By Vashni Benjamin As we slowly return to our daily lives after saying farewell to the brothers and sisters we lost to the deadly blasts last Sunday and reality begins to sink in, it is very likely that most of us are still feeling the after effects of the terror that gripped our country. As a nation that is only just recovering from a 30-year war, we are no strangers to bloodshed, but no experience we have had prior can make this burden easier to bear. More often than not, we focus on the lives lost and physical damage that was left behind and as a result, neglect the psychological effects of a terrorist attack such as this. No matter if you’ve lost a loved one, were in the vicinity of the blast, or even only heard about it through the news, you most probably felt sadness, worry, or even resentment. Psychological health is largely compromised during such times and many of us may suffer from symptoms associated with traumatic stress response without even knowing it. Throughout these tough times, it is important to remember that you are not alone and help is always available. To help us understand the role of mental health in such a situation, we reached out to The Ohana Project – a team of mental health experts providing psychological aftercare to anyone who needs it. What type of psychological trauma can occur after attacks such as the series of bombings that hit the country recently? Terror attacks can impact each and every one of us in different ways. Given what we have been through as a country in the past, it can sometimes ignite old traumatic memories and create emotional discomfort. We may have reactions of anger, grief, and sadness as a result of experiencing an attack of this magnitude. Psychological trauma can occur as a spectrum of consequences ranging from distress responses to behavioural changes and onset of diagnosable psychiatric illness. Common trauma reactions can include the following: Replaying the trauma Nightmares and flashbacks Difficulty trusting people Believing the world is extremely dangerous Blaming yourself for the trauma Hypervigilance (enhanced state of sensory sensitivity that can lead to high levels of anxiety) Seeing yourself as weak or inadequate Feeling constantly on guard and seeing danger everywhere Being easily startled Experiencing anxiety, fear, shock, denial, disbelief, anger, agitation, edginess, irritability, and mood swings Withdrawing from others Feeling disconnected or numb Can it affect people who weren’t directly hit by the blasts? Yes, of course. This is what we identify as vicarious trauma which is experiencing trauma through other people’s stories and experiences. People living in the vicinity of the affected churches or hotels, people working in the aforementioned places, those who regularly visit them, or those who witnessed the incidents can be psychologically affected. Furthermore, those who are continuously exposed to the news on such events can experience symptoms similar to those mentioned above as their sense of safety is threatened. If you were personally affected by the blasts, how important is it to talk to someone about mental health? This is a critical step in recovering from incidents such as terror attacks as talking to someone about your personal experience of the crisis and how you feel about it would help release your pent-up emotions and gain more clarity on the things that are worrying you. However, it is important that you do so only when you are ready and with someone who you trust and are comfortable with. It is also up to you to decide which information you want to share. The process of understanding what happened to you and how you feel about it has no correct way or a timeline. On a different note, those who are approached by affected individuals should be mindful not to force them to open up or share information they are not willing to share as that could cause more harm. Primary care providers see some of the worst parts of the destruction. How important is it that they are given the emotional support they need? This is one of the most neglected areas in our emergency response system. Mental health and psychosocial needs of first responders and frontline health professionals are often disregarded at multiple points in our health system. The lack of priority given to the mental health and wellbeing of our health staff increases the risk of psychological distress and posttraumatic symptoms. This obviously could affect their capacity to serve and make decisions in the long run. It is essential to have mandatory systematic procedures in place to monitor how the health staff is coping as they are highly unlikely to approach anyone to talk about their difficulties. It’s important that emergency response personnel are offered opportunities to debrief, reflect how they feel, and obtain psychosocial support mechanisms when required. Considering that many Sri Lankans are just recovering from the aftermath of the war, how can a tragedy of this sort be psychologically triggering? Sri Lanka has experienced not only the civil conflict, but racial and religious riots and devastating natural disasters. A terror attack of this nature could lead people to relive the memories, undergo flashbacks, and experience shock and disbelief as they were in the recovery phase where things were slowly falling back into place. It could also bring back memories of their losses which could trigger the same sense of fear, uncertainty, and insecurity that they previously experienced. As racial and religious tension is a sensitive issue in Sri Lanka, the recent attacks could potentially aggravate existing ideologies which could prove harmful. On the other hand, being exposed to so much adversity would revoke the institutional memory we have as a country on how to deal with certain situations. The older generation who experienced the war first hand could have developed mechanisms of resilience and coping that could help them in times like these. However, the