty. They also find ways to transform adversity through beliefs, positive growth, spirituality or religion.

Summary

The strategies you choose can make a difference in maintaining hope, ability to endure, connectedness, ability to remain calm, and sense of safety. As you practice these actions, adapt them to your current circumstances. Do your best from moment to moment and remember that you don't need to be perfect or steady at all times. Try to be kind to yourself and remember that anything you do to role model these strategies will help your children grow and be able to help others as friends or caregivers themselves.

People who are more directly affected by the shooting or those with previous histories of trauma or prior mental health conditions may need to get more tailored or individual support. Meeting with others who have faced similar challenges can help, however, mental health treatment may also be needed. If you feel very distressed or unable to function, contact a medical or mental health provider. There are effective treatments for acute stress disorder, PTSD, and complicated grief—all problems that can develop after a trauma. The sooner you get help, the sooner you will start to feel better.

Stress and Coping

The outbreak of coronavirus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children. Coping with stress will make you, the people you care about, and your community stronger.

Everyone reacts differently to stressful situations. How you respond to the outbreak can depend on your background, the things that make you different from other people, and the community you live in.

People who may respond more strongly to the stress of a crisis include

• Older people and people with chronic diseases who are at higher risk for COVID-19
• Children and teens
• People who are helping with the response to COVID-19, like doctors and other health care providers, or first responders
• People who have mental health conditions including problems with substance use

If you, or someone you care about, are feeling overwhelmed with emotions like sadness, depression, or anxiety, or feel like you want to harm yourself or others call

• 911
• Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746. (TTY 1-800-846-8517)

Stress during an infectious disease outbreak can include

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Increased use of alcohol, tobacco, or other drugs

People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. Additional information can be found at the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Taking care of yourself, your friends, and your family can help you cope with stress. Helping others cope with their stress can also make your community stronger.

Things you can do to support yourself

• Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.
• Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.
• Make time to unwind. Try to do some other activities you enjoy.
• Connect with others. Talk with people you trust about your concerns and how you are feeling.

Call your healthcare provider if stress gets in the way of your daily activities for several days in a row.

Reduce stress in yourself and others

Sharing the facts about COVID-19 and understanding the actual risk to yourself and people you care about can make an outbreak less stressful..

When you share accurate information about COVID-19 you can help make people feel less stressed and allow you to connect with them.

For parents

Children and teens react, in part, on what they see from the adults around them. When parents and caregivers deal with the COVID-19 calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

Not all children and teens respond to stress in the same way. Some common changes to watch for include

• Excessive crying or irritation in younger children
• Returning to behaviors they have outgrown (for example, toileting accidents or bedwetting)
• Excessive worry or sadness
• Unhealthy eating or sleeping habits
• Irritability and “acting out” behaviors in teens
• Poor school performance or avoiding school
• Difficulty with attention and concentration
• Avoidance of activities enjoyed in the past
• Unexplained headaches or body pain
• Use of alcohol, tobacco, or other drugs

There are many things you can do to support your child

• Take time to talk with your child or teen about the COVID-19 outbreak. Answer questions and share facts about COVID-19 in a way that your child or teen can understand.
• Reassure your child or teen that they are safe. Let them know it is ok if they feel upset. Share with them how you deal with your own stress so that they can learn how to cope from you.
• Limit your family’s exposure to news coverage of the event, including social media. Children may misinterpret what they hear and can be frightened about something they do not understand.
• Try to keep up with regular routines. If schools are closed, create a schedule for learning activities and relaxing or fun activities.
• Be a role model. Take breaks, get plenty of sleep, exercise, and eat well. Connect with your friends and family members.

For responders

Responding to COVID-19 can take an emotional toll on you. There are things you can do to reduce secondary traumatic stress (STS) reactions:

• Acknowledge that STS can impact anyone helping families after a traumatic event.
• Learn the symptoms including physical (fatigue, illness) and mental (fear, withdrawal, guilt).
• Allow time for you and your family to recover from responding to the pandemic.
• Create a menu of personal self-care activities that you enjoy, such as spending time with friends and family, exercising, or reading a book.
• Take a break from media coverage of COVID-19.
• Ask for help if you feel overwhelmed or concerned that COVID-19 is affecting your ability to care for your family and patients as you did before the outbreak.

For people who have been released from quarantine

Being separated from others if a healthcare provider thinks you may have been exposed to COVID-19 can be stressful, even if you do not get sick. Everyone feels differently after coming out of quarantine. Some feelings include :

• Mixed emotions, including relief after quarantine
• Fear and worry about your own health and the health of your loved ones
• Stress from the experience of monitoring yourself or being monitored by others for signs and symptoms of COVID-19
• Sadness, anger, or frustration because friends or loved ones have unfounded fears of contracting the disease from contact with you, even though you have been determined not to be contagious
• Guilt about not being able to perform normal work or parenting duties during quarantine
• Other emotional or mental health changes

Children may also feel upset or have other strong emotions if they, or someone they know, has been released from quarantine. You can help your child cope.

It is common to feel stress symptoms before or after a crisis. Natural and human-caused disasters can have a devastating impact on people’s lives because they sometimes cause physical injury, damage to property, or the loss of a home or place of employment. Anyone who sees or experiences this can be affected in some way. Most stress symptoms are temporary and will resolve on their own in a fairly short amount of time. However, for some people, particularly children and teens, these symptoms may last for weeks or even months and may influence their relationships with families and friends. Common warning signs of emotional distress include:

• Eating or sleeping too much or too little
• Pulling away from people and things
• Having low or no energy
• Having unexplained aches and pains, such as constant stomachaches or headaches
• Feeling helpless or hopeless
• Excessive smoking, drinking, or using drugs, including prescription medications
• Worrying a lot of the time; feeling guilty but not sure why
• Thinking of hurting or killing yourself or someone else
• Having difficulty readjusting to home or work life

For those who have lived through a natural or human-caused disaster, the anniversary of the event may renew feelings of fear, anxiety, and sadness. Certain sounds, such as sirens, can also trigger emotional distress. These and other environmental sensations can take people right back to the disaster, or cause them to fear that it’s about to happen again. These “trigger events” can happen at any time.

