Natural disasters and other catastrophes (traffic accidents, plane crashes, radiation accidents, terrorist attacks) are extremely stressful events for both survivors and witnesses.

Such disasters can shake your sense of security, leaving you feeling helpless and vulnerable in the face of a dangerous world.

Common reactions in response to a traumatic event

Survivors of traumatic events experience a wide range of intense physical and emotional reactions. Emotions often come in waves. At times you feel nervous and anxious, at times you withdraw from the world and become apathetic.

Normal emotional reactions are the following:

• Shock and denial. You may have difficulty accepting the reality of what happened.
• Fear that what happened might happen again or that you might lose control and break down.
• Sadness (especially if people you know die).
• Helplessness. The suddenness and unpredictability of natural disasters and accidents makes you feel helpless and vulnerable.
• Feelings of guilt (because you survived when other people died, or maybe because you believe that you could have helped or even prevented the incident).
• Anger (at God or the people you hold responsible for what happened).
• Shame (due to feelings and fears you have).
• Relief that the worst is now over.
• Hope that life will gradually return to normal.

Normal physical reactions include the following:

• Tremor of the limbs and whole body;
• pounding heart;
• Accelerated breathing;
• Lump in throat;
• Feeling of heaviness or storm in the stomach;
• Dizziness or fainting;
• Cold sweat;
• Jumping thoughts.

A traumatic event can turn your world upside down and destroy your sense of security. Therefore, even small steps towards restoring safety and comfort matter.

Taking action on your own to improve your condition (rather than passively waiting for help) will help you feel less vulnerable and helpless. Focus on what helps you feel calmer, more grounded, and in control.

Set a daily routine

What is familiar to us gives us a feeling of comfort. Returning to your normal daily routine will help keep traumatic stress, anxiety, and hopelessness to a minimum. Even if your work or school schedule is disrupted, you can structure your day with regular meals, sleep, family time, and relaxation.

Do things that help you distract yourself (read books, watch movies, cook meals, play with your children) so that you don’t spend all your energy and attention thinking about what happened.

Contact other people

You may feel the urge to withdraw from social activities. But it is important for you to keep in touch with those who care about you. The support of people in your immediate circle is extremely important. So let your close friends and family members be your support during difficult times.

• Spend time with loved ones.
• Chat with other survivors.
• Do normal things with other people that have nothing to do with the traumatic event.
• Participate in memorial events and other social rituals.
• Attend a support group.

Fight feelings of helplessness

Remind yourself that you have the strength and ability to get through difficult times. One of the best ways to regain your confidence is to help other people. You can:

• Become a volunteer for a charity.
• Become a blood donor.
• Make a donation.

It is important to protect yourself and your loved ones from reminders of what happened, which could cause additional harm. Yes, some are able to regain a sense of control by watching media coverage. However, there are those who are very upset by such reminders. In fact, retraumatization is quite common. That's why:

• Limit your observation of media coverage of the incident. Avoid watching news programs right before bed. And don’t watch them at all if such programs evoke negative emotions in you.
• The desire to receive information is absolutely normal. However, try to avoid upsetting images and videos. It is better to read magazines and newspapers than watch TV.
• Protect your children from reminders of what happened.
• After watching the news, discuss what you saw and how you feel about it with your loved ones.

Accepting your feelings is a necessary part of the healing process:

• Give yourself time to mourn losses and heal emotional wounds.
• You should not try to force the recovery process. Please be patient.
• Be prepared for complex and volatile emotional reactions.
• Give yourself the right to feel what you feel. Don't judge or beat yourself up for it.
• Talk to someone you completely trust about how you are feeling.

Tip 4: Make reducing psychological stress a priority

Almost everyone experiences psychological distress after a traumatic event. While some level of traumatic stress is normal and even beneficial, too much stress can become an obstacle to recovery.

Relaxation is not a luxury, but a necessity

Traumatic stress is a significant burden on both mental and physical health. You need time for rest and relaxation to allow your brain and body to return to normal functioning.

• Practice meditation; listen to music that calms you down; walk in beautiful places, visualize the places you like to visit.
• Find time for things that bring you joy (a hobby, a favorite pastime, spending time with a close friend).
• Use the time of forced inactivity for relaxation. Enjoy a delicious meal, read a bestseller, watch an inspiring or funny movie.

Sleep and the reduction of traumatic psychological stress

After a traumatic event, you may have difficulty sleeping. Anxieties and fears can cause insomnia, and nightmares will force you to wake up frequently. Getting quality rest after a traumatic event is important, and lack of sleep creates additional psychological stress and makes it difficult to maintain emotional balance.

As you recover, sleep problems will disappear. In the meantime, you can improve your sleep with the following strategies:

• It is better to go to bed and get up at the same time every day.
• Limit your consumption of alcoholic beverages, as alcohol disrupts sleep.
• Before going to bed, it is better to do something that helps you relax: you can listen to soothing music, read a book, or meditate.
• In the afternoon, try to avoid caffeine consumption.
• Exercise regularly. Just don't exercise too close to bedtime.

Signs that you need to get help

The emotional reactions observed after a traumatic event in themselves should not be a cause for concern. Most of them will begin to disappear relatively quickly. However, if your traumatic stress reactions are so severe and persistent that they interfere with your ability to function normally, you may want to seek out a mental health professional. Get help if:

• It's been six weeks and you don't feel any improvement.
• You are unable to function normally both at home and at work.
• You are tormented by frightening memories and flashbacks, as well as nightmares.
• It becomes increasingly difficult for you to contact and communicate with people.
• You are overcome by suicidal thoughts.
• You try to avoid anything that reminds you of the traumatic event.

