 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through All CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on tips for responding after a disaster. Now a lot of people are experiencing stress right now because of all the hurricanes that have been coming our way and those who have already experienced hurricanes that have come through. So we're going to talk about some things that can help reduce stress and help you get through this initial period after the disaster. We'll review common reactions to disaster and interventions, and that includes adult reactions as well as what you might see in children. We'll identify common stressors in shelters, common issues when sheltering in place because staying at home isn't all it's cracked up to be sometimes either, but explore how to reduce stress and anxiety through facilitated and independent activities and facilitated groups. Now a lot of the things I'm going to talk about today, I'm going to talk about from the perspective of if you're in a shelter, but a lot of it can also be applied if you decided to shelter in place and you're at home, especially if you're at home and you have children running around and they're bouncing off the walls. We'll talk about some ways to try to deal with everything that's going on and maintain your sanity. The first thing I want everybody to understand that acute stress is a normal reaction to an abnormal event. People getting stressed out and angry and irritable and anxious and depressed right after a disaster, that is totally normal. And the majority of people are going to recover with no long-term effects. Once their body kind of reboots and figures out what to do, everything will kind of slowly get back to normal. Some people will develop some traumatic stress reactions, but those are not the majority of people, especially if they didn't already have traumatic stress or other mental health issues going into the disaster. People who have a history of mental health issues like depression and anxiety or PTSD or even substance abuse may experience a resurgence of those problems. It doesn't mean that it's going to come back as strongly as before necessarily, but it is important to understand that there is a risk that you will experience a slight partial or even full relapse of your symptoms. So you need to be aware of that and intervene early to prevent your symptoms from getting bad. So when sheltering in place, you know, we're going to start out with the thing that some people are doing, just kind of battening down the hatches and waiting for the storm to pass. If you're in one of those places right now or you're ever in a situation like that, there can be anxiety about the situation and your safety. Now, this is true not only for hurricanes and lizards, but this can also be true for tornadoes. We live right in Tornado Alley. So whenever we have the tornado warnings going off and we all have to go down to the basement and shelter in place, there's always a little bit of anxiety about what's going to happen, if it's going to hit us, you know, how the farm animals are going to survive, et cetera. So it's common to worry about the situation and your safety, but there's nothing you can do about it except for what you are doing. So we're going to talk about some distress tolerance skills later because anxiety is a normal feeling. That's your body going, there is a threat, you need to do something, Bubba. And then your conscious and cognitive mind kicks in and goes, okay, am I doing everything I can in the moment? And if the answer is yes, then continuing to worry about it is just speeding through energy that you probably need to conserve. So we'll talk about how to try to lessen the anxiety. It's probably not going to make it go away, but lessen it. People may be concerned about loved ones who are elsewhere. If you're sheltering in place and you've got a loved one who is, you know, 30 miles away or maybe they're in a hospital somewhere or a nursing home, you might be worried about their safety because they're not with you. And that's perfectly normal. And there's not a lot you can do about that because a lot of times the phone lines get jammed with other people trying to call in and check on their loved ones. And thankfully there was a plan in place ahead of time with the nursing facility or the treatment facility where you could check on the status of your loved one. Feelings of isolation, loneliness, sadness or boredom. You're in the house, you're knocking around. I know after Katrina in 2005 when we had a bunch of hurricanes hit Florida that year. And our power went out and was out for, we were lucky. We were out for about a week, but I had an infant and a three year old, and my husband was in law enforcement at that point so he was out working the road. And it was just me, those two children and no air conditioning. And I felt very isolated and kind of bored and a little star crazy because you know there wasn't the stuff that we normally did, we couldn't do we couldn't drive and go down to the play play area at McDonald's. So talk about some things, some games towards the end, and things you can do to help kind of alleviate some of the nervous energy, if you will, and and sense of isolation and loneliness. Guilt about not being able to perform normal duties or help out, you know, some people want to be able to help out but they just can't you know they're stuck at home they can't get the car out, whatever the case is. Guilt is not going to do you any good guilt is anchor it yourself for something you feel you should be doing. Well, if you can't do it, you can't do it so what else could you do beating yourself up for something. At this point, you know, you're kind of stuck so it's not doing anything but depleting your energy and any happy chemicals you might have fear over loss of income or the cost of repairs, totally normal thing to be anxious about. You can start making out a budget, you can figure out what you expect costs to be and be aware that a lot of times after a disaster, you can get with the local FEMA agency, or the local FEMA representative, and there is funding available to help repair houses. You have home owners insurance that can help with some of those repairs. So there are places you can get help and assistance, also calling the local United Way after the hurricane or whatever it is has passed. And the initial rush of everything is over and the phones are being staffed again. You can often often get information about churches and nonprofits that are also willing to help with repairing homes in order to make them safe and livable and changes to eating and sleeping patterns. Now I don't know about you but when I'm home, even on the weekends, even when it's not a shelter in place sort of situation, I tend to eat more and I tend to graze kind of all the time. And it's tempting to take one of those mid-afternoon naps when that lol comes at like two o'clock to lay down on the sofa and take a nap. When you do that, it starts messing up your circadian rhythms. Your body quits knowing when it's hungry and when it's just eating because it's bored. And it quits knowing when it's time to sleep because if you're getting a REM cycle in the middle of the afternoon, then it's probably going to mess up your evening sleep, which is going to leave you waking up tired. Then you're going to want to take another nap and the cycle just keeps repeating itself. So it's really important to maintain your same sleeping patterns. Now I will tell you, you know, after hurricanes, particularly, and blizzards, when there's not a lot of sunlight, and you know how it is even just on a day where it's really gray outside and there's not a lot of sunlight, it's hard to wake up. So if you have power, and that's a big if, if you have power, it's really important to turn on the lights and not sit in the dark. If you don't have power and it is safe, it's important to get outside so your body knows, okay, it's time to be awake. There is some semblance of sunlight going on. That will help set your circadian rhythms so you get improved sleep and your body has a better inkling because of hormone regulation about when it's supposed to eat and, you know, when you're kind of not supposed to be eating. People who are in shelters have suffered a trauma and they have experienced loss of control and a sense of helplessness if they've been told you've got to leave everything that you love behind and go stay in this elementary school gymnasium or something. That's pretty traumatic and that the expectation is when they get