12 Questions About Trauma, Grief, PTSD, Crisis Response, and Mental Health

Trauma, grief, crisis, and sudden loss can affect people in many different ways. Some reactions are emotional, such as fear, anger, guilt, or sadness. Others may be behavioral or physical, including trouble sleeping, social withdrawal, changes in appetite, increased substance use, restlessness, or difficulty concentrating. Part of a therapist’s training involves learning how to recognize these different responses and understand what kind of support may be most helpful at different stages of recovery.

I originally created the 12 questions below as part of my graduate training in crisis intervention and counseling. They cover topics such as how people respond after disasters, common short- and long-term effects of trauma, crisis counseling, grief and bereavement, PTSD treatment, military mental health, and how professionals communicate news of a death. Together, they offer a look at some of the concepts counselors study when preparing to work with clients who are going through overwhelming or life-changing experiences.

You can take the questions as a quiz, read through the answers and explanations, or simply use them as an introduction to how therapists think about trauma and crisis. The goal is not to suggest that everyone responds to loss or trauma in the same way. Rather, these questions show some of the frameworks therapists may use to better understand what a client is experiencing, identify when additional support may be needed, and help someone gradually regain a sense of stability after a difficult event.

Question 1: How Do People Respond in the Hours After a Disaster?

Question 1. (Source: Chapter 10, p. 249, Section on "Characteristics of and Responses to Disasters, Terrorism. And Hostage Situation'') There are many shared possible responses during an initial disaster strike and hors after disaster, however, some responses are unique to “Hours after disaster”. Which are they?

A. Shock, fear/panic, self-reservation, helplessness, denial. (Incorrect. While these are common possible responses during the hours after a disaster, they’re not exclusive to this time period after a disaster strikes. If these symptoms present alone, they’re probably signs of an initial response to disaster.)

B. Anger, grief, energy, emotion, action without efficiency, rumination. (Correct. In addition to shock, fear/panic, self-reservation, helplessness, denial, those experiencing disaster just hours after it strikes are prone to respond emotionally, typically with anger, and may ruminate among other common possible signs.)

C. Stops talking about disaster, ruminates about disaster, resilience, setbacks can occur. (Incorrect. While these are common possible responses after a disaster, they’re more likely to happen during the first month after disaster. it's important to note that, counterintuitively, some can stop talking about disaster while others may continue to talk and ruminate about it.)

D. Disappointment, physical and emotional fatigue, possible onset of panic disorder, anxiety disorder, etc. (Incorrect. While these are common possible responses after a disaster, they’re more likely to happen months after a disaster. Some may move on, while others may be afflicted with more serious mental health issues)

Correct Answer: B. Anger, grief, energy, emotion, action without efficiency, rumination.

General Feedback: Being able to identify the various stages of responses after a crisis is vital as a therapist. By understanding the possible responses at each period of time after a disaster strikes, a therapist can select the right intervention needed. During the hours after a disaster, a therapist may remind the client of resources available, help with problem solving, and connect with loved ones.

Question 2: What Behavioral Changes Can Follow Trauma or Disaster?

Question 2. (Source: Chapter 10, p. 251-252, Section on "Characteristics of and Responses to Disasters, Terrorism. And Hostage Situation'') Per Everly and Mitchell (1999) there are many short and long-term consequences of disaster, affecting behavior, cognition, emotions, and the physical body. What are some common behavioral issues?

A. Difficulty eating and/or sleeping, restlessness, conflicts with others, withdrawal, lack of interest in social activities, increased drug/alcohol use (Correct. These are the behavioral responses to a traumatic situation or crisis. As a therapist, it’s important to listen closely to clients who discuss their difficulties with sleeping or eating, increases in conflict, and withdrawal, among other symptoms.)

B. Increased heart rate, tremors, dizziness, weakness, chills, decreased libido, headaches, fatigue, sweating, rapid breathing, and vomiting. (Incorrect. While these symptoms may resemble behavioral responses, they’re actually physical reactions. Physical responses can be acute or chronic and can vary from person to person.)

C. Apathy, feeling overwhelmed, depression, irritability, anxiety, agitation, panic, helplessness, anger, grief, fear, guilt, loss of emotional control, denial (Incorrect. Although these symptoms may resemble behavioral responses, they’re actually emotional reactions. Emotional states may be acute or lasting.)

