Stress and Health: Supporting Loved Ones After Trauma

By Rachel Gilgoff, M.D., FAAP, and Devika Bhushan, M.D., FAAP

This is Part 4 of 4 of a series on stress and health. Previous posts covered: what you need to know about stress, how to turn off the stress response, and reversing the health impacts of stress.

When something stressful happens—getting in a fight, being bullied, witnessing a scary event like a fire or gun violence—our brains may go into freeze (collapse), fight (attack), or flight (run) modes. Our ‘thinking’ brain may go offline and we are ruled by emotion. Afterwards, even simple reminders—a sudden loud noise or smoky smell—can trigger that same stress response.

Previously, we learned how the stress response can be life-saving, like when we face a predator. We also learned how repeated, prolonged, or excessive activation of the stress response can lead to wear and tear on our bodies. It can affect our brains, hormones, immune systems, and even our genes—and potentially lead to poorer mental and physical health, ranging from depression to heart disease to cancer.

We also learned about tools to reverse the stress response both in the moment and its health consequences over time.

Relatedly, how can you best support someone close to you after a traumatic experience?

Starting the healing process

After an extremely stressful or traumatic experience—like abuse—people may feel they are ‘broken,’ like something is wrong with them, or that they are just ‘bad.’ In circumstances like these, it can be helpful to remind your loved one that:

1. They did nothing to deserve what happened to them.
2. What they’re experiencing now are ‘normal’ reactions to an abnormal experience.
3. The experience may have harmed them, but healing is entirely possible.

Approaching your loved one

The brain processes information from the bottom up—from the most basic to more complex functions. This means that the regulatory (which govern automatic functions such as heart rate) and relational parts of our brains will be the first parts to process and respond to what we experience.

To best reach and support someone who is traumatized, we can use neuroscientist Dr. Bruce Perry's 3 Rs framework—Regulate, Relate, Reason—to tap into your loved one’s brain functions in the order that’ll be most effective based on their physiology.

A. Regulate: First, regulate or clam our own stress responses and that of loved ones.

B. Relate: Then, relate to how our loved is feeling. Help them feel seen.

C. Reason: Once there's safety and understanding, help your loved one process what happened through reason.

A. First, regulate or calm the stress response

• Calm your own stress response first. Before talking with your loved one, take a few moments to check in with yourself and if needed, lower your own stress response. What is happening with them may, of course, affect you and others. It is normal to have your own worries and frustrations around whatever is happening. Take a few deep breaths, go for a walk, journal, or chat with a friend. If you're having a hard time, reach out for professional help.
• Limit upsetting information. Especially after an acute event, it can often help you and your loved one feel better faster to limit exposure to graphic images, videos, and news related to the traumatic event. Some families even find it helpful to take a group social media and news break around traumatic events.
• Maintain routines. Routines help us feel safe and in control in times of stress. Help your loved one stick with familiar routines, such as around meals or bedtime, where possible, to feel the safety of regularity. Also make time for new routines that provide extra comfort and togetherness as needed.
• Enact healing strategies. You can also support your loved one by helping them manage their stress response both in the moment and longer-term. Strategies like better sleep, movement, time in nature, and mindfulness practices can help them turn off the stress response and promote healing.

B. Then, relate and connect

Connection and safety can strongly buffer — or counteract — stress and trauma, helping to prevent and even reverse health impacts. Just by being there, having a calm tone of voice, listening and connecting with your loved one, you have the power to lower their stress hormone levels and turn off their stress response. By doing this, you also give them space to process what happened and protect their health.

• Take note or ask them how they like to be supported. When stressed, some people want more togetherness, while others need more space. What they need may also change from day to day, hour to hour. Consider making a plan about how they would want to be supported during particularly rough times ahead of time.
• Active, ‘heartfelt’ listening. Put down your cell phone, turn off the TV, and ask how your loved one is feeling. Really listen. Don’t feel you need to have the answers or jump to solving their problem. Sometimes what your loved one needs most is to feel heard and understood. Validate their feelings and give them space to express their concerns. If you’re supporting a child: When it's time, you can also model naming your own difficult emotions. That can help kids in particular understand how to talk about feelings, that it’s okay to be vulnerable, and to ask for help when needed.
• Be curious and kind. Ask questions to find out more about what is going on, understand your loved one's perspectives, and better help. Even if you disagree with or are worried about how they are responding to the stressful event, it’s important to understand your loved one’s worries and feelings. Try to maintain a stance of curiosity and to not interrupt, shame, blame, or make assumptions.

In your responses, choose kindness and compassion. This can be especially hard when we are feeling our own stress and frustration. Remind yourself that both you and your loved one are doing the best you can with the resources and skills you have right now. Take moments to be kind to yourself, too.

• Let them know they aren’t alone. Let your loved one know you are there for them through this in whatever ways are most helpful; consider saying something like, ‘we'll get through this together.’ It can also help to let your loved one know that there are others who have gone through similar experiences — depending on their age, consider connecting them to support groups, peers, online resources, books, videos, or a therapist.

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C. Finally, reason: process and plan

• Honesty builds trust. We all—most especially kids—crave solid information in times of uncertainty. Ask your loved one what they’re scared about, what they already know, and what questions they have left—and see if you can help fill in the gaps. Even very young children know or sense a lot. In supporting a child, do correct any misconceptions or magical thinking they may have, but don’t lie or misrepresent the truth—be reassuring and give them the facts in an age-appropriate way. This will help build a sense of safety and understanding around what happened.
• Help them understand what is happening inside—and what to do now. Your loved one likely doesn’t want to be acting how they’re acting or feeling how they’re feeling. You might be able to help them better understand what’s happening in their brains and bodies and how to feel better. Highlight that they are having normal reactions to abnormal, stressful events. The hand brain model can help us easily understand how we can ‘flip our lid’ when we are stressed and overwhelmed. And when the thinking brain goes offline and we are run by our emotions, the tools described here and elsewhere in this series can make all the difference. If you’ve had practice using them, you can introduce your loved one to those that you’ve found particularly useful.

A version also appears in the American Academy of Pediatrics and my newsletter.

Rachel Gilgoff, MD, FAAP is an integrative medicine specialist, child abuse pediatrician, science writer, researcher, and mother.