Advice if you have suffered a severe incident - for you and your relatives

How you act, in the following hours immediately after the incident, can have a great impact on how traumatic memories will be stored in your mind. Try to lead your attention to something positive.

Follow this advice in the first six hours immediately after the incident:

1. Do somethings that helps you calm down

Try as much as possible to relax, since this can help dampen the flow of emotions that you are feeling. For example, you can listen to calming music or watch a movie with a calming plot. You can also play an uncomplicated computer game, such as Tetris. These activities can help you calm down, and help you think of something else. If you manage to calm down, you will produce less adrenaline in your body, which will be a positive outcome. Avoid intensive physical activity that increases your heart rate. Avoid any consumption of alcohol.

2. Avoid falling asleep

It can be tempting to fall asleep after an incident, but you should wait for at least 6 hours. If you sleep, it enlarges the risk of storing the traumatic memories of the incident in your memory.

3. Do not talk about the incident immediately after the occurrence

As far as possible, recite the incident in short, factual terms in the immediate hours after the incident. If you recite the incident in detail, it might enlarge the risk of storing the traumatic memories of the incident in your memory. This might cause recurring flashbacks, such as nightmares, uncomfortable sensory perceptions, and unpleasant impressions. Avoid talking in detail about the feelings or physical reactions the incident has triggered.

4. Let others care for you and avoid being alone

In the hours immediately after the incident, you should not be alone. Be surrounded by relatives or friends, who can take care of you. Abstain from talking about the incident. Instead do something that makes you feel good, such as being comfortable under a blanket, feeling the warmth of a cup of tea or holding hands with someone you care about. It is important that you do not feel alone, as this can reduce the risk of negative implications in the future.

5. Get help to create an overview of the incident

If there is any help personnel or others present, it can be beneficial to receive their help for creating an overview of the incident. When you have an overview, it can be easier to tone down your thoughts and considerations.

If you try to create your own overview from memory, there is a risk that you will sustain the traumatic memories from the incident. You should try to avoid this.

In this phase, you should be pleased, if you can outline the incident. It can be beneficial to talk to others, who were involved in the incident after a while. Together, you can reach an overview and description that is as coherent and objective as possible. By talking to others, you might feel less lonely.

Humans react differently after a severe incident. This is an overview of reactions, which typically occurs within the first hours or days after an incident.

Everything around you can seem unreal – as if it is all a dream.

• Changed perception of time. It might feel as if time has stopped entirely, or it can go by very fast.
• Sense impressions can be stuck in the mind with high intensity. Smells and sounds can be remembered vividly.
• Physical reactions. Your body might react by trembling, rapid heartbeats, indisposition, headaches, and alternately sweating and freezing.
• Emotional reactions. Immediately after the incident, sense impressions can be very painful, because they are stored in your memory. Your thoughts might revolve around subjects such as death or meaninglessness.
• Absence of a reaction. Some humans do not emotionally react after a severe incident. Some may speculate whether it is normal to be unaffected by the situation.

Other reactions that may occur right after the incident

A severe incident may trigger some overwhelming thoughts or emotions. It can change your perception of the world as a safe and predictable place.

You may be filled with thoughts, such as “how was this incident even possible?” and “what do I do if it happens again?”.

You may feel powerless or helpless. You may feel a loss of control or that life has no meaning.

You may lose faith in other people and have thoughts such as “who can I trust?” or “there is no God, when something like this happens”.

You may start blaming yourself and feel that you have failed. “I should have seen it coming” or “why didn’t I do something?” can be some of the thoughts that follows.

Other reactions that may occur:

• You may be irritated, angry, or hostile to your surroundings
• You may be observant and suspicious
• You can be withdrawn and self-destructive

Some may lose total interest in their surroundings and they may feel distant, as if they are not present. Others are not able to feel positive emotions. Many have problems with insomnia.

Reactions occurring four weeks after the incident

Mental reactions can occur at times. They may occur and disappear again – with varies in strength and duration. The reactions vary from person to person.

Some can get over the reactions quickly, and return to their daily life, while others can be affected in long periods of time. Strong reactions in the first month does not mean that it will continue for a long period of time.

Seek help if the reactions enhances or proceeds

If you are highly affected by the incident after four weeks, you should seek professional help. Start by contacting your own physician, who will evaluate if you need treatment, such as a psychologist.

Supplement to psychological counselling

If you are a member of the health insurance, Sygeforsikringen Danmark, in group 1 or 2, you can be referred to a crisis counselling course with a psychologist. Your own physician or the duty doctor can refer you to a relevant psychologist. The course will consist of 12 consultations, which must begin within 6 months and end 12 months after the incident at the latest.

You should be aware of these symptoms

If you are burdened by these symptoms for weeks or months after the incident, you should seek professional help

• If you experience the incident repeatedly. Strong impressions are stored in your memory. They especially occur when you are trying to fall asleep, and it decreases the quality of your sleep.
• Anxiety and restlessness. You may feel anxiety towards something happening to you or your family. You may feel uncertain, uneasy, and restless - or you may feel helpless or powerless.
• Physical reactions. If you are experiencing tension, stomach aches, headaches, tiredness, or other reactions.
• Mental imbalance. Such as reacting strongly to smaller, everyday problems.
• Irritation and lowered patience.
• Anger. Typically, towards the reliable part in the severe incident you experienced.
• Guilt, shame and blaming yourself. Feelings that may occur without any reason.
• Isolating yourself. A strong urge to withdraw from social activities and only be around our closest relatives or friends. You may experience yourself as passive, with no initiative towards daily chores.
• Problems with concentration and memory. Having problems when focusing on work assignments or chores. Daily chores can be perceived as unimportant.