Children are often the most vulnerable of those impacted during and after a disaster. According to the National Child Traumatic Stress Network, a growing body of research has established that children as young as infancy may be affected by events that threaten their safety or the safety of their parents or caregivers.

Disasters are unfamiliar events that are not easily understood by children, who can find them emotionally confusing and frightening. During the time of turmoil, they may be left with a person unfamiliar to them and provided with limited information. Some warning signs of distress in children ages 6 to 11 include:

• Withdrawing from playgroups and friends
• Competing more for the attention of parents and teachers
• Being unwilling to leave home
• Being less interested in schoolwork
• Becoming aggressive
• Having added conflict with peers or parents
• Having difficulty concentrating

For teens, the impact of disasters varies depending on how much of a disruption the disaster causes their family or community. Teens ages 12 to 18 are likely to have physical complaints when under stress or be less interested in schoolwork, chores, or other responsibilities.

Although some teens may compete vigorously for attention from parents and teachers after a disaster, they also may:

• Become withdrawn
• Resist authority
• Become disruptive or aggressive at home or in the classroom
• Experiment with high-risk behaviors such as underage drinking or prescription drug misuse and abuse

Children and teens most at risk for emotional distress include those who:

• Survived a previous disaster
• Experienced temporary living arrangements, loss of personal property, and parental unemployment in a disaster
• Lost a loved one or friend involved in a disaster

Most young people simply need additional time to experience their world as a secure place again and receive some emotional support to recover from their distress. The reactions of children and teens to a disaster are strongly influenced by how parents, relatives, teachers, and caregivers respond to the event. They often turn to these individuals for comfort and help. Teachers and other mentors play an especially important role after a disaster or other crisis by reinforcing normal routines to the extent possible, especially if new routines have to be established.

Adults impacted by disaster are faced with the difficult challenge of balancing roles as first responders, survivors, and caregivers. They are often overwhelmed by the sheer magnitude of responsibility and immediate task of the crisis response and recovery at hand. They must also take the time to address their own physical and emotional needs as well as those of their family members and community.

Warnings signs of stress in adults may include:

• Crying spells or bursts of anger
• Difficulty eating
• Losing interest in daily activities
• Increasing physical distress symptoms such as headaches or stomach pains
• Fatigue
• Feeling guilty, helpless, or hopeless
• Avoiding family and friends

Adults most at risk of experiencing severe emotional stress and post-traumatic stress disorder include those with a history of:

• Exposure to other traumas, including severe accidents, abuse, assault, combat, or rescue work
• Chronic medical illness or psychological disorders
• Chronic poverty, homelessness, or discrimination
• Recent or subsequent major life stressors or emotional strain, such as single parenting

Adults most at risk for emotional stress include:

• Those who survived a previous disaster
• Those who lost a loved one or friend involved in a disaster
• Those who lack economic stability and/or knowledge of the English language
• Older adults that may lack mobility or independence

As with children and teens, adults also need time to get back into their normal routine. It is important that people try to accept whatever reactions they have related to the disaster. Take every day one-at-a-time and focus on taking care of your own disaster-related needs and those of your family.

First responders and recovery workers include:

• Fire fighters, police officers, emergency medical technicians, 911 operators, and other fire, emergency, and medical personnel
• Military service men and women
• Clergy
• Staff and volunteers serving with disaster-relief organizations, including sheltering, animal rescue, food service, and crisis counseling

First responders and recovery workers are not only physically and emotionally tested during an emergency, but they also may have loved ones in the area for whom they are concerned. They also are often the last to seek help for work-related stress.

Warnings signs of stress in responders and recovery workers may include:

• Experiencing a rapid heart rate, palpitations, muscle tensions, headaches, and tremors
• Feeling fear or terror in life-threatening situations or perceived danger, as well as anger and frustration
• Being disoriented or confused, having difficulty solving problems, and making decisions
• Engaging in problematic or risky behaviors, such as taking unnecessary risks, failing to use personal protective equipment, or refusing to follow orders or leave the scene
• Becoming irritable or hostile in social situations, resorting to blaming, and failing to support teammates

First responders and recovery workers most at risk for emotional distress include those who have experienced:

• Prolonged separation from loved ones
• Life-threatening situations
• Previous deployments that caused disruptions in home or work life
• Trauma from having witnessed or been exposed in some way to difficult stories of survival or loss

For first responders, being prepared for the job and strengthening stress management skills before a disaster assignment is the best protection from stress. Responder stress can be diminished by practicing for the disaster role, developing a personal toolkit of stress management skills, and preparing themselves and loved ones for a disaster.

Disasters can be extremely disruptive to individual families and community routines, leading to stress and inviting all types of violent behavior, including intimate partner violence or family violence. Women and girls can be particularly at risk. Following a disaster, resources for reporting violent crimes may be temporarily suspended or unavailable. For women and girls who have experienced intimate partner violence, sexual violence, or family violence, this can further heighten their sense of isolation and vulnerability.

Before, during, and after a disaster, what may seem like fighting between intimate partners or family members may actually be a symptom of a larger pattern of abuse. Further, during the response and recovery phase after a disaster, the risk for violence against women and girls becomes greater. These disaster survivors may become displaced from their homes and moved to shelters or temporary housing, where they encounter overcrowded, co-ed living conditions and a lack of security, among other things.

