Coping with Trauma
The recovery process following a severe trauma will take some time. The purpose of this site is to provide the Arkansas Colleges of Health Sciences community with some tips for self-care and coping.
Coping tips and strategies:
Allow room in your schedule for the activities that help you deal with stress. Some examples may include spending time with friends, going for a walk, listening to music, writing in a journal, exercising, or enjoying a favorite movie or dessert. Setting aside even brief periods of time for self-care can be a big help in managing a crisis.
Your attention span and concentration levels may fluctuate during the next few weeks. Be sensitive to this by planning out a study schedule that seems feasible to you. For some, this may involve shorter blocks of study time interspersed with shorter, more frequent study breaks.
Keep in mind that the grieving/coping process will proceed differently for each of us. Be as supportive of yourself in your recovery as possible. Remind yourself that it is normal and ok to take the time you need to work through such a severe trauma.
Be aware that you may have different coping needs at different times. Sometimes you may feel like talking, sometimes you may feel like crying, sometimes you may wish to focus your attention away from the crisis completely.
Allow yourself to turn off the news and get some distance from the crisis when you need to. It is O.K. (and important) to have time for laughter and fun, even during a time of national grieving.
Reaching out to others in a supportive way can often be quite helpful. Such support may include volunteering time in the community, participating in Red Cross blood drives, or contributing to a campus memorial. Even small acts of support and giving can alleviate some of the helplessness commonly felt after such a severe crisis.
What is an eating disorder?
Many people have trouble managing how much they eat. Holidays seem to invite overeating. Certain sports (e.g., wrestling, ballet) or special times (e.g., summer) may warrant a close watch over how much weight is carried or when dieting seems to be a must. Yet, for some, eating and dieting may play too central of a role in their lives. One type of an eating disorder arises when a person periodically overeats or “binges”. These episodes are often followed by self-induced vomiting or purging using laxatives. The number of binges may vary daily or weekly. This eating disorder is called bulimia nervosa.
Another eating disorder may emerge when a person continually places limits on what they eat until they are fasting regularly. This eating disorder is known as anorexia nervosa. A preoccupation with food, dieting and possibly excessive exercising accompanies this eating disorder. Bulimic episodes may also accompany anorexia.
How do eating disorders develop?
There are many theories present today which provide explanations for why an eating disorder develops. These include psychological, biological, and social perspectives. What is known about the development of an eating disorder is that it is complex and may involve all the perspectives mentioned.
What signals that you or someone you know may have an eating disorder?
- Refusal to maintain body weight at or above a minimally normal weight for age and height
- Dry skin, intolerance of cold, lack of menstrual periods, distorted body image, excessive exercise
- Denial of hunger, intense fear of gaining weight
- Fluctuating body weight from alternating overeating and fasting, excessive guilt overeating, depression, disappearing after meals
- Frequent overeating, especially when under stress, feelings of being out-of-control
- Recurrent use of self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise to prevent weight gain
- Self-evaluation is unduly influenced by body shape and weight
How can you help someone who may have an eating disorder?
- Approach with compassion and a plan that involves a statement of concern and the basis for that concern. Avoid making a statement about weight (e.g., “you look too thin”) which may be taken as a compliment. Instead, confront the person with your observation that they look unhealthy, unhappy, and that you are concerned and know where they can get help.
- Be prepared – you may trigger an outburst of anger.
- If the person questions you about their weight, ask them “What do you think? It is how you feel about yourself that’s important, not what I think.”
- Use positive statements. Scare tactics do not work.
- Have on-hand specific information about the options for help: where to go, whom to see, how to get an appointment, and how much it will cost. You might offer to go with the person.
- Consult a professional for help in making your caring confrontation.
The experience of studying abroad is usually both exciting and stressful. International students face the challenge of addressing academic and personal concerns in an environment that is new and unfamiliar. The counselors at the CEW want to offer their assistance while you study at Arkansas Colleges of Health Sciences.
What are the Most Common Concerns Experienced by International Students?
Although international students encounter some of the same academic and personal concerns as their American counterparts, they may also experience a number of unique challenges:
- Separating from family and friends
- Learning to deal with new customs, behaviors, and attitudes
- Using a foreign language
- Adjusting to a new educational system
- Relating to peers, roommates, and professors
- Adjusting to changes in diet
- Finding that financial funding is not sufficient
- Finding that the academic program does not address the student’s needs or the needs of his or her country of origin
- Finding that some individuals do not understand people from other cultures
Overall, these concerns can make the process of adaptation to a new culture and a new academic environment very difficult and stressful. Consequently, you may feel:
How can the CEW help?
The counselors at the CEW are sensitive to the needs of international students. They are interested in students’ personal and professional growth. The counselors provide a safe atmosphere for students to address questions and concerns and to help them explore possible ways to resolve or cope with difficulties they have encountered.
