Dealing With Traumatic Bereavement

43710 Makeup_Layout 1 20/01/2011 17:23 Page 1
Dealing with Traumatic Bereavement

a resource for those supporting people
who have experienced traumatic bereavement
Foreword
The first edition of these booklets was
developed in 2002, following 30 years of conflict
in Northern Ireland, during which time more
than 3,600 individuals were killed and many
more injured, both physically and
psychologically. It is estimated that more than
115,000 people lost a close relative and many
young people were affected as victims,
witnesses, participants and survivors in
decimated families and communities.
This second, revised edition has been produced

in the knowledge that, whilst we now live in
relative peace, past trauma continues to affect
many people’s lives; and of the 15,000 deaths
which occur in Northern Ireland every year,
approximately 10% occur in a sudden or
traumatic way, for example due to road traffic
collisions, suicide, accidents and assault.
The need for simple, freely available advice for

carers and families, that is helpful at different
stages and for different problems in the grieving
process, is still as important as ever. The aim of
this resource is to ensure that, regardless of
location, faith, culture or circumstances of
death, everyone who experiences a traumatic
bereavement receives the same quality of
service across the statutory, community and
voluntary sectors.
Many thanks go to the original writers for

producing the first edition, the office of the
OFMDFM for funding this edition, the Eastern
Trauma Advisory Panel members as well as
groups and individuals who continue to support
people who have experienced a traumatic
bereavement.
2
103
BT10-551
Introduction Using the reference

The effects of traumatic bereavement are
unique for each individual, and vary in nature
book
This resource comprises guidance for those
and intensity. As well as confounding the grief
supporting people who have experienced a
process, traumatic bereavement can lead to the
traumatic bereavement. (Sections 1-6).
development of post traumatic stress disorder
The appendices contain four information
and depression (Dowdney, 2000)1. However, for
booklets which have been developed to help
the majority of victims, effects will be non-
individuals, families and communities when
specific with age appropriate manifestations,
they experience a sudden death. These can be
which can vary according to factors such as
accessed in A5 booklet format for distribution
gender, personality, and social support (Cairns,
and are also available electronically to
1998)2. As bereaved children mature, they can
download from the bereavement page on
be reinjured through prolonged exposure to
Belfast Health and Social Care Trust website
sadness and loss (Terr, 1991)3, and are
www.belfasttrust.hscni.net and Cope with Life
therefore more vulnerable to subsequent
website www.copewithlife.org.uk
trauma.
It is anticipated that this valuable resource will

Many people who are bereaved experience a
be brought to the attention of current staff in
normal grieving pattern. They require little other
your organisation/agency and to newly recruited
than the support of their family and community
staff at their induction.
in a secure recovery environment. In such
circumstances those who are in regular contact
with the bereaved person may only need some
acknowledgement or advice on how to interact
with them or an understanding of their need at
that point in time. Others, especially those
bereaved traumatically, may need more
extensive or expert intervention. The
distribution of relevant information through the
existing framework of voluntary and statutory
contact will remain the best way of helping and
supporting bereaved people who do not require
further intervention.
1. Dowdney. L, 2000, Childhood Bereavement

2. Cairns. E, 1998, The Conflict in N.Ireland
3. Terr, LC, 1991, Childhood Traumas
3
Contents
Information for those supporting people who have experienced a traumatic bereavement
Section 1: Guidelines for the immediate response in sudden death situations 5
Section 2: Traumatic bereavement in childhood and adolescence 9
Section 3: Traumatic bereavement in adulthood 27
Section 4: Common grief reactions 35
Section 5: Relaxation techniques 51
Section 6: Self-care for professionals 57
Appendices: information for family members and friends 61
Appendix 1: Dealing with sudden death: helping children and adolescents 63
Appendix 2: Dealing with sudden death: information for young people 73
Appendix 3: Dealing with sudden death in adulthood 77
Appendix 4: Dealing with sudden death: common grief reactions 83
4
SECTION 1
Guidelines for the immediate response

in sudden death situations
5
SECTION 1: guidelines for the immediate response in sudden death situations
People will respond to death and traumatic less threatening for children.
events differently according to their age and
level of understanding. Reactions to sudden Take children’s fears seriously – reassurance
death can be severe regardless of whether or and truthful information can address immediate
not the traumatic event was witnessed. Children fears about safety (and the safety of other
will be distressed by what they have seen, family members – especially those not present).
heard, or believe; and sensitive to the distress
of others round them. Most people develop Take appropriate action – take the required
fantasies about what has occurred unless time action to assure children and families of their
is taken to explain the situation to them, in safety (lock doors and windows, call a relative
language appropriate to their level of or trusted adult to stay with the family or in the
understanding. Children of pre-school age and home, if necessary); identify and locate a child’s
younger can often only be comforted by a particular comfort object, for example, a
parent or trusted adult. Young children can be favourite toy or blanket.
distressed by the disturbance to their routine.
Adolescents and some people with learning Communicating with families
disabilities may have difficulty expressing their
Verbal communication - concentration and
emotions and can show their upset in a way
memory can be drastically and immediately
similar to that of a younger child. Each person
affected by trauma; information must be
will react differently and their responses are not
repeated often or given in written form to be
always obvious.
remembered clearly. Information communicated
to a family member or friend who is less
Promoting safety for children affected by the trauma is more likely to be
Keep family members together – children feel remembered. They can then relay it to the
safest with a parent or trusted adult; siblings family at a later stage. The chosen person
can support each other when kept together. needs to be acceptable to all sides of the family,
and should also keep children informed of what
Communication and preparation – age is happening.
appropriate explanations from familiar adults
will make separation Personal contact information – families may
require a follow-up contact name and number in
case they wish to seek further information or
ask questions at a later date (written or printed
contact information is useful).
Prepared information and hand-outs – written

information on the coroner’s service,
specialist services, and advice relevant to
sudden death can be useful for families in
both the long and short term.
The media – media involvement is not

unusual and may lead to the reporting of
6
specific details to the public. Interviews and worries about safety. Keep everyone informed,
personal statements to the media are voluntary particularly children, about what is happening to
and families should be made aware that they other family members and what will happen to
have a choice in this. Some families later regret them.
early statements released to the media - they
should be advised to discuss the various Police services
options with other family members or a trusted Inevitably in a sudden death, police will attend
friend. Families should consider whether they the scene. As this is a confusing time, printed
want media involvement, whether they would information containing useful contact numbers
like to release pictures, and what details they or information on likely courses of future action
wish to share. Once information is released to (criminal or medical investigation) can be
the media, they have no control over what is helpful. Keeping families advised of what is
finally broadcast. Once they give one interview, happening to everyone will reduce confusion.
they will most likely come under pressure to Avoiding unnecessary separations of children
give others (which they have the right to from each other or their families will reduce
refuse). Once information is in the public anxiety and distress. Within the police service
domain, people will be aware of the detail of there is expertise in taking witness statements
what has occurred so children in the family from children.
need to be prepared for this.
Hospital services
Making the loss real When an injured person is admitted to hospital,
Provide age-appropriate explanations and staff should be aware of the need for family
preparation – give clear, definite explanations of members to be kept informed about what is
what occurred and what is going to happen going on. Within the hospital certain staff have
next; explanations should match a person’s skills and expertise which are useful, both at the
level of understanding. The more they know time of admission and following death, (e.g.
about what really happened, the less time they bereavement support, chaplaincy, clinical
will spend imagining scarier possibilities. This psychology, social work). It is often during this
applies even when the person has witnessed time that advice needs to be given about post-
the incident, as they are not always able to mortem examination, coroner, and funeral
understand what they have seen. arrangements (this information is contained in
Trust bereavement booklets).
Viewing the body can be a sensitive issue and
people need to be prepared for the experience. General Practitioners (GP)
Viewing may or may not be advisable The family GP should be alerted to offer help
depending on the circumstances of death; you and short-term medication where necessary. It
can offer advice and support on such matters. is inadvisable for other family members and
friends to offer medication as these may cause
Agencies unintentional side effects.
Fire and ambulance
Out of hours social work service
Injured people may require different emergency
treatments – with the severely injured most Emergency social workers may be called for
likely to be separated from the rest of the group child placement or protection issues, and are a
(e.g. going to hospital). Avoiding separations (if good source of information and support.
possible) will reduce potential confusion and
7
Faith representatives
The family may want early contact with their
faith representative, who will be a source of
advice, comfort and support for them.
Funeral directors
The funeral director can provide options for
funeral arrangements and assist decision
making. In particular they can advise on
aspects of the rituals that family members can
be involved in; such as drawing pictures, writing
letters, or selecting photographs to be used in
the funeral service or placed in the coffin.
Coroner
As the death was unexpected, and may be
unexplained, it falls within the remit of the
coroner. As such it is possible that a post-
mortem examination will be conducted which
may result in a delay in the body being released
for burial (Coroners Post-mortem Examination:
Information for Relatives booklet,
www.coronersni.gov.uk). This should be
explained to the family, along with the post-
mortem examination process. They should also
be made aware that a coroner’s liaison officer
will be allocated to them to keep them updated
on progress.
8
SECTION 2
Traumatic bereavement in childhood and

adolescence
9
SECTION 2: Traumatic bereavement in childhood and adolescence

Being aware of the physical, psychological and emotional development of children, it is clear that each age
group deals with traumatic bereavement in different ways.
Early childhood (0-5 years)
General development Young children’s understanding of

Young children undergo almost constant death
physical and psychological change – and are They react to separation instinctively – they are
learning to move, communicate, and most affected by deaths of parents or parent
understand the world for the first time. They figures. This is true even if they don’t
also begin, very early on, to form attachments understand what the word “death” means or
to parents or parent figures, and so are capable aren’t capable of sympathising with others.
of grief (although maybe not the way adults They do understand separation and loss.
understand it).
They do not understand that death is the final
They need the support of adults in learning to and irreversible end of life – they may ask when
express themselves verbally and emotionally – the person who died is coming back or think
as a result, sometimes the depths of children’s they will be lonely under the ground. This can
understanding or misunderstanding can be give rise to fears of burial.
underestimated. They need clear and
consistent explanations to reduce confusion, They do not understand euphemisms for death
and will need repeated explanations over time, (like “sleeping” or “going on a journey”) – they
in order to fully understand what is said. may wonder when the person who died is
coming back, why everyone doesn’t die when
They do not always talk about what upsets they go to sleep, or become reluctant to go to
them, but use play to process emotionally-laden sleep themselves.
events – this may be because they find it
difficult to give their attention to separation or They may believe there are magical or unseen
grief for periods of time. Through play they reasons for death – they may mistakenly
explore and try to understand events they have believe that a person has died because of
experienced in their own way and in their own something they said or did, or believe that
time. This is how young children work through death can be undone by certain actions or
grief. people.
The understanding of children with learning Long-term implications of death and permanent
disabilities may be similar to that of a younger separation are unclear for them – they may
child – therefore communications and appear unaffected or continue playing after
explanations should be tailored to their level of hearing the news of the death. This ability to
understanding rather than age. They can be switch off helps children cope. However, they
helped to deal with traumatic bereavement and are likely to think about the death during
will respond best to care-giving which is tailored quieter, less active times (e.g. at bedtime).
to their understanding and addresses their
fears.
10
Young children’s reactions to Young children’s reactions to

trauma traumatic bereavement
They experience trauma as fright – when a Young children’s grief following traumatic
child is old enough to recognise a situation as bereavement will vary according to how
threatening, their bodies react with a pre- emotionally close or dependent they were on
programmed fright response. This strong bodily the person who died; and also how exposed
response is unsettling, and can recur later when they were to the circumstances of the death.
the child feels unsafe. They cannot control
these reactions very well without the help of an They react to separation – it is a natural
adult. Such fright responses include crying, response for them to be distressed when
over-reacting or being easily startled. separated from their care-givers for long
periods of time. This means they can be upset
They may believe there are magical or unseen by death even if they do not understand it. In
reasons for trauma – they may believe the effect, young children experience death as a
traumatic event was caused by something that separation.
occurred at the same time, coincidently. They
need simple explanations to make meaning of They will be most upset by the death of a
the event. parent or parent figure, as these are the people
on whom they depend most. In addition, they
They need to understand what has happened – may also react to the distress expressed by the
they may ask why the person died, or will re- adults around them. Parents at this time may
enact the traumatic events through play (e.g. not have the ability to respond to them due to
using dolls or action figures in role-play). the stress and practicalities
Sometimes the trauma or death is avoided or of bereavement.
reversed in these re-enactments, as children
wish to undo the unpleasant consequences of
trauma. The need to understand is universal. In
the absence of an understandable explanation,
children’s fantasies about what they hope or
fear happened during the traumatic event
become accepted as reality.
They can experience stress – for a time they

may show signs of being irritable, easily startled
or clingy, nervous of anything that reminds them
of the trauma, or otherwise distressed.
Alternatively, they may surprise parents by
returning to routines. Night-waking, bed-wetting
and feeding difficulties are common signs of
stress in young children. Sometimes they can
become more exaggerated in their behaviours,
or more withdrawn than they were before the
death; these signs aren’t always obvious.
11
They react to trauma – they do not always explanation as soon as possible, to assist their
understand what happens in a traumatic grieving.
situation but can become intensely frightened
by it. Normally intense fright means that the They create traumatic fantasies to fill in gaps in
memory of trauma can persist until such times their knowledge – sudden deaths that are not
as they understand and deal with it. witnessed directly or that leave surviving
children with unanswered questions about the
Memories and feelings of trauma are hard to death (or person who died) often lead to
forget – these can be frightening and are not traumatic fantasies. These are the explanations
always easy to control. They leave children children create to fill in gaps in their knowledge
nervous, expecting future traumas and cause of the events surrounding the death. These
important changes in the body’s chemical might include fantasies that they are ultimately
system. This makes them very alert and in need responsible for the death, or that the person
of soothing or reassurance. Traumatic who died is angry with them. Traumatic
memories may lead them to avoid certain fantasies can be distressing and provoke strong
triggers which remind them of the death (e.g. emotional reactions. They usually focus on the
people, places, objects) but these may worst possibilities, and fade with time as
resurface uncontrollably from time to time (e.g. children learn more about what happened.
through vivid dreams or at quiet times such as Those who have traumatic fantasies need
bedtime). reassurance, with appropriate levels of detail
conveyed in language they can understand.
They become fatigued by fright – prolonged
exposure to or experience of fright causes their They have private or magical beliefs – they may
bodies to react in ever stronger ways. Usually, believe that the death was caused or could
children who feel safe only experience a have been stopped by them or someone who
moderate jolt of extra energy when they get a was involved. However, these beliefs are not
fright. However, the fright response becomes always shared openly. They may need
stronger the more it is used, so when they feel encouragement to talk about their beliefs
unsafe or experience traumatic memories they without fear of reprisal or ridicule, as these
use up a lot of energy. Over days and weeks beliefs are often associated with strong
this can drain their bodies of resources and emotions such as anger or fear.
leave them vulnerable to illness or infection.
They are highly sensitive to the reactions of
What affects young children’s people around them – they use these reactions,
and in particular the reactions of the main
experience of traumatic parent-figure, to judge how they should react.
bereavement? Their acute sensitivity to other people’s
Sudden deaths which are witnessed will have a behaviour during times of crisis and aftermath is
more direct impact – witnessing a sudden death often grossly underestimated. Ideally, they need
is usually stressful for children even if they don’t to see the expression of adult grief and sadness
understand what they see. Memories of trauma in a safe environment where they are free to
are multisensory, so they will be distressed by ask questions, rather than witnessing
the memories of what they saw, heard, smelled, uncontrolled grief or grief out of context.
and touched. Children who witness such deaths
will need reassurance and some degree of
12
They have shorter spans of attention than

adults – they cannot stay sad, worried, angry, or
happy for long periods of time without being
distracted. This can make their grief appear
less intense, whereas in reality their grief is
painful, but switches on and off very rapidly.
Often, their grief reactions occur at times of low
activity, such as at bedtime or early morning.
Their grief and trauma can be private – they

don’t always have the words to explain how
they feel. As a result, the level of their distress
can be underestimated by adults.
They can become pre-occupied with safety – in

the aftermath of traumatic bereavement, their
fears about safety can be intense. Often, they
appreciate concrete reassurance that they are
safe (e.g. allowing them to lock doors and
windows at night before they go to bed).
Reassurance of this type is necessary,
especially in the short term, if settings such as
home, pre-school, or play groups are connected
to the death.
They are sensitive to daily routines – a death in

the family can disrupt daily routines and make
the child’s world less predictable and secure.
They feel safest when they are with a trusted
adult and know what their daily routine is.
They are dependent on and sensitive to their

carers – the adjustment of the main caregiver is
known to be the biggest influence on the extent
to which a child will cope with a traumatic
bereavement. The more distressed the adult,
the less likely the child will cope and vice versa.
13
MIDDLE CHILDHOOD (5-10 YEARS)
General development Children’s understanding of death

Children between the ages of five and ten have Death is unavoidable and irreversible, with
a greater understanding of their emotional, concrete causes – children begin understanding
social, and physical worlds – they understand that death happens to everyone at some point
the world better than younger children and will and that you cannot bring someone back from
attempt to develop their own skills and sense of the dead. They know death is caused by old
competency. Understanding and development age, illness, trauma, etc. rather than through
progress gradually and at different rates as magical or mysterious means.
children mature across the age-range.
They are unwilling to consider it as a possibility
They socialise beyond the family unit – a for themselves – they don’t like to think about
milestone for children at this stage is the their own death or the death of others around
beginning of social independence. They them.
become more sensitive to groups outside the
family, and can become withdrawn or agitated They can empathise with others, but (boys
in different social circles following trauma. especially) are likely to hold back their feelings
– they are developing the ability to consider and
They learn about rules and fairness – their play share in the feelings of those around them, but
changes to include rule-based games and more don’t always share their own concerns. They
organised sports and activities. Incidents such understand that death brings sadness to those
as trauma and bereavement can be seen as who cared about the person who has died.
unfair, and prompt the questions “Why me?” or
“Why my family?” They may assume the person who died can
still see or hear them – they can believe
The understanding of children with that they are being watched over or
learning disabilities may be similar to that followed by the person who has died,
of younger children – therefore either closely or from a distance. This
communications and explanations can be either reassuring or unsettling.
should be tailored to their level of
understanding rather than age. They They can become pre-occupied with
may require simplified unfairness – they can feel a sense of
explanations of death and injustice and view traumatic
trauma and more practical bereavement as unfair to them or
support or access to resources undeserved. They may feel
than the family can provide singled out by their loss and
alone. The guidelines for different from others around
younger children may them – particularly if they’ve
better reflect their level lost a parent.
of understanding or
behaviours.
14
nervous of anything that reminds them of the

Children’s reactions to trauma
trauma, or otherwise distressed. Nightmares
Children’s reactions to trauma are not solely
and difficulties with friends and school
based on actual memories or exposure to
performance are common signs of stress in
trauma (although these are major
children of this age. This stress is often the
determinants). Those who do not fully
result of reminders or intrusive thoughts related
understand the methods or motives behind
to the trauma, and the pressures involved in
traumatic events attempt to fill in the gaps
avoiding further reminders of the trauma in their
through fantasy, imagining worst case
environment (which may be unknown to
scenarios and believing them to be true. These
parents).
fantasies are traumatic in themselves, and must
often be confronted with the help of a trusted
adult.
Children’s reactions to traumatic
bereavement
They experience trauma as fright – they are old Children’s grief following traumatic
enough to recognise a traumatic situation as bereavement will vary according to how
threatening both to themselves and others. emotionally close they were to the person who
Their bodies react with a pre-programmed fright died; and how exposed they were to the
response. This strong bodily response is circumstances of the death.
unsettling, and can recur later when the child
feels unsafe. They find it difficult to control They react to separation – they will be
these reactions even with the help of an adult. distressed when separated from people they
They may cry, over or under-react, become pre- spend a lot of time with. Following a traumatic
occupied with the trauma in some way, or feel bereavement they will undergo grief even if they
and behave in an agitated manner. don’t express it in the same way as an adult.
They may believe there are secret or unseen They react to trauma – they become intensely
reasons behind the trauma – they often blame frightened by traumatic situations, but are not
themselves. They may believe the traumatic usually in a position to physically prevent the
event was caused by something they did or trauma occurring. As a result, they can feel that
said (such as being angry with the person who they, or their family, are more vulnerable to
has died); or that they could have somehow future trauma, and can experience periods of
prevented the trauma. prolonged nervousness and need for safety.
This can interfere with the attainment of
They need to understand what happened – they important emotional and developmental
may ask why the person had to die in traumatic milestones such as a sense of competency and
circumstances, and question the fairness of control.
their situation. They use fantasy to replay the
traumatic scene in their heads. Sometimes the Memories and feelings of trauma are hard to
trauma or death is avoided or reversed in these forget – these can be frightening, and are not
re-enactments, as they wish to undo the always easy to control. They leave children
unpleasant consequences of trauma. nervous, expecting an unsafe future, and lead
to important changes in the body’s chemical
They can experience stress – they may show system. The experience (and later re-
signs of having low concentration, being experiencing) of traumatic memories is
irritable, fatigued, easily startled or clingy, multi-sensory and provokes a strong fright
15
reaction which is difficult for children to describe