1.1. The concept of stress by G. Selye.

1.2. The concepts of “trauma”, “traumatic stress”, “post-traumatic stress disorder”.

1.1. The concept of stress by G. Selye

The creation of the biological concept of stress was started by Hans Selye in 1936. He called balancing the body’s activity with constantly changing environmental conditions one of the main functions of the psyche. Thus, central to the concept of stress
G. Selye became a homeostatic model of the body’s self-preservation and mobilization of resources to respond to a stressor. In this sense, stress is one of the natural human states. Stress (from the English stress - pressure, pressure) is any more or less pronounced tension in the body associated with its vital activity. We are talking about a set of stereotypical, phylogenetically programmed reactions of the body, caused by exposure to various intense stimuli in our environment or difficult life situations. In their initial essence, the body's reactions are adaptive in nature. And in this capacity, stress is an integral manifestation of life.

The starting points that cause stress are stressful events or stressors. Stressors are usually divided into physiological(pain, hunger, thirst, excessive exercise, high

and low temperature, etc.) and psychological(danger, threat, loss, deception, resentment, information overload, etc.). The latter, in turn, are divided into emotional and informational.

If we consider events as stressors, then they can be systematized by the size of the negative significance and by the time required for adaptation. Depending on this, critical life events, traumatic stress, everyday stressors or chronic stressors are distinguished (Pushkarev A.L. et al., 2000).

Based on the type of impact on a person, stress can be divided into the following types:

1. 
   Systemic stress, reflecting the tension of predominantly biological systems. They are caused by poisoning, tissue inflammation, bruises, etc.
2. 
   Mental stress that arises from any type of influence that causes an emotional reaction.

G. Selye identifies two types of stress - eustress And distress. Distress is always unpleasant and is associated with harmful effects. Eustress has a positive effect, because mental processes are activated, emotions are sthenic in nature. Eustress is called such a loss of balance that occurs when a subject experiences a correspondence between the efforts required of him and the resources at his disposal. Concept distress reflects such mental states
and processes in which, at least for a time, the relationship between the effort required and the resources available seems to be upset, and not in favor of the resources.

G. Selye identifies three main stages in the development of stress:

1. 
   the first is the alarm stage, or the anxiety stage,
2. 
   the second is the stage of resistance, or resistance,
3. 
   the third is the stage of exhaustion.

At the first stage, the body’s adaptive resources are mobilized, the person is in a state of tension and alertness. This phase is characterized by the fact that a person ceases to feel diseases, to feel symptoms that are classified as “psychosomatic”: gastritis, colitis, ulcers, migraines, allergies. Is it true,
by the third stage they return with triple strength.

If the stress factor is too strong or continues to act, then a stage of resistance begins, which is characterized by the almost complete disappearance of signs of anxiety; the level of body resistance is significantly higher than usual. At this stage, a balanced expenditure of adaptation resources is carried out. If the stress factor is extremely strong or acts for a long time, the stage of exhaustion develops.

At this time, the energy is exhausted, physiological and psychological defenses are broken. Signs of anxiety reappear.

According to G. Selye’s figurative comparison, these three phases of the general adaptation syndrome resemble the stages of human life: childhood (with the inherent low resistance and excessive reactions to stimuli at this age), maturity (when adaptation occurs to the most frequent influences and resistance increases) and old age (with irreversible loss of resistance and gradual decrepitude), ending in death.

Coping with stress includes psychological (this includes cognitive, emotional and behavioral strategies) and physiological mechanisms. If attempts to cope with the situation are ineffective, stress continues and can lead to pathological reactions. Under some circumstances, instead of mobilizing the body to overcome difficulties, stress can cause serious disorders (Isaev D.N., 2004).

1.2. The concepts of “trauma”, “traumatic stress”,
"post-traumatic stress disorder"

The scientific term “stress” has long been included in everyday language, they write about it in popular and fiction literature, and they are looking for ways to avoid and relieve this condition.

However, it is necessary to distinguish between “normal” stress, which does not disrupt human adaptation, and traumatic stress. Traumatic stress occurs when the result of exposure to a stressor is

mental disorder.

In the early 80s. An independent research direction has emerged that deals with extreme overloads, their overcoming and consequences, as a result of which such concepts as “traumatic overloads”, “traumatic stress” or, simply, “psychological trauma” have emerged. But the concept of trauma, despite its frequent use, is defined mainly in general terms: an event of high intensity with a simultaneous lack of ability to adequately cope and exceeding the adaptive potential of the individual, which can result in adaptation disorders and stress-related disorders (Freedy J. R., Hobfoll S. E. , 1995). According to DSM-IV (Diagnostic and Statistical Manual of Mental Disorder - Psychiatric Classification Standard prepared by the American Psychiatric Association). A traumatic event occurs when it involves death, the threat of death, severe injury, or some other threat to physical integrity; Moreover, this event can affect a person directly or indirectly - through significant persons. But sometimes trauma also occurs due to the fact that a person witnesses the danger that threatens someone, the injury or death of a complete stranger. Such events fundamentally violate the individual’s sense of security, causing anxiety traumatic stress, the psychological consequences of which are varied.

Traumatic stress is a special kind of experience, the result of a special interaction between a person and the world around him. This is a normal reaction to difficult, traumatic circumstances, a condition that arises in a person who has experienced something that goes beyond ordinary human experience (Cherepanova E. M., 1997).

V. G. Romek, V. A. Kontorovich identify four characteristics of trauma that can cause traumatic stress:

1. The event that occurred is realized, that is, the person knows what happened to him and why his psychological state worsened.

2. This condition is caused by external reasons.

3. The experience destroys the usual way of life.

4. The event that occurred causes horror and a feeling of helplessness, powerlessness to do or undertake anything.

The psychological reaction to trauma includes three relatively independent phases, which allows it to be characterized as a process unfolding over time (Pushkarev A.L. et al., 2000).

