Hi everyone, in this feature we discuss Anxiety and Traumatic events. You’ll learn about-
- The signs and symptoms, risk factors and effective interventions for anxiety disorders
- The importance of early intervention for anxiety problems
- The Mental Health First Aid Action Plan for anxiety problems.
- Physical symptoms
Imagine Sarah, a crew member, is suffering from troublesome anxiety. She is sitting on the dock, outside the vessel, and seems to need a moment to collect herself. When you talk to her, she describes some physical symptoms of anxiety.
What are the physiological signs and symptoms of anxiety?
Cardiovascular: pounding heart, chest pain, rapid heartbeat, blushing.
Respiratory: rapid breathing or shortness of breath, feelings of suffocating
Neurological: dizziness, headache, sweating, tingling and numbness.
Gastrointestinal: choking, dry mouth, nausea, vomiting, diarrhoea.
Muscular: muscle aches and pains, restlessness, tremors and shaking.
Importance of early intervention
Just as with depressive disorders, it is important that anxiety disorders are recognised and treated early because they can have a major impact on a person’s subsequent life .If anxiety disorders are not treated when they first begin, the person is more likely to have a range of adverse outcomes in life such as:
- Alcohol or drug problems
- Suicide attempts
- Lower educational achievement.
Let’s talk about Sarah…
Sarah is twenty-eight years old. She was brought up in rural South Africa, she went to University in her closest city and 2 years ago moved to Mallorca and joined the boat, where you both work. She found moving overseas a little overwhelming, and still does 2 years later. She is now living alone, which has also been a major adjustment, as she craves reassurance when she is worrying excessively.
Three months ago, Sarah was in a car accident. At the time she was afraid for her life, and for the lives of the people in the other car. The accident was not her fault, and though neither car could be repaired no one was seriously injured. Lately Sarah has not been performing at the level she is expected to, although she has been working extremely long hours to try to make up for it. You’ve heard that she becomes irritated very quickly and has no patience at work. She confides in you one day over lunch that she has been having a lot of trouble sleeping, sometimes waking up with nightmares about the accident. She is also finding herself very frightened when she drives now. She avoids driving when possible and this has had a major impact on her job, shopping for the boat, not to mention her social life .In spite of an ever-increasing number of symptoms and her increasing withdrawal over time, Sarah hasn’t spoken to her doctor about this, and tells you that you are the first person she has talked to about it. She was raised to believe you need to deal with your own problems and that needing outside help is a sign of weakness.
Besides, the symptoms are often physical, and a recent check up showed she was physically healthy. Sarah tells you that three times in the last year (including once before her car accident) she has experienced something very strange. Her heart rate seems to alter suddenly, her breathing becomes rapid and shallow, her fingers and toes tingle and her head begins to hurt badly. The symptoms all come on very rapidly and last for about ten minutes – they seem to stop once she escapes from wherever she is and finds some place quiet and private to hide. Although Sarah doesn’t want to think too much about it, she suspects they might have been panic attacks – she knows someone who has experienced similar problems before.
Where to begin?
Talking with Sarah about her difficulties. The approach that is helpful to someone with troublesome anxiety is very similar to that for someone experiencing depression – We looked at this in the previous Islander Magazine Issue, where I discussed Depression.
The key points are:
Approach the person about your concerns about their anxiety.
Find a suitable time and space where you both feel comfortable. If the person does not initiate a conversation with you about how they are feeling, you should say something to them. Respect the person’s privacy and confidentiality. Having listened to Sarah talk about her car accident and her symptoms of panic, you begin to suspect she may have an underlying anxiety problem. How would you go about discussing it with her? Can you spend some time with her right now and have a discussion? If work is pressing, you might need to ask her if she can talk again later.
Are there a lot of people around who might overhear? This might make it hard for her to continue to talk openly once you’ve asked about feeling anxious . Is she currently feeling very rushed or upset? You might encourage her to try again when she is feeling a little more calm.
You are particularly concerned about Sarah today. She just doesn’t seem to be herself. She appears to be avoiding contact and conversation with anyone, and although she is working hard, she seems to be unfocused. When she has to talk briefly with you, she seems angry and irritated. Question: Consider how and when you might broach the topic of your concerns with Sarah. How would you do this?
It’s best if you can continue the conversation right away, but this might not be easy if you are both busy, or if there are other people present. You may need to ask if she would be willing to talk to you later. If Sarah is unwilling to talk just then, it can be helpful to say something that will encourage her to talk another time, for example, “I care, and I’d like to try to help”, “Dealing with this might make other aspects of your life easier”, or “If you don’t want to talk to me about this, it would be good for you to think who else might be good to talk to.”