If you or someone you care about is or may be experiencing intimate partner, sexual, or family abuse or violence, call the Disaster Distress Helpline. Other resources are also available:

• National Child Abuse Hotline: 1-800-422-4453 (4-A-CHILD)
• National Domestic Violence Hotline: 1-800-799-7233 (SAFE); TTY 1-800-787-3224
• National Sexual Assault Hotline: 1-800-656-4673 (HOPE)
• National Teen Dating Violence Hotline: 1-866-331-9474; Text “loveis” to 77054

The anniversary of a disaster or tragic event can renew feelings of fear, anxiety, and sadness in disaster survivors. Certain smells or sounds, such as smoke or sirens, can also trigger emotional distress. These and other environmental sensations can take people right back to the event, or cause them to fear that it’s about to happen again. These “trigger events” aren’t associated with any particular day on the calendar and can happen at any time.

What’s more, special occasions like birthdays or holidays can also be difficult for families who have been displaced from their homes due to a disaster. It’s hard to celebrate if you’re facing financial difficulties or living in temporary housing.

Some people start anticipating the anniversary (or special occasion) days, weeks, or even months before it occurs. It’s normal to have fears and concerns about how that day will make you feel. The following tips can help you or a loved one cope with renewed stress as an anniversary approaches or when trigger events suddenly occur.

Be aware that special days may be difficult. It’s common for some stress and other emotional reactions to happen around the anniversary of an event. Simply recognizing that your feelings are normal will help. Dealing with some of your losses and the new realities you’re facing after a disaster can be challenging. Try not to be too hard on yourself.

Be gentle with yourself. Show yourself the same kindness and patience you’d give to others during this time. Allow yourself to feel angry or sad and recognize that these emotions are natural.

Participate in activities that you enjoy. This may be different depending on the individual. Some people like to reflect in solitude while others may prefer spending time with family and friends for support. Some of these activities may include: singing, prayer, meditation, attending a spiritual service, going to the movies, or just getting together with loved ones to share a meal.

Talk about your losses if you need to. If you want to talk about your losses since the disaster, you can. If you want to talk about the future, you can do that, too. Be sure to share your thoughts and feelings with someone you trust. That can be a friend or family member or a health care professional.

Draw on your faith/spirituality. For many, faith and other spiritual beliefs are a source of strength and comfort every day, and most especially during difficult times. Reach out to your faith adviser, spiritual community, or anyone that you feel comfortable talking with about your beliefs to support and console you.

Accept kindness and help from others. Support from family and friends is essential to healing. It’s often difficult for people to accept help because they don’t want to be a burden to others, or don’t want to appear weak. Allow the people in your life to show their care and concern.

Help others. For some people, volunteering is a healthy way to heal and they get a great deal of satisfaction from helping others. Some activities can be as simple as donating food, clothing, and other items.

Disasters affect people who experience and respond to the event. Natural and technological disasters impact survivors, bereaved family members, witnesses to the event, and friends of those involved.

Rescue workers, emergency medical and mental health care providers, and volunteers are also affected. Disasters can also impact members of the media, as well as citizens of the community, the country, and the world.

Disasters can cause a number of different stress reactions in those affected. The steps that can be taken for self-care after disasters to manage coping are also useful for those who are witness to a terrorist act.

What Can I Do?

There are many steps you can take to manage stress after a disaster. You should be aware, though, that healing doesn't mean you'll completely forget the event. You may still feel distress and pain when you think of it. Learn more about Coping with Traumatic Stress Reactions (en Español) to get better at managing your feelings of distress. You may also have more confidence that you will be able to cope.

In addition to those strategies, here are other helpful steps you can take after a disaster:

• Remind yourself that stress reactions after disaster are common. Know that you're not alone, weak, or "crazy." Most reactions fade with time. If they don't, there are usually free programs set up where you live that you can turn to for help after disasters.
• Use problem-solving. Remember that the long-term stress caused by disasters can reduce your ability to think clearly, be creative, and tackle problems. These problem-solving techniques can help:
  • Decide what are your most important problems.
  • Get the information and resources you need to deal with your problems.
  • Break problems down into small steps so you are not overwhelmed.
  • Ask for help from a friend, family member, or counselor to help you brainstorm.
  • Stay on track with your plan for dealing with your problems.
• Spend time with or help others. Disasters are unique types of trauma in that most often many people have been affected. Being with family, friends, neighbors, or others may help you realize that you are not the only one affected. Being with others helps rebuild trust in other people. Also, spending time with others gives you a chance to provide support or to help rebuild.Helping other people in need or working in your community can make you feel better about yourself. It can relieve stress to take your mind off your own problems for awhile, and maybe you will see them in a different light. Providing support or rebuilding lifts your mood and makes you feel less alone.
• If you are grieving, find a way to honor the losses. Disasters can create a lot of loss in a person's life. Losses may include loved ones, friends, coworkers, pets, home, possessions, job, or quality of life. Try writing about your loss or creating a ritual, ceremony, or service to express your grief. Such practices can help you feel connected to a lost loved one. Rather than expecting to just "get over it" and move on with your life, it may help to take time to honor and affirm your relationships or values.
• Take a broader view. Make a list of your personal values. Pinpoint those things that the disaster highlighted as most important to you. Use this list to remind yourself of your goals and priorities. It can guide you to live your life in a way that is true to those values.
• Practice helpful thinking. Check out your thoughts. If they are causing you to feel stuck or helpless, try to think of more energizing, helpful thoughts. For example, if you find yourself thinking, "I can't do it," challenge yourself with questions such as:
  • "Is it really true that I can't do it?"
  • "Is it ALWAYS true?"
  • "Under what circumstances could I do it?"
  • "Could I do it if I had some help?"
  Then you can put in place a more helpful thought. In this case, you might say to yourself, "With the right help, I can get through this
• Take a time out if you're feeling angry. The stress that comes along with disasters can create irritability and anger. This can affect your health, sense of self-control, and relationships. Anger can also increase your heart rate so much that you cannot clearly concentrate on the problem you are facing. Take a break to calm down before going into situations that anger you. This may help you keep a clear head. It may also preserve your health and relationships.
• Plan ahead. If you are afraid of future disasters, you may feel less worried if you learn more about the type of disaster that occurred. Then make up a plan:
  • Learn the warning signs of disaster.
  • Learn what you can expect to happen afterward.
  • Become prepared. Create an emergency preparedness kit for your family.
  • Take steps to make your house, job, or school safer.
  • Make and practice a family safety plan.
  • Have your children help, if they are able, with the preparations.