D. Blaming, uncertainty, poor troubleshooting abilities, poor concentration, disorientation, lessened self-esteem, intrusive thoughts, rumination, nightmares, difficulty with memory (Incorrect. Despite the fact that these symptoms may resemble behavioral responses, they’re actually cognitive reactions.)

Correct Answer: A. Difficulty eating and/or sleeping, restlessness, conflicts with others, withdrawal, lack of interest in social activities, increased drug/alcohol use

General Feedback: The responses to trauma and crises are wide and varied. Some may become conflictive in their relationships, others may develop difficulty eating, have trouble sleeping, develop a sense of restlessness, experience social withdrawal, feel a lack of interest in social activities, and increase their use of substances, including drugs and alcohol. Knowing the symptoms can help clinicians select and implement an appropriate therapeutic intervention.

Question 3: What Does Crisis Counseling After a Disaster Involve?

Question 3. (Source: Chapter 10, p. 255, Section on "Crisis Counseling Program'') Castellando and Plionis (2006) helped develop the Crisis Counseling Program, which is frequently used for natural disasters. What are the components of this model?

A. Assess strengths, restore pre disaster functioning, provide validation, provide a psychoeducational focus (Incorrect. This response contains many of the components, but not all of them. The missing component is accept the face value. Accepting the face value means guiding the client to accept the crisis and hopefully move on.)

B. Assess strengths, restore pre disaster functioning, accept the face value, provide validation, and provide a psychoeducational focus (Correct. Jellinek’s model includes four stages of alcoholism. The prealcoholic stage is when alcohol is used to relieve tension, next, physical symptoms appear. Next, withdrawal and loss of control occur. And finally, severe psychological, social, and psychical problems arise, culminating in death.)

C. Assess strengths, provide validation, and provide a psychoeducational focus (Incorrect. Although this response contains many of the components, it does not include all of them. The missing components are restoring pre disaster functioning and accepting the face value. Restoring functioning refers to restoring functioning to pre-disaster levels.)

D. Assess strengths and provide a psychoeducational focus (Incorrect. While his response contains many of the components, it does not contain all of them. This response only includes the first and last components. The middle components are restoring pre disaster functioning, accepting the face value, and providing validation.)

Correct Answer: B. Assess strengths, restore pre disaster functioning, accept the face value, provide validation, and provide a psychoeducational focus

General Feedback: The Crisis Counseling Program is a model that assesses strengths by highlighting the resources individuals have (both physical and internal), restores pre disaster functioning so those who have experienced disaster can resume life with a sense of normalcy, accept the face value, provide validation, and provide a psychoeducational focus. These steps help restore a person after they’ve experienced a crisis so that they can ideally move on with their lives.

Question 4: What Factors May Help People Accept Death?

Question 4. (Source: Chapter 12, p. 296, Section on "The Death Awareness Movement: Kubler-Ross'') Per Carey (1975) there are several factors that facilitate the process of death acceptance. What are they?

A. Being fearless, having a low degree of anxiety and neuroticism (Incorrect. While these may be factors that improve the acceptance of death, they’re not mentioned in Casey’s study. The study mentions few regrets, open communication about terminal illness, close relationships and concern.)

B. Having lived a full life without many regrets (Incorrect. While this is one of the factors, there are still others. These include few regrets, open communication about terminal illness, close relationships, and concern for friends and family.)

C. Having lived a full life without many regrets, and talking frankly about terminal illnesses (Incorrect. While these two factors may be true per Casey’s findings, there are additional factors. The other factors are close relationships, and concern for friends and family)

D. Having lived a full life without many regrets, talking frankly about terminal illnesses, holding hope for a life after death, having a close relationship with a significant other, and being concerned for one’s children and friends (Correct. These are the factors that improve the acceptance of death. How one has dealt with past stressors is also indicative of how one may deal with terminal illness and death as well.)

Correct Answer: D. Having lived a full life without many regrets, talking frankly about terminal illnesses, holding hope for a life after death, having a close relationship with a significant other, and being concerned for one’s children and friends

General Feedback: Accepting death is easiest when one has lived a full life without many regrets, talking frankly about terminal illnesses, holding hope for a life after death, having a close relationship with a significant other, and being concerned for one’s children and friends. Additionally, the Death Awareness Movement posits there are multiple stages to death, including denial, rage and anger, bargaining, depression, and acceptance.

Question 5: What Are Worden’s Tasks of Grieving?

Question 5. (Source: Chapter 12, p. 298, Section on "Worden’s Task Model of Grieving'') Worden’s Task Model of Grieving involves a process model of grieving that helps to empower the bereaved. What are the tasks one must complete?

