Maintaining Mental Health in the Face of Crisis: Dealing with Post-Traumatic Stress, by M.G., MSN, RN

Many of us have considered how we would provide for our family’s physical needs, including medical care, during a prolonged crisis. Indeed, it would seem foolish to be unprepared for trauma related to accidents, violence, fire, et cetera, when professional medical care might not be available for weeks, months, or more. What most of us don’t think about is the effect that a long-term crisis and/or exposure to traumatic events could have on our mental health. Next to food, shelter, and security, this may seem to be a low-priority concern, but depression and anxiety related to traumatic events can have lasting and highly detrimental effects, ranging from loss of productivity to violence and suicide.

Anxiety Disorders

We may feel that we are tough and hardened to the rigors of even the worst scenarios we can imagine. Many soldiers have felt the same way before entering combat and yet still developed anxiety, depression, and Post Traumatic Stress Disorder (PTSD). Anxiety disorders, such as PTSD, are common in those who face extreme mental stress, as they are related to increased activation in the fear center of the brain.

Not Mental Weakness But How Brains Deal With Intense Fear and Prolonged Stress

These disorders are not a sign of mental weakness but simply the result of how our brains deal with intense fear and prolonged high levels of stress. Typical signs to look for are hyper-vigilance (jumpiness, loss of sleep, increased hostility), intrusive thoughts (inability to stop thinking about traumatic experiences), and recurring nightmares. Along with emotional detachment and depression, these signs are the hallmarks of PTSD. If left untreated, these symptoms can lead to suicidal thoughts and actions, and increase the risk for violent and abusive behaviors towards others.

Not Just Soldiers

Accident survivors and victims of violent crime (especially rape) are commonly diagnosed with PTSD, so it’s not just soldiers who are at risk. It’s not absurd to think that our family members, our friends, and even we might succumb to these problems if things turn out to be as bad as some predict. In a changed world where much of what we’ve taken for granted is gone, even the strongest and most resilient of us could have a tough time coping. This is especially true for children, since they usually don’t deal with change as well as adults. In a TEOTWAWKI scenario, or even in a prolonged crisis, maintaining mental well-being may be as much of a challenge as maintaining good physical health.

Early Action Can Be Very Effective

Fortunately, early action can be very effective in reducing the fear and anxiety caused by traumatic events. Simple and easily implemented measures can help those affected by PTSD to cope with their situation and return to normal functioning. Scores of books and manuals have been written on treatment methods for anxiety disorders and PTSD; more than we have time to go into here.

Intervention That Is Easy To Follow

This essay presents an intervention that is easy to follow and which can provide help to those suffering from PTSD when no professional mental health care is available. The plan is based in Cognitive Behavior Therapy (CBT), which stresses short-term treatment to change thoughts and behaviors, thereby reducing fear and stress. To keep it simple, the plan focuses on two specific areas: exposure therapy and group support.

Exposure Therapy

You’ve probably heard the phrase, “You have to face your fears in order to beat them.” This is the basis of exposure therapy. The goal is to desensitize a person to traumatic events by helping them to face their own fears. One of the methods commonly used is journaling. Writing out a detailed account of traumatic experiences has been proven to lessen their effect, reducing their power to prolong fear and anxiety.

The same idea works for recurring nightmares but with a twist. With bad dreams, the key is to write the dream out, but change the ending to how you would like it to end. Don’t be nice or polite when doing this, but think at a “caveman” level. If someone attacks you in the dream, write out how you would destroy them. Then read this “corrected” dream each night before going to bed. This idea comes from Navy psychiatrist Beverly Ann Dexter, and it’s been proven to work.

Journaling of both experiences and recurrent nightmares is an important aspect of CBT, and it provides a homework-like structure. It is important that journaling be done every day, even if you’re writing the same ideas over and over again. The repetition helps to lessen the effect of intrusive and recurrent thoughts and dreams, and reduces anxiety. It sounds simple, but it works.

Group Support

In addition to journaling, group support meetings also work to help reduce the effects of PTSD. Meetings provide a context for the journal writings, and a small group setting allows a comfortable place for people to read their journal work aloud to others who have experienced the same or similar trauma. This action further cements the exposure process and helps to affirm that these individuals are not alone in their reactions to stress. The writing and reading of journal work together help to promote desensitization to the initial trauma and help to instill resilience to future trauma.

Group meetings provide peer support by allowing people to work through their own problems alongside others who share similar issues. Discussions help people to better understand and cope with their own experiences, and listening to the experiences of others contributes to the exposure therapy aspect of the intervention.