Counselors are aware that it is difficult at first to discuss personal problems with a stranger. Generally, these difficulties diminish once students start to trust their counselor. Services are free to all students and all conversations are confidential. The CEW does not release information about a student without that student’s written permission, except in the case of imminent danger to self or others, child/dependent abuse, court order, or where otherwise required by law. Notations of counseling are not part of a student’s university record.
What is self-esteem?
Self-esteem is the way we view and think about ourselves and the value we place on ourselves as a person. Think about: What words would you use to describe yourself? What value did you place on yourself or aspects of yourself? Were your descriptions generally positive, balanced, or negative?
What is low self-esteem?
Low self-esteem is having a generally negative overall opinion of oneself, judging, or evaluating oneself negatively, and placing a general negative value on oneself as a person. People with low self-esteem usually have deep, basic, negative beliefs about themselves, which are often taken as facts and can have a negative impact on the person’s life.
Examples: I get nervous talking to new people. I am socially inept! I could not understand the course material today. I must be really stupid!
The impact of low self-esteem
Criticize themselves and abilities, brush off compliments or positive qualities, focus on mistakes, what they did not do, or what other people seem to do or have. In school or work, may avoid challenges and achieve less in personal relationships, may become upset or distressed by any criticism or disapproval. They may bend over backwards to please others, be extremely shy or self-conscious, Avoid or withdraw from intimacy or social contact, less likely to stand up for themselves from being abused.
How self-esteem develops
Early life experiences: beliefs about ourselves are the result of experiences we have by a variety of methods including observing what others do, media, direct experiences, and listening to what people say. Negative thoughts and beliefs about ourselves may have come from negative experiences. Punishment, neglect, or abuse- unhealthy parenting or interacting with children may be due to a variety of reasons and can lead to a parent not being able to validate a child that may cause chronic feelings of rejection or worthlessness in early childhood. Difficulty in meeting parents’ standards, not fitting in at school or home, and difficulty in meeting peer group standards. During childhood and adolescence, interactions with peers can become more important, especially if bullying occurs. Appearance and social media also become important. Being on the receiving end of other people’s stress or distress. Sometimes families experience stressful or distressing events, which may cause parents to not give children as much attention and respond negatively to their children while being unhealthy models of how to handle stress. Cultural variables: religion, race, ethnicity, SES, citizen status, language etc… An absence of positives: not enough attention, encouragement, warmth, etc…
How the past affects the present
Current self-esteem is likely to be impacted by past experiences that contributed to negative core beliefs.
Rules and Assumptions
When we strongly believe negative statements about ourselves, it often leads to feeling bad about ourselves and experience strong negative emotions. To ensure survival and to keep functioning, we begin to make certain assumptions, rules, and guidelines for how we live that protects our self-esteem. Rule: I must be the best at everything, or I must never make any mistakes. Assumptions: If I ask for help, I will be put down or No matter what I do, it will never be good enough.
Unhelpful Rules and Assumptions Generate Unhelpful Behaviors
The guidelines or rules for behaviors may lead to people having unrealistic expectations of their performance and engage in behaviors that they may feel are helpful to achieving the expectations. When a negative core belief is activated, people are likely to think that situations will end badly or become very self-critical.
Sometimes, what we think may be consumed by predicting the worst and jumping to conclusions: I will fail, or Others will criticize me.
Being unable to meet unrealistic expectations may lead to negative self-evaluation, which means the way you think is consumed by self-blame and self-criticism. You may then behave in certain ways such as isolating yourself or withdrawing because you may think you do not deserve enjoyable things.
What can I do now?
Think of some qualities that you like about yourself. This may be easy to dismiss and cause discomfort for acknowledging positive qualities but is necessary for a more balanced self-evaluation.
A tendency to only pay attention to negative views or events may cause you to miss and ignore compliments, achievements, or positive qualities that may exist. Increasing the amount of fun, enjoyment, and pleasure during your week and increasing/acknowledging your achievements during the week are other ways of promoting more balanced self-view.
Adjusting Rules and Assumptions
Rules/assumptions may be rigid and difficult to change. Helpful rules are realistic, flexible, and adaptable that enable healthy functioning. Although rules appear to help protect self-esteem, they are keeping negative core beliefs and low self-esteem in place without being challenged
Start by identifying rules/assumptions, think about: What you expect of yourself in various situations, what you expect from others, family sayings you were exposed to as a child
Then: Question their impact and helpfulness, Identify their advantages and disadvantages
Self-esteem affects virtually every facet of your life. When you value yourself and have good self-esteem, you feel secure and worthwhile and have generally positive relationships with others. You feel confident about your abilities and tend to do well at school or work. You are also open to learning and feedback, which can help you acquire and master new skills. With healthy self-esteem you are:
- Assertive in expressing your needs and opinions.
