Scope of the Emotional Impact
On the fifth and sixth days following the earthquake, the Los Angeles Times newspaper conducted a survey of 1,116 adult residents of Los Angeles County and found that 54% of respondents "had psychological aftereffects" related to the quake. The respondents to this question who lived in the San Fernando Valley or Santa Clarita Valley - the highest impact areas around the epicenter - had a much greater percentage, 78% reporting psychological aftereffects. Even more importantly, 25% of those responding to the survey indicated that this earthquake was "one of the worst experiences of my life," with over twice that number, 52%, coming from respondents in the high impact areas. Also in the high impact areas, 44% of the respondents indicated their "first reaction" to the quake was feeling "terrified."
Those terrifying, worst experiences of our lives are the ones that often overwhelm our ability to cope and, thus, produce emotional trauma (also called traumatic stress). It is conceivable that in L.A. County alone, with about 6.5 million adult residents, one-quarter of the population, over 1.5 million people, suffered from significant post-quake traumatic stress in the ensuing days and weeks. And this does not account for the over two million children and teenagers and the residents of southern Ventura County, which was also hit hard by the quake. If not dealt with appropriately, this traumatic stress can cause long-term, life-debilitating psychological damage (e.g., post-traumatic stress disorder).
Personal Reports of Emotional Trauma from the Earthquake
As a consultant to businesses on how to minimize the effects of emotional trauma from tragic events, I worked with several companies after the Northridge quake, conducting "debriefings" for groups of employees. A debriefing is a group intervention that facilitates the process of recovery from traumatic stress. In the companies where I did debriefings, the numbers of employees who voluntarily attended these sessions ranged from about 5% to 20% of the work force. However, in one small company in which an employee had been killed during the earthquake, about 50% of the employees attended. From these debriefings came the very personal stories of how this tragic earthquake affected emotional lives.
People in the debriefings often described the violence of this earthquake in spine-tingling terms. Some were literally bounced out of bed. A large man - about 6'4", 225 pounds - described being propelled skyward by the first jolt and landing on the floor. In some areas the shaking was so intense that inhabitants could not stand or walk. Descriptions of furniture being hurled across the room, pictures and mirrors crashing to the floor, and bookcases discharging their contents, were commonplace. One person described the experience as "like a giant ape had picked up my house and was shaking it up and down."
Many people told lurid tales of stark terror. For those people in the most impacted areas, their first thought frequently was, "I'm going to die," or "This is the Big One," or "My kids may die." Some described themselves as "frozen," unable to move or speak, while others said that they screamed at the top of their lungs. Several women expressed surprise at their own screaming, saying that they had never screamed during a frightening event before in their lives. Fainting during and immediately following the quake was also reported.
Continued fear and anxiety are common emotions following a terrifying experience. In addition to the shaking of the initial quake and its multitude of aftershocks, many people found other elements of their experience that continued to produce fear. For some it was the sudden, total darkness, while for others it was the sound of the quake - like "a bomb exploded," or "a freight train coming through the house." Phobic level of fear of darkness or loud noises were reported several days following the quake. For some people, being alone during the days and weeks that followed caused a feeling of panic. Several people in the debriefings required constant companionship - even in the bathroom. Many in the high impact areas were afraid to take a bath or shower in their own homes.
The aftershocks that accompany a major earthquake are a frequent reminder of the terror experienced during the initial quake. Many people reported that the aftershocks "are driving me crazy." In Southern California this extreme sensitivity to small and moderate tremors was not only a symptom of traumatic stress (i.e., "hyperarousal") but also a somewhat realistic concern that the next tremor could be the beginning of "The Big One." For many days following the quake, this hypersensitivity to tremors had many people sleeping (or trying to sleep) fully clothed in their beds or under their dining room tables.
In the area of sleep disturbances, a fascinating phenomenon occurred after the Northridge quake, which hit at 4:31 a.m. A very high percentage of the people in my debriefings reported awakening spontaneously around 4:30 a.m. for days after the quake, as if their biological alarm clocks had been set by this traumatizing event.
When our sense of security is shattered, traumatic stress is the likely outcome. Many people expressed feeling insecure in their homes, lacking faith in the structural integrity of their houses or apartments. One woman phrased it poignantly, "My house is still my house, but not my home. I don't trust it anymore."