back, there's going to be some sort of loss to their house, to their possessions. For some people, even their pets who have run away or heaven forbid have died or, you know, the scenarios can go on. But people who are in shelters are experiencing extreme stress. They may not even know where some of their loved ones are. Maybe they got, you know, they had to evacuate quickly and they weren't able to call their aunt that was 30 miles down the road and say, where are you going? Are you going to be safe? So they're wondering if their family and friends are safe and they're stuck there. A lot of times, cell phone service is crappy at best because everybody's trying to use the same tower if the towers are even working. So people can't even communicate to try to track down their loved ones and it can cause a lot of distress. So being aware of this, just being aware that people are on edge and they have every right to be. You know, they just lost control of a significant portion of their life for a short period of time, but still a period of time. So how can we help them work through that? If you're sheltering in place and you're a parent, how can you help your kids work through that? If you are sheltering in place and you're a person, which I hope you are, then you're going to have to figure out how you're going to come to terms and make sense of this. And when I talk to clients, a lot of times I liken life as a book. You know, think about writing your own autobiography. And this is but a chapter in that book. So when you're writing this chapter, how is it going to resolve and how is the next chapter going to start? This doesn't have to dictate the entire rest of your life. This can just be a little plot twist. So how is it that you're going to integrate this into your life narrative in a way that you come out as the shining hero in your autobiography? Additional stressors and shelters, an environment that's crowded, noisy or overstimulating. If you put a bunch of people in a room with no walls, it's going to be crowded and noisy and overstimulating. Some people respond better to that, especially extroverts who like to talk to other people. They'll move around. They'll talk to other people. It's great. It's grand. But even they can get a little bit overstimulated at times. People who are more introverts will find this extremely overwhelming and extremely anxiety provoking and draining. So it's important in shelter situations that people have a place where they can go and we'll talk about quiet places in a little while. They have a place where they can go to just collect their thoughts where there's no input, you know, and it can be, I don't want to say a closet, but it can be a small room with, you know, just kind of nothing on the walls. If you're in an elementary school, if you have a classroom that you can let people go into and just sit where it's quiet. If they can go outside and sit on a picnic bench and not be disturbed where it's a place where people know that if somebody's out there, they're not wanting you to go out there and talk with them. They want some quiet space. Another reason that people may have additional stress, and this is kind of from a Feng Shui perspective, it's less secure than home. So there's always somebody walking around behind you, always somebody around your stuff, always somebody around your kids, always. And it doesn't mean that the somebody's mean you any harm. But as people were aware when there's strangers around, it is more stressful than if you're sitting in the comfort of your own living room with the doors and windows locked, which also means that when you're trying to sleep, you're going to sleep less restfully than you would if you were in your own home and you had your doors and windows locked. Bearing that in mind, stress will increase, especially the longer people are in a shelter. It means they're getting less sleep or less quality sleep. And it can cause them to start getting more irritable and more anxious than they would if they were out getting proper the sleep that they needed. In order to prevent poor sleep, encourage routine in the shelter, try to help people feel as safe as possible wherever they keep their possessions if they have valuable possessions so they feel like those possessions are secure. If they feel like they need to be against a wall so they don't have people walking around them at all times of the night. Or if you have people who have particular fears and have difficulty winding down, maybe they can sit closer to the area where somebody is awakened on duty 24 hours a day, whatever you can do. Another thing that causes poor sleep and shelters is ergonomics. Those cots are not comfortable. Even if they brought their own pillow, which is rare, they're not going to get the same kind of sleep that they would get on a pillow top mattress. So again, people are not getting quality sleep. Think about how well you deal with life when you're exhausted, especially if you've been exhausted for several days and you've got a lot of stress going on. Because of poor ergonomics, not only where they're sleeping but sitting in the pulled out metal chairs and those sorts of things, people may start to experience pain, which will also make them more irritable. And we're going to talk in a little while, but keeping them active, encouraging people to stretch and helping them nip pain in the bud, if you will, if they notice they're starting to get stiff to address that early, can help reduce some of the stress and irritability. Nutritional changes. If you're not eating the stuff you're used to eating and maybe you don't even like the stuff that's being served. People may start getting a little bit irritable and maybe not eating as much as they should or eating the way they should. They may not be getting the same nutrients that they normally do. So their body's adjusting, which can cause some mood changes. A lot of times when people are sheltered or sheltered in place, they will increase their consumption of caffeine and nicotine. They may have caffeine to try to stay awake, you know, again, because they're not getting the daylight, their circadian rhythms may be messed up and maybe just they don't have anything else to do. And nicotine can seem calming to some people, so they may smoke or dip more. Both of those are stimulants which are going to increase anxiety and irritability. It's the same token. If people are diehard coffee drinkers or smokers, you don't want them going into a shelter and finding out that you can't have caffeine or nicotine. The withdrawals will just really work against you to put it nicely. And it may not be safe in certain circumstances. It may trigger extreme panic, anxiety, depression, rage. So obviously, depending on the shelter rules, you know, allowing people to have access to their caffeine and be able to go out to smoke if they need to, is probably ideal in this sort of situation. But if you are one who does drink coffee, just maintaining a log, if you will, of how much caffeine and nicotine you're taking in, so you make sure that you're not overdoing it. Caffeine stays in your body for 12 hours, so the caffeine you drink at noon is going to be inhibiting your sleep quality, at least, until midnight. So, you know, try to cut back or quit the caffeine before noon. Again, don't make significant lifestyle changes intentionally while you're in a shelter. But if you don't normally drink caffeine after, you know, 11 or 12, then try not to start. Another stress can be ambiguity about what lies ahead. If you shelter in place, you know if your roof is okay, you know if your house is flooded, you know all that stuff, and you can start dealing with it. But if you're in a shelter, you have no idea what you're walking home to or going home to, and all you're getting is potentially media images. And the media is not going to pick images of the neighborhoods that survived the best. They're going to pick the images of the worst devastation. So, a lot of times people get really anxious about what they're going back to. And there's not a lot that a shelter worker can really do about that. We have to help people figure out how to tolerate that anxiety and worry until they can get a real answer, until they know for sure what's going to happen. And boredom and time to dwell. In shelters and sheltering in place, there is just a lot of time. We're used to doing things. Now, if you are lucky enough to have power or backup batteries and mobile devices, you might be able to be occupying yourself. But at a certain point, even that