Preparing for and Responding to Threatening / Stressful Events: A Self-help Guide for Employees

This content was archived on June 24, 2013.

Notice to the reader: The content found on this page is a snapshot of the document as it was presented to the public at the time of publication. The Workplace Health and Public Safety Programme (WHPSP) became the Emergency Preparedness and Occupational Health Directorate (EPOHD) in 2010. Find more information on EPOHD's roles and responsibilities.

Table of Contents

1. Purpose of the Employees' self-help e-guide
2. Before and during an event/ Building resilience
   • 2.1 Being aware of, and improving your personal strengths, competencies and autonomy
   • 2.2 Maintaining emotionally supportive relationships at home and work
   • 2.3 Being informed about what is happening in your environment
   • 2.4 Being informed about typical emotional, bodily and behavioural reactions to trauma and knowing your personal stress reactions
   • 2.5 Practicing healthy living and good self-care before tragedy strikes
   • 2.6 Having emergency response plans
3. Coping in the aftermath
   • 3.1 Knowing what to do in the first few days following a traumatic event
   • 3.2 Returning to work after a traumatic event
   • 3.3 Finding meaning in adversity: Relating to others, giving and receiving needed support
4. Special circumstances
   • 4.1 Quarantine and Social Isolation
5. When to seek help?
6. Additional available resources
   • 6.1 Internal resources
   • 6.2 External resources
7. References

1. Purpose of the Employees' Self-Help e-Guide

This self-help guide is designed to help employees take an active role to:

• Strengthen their resilience to threatening/stressful events. Preparation and knowledge enhances our innate resilience, drive to survive and live fully again after traumatic or potentially traumatic events;
• Strengthen knowledge about what to do after threathening/stressful events. There are things that you can do in the aftermath to mitigate your short term and long term reactions to the event.

2. Before and during an event/ Building resilience

Resilience is the human ability to maintain a state of balance and healthy levels of psychological and physical functioning in the face of tragic events. The great majority of people exposed to traumatic and potentially traumatic events continue to have positive emotional experiences and show only minor, temporary disruptions in functioning.

2.1 Being aware of and improving your personal strengths, competencies and autonomy

There are multiple personnal tools that can be used to maintain its balance and strengthen resilience to extremely aversive events. Because of their key roles, it's important to be aware of them and improve them when possible.

1. Hardiness:
   Being committed to finding meaning and purpose in life, believing that you can influence the "outcome" of an event and believing that you can learn and grow from both positive and negative experiences will help you gain a sense of control.
2. Self-enhancement:
   Positive self-esteem, looking out for personal needs in the face of personally threatening events and maintaining active social networks will help strengthen your resilience.
3. Emotional control:
   In the midst of threatening events a certain amount of emotional repression and denial can be helpful. In the long term, however, it is not helpful to bury distressing thoughts, feelings and memories. It is better to find someone you feel comfortable speaking with.
4. Positive emotion and laughter:
   Positive emotions (gratitude, interest, love, etc) and laughter are protective ways to cope with adversity.
5. Engaging in goal directed activities:
   Being engaged in activities, however small, to improve things for yourself and others is extremely strengthening and hope inducing. Taking action is a powerful way to gain triumph over the meaninglessness of trauma and other adverse circumstances.

(Bonanno; Janoff-Bulman; Lightsey)

2.2 Maintaining emotionally supportive relationships at home and at work

Humans are social by nature and connections with significant others provide an important centering function that helps us to bounce back from excessive stress and trauma and help us find meaning out of disaster and tragedy.

It has been found that the workplace offers a significant amount of emotional support. Being involved with your co-workers and supervisor in planning and developing an Emergency Response Plan is one way to prepare for traumatic events that may occur in the workplace.

Staying connected with others can make you feel less alone when an event occurs and can help you sort out reactions to the events. Think of the people in your social network at present that are most significant in your life. Include family, friends, partner, co-workers and/or professionals such as family doctor. Make sure you have their phone numbers both at home and in the workplace. Assess what you are doing to maintain a social network and whether you need to reach out more to others in your life.

If you have children spend more time with them. Ask them about their reactions to the event. Sudden changes in family routines, as well as fears and anxieties resulting from their own disaster experience can change the way children and teens behave. Involve them in recovery activities. Small children, in particular, need more physical care, holding and reassurance. For more information on  Helping Children and Adolescents Cope visit the  Public Health Agency of Canada's Office of Emergency Services web site.