Summing It Up

The period following a disaster can be very stressful for survivors and many others who have been involved. Certain steps can help you manage stress and cope with the problems you face. Some strategies involve problem-solving skills and shifting your thoughts or outlook. Other steps highlight the support you can get from and give to others. The best results come from people working together to help each other after a disaster.

After a natural disaster, it’s normal to feel different and strong emotions. Feeling emotional, nervous, or having trouble sleeping and eating can all be normal reactions to stress. Here are some healthy ways you can deal with stress.

Take care of yourself.

• Eat healthy, well-balanced meals
• Exercise on a regular basis
• Get plenty of sleep
• Give yourself a break if you feel stressed out

Talk to others.

• Share your problems and how you are feeling and coping with a parent, friend, counselor, doctor, or pastor.

Avoid drugs and alcohol.

• These may seem to help, but they can create additional problems and increase the stress you are already feeling.

Take a break.

Listen to other teens’ stories about life after a natural disaster.Low Resolution Video

Listen to other teens’ stories about life after a natural disaster. Find videos, posters, and graphics here.

• If news events are causing your stress, take a break from listening or watching the news.

Recognize when you need more help.

• If problems continue or you are thinking about suicide, talk to a psychologist, social worker, or professional counselor.
• You can also call or text SAMHSA’s Disaster Distress Hotline: 1-800-985-5990. People with deafness or hearing loss can use their preferred relay service to call 1-800-985-5990.

It is natural to feel stress, anxiety, grief, and worry during and after a disaster. Everyone reacts differently, and your own feelings will change over time. Notice and accept how you feel. Taking care of your emotional health during an emergency will help you think clearly and react to the urgent needs to protect yourself and your family. Self-care during an emergency will help your long-term healing.

People with preexisting mental health conditions should continue with their treatment plans during an emergency and monitor for any new symptoms.

Take the following steps to cope with a disaster:

• Take care of your body– Try to eat healthy well-balanced meals, exercise regularly, and get plenty of sleep. Avoid alcohol, tobacco, and other drugs. Learn more about wellness strategies for mental health.
• Connect with others– Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships, and build a strong support system.
• Take breaks– Make time to unwind and remind yourself that strong feelings will fade. Try taking in deep breaths. Try to do activities you usually enjoy.
• Stay informed– When you feel that you are missing information, you may become more stressed or nervous. Watch, listen to, or read the news for updates from officials. Be aware that there may be rumors during a crisis, especially on social media. Always check your sources and turn to reliable sources of information like your local government authorities.
• Avoid too much exposure to news – Take breaks from watching, reading, or listening to news stories. It can be upsetting to hear about the crisis and see images repeatedly. Try to do enjoyable activities and return to normal life as much as possible and check for updates between breaks.
• Seek help when needed– If distress impacts activities of your daily life for several days or weeks, talk to a clergy member, counselor, or doctor, or contact the SAMHSA helpline at 1-800-985-5990.

Look out for these common signs of distress:

• Feelings of numbness, disbelief, anxiety or fear.
• Changes in appetite, energy, and activity levels.
• Difficulty concentrating.
• Difficulty sleeping or nightmares and upsetting thoughts and images.
• Physical reactions, such as headaches, body pains, stomach problems, and skin rashes.
• Worsening of chronic health problems.
• Anger or short-temper.
• Increased use of alcohol, tobacco, or other drugs.

If you experience these feelings or behaviors for several days in a row and are unable to carry out normal responsibilities because of them, seek professional help.

The majority of disaster-affected individuals are likely to do better if they feel - or are helped to feel - safe, empowered to handle the post-disaster context, connected to others, and calmer. Those who are optimistic or hopeful also tend to do better.

For those who do need help, most can get back on their feet with education, practical help, and simple supportive actions called Psychological First Aid (PFA).

Practical Help

A key to recovery from disasters is feeling that you have the resources with which to rebuild your life. The most basic resources include information, food, safety, medical support, and shelter. Other important resources are family, community, school, and friends. In fact, having resources is so important that many programs for disaster recovery focus primarily on providing practical help and building people's resources.

Psychological First Aid

Those distressed after disaster may benefit from Psychological First Aid. (See "Sources" section below for PFA development information.) The core actions of PFA should be based on the most important needs and priorities of those affected by disasters, such as safety, comfort, calming, and practical help. The guide also includes handouts (PDF) with information on:

• Understanding post-disaster reactions
• Positive ways of coping
• Connecting with social supports
• Links to needed services

Education to Build Community Resilience

Resilience means being able to recover or bounce back after a disaster. One way to build resilience is through educating yourself about how disasters affect people, how to cope effectively, how to give and receive social support, and how to get further help if needed.

