COPING WITH THE EFFECTS OF A TRAUMATIC EVENT
Contacts for help and advice (at the bottom of the page)
This leaflet is written for people who have recently been exposed to a traumatic event, however if you have experienced the events described some time in the past, this may help you understand your immediate and longer term reactions and seek any support you may feel you need if still experiencing problems.
Most of the time our lives seem safe and predictable. Serious car accidents, plane crashes, train derailments, natural disasters, criminal assaults and other sorts of traumatic events seem to happen to other people, not us. We read about them in the papers, we watch them from a distance on TV, but we do not expect to experience them directly ourselves.
Sadly however, any of us can be the victims of sudden and unexpected tragedies or losses. They can, and sometimes do happen to us or to people we are close to, and not just to other people in other places. If they do, we are likely to experience a range of unfamiliar feelings and reactions associated with the shock of the event and may have some difficulty in collecting our thoughts and handling our feelings about what has happened.
This leaflet is therefore designed to outline some of the ways you might feel or react if, regrettably, you are the victim of an unexpected trauma. There are no 'right' or 'wrong' ways to react, and different people exposed to the same trauma may respond in quite different ways. Although your own experience will be unique and personal to you, this leaflet will give you some idea of how others have sometimes reacted in similar situations. We hope the information will help you to understand and handle any feelings of shock you may have, and will help you along the normal process of psychological adjustment and recovery.
HOW DO PEOPLE USUALLY REACT AFTER A TRAUMATIC EVENT?
While most people involved in a traumatic incident will be shaken by what has happened, some adjust to their experiences with little or no apparent distress and emerge emotionally unscathed. This would be considered a quite normal response. Sometimes people may in fact feel satisfied by the way that they have acted when faced by the traumatic event (for example if they have been able to help others who have been involved).
Other people, however, are shocked and stunned by the traumatic event, and have difficulty believing what has happened to them. In the days following the incident, some people feel confused, distressed and fearful, or experience other emotions or reactions, which can themselves, be unpleasant and worrying. Even though such reactions can seem strange, it is important to understand that they are also entirely normal and understandable responses to severe stress and shock. In most cases the reactions (which are sometimes called an 'Acute Stress Response') are short-lived and pass after a few days or weeks.
Because they can be unfamiliar, it may be however helpful to describe the feelings, emotions and behaviours sometimes experienced or displayed by victims (and sometimes also by witnesses, relatives and emergency workers), in the hours and days following a traumatic event. These can include any of the following:
PSYCHOLOGICAL REACTIONS
Anxiety-
being jumpy or easily startled by loud noises, sudden movements, etc. Hypervigilance-
Sleep disturbance - difficulty in getting off to sleep, restless sleep, vivid dreams, nightmares.
Intrusive memories - intrusive thoughts/images of the traumatic incident, and sometimes feeling as if the trauma is recurring (flashbacks).
Guilt - feelings of regret or embarrassment about not having performed or coped as well as you would have wished, about letting yourself or others down, about being in some way responsible.
feelings of depressed mood and tearfulness. Sadness -
Anger- at what happened, the injustice; "Why me?"
at those you feel are responsible for the trauma. wanting somebody to accept responsibility or blame.
Emotional numbness or blunting - feeling detached or unable to experience any feelings.
Withdrawal - tending to retreat into yourself, avoiding company.
Disappointment- thinking that people (including family) do not really understand how you are feeling.
. Avoidance -of activities and situations arousing unpleasant memories.
PHYSICAL SYMPTOMS
You may also have certain bodily sensations, with or without the psychological reactions described above. Many of these symptoms are signs of anxiety, tension, or stress. For example:
Shakiness, trembling.
Tension and muscular aches (especially in the head and neck).
Insomnia, tiredness, fatigue.
Poor concentration, forgetfulness.
Palpitations, shallow rapid breathing, dizziness.
Gastrointestinal symptoms such as nausea, vomiting and diarrhoea.
Disturbance of menstrual cycle or loss of interest in sex.
IMPACT ON RELATIONSHIPS
In some cases a shared sense of adversity or loss can bring people closer together, help create new bonds or strengthen relationships. Although family and friends are usually understanding and supportive, the experience of trauma can however sometimes place strains on relationships. You may feel that too little, or the wrong sort of help and support is offered, or that others do not appreciate what you have been through and expect too much of you. Sometimes, when relationships become strained, there is a tendency for people to rely on drink or drugs as a means of coping.
IS THE WAY I'M FEELING AND REACTING NORMAL?
It is again important to emphasise that there are no right or wrong ways to react after a traumatic experience. Everyone's reactions will be individual and not everybody will experience all of the feelings described above, nor experience them to the same degree.
Your reactions will vary from those of other people for a number of reasons, including differences in personality, in ways of expressing emotion, and in styles of coping. People also vary in terms of their previous experiences of adversity or trauma, as well as in the extent to which there are existing stresses and strains in other areas of their lives. The exact nature of the traumatic event and of your experiences as it happened will also make a difference - feelings of distress may be particularly pronounced if the incident was completely unexpected, if it was extremely violent, if you saw people who had died, or if you or others involved were seriously injured.