A. Use Cognitive Behavioral Therapy and mindfulness-based practices to attenuate grieving (Incorrect. While these interventions have been shown to be effective in a therapeutic context, Worden’s Task Model of Grieving involves a series of tasks a grieving person must follow.)

B. Accept the loss, experience the pain, adjust to an environment without the person, reinvest emotional energy into other relationships (Correct. To better overcome loss, it’s important to accept the loss as real, work through the pain of grief, adjust to a world without the person in one’s life, and move on with life.)

C. Form new relationships with new people (Incorrect. Although reinvesting emotional energy into other relationships is a part of Wroden’s Task Model of Grieving, it’s not required to form new relationships. That is, you can invest in relationships with others who are known to you and with whom you have an existing relationship.)

D. Go to therapy and engage in logotherapy, expressive therapy, and address spiritual needs (Incorrect. Although These interventions have been shown to be effective in a therapeutic context, Worden’s Task Model of Grieving involves a series of tasks a grieving person must follow. These interventions are alternatives to cognitive behavioral therapy)

Correct Answer: B. Accept the loss, experience the pain, adjust to an environment without the person, reinvest emotional energy into other relationships

General Feedback: Working through the loss of someone involves accepting the loss (which may be hard when the loss is sudden or far away), experiencing the pain (involving recognizing it and not dissociating through working, cleaning, and other activity), and adjusting the environment without the person. Lastly, it’s vital to move on and pour emotional energy into other relationships.

Question 6: How Can a Therapist’s Own Experiences Affect Grief Counseling?

Question 6. (Source: Chapter 12, p. 325, Section on "Counseling the Crisis Counselor'') Worden (2009) warns of three areas that may affect a counselor’s ability to be helpful. They are:

A. Counselors who have had a similar loss that they have not worked through, having lost someone recently, being afraid of death (Incorrect. Although counselors who have had a similar loss that they have not worked through and existential fear toward death are impediments to the counseling process, losing someone recently may not prevent effective therapy.)

B. Counselors who have had a similar loss that they have not worked through, working with a client’s loss when they fear a similar loss, existential fears resulting from the counselor’s failure to come to terms with mortality (Correct. It’s important to be mindful of these factors that can impede the counseling process and to avoid countertransference.)

C. Existential fears resulting from the counselor’s failure to come to terms with mortality (Incorrect. Although existential fears resulting from the counselor’s failure to come to terms with mortality may impede the counseling process,there are two other factors, namely: counselors who have had a similar loss that they have not worked through, working with a client’s loss when they fear a similar loss.)

D. Working with a client’s loss when they fear a similar loss, having a terminal illness, and fearing death (Incorrect. While counselors who have had a similar loss that they have not worked through and existential fear toward death are impediments to the counseling process having a terminal illness the counselor is facing may not impede therapy if they’re adapting effectively.)

Correct Answer: B. Counselors who have had a similar loss that they have not worked through, working with a client’s loss when they fear a similar loss, existential fears resulting from the counselor’s failure to come to terms with mortality

General Feedback: Three areas for counselors to self-monitor themselves when working with grieving clients include: having experienced a similar loss they haven’t yet resolved, unsettled existential fears about death, and working with a client’s loss when they fear a similar loss. Accounting for these factors and taking action to remedy them can help to avoid countertransference.

Question 7: Which Therapies Are Used to Treat PTSD?

Question 7. (Source: Chapter 13, p. 335-336, Section on "Interventions for Post-Traumatic Stress Disorder'') There are many interventions for Post-Traumatic Stress Disorder indicated for military populations. What are they?

A. Expressive Therapies such as writing, art projects, and singing (Incorrect. While these therapies may be effective for other disorders, when it comes to Post Traumatic Stress Disorder, it’s more effective to use trauma-focused cognitive behavioral therapy, exposure therapy, and cognitive processing therapy.)

B. Cognitive Behavioral Therapy and Art Therapy (Incorrect. Although cognitive behavioral therapy is effective for post-traumatic stress disorder, other therapies are also effective, including cognitive processing therapy and prolonged exposure techniques.)

C. Logotherapy, Mindfulness-based interventions (Incorrect. While these therapies may be effective for other disorders, when it comes to Post Traumatic Stress Disorder, it’s more effective to use trauma-focused cognitive behavioral therapy, exposure therapy, and cognitive processing therapy.)

