Despite our assumption, change is inevitable. In fact, change is the only constant in life. Every year, month, week, day and second is different. Our brain deludes us into thinking we live in a world of predictability and constants by maintaining routines and organising randomness into patterns. This helps us feel safe and prevents us from being overwhelmed by the constant change to which we are exposed.
Sometimes, however, change is so great and unexpected that it totally challenges or even shatters our comfortable view of the world. Such change is usually in the form of loss. Such events include sickness, death, job loss, relationship breakdowns, bullying, assault and injury. Often, the catastrophic impact, and sometimes irreversible nature and unexpected suddenness, of these events makes them highly salient and devastatingly traumatic.
Despite formal definitions, in clinical practice I have always regarded trauma as the result of significant, unexpected change that challenges a person’s existing world view to such an extent it is not easily reconciled. This often includes loss and grief.
Do we all react the same to change? Our reactions to change are idiosyncratic. Every person will react differently based on many variables or factors. This might include whether the change was expected, how the change was introduced, their previous experience with change, their resiliency, their psychological health and well-being, the way they perceive and think about the change, their developmental history, their environment and lastly availability and quality of social support.
Triage: The First Response Under normal circumstances, people’s reactions might vary from indifferent to an acute crisis. When a critical incident occurs, triage is important to ensure individuals are not having a catastrophic reaction. Acute reactions of concern include dissociation or some other form of acute reaction relating to their mood or cognitive status that might place them at risk of impulsive or dangerous behaviour. There might be higher risk for those with a history of impulsive behaviour, significant trauma, previous acute mental health conditions or substance abuse.
Adjustment to Change For most people, a range of emotions and behavioural reactions are experienced over six to eight weeks post-incident. Reactions might include agitation, mood swings, hypersensitivity, nightmares, disturbed sleep, hyper-vigilance, withdrawal, anxiety, depression, rumination and so on. Reactions can also vary according to cultural and religious experiences, practices and beliefs. These symptoms and signs can be very normal. People often think they are losing their mind. Remember, they are a normal reaction to an abnormal situation.
Kubler-Ross developed a model of human response to change. While this model is very useful, remember everyone’s adjustment is unique and they might experience the emotional reactions listed to varying levels in a different order, or not at all. Below is a pictorial presentation of reactions to grief based on a modified version of the original work by Kubler-Ross.
It is good to seek professional help after a critical event and have a health professional review your well-being and provide psycho-education as to what to expect and create a recovery plan which considers management of risk, should it arise.
Psychological therapy might be required if symptoms are severe, worsen, cause serious distress, or are not resolving after six to eight weeks. Psychological counselling is then recommended to review your well-being, as well as identify and resolve factors that are preventing natural resolution of trauma or grief.
Complex and Complicated Grief Reactions Often, individuals experience problems adjusting when there are circumstances around loss that are complex or complicated. Such events include: the death of a child, someone being seriously injured as a result of someone else’s irresponsible or even malicious actions, the gruesome nature of an event, guilt over a conflict, or the nature of the premorbid relationship with the deceased, conflicting emotions in response to the event, unfinished business, and feelings of guilt and shame for something you perceived you did or did not do. Sometimes, it is the chronic nature of an event such as ongoing bullying, an extended period of illness, or repeated and protracted abuse as a child or a partner, or the helplessness of standing by while witnessing or being aware of, harm being sustained by, or abuse of, others.
Letting Go or Finding Meaning While some people can let go and move on others need to find meaning in the experience. We now understand people do not have to let go of the past, objects of loss, or the deceased. Rather, the objective is to find new meaning and form a different relationship with the person, event of object. This is a highly individual experience and it is where psychological therapy can assist.
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Dean Harrison (Director/Principal Counselling Psychologist) iflow psychology
Copyright Dean Harrison 2020