Assess and assist with any crisis
Imagine that you’ve approached Sarah. The next thing is to assess and assist with any crisis. What could the crises be?
The main crises associated with anxiety are:
Panic attacks and Traumatic events.
People with anxiety disorders are also at increased risk of suicidal thoughts, and of engaging in suicidal behaviours or non-suicidal self-injury.
This issue will teach about panic attacks, then traumatic events.
Panic attack facts
One crisis associated with anxiety is panic attacks. In order to help Sarah and to assess whether she is having a panic attack, you’ll need to know some basic facts.
Sarah’s panic attack.
You notice Sarah slip into an empty meeting room one day, and you follow her. She is trembling, shaking and looks very distressed. She seems to be struggling to breathe and puts her hand up to her heart. As she does so, you begin to worry that she is having a heart attack. When you ask if she is experiencing chest pain, she shakes her head. Because you know Sarah is prone to feeling anxious, you ask if she thinks she might be having a panic attack and she admits that she does. “I’ve had a few this year,” she says.
What is the first thing you should do according to the guidelines for assisting someone who is experiencing a panic attack?
Action 1: Approach the person, assess and assist with any crisis.
The initial task is to approach the person, look out for any crises and assist the person to deal with them.
The key points are to: Approach the person with your concerns about their mental health problem. Find a suitable time and space where you both feel comfortable. If the person does not initiate a conversation with you about how they are feeling, you should say something to them. Respect the person’s privacy and confidentiality. Look out for any indications the person may be in crisis. Possible crises are that: The person may harm themselves (e.g. by attempting suicide, by using substances to become intoxicated, or by engaging in non-suicidal self-injury);The person experiences extreme distress (e.g. such as a panic attack, a reaction to a traumatic event or a severe psychotic state);
Action 2: Listen non-judgmentally
Listening to the person is a very important action. When listening, it is important to set aside any judgments made about the person or their situation, and avoid expressing those judgments. Most people who are experiencing distressing emotions and thoughts want to be listened to empathetically before being offered options and resources that may help them. When listening non-judgmentally, the first aider adopts certain attitudes and uses verbal and non-verbal listening skills that: Allow the listener to really hear and understand what is being said to them, and make it easier for the other person to feel they can talk freely about their problems without being judged .It is important to listen non-judgmentally at all times when providing mental health first aid.
Action 3: Give support and information
Once a person with a mental health problem has felt listened to, it can be easier for the first aider to offer support and information. The support to offer at the time includes emotional support, such as empathising with how they feel and giving them the hope of recovery, and practical help with tasks that may seem overwhelming at the moment. Also, the first aider can ask the person if they would like some information about mental health problems.
Action 4: Encourage the person to get appropriate professional help.
The first aider can also tell a person about any options available to them for help and support. A person with mental health problems will generally have a better recovery with appropriate professional help. However, they may not know about the various options that are available to them, such as medication, counselling or psychological therapy, support for family members, assistance with vocational and educational goals, and assistance with income and accommodation.
Action 5: Encourage other supports
Encourage the person to use self-help strategies and to seek the support of family, friends and others. Other people who have experienced mental health problems can also provide valuable help in the person’s recovery.
Traumatic Events & Anxiety
Now, we will discuss a common cause for anxiety in yachting, and globally, traumatic events.
Mass traumatic events .Mass traumatic events are those that affect large numbers of people.
They include: Severe environmental events (such as hurricanes, fires and floods)
Acts of war and terrorism
In addition to the general principles for helping someone after a traumatic event there are extra considerations for a ‘mass traumatic event’.
For example, Richard is a Bosun. One morning you notice Richard arriving late into work, looking pale and distressed. You ask him what is wrong and he tells you he just witnessed a cyclist colliding with a bus. The cyclist was badly injured and there was a lot of blood. Richard stayed until an ambulance arrived but he doesn’t know if the cyclist survived.
Richard is shaking and asks you “How can I find how out if he made it? What hospital would he be in?”
Witnessing this accident was a traumatic event for Richard.
To assist: Sit down with Richard and ask him how he is. Let him know you care and will help if you can. Ask him what could help him. Give him truthful information and admit that you lack information if you can’t answer his questions.
Talking to Richard at the time of the incident.
When talking to someone like Richard who has just experienced a traumatic event:
Show you understand and care. Ask them how they’d like to be helped
Repeat yourself several times if necessary.
