Coloradans know all too well what it’s like to deal with tragedy and trauma related to mass shootings.

Now people in Colorado Springs must face unspeakable sorrow once again after a gunman killed at least five people at Club Q, a Colorado Springs nightclub that serves LGBTQ patrons.

Violence like the Club Q mass shooting ignites trauma and anxiety for people who were close to the attack including survivors, family members, emergency responders and medical providers. But even those who are far removed from the attacks can suffer, said the Rev. Dr. Christopher Keith. He’s a chaplain supervisor at UCHealth Memorial Hospital Central in Colorado Springs, where he supports patients, families and staff members. He also has a doctorate in counseling.

“There’s a lot of anxiety and stress,” said Keith. “People will be on high alert and will be fearful.”

It’s wise for people to be aware of the common symptoms of post-traumatic stress disorder or PTSD. They include intrusive thoughts or images about the traumatic event, nightmares, intense emotions and physiological symptoms like jumpiness, a racing heart or hypervigilance.

People who have experienced trauma previously are at greater risk if they get exposed again. Unfortunately, that means that Coloradans who have had to endure trauma from mass shootings multiple times are at high risk. Members of the LGBTQ community also may feel especially vulnerable since police are investigating the Club Q shootings as a potential hate crime.

Keith answered questions about trauma and offered advice for how people can cope with the challenges following the shooting.

What do I do if I need help immediately?

If you are experiencing a mental health crisis, please call 911 or 988, the new emergency phone line for people dealing with suicidal thoughts or other behavioral health crises. You can also call or text the Colorado Crisis Hotline. Call 844-493-8255 or text “TALK” to 38255. Colorado Crisis Services also has walk-in centers.

Another source for help is The Trevor Project, the world’s largest suicide prevention and mental health support group for LGBTQ youth. Learn more about how to get help 24/7.

Be aware that tragedies can awaken trauma from the past

Keith said new tragedies can reawaken anxiety and fear from past events. People who have suffered from PTSD in the past can suffer from it again. And that can impact those who are seemingly far from the tragic event.

“We call that ‘secondary impacts’. It’s like rings that spread out in a pond. Trauma can hit us, and we’re not even sure where it’s coming from,” Keith said.

Stress, anxiety and behavioral health problems all have been on the rise since the start of the pandemic.

“Those of us in the caring professions also have noticed heightened extremism. There’s a lack of grace for one another,” Keith said.

He wishes people could be much kinder to one another and could reach out to those who clearly are struggling.

Be gentle with yourself and others

“There’s a wide range of ‘normal’ responses to difficult events,” Keith said.

It’s normal to experience changes in mood, energy, relationships, sleeping and eating patterns.

“We all respond differently based on the nature of the event, our personal and professional history, and physical and emotional health,” Keith said.

Get some exercise

Walk or run, do yoga, play ball or swim. Get outside if possible. Exercise can really help with stress.

Talk to a supportive person

“Some time alone is fine,” Keith said. “But talking with a supportive person can be very helpful. Friends and family are great, but a trained professional may be best if things aren’t getting better.”

Be deliberate about relaxation

“Have a massage, meditate, listen to quiet music or take a warm bath,” Keith said. “High stress events, like mass shootings, leave many people with tension in their bodies. Relaxation techniques can help soothe our minds and our spirits.”

Breathe

“Deep, intentional breathing releases stress, oxygenates our bodies, and helps us settle down.  Take a few minutes to sit in a comfortable chair in a quiet environment and just take deep easy breaths,” Keith said. “Pay attention to where you’re holding tension in your body and let your breathing help relax those areas.  Do this especially if you feel yourself getting worked up about memories or aspects of the event.”

You can also try what’s known as 5 by 5 breathing.

Simply inhale deeply and slowly through the nose for five seconds, counting 1-one thousand, 2-one thousand, 3-one thousand, 4-one thousand, 5-one thousand. Then exhale very slowly through the nose and mouth, again counting for five seconds: 1,2,3,4,5. You should feel calmer as you breathe. Free apps are available that guide you through paced breathing with sound or imagery.

Keep an eye on yourself, family members and colleagues

“Look for reactions or behaviors that don’t get better over time, affect quality of life, or are a risk to self or others,” Keith said. “If you’re worried about yourself, a family member or a colleague, get help.”

Eat well

 For some people, it’s hard to eat after dealing with a stressful situation. But Keith said healthy food can make a big difference.

“Food is the fuel our bodies and minds run on. Our bodies tend to crave junk food when stressed. Make sure to feed yourself some good, nourishing food,” he said.

He advises people to avoid alcohol and other substances.

“Numbing the pain isn’t a useful solution,” Keith said. “Get help.”

Sleep

“Give yourself time to rest your body and mind. Sleep can be hard after a stressful event,” Keith said. “Try to maintain a normal routine. Avoid caffeine and other stimulants. Avoid screens for at least an hour before you’re trying to sleep. Dim the lights. Keep the room cool. Breathe deeply.”

If sleep problems persist, seek care from your primary care provider or a sleep specialist.

Connect with people, but disconnect from news

To deal with trauma, everyone needs help from loved ones and other supportive people.

Too much time spent scrolling on social media or reading about tragedies can re-traumatize people.

While some people feel they need to know more about a traumatic event, it’s important to limit exposure to media or social media.

Keith encourages people to deliberately disconnect from upsetting news. That’s because people can suffer from PTSD even if they were not immediately impacted by a traumatic event like a mass shooting.

Blanket bans on media sometimes don’t work. If you feel you need to stay up to speed, but you want to limit exposure, try limiting the number of times you check social media or turn on TV. It’s also very wise to avoid upsetting information before trying to sleep.

Try to practice mindfulness

“Mindfulness encourages us to be present to the moment rather than being lost in the past or worrying about the future,” Keith said.  “Apps like Headspace can get you started.  If you’re struggling with worry, ask yourself if anything is actually wrong right at this moment.”

Progressive muscle relaxation is another technique that can help and is a simple technique of tensing one muscle group at a time followed by a release of the tension. Written scripts or guided practice are easily found online.

Recapture your sense of purpose in life, or reconnect with your religious or spiritual faith

While it’s not always possible to pull yourself out of a depression, we sometimes can make ourselves feel better by focusing on the aspects of our lives that give us meaning.

If you are a religious person, connect with people who share your faith. If you are a spiritual person, reach out to others who share your spiritual values and practices.

Keith said chaplains mostly listen to people rather than praying with them. And they never push religion on non-religious people. But spirituality can connect people with purpose in their lives. And spiritual people can provide great solace during difficult times.

“When we walk into a hospital room, our job is not to preach. It’s often just to listen,” Keith said.