While most people will have at least short-lived feelings of shakiness, jumpiness, anxiety or anger, your own response may therefore involve none, a few, several or most of the features of the Acute Stress Reaction. Similarly your responses may be 'mild' or more
intense. If however, in the immediate aftermath and following days you do have intense or unpleasant physical reactions, sleep disturbance, intrusive memories, feelings of fear or guilt, or other reactions of the type described above, it cannot be over emphasised that these are entirely normal reactions to abnormal events and in most cases are not longlasting. You should not feel embarrassed about their occurrence, or worry that they are in any way abnormal or signs of weakness. Expression of feelings related to the incident will not lead to loss of control and in most cases will in fact help you come to terms with what has happened.
THE PROCESS OF RECOVERY
just as there are many normal ways of reacting to traumatic experiences, so too there are many ways of dealing with stress.
'NATURAL' FORMS OF SELF PROTECTION
Some of the reactions to trauma are themselves ways of protecting a person and of coping with distressing experiences. These include:
Numbness
You may find that initially your feelings seem blocked off and that the event seems very distant or dream-like. This can be a way of allowing the distress of the incident to be felt only slowly and gradually. Others around you may (wrongly) think you are 'unfeeling' or 'being strong'.
Going over the event
Letting the experience enter you mind and thinking about it can allow you to try to make sense of what has happened.
THINGS YOU CAN DO TO PROMOTE RECOVERY
Accessing and accepting support from others
It is very comforting to receive physical and emotional support from other people. It is important not to reject support by trying to appear strong, or trying to cope completely on your own. Talking to others who have had similar experiences, or understand what you have been through, is particularly important - it can allow you to release pent up feelings and enables barriers to come down and closer relationships to develop. Some friends may be reluctant to push their support forward even though they would like to help - do not be afraid to ask and say what you want.
Taking time out for yourself
In order to deal with your feelings, you will however at times find it necessary to be alone, or just with close friends of family.
Confronting what has happened
Confronting the reality of the situation, e.g. by talking to a friend, will help you come to terms with the event.
Staying active
Helping others, keeping busy and distracting yourself through other activities can give some temporary relief.
Returning to your usual routine
it is usually advisable to return to your usual routine as soon as possible after the event in order to avoid incubation and magnification of fear while away from the situation.
All of the above can prove very helpful and make your experience easier to bear. However, over-use of some coping mechanisms can be counter-productive and even detrimental if they divert you away from getting the help and support you need. Over-activity or excessive use of distraction can, for example, be unhelpful if it prevents you confronting the reality of the event. Your recovery may be delayed if you suppress your feelings too much or for too long (numbness), or if you become preoccupied with repeated thoughts of the event. Gradually confronting the reality of what has happened, accepting support from others, and talking through your feelings are particularly important ways of gaining emotional release and coming to terms with your experiences.
WHO SHOULD I TALK TO?
Generally speaking it is 'good to talk' about your reactions and feelings about what has happened. In the main it is probably best to talk to people who you know, trust and feel comfortable with - usually this will be with members of your family or with close friends. Sometimes however this may not be possible - you may be away from your family and friends, your family or friends may themselves have been involved, or you may find it difficult to talk about your feelings within your family (because you do not wish to upset them, or because relationships are strained). If this is the case you might find it helpful to talk to colleagues at work, to a G.P, a member of the clergy, or to call a telephone Help Line - details of these are included at the end of the leaflet. Remember though that you do not 'have' to talk to a counsellor if you don't want to, and that where possible it is usually enough to draw upon your family or usual forms of support.
WHEN TO SEEK PROFESSIONAL HELP
It is important that you allow yourself to talk to your family or friends about your experiences and feelings at the earliest opportunity. If, however, some of the normal reactions described above are particularly intense and distressing, or if they persist for a long time (for more than about 4 to 6 weeks), it may be advisable to seek professional help. Some of the pointers suggesting you should consider asking for help include:
If you feel that you are overwhelmed by and cannot handle intense feelings and bodily sensations.
If you have no one to share your emotions with and you feel the need to do so.
If, 4 to 6 weeks after the traumatic event (if you have experienced a personal loss as a result of the event, then this recovery will take considerably longer e.g. months, sometimes years)
you continue to feel numb and empty, or have persistent feelings of tension, confusion, exhaustion, or other unpleasant bodily sensations.
you have to keep overactive in order not to focus on your feelings.
you continue to have intrusive thoughts or recollections of the traumatic experience.
you continue to have nightmares or poor sleep.
your relationships seem to be suffering badly, or sexual problems develop.
you are drinking to excess.
your work performance suffers, you make mistakes or you have accidents associated with poor concentration.
WHERE TO SEEK PROFESSIONAL HELP
If you wish to find our more about the availability of confidential counselling you should in the first instance approach your own G.P, who will be able to advise you on options and put you in touch with someone who can help.