What affects children’s experience
or understand (e.g. they would have difficulty in
describing a wave of panic or heartache). of traumatic bereavement?
These reactions can be unsettling, and lead to Sudden deaths which are witnessed will have a
headaches, abdominal pains, and tiredness. more direct impact – seeing a sudden death as
it happens is intensely stressful and frightening
They can develop a range of specific symptoms for children, and can be made worse if they do
– following a traumatic bereavement they often not understand what was witnessed. However,
develop disturbing symptoms which are not memories of trauma need not only be visual –
always obviously connected to the event. These children who did not see the death occur may
include poor concentration, disorganised have heard, smelled or felt it, and are just as
memory and low motivation; which all have an distressed by the memory of these sensations.
impact on adjustment to school. This can have Those who witness a death need reassurance,
a lowering effect on their self-esteem and give good information and support in understanding
rise to other difficulties. Some children may be what happened as soon as possible. Initially,
more withdrawn while others might act out their the memories of what occurred may be a
difficulties, appearing to be unconcerned by greater source of stress than the bereavement
what has occurred. In all cases of traumatic itself, preoccupying the child and preventing
bereavement, it should be expected that normal grieving.
children experience a range of reactions; not all
of which will be obvious in their behaviour in They create traumatic fantasies to fill in gaps in
school. their knowledge – sudden deaths that are not
witnessed directly or that leave surviving
They become fatigued by fright – prolonged children with unanswered questions about the
exposure to or experience of fright causes them death (or person who died) often lead to
to react in ever stronger ways. Usually, children traumatic fantasies. Traumatic fantasies are the
who feel safe only experience a moderate jolt of explanations they create to fill in gaps in their
extra energy when they get a fright. However, knowledge of the events surrounding the death.
the fright response becomes stronger the more These might include fantasies that the death
it is used, so when children are traumatically took longer than it actually did, or that the
bereaved they use up a lot of energy when they person suffered for a long time. They may also
feel unsafe or experience traumatic memories. believe that they could or should have done
Over days and weeks this can drain their body something simple to avoid the death, or place
of resources and leave them vulnerable to undue importance on the last disagreement
illness or infection. they had with the person who died. Traumatic
fantasies can be distressing and provoke strong
They can be overwhelmed – the overall effect emotional reactions. They usually focus on the
of grief and trauma is more difficult to deal with worst possibilities, which fade with time as
than either grief or trauma alone. The effects of children learn more about what happened.
traumatic bereavement are prolonged, and can Those who have traumatic fantasies need good
be re-experienced as children develop and information (with appropriate levels of detail)
understand more of the world around them. conveyed with reassurance.
Families may also be overwhelmed, and
settings such as school can become a refuge They have private or unseen beliefs – they may
where a sense of normality and competency believe that the death was somehow related to
can be achieved. or brought on by their own actions or thoughts.
16
They may also believe that the person who has They are sensitive to daily routines – they feel
died can still see or hear them. However, these safest when they are with a trusted adult and
beliefs are not always shared openly. They may know what their daily routine is. Participation in
need encouragement to talk about these beliefs home, school, and familiar recreational
without fear of reprisal or ridicule, as they are activities gives their life a sense of predictability
often associated with strong emotions such as and stability. A death in the family can disrupt
anger or fear. these routines, and make the child’s world less
predictable and secure. They may also need to
They listen to the reactions of parents and know the routine of their parent figures or family
family more than others realise – they use the members in order to feel secure.
reactions of people around them, and in
particular the primary caregiver, as cues for They are sensitive to the reactions of other
how they should react. They may be more children – following a sudden death there is
affected than they seem by excessive adult often extensive media involvement so much of
displays of emotions such as anger, anxiety, the detail is known by other children in the
blame, and sadness. It is well recognised that community. This exposes them to risk,
children’s adjustment to traumatic bereavement particularly on their return to school, if they
is significantly affected by the coping of the themselves are unsure of what happened, or
main caregiver. they have not been prepared to deal with
questions and comments.
Their grief and trauma can be unseen – they
can be reluctant to talk about their traumatic
bereavement for fear of upsetting or saddening
family members. They may also feel it
inappropriate to talk about it to friends,
teachers, or significant others. As children grow
older there will be a greater need for privacy
and control, so they need to be given
permission and encouragement to express their
concerns and emotions. This is necessary as
their underlying reactions can be masked by
other behaviours (such as playing the clown
when they are actually very upset).
They can become pre-occupied with safety – in

the aftermath of sudden death, their fears about
safety can be intense. Often, they need
concrete reassurance that they are safe (e.g.
locking doors and windows at night before they
go to bed). Reassurance of this type will be
necessary, especially in the short term, if
settings such as home, school, or social/sports
clubs are connected to the sudden death.
Death in a school can pose particular problems
as parents may not be aware of the extent to
which their child has been affected.
17
ADOLESCENCE (10-18 YEARS)
General development understanding rather than age. They may

Adolescents have a better understanding of the require simplified explanations of death and
world – they are capable of understanding the trauma and more practical support or access to
long-term consequences of death and trauma. resources than the family can provide alone.
It is also around this time that most begin to The guidelines for younger children may better
consider issues around their own mortality. reflect the level of understanding or behaviours
of the adolescent.
They place an emphasis on peer relationships
and begin to show pronounced gender Adolescents’ understanding of
differences – networks develop spontaneously death
in their social circles. Girls are better at finding
Death is unavoidable and irreversible, with
support from peer groups, boys are more likely
concrete causes – adolescents understand that
to act out the effects of trauma. Social identities
death happens to everyone at some point and
and group involvement become more important
that you cannot bring someone back from the
than in previous stages of their development.
dead. They know death is caused by age,
illness, trauma, etc. rather than through magical
Adolescence is a natural period of change and
or mysterious means. Sudden or unnatural
reorganisation – they typically become more
deaths are seen to have perpetrators.
independent of family members and parent
figures. Combined with other physical and
They can empathise with others, but (boys
psychological developments this can make for
especially) are likely to hold back their feelings
ambivalent emotions in adolescents (where
– they can share and understand the feelings of
they vary between the need for support from
those around them, but may be unwilling to
their family and the need to gain independence
reveal their own feelings. Peer groups can be
from them). This is often manifested in a desire
useful as emotional resources beyond the
for increased privacy and control over their own
family circle, with girls being better at seeking
lives.
out friends they can relate to.
Their reactions can be more emotional or

They can become pre-occupied with
exaggerated than in previous years – their short
justice/injustice – they can feel a sense of
term reactions can be driven by emotional
injustice and view traumatic bereavement as
responses and appear exaggerated. They
unfair or undeserved. Issues of punishment or
engage in more risk taking activities than
retribution can come into play, and serve to
younger age-groups, such as the use of
prolong grief, especially if media involvement or
alcohol, drugs, and involvement in sexual
criminal proceedings are protracted. These
behaviours. They may also become more
feelings can recur in adolescence if the
inhibited in certain areas of life, and more
bereavement occurred earlier in childhood.
sensitive to social pressures to conform.
The understanding of adolescents with learning Adolescents’ reactions to trauma

disabilities may be similar to that of younger Adolescent’s reactions to trauma are not solely
children – therefore communications and based on actual memories or exposure to
explanations should be tailored to their level of trauma (although these are major
18
determinants). If they do not fully understand common signs of stress in adolescents.

the methods or motives behind traumatic
events they attempt to fill in the gaps through They can over-estimate the negative role they
fantasy, imagining worst case scenarios and played in the traumatic situation – and feel
believing them to be true. These fantasies are guilty or embarrassed about their reactions.
traumatic in themselves, and must often be They can be pre-occupied with any negative
confronted with the help of trusted adults or contact they may have had with the person
friends. prior to their death; or with thoughts of how they
could have acted differently. They may also feel
They experience trauma as fright or terror – personal responsibility or blame themselves for
they are old enough to recognise a traumatic not doing things differently.
situation as threatening both to themselves and
others. Their bodies react with a pre- They understand the long-term implications of
programmed fright response. This strong bodily trauma – they realise that what’s happened will
response is unsettling; and can recur later when stay with them for life, that it will affect their
the adolescent feels unsafe or is reminded of home and social life, and that some of the
the trauma. These reactions can be distressing changes that have occurred will be permanent.
and difficult to control.
Adolescents’ reactions to
They need to understand what happened – they
will want to understand more about the death,
traumatic bereavement
including issues of fairness or justice, which are Adolescents’ grief following traumatic
difficult to explore. However, thinking about it bereavement will vary according to how
can be a distressing experience, especially emotionally close they were to the person who
when the trauma is recent. Understanding, or died; and how exposed they were to the
finding a meaning for trauma, can be very circumstances of the death. These deaths
important at this age, especially if it leads to can include those of friends or
the prevention of future traumas. members of the community with whom
Unfortunately, not all the facts about they identify.
trauma are known initially – many trauma
survivors must wait for criminal or They react to separation – they do this
scientific investigations to find the truth in much the same way as adults. This
and for some it will never be known. includes feelings of sadness, loss,
yearning, heartache, and
They can experience stress hopelessness. However,
– they may show signs of many will have few past
being irritable, easily experiences with death
startled, nervous of and loss, and fewer
anything that reminds established coping
them of the trauma, or mechanisms for dealing
otherwise distressed. with stressful situations
Night-mares, social of this nature.
withdrawal, poor
concentration and They react to trauma
difficulties with school – they become
performance are intensely frightened
19
by traumatic situations. Often, traumatic questions and comments from their peers. For
memories can be very upsetting and some, being different from others becomes the
uncontrollable, and are re-experienced over a most difficult issue to deal with.
period of time. Trauma interrupts their daily
lives, and makes fitting into old routines and They can be overwhelmed – the overall effect
social interactions more difficult. Bodily of grief and trauma is more difficult to deal with
reactions to trauma can lead to fatigue and than either grief or trauma alone. The effects of
vulnerability to illness in the adolescent. It may traumatic bereavement are prolonged, and can
also exaggerate difficulties in home, school, or be re-experienced over time as adolescents
community settings which pre-date the learn more about the world. They can result in
traumatic bereavement. anger, blame, or guilt which can be difficult or
shameful to talk about, and affect members of
Memories and feelings of trauma are hard to their family and community. Often settings such
forget – these can be frightening, and are not as school can be appreciated for the relief they
always easy to control. They leave the offer from thinking about the bereavement. As
adolescent nervous, expecting an unsafe part of the overall effect, dramatic changes can
future, and lead to important changes in the be seen in the behaviour of the adolescent (e.g.
body’s chemical system. As a result, some greater involvement in class-clowning, risk-
memories of the person who died can cause taking behaviour, social withdrawal, or sudden
upset instead of comfort. They may be brought maturity).
to mind uncontrollably, either in response to
reminders or at random. They also have a What affects adolescents’
physical component, in that they often result in
increased heart and respiration rates, and can
experience of traumatic
be tiring, distracting, and unsettling. bereavement?
Sudden deaths which are witnessed will have a
They become fatigued by fright – prolonged more direct impact – seeing a sudden death as
exposure to or experience of fright causes an it happens is intensely stressful and frightening
adolescent’s body to react in ever stronger for adolescents, and can be made worse if they
ways. Usually, those who feel safe only misunderstand what they have witnessed.
experience a moderate jolt of extra energy
when they get a fright. However, the fright Memories of trauma tend to the multisensory –
response becomes stronger the more it is used, those who do not see a death occur may have
so when they are traumatically bereaved they heard, smelled or felt it and are just as
use up a lot of energy when they feel unsafe or distressed by the memory of these sensations.
experience traumatic memories. Over days and Those who witness a sudden death need
weeks this can drain their body of resources reassurance, good information, and support in
and leave them vulnerable to illness or understanding as soon as possible. Initially,
infection. memories of what occurred may be more
stressful than bereavement itself and give rise
They are highly sensitive to peer reactions – so to specific reactions.
much of the information surrounding a sudden
death is available to others through the media; They create traumatic fantasies to fill in gaps in
anticipating the reactions of others can become their knowledge – sudden deaths that are not
a great source of anxiety or agitation for witnessed directly or that leave surviving
adolescents. They may need to be prepared for adolescents with unanswered questions about
20
the death (or person who died) often lead to Sometimes they need to be encouraged to
traumatic fantasies. Traumatic fantasies are the express their concerns and emotions as their
explanations people create to fill in gaps in their underlying reactions can be masked by other
knowledge of the events surrounding the death. behaviours (such as playing the clown when
These might include fantasies that the death they are actually very upset).
took longer than it actually did, or that the
person suffered for a long time. The adolescent They are sensitive to daily routines and safe
may also believe that they could or should have locations – they feel safest when they are with
done something simple to avoid the death, or trusted friends and are in familiar environments.
place undue importance on the last Home, school, and recreational settings are
disagreement they had with the person who important in making them feel physically and
died. Traumatic fantasies can be distressing emotionally secure. A death in the family or
and provoke strong emotional reactions. They community can disrupt these routines, and
usually focus on the worst possibilities, and make their world less predictable and secure.
fade with time as people learn more about what The death of a pupil or teacher at school poses
happened. Adolescents who have traumatic particular problems as there will be daily
fantasies need good information (with reminders of the person who died, other pupils
appropriate levels of detail) conveyed with will be upset, and pupils become affected by
reassurance. each other’s behaviour. Because this occurs in
a school setting parents may not be aware of
They have private beliefs and emotions – they the extent to which their child is affected by the
may believe that the death could somehow death.
have been avoided if they or some other
person/group had acted differently. Blame and Adolescence is a naturally stressful time –
the need for retribution may be important to traumatic bereavement in adolescence occurs
them depending on the circumstances of the at a time in children’s lives when they are
death. However, these beliefs are not always undergoing dramatic psychological and physical
shared openly – particularly in the family. changes. These include the development of a
Communication on difficult topics such as these new identity and social networks, academic
can be started by parents or friends in order to pressures, conflicts with parents or family,
encourage them to open up and express hormonal changes, and rapid physical
privately held fears and anger. development. For these reasons, many
adolescents may have difficult relationships
They can gain support from family, friends, and with their parents, at a time when they most
the community – they can gain the most need emotional support.
support from the groups they are most involved
in. However, severe trauma can make group
involvement difficult for affected adolescents,
especially for younger ones, who may become
more dependent on the family again for a time.
Their grief and trauma can be unseen – they

can be reluctant to talk about sudden death for
fear of upsetting or saddening family members.
They may also feel it inappropriate to talk about
it with friends, teachers, or significant others.
21
favoured by their parents and family.

GUIDELINES FOR CHILDREN
OF ALL AGE-GROUPS Immediate needs
It is important to remember that children are
Promote a safe environment – it is very
more sensitive to their family’s emotions than is
important for children to feel as safe as possible
generally realised. They will watch the reactions
both immediately after a traumatic
of those around them much more than is
bereavement, and in the long term. Ideally, daily
understood by adults.
routines should be re-established as soon as
appropriate.
It is important that carers are aware that even
young children will actively grieve, so that they
• Work for continuity in home, school or other
try to understand and meet their needs.
activities
Children from five to ten years of age can be
• Maintain a routine as far as possible and
especially vulnerable to false impressions and
prepare the child for any changes to this
fantasies about trauma.
• Avoid unnecessary separations - where
separations are necessary the child should
The needs of adolescents vary according to the
be prepared for them
individual and their circumstances.
• Be alert to the child’s needs and provide
emotional reassurance as necessary
Relationships with family and friends can be
• Make time to listen to what they have to say
equally important in meeting their practical and
and address their anxieties and concerns
emotional needs. Gender, ability, and level of
• Take their fears about safety seriously.
understanding
also have a part
Clear communication – children need simplified
to play in their
and consistent explanations to reduce their
coping methods,
confusion about the death. Clear and honest
which tend to
information and discussion can help identify
be wide
their concerns, which may otherwise be missed.
ranging
For young children death is best explained as
and
meaning that a person stops moving and
may
thinking; they don’t breathe or feel any pain.
differ
Older children and adolescents understand
from
more but may be unsure how to ask for
those
information.
• Give explanations suitable to the age and

level of understanding of the child, using
language you know they will understand –
clear, consistent and not misleading
• Questions about death should be answered
as honestly and clearly as possible. Be
aware that the topic may be revisited on
many occasions
• Be sensitive to the family’s own belief
systems when explaining that, whatever
22
happens after death, once a person dies Coping with emotions – talking with the child
they cannot come back to life. about their feelings may help them confront
their fears and provides reassurance and
Make the loss real – children should be emotional support. Share any grief you may feel
encouraged to participate in rituals surrounding personally in a measured way.
death (while respecting any choice they make),
and to keep mementos of the person who has • Talk through any issues or anxieties the
died for the future. child may have (e.g. anxiety about
something happening to a parent or
• If children are to participate in rituals like themselves)
viewing the body and attending the funeral, • Allow children to express feelings of anger,
they should be prepared for what they will blame or guilt
see • Provide comfort and reassurance that what
• Encourage the child to do something for the they are feeling is normal
person who died (e.g. put a drawing, letter • Reassure children that it is okay to have fun
or present in the coffin) and continue with normal activities
• Share feelings of sadness, but excessive • Be aware that in young children feelings are
displays of anger sadness or blame should generally expressed through emotional
be avoided upset and behaviours (rather than words)
• Children may want to keep a personal • It is easier to identify what young children
reminder of the person who died with them. are thinking and feeling through play,
drawing, acting etc.
Long-term needs
Children need to understand – it is normal for Re-establishing routines or building new ones –
children of all ages to require an adjustment children become disturbed by changes to their
period to traumatic bereavement, during which routines and therefore feel more secure when
certain topics will need to be discussed more these are re-established. They like predictability
than once. Younger children may use play that in people, places, times and activities. Routines
re-enacts the trauma or events associated with should include:
it to explore confusing or emotional topics. This
may be upsetting to watch. • Bedtime routines: usual activities leading up
to bedtime (e.g. brushing teeth, bedtime
• Facilitate young children’s play story)
• Allow questions and conversations; • Mealtimes at the same time and place each
questions should be answered as clearly day
and consistently as possible • Attendance at playgroup, school and other
• Some children may only manage short activities
conversations and young children will ask • Leisure times with friends.
some questions repeatedly since they
cannot understand death fully Dealing with reminders – unsettling reminders
• An older child may want to talk about of the death or trauma can come at random or
feelings of fairness, injustice and blame in response to triggers in the child’s life.
• Look at albums and talk about photographs Managing reminders and triggers can provide
and other mementos them with more stability and a sense of greater
• Visits to the grave and other relevant places emotional control.
may be helpful.
23
• Develop a plan to avoid or minimise prefer to talk to others outside the family as
unnecessary exposure to reminders which time goes on
are unsettling • Encourage a sense of optimism about the
• Develop a plan to deal with reminders and future.
triggers should they arise
• Provide reassurance that reminders and Management at school
triggers will become weaker and less
Young children are highly sensitive to the
frequent over time
reactions of adults around them. Ideally, their
• Prepare for significant dates such as
interactions with adults and teachers should be
anniversaries, birthdays and other occasions
comforting and predictable. Following traumatic
• Prepare for events such as court cases,
bereavement, family routines are often broken
coroner’s investigations, or media coverage
and adults can behave in ways that young
involving the death. It is helpful for the child
children do not fully understand. While parents/
to know in advance what details will be
families have the task of explaining what
covered at these events, and whether or not
happened, school life can offer the day-to-day
they have to participate.
stability and structure that most children need.
Facilitating the coping of the main caregiver –

Traumatised and bereaved pupils react in a
the wellbeing of the main carer is essential to
variety of ways as they try to come to terms
the wellbeing of the child. Adults need to take
with their experience. Their teachers may notice
time and accept support to manage their own
changes in their concentration and behaviour
reactions to trauma and grief.
over the first two years. Be mindful that they will
revisit the death as they move through their
• Be aware of the impact of the main carer’s
developmental stages. Teachers cannot change
coping (or not coping) on the child
the events that have happened but, by their
• Encourage the adult caregivers to seek
support, they can make a difference.
support for themselves, if necessary.
• Inform relevant adults in the school setting

Looking to the future – new feelings and
of what has happened to the child
understanding of death will emerge as children
• Keep a record of a) date of bereavement, b)
grow and realise more about the world.
relationship of person who died to the child
Keepsakes and anniversaries will be special to
and c) dates of relevance – birthdays and
children in the future.
anniversaries
• Attach a sticker to the outside of the child’s
• Children should be involved in marking
file and a label with details inside the cover.
anniversaries and significant occasions
This way there is less likelihood of any
• They will need to continue to invest in new
member of staff missing it
friendships and find meaning and strength
• Keep in touch with home, being aware that
from their experience instead of vulnerability
grieving parents may not always be able to
• Accept changes in their opinions, memories,
support their children effectively
and worries over time
• Ensure that, if a teacher or classroom
• Encourage children to hold onto mementos
assistant is off, a system is in place to inform
and keepsakes
the substitute figure of the child’s situation
• Be aware that they may have new questions
• Ensure that this information is flagged or
about the death in the future as their
passed on to the next teacher or school.
understanding grows, adolescents may
24
• Be sensitive to special dates (e.g.

Management in the classroom
Mother’s/Father’s Day), anniversaries, or
Returning to school following a traumatic
events where parents usually attend. These
bereavement should be planned to minimise
will affect the child and their family. If a class
potential difficulties:
is making Mother’s/Father’s Day cards,
children should be encouraged to make
• Talk with parents and the child about when
them for a parent who has died. Allow them
to go back to school, what information to
to keep these cards or give them to a trusted
share with classmates, and any specific
adult for safekeeping
worries or requests they may have. Some
• Children may become withdrawn and
children need to be prepared for what their
isolated from their peers (they have gone
classmates already know, or how they
through an experience that most of their
reacted. They also need to know how to deal
peers will not be able to comprehend fully).
with questions or comments from other
Their outlook on the world may have
pupils
changed
• Talk with the class or group about what
• Bereaved adolescents are more likely to be
happened (with the family’s agreement). Use
bullied at school, and may be less able to
age-appropriate explanations and let them
cope with this
know when the child will be coming back
• Encourage peer group support for older
• Be prepared for your own reactions –
children – adolescents with similar losses
children will be very sensitive to the
may be able to support each other. Talking
reactions of familiar adults
and sharing in groups helps normalise
• Be aware that grieving parents may not
experiences and eliminate social isolation
always be able to support their children as
• Older children may not wish their family to
well as they used to. For some children
know about any difficulty at school because
school can be the most safe and predictable
they want to protect them. Deal with this
time during their day
sensitively and respect their wishes where
• Expect the child to function in the class but
possible, while at the same time
be flexible with their workload. Be
encouraging more open communication with
sympathetic, gentle and firm. Children may
their family
need extra support or consideration in the
• If a child in the class has died, other
early stages
classmates may wish to make a memory
• Their concentration and memory may be
box, book of thoughts, or other such gift for
affected and will only return to normal as the
the bereaved family. If the class is to
bereavement and trauma issues are
participate in a funeral or other ritual, they
resolved (may take up to two years or
need to be prepared for what will happen.
longer). Teachers may need to discuss with
the child and their family the option of
Be aware that children will revisit their grief as
deferring exams until a later date
their understanding grows, leading to possible
• Some children throw themselves into their
changes in temperament, capacity, and
work and become model pupils. It is unlikely
behaviour which will not always be obviously
that they will be able to maintain this in the
connected to traumatic bereavement.
long term
• Ensure that there is a quiet place where the
child can talk, or just be alone (but
supervised), if the need arises
25
OUTCOMES
Most children will recover from traumatic
bereavement; however there is no definitive
timetable for the conclusion of grief, indeed
bereavement is often seen as a lifelong
influence on development. The most intense
reactions tend to be experienced in the first two
years. They can be helped to manage their
difficulties, to reduce their confusion about
death and trauma, to increase their sense of
safety, and to form healing emotional bonds
with family and peers.
Children can work through the effects of

traumatic bereavement with the emotional
support of their family and friends, a stable,
caring environment; and good information,
based on fact, which helps them gain
appropriate understanding of the bereavement.
However, parents must be prepared for children
to revisit their trauma and bereavement again
throughout childhood and their teenage years
as they understand more about themselves and
the world. During these times their behaviours
may become more difficult.
26
SECTION 3
Traumatic bereavement in adulthood
27
SECTION 3: Traumatic bereavement in adulthood
The understanding of adults with learning

General needs
disabilities may be similar to that of a younger
Adults have common needs – all adults have
person – therefore communications and
needs such as the need to be safe and
explanations should be tailored to their level of
provided for, to have companionship, emotional
understanding rather than age. They may
bonds, and social support from other people;
require simplified explanations of death and
and to have good self-esteem. People will
trauma, and encouragement to discuss any
express these needs differently (one person’s
areas of the death they are unclear about. They
idea of safe may be very different from
may also require more practical support or
another’s). Different needs will be more
access to resources than the family alone can
prevalent at different times of life. For example,
provide. For adults who have less
a person may feel very little need for safety
understanding of death than their peers, it may
under normal circumstances, but they may be
be helpful to read the guidelines provided for
greatly concerned about it following an
younger age groups.
accident. People may also find that their need
for companionship (e.g. emotional bonds and
social support) will change over time.
Understanding of death
Death is unavoidable and irreversible, with
Men and women react differently to similar concrete causes – adults understand that death
situations – men and women have different happens to everyone at some point and that
ways of coping with events and offering help to you cannot bring someone back from the dead.
others. In stressful situations men are less likely They also understand that death is caused by
to talk about their problems and more likely to age, illness, trauma, etc. even though they may
work through them by either taking action or not understand the specifics. Sudden or
distracting themselves. Women are more likely unnatural deaths (or the death of a child) are
to work through their problems by confiding in less likely to be understood or accepted, and
someone who can help them or identify with more difficult for adults to come to terms with.
their situation.
They can empathise with others, but men
Partnerships and families – these can be a especially are likely to hold back their feelings –
source of both stress and healing. Becoming a they can share in and understand the feelings
parent or a spouse brings with it new of those around them, with women being better
challenges and a lot of adjustment. However, at seeking out friends they can relate to.
these roles also fulfil many emotional needs as
being part of a family or partnership means the They can become pre-occupied with
person has access to emotional resources and justice/injustice – they can feel a sense of
security when they need it. People in injustice and view sudden death as unfair or
partnerships generally survive trauma more undeserved. Issues of punishment or retribution
successfully, providing their partner or family can come into play and serve to prolong grief,
isn’t the major source of stress or isn’t especially if media involvement or criminal
significantly affected by the same event. proceedings are protracted. These feelings can
recur in adulthood if the bereavement occurred
earlier in life.
28
concentration difficulties at work are common