Use clinical and technical language
Communicate as a superior or expert.
Richard – a week later
Many people are fearful of talking with someone who has experienced a trauma because they think they’ll make it worse. Others think it is important that people talk about their experiences.
So, over the next couple of days, Richard still seems to be somewhat distressed, jumpy and a bit irritable.
In the weeks or months to come encourage Richard to tell others when he needs or wants something, rather than assume others will know what he wants. Also encourage him to identify sources of support, including loved ones and friends, but remember that it is important to respect his need to be alone at times.
Richard over coming months
You’ve helped Richard through the immediate aftermath of the traumatic event, showing him that you care and respecting his needs.
Discourage Richard from using negative coping strategies such as:
Working too hard
Using alcohol or other drugs
Engaging in self-destructive behaviour.
Encourage Richard to:
Take care of himself.
Get plenty of rest if he feels tired.
Do things that feel good to him (e.g. read, exercise, watch television).
Think about any coping strategies he has successfully used in the past and use them again.
Respect Richard’s need to talk (or not talk)
Be aware that Richard may suddenly or unexpectedly remember details of the event , and may or may not wish to discuss these details. If this happens, the general principles for helping someone after a traumatic event in the Action plan above using the steps 1 to 5.
Encourage professional help if needed.
After four weeks, some return to normal functioning is expected. You should encourage Richard to seek professional help if, for four weeks or more, after the trauma: He still feels very upset or fearful. He is unable to escape intense, ongoing distressing feelings. His important relationships are suffering as a result of the trauma. He feels jumpy or has nightmares because of or about the trauma. He can’t stop thinking about the trauma. He is unable to enjoy life at all as a result of the trauma.
Richard recovers well. You make a point of taking Richard to lunch one day several weeks later. He tells you he’s feeling much better. He thanks you for your genuine care at the time of the accident, and says it made a big difference to him at the time.
What is an anxiety disorder?
Everyone experiences anxiety at some time. An anxiety disorder differs from normal anxiety in the following ways:
It is more severe.
It is long lasting.
It interferes with the person’s work, other activities or relationships.
Anxiety can show in a variety of ways:
Prevalence of anxiety
The percentage of people aged 18 or over with an anxiety disorder in the previous year varies between 5.3% and 18.2% in developed countries. Anxiety disorders are around twice as common in women as in men, similarly to mood disorders.
Anxiety disorders often co-occur with mood disorders and substance use disorders.
People who are most at risk are those who:
Have a more sensitive emotional nature.
Tend to see the world as threatening.
Have a history of anxiety in childhood or adolescence, including marked shyness
Are female ,Have alcohol use problems
Experience a traumatic event.
Family factors that increase risk: A difficult childhood
A family background which involves poverty or a lack of job skills
A family history of anxiety disorders
Parental alcohol use problems
Separation and divorce.
Types of anxiety disorders
Crises associated with anxiety
Intervention, treatment and support
Crises associated with anxiety
Crises that may be associated with anxiety are:
The person goes into an extreme level of anxiety and experiences a panic attack.
The person has experienced a traumatic event.
The person has suicidal thoughts and behaviours.
The person is engaging in non-suicidal self-injury.
Intervention, treatment and support
These health professionals can provide help:
GPs, Psychologists, Counsellors, Psychiatrists, Mental health nurses, Allied health professionals such as occupational therapists and social workers.
Evidence-based treatments for anxiety disorders:
Psychological therapies such as cognitive behaviour therapy (CBT) and behaviour therapy. Medical treatments such an antidepressant medications. Complementary therapies and lifestyle changes such as relaxation training can be beneficial.
As we have seen, anxiety disorders are characterized by a variety of symptoms. One of the most common is excessive and intrusive worrying that disrupts daily functioning. Other signs include agitation, restlessness, fatigue, difficulty concentrating, irritability, tense muscles and trouble sleeping. Recurring panic attacks may indicate panic disorder, fearing and avoiding social situations could indicate social anxiety disorder and extreme phobias could be a sign of specific phobia disorders.
Regardless of which type of anxiety you or your colleague may have, there are many solutions you can use to help relieve using the Action steps above and recommending to work with a licensed healthcare professional, who understands Yachting and the unique traits of our industry. Please consider enrolling in a Mental health First Aid Course, making Mental Health First Aid a norm on your vessel and remember to get your hands on the list of qualified and recommended Practitioners the Life is for Living group have readily available and make it available to all crew.
Together we rise.