First phase- phase of psychological shock - contains two main components:

1. Suppression of activity, disruption of orientation in the environment, disorganization of activities.

2. Denial of what happened (a kind of protective reaction of the psyche). Normally, this phase is quite short-lived.

Second phase- impact - characterized by pronounced emotional reactions to the event and its consequences. This can be intense fear, horror, anxiety, anger, crying, accusation - emotions characterized by immediacy of manifestation and extreme intensity. Gradually, these emotions are replaced by reactions of criticism or self-doubt. It proceeds along the lines of “what would have happened if...” and is accompanied by a painful awareness of the inevitability of what happened, recognition of one’s own powerlessness and self-flagellation. This phase is critical in the sense that after it either the “recovery process” begins, or fixation on the injury occurs and the subsequent transition of the post-stress state into a chronic form. In the latter case, the person remains in the second phase of response. With a successful emotional response, third phase- normal response phase. It can be presented in the form of a diagram (Fig. 1).

Rice. 1. Phases of recovery from a stressful state
Disorders that develop after experiencing psychological trauma affect all levels of human functioning (physiological, personal, level of interpersonal and social interaction), lead to lasting personal changes not only in people who have directly experienced stress, but also in their family members.

For some people, experiencing traumatic stress causes them to develop post-traumatic stress disorder (PTSD) in the future.

Post-traumatic stress disorder (PTSD) is
a non-psychotic delayed reaction to traumatic stress that can cause mental disorders in almost any person. The range of phenomena that cause traumatic stress disorders is quite wide and covers many situations when there is a threat to one’s own life or the life of a loved one, a threat to physical health or the image of “I”. Post-traumatic stress disorder (PTSD - Posttraumatic Stress Disorder) is defined as a complex of symptoms observed in those who have experienced traumatic stress. It is assumed that symptoms may appear immediately after exposure to a traumatic situation, or may occur many years later.

In accordance with the characteristics of the manifestation and course, three subtypes of post-traumatic stress disorders are distinguished (Romek V. G., Kontorovich V. A., 2004):

• 
  spicy, developing over a period of up to three months (it should not be confused with acute stress disorder, which develops
  within one month after the critical incident);
• 
  chronic, lasting more than three months;
• 
  delayed, when the disorder occurred six months or more after the trauma.

Currently, a number of foreign authors propose to supplement the diagnosis of post-stress disorders with another category - post-traumatic personality disorders(or PTPD - posttraumatic personality disorder), which seems to be a fairly logical step, since the presence of chronic symptoms of PTSD is often noted throughout the subsequent life of a person who has experienced massive psychotrauma. Of course, such a trauma can leave an indelible imprint on a person’s soul and lead to a pathological transformation of his entire personality.

Schematically the relationship between different stages of the formation of post-stress in terms of time of occurrence, duration and depth

violations by V. G. Romek, V. A. Kontorovich are presented as follows (Fig. 2).


Rice. 2. Stages of formation of post-stress disorders

The ravages of trauma continue to impact a person's entire life, disrupting the development of a person's sense of security and self-control. This causes strong, sometimes unbearable tension. And if this tension is not relieved, then the integrity of the psyche is in real danger. In general terms, this is the path along which the development of post-traumatic stress condition occurs.

Questions for self-control

1. 
   Name the main types of stress.
2. 
   What stages of stress development did G. Selye identify?
3. 
   What characteristics distinguish traumatic stress from “normal” stress?
4. 
   What is the difference between traumatic stress and post-traumatic stress disorder?
5. 
   Describe the phases of the psychological response to trauma.
6. 
   What are the types of post-traumatic stress disorders depending on the characteristics of their course?
7. 
   How are post-traumatic stress disorders different from post-traumatic personality disorders?
8. 
   Formulate the stages of formation of post-stress disorders.

Exercise

Review the stress statements below. Determine which ones are false and which ones are true. Justify your point of view.

List of statements

• 
  Stress-related symptoms and psychosomatic illnesses cannot cause me real harm, since they all exist only in my imagination.
• 
  Only weak people suffer from stress.
• 
  I am not responsible for the stress in my life. Stress is inevitable these days - we are all victims of it.
• 
  I always know when I'm overly stressed.
• 
  Sources of excessive stress are easy to recognize.
• 
  All people react to stress in the same way.
• 
  When I start to feel overly stressed, all I have to do is sit down and relax.

1. 
   Isaev, D. N. Child medical psychology. Psychological pediatrics / D. N. Isaev. - St. Petersburg. : Speech, 2004. - 384 p.
2. 
   Malkina-Pykh, I. G. Extreme situations: a reference book for a practical psychologist / I. G. Malkina-Pykh. - M.: Eksmo, 2005. - 960 p.
3. 
   Romek, V. G. Psychological assistance in crisis situations / V. G. Romek, V. A. Kontorovich, E. I. Krukovich. - St. Petersburg. : Speech, 2004. - 256 p.
4. 
   Selye, G. Essays on the adaptation syndrome / G. Selye. - M.: MEDGIZ, 1991. - 54 p.
5. 
   Selye, G. Stress without distress / G. Selye. - M.: Progress, 1979. - 48 p.

Traumatic stress– a special form of general stress reaction. When stress overloads a person’s psychological, physiological, and adaptive capabilities and destroys defenses, it becomes traumatic, that is, it causes psychological anxiety. Not every event can cause traumatic stress. Psychological trauma is possible if:

– the event that occurred is conscious, that is, the person knows what happened to him and why his psychological state worsened;

– the experience destroys the usual way of life.