will probably get tedious and people start to get bored, which means they're going to start to get restless and want to do something. And inability to do something will make them irritable. Boredom also leads to time to dwell on the what ifs. What if I go out there and my house isn't there anymore? What am I going to do about this? What if this has been going on for two weeks? What if my boss decided to fire me in those two weeks? So people can get really spun up on what ifs or they can dwell about things in the shelter that irritate them. Something that normally would be inconsequential, maybe a toilet's backed up, not all of them, just a toilet. They may start dwelling on or if they have difficulty getting their medication or they have to wait in line to get lunch or dinner. People can start getting irritable about the things they have to do and dwelling on it and thinking about how unfair it is or how frustrating it is. And the reason for that is they have so little control over what else is going on in their life, they may start dwelling on the things in their current environment that they have no control of either. And wanting to get control, which will make them angry, which may make them try to act out and regain some of that control. It makes sense when you stop and think about it. When people feel powerless, they want to regain some semblance of control over something. And everything that they notice that out of their control is going to feel like a direct assault and they're going to want to try to get control of some things. So as shelter workers, as volunteers, as other people in shelters, we can help people figure out what they do and don't have control over. So they can focus on the things over which they have control, which we'll talk about. So common responses in adults and adolescents. Most adolescents respond similarly to adults. So I kind of glumped them in here. But you want to take each person as an individual. Difficulty-communicating thoughts. When you're under a lot of stress, sometimes it's hard to put your thoughts together and get them out to people and effectively communicate. Encourage people to write their thoughts down if they need something communicated or if something's bothering them but they can't put their finger on it. Encourage them to write it out or go talk about it with somebody and try to help them ferret out what they're thinking. Difficulty-sleeping like we talked about before. Sometimes it's going to be due to anxiety and there's not a lot we can do about that. But we can help people practice progressive muscular relaxation, guided imagery, where they imagine their favorite place in their mind and imagine all the sensations. What does it look like? What does it smell like? What does it feel like? Help them get good ergonomics. Make sure they have a good pillow. Make sure they're not too hot or too cold. As much as you can in whatever situation it is. Make sure that they practice stretching anything they can do to relieve minor aches and pains that are making it difficult to sleep. In any environment, try to make sure that it's quiet and as dark as possible during sleep time. People may have difficulty with balance in life, focusing all on work or all on the recovery process or all on one thing or another. This comes up more once people are out of a shelter or out of the shelter in place situation. But it's important to write down what's important and make sure that you're attending to everything that you need to. Low threshold of frustration is very common. You're already stressed out. You're already on the brink. You're already feeling like you're out of control of things. So when something else comes, it may always feel like that one straw that broke the camel's back. So practicing the pause, being able to take a breath and go, okay. This really sucks. I don't think I can handle one more thing. But I'm going to take a breath, step back and figure out what next. Increased use of drugs or alcohol. Hopefully we're not seeing that in shelters, but you can see that after people get out of shelters or if they're sheltering in place. So paying attention to the use of drugs or alcohol to numb, boredom, pain, anxiety, those sorts of things. Limited attention span and poor work performance. You may ask somebody to do something. And whether if you're sheltering in place, you may ask somebody to do a chore and they do it halfway and then kind of get distracted on something. We want to give people a kind of a wide berth here and bring their attention back to it. I'm not saying let it go, but try not to be too critical if things don't get done thoroughly or completely the first time. Bring their attention back to it so they can finish it. Another thing that can help with limited attention span and work performance is to have things written down. If you want something done, write it down and be detailed. What does it mean, for example, to clean your room? What does it mean, for example, to clean the bathroom? Not just something specific like that, but wipe down the sink, wipe down the toilet, make sure there's toilet paper, make sure there's soap at the sink. Those are things that people can look at and check off so they're not having to focus on sort of a broad meta concept. It's very specific. People may start experiencing headaches, stomach problems, and even back aches because a lot of us store our attention in our neck and back. Those are common stress symptoms. Now, those also can be common symptoms of other physical things, but helping people recognize that staying stressed out is only going to make those things worse. And then if they need to be referred to medical, then referring them to medical. Cold or flu-like symptoms. In shelters, you want to, you know, try to practice whatever universal precautions you have in order to sort of isolate people who may be starting to be symptomatic if you have another room that they can go into or have them on kind of on one side of the room. I mean, with that many people in an area, they're all going to be exposed to airborne bacteria. So as much hand washing and hygiene as possible is going to help encourage people to cough or sneeze into the crook of their elbow and, you know, refer to medical when necessary. Disorientation or confusion. This doesn't mean somebody's got dementia or something's going wrong necessarily. This is very common when people get really stressed out. They have hard time remembering things. They could get confused kind of easily. They may have stuff on the tip of their tongue. It's really frustrating, but a lot of times, you know, most of the time, once the stressor has passed, if they didn't have that symptom before the stressor, then the symptom will resolve in order to help people who are feeling disoriented, help them have reminders of their place, you know, pictures or whatever around their space so they can find their space, have rules up or schedules up. So people who get confused about when they're supposed to eat and when they're allowed to do stuff, there's a schedule up that people can consult which reduces some of the anxiety and them asking questions too many times. The same thing is true if you're sheltering in place with your family. People may get a little confused about what's going on or when they're going to be able to leave or whatever. If you've got routines at your house, especially if children are involved, keep to those routines that will help reduce greatly any of this disorientation and confusion. Difficulty concentrating, you know, kind of goes along with difficulty communicating and confusion. Give yourself a break, cut yourself some slack. When you are under extreme stress, your body is working on survival. It is not working on trying to finish writing that grant or finishing that project your boss asked you to do. Right now, focus on the moment. Stay in the moment and if you need to write things down, for example, maybe you've got people in your household who take medications. Make a little chart that you can check off after you've given people their dose of medication if your kid has to take antibiotics three times a day or something. That way you're not going, did I give that person the medication they needed or not? Write it down. Don't force yourself to concentrate. Don't remember anything more than you have to right now. Write everything else down. Reluctance to leave home. You know, you don't want to leave because if you leave, you might not come back to anything. It can be a fear, but encouraging yourself to reflect on, you know, if