One of the many emotions survivors of a tragedy experience that is not much talked about – whether it is a natural disaster, an act of violence, an armed conflict or another trauma – is survivor guilt. Some survivors feel guilty that they survived when others did not. Others believe they could have done more to save those who died. Some feel guilty that someone died saving them. Survivors are typically left with many unanswered questions: Why did it happen? Why did I escape death while others died? How can I enjoy life when others cannot? Could I have done something that would have changed the outcome?

Survivors tend to hold false beliefs about their role in the tragedy that lead to their feelings of guilt. They may have an exaggerated belief about their ability to change an outcome or cause a negative outcome; they internalise blame and attribute the cause of the tragedy to themselves rather than to things outside their control. They may also ruminate over what happened and what they could have, or should have, done.

The likelihood of experiencing survivor guilt increases if a person has a history of childhood trauma, a history of mental health concerns, or does not have the support of family and friends. People with low self-esteem may place less value on their own wellbeing and are more likely to question whether they ‘deserved’ their good luck of surviving. Thoughts, such as the following, may occur: ‘Why did I survive?’ ‘I don’t deserve to be here’, ‘If I had done something differently, this wouldn’t have happened’, and ‘I couldn’t stop it, so it’s all my fault’. According to Colin Ross and Naomi Halpern in their 2009 book, Trauma Model Therapy, self-blame compensates for feelings of powerlessness and helplessness; believing that it is one’s own fault gives one an illusion of power and a sense of control in being able to prevent something similar from happening again.

Survivor guilt may also cause the person suffering from it to see the world as an unfair and unsafe place and themselves as a bad person deserving of punishment. The person may not seek help, as they believe that they don’t deserve to feel better. Sometimes, the pain becomes a way to maintain the bond with their loved ones.

It is important to know that recovery from survivor guilt is not a linear process; the guilt and grief may come in waves. Sometimes, people may start feeling better and then suddenly feel bad again when they hear about another traumatic event.

While some people take longer, most people suffering from survivor guilt improve within a year. There are things one can do to help this journey from grief and guilt to healing:

• It is important to recognise, allow and accept your feelings. Before you accept your feelings, you must accept the reality of the event itself. Remember that these feelings are common. Feeling guilty does not mean that you are guilty. Sadness, fear, anxiety, grief and guilt are normal responses to any tragic event, as is experiencing some relief about your own luck as you mourn the loss of others.
• Give yourself permission and time to grieve, knowing that there is no defined time limit governing when it should be over.
• Share your feelings with family, friends, a counsellor or a support group – whatever works for you. Consider getting professional help to experience some relief and regain control of your life.
• Focusing on the external factors that created or caused the situation can help you let go of the self-blame and guilt.
• Use grounding techniques based on mindfulness principles, like focusing on breathing, feeling nearby fabrics and noticing sounds (among others).
• Learn to forgive yourself – even if you feel that your actions were responsible for harm to another person – because you are human.
• Shift your focus to doing something good for someone else. This could even be a simple thing like donating blood, making a cash donation or giving someone the gift of listening.
• Practise self-care by doing things that feel good and that you enjoy, besides the usual prescription of getting enough sleep, eating a balanced diet and exercising regularly. The more you focus on the things that bring you joy, the more you can train your brain to feel more optimistic and resilient in the face of adversity. Always remember what makes you happy: What are you passionate about? What are you grateful for? What are you good at? Understand how you can use the answers to these questions to protect your energy and redirect your focus to the things that matter.

Finally, please reach out for support if you, or someone you know, can identify with survivor guilt.