Traumatic stress is a special kind of experience, the result of a special interaction between a person and the world around him. This is a normal reaction to abnormal circumstances. Both children and adults who have experienced traumatic stress may sometimes appear abnormal or crazy when in fact they are not.

There are mechanisms of stress that are the same for children and adults. A certain degree of stress can even be beneficial, as it plays a mobilizing role and helps a person adapt to changing conditions. But if stress is strong and continues for too long, then it overloads a person’s adaptive capabilities and leads to psychological and physiological “breakdowns” in the body.

The most widespread concept is “psychological trauma”“received within the framework of the theory of post-traumatic disorder and crisis psychology that emerged in the late 80s. Psychological trauma is the experience of a special interaction between a person and the world around him. Psychological trauma - experience, shock. The most striking examples of psychological trauma are humiliation and threat to life and health.

Theoretical models of posttraumatic stress.

As a result of many years of research, several theoretical models have been developed, among which we can highlight: psychodynamic, cognitive, psychosocial and psychobiological approaches and the multifactorial theory of PTSD developed in recent years.

Psychological models include psychodynamic, cognitive and psychosocial models. They were developed during the analysis of the basic patterns of the process of adaptation of victims of traumatic events to normal life. Research has shown that there is a close connection between ways of getting out of a crisis situation, ways of overcoming post-traumatic stress (eliminating and avoiding any reminders of the trauma, being immersed in work, alcohol, drugs, the desire to join a mutual help group, etc.) and success subsequent adaptation.

According to the psychodynamic approach, trauma leads to disruption of the symbolization process. Freud viewed traumatic neurosis as a narcissistic conflict. He introduces the concept of a stimulus barrier. Due to intense or prolonged exposure, the barrier is destroyed, libidinal energy is shifted to the subject himself. Fixation on trauma is an attempt to control it. In the modern classical psychodynamic model, the following are considered as consequences of traumatization: regression to the oral stage of development, displacement of libido from the object to the Self, remobilization of sadomasochistic infantile impulses, the use of primitive defenses, automation of the Self, identification with the aggressor, regression to archaic forms of functioning of the “Super-I” , destructive changes in the I-ideal. It is believed that trauma is a trigger mechanism that actualizes childhood conflicts.

This model does not explain all the symptoms of a traumatic response, for example, constant acting out of the trauma. In addition, childhood trauma can be found in the experience of any person, which, however, does not predetermine the development of a maladaptive response to stress. In addition, classical psychoanalytic therapy is ineffective for treating this disorder.

Another aspect of individual characteristics of overcoming PTSD - cognitive assessment and reappraisal of traumatic experience - is reflected in cognitive psychotherapeutic models. The authors of this direction believe that the cognitive assessment of a traumatic situation, being the main factor in adaptation after trauma, will most contribute to overcoming its consequences if the cause of the trauma in the mind of its victim, suffering from PTSD, becomes external in nature and lies outside the personal characteristics of the person (broadly well-known principle: not “I’m bad”, but “I did a bad thing”).

In this case, according to researchers, faith in the reality of existence, in the existing rationality of the world, as well as in the possibility of maintaining one’s own control over the situation is maintained and increased. The main task in this case is to restore in consciousness the harmony of the existing world, the integrity of its cognitive model: justice, the value of one’s own personality, the kindness of others, since it is these assessments that are most distorted in victims of traumatic stress suffering from PTSD (Kalmykova, Padun, 2002).

Within the cognitive model, traumatic events are potential destroyers of basic ideas about the world and about oneself. A pathological reaction to stress is a maladaptive response to the devaluation of these basic ideas.

In the psychophysiological model, the response to trauma is the result of long-term physiological changes. Variability in responses to trauma is due to temperament.

According to modern data (Kolb, 1984; Van der Kolk, 1991, 1996), under stress, the turnover of norepinephrine increases, which leads to an increase in the level of plasma catecholamine, a decrease in the level of norepinephrine, dopamine, serotonin in the brain, an increase in the level of acetylcholine, the emergence of analgesic effect mediated by endogenous opioids. Decreased levels of norepinephrine and a drop in dopamine levels in the brain correlate with a state of mental numbness. This condition, according to many authors (Lifton, 1973; 1978; Horowitz, 1972; 1986; Green, Lindy, 1992), is central to the stress response syndrome. The analgesic effect mediated by endogenous opioids can lead to opioid dependence and seeking out traumatic-like situations. A decrease in serotonin inhibits the system that suppresses the continuation of behavior, which leads to a generalization of the conditioned response to stimuli associated with the original stressor. Suppression of the functioning of the hippocampus may cause amnesia for specific traumatic experiences.

The disadvantage of these models is that most studies have been conducted on animals or in vitro. They also do not take into account the dependence of the psychophysiological response on cognitive mediation, which was shown in the experiments of Lazarus.

The information model developed by Horowitz (1998) is an attempt to synthesize cognitive, psychoanalytic and psychophysiological models. Stress is a mass of internal and external information, most of which cannot be reconciled with cognitive schemes.

According to the psychosocial approach, the trauma response model is multifactorial, and the weight of each factor in the development of the stress response must be considered. It is based on Horowitz's model, but the authors and supporters of the model also emphasize the need to take into account environmental factors: factors of social support, stigma, demographic factors, cultural characteristics, additional stress. This model has the limitations of an information model, but the introduction of environmental factors allows for the identification of individual differences.

Until recently, the “two-factor theory” was the main theoretical concept explaining the mechanism of PTSD. It was based on the classical principle of conditioned reflex conditioning of PTSD (according to I.P. Pavlov) as the first factor. The main role in the formation of the syndrome is given to the traumatic event itself, which acts as an intense unconditional stimulus that causes an unconditional reflex stress reaction in a person. Therefore, according to this theory, other events or circumstances, neutral in themselves, but in some way associated with the traumatic event stimulus, can serve as conditioned reflex stimuli.