A feeling of total helplessness is one of the most common emotions after any catastrophic event, especially a natural disaster. During an earthquake we have been reminded rather harshly that we can not control the enormous forces of Nature. Certainly, this feeling of helplessness was pervasive among the people living in the Los Angeles area. One woman described her feeling of being "a gnat in the Universe," as she made a flicking gesture with her hand. Coupled with this sense of helplessness and lack of control is often an intensified awareness of our own mortality.
A heightened sense of mortality was especially common among those who knew someone who died in the quake. "It (a co-worker's death) really brought it home to me what these things can do," was a familiar lament of those who knew the deceased. In some people, these feelings of helplessness and the finite nature of life, if left unattended, can lead to serious depression.
Consequences of Traumatized Employees
Employees who have been traumatized - on or off the job - by a catastrophic event usually will be impaired in performing their jobs. Even after the most extreme reactions may have passed, many will continue to experience one or more of a variety of common reactions (see Table 1) for days, weeks or months after the event. The scope and duration of these "common reactions" (or symptoms) is described by many research studies. For example, of those who were in the path of an early-morning (4:55 a.m.) tornado that ravaged a 12 mile path through Madison, Florida, 38% continued to exhibit one or more post-trauma symptoms - insomnia being the most common - one month following the tornado. For traumatized individuals who do not process their traumatic stress adequately, these reactions may "concretize" into long-term emotional disturbances (e.g., post-traumatic stress disorder) that require intensive psychotherapy to resolve. Among those affected by the Madison tornado, after a month 10% of these people met the criteria for a psychiatric diagnosis of an emotional disorder related to the trauma.
The extent and duration of post-trauma reactions appears to be related to the severity of the traumatizing event. A full two years after the catastrophic flood that resulted from the dam bursting above Buffalo Creek, West Virginia, 80% of the hundreds of survivors interviewed were still experiencing significant post-trauma reactions.
For employers with traumatized employees, the adverse consequences of not attending to this issue are significant and potentially long term. In the short run, weeks-to-months, both morale and productivity will likely suffer, as employees continue to experience the common reactions of traumatic stress. Hostile conflicts will become more common to the extent that people are feeling more tired, forgetful and lack concentration.
In the longer-term scenario, the loss of valued employees and increased mental health care costs become important issues. When the traumatizing event occurs on the job, some employees may find it necessary eventually to leave their jobs, because the work environment continues to cause flashbacks or other emotional discomfort. In emergency service agencies many careers have been lost by failing to deal effectively with the emotional issues related to a "bad call." For employees whose trauma results in long-term, diagnosable disorders, the mental health care required is often months of intensive psychotherapy. For self-insured companies, the financial risk of this scenario is high.
Where state law allows, stress-related Worker's Compensation claims and/or civil suits will be filed more frequently by traumatized employees, especially when the trauma occurs at the worksite. In the absence of preparation or intervention to address employees' emotional trauma, many of these claims will be judged as legitimate, posing a major risk exposure for the employer.
Clearly, attending to the welfare of human resources is an essential feature of recovering a business from a catastrophic event. Because the emotional trauma from such an event can demonstrably diminish and, sometimes, disable the effectiveness of a significant portion of the work force, addressing this issue aggressively with both preparedness and planning is warranted.
Employer-Sponsored Interventions Will Help
Some people find their own ways to process the aftermath of a traumatizing event, but others need help. In fact, when the traumatic event is of the "terrifying," life-threatening variety, probably most of those experiencing the event could benefit from professional assistance. After a community-wide disaster or an internal tragedy, employers should consider providing an intervention resource for those who want it. But what kind of intervention is best?
Many companies today have employee assistance programs (EAP's) to provide counseling for employees on a wide range of life's problematic issues. Accessing the standard EAP counseling services, either telephone or face-to-face, may be helpful for some traumatized employees. However, the barrier of making the appointment or the stigma (to some) of "seeing a therapist" limits the use of this resource typically to only a small percentage of those affected.