Reactions to trauma
signs of stress.
Adults’ reactions to trauma are not solely based
on actual memories or exposure to trauma
They can over-estimate the negative role they
(although these are major determinants). Those
played in the traumatic situation – and feel
who do not fully understand the methods or
guilty or ashamed of their reactions. They can
motives behind traumatic events attempt to fill
be preoccupied with any negative contact they
in the gaps through fantasy, imagining worst
may have had with the person prior to their
case scenarios and believing them to be true.
death, or with thoughts of how they could have
These fantasies are traumatic in themselves,
acted differently (although these may be
and must often be confronted with the help of
secret). They may also feel personal
trusted adults or friends.
responsibility or blame themselves for not doing
things differently. For some there is a strong
They experience trauma as fright or terror –
sense of survivor guilt.
adults are experienced enough to recognise a
traumatic situation as threatening both to
They understand the long-term implications of
themselves and others. Their bodies react with
trauma – they realise that what’s happened will
a pre-programmed fright response. This strong
stay with them for life, that it will affect their
bodily response is unsettling, and can recur
home and social life, and that some of the
later when they feel unsafe or are reminded of
changes that occur following trauma will be
the trauma. These reactions can be distressing,
permanent.
difficult to control, and may give rise to specific
post-traumatic reactions (which may be short or
long term).
Reactions to traumatic
bereavement
They need to understand what happened – Adults’ grief will vary according to how
adults want to understand more about the emotionally close they were to the person who
sudden death than just the bare facts, tackling died; and how exposed they were to the
issues such as justice which are difficult to circumstances of death.
explore. However, thinking about it can be a These deaths can
distressing experience, especially when that include those of
trauma is recent. Understanding, or finding a friends or
meaning for trauma, can be very important in members of
coming to terms with it, especially if it leads to the
the prevention of future traumas. Unfortunately, community
not all the facts about trauma are known initially with whom
– many trauma survivors must wait for criminal, they
historical or scientific investigations to find the identify.
truth and for some it will never be known.
They react to
They experience stress – stress responses in loss – following
adults are well known. They may show signs of bereavement
being irritable, easily startled, nervous of or long-term
anything that reminds them of the trauma, or separation,
otherwise distressed. Nightmares, intrusive adults
thoughts, poor anger management and
29
experience grief. This includes feelings of important changes in the body’s chemical
sadness, anger, guilt, blame, loss, yearning, system. As a result, some memories of the
heartache, and hopelessness. These feelings person who died can cause upset instead of
will change in intensity and severity over time, comfort. They may be brought to mind
and may overlap or come and go rather than be uncontrollably, either in response to reminders
experienced as predictable stages or of the trauma or at random. They also have a
progression. Some people will have past physical component, in that they often result in
experiences of death and loss which may help increased heart and respiration rates, and can
them cope. Younger adults usually have fewer be tiring, distracting, and unsettling.
established coping mechanisms for dealing with
stressful situations of this nature. Their bodies become fatigued by fright –
prolonged exposure to or experience of fright
They react to trauma – adults become intensely causes the body to react in ever stronger ways.
frightened by traumatic situations, particularly Usually, adults who feel safe experience only a
those they have witnessed. Often, traumatic moderate jolt of extra energy when they get a
memories can be very upsetting and fright. However, the fright response becomes
uncontrollable, and are re-experienced over a stronger the more it is used, so when a person
period of time. Trauma interrupts daily lives, is traumatically bereaved they use up a lot of
and makes fitting into old routines and social energy when they feel unsafe or experience
interactions more difficult. Bodily reactions to traumatic memories. Over days and weeks this
trauma can lead to fatigue and vulnerability to can drain the body of resources and leave it
illness. It may also exaggerate difficulties in vulnerable to illness or infection.
home, work, or community settings which pre-
date the traumatic They can be overwhelmed – the overall effect
bereavement. of grief and trauma is more difficult to deal with
than either grief or trauma alone. The effects of
Memories and traumatic bereavement are prolonged, and can
feelings of be re-experienced over time as reminders re-
trauma are awaken memories of the event. They can result
hard to forget in anger, blame, or guilt which can be difficult or
– these can shameful to talk about, and affect other
be members of the family and community. Children
frightening, are particularly sensitive to the emotional state
and are not of their parents. Often work settings can offer a
always easy to welcome relief from thinking about the
control. They bereavement.
leave people
nervous, What affects adults’ experience of
expecting
an
traumatic bereavement?
unsafe Sudden deaths which are witnessed will have a
future, more intense impact – seeing a sudden death is
and intensely stressful and frightening. Memories of
lead to trauma are not only visual but may include
hearing the sounds associated with the death
(e.g. loud bangs, screaming, sirens) as well as
30
remembering smells and other sensations, communication on difficult topics such as these
which can be just as distressing. People who in order to encourage the adult to open up and
witness a sudden death will need reassurance, express privately held fears and anger.
good information, and support as soon as
possible, to help them understand what They can gain support from family, friends, and
happened. Initially, memories of what occurred the community – the best support is gained
may be more stressful than bereavement itself from the people they are most involved with.
and are linked to a continued sense of threat However, severe trauma can make group
(feeling very unsafe or vulnerable to attack), involvement difficult for affected adults, who
survivor guilt (questioning the fairness of your may become more isolated or over-involved
survival in comparison to the death of a loved with their own family. Changes in behaviour and
one), and pre-occupation with the intrusive attitude to relationships can also affect
memories of what occurred. emotional support from close friendships.
They create traumatic fantasies to fill in gaps in They are sensitive to routines and locations –
their knowledge – sudden deaths that are not people feel safest when they are with trusted
witnessed directly or that leave surviving adults friends and are in familiar environments. Home,
with unanswered questions about the death (or work, and recreational settings are important in
person who died) often lead to traumatic making them feel physically and emotionally
fantasies. These fantasies are the explanations secure. A death in the family or community can
people create to fill in gaps in their knowledge disrupt these routines, and make the person’s
of the events surrounding the death. They might world less predictable and secure.
include fantasies that the death took longer
than it actually did, or that the person suffered
for a long time. People may also believe that
they could or should have done something
simple to avoid the death, or place undue
importance on the last disagreement they had
with the person who died. Traumatic fantasies
can be distressing and provoke strong
emotional reactions. They usually focus on the
worst possibilities, and fade with time as people
learn more about what happened. Adults who
have traumatic fantasies need good information
(with appropriate levels of detail) conveyed with
reassurance.
They have private beliefs and emotions – they

may believe that the death could somehow
have been avoided if they or some other
person/group had acted differently. Blame and
the need for retribution may be an issue
depending on the circumstances of the death.
However, these beliefs are not always shared
openly – particularly in the family if children are
involved. Family or friends can start helpful
31
Make the loss real – participating in rituals

GUIDELINES
surrounding death will help adults make their
The needs of adults vary greatly according to
loss real. These may vary according to their
each individual and their circumstances.
culture or belief systems. Encourage them to:
Relationships with family and friends can be
equally important in meeting their practical and
• Participate in rituals (e.g. funeral, leaving a
emotional needs. Gender, ability, and level of
personal memento on the grave)
understanding also have a part to play in the
• Share feelings of sadness
coping methods of adults, which tend to be
• Identify and keep their own personal
wide-ranging and may differ from the methods
reminders.
favoured by friends and other family members.
Specific reactions to trauma – following trauma

Immediate needs or sudden death there will be specific reactions
Promote a safe environment – it is important to in adults which are difficult to control and affect
feel as safe as possible both immediately after behaviour, mood, and decision making. They
a sudden death, and in the long term. Ideally, may be more easily startled or agitated,
daily routines (e.g. work attendance) should be forgetful or accident prone, more likely to have
re-established as soon as appropriate. Give vivid dreams or difficulty sleeping; and more
time to any concerns the person may have. likely to think repeatedly about the person who
died or aspects of their death. They may also
• Work for continuity in home, work, and feel isolated, cheated, different or set apart from
recreational settings others by their trauma, uninterested in friends
• Give time and emotional reassurance or consolation; and hopeless for the future.
• Take the person’s fears about safety
seriously and, if necessary, develop a • Reassure them that what they feel is normal
concrete safety plan that addresses • Reassure them that reactions such as these
concerns about security (e.g. locking doors, will fade with time and support from others
leaving lights on at night). • Encourage them to take further advice on
their reactions if they are a prolonged source
Clear communication – adults understand of distress (e.g. refer to self-help information,
death, but may not always have the information GP, health worker).
they need to understand the circumstances
surrounding it. It is important for them (or their Practical issues – following traumatic
partners/families) to seek out accurate bereavement there will be many practical
information early, or at the earliest appropriate issues to be dealt with. Some of these need to
time. be handled immediately or soon after the death
occurs (e.g. funeral, obituary), others can be
• Encourage the person to seek out accurate delayed until after the initial shock has passed
information and truthful explanations (e.g. sorting personal belongings). Delaying
• Establish as much detail as is necessary at non-essential decisions or discussing options
an early stage to reduce confusion with relevant people can allow people to sort
• Clear and honest information and discussion through their feelings and think through choices
can help identify concerns that may which will be important in the long term.
otherwise be missed. Encourage them to:
32
• Pace themselves and avoid making too • Develop a plan to avoid or minimise
many early decisions unnecessary exposure to reminders which
• Use resources such as family, close friends, are unsettling
faith representatives, or GPs who may have • Significant dates such as anniversaries,
experience in wide-ranging issues relating to birthdays and other occasions should be
traumatic bereavement prepared for in advance
• Wait until they are ready before making big • Events such as court cases, coroner’s
decisions (such as sorting the personal investigations, or media coverage involving
effects of the person who died). the death should be prepared for and
discussed. It is helpful for people to know in
Long-term needs advance the topics which will be covered at
these events, and what details are likely to
Adults need to understand – they may need to
be discussed
discuss difficult topics including issues relating
• Develop a plan for dealing with reminders
to unfairness, anger, guilt, or blame. Distressing
when they arise
issues or events will need to be discussed more
• Provide reassurance that reminders and
than once. Visiting the grave or places where
triggers will become weaker and less
the adult feels close to the person who died can
frequent over time.
help with coming to terms with the death.
Encourage them to:
Looking to the future – new feelings and
meanings will emerge as the person works
• Ask questions and talk about any feelings of
through their experience. Anything positive
anger, blame, guilt, and justice
which comes from traumatic bereavement is
• Visit the grave or other relevant places
likely to be a source of strength for them in the
• Look at albums and photographs.
years to come (e.g. being able to help other
traumatised people). Keepsakes and
Coping with emotions – talking with the adult
anniversaries will be special to them in the
about their feelings may help them confront
future, as will positive reminders of the person
their fears and provides reassurance and
who died.
emotional support. Share any grief you may feel
personally in a measured way.
• Be aware that people will change their
opinions over time
• Talk about their anxiety about something
• Be prepared for younger adults to have new
happening to their family or themselves
questions about the death again in the future
• Talk about guilt feelings and/or anger,
• Be optimistic about the future – things can
blame, regret …
and usually do get better.
• Reassure them that what they feel is normal
• Help them reconnect with happier memories
of the person who died.
Dealing with reminders – unsettling reminders

of the death or trauma can come at random or
in response to triggers. Managing reminders
and triggers can provide people with more
stability and a sense of greater emotional
control.
33
OUTCOMES
Most adults recover from traumatic
bereavement; however there is no definitive
timetable for the conclusion of grief, indeed
bereavement is often seen as a lifelong
influence. The most intense reactions tend to
be experienced in the first two years.
Adults who are traumatically bereaved can be

helped to manage their difficulties, reduce their
confusion about death and trauma, increase
their sense of safety, and to form healing
emotional bonds with family and friends. In this
way, the most acute consequences of traumatic
bereavement can be worked through with a
small number of people (usually a mix of family
members and close friends).
Specific symptoms can develop which may be

difficult to cope with. See management
guidelines contained in Section 4 “Common
grief reactions”
34
SECTION 4
Common grief reactions
35
nightmares) are a normal and healthy reaction

SLEEP DISTURBANCE
to a bereavement or sudden traumatic event.
Sleep They may focus specifically on some aspect of
Sleep is an important activity that helps the trauma or appear unrelated to it, but
maintain a healthy body and improves become less frightening and more general as
concentration, memory, and the performance of the person comes to terms with their loss. Most
daily tasks. Most people have individual people dream three to six times each night but
routines for relaxing or getting to sleep. Some do not remember their dreams when they wake.
relaxing routines (e.g. reading, having a cup of
tea before bed) will not work for everyone and Sometimes disturbing dreams or nightmares
can sometimes make getting to sleep more can be so vivid or upsetting that they wake the
difficult. person up or prevent sleep. A well-meaning
parent, sibling or partner may also wake up a
Routines and activities before bedtime person who is having a distressing dream.
(especially the last hour before bed) will have a Interrupted dreams such as these (where the
noticeable impact on people’s ability to sleep. dream does not end naturally) are the most
There is no absolute amount of sleep people distressing and least helpful. Some people may
should have because they require different need help from trusted adults or friends in
amounts to remain healthy, depending on their coming to terms with the underlying causes of
age and level of activity. Generally speaking if their vivid dreams, or be allowed to dream and
they do not appear tired during the day they are finish their nightmares without being wakend up.
probably getting enough sleep.
Sleep disturbances
Dreaming Sleep disturbances occur when a person has
As well as being necessary for physical well- difficulty getting to sleep, staying asleep (night
being, sleep also allows people to dream. waking or waking very early), or getting
Dreams are used to process emotions, refreshing sleep. Sleeping patterns change as
organise memories, and prepare the mind for people grow, and different sleeping problems
the day to come. They may be senseless, will occur at different ages. For example,
enjoyable, or utterly terrifying, but they all have adolescents are more likely to have daytime
a purpose. sleepiness and trouble getting to sleep early at
Distressing night than adults.
dreams
(e.g. It is common for sleep disturbances to occur in
people who have witnessed or been affected by
a sudden death or traumatic event. Most
disturbances involve difficulty getting to sleep or
staying asleep, having sleep-related fears (e.g.
safety worries); or disturbing dreams. These
may result in:
• Staying up late or not being able to get to

sleep at a reasonable hour (feeling that it is
too early for sleep or that sleep is
impossible); or a younger child resisting
going to bed
36
• Wanting to sleep in the same room as Following traumatic bereavement, people

someone else for safety sometimes need to find new ways to wind down
• Having nightmares, or night terrors (waking or get to sleep at a regular time. Relaxation,
up screaming) exercise, diet, and planning are the most
• Waking repeatedly or at random during the effective ways of improving sleep and do not
night carry risk in the long or short term. Addressing
• Younger children regressing back to bed safety fears and providing reassurance can also
wetting be extremely effective in combating sleep
• Waking very early in the morning and being disturbance and preventing future problems.
unable to get back to sleep
• Being sleepy or irritable the next day. Improving sleep
Dealing with causes of poor sleep – many of
Disturbances such as these are normal
the causes of poor sleep involve changes to
following traumatic bereavement, and will
routine such as bedtime, activities before bed or
usually fade away with time as the person
the person putting a child to bed. Changes to
comes to terms with their emotions and
the bedroom environment, for example, the
understanding of what happened. For some this
temperature, light level or background noise
will take a long time, while others will not have
can also have an effect. It may be necessary to
any problem sleeping at all. Some people will
remove ticking or brightly lit clocks that act as
need reassurance and support from family or
reminders that the person is not sleeping. Some
friends in order to overcome their sleep
medicines, large meals, or drinks like tea,
disturbances. They can be helped to improve
coffee or alcohol can interfere with normal
their sleep by considering the following:
sleep, as can lack of exercise during the day.
Some people will benefit from extra exercise
• Signs of stress (e.g. irritability, anxiety,
after a traumatic event.
muscle tension)
• Fears about safety (for themselves or other
People may have trouble sleeping because of
family members)
fears about their own safety or perhaps the
• Specific fears related to bedtime
safety of their family home. They may have
• Changes to the setting, level of background
specific fears related to bedtime which might
noise, or temperature of the bedroom (e.g.
include fear of not being able to sleep or of
sleeping in a different room)
having nightmares; they may also fear reliving
• Side effects of medication (e.g.
the trauma or having other intrusive thoughts,
decongestant medication)
usually related to memories or fantasies about
• Lack of exercise
what happened. These fears should be taken
• Changes in bedtime routine (e.g. timing,
seriously as they can be genuine sources of
activities involved)
distress in many people following a traumatic
• Expecting the problem to get worse and
loss.
watching the clock through the night
• Napping during the day
Bedtime and early morning are times when
• Drinking tea, coffee, and caffeine drinks at
people are likely to think back on trauma, loss,
night
or how their life is different now. This can be
• Drinking alcohol at night
reflected in trouble getting to sleep at night, or
• Smoking before going to bed.
trouble getting back to sleep if a person wakes
early in the morning.
37
If these causes are suspected they may be • Switching the person’s attention away from
addressed directly through reassurance and the intrusive image or thought before it can
action, or with the advice of a GP (health play out in their head
assessment and medication). Helping to restore • Focusing their attention on a sensation (e.g.
or re-establish a bedtime routine which matches finger tapping) or action (e.g. counting to ten
(as closely as possible) the original routine will repeatedly) to block out all other thoughts
be very beneficial, as will providing reassurance or
(both emotional and physical) about the • Listening to low level, soothing background
person’s specific fears and worries at night. music that is loud enough to comfort but
quiet enough to promote sleep
Awareness and Preparation – being aware of • Using a comfort object or toy (e.g. blanket).
what is helpful and unhelpful in getting an
individual to sleep is very useful. Not all ways It is important to have a method of distraction
suggested to improve sleep will suit everyone identified and practiced in advance.
(e.g. some people need to sleep with music on
and some need total silence). Relaxation – this is an important skill for people
who have been traumatically bereaved, as
It is important to be aware that changes in trauma and loss create many difficult memories
people’s lives bring changes to their sleeping and overwhelming moments. Learning an
habits. This may be most noticeable following a individual way of dealing with emotional stress
traumatic loss or event. For example, most can be invaluable. This could be getting good
people will have concerns about safety and exercise, socialising, watching a favourite DVD,
may want to sleep in a room with someone listening to music or just having a place to be
following a traumatic bereavement. This is a alone. In general children relax through play
normal reaction, and sleeping in a room with and younger children may also find a favourite
someone else can help a person relax and toy or object soothing or relaxing.
sleep more soundly. Being afraid, alone in their
own bed and unable to sleep, is likely to Following trauma and bereavement, people
prolong distress. However, not wanting to sleep may need to find different methods of relaxing
alone can be difficult in the long-term. It is or unwinding than they used in the past. The
important to take a balanced approach and to following are some popular ways to relax:
gradually return a person to their normal
sleeping routine over time, for example a child • Yoga
may initially sleep in a parent’s bed with a • Walking
staged return to their own bed. • Jogging
• Exercise
Distraction – some people are unable to get to • Sports
sleep because they can’t stop remembering or • Music
thinking about the trauma. These thoughts can • Fresh air
be brought on by a dream or nightmare, by • Games
something that reminded them of the trauma • Reading
during the day, or sometimes for no apparent • Watching TV
reason. Distraction is one of the most effective • Hobbies
ways to deal with these thoughts when they • Massage
arise. It involves: • Controlled breathing
• Talking with friends
38
• Aromatherapy about their children’s fears – children must be

• Structured relaxation (tape or book). gently encouraged to share any fears they
have, again this is best done during the day and
Children may find playing with friends, someone avoided at night.
reading or singing to them, and sitting on a
parent’s knee relaxing. • Reassure the person emotionally and
physically
Not all relaxation techniques will be suitable for • Take their fears seriously
everyone, but most people will find at least one • Develop a safety routine if they feel unsafe
which works for them. Adults may find it useful in their room or home (e.g. develop a routine
to learn at least one formal relaxation method for locking windows and doors at night)
such as controlled breathing, guided imagery, • Reassure the person that these fears will
or progressive muscular relaxation (these fade with time
techniques are described later). • Work with children to decide on a way of
overcoming nightmares or anxieties (e.g.
GUIDELINES special karate chops to kill monsters,
becoming invisible to bad people)
Take a flexible approach – people have different
• Practice methods of relaxation during the
needs and ways of relaxing depending on their
day until they are familiar and comfortable.
age, gender, and personality. Think about how
stress, noise, temperature, surroundings,
Develop a bedtime routine – a bedtime routine
timing, diet and exercise affects sleep.
is essential for letting the body know it should
prepare for sleep. Preparing for sleep can start
• What works for one person may not work for
much earlier than bedtime (e.g. not drinking
another
alcohol or caffeine in the four to six hours
• What works at one time may not be suitable
before sleep); or five minutes beforehand (e.g.
later on
drinking some warm milk just before bed). Aim
• People of different ages are likely to have
to establish consistent and reassuring routines.
different ways of relaxing or preparing for
sleep
• Identify, in advance, routines that will help
• Be prepared to try different approaches
the person relax or prepare for sleep
• Some people will rapidly return to normal
especially in the last hour before bedtime,
sleeping patterns, others will take longer.
for example, listening to music or
reading/having a story read
Take fears seriously – bed/night time fears and
• Identify activities which should be avoided
nightmares can be very real and frightening.
before bed, for example, energetic physical
Following traumatic bereavement they can be a
activity, exciting computer games, listening
healthy sign that the person is tackling their
to loud music or drinking strong
emotional problems. People will often respond
tea/coffee/alcohol or sugary drinks
positively when encouraged to face their fears
• Help people decide something they can do if
in creative or practical ways. Teaching them to
they are awake and worried during the night
overcome night-time fears can go a long way
(e.g. read a favourite book, play with a
towards reducing their stress. This is best done
favourite toy or have warm milk).
during the day and avoided at night, otherwise it
can serve to remind the person of their fears
near bedtime. Parents may not always know
39
Develop strategies for dealing with intrusive twenty minutes a day should be spent
thoughts or images – people need practice in practicing relaxation until the person feels
how to deal with intrusions if they are unsettling comfortable with a method that suits them. It is
or prevent sleep. Some people use distraction, important that they keep practicing even after
others may use relaxation to overcome them. the basics are understood as the body will
Not everyone will know how to do this initially, continue to learn how to relax more quickly.
and may have to be taught simple techniques.
• Choose a method of relaxation and practice
• Identify and practice a method of distraction it regularly, the assistance of a recording or
to help interrupt unwanted thoughts, for instructions read by a friend may help with
example, count backwards from a hundred learning
or finger-tapping, children can recite their • Recommend setting aside a regular time
favourite poem or sing a simple song during the day to practice (not just at
• Use relaxation or exercise to reduce stress bedtime)
• Set aside time to think about the intrusive • Suggest using more than one technique
thoughts or images, how they were (e.g. muscle relaxation and controlled
triggered, or how they relate to the trauma. breathing)
Talk about fears and provide reassurance • Try to make the experience creative and fun
• Children may need a night-light and/or quiet for children
soothing music. • Encourage regular exercise.
Set aside time to think about the trauma in a Regular exercise – exercise has a highly
constructive manner – many people are beneficial effect on sleep and general
tempted to put thoughts of the trauma from their wellbeing. It is recommended that twenty to
minds because they are too distressing. Some thirty minutes exercise should be taken three or
people find this more difficult to do at night four times a week. This can include:
when they are trying to sleep, and their
thoughts may keep them awake for some time. • Brisk walking
Identifying a particular time to think about the • Cycling (machine or on the road)
trauma enables people to prepare themselves • Swimming
for this upsetting task. • Gardening or housework
• Running
• Encourage the person to make time for • Games – football, tennis, squash, badminton
reflection in their daily or weekly routine, • Exercise in the gym; weight training;
either alone or with a trusted adult/friend exercise machines.
• Help them plan what they will do in this time,
for example, reflection or creating a journal
or scrapbook
• Recommend a time of relaxation afterwards.
Practice relaxation methods – relaxation is the

best way to prepare for sleep, and is a skill that
most people can become good at in a short
space of time. It can be practiced alone or with
a partner or friend, preferably in a quiet place
which the person finds peaceful. At least ten to
40
• Only allow your child to sleep in your bed as