2.3 Being informed about what is happening in your environment

Being as well informed as you can of the disaster or traumatic event, having an emergency response plan (including knowing your workplace Emergency Response Plan as well as creating your own personal and family Emergency Response Plan), and knowing about available resources within yourself and in your community and workplace, all combined to give you more of a sense of control, strength and resilience. After an event has occurred, finding out what has happened may be the key to recovery. Sharing with others what you witnessed can also help you better assess what has happened and it's implications to you and others.

2.4 Being informed about typical emotional, bodily and behavioural reactions to trauma and knowing your personal stress reactions

"Trauma" means wound. Like any purely physical wound, trauma can take its toll on the "bodymind". It can create emotional wounds that are painful and can take some time to heal. Recovery then requires patience to feel, to express your reactions and to relate with others who can support you and receive your support. With the support of family and friends, most people recover without further problems in a short period of time.

In fact, most experience temporary disruptions following a highly disruptive event and many do not undergo significantly long term wounding, and return to normal functioning fairly quickly.

That being said, whenever we feel that our lives are threatened, our inborn survival instincts automatically kick in. Our body and mind gear up and take over to fight the danger or to flee from it. Here is a list of typical reactions triggered whenever we go into fight or flight response mode:

• a. Reactions in your body: Initially you may have:
  • rapid heartbeat and breathing;
  • sweating and cold, clammy hands;
  • upset stomach and diarrhea;
  • dry mouth, stomach in a knot, uncontrollable shaking; and
  • muscle tension and aches and an inability to relax.
• b. Reactions in your thinking process:
  • Confusion, disorganization, inability to concentrate;
  • Denial, disbelief, sense of unreality, dissociation;
  • Heightened awareness of certain details;
  • Illusion that we are at the center of events; and
  • Dazed, bewildered.

Days or weeks after the event, you may find it hard to stop thinking about the event, find it hard to remember day to day things, and feel disorganized at work and at home. You may have recurrent flashback of event and find that you have great difficulty making decisions.

• c. Reactions in how you feel:
  • fear, anxiety, shock;
  • powerlessness, helplessness;
  • horror, terror, anger;
  • numbness;
  • sense of loss; and
  • sense of frailty and vulnerability, sense of abandonment.

Days or weeks after the event, you may fear that a similar event may reoccur. If there have been deaths or injuries you may feel guilt for being alive, anger at the senselessness and injustice of the event as well as sadness for the losses and anxiety about the future. You may feel unable to laugh or feel pleasure or feel constantly worried, nervous or upset. You may feel hopeless about the future and detached and unconcerned about others.

• d. Reactions in your behavior: Initially you may:
  • attempts to confirm danger, seek cover or attempt to escape;
  • look for someone who will help/advise;
  • protect/rescue family and/or co-workers; and
  • freeze, faint, cry, scream, or do the same thing over and over again.
• After awhile you may:
  • isolate yourself from family and friends;
  • fail to engage in exercise, healthy diet, safe sex and regular health care; and
  • depend on tobacco, alcohol or food to cope.

For more information on how to deal with your stress contact your Employee Assistance Program (EAP).

2.5 Practicing healthy living and good self-care before tragedy strikes

There are a number of potentially prolonged situations where government employees may be working in a capacity of response to a crisis. As part of their work federal employees may need to provide a wide range of community services. In those cases, having a self-care plan for high intensity work will be particularly important.

A lifestyle that sustains and supports emotional and physical health requires you to be aware of key ingredients that help to maintain and refuel your energy. Develop a self-care plan tailored to your unique needs, identify ways to improve and maintain your energy level and your ability to cope and name the main resources that you will need in order to take care of yourself during times of disaster or threatening events. Important elements to include in your preparation are:

1. Maintaining Lifestyle Routines

   Daily routine tasks and habits are often performed without much thought. These routines are important contributions to sustain emotional and physical well being. Assess whether you need to reprioritize your daily activities and maintain whatever healthy routines are possible during times you are involved in a high intensity work period or excessive stress and trauma.

2. Maintaining Physical Fitness and Planning For Fun

   Physical fitness and times for fun are renewing to our bodies and our minds. Think of the physical activities that you currently engage in as part of your self-care routine and assess whether you need to do more of these. If you are not a regular exerciser, think of some ideas about how to increase your physical activity on a daily basis (i.e., walking to and from work, to the bus or subway station). For more information, see  Canada's Physical Activity Guide.