D. Trauma Focused Cognitive behavioral Therapy, Exposure Therapy, and Cognitive Processing Therapy (Correct. Since Jellinek describes alcoholism as a progressive disease, we can conclude that it’d be illogical ot jump into the prodromal stage [which is when one becomes preoccupied with alcohol and physical symptoms begin appearing] without first initiating the prealcoholic phase, i.e. when alcohol is used to take the edge off.)

Correct Answer: D. Trauma Focused Cognitive behavioral Therapy, Exposure Therapy, and Cognitive Processing Therapy

General Feedback: When working with military populations, it’s important to be aware of Post Traumatic Stress Disorder therapies given the prevalences of PTSD in this community. The go-to therapies include Trauma Focused Cognitive behavioral Therapy, Exposure Therapy, and Cognitive Processing Therapy. Other therapies may enhance the therapeutic process, although there’s not as much evidence to support them as there is for these three tried techniques.

Question 8: What Is Cognitive Processing Therapy for PTSD?

Question 8. (Source: Chapter 13, p. 336, Section on "Section on "Interventions for Post-Traumatic Stress Disorder'') Cognitive Processing Therapy has shown positive effects for addressing PTSD. What are some of its features?

A. Working on homework assignments and writing impact statements (Incorrect. While there is a specific protocol allotted for Cognitive Processing Therapy, there are other elements as well. Writing an impact statement involves detailing what the traumatic events mean to cleints.)

B. 12-session, manualized approach that starts with psychoeducation, writing impact statements, completing homework assignments and confronting problematic beliefs (Correct. Cognitive Processing Therapy involves many components, including writing an impact statement, working on assignments, and challenging maladaptive beliefs.)

C. 12-session, manualized approach (Incorrect. While there is a specific protocol allotted for Cognitive Processing Therapy, there are other elements as well. Alsom it’s important to note that treatment may take longer than 12 sessions.)

D. Cognitive Processing Therapy shares the same features as Cognitive Behavioral Therapy (Incorrect. While both modalities are used to treat Post Traumatic Stress Disorder, Cognitive Processing Therapy and Cognitive Behavioral Therapy are unique processes.)

Correct Answer: B. 12-session, manualized approach that starts with psychoeducation, writing impact statements, completing homework assignments and confronting problematic beliefs

General Feedback: While Cognitive Behavioral Therapy and Prolonged Exposure Therapy techniques are important for a counselor to know, being cognizant of other modalities may get of grand importance, especially when working with unresponsive or stuck clients. Cognitive processing Therapy helps to modify various maladaptive beliefs and cognitions.

Question 9: How Can Military Life Affect Spouses and Children?

Question 9. (Source: Chapter 13, p. 330, Section on "Mental Health and military Stigmatization'') What is true of military spouses and children?

A. They often carry the rank of their military spouse or parent informally (Correct. The ranking of the military member is often informally worn by the family. That means that career advancement can be detrimentally affected by the behavior of their families. As such, there is tremendous pressure on military families to behave well.)

B. They tend to use substances more often (Incorrect. There is no evidence that military families engage in using substances like drugs and alcohol more than others. In fact, since military families often affect the rank of the military member, this may lead to better behavior.)

C. Military children are more likely to engage in fights and aggressive behavior (Incorrect. There is no evidence that military families engage in fighting and aggressive behaviors more than others. In fact, since military families often affect the rank of the military member, this may lead to better behavior.)

D. Military families readily access mental health services (Incorrect. Mental health stigmatization is a real threat to military families. There still remains a stigma of weakness among the military community for accessing and benefiting from mental health therapy and resources.)

Correct Answer: A. They often carry the rank of their military spouse or parent informally

General Feedback: While the lives of military members can be incredibly taxing, it’s important to consider the lives of those within the family unit who are also impacted by their involvement in the military. The spouses and children can impact the ranking of military members, thus they may feel a certain pressure to behave well, and this pressure may need to be addressed in the therapeutic process.

Question 10: How Should Someone Be Told That a Loved One Has Died?

Question 10. (Source: Chapter 14, p. 346, Section on "In Person and in Pairs'') There are many best practices when it comes to notifying survivors of the death of a loved one. What are they?

A. Make death notifications in person, not by phone, as human connection can attenuate initial shock. The initial notification should include children. (Incorrect. While it is true that death notifications should be given in person, not by phone to attenuate initial shock, in general, children should not be involved..)