DEALING WITH NIGHTMARES
a last resort; instead try leaving a light on in
Facts about nightmares their room, playing low music or sleeping in
• Nightmares are a normal part of childhood their bed with them
from the ages of about three or four years • Do not share any of the details of what you
upwards and are associated with the heard or suspect the nightmares are about,
development of the imagination the person will most likely forget it when they
• Most people are not awake or aware when wake up. Take your cue for action from
they have nightmares them: ask them if they slept well or how they
• Nightmares, like dreams, are a natural way feel when they get up in the morning
of dealing with painful or emotional issues • Avoid being overly sympathetic about
• Although nightmares can be very vivid, even nightmares as children can sometimes see
to the point where they wake a person up, this as a reward.
they are usually more distressing to the
person watching than the dreamer If the person has no anxiety about
• People are biologically programmed to nightmares:
forget dreams and they will be forgotten if • Avoid discussing nightmares, but talk about
the person doesn’t spend time thinking feelings of sadness and grief during the day.
about them immediately after.
If the person has anxiety about nightmares:
Managing nightmares • Discuss nightmares; try to get them to
• Allow people who are having nightmares to describe what they feel. They may be able to
continue dreaming. They can be calmed with trace the nightmare back to their trauma and
gentle soothing (soft spoken reassurance, need help to deal with specific fears or
lullabies, holding) that does not wake them memories
up properly but can divert the flow of a • Help them feel safe but avoid making them
nightmare feel that you’ve saved them or protected
• Work towards getting the person back to them from anything
sound sleep as soon as possible. This • Help the person realise dreams and
means avoiding the approach “wake up, nightmares only exist in their imagination,
wake up – you’re having a nightmare”. and that they cannot be hurt or controlled by
People will have trouble getting back to them
sleep if they wake up scared • Get them to imagine happy endings to their
• If the person is already awake and nightmares or bad dreams. After some
screaming hold them, make soothing noises, practice, these will be remembered in the
put on soft lighting nights to come.
and stay with
them until they
calm down.
Give a child
what comforts
them, for
example, their
favourite teddy
or blanket
41
OUTCOMES INTRUSIONS
Sleep disturbance is one of the first signs of What are intrusions?
traumatic stress, and also one of the most Intrusions are specific, repetitive thoughts and
persistent. It is often used as a marker for how images relating to trauma that are normally
people are physically and emotionally coming to experienced in the days and weeks following a
terms with trauma and loss, and is a natural traumatic event. The extent to which these
response to sudden or dramatic change in thoughts and images recur varies greatly, as
children and adults. does the nature of people’s reactions to them.
For some people, traumatic thoughts and
It can sometimes continue in people who are no images will play only a minor role in their
longer acutely affected by traumatic bereavement, or will be absent altogether. For
bereavement because it becomes a habit. others, intrusions can interfere with the ability to
However, unless there is a definite medical or work, concentrate, and sleep, and lead to
continuing physical reason for disturbed sleep, strong emotional and bodily responses like fear
normal sleeping patterns can be re-established, or anger.
with advice, encouragement and action.
Intrusions occur when a person’s normal flow of
For some people, sleep disturbance can either thoughts is interrupted and dominated by
be prolonged or have a more noticeable effect unwanted thoughts, images, or impulses related
on work, education, family or health. They can to a trauma. These repetitive intrusions then
benefit from understanding more about sleep, become the centre of attention in the person’s
how to develop a bedtime routine, and how to mind and, although they are difficult to control,
develop methods of relaxation and distraction they are normal reactions to traumatic
for themselves and/or their children. circumstances.
Sleep disturbance may appear following the Types of intrusions

death or after a period of time. Sleeping habits
Nightmares – are one of the most common
may change in response to anniversaries,
forms of intrusion, and are generally understood
future trauma or other reminders. Sleep is likely
to be a natural human response following a
to be disturbed in the short term or not at all,
traumatic event. It is normal to have some type
and should return to normal without having to
of night waking, disturbed sleep, disturbing
complete any of the steps outlined here.
dreams, nightmares or night terrors following a
bad fright or scare. Nightmares can either focus
on some aspect of the trauma or can appear
unrelated to it.
Repetitive thoughts – are the everyday

fantasies, daydreams, and imaginary scenarios
that people run through their heads during the
course of the day. Following trauma, some
people may find that specific repetitive thoughts
or images of the trauma surface from time to
time either at random or in response to triggers
in the environment (e.g. something they’ve
seen, heard, or smelled that reminds them of
42
what happened). These intrusions can take the environment (e.g. the smell of smoke, a loud
form of: noise, the sight of blood, or a related news
story), or at random. Intrusions are also likely to
• Persistent thoughts relating to the traumatic occur at times of low activity such as bedtime or
bereavement such as “Why did it have to first thing in the morning. Generally, the
happen?” or “I am jinxed” frequency and unpleasantness of intrusions will
• Intrusive impulses such as panic or the urge diminish naturally as time goes by, but there are
to check doors and windows also ways of managing intrusions.
• Intrusive images such as remembering or
imagining the sights, sounds, or other details Managing intrusions and reminders
associated with the traumatic bereavement.
Avoidance of unnecessary reminders – this is
the most commonly used method of managing
Unlike normal daydreams which can be
the effects of intrusions and trauma. It involves
enjoyable or neutral, intrusions of this type are
avoiding some of the places (e.g. the hospital
unpleasant and troublesome.
where the person died), people, or things that
are reminders of the trauma, in order to avoid
Flashbacks – are like daydreams only more
the threat of further intrusions. In cases where
intense and realistic. People who have
this is impossible, for example, where there are
flashbacks report feeling as if they were back in
reminders in the home, people sometimes try to
the traumatic situation, being able to see, hear,
avoid feeling distress by controlling their
or even smell in great detail the specifics or
emotional responses.
surroundings of the traumatic event.
Flashbacks are usually accompanied by highly
In the long term both of these strategies
charged emotions, speed up the action of the
(avoidance and emotion control) are damaging
heart and lungs; and are very frightening. They
to the person and usually prolong distress.
can prove difficult to control, and may need to
However, most people try to manage the
be managed with special techniques. However,
reminders in their minds and in their
flashbacks can also disappear on their own.
surroundings, so as not to be overwhelmed. For
example, a person may avoid thinking about
Repetitive play – this is a common childhood
their trauma during working hours but put aside
reaction to trauma and death. Children use play
time at night to reflect on it. Alternatively, they
to understand the world around them and learn
may only expose themselves to mild triggers
new skills. As a reaction to traumatic
and avoid others until such time as they feel
bereavement, children often incorporate certain
they are ready to deal with them. Some people
aspects of the trauma into play (e.g. making toy
may need support to deal with reminders.
cars crash after a road traffic accident, or
playing cops and robbers after a shooting).
Distraction – distraction is one of the most
Often this play is not enjoyable for the child, nor
effective ways of dealing with intrusions when
will it necessarily make the child feel better
they arise. It involves switching a person’s
when it is finished. Although this play can be
attention away from the intrusive image,
unsettling to watch, children may need to do it.
impulse or thought before it can play out in their
head. Instead they focus on a sensation (e.g.
What causes intrusions? tapping a finger) or action (e.g. counting to ten
Intrusions are part of the mind’s reaction to repeatedly) to the exclusion of all other
trauma-related stress. They can occur in thoughts.
response to a reminder or trigger in the
43
GUIDELINES
Other methods of distraction emphasise
Take a flexible approach – the needs of people
thought-stopping where, during an intrusion, the
who have been traumatically bereaved are
person shouts “stop!” aloud (or in their head if
individual and changeable as they work through
they are not alone), in order to clear their
their grief. As a result, the effects of different
minds. If necessary, they are then free to use
intrusions and reminders will vary over time,
distraction to keep their minds clear until the
and require flexible planning.
threat of intrusion has passed. Certain methods
of distraction will suit some people more than
others (e.g. whistling a favourite tune), so it is
another
important to identify and practice an individual
method of distraction in advance.
later on
• Men and women are likely to have different
Relaxation – this is an important skill for people
coping methods
who have been traumatically bereaved, as
• Be prepared to try different approaches.
trauma and loss require them to face many
difficult memories and overwhelming moments.
Set aside time to think about the trauma in a
Learning an individual method of dealing with
constructive manner – many people are
stress can be invaluable.
tempted to put thoughts of the trauma from their
minds as they are too distressing. Having a set
People relax in many different ways, from
time to think about the trauma enables people
taking a bath, reading a book or watching
to prepare themselves for this upsetting task.
television; to long walks, running or playing
They may choose to do this alone or with a
sports. Not all relaxation techniques will be
trusted adult or friend. Many people use this
suitable for everyone, but most people will find
time to create a journal or scrap book to help
at least one which works for them. Following
work through their feelings and concerns. They
trauma and bereavement, people may need to
should be encouraged to:
find different methods of relaxing or unwinding
than they used in the past.
• Make time for reflection in their daily or
weekly routine
• Plan what they will do in this time (e.g.
reflection, writing)
• Allow time afterwards for relaxation.
Prepare for reminders – identifying, in the

environment, reminders and triggers for
intrusive reactions will allow the person to
become more in control and know what to
expect. It can be especially important in cases
where the media or legal processes are
involved. This helps make the person’s life
more predictable and less overwhelming. They
44
• Identify triggers and reminders in advance

OUTCOMES
• Be aware of on-going triggers like news
For people who have intrusive thoughts and
items.
imagery the experience can be very upsetting
and difficult to prepare for. Thankfully most
Develop strategies for dealing with reminders –
intrusions will weaken and diminish over time
with practice people will learn how to deal with
as people confront their loss and move through
triggers in their environment before they occur.
their grief.
Having the support of a friend or family member
with them may help reduce distress. They
In the early stages after bereavement, when
should identify and practice a method that
intrusions tend to be strongest, following the
interrupts their intrusions.
above guidelines can make the experience less
overwhelming. In cases where intrusions persist
• Thought-stopping (e.g. finger tapping)
over extended periods of time, especially if they
• Mental distraction (e.g. counting backwards
interfere with work, education, or family life, a
from a hundred)
person can be helped to understand more
• Using relaxation, deep-breathing or exercise
about them, how to recognise them and to
to reduce distress
develop methods of managing them. While
• Setting personal time aside to think about
there is no cure for intrusions but they can be
the intrusion, how it was triggered, or how it
made more manageable until they diminish
relates to the trauma.
naturally.
Regulate the number and intensity of reminders

that are encountered – especially in the early
stages of traumatic bereavement, people can
be easily overwhelmed by exposing themselves
to too many traumatic reminders before they
are prepared. It is a good idea to regulate or
limit the reminders if necessary, so that people
can get used to them at a manageable pace.
• Be aware of personal limits

• Identify reminders which could be
overwhelming
• Develop a plan for making severe triggers
more manageable.
45
of control or frightening. They will become

ANGER
angered by things which were not a problem in
What is anger? the past, or will feel misunderstood.
Anger is an emotional response experienced by
all people. It can vary from mild irritation to
Anger management
extreme rage, and can build up over long
The goal of anger management is to reduce the
periods of time or burst forth in a matter of
physical and emotional pressure to act out
seconds. It is natural for people to experience
aggression. This is done by identifying anger
different levels of anger in their lives. This is
triggers (e.g. not being listened to) and
due to differences in personal or family
developing a plan for dealing with these as they
circumstances, and body chemistry.
arise. Techniques such as relaxation (deep
breathing) or distraction (counting) are often
Anger can be caused not just by what other
used to control anger; or safe methods of
people do to us but also by what we do
expressing anger are used (exercise or keeping
ourselves. It could be directed at family, co-
an anger diary).
workers, friends, or strangers. It can be caused
by excessive worrying, traumatic memories,
Awareness and preparation – this is the most
sleep disturbance, substance or alcohol abuse,
effective method of managing anger. It involves
illness, stress, and poor communication.
identifying the causes of anger, and planning
what to do when they arise. Having a plan in
Anger is a natural response when a person
advance can give the person back a sense of
feels threatened. The brain releases hormones
control and optimism.
and other chemicals to excite the body and
prepare it for action. The way a person thinks
One of the most important steps in this process
changes so that they are more focused on
is identifying the changes which occur when a
aspects of a situation which they feel
person begins to get angry. Very often these
threatened by, and less concerned about the
changes involve speeding up the heart rate and
opinions of others. In highly threatening
breathing. Other signs include frowning, feeling
situations this can be a way for the individual to
flushed, tension in the shoulders, and irritability.
protect themselves as a last resort.
Once these signs are identified, the person can
work on a method of avoiding escalation into
Both trauma and bereavement can leave
full blown anger.
people feeling very angry. Dealing with
injustice, blame and the necessity of continuing
Identifying causes of anger can be done with
on with life are all sources of anger which are
either the help of a friend or alone (e.g. keeping
normally experienced after a traumatic
private ‘anger diaries’ of when and how anger
bereavement. Although this anger can resolve
takes control). These can help the person see if
itself with time, for some people it will be
there are patterns or triggers associated with
prolonged. They need to learn to control their
their anger such as places, people, time, events
anger, express it safely or control its impact on
(they may also include traumatic memories,
others.
sleep disturbance, caffeine, alcohol, family
members, co-workers, finances, time of day).
Excessive anger is difficult to define and will
Once triggers are identified, the person can
vary from person to person. Usually if a person
decide on the best method of dealing with them.
has a problem with anger they will know it
themselves. They may act in ways that feel out
46
Avoidance – avoidance is a good way of of anger or a hard day. Following trauma and
managing the sources of stress in everyday life bereavement, people may need to find different
so that they do not become overwhelming. For methods of relaxing or unwinding than they
example, a person may avoid thinking about a used in the past. The following are some
distressing memory or situation during working popular ways to relax:
hours but put aside time at night to reflect on it.
Alternatively, they may only expose themselves • Yoga
to mild triggers and avoid others until such time • Walking
as they feel they are ready to deal with them. • Jogging
Avoidance can help make life more stable and • Exercise
predictable, and gives the person control over • Sports
their progress. This can be especially useful • Music
immediately after a sudden death, when people • Fresh air
are more likely to be overwhelmed. • Games
• Reading
Distraction – distraction is an effective way of • Watching TV
dealing with anger as it arises. It involves • Hobbies
switching a person’s attention away from their • Massage
anger when that anger is destructive. Instead, • Controlled breathing
the person focuses on: • Talking with friends
• Aromatherapy
• A sensation (e.g. taking a deep breath, • Structured relaxation (tape or book).
finger tapping)
• An action (e.g. counting to ten slowly) Adults may find it useful to learn at least one
• A thought (e.g. I am calm). formal relaxation method such as controlled
breathing, guided imagery, or progressive
These should be focused on, to the exclusion of muscular relaxation (these techniques are
all other thoughts. Certain methods of described later).
distraction will suit some people more than
others, so it is important to identify and practice
a method of distraction in advance.
Relaxation – this is important for people who

have been traumatically bereaved, as trauma
and loss require them to face many difficult
memories and overwhelming moments.
Learning a method of dealing with emotional
stress can be invaluable.
People relax in many different ways, from

taking a bath, reading a book or watching
television, to long walks, running, or playing
sports. Not all relaxation techniques will be
suitable for everyone, but most people will find
at least one which works for them. Relaxation is
an important tool for calming down after a bout
47
• Speak in a clear voice, and go slowly

GUIDELINES
• Listen to other people and imagine their
Take a flexible approach – the needs of people
concerns
who have been traumatically bereaved are
• Check with other people that everyone has
individual and changeable as they work through
the same understanding
their grief. As a result, levels of anger will vary
• Make all complaints as specific as possible
over time, and require flexible planning.
• Keep talking to others.

Be prepared for triggers – identifying triggers for
another
anger or aggressive reactions in the
environment will allow the person to become
later on
more in control and know what to expect. This
• Men and women are likely to have different
helps make their life more predictable and less
coping methods
overwhelming. Identifying personal warning
• Be prepared to try different approaches.
signs that anger is on the rise (e.g. flushed
face, faster heart beat and breathing) can also
Set aside time to think about the trauma in a
help identify triggers and minimise anger. In the
constructive manner – many people are
early stages of traumatic bereavement
tempted to put thoughts of the trauma from their
especially, people can be easily overwhelmed
minds as they are too distressing. Having a set
by exposing themselves to too many triggers
time to think about the trauma enables people
before they are prepared. They should be
to prepare themselves for this upsetting task.
encouraged to:
They may choose to do so alone or with a
trusted adult or friend. Many people use this
• Identify triggers in advance
time to create a journal or scrap book to help
• Be aware of on-going triggers (e.g. finance,
work through their feelings and concerns. They
work, other people)
• Be aware of personal warning signs (e.g.
faster pulse).
• Make time for reflection in their daily or
weekly routine
Develop strategies for dealing with anger –
• Plan what they will do in this time (e.g.
people need practice in how to deal with
triggers in their environment before they occur.
Some people use distraction (e.g. counting,
thought-stopping, or taking deep breaths) to
Use good communication – good
take a step back from their anger, whereas
communication can eliminate the need for
others may use relaxation, humour, or having a
anger because it facilitates the exchange of
friend or family member with them to help
ideas and concerns without aggression. Much
diffuse it. They should be encouraged to:
of what is said when a person is angry does not
represent true opinions, and can make the
• Identify and practice a personal method of
situation worse. Some people may avoid talking
mental distraction (e.g. counting or thought
or conceal their anger only to have it surface
stopping) to interrupt angry thoughts
again later. They should be encouraged to:
• Use relaxation or exercise to reduce stress
• Set personal time aside to think about the
• Think through all responses before
anger, how it was triggered, or how it relates
responding
to the trauma
48
• Express anger in a controlled way (e.g. in an

OUTCOMES
anger diary, shouting into a pillow, or
Many people who have been bereaved
exercising).
traumatically will experience only moderate
amounts of anger, or none at all. Anger is likely
to be directed at particular people or groups
related to the trauma or family, and should fade
and or be resolved naturally without having to
complete any of the steps outlined here.
For some people, anger can either be

prolonged or have a more noticeable effect on
work, education, family, sleep, etc. A person
can benefit from understanding more about
anger, how to recognise it before it takes
control, and how to develop methods of
managing it.
Anger relating to a traumatic bereavement can

appear immediately or after a period of time. Be
prepared for the anger to resurface in response
to the media, anniversaries or other reminders.
49
50
SECTION 5
Relaxation techniques
51
1. Lie in bed with your eyes closed and

These techniques can be taught to
imagine you are in your favourite, most
help with personal grief reactions; peaceful place. It may be on a sunny beach, a
or to parents for use with their hilltop, their back garden or all alone in a cave
children. in the Himalayas. It does not have to be a real
place as long as you can picture it in your mind.
Deep breathing
2. Imagine you are there now. You can see
One of the main reasons many of us are tense
your surroundings, hear the peaceful sounds,
is our breathing. Most people breathe very
smell the fragrance of the flowers, and feel the
shallowly, using only the top part of their lungs.
warmth of the sun or whatever sensations are
Deep breathing allows us to use our entire
there. Just relax and enjoy it – and drift off to
lungs, providing more oxygen to the body. It is
sleep.
probably the most effective and beneficial
method of relaxation.
Once you’ve found a place that is especially
peaceful and effective you’ll find that the more
1. Lie down on your back.
you use it the more you can count on it to help
you relax and drift off to sleep. It’s comfort and
2. Slowly relax your body, starting with your feet
familiarity will make it more and more effective.
and moving through every part of your body
until you have reached — and relaxed – your
Children can be taught this technique. Below
face and scalp. “Relaxed” can be described as
are some detailed examples of guided imagery
the fuzzy or warm feeling you get before sleep.
for children which adults may also find
beneficial.
3. Slowly breathe in; first filling your belly, then
the stomach area, and then your chest and tops
1. Ask the child to think of a colour, smell,
of your lungs - almost up to your shoulders.
humming, light, warmth, or other pleasant,
Hold the air for a second or two, and then to
comfortable feeling that makes them feel
breathe out slowly. Empty the very bottom of
peaceful and relaxed.
your lungs first, then the middle, then finally the
top.
2. Guide them through a deep breathing
exercise.
Continue this breathing for 4 or 5 minutes. Don’t
force your breathing: it is not a contest to see
3. Ask them to close their eyes and imagine that
how much air you can take in. Just do it in a
with each breath they take in, their body
relaxed, peaceful manner. Deep breathing is
becomes filled slowly with their favourite colour,
the basis of a lot of relaxation techniques, and
smell, humming, light, warmth, or other
once mastered, can be used with either guided
pleasant, comfortable feeling.
imagery or progressive muscular relaxation to
deepen relaxation.
4. Then have them practice – still with closed
eyes – breathing in that colour or sensation and
Guided imagery “sending” it (blowing it) throughout the body. If
Guided imagery is something that people can the child, for example, chooses “blue,” guide
enjoy and become very good at in time. It is a them to visualise the blue colour going down
technique which uses imagination to help gain their throat, into the neck and chest, down to
greater control over relaxation levels. the tummy, and so on until they are filled with
52
the beautiful, peaceful, wonderful blue…and are back of the calves, ankles, feet and toes. The
relaxed and in control. more detail you use the better; children will
enjoy learning about their bodies and what they
An example of this is the healing light: can do with them.
1. Ask the child to sit or lie down in a The worry stone

comfortable position. Clothes should be worn
A worry stone is a small smoothed stone (small
loose and not constrictive.
enough to fit in the palm of a small child) which
is rubbed, rolled, squeezed, or squashed
2. Ask them to close their eyes, breathe slowly
whenever a person feels worried. The worries
and deeply, and to listen only to the sound of
are sucked into the stone, where they become
their breathing for a while.
trapped and unable to bother anyone. The more
the stone is used the more powerful it becomes
3. After a minute or two, tell them that you are
and the quicker it absorbs worries. Worry
going to call the healing light. Ask them to
stones have been used by children and adults
imagine that a small, bright light is beginning to
right through history, and are a free, easy, and
shine just above their forehead. Tell them that
private way to control anxiety. They can be
the light is nice and warm and beautiful, but not
used successfully to help control worries, stop
hot. The light is white (or the child’s favourite
smoking, reduce panic-attacks, and manage
colour), and it pours down onto their forehead
the effects of intrusions.
bringing gentle warmth and a pleasant feeling.
Either buy a worry stone or select a small,