- Able to form secure and honest relationships and less likely to stay in unhealthy ones.
- Realistic in your expectations and less likely to be overcritical of yourself and others.
Android application: Self Esteem Blackboard
People in a crisis often lose perspective and the ability to solve problems in an organized and realistic manner. They may resort to less effective coping responses that can make the crisis worse. Sometimes a crisis is so severe that the person’s ability to cope is overwhelmed, and the individual becomes suicidal. The suicidal person who insists that the suicidal thoughts be kept secret is not dealing constructively with the crisis.
Most people who are suicidal will communicate their thoughts and feelings, often directly. Suicidal people frequently express helplessness and hopelessness regarding their current stresses and the future. Special “good-bye” statements or actions, such as giving away prized possessions, might also indicate a suicidal crisis. ALL SUICIDAL COMMUNICATIONS MUST BE TAKEN SERIOUSLY.
Depression and Other Risk Factors for Suicide:
- Loss of interest or pleasure in most activities.
- Extreme changes in eating or sleeping patterns.
- Inattention to appearance.
- Extreme guilt, self-blame, or feelings of worthlessness.
- Heightened anxiety.
- Recurrent thoughts of death or suicide
Additional Factors that Increase the Risk of Suicide:
- Alcohol and other substance abuse.
- High levels of anger or rage.
- Recent, overwhelming losses; traumatic stress.
- Previous suicide attempts.
- Exposure to someone else’s suicide attempt.
- Access to means (e.g., weapons, pills).
How to Respond
- Do: Listen and offer support.
- Widen options and explore alternatives for problem solving and positive action.
- Ask direct questions about the person’s intentions. Ask if the person is considering suicide. Ask if they have a plan.
- Communicate your concern for the well-being of the person.
- Recommend that the person contact a mental health professional; call one yourself; or offer to accompany the person to an initial appointment.
- Call Campus Police if you believe the risk of suicide is immediate.
- Do Not: Do not tell the person to “go ahead”.
- Do not say everything will be all right.
- Do not tell the person about someone who “has it worse”.
- Do not swear secrecy to the suicidal person.
- Do not leave the person alone if you believe the risk of suicide is high.
Call Campus Police at: 479-308-2222
Suicide Prevention Hotline: 1-800-273-8255
Medical School and Alcohol Abuse: 15 Warning Signs
It’s no secret that drinking is a noted pastime among college students. However, the problem seems to be exacerbated in the medical school community. In fact, a recent study by the Mayo Clinic found that about a third of medical students experience clinical alcohol abuse or dependency. That’s twice the rate found in US surgeons, physicians, and the general public.
Warning Signs of Alcohol Abuse and Addiction
Family history. Research has shown that genetics are responsible for about half of the risk of alcoholism. If your loved one’s parents have a history of substance abuse, it doesn’t necessarily mean she’s guaranteed to face the same situation, but it certainly puts her at greater risk. If you’re close enough with your loved one to discuss this history with her, do so with respect and caution. Don’t make any assumptions or accusations; instead, simply let her know you care about her and wouldn’t want something she has no control over, like genetics, getting in the way of her achieving her dreams.
Irritability and mood swings. This can be a tricky one to keep an eye out for in medical students. Your loved one is facing excessive amounts of stress with the school alone, plus any other personal issues she may have on her mind. It may come down to noting exactly which topics make her irritable, especially if it happens when discussing her drinking habits or tendency to spend nights going out. This warning sign alone isn’t enough to immediately point to an alcohol abuse problem, but its presence along with other indicators is certainly significant.
Recurring arguments or fights with family and friends. The irritability and mood swings discussed above can often lead to regular fights with loved ones, even over seemingly inconsequential topics. This can often lead to general problems in her relationships. If you’ve noticed she seems to constantly be at odds with family, friends, roommates, classmates, professors, and anyone else close to her, there might be a bigger problem at play.
Blackouts and forgetfulness. Drinking so much that you can’t remember the entire occasion is a major sign of alcohol abuse. She might not remember how she got home from a party, how she got that scrape on her arm, or how her cell phone screen got shattered. Her forgetfulness may even come into play throughout the day — alcohol interferes with the brain’s ability to record memories, so she may have more difficulty retaining information in general. She might forget the due date of a paper, an upcoming exam, or an important appointment.
Acting secretive and engaging in suspicious behavior. Even if she hasn’t fully acknowledged that she has a problem, she may start to hide her activities from others. She may demand more privacy from her roommate who comes home unexpectedly or accuse parents of giving her the third degree when they ask what she did over the weekend. This is often overcompensation in attempting to hide her habit.
Further, people who have become physically dependent on alcohol may look for any opportunity to drink — in the mornings before class, in their rooms alone, even at work or school — and become paranoid that their habits will be found out. If you notice that she’s sneaking off to be by herself at strange times and isn’t willing to talk about what she’s doing, there may be cause for concern.