However, using the two-factor theory, it has been difficult to understand the nature of some symptoms unique to PTSD, such as “persistent return to experiences associated with the traumatic event.” These are symptoms of intrusive memories of the experience, dreams and nightmares about the trauma, and, finally, the flashback effect. In this case, it is almost impossible to establish which “conditioned” stimuli provoke the manifestation of these symptoms, so weak is their visible connection with the event that caused the trauma.

Traumatic stress is a special form of the general stress response. It overloads a person’s psychological, physical, and adaptive capabilities. Not every event can cause traumatic stress.

Characteristics of injury:

1. the event that occurred is realized (that is, the person knows what happened to him and why his psychological state worsened.

2. the condition is caused by external reasons.

3. the experience destroys the primary way of life.

4. the event that occurred causes horror and a feeling of helplessness, powerlessness to do or undertake anything.

Traumatic stress is a special kind of experience, it is the result of the interaction between a person and the world around him, it is a normal reaction to abnormal conditions, circumstances arising in a person who has experienced something beyond the scope of normal human experience (threat to life, death, injury, violence, etc.) .P.).

An event that causes traumatic stress may include those when there is a threat to one’s own life, or the life of a loved one, a threat to physical health or self-image. The disorder can be more severe and long-lasting when stress is caused by a person than by external causes of a natural or man-made nature.

In the International Classification of Mental Disorders, traumatic stress is defined as a complex of reactions when (I. Cherepanova):

1. The traumatic event is persistently experienced again and again. This can happen in various forms:

· Repetitive and forceful memories of an event, including images, thoughts, or ideas(don't think about the yellow monkey). A person tries with all his might to forget about it, but it will always find a loophole to remind of itself. This same group of symptoms includes repeated childhood games that reflect elements of the traumatic event. This is a special type of game when children monotonously repeat the same plot of the game without introducing any changes or development. In such games, as a rule, there are no cathartic elements, i.e. Children, having played out certain stories, do not feel relief.

· Recurring nightmares about the event.

· Actions or feelings consistent with those experienced during the trauma(illusions, hallucinations and so-called “flashbacks”, when episodes of a traumatic event pass before the mind’s eye, as in a movie, sometimes even brighter and more clearly than it was in reality, and it doesn’t matter whether these phenomena occur in reality or in a dream condition, or during intoxication (for example, under the influence of alcohol or drugs) - thunder is a reaction to an earthquake.

· Intense negative feelings when confronted with something resembling (symbolizing) the traumatic event. Physiological reactivity if something resembles or symbolizes a traumatic event: stomach cramps, headaches. etc. So, if a girl is raped in an elevator, she breaks into a sweat every time she enters it.

2. Stubbornly avoids everything that may be associated with the trauma: thoughts or conversations, actions, places or people that remind you of the trauma (the girl mentioned above began to avoid using the elevator).

3. There is an inability to remember important episodes of trauma, i.e. a person cannot remember some episodes of what happened to him.

4. There is a marked decrease in interest in what previously occupied him, the person becomes indifferent to everything, nothing captivates him.

5. There is a feeling of detachment and alienation from others, a feeling of loneliness.

6. Dullness of emotions - inability to experience strong feelings (love, hate, etc.)

7. There is a feeling of a shortened future, i.e. short life perspective, when a person plans his life for a very short time. The child cannot imagine that he will have a long life, family, career, children, etc. Working with children from various regions of our country, I saw that many of them expected the end of the world to come soon. Depending on the characteristics of the region, some are convinced that chlorine tanks that have expired will explode, while others expect radiation contamination or genocide. Many children living in the contaminated area are convinced that they will soon die.

When experiencing a traumatic event, the following are found: symptoms:

· Insomnia or interrupted sleep. Sleep is one of those manifestations that are disrupted at the slightest psychological distress. A person is visited by nightmares, and he himself involuntarily resists falling asleep - this is the reason for his insomnia: the person is afraid to fall asleep and see this dream again. Insomnia can also be caused by high levels of anxiety, an inability to relax, and persistent feelings of physical or mental pain. Regular lack of sleep, leading to extreme nervous exhaustion, complements the picture of traumatic stress.

· Irritability or outburst of anger."Sometimes I feel like I could kill someone who's angry with me."

· Impaired memory and concentration. At some moments, concentration can be excellent, but as soon as any stress factor appears, a person loses the ability to concentrate. In children, this disorder sometimes becomes so severe that their educational success is greatly impaired. Excellent students become poor students, experiencing this very painfully.

· Hypervigilance. A person closely monitors everything that happens around him, as if he is in constant danger. But this danger is not only external, but also internal - it consists in the fact that unwanted traumatic impressions, which have destructive power, will break into consciousness. Hypervigilance often manifests itself in the form of constant physical tension. This tension can create many problems. First, maintaining such a high level of alertness requires constant attention and an enormous expenditure of energy. Secondly, the person begins to feel that this is his main problem. And as soon as the tension can be reduced and relaxed, everything will be fine. Physical tension can perform a protective function - it protects our consciousness, and psychological protection cannot be removed until the intensity of the experience has decreased. When this happens, the physical tension will go away on its own.

· Exaggerated response - p at the slightest noise, knocking, etc. the person flinches, starts running, screams loudly, etc. This exaggerated response led to more casualties after the earthquake. Then the strongest shock was followed by others, weaker and not dangerous. But people, feeling the tremors, jumped out of the windows, falling to their deaths.

