An earthquake in Colombia has been one of the most searched subjects in the United States this week, and a predictable second wave of searching follows every disaster: people trying to work out whether what they are feeling is normal. The short answer is that it almost certainly is. The longer answer is that the most intuitive thing to do in the first week is also the one intervention that has been tested and found not to work.
Is what you are feeling normal
Almost certainly yes, and the reactions people worry most about are the ordinary ones. Numbness, a sense of unreality, irritability, broken sleep, jumpiness at sudden noise, and being unable to stop picturing it are all common in the first days, and none of them is a sign that you are handling it badly.
The reaction that worries people most is the absence of one. Feeling flat or detached rather than visibly upset is not evidence of coldness or of something being wrong with you; it is one of the most frequently reported responses of all. Most people who live through a disaster recover without any treatment, which is the single most important fact in this article and the one least often said out loud.
The intervention to avoid
Single-session psychological debriefing, where somebody is walked through the details of what happened shortly after it happened, does not prevent post-traumatic stress disorder. A Cochrane review of the trials found no reduction in later symptoms, and some studies found worse outcomes in the group that received it. [rose-debriefing]
This is worth stating plainly because it is so counter-intuitive that it keeps being reinvented, usually with the best intentions, by employers and schools in the week after something terrible. The likely mechanism is that walking somebody through a detailed account before they are ready can consolidate the memory rather than settle it, and it interrupts a recovery process that would mostly have happened on its own.
None of this means talking is bad. It means scheduled, structured, compulsory talking with a stranger is not treatment. Talking to people you trust, when you choose to, at your own pace, is a different activity entirely.
What does help early
Practical things, almost all of them unglamorous. The framework here is psychological first aid, and its content is much closer to what a competent friend would do than to anything clinical. [who-pfa]
- Safety and basic needs first. Somewhere to sleep, something to eat, knowing your people are accounted for. Nothing psychological lands before this is settled.
- Accurate information about what happens next. Uncertainty is a large part of what makes the aftermath hard, and specific information about aid, buildings, school and work does more than reassurance does.
- Contact with your own people. Social connection is one of the more consistent predictors of who recovers well. This means your actual community, not a support group of strangers.
- Practical help with the concrete problems. Forms, insurance, transport, childcare. Removing a real problem lowers distress more reliably than discussing the distress.
- Sleep. It is the thing most disrupted and the one whose absence most reliably makes everything else worse.
Notice what is not on that list: getting the person to describe the event. Psychological first aid explicitly does not require anyone to talk about what happened. [nctsn-disaster]
A schematic of the approaches described in this article and their common alternatives. Not measured data.
Why you feel this bad when you were not there
Because repeated exposure to disaster coverage is itself associated with distress, and the association is not small. Research following large-scale events has repeatedly found that people consuming many hours of coverage report more symptoms, in some studies more than people who had direct exposure to the event.
The mechanism is straightforward once stated. Watching the same footage many times is not the same as learning the news once; it is repeated exposure to a threat cue with no new information and no resolution, which is close to the opposite of how distressing memories normally settle. The practical rule is to get the information rather than the feed: check at set times, read rather than watch where you can, and stop rewatching the same clip.
If you have family in the affected area, this changes shape. You are not doom-scrolling, you are waiting for news, and the answer is a direct channel to them or to the relevant authority rather than the coverage.
The four to six week marker
Whether things are still frozen at four to six weeks matters far more than how bad the first week was. Ordinary recovery is not a smooth line, but over that period the trend should be towards fewer bad days, shorter waves of distress, and some return of ordinary function.
Worth speaking to a doctor or a therapist about if, at six weeks:
- The distress is unchanged or worse rather than gradually easing.
- You are avoiding places, people or activities you need in your life.
- You are still not sleeping.
- You are using alcohol or something else to get through the evening.
- You feel detached from people you were close to before.
If treatment is needed, the evidence-backed options are specific trauma-focused therapies rather than general counselling, so ask for them by name. Our trauma and PTSD guide covers what those involve, and does talking about trauma help covers the same debriefing question in more depth.
Where are you at week four?
Tick anything true of the last week rather than of the first week. This is a reflection prompt rather than a test, and it produces no diagnosis.
0 of 6 ticked
Several of these together, a month on, suggests this is not settling on its own. That is a reason to speak to a doctor or a therapist rather than to wait longer, and to ask about trauma-focused treatment specifically rather than general counselling.
Some movement and some sticking points. Give it another fortnight while doing the practical things, and treat avoidance in particular as the item to act on, because avoidance is the one that tends to entrench rather than fade.
What you have ticked is consistent with the usual pattern of recovery, which is uneven rather than smooth. Nothing here suggests you need treatment, and most people in your position recover without it.
When to seek help
Speak to a doctor or a therapist if distress after a disaster is unchanged or worsening at four to six weeks, or if at any point it is stopping you working, sleeping or leaving the house. Ask about trauma-focused treatment by name, because general supportive counselling has a weaker evidence base for this than the specific therapies do.
Go sooner if you are avoiding more and more, if you are using alcohol or drugs to get through the day, or if someone close to you has said they are worried about you. Avoidance is the symptom that most reliably entrenches when left alone.
Contact your local emergency services or a crisis helpline if you feel unsafe or have thoughts of harming yourself.
How MyFreud can help
MyFreud is a mobile app that helps you find solutions to problems that have affected your mind and productivity. In the weeks after something like this, live coaching sessions give you somewhere to sort the practical from the emotional, each one ends with an actionable plan rather than a feeling, daily tracking shows you the trend across four to six weeks that you cannot see from inside a bad day, and the notepad holds the concrete problems so they stop circling at 3am.
Download MyFreud and start today: App Store or Google Play.