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Tuesday Nov 07, 2017

In Wake of Disaster, Family Physicians Can Help

Hurricanes pummel Caribbean islands and the Southern United States.

Fires rage on the West Coast.

A terrorist drives a truck onto a busy New York bike path.

Gunmen open fire on a huge concert in Nevada and in a tiny church in Texas.

[Young female doc comforting distraught woman]

In deference to this surge of fatal and life-altering events, our medical community must be better equipped than ever to deal with the physiological effects of trauma on the human body and psyche. Trauma-informed care(www.samhsa.gov) continues to evolve as we face new disasters created by both nature and man.

In her blog(brickelandassociates.com), Robyn Brickel, M.A., writes that traumatic events can change our brain chemistry when they occur during formative periods or when an individual lacks the proper coping mechanisms to process a trauma. Trauma, or overwhelming stress, can present as a singular event or as a neglectful pattern. The result of experiencing trauma or having unresolved trauma can lead to chronic alarming of the fight-or-flight center of the brain, which can, in turn, lead to chronic anxiety states and personality disorders. Moreover, witnessing other traumatic events, even on social media, can trigger recurrence of trauma.

As family doctors, we can see such effects of trauma in our daily encounters with patients. I can attest to the rise of gastrointestinal complaints and to more patients with insomnia, anxiety, chest pain and dizziness coming through my clinic doors. So, what can we do to address trauma and its effects?

Addressing trauma takes relationship-building and time to allow the patient to evaluate what often are deep-seated wounds. Repeat visits allow us to set a foundation, where grounding can take place. Creating a safe, welcoming environment could be as simple as allowing the patient a moment to reflect on a positive thought, memory or image. For younger patients, this could mean drawing or coloring a picture or singing a favorite song. For patients who come to me worried about their loved ones in hurricane-ravaged areas, allowing them time to discuss a joyful memory from home or with that relative may center them enough to allow for a therapeutic result.

Another helpful approach, CARESS (Communicate Alternatively, Release Endorphins, Self-Soothe), is a set of techniques to help manage emotions when moving beyond self-destructive behavior, defined as any behavior that interferes with one's ability to create meaningful daily interactions. The approach can provide a framework to rebuild healthy coping skills during periods marked by intense emotions.

As a family physician, it is important to have a network of resources that can help the patient in a multidisciplinary fashion. Community collaborations and local therapists may be at your disposal to continue the dialogue and serve as a network of support. Inevitably, as a patient begins the process of healing, heighted anxiety and traumatic experiences may resurface.

What are ways in which a patient can safely process traumatic experiences? This safe processing is called containment, where one creates a conscious space to allow the traumatic experience to come to the forefront. The easiest method is journaling or imagery, which is like putting those bad memories in a box. This takes time, effort and energy that some patients are not ready to face initially. However, as their family physician, you can help create a safe space for the patient.

Trauma overwhelms the limbic system, and as a result, it can deaden the creative centers of the brain. Grounding or centering allows a person to stimulate other aspects of the brain to counter the effects of anxiety or fear. Regular practice of mindfulness, art, exercise or play can reduce the effects of stress and anxiety. Putting grounding work into a daily routine helps restructure one's chemistries and rebuilds vital pathways toward healing and growth(www.forbes.com).  

And even if we don't have an opportunity to directly help some of the tens of thousands of people fleeing from disaster-stricken areas, we can help the millions of people left behind. The AAFP Foundation has raised more than $100,000 to help those affected by the 2017 hurricane season. Please visit the Foundation's website(www.aafpfoundation.org) to learn how you can help. In addition, several of the Academy's constituent chapters also have raised more than $100,000 to help AAFP members in Puerto Rico buy generators and other supplies. People wishing to contribute to this effort should visit the Indiana AFP's website(www.in-afp.org).  

Of course, this is not the first time we have seen our nation struggle to respond to disaster. Although our ability to anticipate and react to events may improve, our lessons from recent events show us that we can do still better to meet the immediate, as well as the ongoing, psychological needs of those affected.

Marie-Elizabeth Ramas, M.D., practices family medicine, including maternity care, in Nashua, N.H. She enjoys spending time with her husband, Ray, and their three children.

Posted at 04:50PM Nov 07, 2017 by Marie-Elizabeth Ramas, M.D.

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