Efforts to reach out and inform the community are sometimes provided by recovery workers, through the media, or on the Internet. Education may focus on:

• Reactions to disaster
• Building resilience and positive coping
• Providing support to each other
• Connecting to health and mental health care providers

Many types of healing practices also go into building community resilience. These practices involve communal, cultural, memorial, spiritual and religious healing practices. Training may be provided to local responders and healers, community leaders, and health providers. These workers are taught to make use of resources that are already in place or that occur naturally after disaster.

Workers try to give survivors knowledge, attitudes, and skills that can be used to build the community. Part of the process also involves grieving the community's losses and making meaning of the disaster. Other goals include getting back to the normal rhythms and routines of life, and gaining a positive vision of the future, with renewed hope.

Crisis Counseling and Skill-Building

Programs and treatments exist for all levels of need after a disaster. Crisis Counseling Programs and Skills for Psychological Recovery are two examples.

Crisis Counseling Programs

The Federal Emergency Management Agency (FEMA) supports Crisis Counseling Programs (CCP) for survivors of federally-declared disasters. CCPs focus on both those affected by the disaster and the community as a whole.

They provide affected individuals with practical help in coping with their current issues. They serve a full range of children, teens, parents or caretakers, families, and adults. Crisis Counseling Programs also help businesses and neighborhoods. They focus not just on those at highest risk for problems, but also on providing resources to make the whole community stronger.

Skills in Psychological Recovery

Skills in Psychological Recovery (SPR) is another model that can often be helpful. (See "Sources" section below for SPR development information.) The SPR model aims to develop and reinforce those skills that will help affected individuals be more resilient. SPR is usually offered by trained and supervised crisis counselors. Their aim is to provide a safe and comforting relationship within which to help you develop skills that have been found to be related to better recovery following disasters, including:

• Problem-solving
• Planning more positive and meaningful activities
• Managing stress and reactions to the disaster
• Engaging in more helpful thinking
• Building healthy social connections

Trauma-Focused Treatment for PTSD

Some affected individuals may still be in distress after PFA, crisis counseling, or SPR. For those in need of more intensive services, research supports trauma-focused psychotherapy for PTSD as an effective treatment following disaster. Trauma-focused psychotherapy is a broad term that refers to several specific psychotherapies for PTSD.

"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.

Summing It Up

There are a number of different recovery programs after disaster. The goals of these programs are to help those affected and the community to recover. No matter how you are reacting to the disaster, there should be a program to help you. With support, you can build your resources, resilience, skills, and mental health.

People can experience a wide range of emotions before and after a disaster or traumatic event. There’s no right or wrong way to feel. However, it’s important to find healthy ways to cope when these events happen.

Take Care of Yourself and Your Loved Ones

Eating a healthy diet, avoiding the use of drugs and alcohol, and getting regular exercise can reduce stress and anxiety. Activities as simple as taking a walk, stretching, and deep breathing can help relieve stress.

• Limit your consumption of news. We live in a society where the news is available to us 24 hours a day via television, radio, and the Internet. The constant replay of news stories about a disaster or traumatic event can increase stress and anxiety and make some people relive the event over and over. Reduce the amount of news you watch and/or listen to, and engage in relaxing activities to help you heal and move on.
• Get enough “good” sleep. Some people have difficulty falling asleep after a disaster, or wake up throughout the night. If you have trouble sleeping, only go to bed when you are ready to sleep, avoid using cell phones or laptops in bed, and avoid drinking caffeine or alcohol at least one hour before going to bed. If you wake up and can’t fall back to sleep, try writing what’s on your mind in a journal or on a sheet of paper.
• Establish and maintain a routine. Try to eat meals at regular times and put yourself on a sleep schedule to ensure an adequate amount of rest. Include a positive or fun activity in your schedule that you can look forward to each day or week. Schedule exercise into your daily routine as well, if possible.
• Avoid making major life decisions. Doing things like switching jobs or careers can already be stressful and are even harder to adjust to directly after a disaster.
• Understand there will be changes. Disasters can destroy homes, schools, and places of business and worship and can disrupt the lives of people living in affected areas for a long time. Sometimes, people lose loved ones or experience injuries, both physical and mental, that may last a lifetime. Some people may also experience a temporary or permanent loss of employment. For children, attending a new or temporary school may result in being separated from peers, or after-school activities may be disrupted.

General Disaster Response and Recovery Information

• Tips for Survivors of a Disaster or Other Traumatic Event: Managing Stress—This SAMHSA tip sheet gives stress prevention and management tips for dealing with the effects of trauma, mass violence, or terrorism. It lists tips to relieve stress, describes how to know when to seek professional help, and provides accompanying resources. This tip sheet is also available in Spanish.
• Psychological First Aid (PFA)—Developed jointly by the National Center for Posttraumatic Stress Disorder and the National Child Traumatic Stress Network, PFA is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism: to reduce initial distress, and to foster short- and long-term adaptive functioning.
• Be Red Cross Ready: Taking Care of Your Emotional Health after a Disaster (PDF | 307 KB)—This fact sheet from the American Red Cross explains normal reactions to a disaster, what a survivor can do to cope with these emotions, and where to seek additional help if needed.