4. You could say to the child: “You can feel the
smooth stone from a beach/garden:
warmth on your head; it’s warming your skin
and your hair. Slowly feel this light moving down
• It is best to pick a few worry stones and then
your face. Even with your eyes closed you can
let the person decide which one they want to
see this light relaxing all the tiny muscles
use
around your eyes, your cheeks, and your nose.
• The stones can be painted or carved
This light is moving down to your mouth, your
afterwards, but they work just as well if left
lips, and covers the front of your face. Your face
blank
is shining and loose and relaxed now. Feel this
• It is best to pick a small, smooth stone
light rolling down into your neck and shoulders,
because it will allow the person to carry it
making them bright and relaxed. You can
round in their pockets without
actually feel your shoulders drop with all the
damaging clothes, or to use
stiffness just melting away. Imagine you can
the stone in a public place
see this light moving down your arms, to your
without being noticed
elbows, and down again to your wrists, and
• Make sure you wash the
your hands. As the light moves you can feel
stone well before you
warmth moving with it. See each finger filling
use it; this washes
with this healing white light, your hands are
anyone else’s
tingling and bright and relaxed.”
worries from it
and makes it brand
5. Do the same for the lungs, heart, chest,
new and ready for
tummy (have the child pretend that they can
use.
breathe or swallow the light to get it inside
them), before moving down the legs, knees,
53
Sit down with the person and explain to them safe place near the bed (e.g. a locker top)
how to use a worry stone: where you can reach for it if you need it.
This means you will be able to get the stone
• Worry stones suck up worries like sponges without having to turn on the light or move
suck up water very much.
• Once a worry is in a worry stone, it can
never get out Progressive muscular
• When you want to get rid of a worry, close
relaxation
your eyes, and squeeze the stone gently
One of the most common reactions to stress is
until it is tight in your hand (you may want to
muscle tension. Deep muscle relaxation helps
demonstrate or practice this with a child)
to relax the entire body from head to toe by first
• Concentrate on the stone in your hand and
tensing, then relaxing various muscle groups.
imagine the worry getting trapped in the
The whole process takes about 15 minutes and
strong hard stone as you squeeze
can be done almost anywhere.
• When you open your eyes the worry will be
gone and you can relax
1. Sit or lie down and close your eyes.
• The more you use worry stones the better
2. Tense the muscles in your hands by making
they become at taking your worries away.
tight fists and hold for 5 seconds.
3. Relax your fists and feel the difference
If the person feels that the worry stone is full or
between tension and relaxation in these
not working as well:
muscles.
4. Move on to the forearms and upper arms
• Washing worry stones in clear water washes
(both sides separately), then feet, calves,
all the worries out of them
thighs, buttocks, belly, lower back, chest,
• Washed worry stones are brand new and
shoulders, neck, and face (e.g. jaw and
completely empty. They will suck up worries
forehead).
extra fast.
By the time you’re done your muscle tension

Some children will want to bring their worry
will have drained away and you will feel
stone to school or bed with them. There are
relaxed.
different rules for using worry stones in these
places:
5. Deepen the level of relaxation by adding the
deep breathing technique.
• When in school, leave the stone in your
pocket or someplace near where it is out of
view. You don’t have to close your eyes Some examples of using
when you use a worry stone in school, just progressive muscular
squeezing and imagining the worry getting relaxation with children:
trapped with be enough. As time goes by
Introduction
you will get better at using your worry stone
like this, and will be able to use it in class or “Today we’re going to practice some special
on the street without anyone noticing. (It is kinds of exercises called relaxation exercises.
important to inform teachers about worry These exercises help you to learn how to relax
stones to avoid confiscation) when you’re feeling up-tight and help you get
• When in bed, don’t keep the stone in your rid of those butterflies-in-your-stomach kinds of
hand or in a pocket. Leave the stone in a feelings. They’re also special because you can
54
learn how to do some of them without anyone Now relax. Just let your jaw hang loose. Notice
really noticing. In order for you to get the best that how good it feels just to let your jaw drop.
feelings from these exercises, there are some Okay, let’s tackle that gobstopper again now.
rules you must follow. First, you must do exactly Bite down. Hard! Try to squeeze it out between
what I say, even if it seems kind of silly. Second, your teeth. That’s good. You’re really tearing
you must try hard to do what I say. Third, you that gum up. Now relax again. Just let your jaw
must pay attention to your body. Throughout drop off your face. It feels good just to let go
these exercises, pay attention to how your and not have to fight that bubble gum. Okay,
muscles feel when they are tight and when they one more time. We’re really going to tear it up
are loose and relaxed. And fourth, you must this time. Bite down. Hard as you can. Harder.
practice. The more you practice, the more Oh, you’re really working hard. Good. Now
relaxed you can get. Do you have any relax. Try to relax your whole body. You’ve
questions? Are you ready to begin? Okay, first, beaten that bubble gum. Let yourself go as
get as comfortable as you can in your chair. Sit loose as you can.”
back, get both feet on the floor, and just let your
arms hang loose. That’s fine. Now close your Face and nose
eyes and don’t open them until I say to.
”Here comes an annoying old fly. He has
Remember to follow my instructions very
landed on your nose. Try to get him off without
carefully, try hard, and pay attention to your
using your hands. That’s right, wrinkle up your
body. Here we go.”
nose. Make as many wrinkles in your nose as
you can. Scrunch your nose up real hard.
Hands and arms Good. You’ve chased him away. Now you can
“Pretend you are a furry, lazy cat. You want to relax your nose. Oops, here he comes back
stretch. Stretch your arms out in front of you. again. Right back in the middle of your nose.
Raise them up high over your head. Way back. Wrinkle up your nose again. Shoo him off.
Feel the pull in your shoulders. Stretch higher. Wrinkle it up hard. Hold it just as tight as you
Now just let your arms drop back to your side. can. Okay, he flew away. You can relax your
Okay, kitten, let’s stretch again. Stretch your face. Notice that when you scrunch up your
arms out in front of you. Raise them over your nose your cheeks and your mouth and your
head. Pull them back, way back. Pull hard. Now forehead and your eyes all help you, and they
let them drop quickly. Good. Notice how your get tight too. So when you relax your nose, your
shoulders feel more relaxed. This time let’s whole body relaxes too, and that feels good.
have a great big stretch. Try to touch the Oh-oh. This time that old fly has come back, but
ceiling. Stretch your arms way out in front of this time he’s on your forehead. Make lots of
you. Raise them way up high over your head. wrinkles. Try to catch him between all those
Push them way, way back. Notice the tension wrinkles. Hold it tight, now. Okay, you can let
and pull in your arms and shoulders. Hold tight, go. He’s gone for good. Now you can just relax.
now. Great. Let them drop very quickly and feel Let your face go smooth, no wrinkles anywhere.
how good it is to be relaxed. It feels good and Your face feels nice and smooth and relaxed.”
warm and lazy.”
Stomach
Jaw “Hey! Here comes a cute baby elephant. But
“You have a giant gobstopper bubble gum in he’s not watching where he’s going. He doesn’t
your mouth. It’s very hard to chew. Bite down see you lying in the grass, and he’s about to
on it. Hard! Let your neck muscles help you. step on your stomach. Don’t move. You don’t
55
have time to get out of the way. Just get ready need your legs to help you push. Push down,
for him. Make your stomach very hard. Tighten spread your toes apart, feel the mud squish up
up your stomach muscles real tight. Hold it. It between your toes. Now step out of the mud
looks like he is going the other way. You can puddle. Relax your feet. Let your toes go loose
relax now. Let your stomach go soft. Let it be as and feel how nice that it feels to be relaxed.
relaxed as you can. That feels so much better. Back into the mud puddle. Squish your toes
Oops, he’s coming this way again. Get ready. down. Let your leg muscles help push your feet
Tighten up your stomach. Real hard. If he steps down. Push your feet. Hard. Try to squeeze that
on you when your stomach is hard, it won’t hurt. puddle dry. Okay. Come back out now. Relax
Make your stomach into a rock. Okay, he’s your feet, relax your legs, relax your toes. It
moving away again. You can relax now. Kind of feels so good to be relaxed. No tenseness
settle down, get comfortable, and relax. Notice anywhere. You feel kind of warm and tingly.”
the difference between a tight stomach and a
relaxed one. That’s how we want to feel – nice Conclusion
and loose and relaxed. You won’t believe this,
“Stay as relaxed as you can. Let your whole
but this time he’s coming your way and no
body go limp and feel all your muscles relaxed.
turning around. He’s headed straight for you.
In a few minutes I will ask you to open your
Tighten up. Tighten hard. Here he comes. This
eyes, and that will be the end of this practice
is really it. You’ve got to hold on tight. He’s
session. As you go through the day, remember
stepping on you. He’s stepped over you. Now
how good it feels to be relaxed. Sometimes you
he’s gone for good. You can relax completely.
have to make yourself tighter before you can be
You’re safe. Everything is okay, and you can
relaxed, just as we did in these exercises.
feel nice and relaxed. This time imagine that
Practice these exercises everyday to get more
you want to squeeze through a narrow fence
and more relaxed. A good time to practice is at
and the boards have splinters on them. You’ll
night, after you have gone to bed and the lights
have to make yourself very skinny if you’re
are out and you won’t be disturbed. It will help
going to make it through. Suck your stomach in.
you get to sleep. Then, when you are really a
Try to squeeze it up against your backbone. Try
good relaxer, you can help yourself relax at
to be skinny as you can. You’ve got to be skinny
school. Just remember the elephant, or the jaw
now. Just relax and feel your stomach being
breaker, or the mud puddle, and you can do our
warm and loose. Okay, let’s try to get through
exercises and nobody will know. Today is a
that fence now. Squeeze up your stomach.
good day, and you are ready to feel very
Make it touch your backbone. Get it real small
relaxed. You’ve worked hard and it feels good
and tight. Get it as skinny as you can. Hold
to work hard. Very slowly, now, open your eyes
tight, now. You’ve got to squeeze through. You
and wiggle your muscles around a little. Very
got through that narrow little fence and no
good. You’ve done a good job. You’re going to
splinters! You can relax now. Settle back and let
be a brilliant relaxer.”
your stomach come back out where it belongs.
You can feel really good now. You’ve done fine.”
Legs and feet

”Now pretend that you are standing barefoot in
a big, fat mud puddle. Squish your toes down
deep into the mud. Try to get your feet down to
the bottom of the mud puddle. You’ll probably
56
SECTION 6
Self care for professionals
57
Traumatic bereavement is a difficult field to important to know what these triggers are and
work in. The assistance you give to those in how to take control of them. Planning will
need will take a toll and be felt in your own life. involve the following two steps:
Personal factors will make you more sensitive
or more resilient to stress at different times. • Prepare yourself for people or situations
Similarly coping methods that worked for you in which are likely to trigger your stress
the past may become more or less important response (e.g. evaluations, staff meetings,
over time; some will remain favourites, while media involvement). These can be either
others will become less suited to your needs. day-to-day occurrences or one-off stressful
Self-care is an on-going effort to keep situations
challenges balanced against the ability to cope. • Decide what to do when you feel your mind
Some useful steps in examining your level of and body becoming stressed. You will need
self-care are listed below: to redirect your thoughts as well as your
physical stress. Practice the method(s) you
Identifying stress choose.
Identify your personal warning signs – thoughts,

Avoidance – where possible, avoid or reduce
feelings, actions, and bodily signals that you are
your participation in situations which repeatedly
stressed or becoming stressed.
distress you. Some of these can be put aside
Examples:
until you feel better able to deal with them.
Even a short break from them can prevent a
• Build-up of negative thoughts or images
build-up of stress spilling over into other areas
(about yourself, other people, other groups,
of your life.
relationships, or the future)
• Difficulties in concentration and memory
Balance – keep variety in your workload and
(accident prone or forgetful)
say no (when appropriate) to work that would
• Becoming irritable, emotionally numb, or
put you at unnecessary risk. Do not be afraid to
finding your emotions difficult to control
discuss temporary changes to your workload
• Feelings of sadness, anger, helplessness,
with your supervisor/manager. The aim is not to
safety fears, or guilt
permanently avoid stress but to manage your
• Self-medicating, smoking, drinking, or using
exposure so that you remain effective.
drugs
Everyone will have their own manageable level
• Changes to sleep pattern, appetite, or level
of stress, so it is important that you find out
of energy
what works for you. Strike the right balance and
• Increased heart rate and breathing, tension
you will not need to rely on will-power or coping
in the shoulders or neck, flushed
mechanisms to get you through the day.
cheeks/face, headache, tiredness.
Relaxation – identify at least one method of

These warning signs often occur in response to
relaxation that works well for you and use it
triggers such as finances, accidents/errors,
regularly or when appropriate. This could be a
criticism, family members or relationships,
formal relaxation technique (deep breathing,
tiredness, alcohol, etc.
guided imagery, progressive muscle relaxation),
a soothing activity (taking a bath, listening to
Managing stress music), or a relaxing pastime (writing, reading,
Plan ahead – some things that you see, hear, or spending time with close friends). Exercise is
feel trigger your body’s stress response. It is also highly recommended as a healthy method
58
of relaxation and stress reduction (e.g. walking, with friends who don’t work in the field of
jogging, swimming, sports, fitness or weights trauma or bereavement.
training). People relax in different ways so it is
important to find out what works for you as an Take time out – find a place where you can take
individual. Make time in your day for relaxation time out and go there on a regular basis. This
(if you haven’t already) and take extra time for can be a place for you to be alone, or talk with
relaxation when you feel your personal warning other people about non-work-related topics.
signs for stress building up.
Stay positive – reward yourself for the important
Distraction – recognise the difference between work you do. On the way home, focus on a
complaining that relieves stress and good thing that happened during the day.
complaining that serves as a reminder. Use
distraction to interrupt unwanted repetitive or Look after your whole self – remember that you
intrusive thoughts, images, and impulses such have physical, emotional, intellectual, and
as these. They will be unable to play out in your spiritual needs. Develop varied interests and
head if you are thinking about something else. supports to address these. Use training and
development opportunities.
To use distraction, choose a helpful activity or
thought that you would like to use to take your Avail of counselling – use employee counselling
mind off negative thoughts or images. Your services if you need to. They are a good source
method of distraction should be something of advice and expertise.
incompatible with the original stress-causing
thoughts. Some ways of thought-stopping and Take a flexible approach – your tolerance for
distraction will be more suited to you than stress will vary over time so be flexible in how
others so it is important to be creative and you approach your workload. Men and women
individual. Once you have found ways of are likely to have different triggers and coping
distracting yourself, practice them until they are methods. If something doesn’t work, try again
automatic. or try something new!
Guidelines The costs and rewards of

working in the field of trauma
Be realistic about your own role –
and bereavement are
remind yourself that you can only
inescapable, but they will
do what you can do. To reduce
never exceed the value
feelings of helplessness, identify
of your own life or the
elements of day to day life
need to remain
where you do have control and
effective.
exercise them.
Use support networks – make

use of your own network of social
and peer support both in work and
at home. Give support to peers and
learn to accept it in return. Ask other
people how they cope with similar
problems. Spend time
59
60
APPENDICES
Information for family members

and friends
61
62
appendix 1
Dealing with sudden death:

helping children and adolescents
63
upsetting for them. They experience death as a

Due to physical, psychological and
separation. If sudden death affects a family,
emotional development, children in they will react to the distress of the people
each age group will deal with around them. The death of a parent will cause
sudden death in different ways. them the greatest upset.
They don’t understand death – they don’t

EARLY CHILDHOOD (0-5
understand that death is final. They may ask
YEARS) when the person who has died is coming back
or think they might be lonely under the ground.
Child development Telling them that death is like going on a
journey or going to sleep will lead to confusion.
Infants and young children are learning to move
They need to understand that people cannot
and understand language for the first time.
come back or wake up after they die.
They depend on you to survive and help them
understand the world. They may not understand
how they feel or how to tell you about it, but will
may ask why the person died, or act out bits of
act out their feelings in other ways. When they
what happened when they are playing (using
are confused about things, they need simple
toys to play different roles). This helps them
answers. You will need to repeat most
understand confusing or scary parts of what
explanations to help them remember.
happened.
They quickly form emotional bonds with their

They make up their own explanations for what
parents. Your child may become upset if
they don’t understand – they may secretly think
separated from you or other familiar faces, this
that the person died because of something they
is a sign that they are capable of grief. They will
did or said (like being angry or naughty). They
not understand why they feel this way or know
may also believe that you can make everything
how to talk to you about it.
go back to the way it was before. They are
looking for simple explanations to help make
They use play to build relationships and
sense of what happened, and will believe these
understand new things. It is an enjoyable way
to be true until you help them understand.
to learn about the world. If your child cannot talk
about their emotions or something that
Sudden death frightens them – they feel scared
confuses them, they will act them out and learn
and helpless when they are threatened, and
about them through play. This is an important
worry more about their safety afterwards. If your
part of their grief.
child is more easily scared or irritated, this is
because their bodies react strongly to feeling
If your child has a learning disability their
unsafe or threatened. They will rely on you to
understanding may be similar to that of a
calm them down and take their fears seriously.
younger child.
They will remember what happened – some

Reactions to sudden death memories of what happened (or what they think
Young children understand separation – they happened) are hard to forget. You will not
will usually form strong bonds within the first six always know how much your child thinks about
months of life. From this point on, separation these. Some things that they see, hear, smell,
from you and other familiar faces becomes or feel will remind them of what happened.
64
Loud noises or sudden shocks may make them They may think the person who died can still
feel unsafe without knowing why. They may see or hear them. They need to be reassured
think more about what happened at quiet times that there is nothing magical about death and
of the day or night. that they are not to blame.
They feel stress – if your child feels frightened Witnessing uncontrolled emotion – your child
or unsafe when they think about what will watch and listen closely to your reactions. If
happened, they use up energy that would you are upset, they will probably become
normally be used for play, exercise, or learning. frightened and upset as well. They may be
The longer they stay frightened or worried, the more affected than they seem if they sense
more energy they use. Over days and weeks excessive anger, sadness or worry in you or
this can be draining for their body and may another family member. They need to see adult
leave them open to illness or injury. grief and sadness in a safe place where they
are free to ask questions.
They are stressed by changes in routine –
mealtimes, bedtime, naps, play, and pre-school Hiding what they are feeling – they may hide
are parts of a child’s day that make them feel their feelings because they don’t want to think
secure. Sudden death disturbs these routines. about them or they don’t want to upset others.
Your child will feel safest when they are with They may not have the words to tell you how
you or close family members, and they know they feel. They need to know they can talk to
what to expect. you about their feelings, even if what they have
to say is upsetting.
They don’t think about the future – they may
continue playing or not be upset when they Feeling unsafe – some children feel very unsafe
hear that someone has died. They do not after a sudden death. Involving them in safety
understand the full consequences of death, and routines (e.g. locking doors, checking windows,
what it will mean to them later. They are likely to turning on alarms, leaving a light on at night)
think about the death during quieter or less can help them feel safer. They need to feel safe
active times like bedtime. at home, pre-school, or at playgroup.
What makes things worse? Children with special needs or

Witnessing a sudden death –this is very circumstances
frightening for your child who will need Children with special needs or circumstances
explanations and reassurance about what will react to sudden death according to their
happened. They will not understand what has level of understanding. If your child has a
taken place. They will remember in detail many learning disability their development may be
things that they saw, heard, smelled, tasted or similar to that of a younger child. They need
felt at the time. This can make them feel very simple explanations of death and trauma, and
unsafe and stop them coming to terms with encouragement to talk and ask questions. With
what happened. care and support they will recover.
Not understanding what has happened – your

child may think they are responsible in some
way for what happened, or that they could have
prevented it by doing something differently.
65
people can come back. You need to be aware

MIDDLE CHILDHOOD (5-10
of how much your child understands death.
YEARS)
They don’t think about their own death – they
Child development won’t like to think about their own death or the
death of others around them in a realistic
Children between five and ten years of age are
sense.
learning to understand the world around them.
Their language and understanding develop
They question what has happened – they may
gradually during this time.
want to know “why me?” or “why my family?”
and feel that things are unfair. They may act out
They are very good observers – they pay
what happened in their heads or through play,
attention to what people do, not what they say,
sometimes changing the story or saving the
and often work out their own meanings for
person who died. This is normal when they are
things. They show what they believe and
working through something that confuses them.
understand by the questions they ask, or their
Expect questions and short conversations
answers to questions like “what do you think
about what happened as they learn more.
happened”.
They are superstitious – they may believe that

They enjoy spending time outside the family at
the person who died can still see or hear them;
school or with friends. When they become
either closely or from a distance. This can be
frightened or worried they may want to spend
either comforting or upsetting for them. They
more time close to their family.
may believe they caused the death by
something they did or thought (like being angry
They like rules and want things to be fair. They
or naughty). Simple and clear explanations from
enjoy playing games but do not like others
you can help them understand what happened.
breaking the rules. They may ask “why me?” or
“why my family?” when something goes wrong.
Sudden death frightens them – they feel scared
If your child has a learning disability their
and helpless when they are threatened, and
worry more about their safety afterwards. If your
younger child. You may find it helpful to read
child is more easily scared or irritated, this is
the guidelines for younger children.
because their bodies react strongly to feeling
unsafe or threatened. They will rely on you to
Reactions to sudden death calm them down and take their fears seriously.
Children understand separation – they will react
when separated from you or the people they They will remember what happened – some
spend a lot of time with. They will be upset even memories of what happened (or what they think
if they don’t understand what death means or happened) are hard to forget. You will not
what has happened. always know how much your child thinks about
these. Some things that they see, hear, smell,
They are beginning to understand death – or feel will remind them of what happened.
between the ages of five and seven years, your Loud noises or sudden shocks may make them
child will begin to understand that death feel unsafe without knowing why. They may
happens to everyone at some point and that think more about what happened at quiet times
you cannot bring someone from the dead. of the day or night.
Before this, they are likely to believe dead
66
They feel stress – stress may affect their prevented it by doing something differently.
friendships, sleeping, concentration, and They may think the person who died can still
schoolwork. Some children will be quieter when see or hear them. They need to be reassured
stressed; others will play up more. Stress and that there is nothing magical about death and
upset in the family will also affect them. The that they are not to blame.
longer they stay frightened or worried, the more
energy they use. Over days and weeks this can Witnessing uncontrolled emotion – they watch
drain their body and may leave them open to and listen closely to your reactions. If you are
illness or injury. upset, they will probably become upset as well.
They may be more affected if they sense strong
Changes in routine distress them – mealtimes, anger, sadness, or worry in you or another
bedtime, chores, play, and school are family member.
predictable parts of a child’s day which make
them feel secure. A sudden death can disturb Hiding what they are feeling – they may hide
these routines. They will feel safest when they their feelings because they don’t want to think
are with you or close family members and they about them or they don’t want to upset you.
know what to expect. They may not feel comfortable talking to friends
or teachers about what happened. They need
They try to understand other people’s feelings – to know they can talk to you about their
they are developing the ability to share in the feelings, even if what they have to say is
feelings of people they know, but (boys upsetting.
especially) won’t always say how they are
feeling. They understand that death brings Feeling unsafe – some children feel very unsafe
sadness to people. after a sudden death. Involving them in safety
routines (such as locking doors, checking
They can become upset about being different – windows, turning on alarms, leaving a light on
older children in this age-group may feel that at night) can help them feel safer. They need to
what has happened is unfair. They may feel feel safe in school, and on the journey there
different from others around them – especially if and back home.
they’ve lost a parent.
Children with special needs or
What makes things worse? circumstances
Witnessing a sudden death – this is very Children with special needs or circumstances
frightening for children who will need will react to sudden death according to their
explanations and reassurance about what level of understanding. If your child has a
happened. They will remember in detail what learning disability their development may be
they saw, heard, smelled, tasted, or felt at the similar to that of a younger child. They need
time. This can make them feel very unsafe and simple explanations of death and trauma, and
stop them from coming to terms with what encouragement to talk and ask questions. With
happened. It is very important that they care and support they will recover.
understand what they have seen.
Not understanding what has happened – they

may think they are responsible in some way for
what happened, or that they could have
67
They are sensitive to emotions – they often hold