you leave home, what's the likelihood that something else is going to happen and your house isn't going to be there. You made it through the worst of the storm. So, you know, going out and coming back, the house is likely to still be there. But it can also be very scary. Like after Andrew, everything was leveled. So there was no, there were no street markers. There were no signs. There were no anything to figure out kind of where you were. So it was very disorienting and kind of scary. And some people were afraid to leave home because they were afraid and this was true after Katrina, too, because they were afraid of looting. Do what you can to protect your environment. And then after that, try to figure out how to deal with the frustration and figure out what's more important, whether it's more important to stay at home with your stuff or go out and do what you need to do. And now that will depend on what your goals are. Depression, sadness and hopelessness. Depression is a sense of hopelessness and helplessness and an expression after a loss. And it's your body going, I give up. It's your brain going, this is not happy. Well, of course, after a disaster, you're going to experience these. So expect these. Give yourself a break and say, okay, I'm feeling depressed right now. I'm feeling hopeless right now. That's okay. What can I do to improve the next moment? What next? Because staying depressed is not going to help. Like I said, depression is a sense of hopelessness and helplessness. So the what next is what can I do to feel a little more empowered? What do I have control over? And what things are there to still hope about? Mood swings are perfectly natural. You may feel depressed and then irritable and then anxious. That's totally normal. Your body is trying to react to stress. Anger and anxiety are flip sides of your body's reaction to stress. Anger is the fight. Anxiety is the flight. Depression is the, I just give up. I can't do anything. I can't fix it. So you may experience all of those during a disaster. You may think, I got this. I can, I can survive this. I can, you know, conquer whatever it is. And then the next minute you're worried about something and then the next minute you're depressed about being stuck in a shelter or having no power or whatever it is. Accept those feelings when they come and then just ask yourself what next? Recognize those feelings or your normal reaction and then what next? Dwelling on them, feeding them is just going to drain your energy. Overwhelming guilt about survival or about the fact that, you know, maybe you lost your house and your kids are devastated. Well, yes, they are. And feeling guilt for that is a normal reaction. However, does that help get your kids stuff back? No. So again, what can you do to improve the next moment? Fear of crowds, strangers or being alone. Just be aware of kind of where that's coming from and try to address it little by little, figuring out where your energy needs to be spent. Whether you need to address the sphere right now or do you need to deal with other stuff and you can worry about crowds and being alone later. Argumentativeness, refusing to follow rules or being overly controlling. Now this is true in shelters or even if you're sheltering in place and you've got extended family around. You may become argumentative and refuse to do chores or start questioning authority and start getting into power struggles. That is perfectly normal. It is not pleasant by any means, but it is. Is it an expected reaction? Yeah, unfortunately, because again, everything's out of control. Your life is kind of topsy turvy. So people may at a certain point try to start regaining some sort of control over how they feel and what's going on in their life, like what they're going to eat or when they're going to eat or whatever is going on. So figuring out how to address this, we'll talk about some interventions later. The response to argumentativeness is often paraphrasing, you know, how the person feels that they're frustrated that this isn't going their way right now and making some sort of a compromise, creating a win-win situation. So both of you get your needs met. And for example, if you're sheltering in place, you've got extended family, they don't like what you're cooking for dinner. But dinner's already like halfway done, you know, express awareness that, you know, this isn't what you normally eat. And, you know, I appreciate you helping out with everything else you've been doing around here. I'm wondering if you want to plan dinner for tomorrow. So you have something that is more to your liking or whatever. And that might help let that person feel like they're more in control. All right, so we've been talking about adults and adolescents, but there are the little teeny boppers that also are experiencing this. So what's going on? Birth through two years. Yes, they are going to experience trauma. They're going to experience distress. Why? Probably because parents are telegraphing it. Children are very perceptive of parents' emotional reactions. So children may experience more irritability, crying more than usual, wanting to be held and cuddled. And for the ones that are closer to two years old, they may start regressing to an earlier age, crawling around on the floor, sucking their thumb if they stopped, and regressing to using baby talk instead of, you know, the words that they had been starting to develop. Recognizing that this is, in many cases, the child's way of trying to get security and stability from the parents. You know, if I act this way, then mom or dad is going to take more control of me than they will when I'm becoming more independent. Wanting to be held and cuddled is another one of those that they want the security. It also helps release oxytocin, which is the bonding chemical, which is also a calming chemical. But it's important that when you're holding and cuddling your child, you're also calm because if you are crawling out of your skin with anxiety or anger, that's going to telegraph to them and they're not going to get the calming reassurance from the cuddling that they're getting. The biggest influence on children at this age is how their parents are coping. So does it mean you can't have a little breakdown? No. You know, you're going to have those moments where you're like, I don't know if I can do this, especially if the disaster is kind of ongoing. And that's okay. But overall, you know, expressing to them that it's going to be okay and reassuring them. And if you've got other adults that can kind of take over when you need a moment, that will be more helpful to helping the birth through two year old child deal with life. Because they don't understand what's going on really. I mean, think about it. They're two. They're living in Elmo land. Preschool, three through six years. These children often feel helpless and powerless in the face of an overwhelming event because of their age and small size. They lack the ability to protect themselves or others. So they're still powerless and they're still needing mom or dad to be emotionally and physically present. As a result, they can feel intense fear and insecurity about being separated from their caregivers. So they may start following you to the bathroom or insisting on being in the bathroom, you know, while you're in the shower with the curtain pulled or whatever. And this is a normal reaction. If you're in a shelter, they may follow you around like a shadow. And that's a normal reaction. So just being aware of what does this behavior mean? Why is this child doing it? What's the benefit of this behavior to the child? And a lot of times it's making sure that you don't disappear like everything else. That's how they're trying to retain control. Preschoolers can't grasp the concept of a permanent loss. So in the weeks following a traumatic event, preschoolers play activities may reenact the incident or the disaster over and over again. The same thing is true if they're seeing it on TV over and over again. They don't understand that this is a replay, that the disaster is gone and that rebuilding has started in some form or fashion. They're seeing it over and over and over again. It's like that nightmare you can't wake up from. So it's important for children at this age to limit their exposure to the media and discussions about what's going on and keep them focused in the present and moving forward. Preschool children may experience crying and depression and inability to concentrate. Again, for these children, their attention span is a lot lower