3. Maintaining Healthy Diet/Nutrition

   Healthy fuel is required when our bodies and minds are performing beyond our usual expectations. Times of heightened stress are when we are most vulnerable to neglect healthy foods and routines as well as succumb to junk food. We are also at risk for over-using our favorite stimulants/relaxants during high stressful periods.

   Eat healthy, balanced meals during times of excessive stress. Eating small to moderate size meals along with frequent snacking is known to help the body's processing of food and provides for brief breaks from your work. Remember to keep yourself well hydrated by drinking plenty of water and fruit juices. For more information visit Canada's Food Guide.

4. Maintaining Effective Work Habits

   Some work habits and routines are more effective during a sustained period of high intensity work. For example, alternate high intensity tasks with low intensity tasks; analyze the task and break it down into manageable parts; when you cannot see a solution, take a break or debrief with a colleague or manager.

   Realize that there are only so many hours in a day, and there is only so much that you can realistically do in that time. Be mindful of what you can realistically accomplish within a given time and how overextension can deplete your energy, focus and productivity.

2.6 Having Emergency Response Plans

1. Family/Significant Others Care Plan (Family Emergency Response Plan):
   Develop an Emergency Response Plan so that if something were to happen while you were at work, your loved ones would know how to protect themselves. Having a family emergency response plan will lessen your worries about their well being. Include family planning for disasters requiring evacuation such as natural disasters, terrorism, bioterrorism or pandemic threats. Involve the entire family in the plan. Also identify the key family responsibilities that are normally expected of you and plan for alternative arrangements. (i.e. optional care providers). Here are essential elements to include:
   • Health: Have extra supply of medical and health supplies. Discuss plans for medical needs before a disaster with adult children away from home and elderly family members. Be prepared for special circumstances of quarantine or caring for influenza infected persons at home;
   • A ready-to-go kit: extra water, bottled beverages, favorite nonperishable and energy foods, flashlights and batteries, first-aid kit, radio, medications, evacuation destination with alternate route, maps, contact numbers; and
   • Knowing where your family is or how to locate them is critical for reducing anxiety.
2. Work Emergency Response Plan:
   A well thought out emergency response plan will help you and your co-workers to respond quickly and effectively. Find out if your unit has an emergency plan. If there is an Emergency Response Plan under your responsibility remain as informed as possible of potentiel risks and their implications on your safety. If not, speak with your manager about the importance of having one. Your manager may want to refer to Preparing for and Responding to Workplace Trauma: A Manager's Handbook (and Preparing for and Responding to Workplace Trauma: A Manager's eGuide for suggestions. You will also find a  " Workplace Safety Toolkit" that may be helpful to you.

3. Coping in the aftermath

After a few days or weeks, strong initial reactions may begin to fade away. It is still important then to continue managing your stress reactions during the weeks and months after an event as to facilitate recovery and as there could be delayed reactions. Maintain your self-care plan and continue monitoring your stress reactions. In addition, here are a few other tools that can help you in coping in the aftermath.

3.1 Knowing what to do in the first few days following a traumatic event

• a. H.A.L.T : Don't get too hungry, angry, lonely or tired.
  • H: Pay attention to signs of hunger. Eat right. Reduce your stress by nourishing your body with regular and healthy snacks and meals. Avoid or reduce caffeinated beverages such as coffee and colas. Caffeine is a stimulant that can increase your stressed feelings, restlessness and disturb your sleep. For ideas on healthy eating, visit Canada's Food Guide
  • A: Find positive ways to deal with anger, such as going for a brisk walk, and other exercise. Talk about your feelings with others.
  • L: Pay attention to signs of loneliness and withdrawal. The positive role of social support is strongly associated with resilience to trauma. Talking to family members, friends and coworkers or writing about your experience:
    • Is a healthy way to deal with and absorb what has happened;
    • Can help people identify feelings or thoughts they have had before, during and after the traumatic experience;
    • Can help promote a sense of control over some of the reactions you experienced and can help you feel less alone;
    • Can reduce emotional intensity, define feelings, reduce isolation, normalize the experience and give a sense of relief; and
    • Can be another way of better understanding and coping with your personal reactions to stress and trauma.

    It is common to talk repeatedly about your experience of the event. In writing, be sure to include positive developments as well as concerns. If you don't have loved ones or colleagues to talk to, call a crisis line, other community resources or a clergy member that are there to help you. You can also contact your Employee Assistance Program.