ADOLESCENCE (10-18 YEARS)
back feelings they are uncomfortable with. They
use friends for emotional support.
General development
Adolescents have a clearer understanding of
may feel that what happened was unfair or
death than younger children. They understand
undeserved; or that there is no justice without
the long-term consequences, and think about
someone to blame or punish. Making sense
their own mortality.
and finding a meaning for what happened can
take a long time. Many families must wait for
They care about what other people think of
criminal or scientific investigations to discover
them, especially their friends. Socialising and
the truth – for some this will never be known.
being liked by friends outside the family
Memories and feelings are hard to forget – their
become very important. They change their
memories or fears about what happened can be
interests and have different ways of coping –
upsetting, distracting, and hard to control. They
girls are more likely to talk about their emotions
remind adolescents of what happened, leaving
and boys are more likely to act them out.
them feeling nervous and unsafe. Some
reminders will trigger these feelings more than
Adolescence is a natural period of change.
others.
Physical and psychological changes bring
emotions very close to the surface, at a time
Sudden death is frightens them – fear can be
when adolescents want to become more
difficult to control or forget. They may feel more
independent. Misunderstanding and feeling
nervous or unsafe at different times. This is a
misunderstood are common for both parents
natural bodily reaction after a strong fright.
and adolescents. Privacy and control can
Dealing with confused feelings and the shock of
become hot-topics.
what happened makes going back to old
routines and friendships more difficult. It may
They react with their emotions; their responses
also exaggerate difficulties at home, school,
can appear exaggerated. This is a normal part
and other settings. Anxiety and upset can lead
of growing up. They take more risks (e.g. with
to fatigue and vulnerability to illness.
drugs, alcohol, sex), and feel more pressure to
conform to friends, fashion, or ideals.
They experience stress – feeling frightened or
unsafe, or thinking a lot about what happened
If your adolescent has a learning disability their
uses up time and energy needed for other
things (e.g. growth, education and pastimes).
younger child. You may find it helpful to read
Over days or weeks this drains their body and
the guidelines for younger children.
may leave them open to illness or injury. They
may show signs of being irritable, easily
Reactions to sudden death startled, or nervous of things that remind them
Adolescents understand death – they of the trauma. Nightmares, social withdrawal,
understand that death is final and happens to poor concentration and difficulties in school are
everyone. They think about loss, and what this common signs of stress in adolescents.
means for the future. However, they have less
life experience than adults, so learning to cope They can be overwhelmed – sudden death is
will be challenging. They may want to know harder to deal with than normal shock or
how the death occurred, and who is to blame. bereavement. Your child may find anger, blame,
68
or guilt difficult to talk about. Media feel worse. They may not want to talk to friends
involvement, justice, historical and criminal or teachers, and pretend they are doing better
proceedings can make this process longer and than they are (e.g. playing the clown when they
more public. School sometimes becomes a are actually very upset).
relief from the unreality of what has happened.
Sometimes dramatic changes occur in your Feeling unsafe– they feel safest when they are
child’s behaviour as they avoid or confront with friends or family in a familiar place. Sudden
different feelings (e.g. class-clowning, risk- death disrupts these routines, and makes their
taking, social withdrawal, or sudden maturity). world less predictable.
They fear the worst – they may feel guilty or The sudden death of someone from school
embarrassed about how they acted or wish they poses particular problems, for example, daily
had been more patient with the person who reminders of the person who died and the upset
died. They realise that what has happened or insensitive actions of other pupils. Because
affects their home and social life, and that these are experienced at school it is difficult for
things can never go back to the way they were. you to know how the death is affecting your
They may feel hopeless or different from other child.
adolescents. They need reassurance that
things can get better with time. Adolescence is a naturally stressful time –
exams, friends, hormones and conflict are big
What makes things worse? pressures. Sudden death makes these
Witnessing a sudden death – is a frightening pressures harder to cope with. Adolescents
experience and your child will need require support and reassurance to deal with
explanations and reassurance about what their emotions, and understand the world in a
happened. Some things that they saw, heard, more mature way.
smelled, tasted or felt at the time will be
remembered in great detail. This can make Adolescents with special needs or
coming to terms with what happened more circumstances
difficult and unsettling.
Adolescents with special needs or
circumstances will react to sudden death
Having private beliefs and emotions – they may
according to their level of understanding. If
believe that the death could have been avoided
your child has a learning disability their
somehow. Blame and the need for retribution
development may be similar to that of a
may be important to them. These feelings are
younger child. They need simple explanations
not always shared openly, particularly in the
of death and trauma, and encouragement to
family. They need to be encouraged to open up
talk and ask questions. With care and support
about their private fears and anger.
they will recover.
Feeling isolated– sudden death can make them

feel isolated and family, friends and community
are important sources of support. They may
need help to go back to clubs, old friendships,
etc.
Hiding their feelings – they may hide their

feelings because they don’t want to make you
69
They need clear and honest information – to

GUIDELINES FOR HELPING
avoid misunderstandings and fears. Death is
CHILDREN OF ALL AGES best explained to younger children as meaning
It is important to remember that children are that a person stops moving and thinking and
more sensitive to their family’s emotions than they don’t breathe or feel pain. They also need
they seem. They will constantly watch the to know that once a person dies they cannot
reactions of those around them and will become come back to life.
upset if adults act in ways they don’t
understand. • Explain the meaning of death as early as
possible, and repeat this explanation when
Adolescents use friends as well as family for your child needs it
support following a sudden death. They cope in • Use your family’s belief system to explain
creative and unusual ways, but may hide how death
they feel or need help coming to terms with • Use language and ideas your child will
anger, blame, or unfairness. understand – be clear, consistent and not
misleading
Immediate needs • Give as much detail as necessary – older
Children need to feel safe – children will know when you are holding back.
immediately after the death
and in the long term. They need help to make the loss real – by
Avoiding unnecessary being prepared for, and taking part in mourning
separations, having consistent ceremonies and doing something personal in
routines, taking your memory of the person who died. Receiving a
child’s concerns keepsake can be very special for them.
seriously and giving
them affection can help • Involve your child in the mourning rituals
reassure them that they (e.g. viewing the person, attending their
are safe. funeral). Prepare them for this by explaining
what will happen before they go
• Return to daily • Encourage them to do something for the
routines quickly (e.g. person who died (e.g. putting a drawing,
home, playgroup/school letter, or present in the coffin)
and leisure activities) • Share mementos and photos with your child
• Avoid unnecessary (they may want to choose their own
separations and when keepsake)
they are necessary prepare • Share your own feelings of sadness but be
your child for them aware that excessive displays of emotion
• Provide emotional can be overwhelming and frightening.
reassurance by giving your child
affection and spending time with Long term needs
them Children need to understand – it is normal for
• Take any fears about them to need to talk about the death from time
safety seriously and, if to time as their feelings change. Younger
necessary, have a safety routine (e.g. check children may only want to ask questions on
doors and windows, leave lights on at night). things they are confused about (such as why
70
people cannot come back to life). They may act to normal life outside the home. They can
out what happened though play. This can be prepare your child’s friends, and answer their
upsetting for parents, but is a sign that they are questions.
working through confusing or emotional topics.
Adolescents may want to talk about the • Talk to your child about the information you
unfairness of what happened. need to share with other people
• Contact adults who are important to them
• Talk about what happened - short and let them know what has happened (e.g.
conversations may be most helpful playgroup/school teachers, leaders of
• Answer their questions simply and truthfully. community organisations).
You may need to do this more than once as
they try to understand They need to get back to routines – as change
• Check what your child understands by and lack of routine can cause stress or upset.
asking them to tell you what they think They feel safest when they know what to do
happened and what to expect. They like people, places,
• Be prepared for a younger child to act out routines, and activities to be predictable.
what happened using play
• Allow adolescents time to talk through • Re-introduce old routines as soon as
difficult issues like unfairness, anger or possible, or develop new ones if necessary
blame • Plan regular bed times and routines with
• Visit the grave and other places where they familiar activities beforehand
feel close to the person who died • Keep mealtimes to the same time and place
• Look through photo albums together. each day
• Support their return to school, work, sports
They need help to cope with emotions – or other activities
children need to talk about their feelings, have • Encourage or organise your child to spend
their fears taken seriously and be given time regularly with friends.
reassurance and affection.
They need help to deal with reminders – some
• Talk to your child about their worries things will remind them of the sudden death or
• If your child has feelings like guilt, anger or trigger unpleasant feelings and worries. They
blame, reassure them that this is normal and will need a break from these and a safe place to
that things can get better with time go to relax and talk.
• Let them know it is okay to play, have fun
and enjoy hobbies • Be aware of the things that are likely to
• Take their fears seriously – talk to them and remind your child of what happened
give them support • Avoid the ones you can and have a plan to
• Help them find what works best for them, for cope with those your child has to come in
example, young children will use simple contact with
ways of coping such as art, play or stories • Do something special for anniversaries,
• Be aware that adolescents may need to talk birthdays, or other occasions
to friends as well as family. • Prepare an older child for court cases,
coroner’s investigations, and public interest
They can be supported by adults outside the by explaining to them what will happen
family – teachers, carers, and other adults in • Be prepared for media interest in your
the community can support your child to return family, or media coverage of other events
71
that may remind your child of their own

experience
• Reassure them that things will get better
with time.
The future
Growing up – children understand more about
the world as they get older. They may feel
differently about what happened as they gain
more understanding. Keepsakes and
anniversaries will be special to them in the
future.
• Expect your child to change how they feel

about what happened as they understand
more
• Reassure them that these changes are
normal
• Expect more complicated questions as they
get older
• Involve them in remembering anniversaries,
birthdays, and other occasions
• Be optimistic about the future – things can
get better.
Each child’s grief is different, so it is difficult to

say much about the future. Sudden death can
be shocking, and change a child’s life forever.
However, most children will get through this
with time, affection, and the support of their
family and friends. The most intense grief and
upset will usually be experienced within the first
two years.
Your child will think about the person who died

and what happened many times as they grow
older. Talking, remembering, and sharing will
help them to understand better what happened.
Looking after yourself - remember your health

and wellbeing is very important to the wellbeing
of your child so look after yourself and accept
help from others if you need it.
72
appendix 2

information for young people
73
Common experiences following the Problems with sleeping

sudden death of someone you You may have difficulties with sleeping, for
know example, being unable to fall asleep and having
When you are bereaved by sudden death you (or being afraid of having) nightmares. You may
may experience some, none or all of these also be concerned about your safety (or the
feelings. These are normal reactions to a safety of your home) overnight. It is okay to
sudden death. Although the feelings can be leave the light on, the bedroom door open, or to
very strong, they will usually weaken over time share a bedroom with someone.
and with reassurance.
Feelings of sadness and longing
Anxiety It is normal to feel very sad and to really miss
You may feel more anxious than usual about the person who died. This sadness usually
your own safety or the safety of important comes and goes and seems to hit you when
people in your life. You may want to protect you least expect it. You may find that this
yourself from, or avoid, situations in which you sadness causes physical reactions such as
feel unsafe or unsettled. tightness in your throat or chest.
You may become concerned about crowds,
traffic, or safety in general – sometimes in an You may wish you could have your life back the
unreasonable way. Loud noises, sudden way it was before. You may feel sad that you
movements, or being alone can make you will never have that life again, that things have
jumpier than you were before. This can be changed forever. All of these feelings come and
difficult for you to understand and you may find go, but eventually fade over time.
it hard to talk to other people about.
Mood swings
Vivid memories You may have mood swings and become easily
You may have very vivid dreams about the upset. You may find that others have mood
person who has died or the death itself. These swings too. This can make spending time with
dreams can seem very real at the time, causing friends or family difficult as everyone can react
strong feelings. You may notice, for example, more emotionally or aggressively than they
that your breathing or heart beat speeds up. used to.
You may be frightened, from time to time, by
very vivid thoughts of the person who died. You may lose interest in the things or activities
These can be so real that you think you can that you used to enjoy. These changes may
see, hear, smell or even speak to them. Don’t affect your choice of friends, or cause you to
worry – this is a normal reaction. become more distant from some of the people
You may become frightened of being in another you used to be close to. These are normal
traumatic situation (e.g. witnessing a death, reactions – with space, time, and patience they
hearing the news of a death). This can happen will gradually improve.
when you are reminded of or think about the
incident, or sometimes at random. Distracting Feelings of anger
yourself with other thoughts or actions can help. Many people experience very strong feelings of
Do something that makes you feel safe and anger. You may feel anger towards the
relaxed instead. following:
• The death itself
• Yourself
74
• The person who died (for dying and leaving Remember – It is not your fault that the person
you alone) died. Feelings of guilt, shame, and anger are
• The cause of death (person or group you normal following a sudden death.
believe to be responsible)
• People or groups who could have prevented Changing personality/behaviour
the death
Other people may say to you that you have
• Northern Ireland/”The Troubles”
changed or you may notice changes in your
• God (for letting this happen)
own behaviour. You may find that you:
• Friends or the rest of the world for getting on
with life.
• Isolate yourself and want to be alone more
• Become very serious
Anger is often related to life being unfair or to a
• Feel useless or struggle to keep control
sense of injustice in the world. These are
• Retreat into a fantasy world or withdraw from
understandable responses following the death
others
of someone you know. It is important that you
• Become more aggressive or more easily
recognise these feelings and find a safe way to
provoked
deal with them, for example, taking exercise or
• Take less care of yourself
talking to a friend.
• Have difficulty with concentration and
memory (e.g. become disorganised or
Feelings of guilt or shame forgetful).
It is very common to feel guilty. You may feel
that: Some of these behaviours can cause other
problems in your life; you may need help to
• You have caused or could have done overcome them.
something to prevent the death
• You wished death or bad luck upon the
School difficulties
person through something you said or did
School may become hard for you. You may
(e.g. your last words to the person were part
find that you:
of an argument)
• The person will only remember bad things
• Have problems with school work,
about you (especially if you were not on
sometimes these can last a long time
good terms before they died)
• Are not as interested in school as
• You should have died instead of the
before
person who did.
• Have difficulties with concentration
and memory, which make paying
It is common to feel shame or
close attention to school-work
embarrassment. You may feel
difficult
that:
• Wish to think about delaying an
examination until a later date.
• You have had a role in
Discuss this with your family
the death, which you
and your teachers
can’t talk to other
• Get into trouble
people about
• Find it difficult to keep
• You and your family are
friends or get along with
now different from others
teachers. They may find it
• You are very vulnerable.
75
difficult to understand why you are behaving covered at these events, and the details that
differently are likely to be discussed.
• Have to deal with teachers and other pupils
who do not know or understand what Remember
happened, with people who make hurtful
It is important to talk to other people about your
comments either accidently or deliberately
feelings, for example, a friend, parent or family
and with people who know or think they
member, someone from school, your GP, or a
know a lot more about what happened than
trusted adult.
you are comfortable with.
The booklet “Common Grief Reactions”, in this

You may not experience any of these difficulties
series, may be helpful if any of the feelings
and may even find that you improve and work
covered in this booklet become too troublesome
harder as school offers a release from your
for you.
grief.
Reminders
Powerful reminders of death or trauma can be
unsettling if you aren’t prepared for them.
Sometimes they are predictable (e.g.
anniversaries) and sometimes they come at
random (e.g. daydreaming). Most often they are
started by something ordinary that is associated
with the person who died (e.g. hearing their
name spoken, seeing the place where they
died, hearing music). Taking control of
reminders involves developing an awareness of
them and the reactions they cause in you, and
changing those reactions over time. You should
be able to do this on your own or with the help
of a friend.
• Identify reminders in your life

• Develop a plan to avoid unnecessary
reminders which are unsettling
• Plan ahead for significant dates such as
anniversaries, birthdays or other occasions
• Develop a method for dealing with
reminders when they arise
• Be reassured that reminders and triggers will
become weaker and less frequent over time.
Events such as court cases, coroner’s

investigations, or media coverage involving you
or the death should be prepared for. It is helpful
for you to know in advance what topics will be
76
appendix 3
Dealing with sudden death

in adulthood
77
think about the incident, or sometimes at

Common experiences following the
random. Distracting yourself with other thoughts
sudden death of someone you
or actions can help. Do something that makes
know you feel safe and relaxed instead.
When you are bereaved by sudden death you
may experience some, none or all of these
Problems with sleeping
feelings. These are normal reactions to a
You may have difficulties with sleeping, for
sudden death. Although the feelings can be
example, being unable to fall asleep and having
very strong, they will usually weaken over time
(or being afraid of having), nightmares. You
and with reassurance.
may also be concerned about your safety (or
the safety of your home) overnight. It is okay to
Anxiety
leave the light on, the bedroom door open, or to
You may be worried about your own safety or
share a bedroom with someone.
the safety of important people in your life. You
may want to protect yourself from, or avoid,
situations in which you feel unsafe or unsettled.
Feelings of sadness and longing
Crowds, traffic, or safety may worry you – It is normal to feel very sad and to miss the
sometimes in an unreasonable way. Loud person who died. This sadness usually comes
noises, sudden movements, or being alone can and goes and seems to hit you when you least
make you jumpier than you were before. You expect it. You may find that this sadness causes
may find it hard to talk to other people about physical reactions such as tightness in your
this. throat or chest.
Vivid memories You may wish you could have your life back the
way it was before. You may feel sad that you
You may have very vivid dreams or memories
will never have that life again, that things have
about the person who has died or the death
changed forever. All of these feelings come and
itself. These dreams can seem very real at the
go, but eventually fade over time.
time, causing strong feelings. You may notice,
for example, that your heart beat or
breathing speeds up when you think Mood swings
about what happened. You may have mood swings and become easily
upset. You may find others have mood swings
You may be frightened or too. This can make spending time with friends
saddened, from time to time, by or family difficult as everyone can react more
very vivid thoughts about the emotionally or aggressively than they used to.
person who died. These can You may lose interest in things or activities you
be so real you think you can used to enjoy. These changes may affect your
see, hear, smell or even friendships, or cause you to become more
speak to them. Don’t withdrawn from some of the people you used to
worry – this is a normal be close to. These are normal reactions – with
reaction. space, time, and patience they will gradually
improve.
You may become
frightened when
you are reminded
of or when you
78
talk to other people about

Feelings of anger
• You and your family are now different from
Many people experience very strong feelings of
others
anger following sudden death. You may feel
• You are very vulnerable.
anger towards:
It is not your fault. Feelings of guilt or shame

• The death itself
are normal following a sudden death.
• Yourself
• The person who died (for dying and leaving
you alone)
Changing personality/behaviour
• The cause of death (person or group you Other people may say to you that you have
believe to be responsible) changed or you may notice changes in your
• People or groups you believe could have own behaviour. You may find that you:
prevented the death
• Northern Ireland/”The Troubles” • Go into a fantasy world or withdraw from
• God (for letting this happen) others
• Friends and the rest of the world for getting • Isolate yourself and want to be alone more
on with life. • Notice a change in sexual behaviour or
attitude towards your partner
Anger is often related to unfairness and a sense • Become very serious
of injustice. This is understandable following • Become more aggressive or more easily
sudden death. It is important that you recognise provoked
these feelings, and find a safe way to deal with • Take less care of yourself
them, for example, taking exercise or talking to • Feel useless or struggle to keep control
a friend. • Have difficulty with concentration and
memory (e.g. become disorganised or
forgetful).
Feelings of guilt or shame
It is very common to feel guilty. You may feel
Some of these behaviours can cause other
that:
problems in your life and you may need help to
overcome them.
• You have caused or could have done
something to prevent the death
• You wished death or bad luck upon the
Difficulty in caring for others
person through something you said or did Dealing with your own grief and distress while
(e.g. your last words were part of an taking care of others is difficult – it involves
argument) balancing the need to grieve with the need to
• The person will only remember bad things be in control. You may feel overwhelmed by:
about you (especially if you were not on
good terms before they died) • The work and responsibility
• You should have died instead of the person • Struggling to return to old routines or create
who did. new ones
• Feeling isolated, if you’ve lost your partner
It is common to feel shame or embarrassment. or source of support
You may feel that: • Exhaustion
• The future.
• You had a role in the death which you can’t
79
Caring for others is demanding; you need to night), and someone you can call when you feel
seek and accept support for this. The more you unsafe. Daily routines, such as going to work,
take care of yourself the better able you will be should be restarted as soon as you feel able.
to take care of others. Avoid long or unnecessary separations from
family and friends.
Work difficulties
• Have a consistent routine at home, work,
Work may become hard for you. You may find
and with friends
that you:
• Avoid unnecessary separations
• Give time and emotional support to others,
• Have difficulties in the workplace or with
and accept help in return
work colleagues – sometimes these can last
• Take your fears about safety seriously and
a long time
have a safety routine to help you relax.
• Have difficulties with concentration and
memory that make paying close attention
You need to talk to other people – following a
difficult
sudden death you may lose interest in other
• Have difficulty keeping existing friends or
people and not want to talk to them about what
getting along with others; they may find it
happened. Talking honestly with friends and
difficult to understand why you are behaving
family about your feelings and confusion can
differently
help bring you back in touch with them and
• Have to deal with people who do not know
yourself. Talk to people or organisations who
or understand what happened, with people
can answer your questions about what occurred
who make hurtful comments either
as the truth can be less painful than what you
accidently or deliberately and with people
imagine happened.
who know or think they know a lot more
about what happened than you are
• Ask questions to help you understand what
comfortable with.
happened
• Make the effort to talk to friends or family
You may not experience any of these difficulties
when you feel the need for support
and may even find that you improve and work
• Find people you can feel comfortable talking
harder at your job as it offers a release from
to and being emotional with.
your grief.
You need to make the loss real – sometimes it