than adults anyway, but it may seem like it's the attention span of a nap now. That's okay. You know, instead of getting angry with them, which is just going to increase their anxiety, try to talk to them about what they need to help them get through. If they're doing schoolwork, maybe chunk it down into 10 or 15 minute segments and then give them a little bit of a break. Write down what you need them to do or make little pictographs so they know what needs to be done. They may start wetting their bed again. That's a normal reaction. It tends to go away as the anxiety goes back down again. So try to avoid getting angry with them if they start wetting their bed. Generally, it's not an intentional act. Withdrawal and isolation. Sometimes the stimulation is just too much and the child will just kind of withdraw into a corner, start isolating themselves. Sometimes this can be the child just needs some quiet time. Other times the child may feel totally overwhelmed and just want to kind of disappear. So it's important that we talk with the child about how they're feeling. Thumb sucking may come back. That is a security activity, recognizing what it means. And again, instead of getting angry with the child, looking at what function is this serving or what message is this communicating to me as a parent about what my child is feeling and how can I help them out. Nightmares and headaches are also common. So helping them understand what the nightmares mean, helping them feel a little more safe. They may need to have a nightlight for a period after a traumatic event. Ask them what they need in order to feel safe. Headaches are again common stress reactions. Clinging and fear of being left alone goes back to that following you're around to the bathroom sort of thing. They don't want to lose the one person or two people in their lives that they need in order to stay alive. They can't shop for themselves now. If you go away, who's going to take care of them? So they feel very anxious. Changes in eating and sleeping habits can happen because of changes in routine or because of stress. So helping kids maintain a normal routine presenting food at normal meal times and paying attention to how much sugar. And if they take in caffeine caffeine that they are getting again to make sure that they're not changing that either. Regression to earlier behaviors crying baby talk not uncommon that often communicates a feeling of insecurity. So helping the child understand what it means but encouraging them to use their big boy or big girl words and rewarding them for age appropriate behavior. Excessive fear of darkness or storms is very common. They're probably going to need to be reassured for a while until they start realizing how often these things happen and nothing bad happens. Fighting can come up because again children just like adults are trying to regain some sort of control. They have all this anger. They have all this anxiety. They have all this pent up unpleasant energy inside and they start lashing out. They may take out their frustrations on the closest target. You know, there may be somebody who just looks at them the wrong way and they get into a fight or they get into an argument. So we want to help them see, you know, was it about that situation? Or do you have a lot of anger that we need to talk about? And that just happened to be an unfortunate outlet and an increase in general physical complaints aches, pains, you know, belly aches. Those are common and often stress related and they can also indicate a need for parental attention and nurturance because, you know, generally when our kids are sick, we do give them more hugs and cuddles and stuff. So this may be a way for the child to ask for more nurturance from the parent. School age, seven through 10 years, these children can understand the permanence of loss. Some children become intensely preoccupied with details of the event and want to talk about it continually. This preoccupation can interfere with the child's concentration at school and it can also prompt irritability from adults because they're like, you know, we already talked about that. I don't want to talk about it anymore. You know, I already told you, you're fine. Now go do something. That's not helpful to the child because they don't have resolution. They still don't feel secure. They still don't understand how to integrate it into their narrative. They're not even to writing full sentences yet, let alone narratives. Children may also hear inaccurate information from peers and even the media. So it's important as parents and caregivers that we make sure that we're checking in frequently with them to see what they know and dispel any myths that they may have heard. This age child may display a wide range of reactions, including sadness, generalized fear against specific fears of rainstorms or the disaster happening again. Guilt overaction or inaction during the disaster. Maybe, you know, something horrible happened and one of their pets got left behind or, you know, whatever the scenario is, they may have intense guilt. Anger that the event was not prevented. Even if it's a natural disaster, children this age can still get angry that their higher power didn't prevent this from happening or their parents didn't prevent their house from getting flooded or whatever. While those might not be, you know, completely logical from an adult standpoint, we can say, well, you know, there was nothing I could do to prevent the house from getting flooded from a child standpoint. Parents and higher powers are, you know, all knowing all being all doing. So when something happens, they don't understand and they need to be able to integrate that. They may have fantasies of playing rescuer. They may imagine it over and over again where they are able to rescue someone or something they lost or they're able to fix it when nobody else was. Regression into earlier behaviors again, irritability and oppositional behavior in children. Again, sometimes this comes out the oppositional behavior because they just don't have anywhere to put that negative energy and somebody ends up being an unfortunate target. Sometimes the oppositional behavior is designed to distract parents. If the parents are all worried and stressed out, then if junior starts acting out, then it distracts the parents back to junior. So junior has some security. He knows that mom and dad are still paying attention, but it also distracts them from arguing or doing whatever they're doing. It can also be to get secure limits. So if a child is in a new situation and starts testing limits seemingly being oppositional, it may be just to make sure that the parent is paying attention and is going to set limits and protect them. These are not conscious thoughts on the part of the child. These are kind of subconscious needs for security and boundaries from the parent and to make sure that the parent is going to be there for them emotionally and physically. So interventions. Prepare a go bag with essentials if you have time. Remember things like medication, razors, brush comb, toothbrush, toothpaste, cell phone and charger, pillow and any security items that the child needs like a pacifier, a blanket or a special stuffed toy. Those are things that often get forgotten in the go bags. So I specifically identified those, but try to do that, you know, before there's even a storm brewing. So you have it ready when there is an emergency. But when there is an impending storm coming, whether it's a blizzard or a hurricane where you've got time, stop media overload leading up to it during and after the event. You know, don't listen to the weather channel 24 seven during this time. Don't have the weather on or the news on 24 seven during this time because again, for children and even for adults, it can keep their anxiety levels up. We need to be able to focus on something else. Once you hear the 5am update, turn off that radio and do something else that will help you move toward your goals because focusing on you can't change the storm. So focusing on it isn't going to change anything. Keep routines as stable as possible. Practice mindfulness each day personally and as a family. So when you wake up in the morning, check in with yourself, go, how am I feeling? What am I needing? Am I hungry? What's going on? What do I want to do today? And then as a family, do the same thing. And this can be a helpful activity in shelters, getting families and groups of people who came in together to kind of put their heads together and go, okay, what do we need