Another approach to helping employees with trauma is becoming more popular and was used by many companies and government agencies after the Northridge quake. This approach is to provide on-site group "debriefings" (sometimes called critical incident stress debriefings or CISD) led by a specialist in emotional trauma.
Debriefings are not therapy, but a group process specifically designed to help people process emotional trauma and to facilitate recovery. Ideally, debriefings should occur 24-72 hours after the traumatic event, but they have diminishing benefit for a few weeks beyond the incident. For most traumatized individuals and their employers a debriefing intervention has several advantages over providing face-to-face counseling (Table 2).
How does a business locate appropriate debriefing services? First check with your EAP, if you have one. Many external EAP providers now have "debriefing networks," and some internal EAP's have "trauma teams" that provide debriefing services. If an EAP provides on-site debriefings, it is important to determine that it uses debriefers who are trained and experienced in dealing with early-stage traumatic stress, not just mental health clinicians who are normally face-to-face counselors and lack training in the debriefing process. Because a debriefing is not "group therapy," it is important to use debriefers who are sophisticated in this distinction and are skilled in facilitating the group debriefing process.
In the absence of an EAP-based debriefing service, there are a growing number of independent consulting companies and practice groups of mental health professionals around the U.S. and Canada that provide these services and, in some cases, management training as well. Identifying such a resource should be an integral part of business recovery planning. Many of the trained debriefers in North America are members of the International Critical Incident Stress Foundation. This Maryland-based, non-profit foundation can be reached at (410) 313-2743, and it will provide information or a referral at no cost to the inquiring organization.
The Need for Management Training
The history of humankind's attempts to understand emotional trauma is replete with periods of disinterest and stark denial by the medical community, sociolegal systems and society at large. In fact, it was not until 1980, spurred by the aftermath of the Vietnam War, that the mental health professional community in the U.S. finally recognized "post-traumatic stress disorder" (PTSD) as a diagnosable psychological disorder. So it is not surprising that the vast majority of the business community still ignores emotional trauma as a significant issue in human resource management and recovering a business from a disaster or an internal tragic event. But traumatized employees are impaired by their symptoms (see Table 1), and these symptoms are not left behind in the parking lot.
Most managers and first-line supervisors know little or nothing about traumatic stress or how to supervise someone who has been affected by a traumatic event. One of the side issues that repeatedly came up during the debriefings after the Northridge earthquake related to "insensitive supervisors," whose supervisory communications often exacerbated employees' trauma symptoms.
A comprehensive emergency preparedness process should have managers, at least in critical departments, trained in recognizing traumatic stress and optimizing their supervision when it exists. Also, training for human resources managers can help these professionals know when to activate intervention resources and how best to promote them.
For those employers that have a predictably high incidence of traumatic events, either from serious or fatal accidents (e.g. highway maintenance, logging) or from violent events (e.g., law enforcement, retail banking), more thorough organizational and management development concerning these predictable events and their emotional consequences is warranted. Recovery to pre-incident performance, morale and turnover will all benefit from these types of training and development.
The Take Home Messages
Both survey data and personal accounts revealed that large numbers of people in the Los Angeles area were traumatized by the violence of the Northridge earthquake. The fact that this quake occurred during non-work hours for most businesses does not mitigate the fact that employees may have been traumatized and, therefore, their job performance impaired. Some fraction of the traumatized employees that do not receive an intervention will acquire a persistent form of post-traumatic stress disorder or other diagnosable disorder. Thus, full and rapid recovery of the human resources of a business may require an effective intervention for emotional trauma.
Because of the seriously negative impact that widespread emotional trauma can have on productivity and ultimate personnel costs, this issue should be addressed in the emergency preparedness and planning process. Training of managers and supervisors about traumatic stress will prevent much of the hostile conflict, resentment, and work disruption that may occur as a result of the symptomatic employees.
Emotional trauma is not under conscious control, it can not be wished away by the afflicted person. Once traumatized, the victim's symptoms will run their course. But employers can provide training and cost-effective interventions that will speed the recovery process and improve the chances of full recovery for all affected employees. A high performance organization is thus reestablished in the shortest possible time.
Advantages of On-Site, Group Debriefing for Traumatic Stress
James S. Graves, Ph.D., is President of HealthLines International in South Pasadena, Calif.