October, 2017

Traumatic Reactions after Wildfires: Common Reactions and Coping
Author: Dr. Anish S Shah, MD 
Wildfires are traumatic events that can have a potentially damaging impact on mental health of most vulnerable section of the population. In the aftermath of wildfires, those impacted may experience financial loss as well as loss of loved ones. In the year 2016, the US experienced 67,743 wildfires affecting a total of affecting 5,509,995 acres of land[1]. Subjects who undergo these traumatic events develop adaptive reactions in response to acute stress which can manifest into significant long term psychological distress (Papanikolaou et al., 2011), causing major depression or post-traumatic stress disorder (PTSD)(Marshall et al., 2007). While most subjects recover from the trauma of wildfires with the passage of time, a minority of victims may continue to have mental health issues over longer periods of time.
The most recent wildfires in the Sonoma, Napa and Santa Rosa counties in California encompassed all layers of state and federal emergency but still destroyed approximately 7700 structures, with more than 40 people confirmed dead[2], forced evacuations and an estimated loss of over 4 billion dollars[3].

[1] https://www.nifc.gov/fireInfo/fireInfo_stats_totalFires.html
[2] https://www.washingtonpost.com/news/post-nation/wp/2017/10/14/more-californians-ordered-to-flee-as-gusting-winds-spread-wildfires/
[3] https://www.cnbc.com/2017/10/23/number-of-structures-lost-in-wine-country-blazes-jumps-to-8400.html


What are common reactions when someone lives through a disaster or traumatic event?

Subjects experiencing wildfires experience intense feelings which occasionally progress into mental health disorders. It is extremely important to identify normal responses to these traumatic, life-disrupting events, which can help in coming to terms with ones thoughts, feelings and actions during the post-traumatic recuperative process. These reactions are not only experienced by disaster victims but also by the rescue personnel such as those helping with the emergency evacuations and the firefighters. There are a wide range of emotional responses and depend on the individual, it is important to identify and address the most common reactions described in the following section.
  1. Experiencing extreme fear, anxiety and feeling stressed. These reactions following the traumatic event may result in subjects becoming short-tempered or emotionally unstable. A subsection of the population may also experience mood swings. Anxiety and nervousness are commonly observed and some subjects may feel depressed or be overwhelmed by social situations, avoiding social interactions to a large extent than before the traumatic event. Following the events such as wildfires, family members may argue more and others may experience the need to isolate themselves in the absence of their usual activities and routine.
  2. Feeling of hopelessness for the future and detachment from the loved ones: in an event of financial and personal losses, people experience a feeling of a hopeless future and might not be in a position to understand and have concern for others.
  3. Denial and shock tend to be the most commonly reported reactions after natural disasters impacting on a large scale. Denial and shock are generally reported immediately after the traumatic event has occurred and these reactions are protective reactions assisting with the coping mechanism. With the passing of time, as shock ebbs, different people experience different emotional responses to the aftermath of a wildfire.
  4. Intense emotional reactions to triggers such as fire, emergency sirens, smoke and ash can include fear and anxiety. These distressing emotions may affect the quality of interpersonal relationships, having most impact on subjects living in a short-term housing arrangement.
  5. Behavioral issues: altered behavior and thoughts may result in elaborate but disturbing memories of the scene of evacuation or flames approaching one's home and family. Reliving these memories may cause physiological responses such as sweating and an increased heart rate. Subjects may also experience difficulty or inability to concentrate and make decisions while experiencing disorientation. Experiencing the event may impact sleep pattern and eating habits.
  6. Manifestation of psychological stress into physical symptoms can make the body more prone to illness. It is not uncommon to experience severe headaches, heavy chest and nausea due to extreme stress. The exacerbated stress and anxiety can also worsen the pre-existing conditions in the aftermath of the wildfires.