today? How are we feeling? You know, who's going to do what and what are we going to do to keep ourselves busy today? Have them encourage people to make plans so they can think instead of just like wandering around aimlessly. Think about what they might do. And as a shelter supervisor or maybe a volunteer that comes in and outreach worker, if you come in at the same time each day or present a schedule of when you're going to be there with activities, that can also be helpful because people know what's coming up and what they might be able to expect and do. When communicating with one another, regardless of whether you're with family or in a shelter, validate each other's feelings and identify a tangible solution. So if somebody is frustrated that they're having to wait in line for lunch, you know, validating that it is really frustrating to have to wait in line and, you know, it'll be really nice when we can make our own food. But we can't do that right now. So what's a tangible solution? You know, waiting in line, one of those solutions may be bringing your mobile device so you can play on that or getting in line with somebody that you like so you can talk with them. And it doesn't seem so arduous while you're waiting in line for 20 minutes. But try to find a solution to make that situation better. And try to replace butts with ands instead of saying, I hear that you want this but it can't happen. You can say I hear that you want this and this is these are some options to try to help you achieve this solution or and I will be with you. You know, if somebody's waiting for medication or something you can say and I will be with you in 20 minutes, instead of saying as soon as I can or later, which kind of puts the person off. If you give them a time, it makes them feel like something's actually going to happen. You can also ask them for how they propose, you know, other solutions in order to make this whatever the situation is, go a little bit more smoothly because people have creative ideas and we can synergize. Other interventions for children, personal contact again is reassuring, calmly providing factual information about the recent disaster and current plans for ensuring their safety along with recovery plans, encourage children to talk about and own their feelings, not just talk about what they're angry about, but also owning the fact that they're angry, and what can they do to improve the next moment. What can you do now? What do you do you have control over and encouraging them to focus on the things that they're grateful for and they do have not just the things they've lost and they're angry about. Spend extra time with children at bedtime and maybe play times, involve children by giving them specific chores to help them feel like they're helping to restore family and community life and this can just be making their bed or, you know, a variety of things we'll talk about. Praise and recognize responsible behavior. Too often we just criticize irresponsible behavior, but in this kind of situation it's even more important to pay attention to the fact that negative attention is better than no attention. So let's make sure to give some positive attention. So we don't have to resort to negative attention. Understand that children have a wide range of reactions to disasters and reassure the children frequently that you're safe and together. Allow them to grieve about their lost treasures, a toy, a blanket or a lost home. What seems inconsequential to you, for example, if your child left his blankie behind, maybe huge to that child. I know when my when my daughter was little, she had this little stuffed animal she called Dirty Blue and she could not sleep without it for quite a while. And there was one time that it got left behind at her granny's place. And oh my gosh, that was a really rough night. This is not the time to start trying to break kids of pacifiers or special objects. But if they do get left behind, allowing the child to grieve, allowing the child to be angry, that it's gone to be depressed that it's gone. And maybe to feel that way for a little while and not just expect them to be like, Oh, well, it's gone and get over it. Try to spend extra time together in family activities to begin replacing pleasant fears with pleasant memories. If your child's having problems at school and talk to the teacher so that you can work together to help your child cope or catch up. The same thing is in the in the shelters. If your child is having problems getting along with others in the shelter or doing what they need to do, talk with a shelter leader or whoever's helping with the child to see what you can do to best facilitate what your child needs at that point in time. And talk with your child about what you'll do if another disaster strikes, letting them help in preparing and planning for future disasters, turning should is into next times. Because during a disaster, you're going to hear this a lot. Well, mom, you should have remembered or mom, you should have or dad, why didn't you. This is a time to start writing that down and go, you're right, you know, so next time we won't forget about it. Why don't we start making a list of all those things. So we don't have this problem next time. Instead of getting into a power struggle about, well, I had other things on your on my mind and I can't remember everything so you need to cut me some slack. Arguing is only going to escalate. So when a child gets frustrated and angry, remember they're trying to regain some control. The best way to give them control is to acknowledge what they're angry about and say, OK, so here's a solution. So next time this happens, if it happens again, we can prevent these problems. Let's start making a list of things that we're learning now that we should have done. So in the shelter, what can you do and this is true sheltering at home or in a shelter shelter, play go fish or card games. Obviously, eight year olds aren't going to be playing poker, but there's a lot of other games you can play with just a simple regular deck of cards. Uno and some other games require special cards if they're there. Great. But try to keep it simple. Solitaire is something you can play by yourself. So if you are at home by yourself, that's something you can do to pass the time. Tic-Tac-Toe, Hangman, charades, I spy. If you don't remember I spy, somebody says I spy with my big brown eyes, something that's red. And the other people in the game try to guess what that person is seeing or thinking about. These can keep kids busy for quite a while. And if adults are willing to kind of put on their kid hat and play with them, it can burn up some time if you're stuck and there's nothing else to do. Mobile device games such as Checkers, Scrabble, Chess and Angry Birds and whatever else you play, those are great as long as you've got a mobile device and a charger. Tell jokes. Encourage kids to tell you jokes that make you laugh because the more you laugh, the less you have time to be angry. And laughing releases endorphins, which is going to help everybody feel happy. I think we've all heard the statement that laughing is contagious. Well, a lot of times it can be. Coloring books or coloring or just drawing can help people just get out some nervous energy or focus on something in the moment, which we're going to talk about with just stress tolerance skills, instead of wondering and wandering. Word finds crosswords and Sudoku are also good for adults and older children to help pass time and keep them busy. Encourage routine lights up and out at the same time each day. Start the day with mindfulness and planning like we talked about each morning give 15 minutes for everybody to kind of get their thoughts together and figure out what they're going to do that day. Try to keep meals at the same time in larger shelters divide the groups into a b and c. Each group gets to go first for one meal each day so the a group goes first for breakfast b group goes first for lunch and see group goes first for dinner for example. That way each group of people has to wait in line less and gets the first dibs, if you will, the hottest food for at least one meal a day. Encourage physical activity such as walking, you know, have a path around the perimeter of the gymnasium or if they can walk outside safely. That's great. Calisthenics these can be done in a small area stretching again this can be done on your cot or in a small area, but it helps keep people from developing the aches and pains and it can also help get rid of some of the nervous aggressive