Tolerance. There are two types of alcohol tolerance: metabolic tolerance occurs when the liver increases its production of enzymes to break down consumed alcohol. In other words, your body adapts to the increased presence of alcohol by finding a way to eliminate it from your system more quickly. Function tolerance occurs when someone becomes less sensitive to alcohol’s effects as a result of chronic use.
In general, developing a tolerance to alcohol means that it takes more to have the same effect. Although over the years our tolerance grows — it likely didn’t take you as much whiskey to become impaired on your 21st birthday as it does by the time you’re 30, for instance — the rate at which tolerance occurs is key. If you notice that your loved one would switch to water after four drinks in her first year of medical school and in her third year doesn’t slow down until around drink nine or ten, there’s an indication of a serious tolerance developing.
Changes in hygiene and appearance. A deterioration in the way someone takes care of herself can be another indicator of an alcohol abuse problem, but again this can be tricky when it comes to medical school. If she used to do her hair and makeup every morning but now usually puts her hair up and only washes her face, it’s more likely that the demands of school are causing her priorities to shift and she’s less focused on her appearance. However, there may be cause for concern if she begins to start showing a complete disregard for basic hygiene habits like regular showering, brushing her teeth, wearing clean clothes, and appearing generally disheveled every time you see her. This may be accompanied by strange smells on her breath, body, or clothing.
Neglecting other activities. Although the medical school will certainly occupy a significant amount of her time and leave less opportunity for hobbies, it’s important to take note if she suddenly seems completely disinterested in participating in any activities she once loved. Maybe she used to go to yoga a few times a week but no longer practices at all, even at home. Her weekly Sunday lunch dates with her sister may have completely fallen to the wayside. It’s especially concerning if she’s the one constantly canceling and is unable to be coaxed into keeping plans.
A decline in school and/or work performance. Medical school is absolutely more difficult than any other level of education she’s encountered thus far, so it’s normal to see an adjustment period while she acclimates to the workload and demands. However, if she begins to show a sudden decline in her grades, rarely attends class, and underperforms in group projects, there’s likely a bigger problem. It may be especially obvious if you notice she’s going out on a regular basis, but keep in mind that sometimes alcohol-dependent people will hide their habits and choose to drink alone at home to avoid arousing suspicion.
Increased risk-taking behavior. Alcohol has the ability to lower our inhibitions and take the pressure off of social situations. This can be a good thing in moderation — it can ease you into a work party with your superiors, help you meet new people, and give celebrations an extra edge — but can be dangerous in some. Alcohol abusers tend to take it to the extreme. They may be more likely to engage in unprotected sex, driving under the influence, or commit petty crimes like vandalism and property damage.
Displaying physical signs. Depending on their level of abuse, alcohol abusers tend to display physical indications like flushed skin, broken capillaries on the face, bloodshot eyes, sudden weight gain or loss, impaired coordination, and shakes or tremors. She may also seem more fatigued and start changing her sleeping patterns or eating habits.
Constantly using alcohol as a way to cope. Alcohol can be an easy crutch in tough times, but in an environment filled with rigorous classes, detailed exams, and intense competition among your peers, it can be a dangerous way to blow off steam. She may begin to depend on alcohol to get her through the rough patches — a poor test score, relationship problems, a heavy school workload, or issues at the job she’s supporting herself with. She may even turn to alcohol first in the good times, whether as a way to celebrate a good grade or simply a way to unwind after a busy week. It’s one thing to have the occasional night of drinking, but if alcohol seems to be her number one choice for feeling “normal” or “better” no matter the situation, she’s displaying questionable judgment.
Loss of control. As things get worse, she may start to appear out of control, as if alcohol controls her life. She may fly into a sudden rage if she can’t acquire it or become desperate at finding someone to indulge with her. There may also be indications as she’s drinking — she might seem actually unable to stop drinking (even if she said she only wanted a couple) or stay out for much longer than originally planned. This is especially noticeable in a medical student, who needs plenty of rest and coherent study time in order to stay on top of her classes.
Displaying withdrawal symptoms. If she attempts to cut back on her drinking, she may exhibit symptoms of withdrawal including night sweats, nervousness, anxiousness, nausea, vomiting, increased blood pressure or heart rate, shaking, and twitching. Sometimes withdrawal can worsen into a condition called Delirium Tremens, which may cause hallucinations, fever, seizures, and confusion. If she displays these symptoms, she is in the midst of a medical emergency and should seek medical help immediately.
Continued use of alcohol despite negative consequences. If all or most of these warning signs are being displayed and her life seems to be in turmoil, yet she still shows no signs of cutting back on her drinking, this is the biggest warning sign of all. This could point to addiction, and she simply may not feel able to quit drinking.