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Section 4
Location-Based Measures of Disaster Exposure

Question 4 | Test | Table of Contents

In the last section, we discussed using the Future-Pull Approach to help natural disaster PTSD clients in order to focus on their future instead of dwelling on the past.

In this section, we will discuss revisiting the site of the trauma and how your client can make this a successful trip.

As you might imagine, after clients have initially visited the sites of the damage which could not only include their own home, but the homes of their neighbors, their place of work, schools, stores they had frequented for years, etc. Here is how I helped Tom through this revisiting stage.

At the time of the tornado, Tom, age 45, and his wife were at their friend’s house which was untouched by the tornado. After the tornado, Tom and his wife, Karen, left for home on foot. There car had been overturned. Many roads were undriveable, filled with debris. The trip home, which usually took 30 minutes driving, ended up taking 2 and a half hours walking. Tom and his wife walked among the ruins and, at times, they were not sure if they were going in the right direction since many landmarks were gone. Tom explained in an emotion choked voice to me during our first meeting, "everything was flattened, damaged, or just plain gone!" Tom was able to describe all the details of the tornado damage which perhaps made it difficult for him to believe what happened. He explained, "all of the houses looked as if they were out of place, as if they had been moved around. Pieces of the houses were missing and trees were knocked down. When Karen and I reached our home, she asked how much farther we had to walk. I was stunned that she couldn’t even recognize our home".

Here is a list of 10 tips that I shared with Tom as he had to revisit the site of his home to collect any remaining personal possessions as well as verification of loss for insurance purposes, etc.

1. Plan your visit out ahead. Ask yourself what you want out of the visit. What problems do you have with the site? If you find yourself avoiding the site, ask yourself why.
2. Work on developing your ability to monitor your arousal level. Are you in grief? Angry? Disoriented?
3. Work out a specific plan to lower your arousal level. With Tom, we developed two techniques of deeper exhalations than inhalations; as well as visualizing the loving smiling face of his wife Karen.
4. Practice the visit, even handling possible meltdowns, before you go. To help, make sure to ask yourself what you will do if you become upset. Since Tom had worked his entire life to save for and help with the construction of his house the loss was more emotional for him than his wife. He stated in my initial interview with him, "when I saw the flattened structure I buckled to my knees and cried. I just couldn’t stop myself." Tom felt Karen would be supportive. He suggested that hot camomille tea seemed to calm him and his wife could help to stabilize his hands if they were too shaky to hold the tea cup.
5. Include someone who you really trust in your plan. It is most beneficial to tell them specifically what you want them to do for you. The steps Tom took are outlined above.
6. Slow down and take the visit one step at a time. With Tom, he felt that having a big breakfast before the visit to his home would make him nauseus and make him throw up. We talked about having some food in his stomach might be beneficial. He said perhaps he could have a couple of pieces of toast.
7. To keep calm use breath, self-talk, imagery, and movement. These ideas are outlined above.
8. Be open to your friend’s suggestions and their support. Tom’s mother and father lived in a nearby city that was untouched by the tornado. He is especially close to his father. We discussed an appropriate phone schedule of increasing the calls to his father from once a week to every other day. HE felt his father would be amenable to this.
9. Monitor your arousal level and bring it back down to a manageable level during each step. I took some time with Tom to discuss what happens in his body when he is becoming stressed. He mentioned he gets a knot in his stomach and feels choked in his throat. He felt that if he felt to overwhelmed by this panicky feeling he would limit his time at the site of his destroyed house. Know when you need to back up or back off and do it. See ideas in the step above.
10. Once you reach the middle of the site, take a moment to sit down and return yourself to a fully present state. Spend enough time walking around the location in order to look at it from different perspectives. Remind yourself "that was then, this is now". Focus on seeing the difference between then and now.

I told Tom, "When you are ready, leave the site and talk about the experience whether it be through talking to your friends, writing about it, drawing it, etc. Any feelings that come up, whether they are old or new, are normal. Make sure to remind yourself of this. Make sure to celebrate and acknowledge your courage, accomplishment, and daring. Think out what you want to do next. Ask yourself if you want to do another visit. Ask yourself if you want to share your experience with your therapist. Do you want to write a journal entry or do you have another ritual that you want to use to accomplish your visit goals?"

Do you have a client like Tom that can benefit from these 10 tips to make their return to the site of their trauma successful?

In this section we discussed revisiting the site of the trauma and how your client can make this a successful trip.

In the next section we will discuss how to talk about a natural disaster crisis with children after the disaster has occurred.

Peer-Reviewed Journal Article References:
Garfin, D. R., Silver, R. C., Ugalde, F. J., Linn, H., & Inostroza, M. (2014). Exposure to rapid succession disasters: A study of residents at the epicenter of the Chilean Bío Bío earthquake. Journal of Abnormal Psychology, 123(3), 545–556.

Sherwood, I. M., Hamilton, J. C., Elmore, J. D., & Allon, S. A. (2017). A comparison of self-report and location-based measures of disaster exposure. Traumatology, 23(3), 265–272.

Smid, G. E., van der Velden, P. G., Gersons, B. P. R., & Kleber, R. J. (2012). Late-onset posttraumatic stress disorder following a disaster: A longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy, 4(3), 312–322. 

QUESTION 4
What is the first step for your client when they are visiting the site of their trauma? To select and enter your answer go to Test.


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