Incidents of Mass Violence: Specific Information

• Coping With Grief After Community Violence—This SAMHSA tip sheet introduces some of the signs of grief and anger after an incident of community violence, provides useful information about to how to cope with grief, and offers tips for helping children deal with grief.
• Disaster-Specific Resources: Mass Violence—This SAMHSA Disaster Technical Assistance Center (DTAC) Disaster Behavioral Health Information Series installment is a collection of resources focused on preparedness and response for specific types of disasters, including mass violence, riots, and trauma.
• Incidents of Mass Violence—The SAMHSA Disaster Distress Helpline supports survivors, family members, responders, and recovery workers who are affected by incidents of mass violence and other disasters. Information on this web page includes a list of risk factors for distress, information on lockdown notices and other warnings, and additional resources for coping.
• Effects of Traumatic Stress After Mass Violence, Terror, or Disaster—This online article from the National Center for PTSD describes the emotional, cognitive, physical, and interpersonal reactions that disaster survivors may experience and discusses the potentially severe stress symptoms that may lead to lasting posttraumatic stress disorder (PTSD), anxiety disorders, or depression. The article also presents information on how survivors can reduce their risk of psychological difficulties and recover from disaster stress.

Resources for Disaster Responders

• Disaster Responders Disaster Behavioral Health Information Series (DBHIS) Installment—This installment of the SAMHSA Disaster Technical Assistance Center's DBHIS includes resources for people who respond to disasters, including human-caused disasters such as incidents of mass violence. It includes links to materials about how responders can support their own mental health while helping others, organizations and agencies that support disaster responders, and information specifically for law enforcement.
• Psychological First Aid for First Responders: Tips for Emergency and Disaster Response Workers—This SAMHSA tip sheet provides first responders with information on how to address people for the first time after a disaster and how to calmly communicate and promote safety.
• Tips for Disaster Responders: Preventing and Managing Stress—This SAMHSA tip sheet helps disaster response workers prevent and manage stress. It includes strategies to help responders prepare for their assignment, use stress-reducing precautions during the assignment, and manage stress in the recovery phase of the assignment. This tip sheet is also available in Spanish.
• Disaster Mental Health for Responders: Key Principles, Issues and Questions—This Centers for Disease Control and Prevention (CDC) web page presents information that may be helpful to disaster survivors and first responders during and after a disaster. The page opens with guiding principles and also features survivor needs and common responses to disasters, signs that someone may need a mental health referral, common signs of stress among disaster responders, and examples of ways to care for yourself after a disaster.
• Understanding Compassion Fatigue: Explains the causes and signs of compassion fatigue, the burnout and secondary trauma a disaster response worker can experience. Offers self-care tips for coping with compassion fatigue and discusses compassion satisfaction as a protective tool. This is also available in Spanish .

Traumatic Stress and Retraumatization Resources

• Effects of Traumatic Stress After Mass Violence, Terror, or Disaster—This National Center for PTSD web page describes the reactions to disaster that survivors may experience and discusses the potentially severe stress symptoms that may lead to lasting posttraumatic stress disorder (PTSD), anxiety disorders, or depression. Information on how survivors can reduce their risk of psychological difficulties and recover from disaster stress is also provided.
• Media Coverage of Traumatic Events: Research on Effects—The National Center for PTSD presents information on the effects of intense media exposure following a disaster. This article describes the association between watching media coverage of traumatic events and stress symptoms. It also offers guidance to help providers avoid retraumatizing children and their parents with whom they work.

National Child Traumatic Stress Network Resources (NCTSN)

The NCTSN has multiple resources to support children, youth, families and community response efforts:

• Psychological Impact of the Recent Shooting
• Talking to Children about the Shooting
• Helping Teens with Traumatic Grief: Tips for Caregivers
• Helping Young Children with Traumatic Grief: Tips for Caregivers
• Tip Sheet for Youth Talking to Journalists about the Shooting
• Helping School-Age Children with Traumatic Grief: Tips for Caregivers
• Helping Youth after Community Trauma: Tips for Educators
• Parent Guidelines for Helping Youth after the Recent Shooting
• En Español [Guía para los Padres Para Ayudar a Los Jóvenes Después de un Tiroteo Reciente]
• After a Crisis: Helping Young Children Heal
• Parents Tips for Helping Preschool-Aged Children after Disasters
• Parents Tips for Helping School-Aged Children after Disasters
• Restoring a Sense of Safety in the Aftermath of a Shooting: Tips for Parents and Professionals

Ask for Help

Warning signs of stress are normal, short-term reactions to life’s unexpected challenges. However, it is important to recognize when you or others experience emotional distress that is persistent and becomes difficult to manage.

• Find a local support group. In a group setting led by trained and experienced professionals, people who have shared a similar experience can exchange thoughts, feelings, and ideas on how to get through difficult times. Support groups provide a safe place for people to find comfort in knowing they are not alone.
• Reach out to family and friends. Talking to someone you trust about your feelings without fear of judgment may offer some relief. Family and friends can be a great resource for support. Your family and friends may have also survived the disaster and understand the emotions you are experiencing. It’s also a good idea to speak with friends who were not involved, because they can be objective and provide additional support.
• Speak with a financial adviser. The loss of a home or job or being unable to work after a disaster can be an overwhelming financial burden people feel they have to struggle with alone. Financial advisers don’t immediately come to mind as a resource after a disaster, but they should be among the first people you call when developing a strategy to rebuild your life. Seeking help from a financial adviser can ease the stress and point you in the direction of other helpful resources or programs tailored to your situation.

If you or your loved ones continue to have feelings of anxiety, fear, and anger for two weeks or more, with no improvement, it’s best to seek professional help. Call or text the Disaster Distress Helpline to locate services and speak with trained crisis counselors who are ready to assist you.

Regardless of your child’s age, he or she may feel upset or have other strong emotions after an emergency. Some children react right away, while others may show signs of difficulty much later. How a child reacts and the common signs of distress can vary according to the child’s age, previous experiences, and how the child typically copes with stress.

Children react, in part, on what they see from the adults around them. When parents and caregivers deal with a disaster calmly and confidently, they can provide the best support for their children. Parents can be more reassuring to others around them, especially children, if they are better prepared.