  • T: Pay attention to signs of tiredness. Remember, the "fight or flight response" may deplete you of energy. Sleep, rest and relaxation are some of the best ways to restore your body and mind to balance and health. After a good sleep the intensity of some of the reactions will subside, but if you had a life threatening experience, expect some reactions to remain intense. Set time aside each day for relaxation and deep breathing.

To help you cope in the aftermath keep in mind as well:

• b. Media:
  • Avoid speaking to the media immediately after a traumatic event;
  • The media may press you to get a victim's response and this can be emotionally draining and trigger additional reactions.
• c. Physical exercise:
  • Exercise helps us feel better, clears our thoughts and helps us think positively.
  • Don't over-exercise. If you are not used to exercising, begin gradually and exercise in moderation; and
  • For ideas on exercise, see  Canada's Physical Activity Guide or call 1-888-334-9769.
• d. Understand your fears and anxieties:
  • Fear is a normal adaptive reaction, indeed a life-saving one;
  • Fear can warn us that danger is close at hand;
  • Normal fear reactions help keep you safe during danger;
  • Fear can help us exercise caution, be alert and mobilize strengt;
  • The sense of fear also often lingers long after the danger is past;
  • You may find yourself overly vigilant, easily startled and on the lookout for danger;
  • Fear that the danger or event may reoccur can dominate your thoughts and feelings and make you anxious;
  • Fear of recurrence may be triggered by sights, sounds, smells, or other stimuli that remind you of the incident. For example, flood victims may be unable to sleep when it rains because they are afraid that raging water may carry away their home as they sleep. Some tornado survivors will seek shelter in their basement at the slightest hint of a thunderstorm; and
  • These fears are normal reactions and are likely to subside as time passes.
• e. Use positive self-talk:
  • "It's normal and OK to feel this way after such a stressful event";
  • "I can do this, I'm having normal stress reactions that will subside";and
  • "There are people who care about me and will help me through this".
• f. Return to your normal routine as soon as you can do so comfortably.

  This will help you regain a sense of safety, security and control. (See next section for more detailed information)

3.2 Returning to work after a traumatic event

If an incident has happened in the work place and you are concerned if it is safe to return to work as an employee you may ask for a certification that the workplace is safe. The Workplace Health and Public Safety Programme (WHPSP) of Health Canada can assist your employer in making sure it is safe to return to work.

• a. Value of Returning to Work:

  Returning to the work after a traumatic event can be quite stressful. Memories of what happened, of the death or serious injuries to colleagues may be overwhelming. However, the workplace may be the best place for you to return to following a traumatic event as returning to a regular routine and being with colleagues can contribute to your physical and emotional recovery and it can provide you and your co-workers with an opportunity to:

  • Meet in a familiar place, surrounded by people you know; and
  • Talk about what happened with people who shared a similar experience and who are also trying to make sense of what happened.
• b. If you were injured and are ready to return to work

  Don't be surprised if you experience some stressful reactions when you are ready to return to your workplace. Initial distress diminishes as you realize that the workplace is now safe and secure. Contact your EAP provider if stress reactions increase.

  If you were seriously injured, a return to work on a gradual basis may be required, along with a suitable work plan and reorientation. This would be discussed and agreed to by the Workplace Health and Public Safety Programme's Occupational Health Medical Officer who is responsible for conducting the Fitness to Work Evaluation (FTWE) and Medical Assessment for an employee's return to work.

• c. Tips on Coping when Returning to Work:
  • Practice self-monitoring and pacing;
  • Have regular daily check-ins with colleagues, family and friends;
  • Talk about the incident, with friends, family and co-workers;
  • Eat regular, well balanced meals and nutritious snacks;
  • Drink plenty of water, fruit juices or herbal teas;
  • Eliminate or cut down on the amount of caffeine consumed (coffee, tea, colas, chocolate);
  • Learn to relax and still your mind and body in the midst of high intensity work, instead of relying on stimulant substances;
  • Even if you do not feel like it, do some physical exercise;
  • Take regular brief walks, change of posture or stretching exercises;
  • Take brief relaxation and stress management breaks;
  • Maintain your regular lifestyle routines as much as possible;
  • Foster flexibility, patience and tolerance;
  • Get sufficient rest and sleep; and
  • Make every effort to avoid use of alcohol, illicit drugs or excessive amounts of prescription drugs which interfere with sleep cycles.