How do I recover following the fire?
After the initial shock subsides, it may be difficult to care about ones physical as well as mental wellbeing due to a number of other issues requiring attention. There are a number of steps one can follow to slowly re-establish a sense of control over one's life and look towards the future with a positive mind. The following section enlists steps that can help in improving mental health and developing a positive outlook after a traumatic event.
  1. Take time to adapt and adjust. It is important to realize early on that recovering from a traumatic event such as experiencing wildfires and loss of material and human life will not be easy. As human beings, we require time to mourn the losses and this is a gradual process.
  2. Asking for support from loved ones and extended family. It is important to understand that those who have experienced the traumatic event may not be in a best position to offer help and may not be as supportive as normal. It is important to look out for help from outside the community as well as voluntary organizations.
  3. Seeking help from local support groups that can help you following the wildfire. Local support groups are often led by trained professionals such as psychologists, well-equipped to handle the situation you are in. Local support groups can be especially helpful for people lacking family support or support through personal networks.
  4. Taking a break from too much information will keep you well informed but limit access to excessive online and television news. This can help in limiting the excessive stress one is exposed to upon repeated exposure to the trauma experienced.
  5. Adopting a healthy lifestyle can improve one's capacity to deal with extremely stressful situations such as natural disasters. It is important to eat a healthy, balanced meals, exercise, relax and get enough sleep. Relaxation techniques can help in tackling sleep disturbances. Alcohol consumption and drugs should be avoided as they do not help with the coping mechanism in the aftermath of a disaster. Furthermore, the consumption of alcohol and drugs may adversely impact the emotional responses by intensifying the feeling of sadness and anger.
  6. Establishing routines in day-to-day life. Scheduling times for meals and exercising can help in structuring the day and avoid focusing on the losses experienced after the disaster. It is important to focus the energy on hobbies and doing things one enjoys.
  7. Delaying important decisions such as change of jobs or changes in personal relationships. Important life-changing decisions are also stressful and should be avoided at best after experiencing natural disaster such as wildfire as they can be overwhelming for one's emotional and mental wellbeing.
  8. Engaging in community building activities: Spending time with people in the community who have also been affected in a similar way helps in the healing process while bringing the community together in the aftermath of the experience.
  9. Making small decisions on a day-to-day basis to help feel in control of one's life and distracting the focus from the long term future can help in the recovery process.
  10. Avoiding non-prescribed mood-altering substances and alcohol: while one may feel overwhelmed by the situation, it is best to avoid alcohol consumption and other substances as they hinder the healing and recovery process.

Taking care of children experiencing wildfires 
Children are vulnerable to extreme stress and anxiety after experiencing emergencies such as wildfires. Children do not have a well-developed coping mechanism to extreme stress and nay demonstrate behavior more typical of younger children. Children may become prone to experiencing nightmares and might not perform well at school as they may be distracted by the trauma. Children may become more irritable in dealing with other adults and their friends. Some may experience loneliness and become withdrawn.

Following steps can be adopted by the parents and caregivers to minimize the stress in children after experiencing wildfires.
  1. Giving enough time and attention to children and letting them know that the parents and/or caregivers are there for them. This is especially important during the first few months following the event.
  2. Being affectionate with children can be extremely comforting to children experiencing trauma. It is important to allow younger children to express their feelings through non-verbal activities such as drawing or painting, which can be excellent ways to relieve stress and engage in social activities with other children and adults.
  3. Encouraging older children to express their feelings and thoughts with their peers as well as parents/caregivers. As children express their feelings and thoughts about their experiences of the wildfires, it reduces their anxiety levels and reduces the confusion that they may experience. Adults interacting with children should engage with them using appropriate language while addressing their concerns and questions. Parents and caregivers should assure the children that they are available at all times to address their emotional concerns.
  4. Maintain regular schedules for meals, play and bedtime to help restore a sense or order to the daily schedule.
  5. Reduce news viewing. Just like in adults, excess information on the disaster can trigger traumatizing memories in children and therefore, should be kept to a minimum.
  6. Dealing with separation anxiety: damage to one's home and community can threaten the sense of safety and normalcy in children and may trigger separation anxiety in younger children, manifesting in behavior such as excessive clinging, crying, screaming, and fear of the dark. Parents and caregivers should maximize good communication skills, strong self-efficacy, and positive coping skills among children to reduce fear and anxiety.
  7. Resuming classroom routines of reading, projects and promoting self-efficacy in children by encouraging them to participate in social and school activities as well as community rebuilding activities can help in reducing stress among children after experiencing natural disasters such as wildfires (Shepard et al., 2017).