Group Sessions

In group sessions, it is important to have a moderator who oversees the process, allowing everyone time to share their thoughts and journals, while keeping comments from others in line with what is helpful. Statements such as, “You should have…”, or, “I would have done…” don’t have a place in this process, nor does any hurtful or derogatory commentary. Everyone should be focused on helping the rest of the group, even if their approach to problems is different. Some people will be talkative, some shy, and if some don’t want to share at first, that’s all right.

Take time to allow people to read their journal writings, and allow discussion to flow from the topics that come up. Discussion helps to provide support, and shows group members they are not alone in what they’re going through.

Group meetings afford an opportunity to help the greatest number of people in a timely manner. They also help to reduce the stigma commonly associated with mental health treatment, leading to a greater likelihood that people will be willing to seek help for themselves and their family members. Groups typically meet once a week for an hour or so, depending on the size of the group, but meetings can be held more often if needed. A group size of six to twelve often works best, but whatever suits your own purposes is fine. Even if you work one on one with a family member, you can still get results, but the benefits of group support are probably going to be more beneficial and highly recommended.

What You Need for a Group Session

What you will need for a group session includes pads of paper and pens or pencils (not bad things to have anyway), a place to meet, and a mediator. That’s it. Meeting places should be safe and non-threatening, and meetings should be held during a quiet part of the day. Mediators should have an even temperament and a fair amount of patience. It also helps If they have some affinity with the group (for example a teenager or young adult would work best with a group of children), but the best quality is simply the desire to help others get through a tough time. The average CBT session is time-limited, usually lasting no more than eight weeks. Shoot for a six to eight week run of group sessions and see how people progress. You should see good results in this amount of time.

Run Future Group Sessions Consecutively

If anyone still needs help after the group session has run its course, encourage them to take part in future groups. Preparing to run several group sessions consecutively can help those who may need more time and allow people who were initially reticent to seek help another opportunity to participate.

A Few Tools To Deal With Anxiety Disorders

This is a rough overview that only highlights a few of the tools used to deal with anxiety disorders. However, it does provide a framework for those who would be without any help during a long-term crisis.

Doing Something Better Than Doing Nothing

Doing something is always better than doing nothing, and this is doubly true for anxiety disorders, such as PTSD. They are more easily treated early on, and if left unattended they will often get worse over time. Look for withdrawal, depression, hyper-vigilance, and intrusive/recurrent thoughts or nightmares. Also, remember that these signs can manifest several months after the original trauma has taken place.

As we’ve seen with the generations of vets who have come home with PTSD, the consequences of non-treatment can be devastating. Suicide now claims more lives than combat for U.S. forces seeing action overseas. Doing what we can to intervene at the early stages of PTSD can make all the difference, for us, our loved ones, and our community.

SurvivalBlog Writing Contest

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  1. A great article on an issue that is largely ignored.
    I will add that identifying people in the group now with mental health issues is the easy part. We don’t know for sure how anyone will react in an emergency, especially one that may be a permanent change in our lives.
    Mental health issues within your group may not manifest themselves until the SHTF event.
    This is the most important issue in a survival situation, and one that threatens our survival as soon as the SHTF. We can take three days to find water if we’re not well prepared or a few weeks to find food, but unless we can instantly adapt mentally to an emergency situation, we’re more than likely dead.
    All the preps in the world can’t help you if your mind is gone.

    This one gets my vote for 1st prize.

    1. Please be aware that the mental health system, its professions, and even diagnoses, are part, even of the essence of the problem. Please see this gentlemen’s work, Dr. GC Dilsaver, at, for a truly biblical approach to so called “mental health.”

      Here is a quote from the site:

      “The mental health paradigm is a false one. As the terms “mental” and “behavioral” health indicates, the mental or behavioral health field has reduced that which is considered essential human well-being down to a person’s mere mentation and behaviors. But it is not the thoughts or actions of a person that are the sole or even essential concern. Rather it is the heart or soul from which they emanate. But the mental health professions have either nothing to say of this soul; or, if they do, it is diametrically opposed to a true understanding of the Christian understanding. From Freud on, what the mental health field has sought to heal is the ego, that is, the pride and self-love of a person. But this pride and self-love is considered in traditional Christian spirituality an impeding disfigurement of the soul to be purged in the process of sanctification.”

      1. The correct answer is “all of the above” as usual.

        God created both the natural and supernatural orders. While your comments about the mental health profession are often true, it is besides the point. An atheist surgeon uses knowledge in the natural order to remove a tumor. If journaling helps, then it helps.

        A non-Christian psychiatrist friend once told me that almost none of his traditionally religious patients committed suicide.