People can become more distressed if they see repeated images of a disaster in the media. Early on, consider limiting the amount of exposure you and your loved ones get to media coverage.

Factors that Influence the Emotional Impact on Children in Emergencies

The amount of damage caused from a disaster can be overwhelming. The destruction of homes and separation from school, family, and friends can create a great amount of stress and anxiety for children.

The emotional impact of an emergency on a child depends on a child’s characteristics and experiences, the social and economic circumstances of the family and community, and the availability of local resources. Not all children respond in the same ways. Some might have more severe, longer-lasting reactions. The following specific factors may affect a child’s emotional response:

• Direct involvement with the emergency
• Previous traumatic or stressful event
• Belief that the child or a loved one may die
• Loss of a family member, close friend, or pet
• Separation from caregivers
• Physical injury
• How parents and caregivers respond
• Family resources
• Relationships and communication among family members
• Repeated exposure to mass media coverage of the emergency and aftermath
• Ongoing stress due to the change in familiar routines and living conditions
• Cultural differences
• Community resilience

What You Can Do to Help Children Cope with a Disaster

Setting a good example for your children by managing your stress through healthy lifestyle choices, such as eating healthy, exercising regularly, getting plenty of sleep, and avoiding drugs and alcohol, is critical for parents and caregivers. When you are prepared, rested, and relaxed you can respond better to unexpected events and can make decisions in the best interest of your family and loved ones.

The following tips can help reduce stress before, during, and after a disaster or traumatic event.

Before

• Talk to your children so that they know you are prepared to keep them safe.
• Review safety plans before a disaster or emergency happens. Having a plan will increase your children’s confidence and help give them a sense of control.

During

• Stay calm and reassure your children.
• Talk to children about what is happening in a way that they can understand. Keep it simple and appropriate for each child’s age.

After

• Provide children with opportunities to talk about what they went through or what they think about it. Encourage them to share concerns and ask questions.
• You can help your children feel a sense of control and manage their feelings by encouraging them to take action directly related to the disaster. For example, children can help others after a disaster, including volunteering to help community or family members in a safe environment. Children should NOT participate in disaster cleanup activities for health and safety reasons.
• It is difficult to predict how some children will respond to disasters and traumatic events. Because parents, teachers, and other adults see children in different situations, it is important for them to work together to share information about how each child is coping after a traumatic event.

Common Reactions

The common reactions to distress will fade over time for most children. Children who were directly exposed to a disaster can become upset again; behavior related to the event may return if they see or hear reminders of what happened. If children continue to be very upset or if their reactions hurt their schoolwork or relationships then parents may want to talk to a professional or have their children talk to someone who specializes in children’s emotional needs. Learn more about common reactions to distress:

For infants to 2 year olds

Infants may become more cranky. They may cry more than usual or want to be held and cuddled more.

For 3 to 6 year olds

Preschool and kindergarten children may return to behaviors they have outgrown. For example, toileting accidents, bed-wetting, or being frightened about being separated from their parents/caregivers. They may also have tantrums or a hard time sleeping.

For 7 to 10 year olds

Older children may feel sad, mad, or afraid that the event will happen again. Peers may share false information; however, parents or caregivers can correct the misinformation. Older children may focus on details of the event and want to talk about it all the time or not want to talk about it at all. They may have trouble concentrating.

For preteens and teenagers

Some preteens and teenagers respond to trauma by acting out. This could include reckless driving, and alcohol or drug use. Others may become afraid to leave the home. They may cut back on how much time they spend with their friends. They can feel overwhelmed by their intense emotions and feel unable to talk about them. Their emotions may lead to increased arguing and even fighting with siblings, parents/caregivers or other adults.

For special needs children

Children who need continuous use of a breathing machine or are confined to a wheelchair or bed, may have stronger reactions to a threatened or actual disaster. They might have more intense distress, worry or anger than children without special needs because they have less control over day-to-day well-being than other people. The same is true for children with other physical, emotional, or intellectual limitations. Children with special needs may need extra words of reassurance, more explanations about the event, and more comfort and other positive physical contact such as hugs from loved ones.

Responding to disasters is both rewarding and challenging work. Sources of stress for emergency responders may include witnessing human suffering, risk of personal harm, intense workloads, life-and-death decisions, and separation from family. Stress prevention and management is critical for responders to stay well and to continue to help in the situation. There are important steps responders should take before, during, and after an event. To take care of others, responders must be feeling well and thinking clearly.

Here are some important steps responders can take to ensure they are able to do their job and cope with challenging situations:

Preparing for a Response:

• Try to learn as much as possible about what your role would be in a response.
• If you will be traveling or working long hours during a response, explain this to loved ones who may want to contact you. Come up with ways you may be able to communicate with them. Keep their expectations realistic, and take the pressure off yourself.
• Talk to your supervisor and establish a plan for who will fill any urgent ongoing work duties unrelated to the disaster while you are engaged in the response.
• Make plans for your household, childcare, and pet care needs if you will be away from home.

During a Response: Understand and Identify Burnout and Secondary Traumatic Stress

Limit your time working alone by trying to work in teams.

Responders experience stress during a crisis. When stress builds up it can cause:

• Burnout – feelings of extreme exhaustion and being overwhelmed.
• Secondary traumatic stress – stress reactions and symptoms resulting from exposure to another individual’s traumatic experiences, rather than from exposure directly to a traumatic event.

Coping techniques like taking breaks, eating healthy foods, exercising, and using the buddy system can help prevent and reduce burnout and secondary traumatic stress. Recognize the signs of both of these conditions in yourself and other responders to be sure those who need a break or need help can address these needs.

