After a Traumatic Event Expand ‘Normal’ reactions: The symptoms you may experience after a traumatic event can be divided into three groups: Re-experiencing the Event (intrusive reactions). You may feel like you are experiencing the traumatic event all over again, through memories (thoughts or images) that come into your mind or into your dreams. Arousal Reactions. You may feel nervous, panicky, anxious, agitated, tearful, be unable to concentrate, have difficulty sleeping, and find yourself over-reacting to small things. Avoidance Reactions. You might try not to think about the traumatic event or anything that might remind you of it. You may shut down your feelings and try to keep to yourself and away from other people or from things you would normally do. You may have a sense of feeling withdrawn or emotionally numb. These symptoms can feel overwhelming and can be very distressing and therefore it is useful to understand why they exist. When you are in a threatening/dangerous (i.e. traumatic) situation your body responds automatically and naturally so that you have the energy for survival (the fight or flight (stress) response). During the fight or flight response your body produces adrenaline that is circulated to muscles enabling the body to move more quickly, be stronger and more tolerant of pain. Your muscles become tense and your breathing rate increases. Sometimes after a traumatic event the brain continues to get messages that there is a threat/danger (just as at the time of the trauma) and the body produces the same (stress) response. Even small triggers (reminders) can cause this response. Other Symptoms Include: Sleeplessness. Nightmares. Anger/Irritability. Feeling worried about the future. A feeling of being on ‘red alert’. Usually, after a few days or weeks, these symptoms settle down. If after one month these symptoms continue additional help might be required. Why do I feel this way? During very threatening incidents it is thought our brains find it very difficult to take in what has happened. Consequently, pictures and/or feelings of the experience tend to come into our minds in ‘flashbacks’ or nightmares. It is generally thought that this may in fact be part of a natural healing process as our brains try to come to terms with what has happened. Any kind of threat to our survival often leads us to re-evaluate our views of the world. We tend to assume that we are invulnerable and when this is challenged, we can become generally more nervous about life and the future. How long will these reactions last? Recovery from a traumatic incident takes time. This is important to remember. Many people find that nightmares and flashbacks decrease, though the time this takes is variable depending on the individual. As the time since the event increases, feelings that there is a danger around every corner also tend to become less. However, many people remain more sensitive to danger than they were previously, though this does not necessarily make people over-cautious, perhaps more realistic than others. How will I know when I’ve recovered? People generally feel they’ve recovered when they are able to enjoy life again, perhaps get back to work and their nightmares and flashbacks have decreased. They do not restrict their activities or avoid doing something because it reminds them of the event. They often find they are able to talk about it without becoming very distressed. Some people seem to recover well without psychological help, but with much support and encouragement from friends and family. However, many people find that some additional therapeutic help is needed in order to reduce disabling flashbacks, help them to lay the event to rest and face the future. If people have been left with disabling injuries following an accident, this also means a lot of work in adapting to these and some kind of psychological support may help with this. Is there anything that will help my recovery? Although people may recover in many different ways, it is generally thought that the following may help: Being able to talk through your feelings and thoughts. Support and understanding from friends and/or family. Gradually getting yourself back to work if possible. Trying to make sure you are still doing enjoyable or pleasurable activities. Spending enjoyable time in other’s company. Lots of sleep, rest and relaxation, to help body and mind recover. Is there anything I might be doing that may not help my recovery? Again, although there are no hard and fast rules, it’s generally thought that the following may not be helpful: Refusing to think about the event or anything relating to it. Refusing to talk about feelings and thoughts. Carrying on as if nothing had ever happened. Avoiding anything that might remind you of the event. Becoming withdrawn and not doing anything enjoyable. Thinking about nothing other than the event. Relying on recreational drugs or alcohol to mask your feelings. When should I get more help? This really depends on how you think the after effects of a trauma are affecting your life. If you feel that the continuing symptoms mentioned above are impacting you in everyday life, and this is not decreasing after 4-6 weeks then it may be time to seek some additional professional help. Where can I get Further Help? Your GP – they have access to various forms of support and can talk to you about your symptoms. Find a GP using the NHS website. Talking therapies/counselling services – available via NHS or privately – see link below DSAA Patient and Family Liaison Nurses – Jo and/or Kirsty may be able to advise you where to find further support or talk to you about the event to provide some closure. Your current Mental Health practitioner (if relevant) The list of linked resources may provide you with information and support services relevant to your situation.