        Sometimes knowledge concerning the natural order is most relevant (how to use a compass). Sometimes knowledge concerning the supernatural order is most relevant (How could God let all those people die?). Sometimes both together.

        Either-or solutions lead to endless arguments because both sides have half of the truth.

        Also, self-love has different meanings. Worldly self love is ego. Christian self love means putting the salvation of your soul above all other things. One is a sin, the other a virtue.

  2. I know they do much good, but be very cautious of support groups and the victim mentality and group-think. Sometimes a village might be best. Other times an engaged, supportive spouse or pastor would be better. And be cautious toward mental health ‘experts’, especially if they prescribe mind-controlling drugs. Often the proven side effects of these drugs include the very symptoms of the ‘disease’ they are suppose to help.

  3. IMHO you can either hack it or you cannot. Making the effort or simply going through the experience will either make you stronger or tear you down. Most of the rest, group sessions and interventions, are just window dressing. What will work is not having a life of ease and plenty but rather enduring a tough life from birth to adulthood. It is much easier to adjust to SHTF if your life has been a struggle all along. So when TEOTWAWKI happens the strong and those who have had to struggle will survive. The rest will be in group sessions.

  4. Can I recommend the book Where There Is No Psychiatrist: A Mental Health Care Manual
    by Vikram Patel, Charlotte Hanlon. It’s not as well known as where there is no Doctor.

        1. Just found out Where There Is No Child Psychiatrist: A Mental Healthcare Manual 1st Edition, by Valsamma Eapen, Philip Graham, Shoba Srinath, Kiriko Kubo is free today as well.

  5. “Kierkegaardian Anxiety as a Sense-Perceptive Faculty for Spiritual Experience” B. Lyons

    Only the wise will read it! Others will most likely reject such a concept.

  6. Thank you for this article & others on mental health. Our pastor has talked about people in the Bible who had symptoms of various mental health conditions & his own issues with depression. I’ve known several friends & extended family members who went thru PTSD, both of whom went to support groups that helped. Sites like this offer lots educational articles, which I appreciate.

  7. Argue for your limitations, and sure enough they’re yours. Richard Bach

    The medical field (of which I am a part) is the root of the problem! A Diagnosis, a prescription, and an excuse for everything! All of which is a CASH COW to the industry!

    Have you ever wondered why all there conditions were rare or unheard of just a few decades ago? Your not going to get any insurance dollars by telling people the truth, that life is not perfect and you need to deal with its imperfections!

    Some people are a bottomless pit of need, that can never be filled and they will drain you dry!

    AVOID at any costs!

  8. It sure seems to me that the more conveniences and comforts in life we have, the more fragile we become as a society. Humans have suffered a whole lot more over the course of history than they do now, and have managed to continue to live, work, raise a family, and be a self sufficient, productive members of society without the need of journals, support groups, warm and fuzzy stuffed therapy animals, prozac or safe places. Take away a few conveniences and luxuries, and the average person doesn’t have time to sit around and dissect his/ her feelings and emotions or wallow in self pity.. Take away his programmable thermostat, and watch how fast he drops his self pity and picks up a splitting maul. If you are forced to put forth the effort to feed, cloth and house yourself, you tend to focus on giving thanks to the good lord for giving you the strength to do it. It tends to minimize the selfishness of looking for acceptance or dwelling on trivial little things that amplify anxiety,worry, stress that force you to focus on petty little inner feelings. It may sound a little abrasive, But then everybody these days are looking for something to be outraged over. It helps with reinforcing their short comings.

    Nothing erases Anxiety faster, and better than physical labor.. feeling depressed? hard physical labor takes your mind out of the ‘whoa is me’ thinking mode…. feeling a little scrappy?.. people getting a little aggressive?.. no better way to take the fight out of a person than hard physical labor.. The problem with people today is that they are too darn soft, and their brains have turned to mush, so every bad experience that crosses their path turns into a huge melodramatic mental episode that grips their lives, and leave them running to a therapist, the medicine bottle or a safe place.

  9. In the not to distant future if you wish to purchase a firearm you will have to be screened by the Community Health Authorities. This will be a simple end run around the 2nd amendment . Believe in God?, You’re crazy .Global warming false ? You must be loco . Abortion is murder ? You are deviant .
    Before you snicker please read the language written into Washington’s State’s new initiative 1639. This initiative sponsored by two Microsoft billionaires gives immense power to community health and community endangerment authorities . I would advise anyone giving data to any mental health facility to take precautions that it will not be used against you.

  10. You should NEVER tell any health care provider any more than they absolutely need to know or anything that you would not want the whole world to know! If you think your records are confidential – then you are mistaken! Read the fine print and your records can be shared with any number of associates and advocates!

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