Why did I survive and my friend didn’t? Why did I have to bury my child instead of my child? Why was my family safe, but my neighbor’s family wasn’t?
Survivor’s guilt or survivor’s shame can add to the shared trauma of an event like the recent school shooting in Uvalde, or a more individualized trauma such as a car accident or a prolonged illness, experts say.
“When we talk about survivor’s guilt, that’s a symptom of PSTD,” said Brent Turnipseed, a psychiatrist and co-founder of Austin-based Roots Behavioral Health. Post-traumatic stress disorder usually emerges several months or longer after a traumatic event, verses acute stress disorder, which is that immediate response.
“PTSD is very difficult to treat,” Turnipseed said.
Following a traumatic event, there can be many different emotions, all of which are normal, said Rakima Parson, a licensed professional counselor with Centered Counseling.
A person dealing with PTSD might feel sadness or fear, but they might also feel nothingness or numb. They might feel guilt that they aren’t feeling more sad, or that they laughed at something or had fun sometime.
They can feel depression or anxiety. They can have flashbacks or nightmares or they might ruminate about what they could have done to prevent it from happening or what they did to cause it to happen.
“There’s not a right or a wrong,” Parson said. “Normalize all of those emotions and how they change from minute to minute.”
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What therapies can help?
Parson said a concern in the aftermath of the Uvalde tragedy is that most resources right now have flocked to the town. Those include therapists and emotional support dogs and social services, but months, even years from now, those resources still need to be available.
“Therapy is huge,” said Maegan Woytek, a licensed professional counselor at Thriveworks in Pflugerville. “When we don’t allow our feelings to naturally resolve, that’s when we get stuck and our brain doesn’t process they way it is supposed to. It overwhelms us.”
It’s important to feel the way you feel and to be able to talk to someone, either a friend, a therapist or a support group about those feelings.
Therapies like cognitive behavioral therapy or trauma-focused cognitive therapy can help. They help a person talk through reframing the event and the significance of the event.
Trauma therapy “helps your brain organized all traumatic, overwhelming information,” Woytek said. “It helps it take that information and process it so it is long-term memory and not feel so fresh.”
It can also help adjust your perception of events, Woytek said. If you’re having thoughts such as “‘why did I survive? or I don’t deserve to survive. This person should have survived. They are a better person than me,’ you are checking yourself about how accurate those thoughts are, ” she said.
Another treatment that is PTSD-specific is eye movement desensitization and reprocessing or EMDR. It trains a person to go through a series of eye movement exercises while thinking about the traumatic event. It’s a way to reprocess the event.
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What else is helpful?
Trauma is very sensory-based, which makes it not as easy to process with words. Play therapy for kids might be helpful or art therapy. There might also be a component of exposure therapy needed: Working up to being in a noisy or crowded place. Going back into a school in a measured way. Returning to driving slowly.
Turnipseed also recommends limiting exposure to news and social media. Too much can trigger the trauma response, heighten the anxiety and disturb the sleep.
Support groups with people who have experienced a similar trauma are also helpful to validate feelings.
Self-care such as doing yoga or some other physical activity or exercise, and meditation are helpful. Trauma can be very dissociative, feeling like you are outside your body. Exercise, yoga, meditation help you feel more connected to your body.
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How long can the survivor’s guilt last?
“It can come and go for years,” Woytek said. “Something triggers it, and it comes back up again.”
With children, they might process it differently at different developmental stages.
Sometimes trauma never goes away, Turnipseed said. “It can last for years and years.”
That doesn’t mean there won’t be joy alongside the waves of grief, Parson said. “How do you hold those two together? … There’s not a right or wrong feeling.”
The other thing that is critical to coping with trauma is your resiliency factor. Do you have a lot of other past traumas? Do you have a good support network? How did the people around you react to the trauma? Do you have access to treatment? Do your feel safe in other aspects of their lives? All of that plays into your resiliency factor.
“There’s no rule as to what can cause trauma,” Woyek said. “It’s how the individual experienced it and their lack of resiliency factors.”
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What are the signs to watch for?
It’s normal to feel stuck, sad, afraid, numb at first after a trauma, but it’s the continuation of those feelings, a worsening of those feelings that are concerning.
Are you continuing to miss work or school? Are you able to eat or are you overeating? Are you drinking too much or using substances to cope? Are you able to do normal things such as bathing and dressing yourself? Are you leaving the house? Are you sleeping? Have you withdrawn from others? Do you express hopelessness or a desire to not be here?
If there are any thoughts of harming yourself, that requires immediate help such as calling a crisis or suicide hotline or hospitalization.
“Any risk of physical danger to the person or someone else, we shouldn’t wait to get into the therapist,” Woytek said.
Friends and family can help by facilitating conversations, acknowledging how they are feeling, and by looking into and helping a person make an appointment for mental health care.
They also can help make sure basic needs are taken care of. A person can’t regulate their nervous system or start the recovery process without physical needs being handled. “It will be some time after the event to really dive into the emotions,” Parson said.
How to get help
Go to namicentraltx.org/crisis/ for resources or call 512-472-4357 in Travis County, 1-877-466-0660 in Hays County or 1-800-841-1255 in Williamson, Bastrop, Caldwell or Burnett counties, or text NAMI to 741741.
For kids, an appointment with a pediatrician might be a good first step. Texas has established a network of mental health care called Child Psychiatry Access Network that pediatricians can access. You can also talk to a school counselor, who can tap into Texas Child Health Access, to get you free telehealth services.
Starting in July, people will also be able to dial 988 nationwide to get crisis mental health services through the National Suicide Prevention Lifeline. Think of it as the 911 for mental health.