Trauma: Managing Flashbacks Expand When flashbacks (intrusive memories involving thoughts and/or images) occur you can feel like you have gone back in time to when you experienced the trauma. Grounding techniques help to refocus you to the present day and can help reduce their intensity. As soon as you notice signs of a flashback pick one of the grounding techniques below and try it out: 1. Focus on any object in the room you are in and…. Describe it in detail to yourself Use your senses (sight, touch, hearing, smell and taste) What size it the object, what colour is it, what shape is it? What do you like about it or dislike about it? What does the object feel like? Is it smooth or rough? Does it have different textures? Does it make any noise? If so what does it sound like? Does it have a smell? If so what does it smell of? If the object you have chosen is a drink or some food; What does it taste of? 2. Grounding Object. Select a small object that is not connected to your traumatic event in any way (e.g. a bracelet, a coin, a stone). Carry this with you. As soon as you notice signs of a flashback, touch and look at your object. 3. Grounding Smell. Identify a scent that you like that is not connected to your traumatic event in any way. Find a way to carry this scent with you (e.g. have a small bottle of perfume or a small bottle of an essential oil). As soon as you notice signs of a flashback, take out your scent and smell it. Describe the scent and how it makes you feel. Allow yourself to feel calm and relaxed. It can also be helpful to remind yourself: What day it is The date The time Your location And to remind yourself that you are in present time, that you are safe now and not in danger.
Sleep Hygiene Expand Most people will experience sleep difficulties at some time in their lives but there is some advice that may be able to help. General Advice Go to bed and get up at the same time each day - your body will adjust to the time you have set and be more prepared for when you should be awake or asleep If you do need a nap, make it less than one hour and not in bed – 45 minutes on the sofa is perfect. Set an alarm! When possible, avoid caffeine and alcohol between lunch and bedtime Don’t eat a large meal before bed, although a small snack may avoid hunger disturbing your sleep Wind down gradually over the evening - avoid any mentally demanding tasks up to 90 minutes before going to bed Put the day to rest - don’t go to bed with thoughts on your mind which may keep you awake Bedroom Environment Your bedroom should be associated with relaxation, try soft lighting and relaxing music to make it as comfortable as possible Do not carry out activities that can evoke intense negative emotions, even watching television can stir up fear, sadness or anger - so avoid having a TV in your bedroom Move the clock so you cannot see the time - clock watching will only increase the pressure to sleep What to do if you wake up in the middle of the night Get up after 20 minutes of not sleeping - do not associate your bedroom with negative experiences such as lying awake Never try to sleep as this will make it harder, instead try a relaxing activity (i.e. reading) which will keep your attention from worrying about the fact you are not yet sleeping Return to bed when you feel tired but try not to stay awake for longer than 30-45 minutes Don’t go over problems - there is nothing you can do about them in the middle of the night. If necessary, write them down and leave the list downstairs to think about the next day Try repeating your going to bed routine Anything between 4 and 10 hours sleep a night is normal, so you may have woken up because you have had all you need - anymore sleep could just end up making you feel more tired
The Link Between Mood and Pain Expand Pain has a psychological component. This is not to say that pain is in your head. Instead, your mood can act as a volume control for pain – turning it up and down. Serotonin is a chemical in our brain that is linked to both mood and pain perception. The lower your mood, the more pain you feel. Anxiety Increases Pain Anxiety increases muscle tension which results in greater pain Anxiety also increases alertness to physical changes in the body Anxiety results in more worried and catastrophic thoughts, which may prevent you from doing things despite your pain Depression Increases Pain Pain magnifies low mood Feeling depressed makes it difficult to change habits Depression results in feelings of isolation and loss of self confidence Depressed people can feel out of control and have many negative thoughts, possibly preventing you from doing things despite the pain Feeling depressed results in avoidance of social activities and events, this all leads to a vicious circle of isolation and low mood. Our thoughts affect how we feel. When we feel low in mood, we tend to have a lot of negative thoughts. If we can identify that we are having these thoughts, we can challenge them and hopefully replace them with more realistic/balanced thoughts. Ask yourself these questions: What is the evidence for this thought? Are there any alternative ways of thinking about this? What would I say to a friend who is in the same situation? What would my friend say to me? By challenging negative thoughts, and replacing them with more realistic or positive ones, we can: Feel more in control Raise our mood Help ourselves relax Increase our motivation Increase energy and activity Decrease pain Manage life better
NHS talking therapies Expand Talking therapies, or psychological therapies, are effective and confidential treatments delivered by fully trained and accredited NHS practitioners. What are talking therapies? Talking therapies can help with common mental health problems like stress, anxiety and depression. Which therapy you are offered depends on which one has been shown to be most helpful for your symptoms. Here are a few examples: Guided self-help – where a therapist coaches you as you work through a self-help course in your own time, either using a workbook or an online course. Cognitive behavioural therapy (CBT) – based on the idea that thoughts, feelings, what we do, and how our bodies feel physically, are all connected. CBT works to help us notice and challenge patterns of thoughts or behaviours so we can feel better. Counselling for depression – a type of counselling developed for people with depression. Talking therapies are offered in different ways, including: using a self-help workbook with the support of a therapist as an online course one-to-one in person, over the phone or through video consultation in a group You can access talking therapies for free on the NHS. You can refer yourself directly to an NHS talking therapies service without a referral from a GP, or a GP can refer you. NHS talking therapies services are also known as Improving Access to Psychological Therapies (IAPT) services. Use this link to see how to self refer to NHS Talking Therapies: NHS talking therapies - NHS (www.nhs.uk)
Urgent help in a crisis Expand If you or a loved one are having a mental health crisis, you can call a local NHS mental health helpline for 24-hour advice and support: Mental Health Helpline for Urgent Help - NHS (www.nhs.uk) You can call for yourself, your child, your parent or someone you care for. If someone's life is at risk or they cannot be kept safe, call 999 or go to A&E.