When should I seek assistance from Mental Health Professionals?
One should seek help from mental health professionals in case of persistent feelings of being overwhelmed, anxiety or sadness. These feelings can negatively impact the interpersonal relationships and/or performance at work.
Individuals who experience prolonged response to trauma that negatively affects their daily functioning should consult a trained mental health professional with experience handling trauma, especially if they exhibit the following:
  1. Intense depression with crying that continues weeks after the incident.
  2. Persistent insomnia or vivid nightmares and flashbacks about the incident occurring on a regular basis. In a recent study by Psarros et al, insomnia is experienced in around 63.0% of the victims while 46.7% of the subjects have PTSD in the first post-disaster month. Moreover, 51.1% of the total sample experienced 'fear of imminent death'. Female victims have higher incidence of insomnia and PTSD (Psarros et al., 2017).
  3. Lack of concentration and inability to concentrate on daily tasks in a way that it affects ones performance at work and the capacity to carry through the day.
  4. Angry, emotional outbursts in children or serious issues related to performance at school, anxiety related to the fire, social withdrawal must be consulted with a mental health professional trained to handle children.
  5. Poor frustration tolerance and angry outbursts that create noticeable problems in interpersonal relationships and relationship with peers.
  6. History of clinical depression, anxiety disorder or PTSD: those with a history of mental health issues can experience exacerbated problems following natural disasters such as wildfires and need to consult health care professionals.
  7. Suicidal thoughts and attempting to end one's life after experiencing wildfires.
  8. Increased consumption of tobacco and anxiolytics: If one feels the urge to smoke more often after the experience of surviving the wildfires or when one starts medication for anxiety, it is suggested to consult a medical health professional as these symptoms have been linked to experiencing wildfires, and are independent of PTSD (Caamano-Isorna et al., 2011).
  9. Changes in diet and sleep patterns: If one notices stark changes to diet or does not feel like eating or has extreme difficulties getting enough sleep, one must consult a mental health counsellor for advice.
  10. Putting oneself in a situation of extreme harm: If a person has thoughts of putting one's life at risk or the urge for substance abuse in days or months following the incident.

American Psychological Association, Department of Veteran Affairs, American Psychiatric Association, Psychiatric Services

Caamano-Isorna, F., Figueiras, A., Sastre, I., Montes-Martinez, A., Taracido, M., and Pineiro-Lamas, M. (2011). Respiratory and mental health effects of wildfires: an ecological study in Galician municipalities (north-west Spain). Environmental Health 10, 48-48.

Marshall, G.N., Schell, T.L., Elliott, M.N., Rayburn, N.R., and Jaycox, L.H. (2007). Psychiatric disorders among adults seeking emergency disaster assistance after a wildland-urban interface fire. Psychiatr Serv 58, 509-514.

Papanikolaou, V., Adamis, D., Mellon, R.C., and Prodromitis, G. (2011). Psychological distress following wildfires disaster in a rural part of Greece: a case-control population-based study. Int J Emerg Ment Health 13, 11-26.

Psarros, C., Theleritis, C., Economou, M., Tzavara, C., Kioulos, K.T., Mantonakis, L., Soldatos, C.R., and Bergiannaki, J.D. (2017). Insomnia and PTSD one month after wildfires: evidence for an independent role of the "fear of imminent death". Int J Psychiatry Clin Pract 21, 137-141.

Shepard, B., Kulig, J., and Botey, A.P. (2017). Counselling Children after Wildfires: A School-Based Approach. Canadian Journal of Counselling & Psychotherapy/Revue Canadienne de Counseling et de Psychotherapie 51.

Siyan Clinical Corporation
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