You may spend a lot of your strength on dealing with your own reactions. Accept if you are experiencing a period, where you cannot cope with your usual workload. Accept help from others, so they can relieve the pressure. Do not let the incident take over your life. Prioritise to spend time with people you love.

Do not give up

You may find it hard to concentrate – or your ability to feel motivation, light and joy can be challenged. Try to do what makes you happy.

Be aware that you may react differently than usual, when you are socialising with others – and accept that this is your current situation.

If the incident makes you feel as if you have lost your purpose in life, you should consider seeing a priest or a psychologist. They are professionals, who are accustomed to talking about the difficult aspects in life.

If you are a relative to a person, who have suffered a severe incident, it is natural that you may have strong feelings or reactions towards the situation.

Be aware of your own feelings and resources, even though you want to help and do what is best for the relative.

How to help

This is advice on how to help – immediately after the incident and in the long term.

• Show that you are present. In the immediate, acute phase, it is important that the distressed person does not feel alone. Be there for the person and tell them in words “you are not alone; I am here with you”.
• Show affection – listen, talk, and hold. Listen and ask the distressed person about how they are feeling. They might have a need to talk about the incident repeatedly. It is important to have breaks in between, to avoid that the grief, associated with the incident, takes over their mind.
• Move focus elsewhere. Suggest going for a walk or spending time together. Ensure the person that you want to listen, but make sure that you talk about other things too. Do something together that can deflect from the severe incident.
• Accept reactions and outbursts. This is especially important immediately after the incident. The distressed person may say or do things that should not be taken too seriously. Even a person, who is normally in balance, can be irritated and/or angry. They may target their negative feelings towards the relatives closest to them.
• Be there for the distressed person. Be attentive and try to calm down the distressed person if they need it. Children often settle down if they are gently stroked on their back. Gentle strokes can also be soothing for adults but should be avoided if the person has been exposed to a physical assault. Instead, tug the person into a blanket or suggest going for a walk. Walk slowly if there is a need for it.
• Be attentive – especially towards signs that the person may do harm to themselves or others.
• Be patient. It may take time to process severe incidents.
• Be available as much as you can. Offer to stay with the distressed person in the days and nights immediately after the incident. Offer to help with chores (for example cooking or laundry). You can also help with chores outside the home, such as shopping, but pay attention to whether the distressed person is isolating themselves at home.
• Do something together. Help each other with chores – or do something else together. Doing activities together can reduce the loneliness and pain that the distressed person may be feeling.

Help the person to slowly ‘return to reality’

A person, exposed to a severe incident, can be inclined to deny any occurrence of the incident. This is a normal reaction, which originates in the person’s need to protect themselves. A version of this reaction is to suppress any emotional pain. It can cause problems for the destressed person if they refuse to open up and talk about the incident.

What to be aware of when you want to help – it can be a very delicate balance

• Do not push the distressed person, if they are not ready to talk about the incident.
• Accept that you can be rejected – do not take it personally.
• Carefully, ask about the incident. This is a way to show that you are ready to talk about the incident, even though it might be difficult.
• It is positive, if you try to cheer up the distressed person, but understand that the person may need to share their pain with you.
• Be patient and only push the distressed person at a minimum. It does not help to tell the person to “pull it together”. The person may be trying their best, and they may get the impression that they are not trying hard enough. Remember that their emotional pain can be intolerable.
• Suggest activities that can distract from the pain and anxiety that the distressed person may feel. Activities can rebuild self-confidence and faith in general. It can lead the attention away from the difficult time.

REMEMBER: Your role as a relative is to help the distressed person seek professional help or counselling. You can find contact information below.

Be aware of your own limitations

You are, as a relative, a valuable support, but it is important that you are aware of your own limitations.

• Tell the distressed person that you want to help, but that you are uncertain about how to help them in the best way possible.
• Be aware of your own needs. You may need to talk to someone to process the situation.

It is not uncommon that relatives need professional help. Contact your physician, a social worker, or a psychologist. Some finds help in talking to a priest.

Both the person, who experienced a severe incident and their relatives, may need professional help. Here is an overview of some of the relevant offers that can be utilised:

• Your own physician can help or refer you to a psychologist or group counselling. You can find the contact information to your physician on your health insurance card.
• Duty doctor – phone number: + 45 70 150 300

Outside business hours, you can contact the duty doctor in acute situations. The duty doctor can be reached every day of the year from 4 pm – 8 am.

• Psychiatric emergency department –
  phone number: + 45 98 13 42 02

The psychiatric emergency department is open round-the-clock, every day of the year. The department is only used for emergencies.

Please, call ahead of your visit or show up at the emergency department at the psychiatric hospital in Aalborg. The address for the psychiatric hospital is Mølleparkvej 10, 9000 Aalborg. When you show up at the emergency department, a nurse will attend to you. If necessary, you are offered a conversation with a doctor.

Telephone helplines

• Victims Support Denmark, Offerrådgivningen.
  Tel. + 45 72 19 36 60
  www.offerraadgivning.dk
• The Social Emergency Department, Den Sociale Skadestue. Tel. + 45 98 12 32 92,
  www.densocialeskadestue.dk
• The National Association Help Victims of Crime, Landsforeningen Hjælp Voldsofre.
  Tel. + 45 86 41 59 00
  www.voldsofre.dk
• The suicidal line, Livslinien. Tel. + 45 70 20 12 01,

www.livslinien.dk