energy. Kids can play duck duck goose or put on kids music and encourage them to dance. You can even encourage them to do some kind of little performance talent show thing for the shelter if there's a parent or parents that are willing to help kind of put this together. It can be something that the group can focus on. And then it can provide theoretically amusement for the rest of the shelter. Encourage people to do chores each day in their zone depending on how you define that that can be your room if you're at home or in a shelter around your bed area, making sure to pick up any tissues used overnight and make your bed and that kind of stuff. Environmentally make sure there are quiet spaces that are both visually quiet so there's not a lot of stuff on the walls people can just like go and they're not being bombarded with bright colors and flickering lights and stuff. And also auditorily quiet, you know, you're not hearing a lot of stuff so again, if people can go outside to a picnic bench, or if they can go to another to a classroom or something where it's quiet and they can just sit and be for a few minutes and not have the noise. Think about the Grinch, how we always talked about oh the noise the noise noise noise. It can get to people after a while, everybody needs quiet time. If you have the ability to offer earplugs or headphones, you know that's great. Encourage people to if they've got headphones to use those because not everybody likes the same kind of music talk radio or appreciates the same news channel so headphones are definitely very helpful. Encourage awareness of space because too often we start bleeding over into other people's space and, you know, I think if you've ever shared a room with someone, or even, you know, been on a long flight somewhere where you start taking up more and more of your seat and the next person's arm rest. You realize how much we start to kind of expand over time. So encourage people to be aware of how much space they're taking up and to stay within their boundaries, if you will. And try to keep it smelling good. Encourage good hygiene and encourage make sure that the floors are getting cleaned and you know the toilets aren't backing up and things like that. People who are in an environment that smells better are going to have a better attitude and you don't even have to have essential oils. When it starts smelling stinky and people feel like they're living in squalor then their mood is going to go down. So groups, goal identification and radical acceptance. The first part is goal identification and this is important to do first. Encourage people to identify what things people and experiences are most meaningful to you in order for you to have a meaningful life. What do you have to have, you know, not just right now, but in general. Okay, so you have those things and it's usually family a good job and whatever else is meaningful to them. And then ask them and you can give them a list of values you can find online a list of like 50 values and have people identify five of those values that are most important. And sometimes I'll just tell people, you know, when you die, what five things do you want people to say about you or write on your epitaph what five values that you were compassionate you are patient you are kind you are what things do you want to be remembered for. And have people write those down, because then we're going to move on to radical acceptance. Radical acceptance means accepting that what has happened cannot be changed it doesn't mean you like it. It just means it can't be changed. And how you feel right now is how you feel if you feel angry, you feel angry. It is what it is. And instead of fighting against it you accept it. And you follow that up with what can you do to improve the next moment moving you closer to your goals and embodying the values you hold dearly. That's a long sentence. But that means you have to practice the pause and go okay, I've got I'm really angry right now and I've got three or four options I can yell screen throw a tantrum and put my fist through the wall. But is that going to get me closer to my goals and does that demonstrate the values that are important to me, such as patience and kindness. Well, no. Okay, so what are my other options here. What can I do to improve the next moment. So I don't have to. So I'm not feeling angry anymore. But they also help me get closer to my family and demonstrate patience and acceptance. Once people get the hang of doing that. There are going to be times that there are things they just can't improve, you know, being stuck in the shelter is one of them, for example, or being stuck without power. There's just nothing you can do about it and being angry doesn't fix anything. But there's nothing you can do to get the power on any faster. So what do you do to stress tolerance activities. Now you can do these in shelters with groups you can help people learn how to do these. So when there's something they can't control that's gnawing at them that's making them anxious or angry or depressed. They can try some of these activities in order to get away from that feeling for the moment. Now, imagery, I've talked about this earlier, encourage them to think about their favorite place and really close their eyes and get there. What does it smell like? What does it feel like? What does the air feel like on their skin? What does the sun feel like? What else do they feel? What do they hear? And sometimes I might ask people to identify five things in each area, five things they see, five things they smell, and that can be hard. Five things they hear and five things they can feel. So if they're in the woods, they might feel the sun, they might feel the moisture in the air, they might feel the cool breeze. You know, you see where I'm going with this. So encouraging them to really get into that scenario because if they're focused on that, they're not focused on what's causing them anxiety. With kids, you know, it can be an imaginary place. It can be a fantasy land or a princess castle or whatever it is, but encourage them to tell you and they have a hard time closing their eyes and thinking about this. So encourage them to tell you what is it like, you know, what is this place that you're going to like so they can articulate it. Once they've done that a few times, then they're going to start thinking about it on their own more and they can go there a little bit easier without having to talk it out each time. With adults, you can encourage people to try to find meaning in this experience. How is this going to change me for the better? Children have a more difficult time with that. Prayer, if that works for people is very helpful. Relaxation activities. Encouraging people to just stop thinking for the moment and focus on progressive muscular relaxation. Focus on their breath. Focus on each muscle in their body going from head to toe and feeling those muscles relax and if they're tense, relaxing them. Encourage people to focus on one thing in the moment. So find a candle or a picture or something and really focus on it and look at it and appreciate every little nuance of that thing. You can also encourage them to look around and I do five, four, three, two, one, five things you see, four things you hear, three things you smell, two things you can feel, and one thing you can taste. And usually when you get out to taste, they're like, I haven't brushed my teeth in a while. Okay, well, that's fine too. But at least you're in the moment. Vacation, take a mental vacation. Just check out for a little while. Imagine, think about a project that you want to work on or just go somewhere in your mind and encourage yourself. Those are other things you can do. You can tell yourself that you're going to get through this, but those are all activities that you can do as a group. You can definitely teach in a group so people can do them individually while they're in the sheltering experience when they experience things that they just can't change in the moment. Other things they can do, activities. So as a volunteer, as an outreach worker, as a shelter worker, even as somebody in a shelter, you know, shelter coordinators can identify four or five people that can work together to create activities that people can do. Hopscotch, talent shows, group, group support, crafts, you know, brainstorming with whatever resources you have available in your shelter or in your place. What types of activities can we do? And don't forget games, you know, don't forget charades and those sorts of things. Because