B. Make death notifications in person, not by phone, as human connection can attenuate initial shock. The initial notification should not include children. (Correct. Delivering the news of death of a loved one is highly personal and it’s best done in person as reactions may arise that require assessment of self-risk or medical attention.)

C. The death notification should be given by someone who is emotionally involved with the loved ones of the deceased persons. (Incorrect. It’s preferable that the notification of death be given to someone who is not emotionally involved. However, those who are emotionally involved can be called to act as physical support.)

D. Death notifications should be given by phone to respect those who may be grieving. (Incorrect. Delivering the notification of death is best done in person. This is crucial since reactions may arise that requires assessment of self-risk or medical attentions)

Correct Answer: B. Make death notifications in person, not by phone, as human connection can attenuate initial shock. The initial notification should not include children.

General Feedback: Dealing with death as a counselor is bound to happen at some point. Whether working with a suicide case or a tragic accident, it’s important to know best practices when it comes to revealing the news to family members and loved ones. In general, it’s best to first deliver the news to adults in private so that they can decide how to proceed with telling their kids.

Question 11: Why Do Timeliness and Accuracy Matter When Delivering News of a Death?

Question 11. (Source: Chapter 14, p. 346, Section on "In Time and with Accurate Information'') In addition to delivering the notification of death in person, there are important elements related to timeliness and accurate information. What are they?

A. Notice should be given in a timely manner, however, it’s not necessary to have all of the facts. Getting the information delivered speedily is what’s key. (Incorrect. Ensuring that death notifications are timely and accurate are key. It’s important to verify the accuracy of the information.)

B. Notice should be given in a timely manner and it’s important to verify the accuracy of the information. (Correct. The notification of death should be given to survivors in a timely manner so as to avoid seeing or hearing about the event first through others or via the media. Verifying the accuracy of the news is also key to avoiding unnecessary grieving.)

C. It’s not important for notice to be given in a timely manner; what's more important than all of the facts are accurate. (Incorrect. While ensuring that the facts are correct is vital, guaranteeing that death notifications are timely and accurate is also key. Timeliness helps survivors to avoid seeing or hearing about the event first through others of via the media )

D. Death notification should be given to the survivors of someone suspected of having died without complete verification or accuracy, and timeliness is not too important. (Incorrect. Neither of the two proposed ideas are correct. Ensuring that death notifications are timely and accurate are key. It’s important to verify the accuracy of the information.)

Correct Answer: B. Notice should be given in a timely manner and it’s important to verify the accuracy of the information.

General Feedback: Aside from knowing how to deliver the notification of death (e.g. in privacy away from kids, in person), it’s important to know when to deliver the notification and what must happen before the notification is delivered. The notification should be delivered as soon as the accuracy of someone’s death is verified, so as to avoid unnecessary suffering.

Question 12: Why Is Plain Language Important When Talking About Death?

Question 12. (Source: Chapter 14, p. 348, Section on "In Plain Language'') Jennifer’s mother just died and you are ehr therapist. Which of the following is an example of an appropriate notification?

A. ”I’m very sorry to tell you this, but your mom passed on.” (Incorrect. While the initial phrasing is good since it prepares the person for bad news, using language such as passing on is too vague and can be misinterpreted.)

B. "I have some very bad news to tell you. Your mother died” (Correct. The initial phrasing “I have some very bad news for you” allows the survivor a moment to prepare for the shock. “Your mother died” is plain and to the point, avoiding ambiguities.)

C. “Ready for some news? Your mom was tragically lost” (Incorrect. The initial question doesn't indicate that the news is bad, which may not allow the person to fully brace themselves. Additionally, being tragically lost may not indicate death; it’s too ambiguous.)

D. “Your mom hung herself. Police found her dead body, and her skin was blue. Her eyes were wide open, and she didn’t even leave a suicide note” (Incorrect. While this phrasing clearly communicates the death of Jennifer’s mom, it uses graphic language that can cause the survivor to panic and feel overwhelmed.)

Correct Answer: B. "I have some very bad news to tell you. Your mother died”

General Feedback: When delivering news of death to a client, it's important to be clear and avoid ambiguities. It may also be best to include an initial statement, such as “I’m sorry to tell you this”, or “I have some very bad news” so that the survivor can brace for the bad news. It’s important to refer to the victim by name to provide another level of verifications and to personalize the deceased.

References

Jackson-Cherry, L. R., & Erford, B. T. (2014). Crisis Assessment, Intervention, and Prevention. Pearson Higher Ed.

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