When bad things happen unexpectedly: Preparing for extreme stressors

When bad things happen unexpectedly: Preparing for extreme stressors

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Daniel Kretchman, PhD

Infinity Behavioral Health - Kretchman and Associates, PLLC

Why have a game plan for highly stressful events? No one wakes up in the morning and thinks ‘Today I’m going to have something really bad happen’[a]. When an extreme event occurs, our thought process will likely change and emotions can be intense. These generally impact decision making, which can lead to choices we may regret later, such as damage to relationships, impact on employment, or relapse[b]. The purpose of this article is to provide direction for coping during the initial period after an extreme stressor.

Throughout life we experience unexpected events, such as a death, acute onset of illness, arrest, end of a relationship, unemployment., or other losses. There are multiple dimensions to consider, such as intensity, suddenness, perceived impact, duration, absence of control[2], and consistency with events expected within a culture[3]. Finally, there are individual and contextual[4] characteristics that can impact our response to a new, intense stressor.

In 2026 I had the misfortune of losing someone close, not due to a “natural death”[c]. Looking at characteristics of that event: it was intense, unexpected, with lasting impact, lack of control, and was inconsistent with our cultural script[3]. Additionally, the method of notification, a contextual component, amplified the emotional impact. On the other hand, I recognized that life happens and there are things outside my control. I was fortunate(?) that I had experience with extreme events and was familiar with self-care for such situations. The question then became ‘how do I take care of myself while adapting to this change?’

The Basics

• Have a plan. We don’t know what or when a loss will happen. A plan lets us get organized while our mind is clear, rather than figuring things out in the chaos of an event. In the process of grief or stress, it can be difficult to act; rather than a rigid plan, consider it a schematic that provides guidance, not unbending “musts”. When implementation of your plan is challenging, it may be helpful to practice unconditional self-acceptance[5].
• The question I like to ask is “What am I going to do to help myself?”. I avoid ‘What am I going to do to help myself feel good (or less bad)?’, because one answer to that can be alcohol or other unhelpful behaviors.
• Avoid catastrophizing. Rational Emotive Behavior Therapy (REBT) considers Awfulizing[5] an irrational belief. Our losses and stressors may be bad, painful, and far from what we want to have happen, but horrible & terrible can impact our ability to recoup from what happened.
• Recognize there is a process. This article is a resource for self-care in the initial days. Depending on the loss, you may go through ups and downs. Approaches that may be helpful include recalling past experiences you’ve overcome, and learning about typical responses to loss.

Creating a plan

People’s plans will likely differ. Following are suggestions and examples to include in a plan. An outline is available in the appendix.

• The Triad. Sleep, exercise, and nutrition can be fundamental in maintaining mental health and helpful for those in recovery. It’s common to experience lethargy, lack of appetite, and problems sleeping following a loss[6, 834]. Consider that one or more of these are likely to happen and identify things you can do. Examples include:
  • Take a walk, use a video for some basic stretching, or maintain previous exercise routines even if at lower intensity.
  • Try to eat at least a small amount at your regular mealtimes. If you tend to eat more than you want, try portion control. Consider eating mindfully (e.g., without looking at your phone or watching TV). Be cautious about consuming high sugar and high carbohydrate foods (aka junk food), as well as alcohol (or other substances).
  • General sleep hygiene can be helpful. This includes having a healthy routine before bed, avoid lying in bed awake for more than 20 minutes (at night or in the morning), and limiting daytime sleep by setting an alarm for 20-40 minutes for naps. Have a list of quiet activities to do if you can’t fall asleep (e.g., coloring, laundry, screen-free time, stretching). Also, making your bed in the morning can be helpful. If you later have on-going difficulty, consider speaking with a sleep professional.
• Who is available and helpful in supporting you? This can include friends, family, clergy, physician, therapist, and other professionals. Meetings (e.g., grief support, SMART Recovery) can be another resource. You can include emergency numbers, such as 988 or your local emergency clinic. Also, recognize who may not be helpful (e.g., former relationships, drug dealers).
• Strong emotions after an intense event are common. Keep in mind that how you feel on the day of the event will likely be different from your feelings after a few days, or a week have passed. If you’ve learned specific skills for regulating emotions, keep a list of skills that can be applied.
• Decision making. Recognize that in times of stress, grief, or significant adjustment our thinking may change. This is not the best time to make life-altering decisions (e.g., quit work, end or start a relationship). Even if you were considering a change, like quitting your job, this may not be the best time to act. If you later decide on that action, you’ll be able to carry it out in a way that can have a better outcome. The bottom line is to have a conscious decision not to make decisions.
• Relaxation/meditation. If you don’t meditate regularly, this is a difficult time to start; however, Progressive Muscle Relaxation can be effective in times of high stress.

Bottom line

Having a plan does not make everything go away or become alright. The event still happened. The goal is to get through the initial period, and having a thought-out strategy gives you a way to reduce the intensity of emotions and limit the likelihood of crisis, relapse, or extreme responses, while adjusting to the loss.

References

1. Substance Abuse and Mental Health Services Administration. (2026). Key substance use and mental health indicators in the United States: Results from the 2025 National Survey on Drug Use and Health (HHS Publication No. PEP26-07-010, NSDUH Series H-61). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases.
2. Ringwald WR, Nielsen SR, Mostajabi J, Vize CE, van den Berg T, Manuck SB, Marsland AL, Wright AGC. Characterizing Stress Processes by Linking Big Five Personality States, Traits, and Day-to-Day Stressors. J Res Pers. 2024:Jun;110:104487. doi: 10.1016/j.jrp.2024.104487. Epub 2024 Mar 15. PMID: 38708104; PMCID: PMC11067701.
3. Tate SR, Brown SA, Glasner SV, Unrod M, McQuaid JR. Chronic life stress, acute stress events, and substance availability in relapse. Addict Res Theor 2006;14(3):303–22. 10.1080/16066350500262817
4. Kretchman D. HALT: Relapse prevention to resilience. Drug Alcohol Res. 2026;5:15477. doi: 10.3389/adar.2025.15477
5. Ellis A, Doyal KA. How to control your anxiety before it controls you. Kensington; 2016.
6. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787opens in new window

Appendix: Plan Outline

Supports (name & phone #)

Emergency contacts

Emotional Regulation – skills that I find helpful

Food

Sleep

Exercises or activities

[a] Those who experience significant anxiety may argue about this, but consider how many times that worry actually materialized.

[b] According to the 2025 National Survey on Drug Use and Health 22.3 million people “considered themselves to be in recovery or to have recovered from their drug or alcohol use problem”[1]. This does not include recovery from other compulsive behaviors, such as gambling or pornography.

[c] Technically, all deaths are natural – an event that brings about the end of a life. Here the phrase means death not due to physical problems that typically result in a person’s demise.