3.3 Finding meaning in adversity: Relating to others, giving and receiving needed support:

Human beings are amazingly resilient in their response to disasters and traumatic events. They adjust to major changes in their lives. They have to grieve their losses, find temporary housing, repair or rebuild their homes, find new jobs, cope with physical disabilities or injuries, deal with physical or personal crises. Disruption in relationships, roles and routines can make life unfamiliar or unpredictable. It can take several months or even a year, for life to begin to feel normal again.

A significant way that people maintain their personal resilience and find meaning in the face of tragedy and the jarring reality that the world is not entirely a safe and secure place is by engaging in purposeful activities and reaching out to help others. Dangers and threats exist and must now be taken into account.

Although a person may be decent and good, bad things can and do happen to them. As these new experiences of reality sink in, we re- adjust our world view. By reaching out to support and be supported by others we can re-work and re-define our traumatic experience and slowly integrate it into our life experience and personal history. The Public Health Agency of Canada's Office of Emergency Services Web site provides brochures on:

•  Responding to Stressful Events: Helping Teens Cope
•  Responding to Stressful Events: Helping Children Cope
•  Responding to Stressful Events: Taking Care of Ourselves, Our Families and Our Communities
•  Responding to Stressful Events: Self-Care for Caregivers

4. Special circumstances

4.1 Quarantine and Social Isolation

There are some situations where workplace, transportation, schools, businesses, stores and so on, will be inaccessible in your community such as during the height of a pandemic outbreak or during a CBRN threat. In these situations Business Continuity Plan must include provisions for working from home. Helpful sites to refer to include:  http://www.bearingpoint.com/esp. Also see Health Canada's "Pandemic Self & Family Care Planning" for information about quarantine and social isolation and guidelines for psychosocial self-care.

5. When to seek help?

If you are experiencing the following (see below), consider seeking support from a health professional or your EAP. Also if you observe these concerns in a colleague, encourage them to contact a health professional or their EAP.

Seek help when you are experiencing one or more of the following:

• Distressing thoughts, behaviours or emotions last more than 3-4 weeks (see signs of traumatic stress);
• You continue to have difficulty functioning as you normally do at work, in the family or in social recreational activities;
• There are continuing physical symptoms such as stomach aches/upsets, nausea, diarrhoea, intestinal cramps, elevated heart rate, elevated blood pressure, elevated blood sugar that do not resolve themselves in 1-2 days;
• There is problematic use of alcohol or drugs;
• At any time you feel a sense of hopelessness or helpless about your emotions or behaviours or life; and
• You feel preoccupied by over-identification with or feeling overwhelmed by victims' and families' grief.

The good news is that there are effective supports and treatments for stress related problems including Post Traumatic Stress. Nowadays, counselling or therapy consists of practical conversations with a trained mental health professional. It includes a confidential discussion of a difficulty and ways to improve one's skills and/or confidence in changing or coping with the situation. It is helpful to work with mental health professionals experienced in working with emergency professionals that are often available through your EAP.

6. Additional available resources

6.1 Internal resources

Federal employees have access to a number of programs and resources which will be of assistance in the days and weeks following a traumatic event. These include:

1. Employee Assistance Program

   Your EAP is an excellent resource for information on stress reactions and stress management following a traumatic event. If you want to speak to someone about your traumatic experience or reactions, ask your Human Resource Personnel to provide you with the name and telephone number of your EAP provider.

2. Trauma Management Services

   Trauma Management Services and Psychological First Aid (PFA) are models that are widely used to help individuals mitigate and manage their reactions to traumatic events. Theses services may be included in your EAP or as a separate program. For more information call your EAP coordinator or Human Resources personnel.

3. Psycho-Social Emergency Response Team

   The Employee Assistance Services Bureau at Health Canada has organized and trained a Psycho-Social Emergency Response Team. This team of trauma professionals from across Canada can assist federal departments or agencies to manage the psychological and social response and recovery activities when a major traumatic event occurs in the workplace. Team members work in cooperation with federal department's EAP in responding to the psycho-social needs of employees. They also provide consultative services to help employees manage the many issues that might arise in the aftermath of a traumatic event. For more information call 1-888-366-8213.

4. Human Resources

   Human Resources and Pay and Benefits can assist you by explaining and assisting you in applying for various entitlements offered by the employer:

   • Pension benefits;
   • Medical benefits;
   • Sick leave; and
   • Disability benefits.

   Human Resources can also assist employees in developing a transition work schedule and work plan for employees who are returning to the workplace. The employees' family physician and the Workplace Health and Public Safety Programme's Occupational Health Medical Officer are also involved in determining if the employee is fit to return to duty.