Guidelines for self-care is difficult to believe that the person who died is
Every adult has their own needs – no two gone, or that they won’t just walk into the room
people will feel the same after a sudden death. like nothing happened. This is a normal reaction
Family and friends can help you meet practical to sudden death. Find positive ways to
and emotional needs. Information, meaning- remember or honour the person who died now
making, and physical safety will also have a big and in the future.
part to play in how you cope.
• Take part in mourning ceremonies (e.g.
Immediate needs attending the funeral, leaving a gift on the
You need to feel safe – it is important for you grave)
and your family to feel as safe as possible. If • Share your feelings of sadness
necessary have a safety routine (shutting • Keep photos or special mementos of the
windows, checking locks, leaving lights on at person who died.
80
family liaison officer, coroners liaison officer

Long-term needs
or advocacy organisation will help support
You need to understand – everyone needs time
you through this time
to adjust after a sudden death. You will need to
• Be prepared for media interest in you and
talk and think repeatedly about what happened
your family; or media coverage of other
before you can understand it fully. Allow
events that may remind you of your own
yourself more time to come to terms with
experience.
unfairness, blame, or anger. Visit the grave or
places where you feel close to the person.
Reminders will get weaker and fewer over time
Looking through photo albums can be helpful.
and you will get better at dealing with them.
• Try to clear up any confusion or unanswered

You need to share the burden – it is important
questions
that you seek support following a sudden death,
• Talk with a trusted friend, counsellor or
especially if you have a caring role.
therapist about difficult feelings and issues
• Take time out for yourself
related to the death; many voluntary
• Plan to have adult company
agencies offer support and experience
• Seek out/ accept help from others (family,
• Look at albums and photographs, and hold
neighbours, agencies, social services)
on to good memories
• Make contact with others in a similar
• Visit the grave or other relevant places from
position.
time to time.
The future
You need to deal with reminders – unsettling
Most people recover from a sudden death in the
thoughts or images of the death can come at
family, but there is no right way to grieve. There
random or in response to things that remind you
is no timetable for grief; for many people it has
of what happened. These can make you upset,
a lifelong effect. However, the most intense
physically and emotionally unsettled, prevent
grief and upset will usually be experienced
sleep, and interfere with your work. Managing
within the first two years.
reminders and triggers can give you more
stability and a greater sense of emotional
• Be aware that your
control.
opinions might
change
• Avoid unnecessary reminders of what
over time
happened until you think you are ready for
• Be
them
prepared
• Be aware that significant dates such as
for new
anniversaries or special occasions will be
questions
reminders
from friends
• Have a plan for dealing with reminders when
and family in
they occur
the future
• Prepare for court cases, coroner’s
• Find new
investigations, and public interest by finding
interests and
out what will happen and talking to other
pastimes if the things you
people about how you feel. Find out what
enjoyed before no longer
details will be released at these events and
interest you or are
how long they are likely to last. A PSNI
available
81
• Hold onto mementos and keepsakes

• Mark anniversaries and significant
occasions
• Be optimistic about the future – although
things will not be exactly as they were
before, things can and do improve.
You may need additional support to deal with

some specific feelings of grief, anger, or anxiety
as family and friends will not always able to
help you with these. The booklet “Common
Grief Reactions”, in this series, may be helpful if
vivid memories, problems with sleeping or
anger become too troublesome for you.
82
appendix 4

common grief reactions
83
up before the end, are easier to remember and

SLEEP DISTURBANCE
therefore most upsetting. Even though it may
Sleep
seem uncaring it is better to allow someone to
Sleep is essential for our health, memory, dream and finish nightmares without being
concentration, and energy. Without sleep it is wakened.
hard to work and get things done. Most of us do
things around bedtime that make us sleepy and
ready for bed. Some people drink warm milk,
What are sleep disturbances?
read a book, or watch late night television to Sleep disturbances are common after the
help them settle down; others don’t like trauma of a sudden death. They can be:
watching television or reading close to bedtime
and won’t find these things relaxing. The things • Difficulty getting to sleep
we do before bedtime (especially the last hour • Difficulty getting good quality sleep
before bedtime) strongly affect our ability to • Difficulty staying asleep — night waking or
sleep. waking very early in the morning.
Different people need different amounts of SLEEP DISTURBANCE IN

sleep to stay healthy, so there is no definite ADULTS AND ADOLESCENTS
amount of sleep a person should have. Usually people are able to work out their ideal
Just like adults, children’s routines before sleeping pattern by themselves, but sometimes
bedtime will affect their sleep. Some things help sleeping habits change. Everyone experiences
them to get to sleep quicker, and some things sleep disturbance at some time in their life. It is
keep them awake. Some children need more or often temporary and most likely to be caused by
less sleep than average. Some have night time one or more of the following:
fears that keep them awake.
• Stress or difficulty in relaxing
Dreaming • Background noise
As well as being necessary for our physical • High or low temperatures
well-being, sleep also allows us to dream. We • Sleeping in a different bed/bedroom
use dreams to make sense of our emotions, • Change of sleeping hours or bedtime
organise our memories, and prepare ourselves • Side effects of medication, drugs or alcohol.
for the day to come. Dreams can be senseless,
enjoyable, or terrifying; but they all have a use. What makes sleep disturbance
Normally we forget dreams that don’t wake us worse?
up. • Drinking alcohol/tea/coffee/caffeine drinks at
night
Nightmares and upsetting dreams are normal • Smoking before bedtime
following a shock or sudden event. Some • Lack of exercise
dreams might be about what happened or • Napping during the day
about the person who died. These usually • Not having a regular bedtime
become less frightening and more general as a • Watching TV throughout the night
person come to terms with what has happened. • Changes to bedtime routine
Sometimes dreams can be so vivid or upsetting • Worrying about not sleeping.
that they wake us up; or someone else may Long term or chronic sleep disturbance can be
waken us when they realise we are having a hard to overcome, and will affect emotions,
nightmare. Interrupted dreams, where we wake concentration, work, appearance and health.
84
Sleep disturbance is normal following a sudden keeping you awake, before they can play out in
death. With time, your sleeping patterns should your head.
return to normal without any outside help;
however, there are some things you can do Relaxation – most people are good at finding
which may help overcome your sleeping one or two ways of relaxing, that they find
difficulties. calming. However, not all ways of relaxing work
for everyone and you may find that what used
Improving sleep to relax you doesn’t work as well anymore. The
following are some popular ways of relaxing:
You may find that, following a sudden death,
you cannot relax or get to sleep like you used
• Taking a bath
to. Relaxation, exercise, diet and planning are
• Reading a book
ways of improving sleep that do not carry risk in
• Watching TV/Video
the short and long term. (Although some people
• Taking long walks
find that sleeping pills or alcohol help them get
• Playing sport
to sleep quicker in the early stages, in the long
• Exercising
run these make it more difficult to sleep and feel
• Talking with a friend
refreshed).
• Prayer/Meditation
• Listening to music
Awareness and preparation – there are many
• Deep breathing
ways of managing sleep disturbance. Some
• Muscular relaxation
people need to sleep with music on, others
• Positive thoughts/images
need total silence. Only you can make these
• Relaxation tape.
individual choices so try out different things and
see what works for you.
Guidelines
Your sleeping habits may change over time, for Take a flexible approach – your needs and
example, it is normal to feel uneasy for a while emotions will change as you work through the
after a sudden death and you may want to changes in your life. Be flexible and creative
sleep with a light on or in a room with someone about what you need:
else. These are natural feelings, and not being
alone or in the dark can help you to relax and • What works for one person in the family may
get to sleep quicker. However these solutions not work for another
may not be practical and you may need to find • What works at one time may not work later
a suitable long term sleeping arrangement. on
• Men and women are likely to
Distraction – thoughts and memories of what
happened can sometimes stop you getting to
sleep (or back to sleep). These thoughts can be
brought on by a dream or nightmare, by
something that reminded you of what
happened, or sometimes at random. Distraction
(e.g. playing soft music, counting backwards
from 100) is a good way of dealing with these
thoughts as they switch attention away
from the images or thoughts that are
85
have different coping methods Make time to think about what happened – set
• Be prepared to try different approaches. some time aside regularly to think about what
happened. You may want to spend this time
Develop a bedtime routine – a bedtime routine alone; or with a friend, a therapist or counsellor.
is useful for letting your body know it should get You could use this time to create a diary or
ready for sleep. Preparing for sleep can start scrap book to help you work through your
early (e.g. avoiding caffeine, nicotine, or alcohol feelings and concerns.
in the four to six hours before bedtime); or five
minutes beforehand (e.g. drinking warm milk • Make time in your daily or weekly routine to
just before going to bed). If you have high levels think about what happened
of muscle tension or stress take at least half an • Plan what you will do in this time (e.g.
hour to unwind (e.g. take a warm shower/bath, thinking or writing)
listen to music). • Allow time afterwards for relaxation.
Staying in bed when you cannot sleep can Practice relaxation – relaxation is the quickest
make things worse. If you cannot sleep after way to prepare for sleep. You can practice it
you’ve gone to bed it may help to get up and alone or with a partner or friend, preferably in a
keep yourself occupied. Do something relaxing quiet place that you find peaceful. Spend at
and once you feel sleepy, go back to bed. least ten to twenty minutes during the day
practicing relaxation until you feel comfortable
• Identify your favourite ways of relaxing at doing it. As you continue to practice your body
night will learn to relax more easily and quickly.
• Avoid doing things that make you more alert It is helpful to have a way of calming down
(drinking tea or coffee, clock-watching, quickly, for example, deep breathing. It is also a
computer games) good idea to learn at least one formal relaxation
• Do something relaxing if you cannot sleep method such as controlled breathing, positive
(drink warm milk, listen to soft music) imagery, or progressive muscular relaxation.
• Try not to nap or lie in bed during the day These three relaxation methods are given at the
• Restful relaxation is almost as good as back of this booklet and are suitable for most
sleep, so try not to worry that you are awake people.
at night.
• Choose your favourite method of relaxation
Use distraction – if you can’t sleep because you • Make time to practice regularly during the
are thinking about what happened, do day
something to keep your mind occupied. • Try using more than one method (e.g.
Focusing on a sensation, image, memory, or muscular relaxation and controlled
action can block out all other thoughts. breathing)
• Decide whether to guide your own relaxation
• Try different methods of distraction until you or to have instructions played from a tape or
find one that works well for you (e.g. read out by a friend.
counting backwards from 100) • Involve a friend or family member to help
• Practice using your chosen distraction you.
during the day
• Use relaxation at night (e.g. soft music or
some other calming activity), or exercise
during the day to reduce stress.
86
For some children returning to old bedtime

SLEEP DISTURBANCE IN
routines is comforting, others need to find new
CHILDREN
ways to wind down at night.
Sleeping patterns change with time, so your
child can have different problems at different
ages. You may find your child:
How you can help
Deal with the causes of poor sleep:
• Doesn’t want to go to bed Bedtime routines: brushing teeth, reading
• Wants to sleep in your bed (or a stories, tucking a child into bed, cuddling, etc.
brother/sister’s) should be carried out by same person, at a
• Goes back to wetting the bed after being dry regular time each night. Getting your child back
at night to a familiar and comforting bedtime routine is
• Has nightmares very reassuring.
• Wakes during the night (regularly, or from
time to time) Bedroom: changing where your child sleeps
• Has night terrors (wakes screaming with no also changes the temperature, light level,
memory of a dream) background noise, and other things that your
• Wakes very early in the morning child is used to when they go to sleep. Try to
• Is sleepy or irritable during the day. make any necessary changes as similar to what
your child is used to as possible.
Problems like these usually fade with time.
However, some children will need support from Medication: some children’s medicines (such as
you to overcome their sleep disturbance decongestants) interfere with normal sleep so
(particularly if they have shocking memories or you may need to check this with your GP.
fears about what happened). You can help your
child by checking for and dealing with: Lack of exercise: exercise during the day helps
use excess energy. If your child is not sleepy at
• Signs of stress (irritability, anxiety, night create opportunities for them to take
clinginess) exercise during the day.
• Fears about safety (for themselves or other
family members) Fears about safety: if your child is worried about
• Bedtime fears something happening to themselves, their
• Changes to the bed/bedroom – different family or family home take their fears seriously
temperature, amount of background light or and reassure them that they are safe (e.g. lock
noise, etc. doors and windows together at night).
• Side effects of medication (some
decongestants affect sleep) Scary dreams and memories: bedtime and
• Lack of exercise early morning are the times your child is most
• Changes to the bedtime routine – different likely remember or dream about what
time, activities (stories, tucking in), adults happened. This can make going to sleep
involved, etc. difficult. Comforters such as favourite blankets,
• Naps during the day (if your child is older toys, and teddies can help.
than 5 years of age)
• Worries that sleeping problems will get Sleeping arrangements: your child’s sleeping
worse. habits may change over time. For example,
most children will have concerns about safety
87
following a sudden death and may want to • Being read or sang to

sleep in a room with someone else. It is • Repeated play
important to take a balanced approach to • Comfort toy/object
meeting these needs. When your child is ready, • Sports and games
they will have to sleep and feel safe in a room • Exercise
on their own. • Board games
• Playing and talking with friends
You can address all of the above issues on your • Water play
own, or your GP or health visitor will help you if • Structured relaxation (from a tape or parent)
you need them to. • Music or singing
• Controlled breathing.
Distraction – some children are unable to get to
sleep because they cannot stop remembering Most children are able to find their own ways to
or thinking about what happened. Distraction is relax and play. You can help your child by
one of the most effective ways of overcoming making sure they get enough time to relax
this. It can involve: before bed.
• Switching your child’s attention away from Guidelines

memories or thoughts of what happened
Be flexible – try to find your child’s best way of
• Focusing their attention on something that
relaxing. Get back to their normal bedtime
blocks out other thoughts (e.g. a mental
routine (or a routine as close as possible to
exercise or activity)
normal), and think about the things that may be
• Playing low, soothing background music
affecting their sleep. They may have specific
(loud enough to comfort but quiet enough to
fears that you need to deal with.
allow sleep)
• Providing a favourite toy, or something else
• Be patient – some children will return to
that is soothing or relaxing
normal sleeping quite quickly while others
• Have a method of distraction ready before
will take longer
your child’s bedtime.
• What works for one child may not work for
another
Relaxation – for a child, relaxation can mean
• What works at one time may not work later
getting good exercise and playtimes during the
on
day; or watching a favourite DVD, listening to
• Routines will change as your child gets older
music or reading/having a story read to calm
• Be prepared to try different things.
them down at night. Having a quiet, safe place
to play can be very helpful. Younger children
Take your child’s fears seriously – your child
may use favourite toys or blankets as soothers.
needs to feel safe before they can sleep.
Following a sudden or shocking event your
Encourage them to face their fears in creative
child may need to find new ways of relaxing.
ways. If you think your child is nervous at night
The following are some popular things children
gently encourage them to share any feelings
find relaxing:
they have and work from there. Do this during
the day so that you don’t remind your child of
• Arts and crafts
their fears near bedtime.
• Reading/Colouring in
• Watching (suitable) TV
• Take your child’s fears seriously and have a
• Sitting on a parents knee
88
safety routine if necessary (e.g. check under use the toilet just before getting into bed
bed, lock windows and doors etc.) • Provide a toy for your child to play with, or a
• Comfort them going to bed by giving hugs comic for them to read if they cannot sleep.
and reassurance
• Talk with them about how to overcome Aim to build up a consistent and reassuring
nightmares and other worries. Creative or routine. When children have safety fears and
fun ideas will appeal to some children find it difficult to sleep being alone in their own
• Practice these ideas during the day until bed can make things worse. Sleeping in a room
your child is comfortable using them. Get with someone else often helps them relax and
your child to imagine what they will do when sleep soundly, but not being able to sleep alone
they have a nightmare, for example, special is not helpful in the long term. It is important to
karate chops to kill monsters, anti-ghost take a balanced approach and to gradually
spray cans or becoming invisible to bad return them to their normal sleeping routine
people. over time, for example they may initially sleep in
your bed and have a staged return to their own
Have a bedtime routine – getting ready for bed bed.
can start early (e.g. no sugary drinks or foods
for two hours before bed); or five minutes Deal with upsetting thoughts and memories –
beforehand (e.g. drinking warm milk just before these can be scary and prevent your child from
going to bed). If your child is not sleepy or is relaxing enough to sleep. Use distraction or
stressed, give them thirty minutes to an hour to relaxation to prevent or block these thoughts
wind down using quiet activities like colouring in out. Children will not know how to do this for
or reading. If they cannot sleep after they have themselves.
gone to bed give them something quiet to do to
keep them occupied and relaxed. This is the • Practice using distraction (or relaxation) with
next best thing to sleep. your child until they can do it for themselves
• Make sure your child gets enough relaxation
• Have a routine of soothing things you and and exercise
your child can do for up to one hour before • Set time aside during the day to talk with
bedtime your child about their upsetting thoughts and
• Avoid memories. Think about what triggers these
activities that thoughts and how they relate to what
make your happened. Reassure your child that it is
child more normal to have upsetting thoughts.
alert, for
example, rough Relaxation – this is the best way to prepare for
play, eating sugary sleep. Children can become very good at this in
foods and playing a short space of time. They learn to relax more
computer games quickly with practice so spend ten to twenty
• Avoid drinks minutes a day practising relaxation until they
in the evening feel they can do it alone. There are three formal
if your child relaxation methods that are suitable for older
has started children at the back of this booklet. Younger
bedwetting children can be soothed by stroking their back,
again, and brushing their hair, cuddles etc.
get them to
89
• Practice a method of relaxation regularly

DEALING WITH NIGHTMARES
with your child
• Practice during the day as well (not just at Facts about nightmares
bedtime) • Nightmares are a normal part of childhood
• Try using more than one method (e.g. from the ages of about three or four years
muscular relaxation and then controlled upwards
breathing) • Most people are not awake or aware of their
• Try to make the experience fun and creative. nightmares
• Nightmares, like dreams, are a natural way
of dealing with painful or emotional issues
• Although nightmares can be very vivid, even
to the point where they wake a person up,
they are usually more distressing to the
person watching than the one dreaming
• Dreams and nightmares are meant to be
forgotten and they will be if time isn’t spent
thinking about them immediately afterwards.
Guidelines for night time

• Allow people who are having nightmares to
continue dreaming (this can be the hardest
thing to do). They can be gently soothed by
softly-spoken reassurance, singing or
holding, that does not wake them up properly
but can divert the flow of the nightmare
• Work towards getting them back to sound
sleep as soon as possible, this means
avoiding the “wake up, wake up – you’re
having a nightmare” approach. People will
have trouble getting back to sleep if they
wake up scared
• If they wake up hold them, make soothing
noises, put on soft lighting and stay with
them until they calm down. Give a child what
comforts them, for example, their favourite
teddy or blanket
• Only allow your child to sleep in your bed as
a last resort; instead try leaving a light on in
their room, playing low music or sleeping in
their bed with them
• Do not share any of the details of what you
heard or suspect the nightmares are about,
the person will most likely forget it when they
wake up. Take your cue for action from
them: ask them if they slept well or how they
feel when they get up in the morning.
90
Sleep disturbance can start at the time of the

Guidelines for day time
death and then re-appear around the time of
If the person has no anxiety about nightmares:
anniversaries, birthdays and other occasions; or
• Avoid discussing nightmares, but talk about
even a number of years later if something
feelings of sadness and grief.
reminds you of what happened.
If the person has anxiety about nightmares:

• Discuss nightmares; try to get them to
describe what they feel. They may be able to
trace the nightmare back to their trauma and
need help to deal with specific fears or
memories
• Help them feel safe but avoid making them
feel that you’ve saved them or protected
them from anything
• Help the person realise dreams and
nightmares only exist in their imagination,
and that they cannot be hurt or controlled by
them
• Get them to imagine happy endings to their
nightmares or bad dreams. After some
practice, these will be remembered in the
nights to come.
The future
Sleep disturbance is one of the first signs of
stress, and often the last to disappear. It is a
natural response to sudden or dramatic
changes in your life. Most people will have
some trouble sleeping or dreaming after a
sudden death. Unless there is an ongoing
medical or physical reason for disturbed sleep,
you will return to your normal sleeping pattern
with care and support.
Sometimes sleep disturbance continues

because poor sleep can become a habit. This
may affect work, education, family, friendships
or health. Understanding more about sleep and
trying out some of the suggestions included in
this booklet may help you or your child get back
to a normal sleeping pattern. If sleeping
patterns do not return to normal you should
consult your GP, for further information on sleep
disturbance or help with related difficulties such
as anxiety or intrusions.
91
that run through your head during the course of

INTRUSIONS
the day. They can be triggered at random or by
What are intrusions? a reminder (e.g. something seen, heard, or
Intrusions are powerful memories, thoughts or smelled). Repetitive thoughts can be:
feelings about what happened (or about the
person who died), that are difficult to ignore. • “Why did it have to happen?” or “Why me?”
They may be upsetting and make it hard for you • Memories of what happened
to concentrate or forget what happened. • Impulses such as the urge to check doors
and windows.
Intrusions occur when your normal flow of
thoughts is interrupted and you are reminded Unlike normal daydreams which can be
powerfully of what happened. They happen enjoyable or neutral, you may find intrusions of
following a reminder of the trauma (e.g. the this type unpleasant. They may make you feel
smell of smoke, a loud noise, the sight of blood, sad, agitated, guilty, angry, or less hopeful
or a news story). Sometimes they happen at about the future.
quiet times (e.g. around bedtime or first thing in
the morning); sometimes they seem to appear Flashbacks – these are like daydreams only
at random. more intense and realistic. People who have
flashbacks feel as if they are back at the time of
They can be repetitive, and sometimes the only death, being able to see, smell, feel, or hear
thing you can think about. Although they are what happened in great detail. Some people
difficult to control, they are a normal reaction have vivid daydreams about what they imagine
following a sudden death. happened. During a flashback or vivid
daydream:
For some people intrusions may not be
distressing at all, others find them very • The event is re-experienced very vividly
upsetting. Some can interfere with your ability • It feels very frightening or scary
to work, concentrate and sleep; or make you • Your emotions take over
angry, sad, or afraid. Usually, you will find you • Your breathing and pulse become faster.
get fewer intrusions as time goes by, and that
they become less upsetting. However, if Flashbacks can seem difficult or impossible to
intrusions are making it difficult to get on with control, but they can be managed with
life there are ways of managing them. specialist help. For most people flashbacks will
fade with time.
Types of intrusions
Nightmares – these are one of the most Repetitive play/actions – this is a form of
common forms of intrusion, and are a natural intrusion that usually only affects children. After
reaction to a sudden death. It is normal to have a sudden death, they may repeatedly act out
some type of night waking, disturbed sleep, what happened through play. This is normal for
disturbing dreams, nightmares or night terrors children and may help them understand what
following a bad fright or scare. Bad dreams and happened. Older children and adults may find
nightmares following sudden death are not that they repeat activities as a way of going
always about what actually happened. over what happened or as a means of coping.
These actions usually fade with time.
Repetitive thoughts – these are everyday
fantasies, daydreams, and imaginary situations
92
Examples of distraction include:

Ways of managing intrusions
Avoidance of unnecessary reminders – some
• A sensation (slowing down breathing)
places, people, or objects will remind you of the
• An action (counting backwards in threes
person who died or what happened. These may
from a hundred, singing)
overwhelm you when you need to be in control
• A thought (replacing negative thoughts with
(e.g. during school or working hours). At night
good ones or positive memories).
they may affect your sleep or dreams. You can
manage the stress of intrusions by:
Some methods of distraction will suit you more
than others, so find those that work for you and
• Avoiding thinking about what happened
practice them.
during work or school and making time to do
so later
Relaxation – being able to relax is important
• Avoiding painful reminders (e.g. location of
following a sudden death. Learning to relax can
the death) until you feel ready to deal with
take time, especially if you feel unsafe.
them
People relax in different ways, from taking a
• Avoiding being alone late at night or at other
bath, reading a book or watching television; to
times when your powerful memories usually
long walks, running or playing sports. Not all
come.
ways of relaxing suit everyone, but most people
will find at least one that works for them.
As time goes on the strength of your intrusions
Relaxing helps you calm down after upsetting
will weaken.
thoughts or memories. Following a sudden
death you may find that what used to relax you
Distraction – this is the most effective way of
doesn’t work as well anymore. The following
dealing with intrusions when they happen.
are some popular ways to relax:
When an intrusion occurs, if you deliberately
think of something else it won’t be able to play
• Yoga
out in your head. There are simple ways of
• Walking
thought-stopping to help you interrupt an
• Jogging
intrusion. They are quick movements or
• Exercise
thoughts that demand your attention.
• Music
• Fresh air
• Shout “STOP” in your head or out
• Games
loud
• Reading
• Clap your hands or snap your
• Hobbies
fingers quickly
• Socialising
• Snap an elastic band that you wear on
• Fitness training
your wrist.
• Controlled breathing
• Massage
Once you stop the intrusion
• Phoning friends
you need to prevent it
• Structured relaxation
starting up again.
• Taking a bath
Distracting your mind with
• Prayer/meditation.
an enjoyable job or
mental exercise is a
useful way to do this.
93
or court case) use relaxation, deep-breathing,

Guidelines
or having a friend or family member with you to
Take a flexible approach – your needs and
reduce distress. Having a good cry from time to
emotions will change over time. Be flexible and
time may help clear your head and deal with
creative in helping yourself.
reminders. Whatever method you chose,
practice it to make sure it works.
• What works for one person in the family may
not work for another
• Practice thought stopping or mental
• What works at one time may not work later
distraction to stop your intrusions
on
• Use relaxation and/or exercise
• Men and women are likely to cope in
• Make time to think about your intrusions,
different ways
when and how they arise, or what they
• Be prepared to try different things.
mean to you.
Make time to think about the things that worry

Manage the reminders in your life – avoid too
you – you may be tempted to avoid thinking
many reminders of what happened until you
about what happened if it is too distressing.
feel ready. If intrusions affect your
Having a set time (every day or week) to think
concentration, memory, or emotional state then
about this is helpful. You may want to do this
you will need to take time away from things that
alone; or with a trusted friend, a therapist or
remind you of what happened. It is a good idea
counsellor. You can use this time to create a
to control or limit your reminders, so that you
diary or scrapbook to help work through their
can get used to them at a manageable pace.
worries and other feelings.
• Be aware of your limits

• Make time for thinking in your daily or
• Identify reminders which are overwhelming
weekly routine
• Develop a plan for making severe triggers
• Plan what has to be done in this time (e.g.
more manageable (e.g. having someone
else around to calm you down).
• Spend time doing something relaxing or
enjoyable afterwards.
Beware of using coping methods that will
become a problem in the long term, such as the
Be aware of your reminders – some things will
use of alcohol and drugs.
remind you of what happened. Knowing what
these are and when to expect them will give
you more control and can make life less
The future
overwhelming. Most intrusive memories will weaken and fade
over time, with the most intense intrusions
• Identify the people, places, memories or occurring in the first two years. If your intrusions
other things that remind you of what do not fade with time or if they interfere with
happened work, education, or family life you may wish to
• Be prepared for reminders due to media consult your GP for help with related difficulties
involvement or legal processes. (such as sleep disturbance) or further
information on specialist services which
Develop ways to deal with reminders – use manage traumatic bereavement.
distraction and thought stopping to deal with Intrusions can start at the time of the death and
intrusions. For powerful reminders (e.g. inquest then re-appear around the time of
94

ANGER
even a number of years later if something,
What is anger?
perhaps in the media, reminds you of what
happened. Anger is a normal emotion that can vary from
annoyance to rage. It is natural for us to have
different levels of anger at different times in our
lives.
Anger is caused by what other people do to us

and by what we do ourselves. Stress, upsetting
memories, poor sleep, drugs, alcohol, illness,
worry and poor communication all play a role in
making us angry. It is okay to feel angry, but it is
important to remember that acting on this
feeling usually makes things worse.
Anger is a natural response when we feel

threatened. The brain releases hormones and
other chemicals to give a rush of energy. The
way we think changes, so that we focus on
feeling threatened or wronged instead of what
other people think. In highly threatening
situations this can be the way we protect
ourselves as a last resort.
Sudden death can make people very angry.

Dealing with unfairness, blame, abandonment
and, at the same time, having to carry on with
life is difficult. Anger will resolve itself with time,
but sometimes you need help to control your
anger or express it safely.
Usually you know if you have a problem with

anger. You may act in ways that feel frightening
or out of control, or sometimes other people
(especially family members) will notice a
change. Things that were not a problem in the
past may now make you very angry.
Managing anger
The goal of anger management is to reduce the
physical and emotional pressure to act out
aggression. This is done by identifying your
anger triggers (e.g. not being listened to) and
developing a plan for dealing with these as they
arise. You can learn techniques such as
95
relaxation (deep breathing) or distraction • Memories of what happened

(counting) to control anger; or use safe • Stress and lack of sleep
methods of expressing anger (exercise or • Caffeine, alcohol, drugs
keeping an anger diary). • Family members, co-workers, finances.
Awareness and preparation – this is the most Avoidance – avoidance is a good way of
effective way to manage anger. Finding out managing the sources of your stress. Sudden
what causes your anger and planning what to death can leave you with overwhelming feelings
do when things go wrong can give you back a of sadness, anger, and injustice. Memories and
sense of control. reminders of what happened will be difficult to
deal with early on. Avoid unnecessary
It is important to recognise the changes that reminders and responsibilities until you are
occur when you begin to get angry: ready for them. For example, you may avoid
thinking about what happened during working
• Heart beat speeding up hours, but make time to think about it later.
• Breathing speeding up
• Frowning Distraction – distraction is a good way of
• Feeling flushed dealing with anger when you can’t avoid the
• Tension in the shoulders situation. Switch your attention away from your
• Headache anger when it is destructive and think about
• Racing thoughts what causes it when you feel calmer.
• Shaking/sweating.
Try to focus on:
Once you feel these changes you know you are
getting angry and need to do something to stop • A sensation (slowing down breathing)
it. You may choose to ignore the feeling, to • An action (counting backwards in threes
avoid other people until you are feeling calmer; from a hundred)
or to use relaxation or distraction to calm down • A thought (repeating “I am calm” to yourself).
immediately. You could also release your anger
in a safe way (shouting into a pillow, taking Some methods of distraction will suit you more
exercise). than others, so choose one that works for you.
Sometimes the distraction can be something
Talking to a friend or keeping an anger diary of that relaxes you, such as taking long deep
when and how anger builds up can help you breaths to calm down or listening to music.
see patterns in your reactions. See if there Using distraction will give you back more
are triggers for your anger: control over your emotions and thinking.
• Places, people, times, or

occasions
96
Relaxation – being able to relax is important Make time to think about what happened – you
following a sudden death. Learning to relax can may be tempted to avoid thinking about what
take time, especially if you feel unsafe. happened if it is too distressing. Having a set
time (every day or week) to think about it will
People relax in different ways, from taking a allow you to prepare for being upset and angry.
bath, reading a book or watching television; to You may want to do this alone: or with a trusted
long walks, running or playing sports. Not all friend, therapist or counsellor. You could use
ways of relaxing suit everyone, but most people this time to create a scrapbook or diary to help
will find at least one that works for them. work through your feelings and concerns
Relaxing is an important way of calming down .
after a bout of anger or a hard day. Following a • Make time for thinking in your daily or
sudden death you may find that what used to weekly routine
relax you doesn’t work as well anymore. The • Plan what you will do during this time (e.g.
following are some popular ways to relax: reflection, writing)
• Yoga
• Walking Speak about your feelings – talking things
• Jogging through can remove the need for anger. This is
• Exercise because it allows you to release emotional
• Music stress and make yourself understood without
• Fresh air the need for agression. When you are angry, a
• Games lot of what you say and do will affect other
• Reading people and make the situation worse. Bottling
• Hobbies up your anger and saying nothing will also
• Socialising make things worse. If you avoid talking about
• Fitness training the underlying causes of your anger or hide it, it
• Controlled breathing will surface again later.
• Massage
• Phoning friends Try to think about why you are angry, and talk to
• Structured relaxation. a friend about it when you are calm. Ask them
to help you identify the early warning signs.
Guidelines
Be flexible – your needs and emotions will • Think about how you act when angry (and
change as you work through the changes in how you would like to act instead)
your grief and anger. Be flexible and creative in • Think through what you want to say before
helping yourself: speaking to someone (this may feel slow at
first but you will get faster)
• What works for one person in the family may • Speak in a clear voice, and go slowly
not work for another • Listen to other people and their concerns
• What works at one time may not work later • Check that people understand you
on • Make your complaints as specific as
• Men and women are likely to cope in possible (try not to use words like always,
different ways never, and every time)
• Be prepared to try different things. • Keep talking.
97
Be prepared for triggers – find out exactly

The future
where, when, and what makes you angry (e.g.
Many people, following a sudden death, will
not being listened to), and use this to
experience only moderate amounts of
understand why you react the way you do.
excessive anger, or none at all. Anger is likely
Knowing your personal warning signs that anger
to be directed at particular people or groups,
is on the rise (e.g. flushed face, faster heart beat
and should fade and or be resolved naturally
and breathing) can help you stop it before it
without having to complete any of the steps
takes hold. If you have to face a situation that
outlined here.
will definitely make you angry take a friend with
you to help you stay calm, or practice relaxation
For some people, anger can take longer to
before and after you go there.
fade, and will affect work, education, family,
sleep, etc. It can be helpful to understand more
• Find out what triggers your anger – do
about anger, how to recognise it before it takes
certain things, people, or situations make
control, and how to develop your own ways of
you angry more than others? Why?
managing it.
• Be aware of day-to-day triggers (e.g.
finance, work, other people)
If your anger does not fade with time or causes
• Be aware of your warning signs (e.g. faster
you a lot of distress you may wish to consult
heart rate).
your GP, health visitor, social worker and the
websites listed at the end of this leaflet for
Find ways of dealing with your anger – practice
further information on anger management or
how to deal with anger. Some people use
help with related difficulties (such as anxiety or
distraction to take a step back from their anger,
sleep disturbance). Your GP will also have
others use relaxation, humour, or the support of
information on specialist services which
a friend or family member. Think about what
manage anger and traumatic bereavement.
works best for you. The method you choose
should be something you are comfortable with
Anger can start at the time of the death and
and you can use at any time.
then re-appear around the time of
• Identify and practice a method of distraction
even a number of years later if something,
(e.g. a happy memory, a breathing exercise)
perhaps in the media, reminds you of what
to interrupt angry thoughts
happened.
• Remind yourself that you are in control of
your anger and can overcome it
• Use relaxation or exercise to reduce stress
• Make time to think about what triggers your
anger, and why that is important to you
• Express anger in a controlled way (e.g. in an
anger diary, shouting into a pillow)
• Get help and advice from others.
98
a tight fist
RELAXATION TECHNIQUES
3. Hold for 5 seconds
Deep breathing 4. Relax your fist and feel the difference
One of the main reasons many of us are tense between tension and relaxation in these
is our breathing. Most people breathe very muscles
shallowly, using only the top part of their lungs. 5. Move on to the forearms and upper arms
Deep breathing allows you to use your entire (both sides separately), then feet, calves,
lungs, providing more oxygen to your body. It is thighs, buttocks, belly, lower back, chest,
probably the most effective and beneficial shoulders, neck, and face (e.g. jaw and
method of relaxation. forehead).
1. Lie on your back or sit in a relaxed position By the time you have focused on all the areas
2. Slowly relax your body, starting with your of your body, your muscle tension will have
feet and moving through every part of your drained away and you’ll feel relaxed. Use deep
body until you have reached – and relaxed – breathing or other relaxation technique to
your face and head maintain this state.
3. Check over your body to see if there are any
remaining areas of tension. If so, relax them
Guided imagery
4. Slowly breathe in:
Lie in bed with your eyes closed and imagine
(a) First fill the very bottom of your stomach
you are in your favourite, most peaceful place.
(b) Then your entire stomach area
It may be on a beach, a hilltop, a garden, or
(c) Then your chest
somewhere you feel peaceful. It does not have
(d) Finally the top of your lungs almost up to
to be a real place, as long as you can picture it
your shoulders
in your mind.
5. Hold for a second or two, and then begin to
exhale. Empty the very bottom of your lungs
Imagine you are there now. You can see your
first, then the middle, then finally the top.
surroundings, hear the peaceful sounds, smell
the fragrance of the flowers, and feel the
Continue this breathing for 4 or 5 minutes. Don’t
warmth of the sun or whatever sensations are
force your breathing; it’s not a contest to see
there. Just relax and enjoy it - and drift off to
how much air you can take in. Just do it in a
sleep.
relaxed, peaceful manner. Deep breathing is
the basis of a lot of relaxation techniques, and
Once you’ve found a place that’s especially
once mastered, can be used with either
peaceful and effective, you’ll find that the more
progressive muscular relaxation or guided
you use it, the more you can count on it to help
imagery to help further relaxation.
you relax and get to sleep. Its comfort and
familiarity will make it more and more effective.
Progressive muscular relaxation
One of the most common reactions to stress is
The worry stone
muscle tension. Deep muscle relaxation helps
to relax your entire body from head to toe by A worry stone is a small smoothed stone (small
first tensing, about 15 minutes and can be done enough to fit in the palm of a small child) which
almost anywhere. is rubbed, rolled, squeezed, or squashed
whenever a child feels worried. Children’s
1. Sit or lie down and close your eyes worries are sucked into the stone, where they
2. Tense the muscles in your hands by making become trapped and unable to bother anyone.
99
The more a child uses a stone the more Some children will want to bring their worry
powerful it becomes and the quicker it absorbs stone to school or bed with them. There are
worries. Children have used worry stones different rules for using worry stones in these
through history – they are a free, easy, and places.
private way to control anxiety. Nowadays
people use them to help control worries, quit • When in school, leave the stone in your
smoking, reduce panic-attacks, and control bad pocket or someplace near where it is out of
memories or thoughts. view. You don’t have to close your eyes
when you use a worry stone in school, just
• Either buy a worry stone or select a small, squeezing and imagining the worry getting
smooth stone from a beach/garden trapped will be enough. As time goes by you
• It is best to pick a few worry stones and then will get better at using your worry stone like
let your child decide which one they want to this, and will be able to use it in class or on
use the street without anyone noticing. (It is
• The stones can be painted or carved important to inform teachers about worry
afterwards, but they work just as well if left stones – otherwise teachers may take them
blank. away)
• It is best to pick a small, smooth stone • When in bed, don’t keep the stone in your
because it will allow your child to carry it hand or in a pocket. Leave the stone in a
round in their pockets without damaging safe place near the bed (e.g. a locker top)
clothes, or to use the stone in a public place where you can reach for it if you need it.
without being noticed This means you will be able to get the stone
• Make sure you wash the stone clean of without having to turn on the light or move
germs before use. very much.
Sit down with your child and explain to If your child feels that the worry stone
them how to use a worry stone: is full or not working as well:
• Worry stones suck up worries like • Washing worry stones in clear

sponges suck up water water washes all the worries out of
• Once a worry is in a worry them
stone, it can never get out • Washed worry stones are
• When you want to get rid of a brand new and completely
worry, close your eyes, and empty; they will suck up worries
squeeze the stone gently until extra fast.
it is tight in your hand (you
may want to demonstrate or
practice this with your child)
• Concentrate on the stone in
your hand and imagine the worry getting
trapped in the strong hard stone as you
squeeze
• When you open your eyes, the worry will be
gone and you can relax
• The more you use worry stones the better
they become at taking your worries away.
100
Availability of booklets and Books for children

bibliography “Mum, will dad ever come back?” by Paula
Hogan
The booklets in this series: Publisher: Blackwell Raintree ISBN 086256-
002-0
• Dealing with sudden death: Helping children
and adolescents “Remembering Mum” by G. Perkins & L. Morris
• Dealing with sudden death: Information for Publisher: A&C Black ISBN 0-7136-4541-5
young people
• Dealing with sudden death in adulthood “The goodbye boat” by M. Joslin
• Dealing with sudden death: common grief Publisher: Lion ISBN 07459-3693-8
reactions
Books for teenagers
are available electronically to download from “Straight talk about death for teenagers” by Earl
the bereavement page on Belfast Health and Grollman
Social Care website - Publisher: Beacon Press ISBN 0-8070-2501-1
www.belfasttrust.hscni.net and Cope with Life
website www.copewithlife.org.uk “Facing change: falling apart and coming
together again in the teen years” by D. O’Toole
The Eastern Trauma Advisory Panel Services Publisher: Compassion Press ISBN 1-878321-
Directory provides information on a range of 11-0
support services that are available through the
health service, voluntary and community-based “Tiger eyes” by Judy Blume
organisations, which offer specialist provision Publisher: MacMillan ISBN 0-330-26954-2
for individuals and families affected by the
trauma of the ‘Troubles’. Psychotherapy and “The Charlie Barber treatment” by C. Lloyd
counselling, training, befriending and social Publisher: Walker ISBN 0-7445-5457-8
support are available. The directory is also
available electronically to download from the
bereavement page on Belfast Health and Social
Care website - www.belfasttrust.hscni.net
101
Eastern Trauma Advisory Panel

STATUATORY REPRESENTATION ETAP
Name Title Agency/Organisation
John McGeown Co-Director for Mental Health Belfast HSC Trust
Aidan Murray Assistant Director of Social Care Regional HSC Board
Arlene Healey Director NI Family Trauma Centre
Mary Corry Director Trauma Resource Centre
Brian Mullan Victims and Survivors Development Officer Community Relations Council
Alex McFarland Senior Educational Psychologist BELB
Dr Oscar Daly Consultant Psychiatrist Lagan Valley Hospital
Bette McMullan Senior Manager Mental Health South Eastern HSC Trust
Lorna Martin Senior Educational Psychologist SEELB
Gary Paul Complex Needs Officer NIHE
Lisa Jane McIlveen Policy Lead, Victims & Survivors OFMDFM
Heather Russell Trust Bereavement Co-ordinator Belfast HSC Trust
Peter Bohill Primary Mental Health Care Manager Belfast HSC Trust
Martina Mullin O’Hare Eastern TAP Co-ordinator Eastern Trauma Advisory Panel
Dr Alistair Black Clinical Psychologist Police Rehabilitation & Retraining Trust
VOLUNTARY/COMMUNITY
Name Title Agency/Organisation
Sandra Peake CEO Eastern TAP Co-Chair & WAVE CEO
Irene Sherry Project Director Bridge of Hope, Aston Community Trust
Susan Reid CEO Victim Support NI
Joe Conlon Manager Holy Trinity Counselling Centre
Wendy Stewart Adult and Family Counsellor New Life Counselling
Zora Molyneaux Connecting Cultures & Psychotherapist
Fiona Murphy Manager Victims and Survivors Trust
Francis Murphy Lifespring Health & Healing Centre
Patricia Jamshidi Trauma Counsellor Corpus Christi Counselling Services
Maggie Lawrence Counsellor Top of the Rock Counselling Services
Sharon Gibson Project Manager Lisburn Prisoners Support Project
Pauline Fitzpatrick Family Support Worker Relatives for Justice
David Colvin Welfare Rights Manager Ex Prisoners Interpretive Centre (EPIC)
Sam Lamont Manager NI Retired Police Officers’ Association
Dave Stewart Director Primary School Counselling Services, Barnardos
Fiona Davidson Director NI Music Therapy
Debi Madden Area Co-ordinator Belfast CRUSE Bereavement Care Belfast
Gail Levingston Area Co-ordinator North Down
& Ards CRUSE North Down & Ards Area
Michael Patterson Director TMR Professional
Guy McCullough Manager Combat Stress
Paddy O’Dowd Services Support Manager Coiste na nìarchimi
Gary Teer Project Co-ordinator Survivors of Trauma Centre
Martin Snoddon Manager Conflict Trauma Resource Centre
Paula Beattie Regional Manager Trauma Recovery Network
Pauline O’Flynn Area Manager (SE Trust area) Lifeline, Contact
Graham Logan Policy Development Manager NI Assoc Mental Health
INDIVIDUAL SERVICE USER

Name Title
John Swift Service User
Beth McGrath Service User
102

Dealing With Traumatic Bereavement

Uploaded by

Copyright:

Available Formats

Dealing With Traumatic Bereavement

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Dealing With Traumatic Bereavement

Uploaded by

Copyright:

Available Formats

What is the purpose of this resource?

What is the purpose of this resource?

What effects can traumatic bereavement lead to?

What effects can traumatic bereavement lead to?

43710 Makeup_Layout 1 20/01/2011 17:23 Page 1

Dealing with Traumatic Bereavement

This second, revised edition has been produced

The need for simple, freely available advice for

Many thanks go to the original writers for

Introduction Using the reference

It is anticipated that this valuable resource will

1. Dowdney. L, 2000, Childhood Bereavement

Section 1: Guidelines for the immediate response in sudden death situations 5

Section 2: Traumatic bereavement in childhood and adolescence 9

Section 3: Traumatic bereavement in adulthood 27

Section 4: Common grief reactions 35

Section 5: Relaxation techniques 51

Section 6: Self-care for professionals 57

Appendices: information for family members and friends 61

Appendix 1: Dealing with sudden death: helping children and adolescents 63

Appendix 2: Dealing with sudden death: information for young people 73

Appendix 3: Dealing with sudden death in adulthood 77

Appendix 4: Dealing with sudden death: common grief reactions 83

Guidelines for the immediate response

SECTION 1: guidelines for the immediate response in sudden death situations

Prepared information and hand-outs – written

The media – media involvement is not

Traumatic bereavement in childhood and

SECTION 2: Traumatic bereavement in childhood and adolescence

Early childhood (0-5 years)

General development Young children’s understanding of

Young children’s reactions to Young children’s reactions to

They can experience stress – for a time they

They have shorter spans of attention than

Their grief and trauma can be private – they

They can become pre-occupied with safety – in

They are sensitive to daily routines – a death in

They are dependent on and sensitive to their

MIDDLE CHILDHOOD (5-10 YEARS)

General development Children’s understanding of death

nervous of anything that reminds them of the

reaction which is difficult for children to describe

They can become pre-occupied with safety – in

ADOLESCENCE (10-18 YEARS)

General development understanding rather than age. They may

Their reactions can be more emotional or

The understanding of adolescents with learning Adolescents’ reactions to trauma

determinants). If they do not fully understand common signs of stress in adolescents.

Their grief and trauma can be unseen – they

favoured by their parents and family.

• Give explanations suitable to the age and

Facilitating the coping of the main caregiver –

• Inform relevant adults in the school setting

• Be sensitive to special dates (e.g.

Children can work through the effects of

Traumatic bereavement in adulthood

SECTION 3: Traumatic bereavement in adulthood

The understanding of adults with learning