For survivors, the response is personal

Passengers who survived this week's Amtrak crash may have a rough month ahead of them, psychologically speaking, but most will recover on their own without much help from professionals.

"Most people will naturally figure this out and come out of it," said David Yusko, clinical director of the University of Pennsylvania's Center for the Treatment and Study of Anxiety.

Predicting who won't is more challenging, he said.

He and Kenneth Reinhard, a New York psychologist who worked for decades at a VA hospital, agreed that educating people about what they are likely to feel - normalizing those painful emotions - would help them accept and process their responses.

Exactly what each person feels will depend on what was personally experienced. "Each car has a different story," Reinhard said.

Initially, many people likely were in shock, he said. Over the next few days, many may cry and repeatedly tell their story. "It's still the initial amazement of realizing, 'I'm still alive,' " Reinhard said.

Then things can get tricky. "They're going to be grateful," he said, "and then they're going to start thinking they should get better soon, it's over."

For many people, it's not over. That's normal.

Survivors can expect to continue feeling some emotional detachment, and have trouble with sleeping and crying spells.

Yusko said they can expect negative feelings, nightmares, and anxiety. Memories of the crash will pop up at weird times.

Over their lives, 60 percent of men and 51 percent of women experience a trauma, Yusko said. Eight percent of men and 20 percent of women develop post-traumatic stress disorder (PTSD).

Train-wreck survivors who had experienced previous traumas or had psychological disorders are at higher risk for problems, said Reinhard.

How badly a survivor was hurt, plus what he or she personally witnessed, affect risk, Yusko added.

Traumatic events can shake survivors' worldviews, especially if they are control freaks, Reinhard said. A wreck like this is a lesson in what can't be controlled.

There's little evidence that anything prevents PTSD, Yusko said, adding, "What we do believe maintains symptoms over a longer period of time is a pattern of avoidance that sets in."

In other words, survivors shouldn't block out places or thoughts that frighten them.

That means it's good to get back on a train. But Reinhard said that needs to be a choice, and survivors should be warned that they might experience anxiety, flashbacks, stomach upset, trouble breathing, or adrenaline rushes.

The trick, he said, is to let the symptoms flow through: "None of these symptoms can hurt you."

Yusko said survivors should not worry much about what they experience for at least the first month. "It's really OK for folks to have some trouble after this," he said. "That's normal . . .. "

Several forms of therapy are proven to help. "PTSD," he said, "is one of the mental health disorders that you really can recover from with very low relapse rates."

The good news is that some people come away from traumatic events with a better, more mature, don't-sweat-the-small-stuff perspective on life.

"Some people are able to take an event and use it for what we call post-traumatic growth," Yusko said.

Many survivors even feel stronger - eventually.

"When you adapt to a traumatic incident . . . you gain incredible adaptive skills that help in many aspects of life," Reinhard said. "When you know what really bad is, you tend to enjoy what really good can be."

Common reactions to trauma - and how to cope: www.philly.com/traumaguideEndText

215-854-4944 @StaceyABurling