The psychological response to trauma is a process unfolding over time, which includes 3 phases:

1 – phase of psychological shock. Contains 2 components: - inhibition of activity, disruption of orientation in the environment, disorganization of activities; denial of what happened. Normally, this phase is quite short-lived.

Phase 2 of exposure – characterized by pronounced emotional reactions to the event and its consequences. Emotional reactions are characterized by immediacy of manifestation and extreme intensity (fear, anger, crying, etc.). Gradually, these emotions are replaced by reactions of criticism or self-doubt.

Phase 3 of criticism - proceeds according to the principle “what would have happened if ...”, accompanied by a painful awareness of the inevitability of what happened, recognition of one’s own powerlessness and self-flagellation (survivor’s guilt). May reach the level of deep depression. After this phase, either recovery begins (response, acceptance of reality, adaptation to the circumstances that have arisen), or fixation on the injury occurs and the post-stress state becomes chronic.

Disorders that develop after experiencing trauma affect not only the participant in the traumatic event, but also members of his family. The consequences of injury can appear many years later, suddenly, against the background of general well-being, and over time the deterioration of the condition becomes more pronounced.

As a result of exposure to a traumatic factor, a dangerous, extreme situation, post-traumatic stress disorder may develop, which is secondary, manifesting itself a certain time after the end of the most extreme situation, reaction to a traumatic event. Post-traumatic stress disorder (PTSD) can be long-lasting and affect the rest of a person’s life. PTSD does not occur in all participants in a particular extreme situation and depends on a number of factors:

1. Personality characteristics, the significance of the situation for the individual.

2. Biopsychic characteristics of the individual (including characteristics of the nervous system, gender and age characteristics).

3. Experience of being in an extreme situation.

4. A history of mental trauma.

5. Various forms of addictive behavior or addiction to it.

6. Lack of support from significant others.

According to ICD-10 (See Appendix), post-traumatic stress disorder can develop following traumatic events that are outside the scope of normal human experience. Stressors that cause PTSD include: natural disasters, man-made disasters, as well as events that are the result of purposeful, often criminal activity (sabotage, terrorist acts, torture, mass violence, military operations, being in a “hostage” situation, destruction of one’s own home and etc.). PTSD occurs when stress overloads a person’s psychological, physiological, and adaptive capabilities and destroys defenses.

Post-traumatic stress disorder is a complex of human reactions to trauma, where trauma is defined as an experience, a shock, which in most people causes fear, horror, and helplessness.

In accordance with the characteristics of manifestation and course, three subtypes of post-traumatic stress disorders are distinguished (psychological assistance in crisis situations):

§ acute, developing within up to three months;

§ chronic, lasting more than three months;

§ delayed, when the disorder occurred six or more months after the injury.

Post-traumatic stress disorder leaves an imprint on the rest of a person’s life, therefore it is necessary to work through this condition to smooth out the consequences of this disorder. Schematically, the relationship between different stages of the formation of post-stress disorders in terms of time of occurrence, duration and depth is presented in the following diagram (Fig. 4)

Stages of formation of post-stress disorders

It is advisable to consider the dynamics of psychopathological consequences in three aspects:

q syndrome dynamics of primary ego stress (stress of awareness of a traumatic reality). Ego-stress phenomena underlie the pathogenesis of the psychopathological consequences of an emergency situation;

q socially acceptable options for the psychopathological evolution of the personality of participants in an emergency situation: mental (neurotic) and psychosomatic disorders;

q socially negative variants of the psychopathological evolution of the personality of participants in an emergency situation: disorders of social behavior, in relation to which the state’s position is of a medico-legal nature (See Fig. 5).

After the affective-shock (acute) reactions have passed, the picture of primary traumatic ego stress (consciousness stress) appears.

The clinical structure of the syndrome is:

1. Frustration regression associated with the action of one of the basic defense-regression mechanisms. The fact of being in an emergency situation is accompanied by an automatic decline in the psyche to the level of a pubertal crisis, which is manifested in emphasized discipline, subordination, subordination, while at the same time an increased likelihood of violent outbursts of directly destructive or chaotic-foolish behavior. Regression finds its experience in its speech confusion. A special place is occupied by the frustration of the needs of self-determination (limitation of rights and freedom). Here the following manifestations of conditionally pathological personality dynamics in the source of an emergency situation can be observed:

§ personification of the source of the threat with the experience of the image of the enemy and the image of the magical assistant;

§ in the presence of an external blockade of the manifestation of aggression, auto-aggressive actions are possible, or further regression is not deeper than the 3-year level with a violation of sphincterial discipline (bear disease). Emotionality is associated with the experience of feeling helplessly exposed to real danger.

2. The affect of painful bewilderment, which is characteristic of the initial period of the existence of ego-stress and reflects the presence of persistent and unsuccessful attempts to comprehend a new, traumatic reality.

3. Affect of psychalgia. An inexpressible experience of mental pain and suffering, which is characterized by duration, secrecy with a tinge of recognition of hopelessness, irrevocability. The structure of the phenomenon of mental pain should include external tension and hyperaesthetic reactions due to their alexithmic form. Long-term alexithmic psychalgia can cause outwardly unmotivated outbursts of alcohol and substance abuse, and suicide. This is possible in any emergency situation.

Primary ego stress turns into secondary stress, which is expressed in a crisis of self-determination.

Resolution, as already mentioned, occurs in the form of socially acceptable and socially negative options.

Socially acceptable options are understood as mental and psychosomatic disorders in which the clinical picture of early psychopathological consequences differs significantly in anthropogenic, man-made, and sociogenic disasters and this is associated with a direct understanding of the role of man in them.