impact of such events varies from individual to individual and it’s important to acknowledge your emotional state and how you feel during these testing times. What are some symptoms and behaviours that can show up in people as a result of these attacks? The following psychological symptoms and behavioural changes may indicate diagnoses of acute stress reaction, depression, anxiety, grief reaction, survivor guilt, and posttraumatic stress disorder (PTSD). Emotional and psychological symptoms: Shock, denial or disbelief, confusion, difficulty concentrating, anger, irritability and mood swings, anxiety, fear, guilt, shame, self-blame, isolation, and feeling sad and hopeless Behavioural changes and physical symptoms: Insomnia or nightmares, fatigue, being easily startled, difficulty concentrating, racing heartbeat, edginess and agitation, body aches and pains, and muscle tension Can this trauma manifest even after the situation calms down? Yes, of course. What we need to realise is that psychological impact and trauma, if unaddressed, can have long-term impact on individuals who directly and vicariously experienced these events. They are more likely to develop PTSD once things settle down and they may manifest both as emotional symptoms and behavioural changes as previously mentioned. People will also tend to avoid thoughts, memories, and feelings closely associated with the traumatic incident and avoid any places, activities, or objects that could trigger memories of the incident. It is crucial that we have short-term and long-term mental health interventions and services available for these individuals. What do we do if we feel like we need help? The best thing to do is to consult a mental health professional such as a counsellor, psychologist, or psychosocial worker. If you are unable to access a professional, you may talk to someone who you are comfortable with and get necessary assistance to approach a professional. There are also mental health hotlines available through which you can get psychosocial support from such as 1333 (24 hours), 1926 (24 hours), 0717639898 (24 hours), and 0112696666 (9am-8pm). How can we spot friends or relatives who may need help? How do we help them? At times like this, it’s important that we be vigilant of who are directly or vicariously affected by the traumatic event. If you know anyone who has difficulty coping in situations like this, make sure to check up on them and offer support as required. There are resources that you can use to gather more information and knowledge. If your friends or relatives show the aforementioned psychological symptoms or behavioural changes, it’s your responsibility to direct them to obtain professional support. Early intervention means that the negative impact can be dealt with more positively. Input from; Uwasara Weerakoon; Trainee clinical psychologist and educator Nivendra Uduman: Counseling psychologist Nilushka Perera: Behavioural health researcher This article was written with information from The Ohana Project – a community mental health initiative in Sri Lanka. The Ohana Project is a multidisciplinary team of professionals from diverse backgrounds such as medicine, psychology, counseling, education, and public health to name a few. They connect on the commitment and passion about shifting the conversation around advocating for health to be viewed as holistic and inclusive of physical, mental, and social wellbeing in a sensitive and encouraging manner. Want to help a child understand what’s happening around them? Amidst the destruction and confusion, many children are left to struggle with understanding difficult concepts such as “death” and “terrorism” on their own. Though we grownups spend hours pondering the “hows” and the “whys”, we tend to shield children from knowing too much and offer no explanation about what’s happening around them. However, it is important to remember that children can be just as perceptive as adults even though they may not understand what’s happening. Therefore, we must try to facilitate conversation about this and give them the reassurance that help is always available. The Cincinnati Children’s Hospital Medical Center offers these tips on how to start. 1. Start by asking what they’ve heard Listen for misinformation, misconceptions, underlying fears, or concerns. Deal with them at their level of understanding by giving them simple but accurate information, remember to not overwhelm them. For teens, address their more mature thoughts, concerns, and perspectives. 2. Explain what adults are doing to keep them safe, but don’t provide false reassurance Help them understand that there may be bad things happening but that there are many good people trying to help protect them. Help them to identify the ones they must approach if they’re caught in a scary situation and have a safety plan in place in cases of emergencies – a relative to contact, a safe place to meet, being wary of strangers etc. 3. Minimise their exposure to the news Though they may look distracted, children may easily pick up graphic details or disturbing images and sounds from the news which may affect them 4. Reassure them that feelings of sadness, worry, and anger are okay Children, like adults, are better able to cope with their emotions if they know that they’re not alone and that these feelings are “normal” 5. Share how you’re feeling and coping Share that you too are feeling the same emotions and that how you plan on dealing with them (i.e talking to someone, doing something relaxing). Children will likely to follow suit. Remaining calm and going about daily routines may help further ease their fears. 6. Let them know that you are available if further concerns come up Let them know that it wasn’t a one-time conversation and that you are available to talk to whenever need arises. If you have concerns about how your child is coping, speak with his or her primary doctor. He or she may recommend a referral to a child psychologist.