Helpful links to charities and organisations: Expand National NHS Anxiety Support Anxiety can affect anyone but is more likey to occur after being involved in a traumatic incident. Please use this link to access the NHS page regarding generalised anxiety including symptoms, self help and treatment options. Visit: https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/ After Trauma After Trauma is a website that connects and supports survivors of traumatic injury and their families. After Trauma aims to provide a community for patients and families to rebuild lives and support each other after experiencing a traumatic injury. There are lots of helpful sections to read and also links to other helpful resources. Visit: www.aftertrauma.org Headway The brain injury association is a charity set up to give help and support to people affected by brain injury. It provides support, services and information to brain injury survivors, their families and carers, as well as to professionals in the health and legal fields. Call: 0808 800 2244 Visit: www.headway.org.uk Brake To support people bereaved and seriously injured by road crashes. Brake’s support service is free if you are bereaved, seriously injured, or helping a road crash victim. You can be allocated a named caseworker. Call: 0808 8000 401 Email: [email protected] Visit: www.brake.org.uk Road Peace Road Peace help bereaved families cope and build resilience through peer support, their local group network, befriending service and trauma support programmes. They also provide information guides on navigating the justice system and help with seeking fair compensation for bereaved families and seriously injured victims. Call: 0845 4500 355 Visit: www.roadpeace.org Back Up They help people and their families to rebuild their independence after a devastating spinal cord injury. They also provide peer support. Call: 020 8875 1805 Visit: www.backuptrust.org.uk Spinal Injuries Association (SIA) Visit: www.spinal.co.uk Limbless Association At the Limbless Association (LA), they believe no amputee need cope alone. Established since 1983, they offer both practical and emotional support for amputees throughout their pre and post-amputation journey. Call: 0800 644 0185 Visit: limbless-association.org ICU Steps Information for patients and relatives on intensive care, recovery and coming to terms with surviving critical illness. Visit: icusteps.org MIND A national and local charity which provides advice and support to empower anyone experiencing a mental health problem. They campaign to improve services, raise awareness and promote understanding. Call: 0300 123 3393 Visit: www.mind.org.uk Changing Faces This is the UKs leading charity for people with a scar, mark or condition. They provide unique and life changing well being support, counselling, skin camouflage and education services. Call: 0300 012 0275 Visit: www.changingfaces.org.uk
Bereavement Expand National Bereavement Compassionate Friends The Compassionate Friends (TCF) is a charitable organisation of bereaved parents, siblings and grandparents dedicated to the support and care of other similarly bereaved family members who have suffered the death of a child or children of any age and from any cause. Call: 0345 123 2304 or email [email protected] Visit: www.tcf.org.uk Find support for parents and siblings Cruse Cruse provides counselling, support, information, advice, education and training services to the friends and relatives of someone who has died, to help them understand their grief and cope with their loss. Call their helpline: 0808 808 1677 Visit: www.cruse.org.uk Chat online with expert grief counsellors Sudden They help when someone has died suddenly, or too soon in their life, because of a sudden medical reason (including COVID-19) or terminal illness injuries, caused by something that happened suicide Their role is to help people during the first ten weeks following a sudden bereavement. You can call them from day one, onwards. Call: 0800 2600 400 Visit: www.sudden.org SADS To save the lives and support the families of children and adults who are genetically predisposed to sudden death due to heart rhythm abnormalities. Also to support those who have lost a loved one to sudden unexplained death. Call: 1 801 948 0654 or email: [email protected] The Lullaby Trust The Lullaby Trust raises awareness of sudden infant death syndrome (SIDS), provides expert advice on safer sleep for babies and offers emotional support for bereaved families. They can offer support to families following the death of a baby or young child. For their helpline call 0808 802 6868 or email [email protected] Visit: www.lullabytrust.org.uk Find out how the Lullaby Trust can support you Winston’s Wish Winston’s Wish supports bereaved children, young people, their families and the professionals who support them. For their helpline call - 08088 020 02 Visit: www.winstonswish.org Support services for children and young people Local Bereavement Mosaic Mosaic are a Dorset based charity supporting bereaved children and young people, their families and the professionals working with them. Mosaic support children and young people who have been bereaved of someone special, such as a parent, sibling, friend or a member of their extended family. This includes all causes of death such as long-term illness, sudden death, suicide, murder or road traffic accident. Call: 01258 837 071 Visit: www.mosaicfamilysupport.org Support services for children and young people in Dorset