SOME DO'S AND DON'TS TO REMEMBER
DO Express your emotions, take the opportunity to review the experience within yourself and with others, let your family share in your grief.
Express your needs clearly and honestly to your family, friends and managers and colleagues at work.
Take time out to sleep, rest, think and be with your close family and friends.
Try to keep your life as normal as possible after the initial period of often intense acute distress.
DON'T Bottle up feelings, avoid talking about what has happened, or let your embarrassment stop you giving others the chance to talk.
Expect the memories to go away quickly - they may stay with you for some time. Forget that others will be experiencing similar feelings to yourself.
Do remember that you are basically the same person that you were before the incident and that if you feel unable to cope with your feelings and reactions help is available.
Some helpful Points of contact:
It is suggested that contact your GP as the first point of contact. Your GP will be in a position to review your needs and refer you on to specialist support within your area. This is the standard procedure.
Another established and very helpful source is NHS Direct: 0845 46 47 Their website is http://www.nhsdirect.nhs.uk
They produce a leaflet on PTSD: http://www.nhsdirect.nhs.uk/nhsdoheso/print.asp?sTopic=Posttraul
The NHS Health Information Service will be able to put you in touch with national and local self-help groups. Tel: 0800 665544
Other Useful organisations:
ASSIST (Assistance Support and Self-Help in Surviving Trauma)
The Penthouse, 11/13 Bank Street, Rugby, Warwickshire, CV31 3PU Tel: 01788 560800
Support, understanding and counselling for people experiencing PTSD, families and carers. Telephone Helpline serves UK.
British Association for Counselling (BAC)
1 Regent Place, Rugby, CV21 2PJ: Tel: 01788 578328
Information and advice about counselling and psychotherapy. Send an SAE for details of local practitioners who specialise in treating PTSD.
Cruse Bereavement Care
Cruse House, 126 Sheen Road, Richmond-upon-Thames, Surrey, TW9 1 UR Tel: 0208 940 4818, Bereavement line 0845 758 5565: Fax: 0208 940 7638: e-mail:
info
crusebereavementcare.org.uk : For all those who have been bereaved.The Compassionate Friends
53 North Street, Bristol, BS1 3EN: Helpline 0117 953 9639 (9.30am -10.30pm daily): website: www.tcf.org.uk:
For parents who have lost a child through illness, accident, murder or suicide.
Ex-services Mental Welfare Society (Combat Stress)
Tyrwhitt House, Oaklawn Road, Leatherhead, KT22 OBY: Tel: 01372 841600 (8.OOam-5.OOpm):
e-mail: contactus@combatstress.org.uk: website: www.combatstress.com.For all members of all ranks of the Armed Forces or Merchant Navy. Three treatment centres available.
Medical Foundation for the Care of Victims of Torture
96-98 Grafton Road, London, NW5 3EJ. Tel: 0207 813 7777: Fax: 0207 813 0011: website: www.torturecare.org.uk.
: National referral centre to which people may refer themselves. Also refers people to local sources of help.
MIND (National Association for Mental Health)
15-19 Broadway, London, E15 4BQ: Tel: 0208 519 2122: Fax: 0208 522 1725: Mind runs a telephone helpline "Mindinfoline": 0208 522 1728 for callers in London and 0345 660 163 for callers outside London. The line is open Monday - Friday, 9.15am - 4.45pm. website:
www.mind.org.uk A useful self-help document on line for PTSD is here: http://www.mind.org.uk/mindpdfs/Understanding Post Traumatic Stress Disorder.odf National association offering support to those who have experienced mental distress. Has regional offices.Northern Ireland Memorial Fund
Room 125 Stormont House Annexe, Stormont Estate, Belfast, BT4 3ST: Tel: 028 9052 7939: Fax: 028 9052 7901:
e-mail: nimf@nics.gov.ukOffers financial assistance for those affected by the NI Troubles: small grants scheme, short break scheme, chronic pain management scheme, amputee assessment scheme, wheelchair assessment scheme and education & training scheme.
Traumatic Stress Clinic
73 Charlotte Street, London, W1T 4PL: Tel: 0207 530 3666: website:
www.traumatic-stress.com/tsc.htmReferral via GP or appropriate agency.
Traumatic Stress Service
Maudsley Hospital, 99 Denmark Hill, London, SE5 8AZ: Tel: 0207 919 3458
National referral centre (via GP or other agency) for those over 17. Offers rapid assessment to people suffering from PTSD or related problems.
Trauma Aftercare Trust (TACT)
Butterfields, The Farthings, Withington, Gloucestershire, GL54 4DF: Tel: 0800 169 6814:
Contact point and referral network for counselling.
Victim Support
Cranmer House, 39 Brixton Road, London, SW9 6DZ:Helpline 0845 303 0900 (Mon-Fri 9.OOam9.OOpm; Sat-Sun 9.OOam-7.OOpm)