right now it's stressful. You want the opposite of stress. So what will help make people feel relaxed or laugh? Exercise is another thing. If somebody knows how to do Tai Chi, maybe they can offer a Tai Chi session once a day. Contribute, volunteer, offer to help get yourself busy doing something, even if that's picking up trash around the outside or cleaning the bathrooms or whatever it is. If you're working, if you're focused on a task, again, you're less focused on worrying. Compare. And a lot of times I encourage people to compare what their current situation is with what could have happened. You know, it could have been worse because to help them see that, yeah, it may kind of suck right now, but it could have been worse. Do things that encourage happy emotions. You know, if you've got kids around, tell knock, knock jokes, encourage them to tell stories. What is it that's going to make people happy? If you've got happy movies that you can play, you know, somebody has a disc player because you're probably not going to have internet. You know, that can help people feel happy, turn on happy music, encourage people to help each other out, whatever it is that's going to help make people happy. And you can make this a goal for your shelter or for your household that everybody has to do at least one thing each day to make somebody else happy. And that should be a goal. Pushing away, when those anxiety thoughts come in, just telling the thoughts that I'm not going to think about this right now, push those thoughts away. Having happy thoughts, encouraging people to think about when this resolves, you know, how wonderful is it going to be to see their friends again or to get back to normalcy. What are the things are still going well in their life that they're happy about if they're in a shelter with their family, you know, the family may be getting on their nerves a little bit, but they can also appreciate the family being close. And folk sensations can also help jar people out of an unpleasant emotional place. So if they put on headphones and play some loud music, or they go outside and they feel the cold rain on their skin, that can help people feel better. Other groups you can do include a hardiness group. Encourage people to look at this situation and ask yourself, what things in your life make it worth living right now? What are you committed to? Because yeah, some things may have disappeared or changed irreparably, but what things are you committed to? And that kind of goes back to those goals we had earlier. What parts of your life or this situation do you have control over? Your reactions to it, how you interact with others, those things you do have control over. Whether the power gets back on today or in two weeks, you don't have control over. So separating what you can and cannot control. And encourage people to think about how they've dealt with problems like this in the past and what challenges they face now and how they can approach them. When they start looking at the past, they'll realize, you know what, I'm a lot stronger than I think I am. I've gone through worse, or maybe I haven't, but I can get through this. I have gone through problems in the past. And this is how I've done it. So these are some of the tools I have to get through distress. And then looking at, you know, the challenges right now, in the moment, getting through today in the shelter, how can I approach these challenges? Don't worry about next week or two weeks from now. Let's focus on how can you get through today. Help people learn about anger and irritability and that it's a natural response to threats and stress. It's the fight or flee reaction. Anger pushes people away or gives them power over other people. And it can also help reduce stimulation. So if people are feeling out of control, they may want to push away other people. I can't take any more input right now. Or I might want to get power over them because I need some sort of control in my life because I don't feel like I'm getting my needs met. So recognizing that anger represents a threat and then figuring out better ways to resolve that threat. When you get angry, encourage people to ask themselves, are you angry at the other person, the situation in general and the other person just happens to be an unfortunate target? Or are you angry at yourself for something, maybe for forgetting the charger for your iPhone or something? Where is this anger coming from and how can you best resolve it? Because if you're angry at yourself for something, then yelling at your neighbor isn't going to do any good. Anger tells you to do something. So how can you improve the next moment? Likewise, when someone gets angry at you, practice the pause, take a moment and reflect on whether it's because of something you did, the situation and you just happen to be an unfortunate target or their stuff and they're just really angry about something right now. And again, you happen to be an unfortunate target. It doesn't make it right. But if you can understand it and not take it personally, it makes it easier to deal with. So seven habits and shelters. Be proactive, seeking alternatives and opportunities to solve problems, not looking at problems as roadblocks. Remembering that anger is often a sign of somebody feeling powerless. So when somebody starts acting angry or irritable, stepping back and saying, okay, proactively, how can we help people feel empowered and in control in this situation? Begin with the end in mind when you're trying to solve a problem, define a win-win with practical realistic outcomes. So if somebody wants something and they're being demanding and they have to have it right now, but you can't give it right now, then how can you create a win-win situation where they feel in control and they feel like they're going to get their needs met? But you also are able to meet your needs. First things first, recognizing that some things are not worth the energy or effort and other things like your health and family are more important. So in shelters and even, again, sheltering in place with extended family, things can get a little tense. And sometimes you need to just take a breath and go, is this worth the fight? Is this worth my energy right now or should I just let it go? Because getting into a fight or an argument is going to drain a lot of energy and could potentially compromise your immune system and make people angry and all kinds of other unpleasant things. Seek first to understand the other person's point of view and the whole situation than to be understood. So you really want to try to understand where they're coming from and what's motivating their behaviors and what they need. What is it that they're trying to get before you try to present your point of view and what's going on? So you need to both be on the same page. And then you can synergize to use each person's strengths. Some people will be great at keeping everybody occupied and entertained. Other people will be better at making sure that routines get done and their structure. So synergize instead of just kind of throwing everything to the wind and sharpen the saw. Encourage each person to take time for relaxation and recreation each day and practice positive health behaviors to prevent vulnerabilities, which means avoid getting over tired, avoid getting over hungry and check in with yourself frequently to see if you need to take a little break and take a time out to get re-grounded. After a disaster, people will experience distress. There are certain things that can be done to reduce stress, whether sheltering in place or at a public shelter. Maintenance of routines is vital though. Prevention of vulnerabilities through proper nutrition, sleep and activity can help reduce stress and prevent some anger and irritability flare ups. And radical acceptance and goal directed activity can help people choose responses that will better assist them in reducing their distress instead of just dealing with the immediate anger that causes more problems. There are a lot of resources on allceus.com on the resources tab that also address dealing with distress after a disaster. There's a lot of handouts that I've compiled there and other videos on distress tolerance and some of the activities that we talked about. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. This episode has been brought to you in part by allceus.com, providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists and nurses since 2006. Use coupon code, counselor toolbox, to get a 20% discount off your order this month.