5. Union Representatives

   Employees may also want to consult with their union representatives for various forms of assistance, for example, compensation, disability, return to work. Some unions have additional assistance and benefits that families of employees may be able to claim.

6. Departmental Security Officer

   In accordance with Treasury Board's Government Security Policy, the Departmental Security Officer (DSO) in each federal department or agency is the designated official who takes the lead in establishing security programs for:

   • The protection of employees (building occupants);
   • Sensitive information holdings; and
   • Assets

   The DSO is responsible for the development and implementation of relevant policies, programs and working tools and for the provision of expert security advice, consultation and emergency response services. If you wish to inquire about emergency plans in your building or floor, you may want to call your departmental DSO for information.

7. Pandemic Flu Information:

   The  Government of Canada Web site for pandemic flu information or the  US Government website for pandemic flu information

6.2 External Resources

1. Municipal Trauma Management Team

   Many municipalities across Canada, as part of their emergency response plans, have a Trauma Management Team in place to assist citizens affected by a major traumatic event. These trauma teams offer a wide rage of emotional support to people who have been victimized in a major traumatic event. Call your local emergency unit, social services or public health agencies in your community to inquire about the provision of trauma support services.

2. Community Resources

   Most communities across Canada have a wide range of agencies and organizations which can offer short and long-term emotional support to people affected by a traumatic event. Here are some key agencies which can help:

   • Child and Family Services;
   • Canadian Mental Health Association;
   • Local Hospital;
   • Distress Line;
   • Crisis Intervention Services; and
   • Bereaved Family Services.

   Make sure to have the Help-Line number in your area and the numbers to your family's regular health care providers readily posted where you can find it easily.

7. References

1. Meissner, Dirk.  Government union calls for inquest in Kamloops murder-suicide. Yahoo! Canada News.
2. Volpe, Joseph E. (1996).  Traumatic Stress: An Overview. The American Academy of Experts on Traumatic Stress
3. Case Western University. (2002).  Traumatic Event.
4. County of Santa Clara. (2002).  After a Traumatic Event.
5. Public Health Agency of Canada. (1990).  Personal Services: Psychosocial Planning for Disasters. Ottawa: Minister of Supply and Services.
6. American Federation of State, County and Municipal Employees. (AFL-CIO). (2002).  Are You Prepared? An AFSCME Guide to Emergency Planning in the Workplace.
7. Government of Western Australia, Consumer and Employment Protection. (2000).  Code of Practice: Workplace Violence.
8. Queensland Government, Division of Workplace Health & Safety, Department of Employment, Training and Industrial Relations. (1999).  Violence at Work: A Workplace Health and Safety Guide.
9. Health Canada, Centre for Emergency Preparedness and Response, Office of Emergency Services. (2002).  Registration and Inquiry Services. Ottawa: Minister of Public Works and Government Services Canada.
10. County of Santa Clara. (2002).  After a Traumatic Event.
11. Health Canada. Mental Health Promotion Unit in collaboration with Office of Emergency Services. (2002).  Taking Care of Ourselves, Our Families and Communities.
12. Ontario Workplace Safety & Insurance Board,  Coping with a traumatic event.
13. Anxiety and Stress Disorders Institute of Maryland, LLP. (2003).  Understanding your response to trauma.
14. Janoff-Bullman, Ronnie. (1985). The Aftermath of Victimization: Rebuilding Shattered Assumptions in Trauma and Its Wake: The Study and Treatment of Post-Traumatic Stress Disorder, 15-35. Charles R. Figley, (Ed.) New York: Brunner/Mazel Publishers.
15. Janoff-Bulman, Ronnie, Shattered Assumptions: Towards a New Psychology of Trauma, New York: The Free Press, 1992.
16. National Institute of Mental Health,  The Long-Term Impact of a Traumatic Event: What to Expect in Your Personal, Family, Work, and Financial Life, United States Department of Health and Human Services, Substance Abuse and Mental Health Services
17. Anxiety and Stress Disorders Institute of Maryland, LLP. (2003).  Your Mental Health Resource: Coping With Stress in Hard Times.
18. Mayo Clinic. (2001).  Post Traumatic Stress Disorder, MayoClinic.com
19. National Center for Post-Traumatic Stress Disorder, Department of Veterans Affairs,  Brief Tips about Self-Care and Self-Help Following Disasters.