In the structure of the early dynamics of the psychopathological consequences of emergency situations, the following phenomena of ego stress are distinguished:

§ painful experiences of guilt, shame, disgust as affects of pathogenic ego-defense

§ episodic experiences of horror, paralyzing fear under the influence of the intimidation factor

§ the emergence and development of “survivor’s guilt”, “corporate guilt” and the expectation of punishment for what happened.

§ situational phobias and the formation of a phobic syndrome with elements of narcissism and regression.

In the development of psychopathological consequences of traumatic situations, a steady process of psychosomatic disability, progressive loss of health, a decrease in the duration and quality of life of all participants in an emergency situation, the development of alcohol and drug addictions, and suicide has been established.

In the structure of the actual psychopathological long-term consequences of a traumatic situation, the following occupies an essential place:

1. disorders of affect (subdepression) with shades of anhedonia (inability to rejoice) and adynamia, asthenic, apathetic masks, a feeling of external change;

2. gradual transition of psychosomatic disorders to the chronic stage and the formation of severe psychosomatosis - hypertension and peptic ulcers;

3. steady growth of social maladaptation and desocialization, the phenomenon of isolation and alienation, autism and reduction of energy potential;

4. the growing phenomenon of loss of professionalism and intellectual performance due to the development of psychoorganic disorders;

5. rapid development of alcoholism with such phenomena as uncontrollable drunkenness, loss of the ability to adequately react emotionally, and a tendency to an anxious and suspicious mood;

6. a steady increase in antisocial psychopathy with symptoms of excitability, affective tension, and criminal rampance.

The clinical picture of the immediate and long-term psychopathological consequences of traumatic situations shows a polymorphism of mental and psychosomatic disorders, variability and complexity of symptoms, a steady increase in social maladjustment, psychopathological disorders, disability, and premature mortality.

Thus, the core of the personality dynamics of a participant in a traumatic situation is neurotic (pathological) evolution.

Options for pathological personality development:

1. Alienation - alienation, severance of ties with universal human reality, autistic personality deformation.

2. Psychosomatic evolution is atypical for age, that is, the development of somatic diseases that arise under normal conditions at a much later age.

3. Toximanic evolution, i.e. development of dependence on various psychoactive substances (PAS).

4. Epileptoid deformation, which is expressed in the formation of a dysphoric (gloomy-sad) mood, anger, and potential readiness for unmotivated destructive outbursts of aggression.

For post-traumatic stress disorder, there are three groups of symptoms (ICD - 10):

1. symptom of re-experiencing,

2. symptom of avoidance,

3. symptom of physiological hyperactivation.

Symptoms of re-experiencing include:

§ constant, repeated experiences of an event that a person tries to forget, but everything around him constantly, in one form or another, reminds of him;

§ recurring nightmares duplicating a traumatic situation;

§ intense negative experiences when faced with something resembling a traumatic event;

§ physiological reactivity (stomach cramps, headaches that occur when reminded of an event).

The symptom of avoidance manifests itself in the fact that the traumatic experience is repressed, the person strives not to get into situations, avoids thoughts, conversations, actions, people that are reminiscent of the experience. There is a feeling of alienation, detachment, and loneliness. There is a loss of the ability to establish close and friendly relationships with others, and the destruction of established connections is possible. The level of aggressiveness increases, outbursts of anger are unmotivated and more often occur in a state of alcohol intoxication.

Physiological hyperactivation manifests itself in difficulties falling asleep, increased irritability, difficulty concentrating, and increased readiness to escape.

Diagnostic criteria for post-traumatic stress disorder. Primary symptoms:

1. The person was exposed to the traumatic event as a participant or witness.

2. The traumatic event was re-experienced in the form of one or more subsequent manifestations (intrusion).

§ Repeated intrusive memories of events, including images, thoughts, sensations.

§ Recurring and very disturbing dreams about the experienced event.

§ Acting or feeling as if the traumatic event were happening again, including feelings of re-enactment of the experience, illusions, hallucinations, and dissociative episodes upon awakening.

§ Severe psychological distress due to external or internal stimuli that symbolize or resemble some aspect of the traumatic event.

§ Physiological reactivity under the influence of external or internal stimuli that resemble some aspect of the traumatic event.

3. Constant avoidance of stimuli associated with trauma and general numbness.

§ Trying to avoid thoughts, feelings or conversations related to the trauma.

§ Attempts to avoid activities, places, or people that trigger memories of the trauma.

§ Partial or complete amnesia of aspects of trauma.

§ Decrease in interest in previously significant activities.

§ Feelings of alienation or detachment from others.

§ Narrowing of the emotional range (inability to love).

§ Inability to focus on the long term.

4. Sustained manifestations of increased arousal that were absent before the injury (hyperactivity).

§ Difficulty falling asleep or staying asleep.

§ Irritability or angry outbursts.

§ Difficulty concentrating.

§ Over-carelessness.

§ Increased reaction to fear.

5. The duration of the disorder (symptoms) is more than 1 month.

6. The disorder causes significant distress or impairment in social, work or other areas of life.

7. Nonspecific somatic complaints (increased tension, fatigue, psychosomatic experiences)

Secondary symptoms:

1. Psychosomatic disorders of the cardiovascular and digestive systems

2. Nervous exhaustion

3. Pain factor

4. Sexual dysfunctions, anxious anticipation of sexual failures

5. Personality disorders (emotional insufficiency, irritability, inadequate self-esteem)

6. Violation of interpersonal relationships.

Research in PTSD has developed independently from stress research, and to date the two fields have little in common. Central provisions in the concept stress, stress proposed in 1936 by Hans Selye (Selye, 1991), is a homeostatic model of the body’s self-preservation and mobilization of resources to respond to a stressor. He divided all effects on the body into specific and stereotypical nonspecific effects of stress, which manifest themselves in the form of a general adaptation syndrome. This syndrome goes through three stages in its development: 1) anxiety reaction; 2) stage of resistance; and 3) the stage of exhaustion. Selye introduced the concept of adaptive energy, which is mobilized through adaptive restructuring of the homeostatic mechanisms of the body. Its depletion is irreversible and leads to aging and death of the body.