Signs Of Burnout:

• Sadness, depression, or apathy
• Easily frustrated
• Blaming of others, irritability
• Lacking feelings, indifferent
• Isolation or disconnection from others
• Poor self-care (hygiene)
• Tired, exhausted or overwhelmed
• Feeling like:
  • A failure
  • Nothing you can do will help
  • You are not doing your job well
  • You need alcohol/other drugs to cope

Signs of Secondary Traumatic Stress

• Excessively worry or fear about something bad happening
• Easily startled, or “on guard” all of the time
• Physical signs of stress (e.g. racing heart)
• Nightmares or recurrent thoughts about the traumatic situation
• The feeling that others’ trauma is yours

Limit your time working alone by trying to work in teams.

Get support from team members: Develop a Buddy System

In a buddy system, two responders partner together to support each other, and monitor each other’s stress, workload, and safety.

• Get to know each other. Talk about background, interests, hobbies, and family. Identify each other’s strengths and weaknesses.
• Keep an eye on each other. Try to work in the same location if you can.
• Set up times to check-in with each other. Listen carefully and share experiences and feelings. Acknowledge tough situations and recognize accomplishments, even small ones.
• Offer to help with basic needs such as sharing supplies and transportation.
• Monitor each other’s workloads. Encourage each other to take breaks. Share opportunities for stress relief (rest, routine sleep, exercise, and deep breathing).
• Communicate your buddy’s basic needs and limits to leadership – make your buddy feel “safe” to speak up.

Responder Self-Care Techniques

• Limit working hours to no longer than 12-hour shifts.
• Work in teams and limit amount of time working alone.
• Write in a journal.
• Talk to family, friends, supervisors, and teammates about your feelings and experiences.
• Practice breathing and relaxation techniques.
• Maintain a healthy diet and get adequate sleep and exercise.
• Know that it is okay to draw boundaries and say “no.”
• Avoid or limit caffeine and use of alcohol.

It is important to remind yourself:

• It is not selfish to take breaks.
• The needs of survivors are not more important than your own needs and well-being.
• Working all of the time does not mean you will make your best contribution.
• There are other people who can help in the response.

Responding to disasters can be both rewarding and stressful. Knowing that you have stress and coping with it as you respond will help you stay well, and this will allow you to keep helping those who are affected.

After the response: Family and Work-life

Family members can help make the transition easier after the response is over.

During a crisis, the public relies on leaders to make decisions, provide updates, and make recommendations affecting their safety and well-being. Leaders, including government officials and leaders in non-governmental organizations, community organizations, and religious groups play an important role in helping communities and individuals cope during and after a disaster. Learn how to help your community cope with a disaster.

• Disaster Distress Helpline: CALL or TEXT 1-800-985-5990 (press 2 for Spanish).
• People with deafness or hearing loss can use their preferred relay service to call 1-800-985-5990.

Recognize Common Reactions to Stressful Events:

It is natural to experience stress during a disaster or traumatic event. Look for these signs of stress in yourself, and members of your family and community:

• Feelings of stress, grief, fear, or anger.
• Struggle to carry out routine activities after a disaster and lack of interest in activities they usually enjoy.
• Sleep disturbances, often including nightmares and thoughts about the disaster.
• Changes in appetite, tiredness, headaches, and stomach aches.
• A need to talk, often repeatedly, about events and feelings associated with the disaster.

Address basic safety needs first, then identify and address common stress reactions.

How to Support Coping:

• Address basic survival needs before focusing on emotional needs.
• Start supporting survivors’ ability to cope by making them more comfortable. (Take simple steps like offering a phone, handing out blankets, and distributing water).
• Expect that disaster relief assistance may be confusing to survivors. They may experience frustration, anger, and feelings of helplessness, and some of these feelings may be directed toward response agencies and representatives of these agencies.
• Give opportunities for survivors to take actions to help themselves and their community in response efforts.
• Provide as much information as possible and continue to update.

When to Refer Someone for Professional Help

These reactions signal a need for referral to a mental health professional or to the SAMHSA helpline:

• Confusion, memory loss, inability to state the current date.
• Strong and constant feelings of sadness or strong anxiety that prevents completing regular tasks.
• Hearing voices or seeing things that are not there.
• Not regularly eating, bathing, or changing clothes or taking care of oneself.
• Thoughts or desires to harm oneself or others or becoming violent.
• Misuse of drugs or alcohol.

Express empathy and listen carefully

Tips for compassionate communication with victims of a crisis:

Through decisive, timely, and compassionate communication, leaders can reduce fear and anxiety.

• Show Respect: Respectful communication is particularly important when people feel vulnerable.
• Express empathy by acknowledging the emotions of those who are suffering.
• Listen and allow emotional expressions or crying without interruption.
• Do not answer questions outside of your expertise. Refer people to appropriate experts.
• Use the same words as the person who is speaking. For example, if they say “passed” instead of “dead,” you should also say “passed.”
• Avoid using examples from your own life and keep the focus on those currently suffering.
• Look for cues in body language, and ask if they would like to be left alone, to talk to someone else, or to talk to a mental health professional or faith leader.

Give opportunities for survivors to take action to take care of themselves and others.

The Role of Leaders in Community Coping and Recovery

During a crisis, a leader may become a symbol of order. Leaders can strengthen a community during a crisis.

• Give members of the community actions they can take to help based on their strengths (i.e., check on neighbors, bring emergency supplies to the elderly, donate supplies, or volunteer to help rebuild).
• Encourage survivors to take care of themselves and others.
• Draw upon cultural and community values to bring people together.
• Give fast and accurate updates.
• Listen to the concerns of others.
• Recognize responders’ contributions during and after a crisis.
• As a leader, help responders that you supervise manage stress during a crisis.