Mental manifestations of the general adaptation syndrome are referred to as “emotional stress” - that is, affective experiences that accompany stress and lead to unfavorable changes in the human body. Since emotions are involved in the structure of any purposeful behavioral act, it is the emotional apparatus that is the first to be included in the stress reaction when exposed to extreme and damaging factors (Anokhin, 1973, Sudakov, 1981). As a result, functional autonomic systems and their specific endocrine support, which regulates behavioral reactions, are activated. According to modern concepts, emotional stress can be defined as a phenomenon that arises when comparing the demands placed on an individual with his ability to cope with this demand. If a person lacks strategies for coping with a stressful situation (coping strategies), a tense state arises, which, together with primary hormonal changes in the internal environment of the body, causes a disruption of its homeostasis. This response represents an attempt to cope with the source of stress. Overcoming stress includes psychological (this includes cognitive, that is, cognitive, and behavioral strategies) and physiological mechanisms. If attempts to cope with the situation are ineffective, stress continues and can lead to pathological reactions and organic damage.

Under some circumstances, instead of mobilizing the body to overcome difficulties, stress can cause serious disorders (Isaev, 1996). With repeated repetition or with a long duration of affective reactions due to protracted life difficulties, emotional arousal can take on a stagnant, stable form. In these cases, even when the situation is normalized, stagnant emotional arousal does not weaken, but, on the contrary, constantly activates the central formations of the nervous autonomic system, and through them disrupts the activity of internal organs and systems. If there are weak links in the body, then they become the main ones in the formation of the disease. Primary disorders that occur during emotional stress in various structures of neurophysiological regulation of the brain lead to changes in the normal functioning of the cardiovascular system, gastrointestinal tract, changes in the blood coagulation system, and a disorder of the immune system (Tarabrina, 2001).

Stressors are usually divided into physiological (pain, hunger, thirst, excessive physical activity, high and low temperature, etc.) and psychological (danger, threat, loss, deception, resentment, information overload, etc.). The latter, in turn, are divided into emotional and informational.

Stress becomes traumatic when the result of exposure to a stressor is a disturbance in the mental sphere, similar to physical disturbances. In this case, according to existing concepts, the structure of the “self,” the cognitive model of the world, the affective sphere, the neurological mechanisms that control learning processes, the memory system, and emotional pathways of learning are disrupted. In such cases, traumatic events act as a stressor - extreme crisis situations with powerful negative consequences, life-threatening situations for oneself or significant loved ones. Such events fundamentally disrupt the individual's sense of security, causing experiences of traumatic stress, the psychological consequences of which are varied. For some people, experiencing traumatic stress causes them to develop post-traumatic stress disorder (PTSD) in the future.

Post-traumatic stress disorder (PTSD) is a non-psychotic delayed response to traumatic stress that can cause mental health problems in almost anyone. The following four characteristics of trauma that can cause traumatic stress have been identified (Romek et al., 2004):

1. The event that occurred is realized, that is, the person knows what happened to him and why his psychological state worsened;

2. This condition is caused by external reasons;

3. The experience destroys the usual way of life;

4. The event that occurred causes horror and a feeling of helplessness, powerlessness to do or undertake anything.

Traumatic stress – This is an experience of a special kind, the result of a special interaction between a person and the surrounding world. It is a normal reaction to abnormal circumstances, a condition that occurs in a person who has experienced something beyond the normal human experience. The range of phenomena that cause traumatic stress disorders is quite wide and covers many situations when there is a threat to one’s own life or the life of a loved one, a threat to physical health or self-image.

The psychological reaction to trauma includes three relatively independent phases, which makes it possible to characterize it as a process unfolding over time.

The first phase - the phase of psychological shock - contains two main components:

1. Suppression of activity, disruption of orientation in the environment, disorganization of activities;

2. Denial of what happened (a kind of protective reaction of the psyche). Normally, this phase is quite short-term.

The second phase – impact – is characterized by pronounced emotional reactions to the event and its consequences. This can be intense fear, horror, anxiety, anger, crying, accusation - emotions characterized by immediacy of manifestation and extreme intensity. Gradually, these emotions are replaced by reactions of criticism or self-doubt. It proceeds along the lines of “what would have happened if...” and is accompanied by a painful awareness of the inevitability of what happened, recognition of one’s own powerlessness and self-flagellation. A typical example is the feeling of “survivor's guilt” described in the literature, often reaching the level of deep depression.

The phase under consideration is critical in the sense that after it, either the “recovery process” begins (response, acceptance of reality, adaptation to newly emerged circumstances), that is, the third phase of the normal response, or fixation on the injury occurs and the subsequent transition of the post-stress state into a chronic form.

Disorders that develop after experiencing psychological trauma affect all levels of human functioning (physiological, personal, level of interpersonal and social interaction) and lead to lasting personal changes not only in people who directly experienced stress, but also in their family members.

The results of numerous studies have shown that the condition that develops under the influence of traumatic stress does not fall into any of the classifications available in clinical practice. The consequences of trauma can appear suddenly, over a long period of time, against the background of a person’s general well-being, and over time the deterioration of the condition becomes more pronounced. Many different symptoms of such a change in condition have been described, but for a long time there were no clear criteria for its diagnosis. There was also no single term to refer to it. Only by 1980 was a sufficient amount of information obtained during experimental studies accumulated and analyzed for generalization.