Understanding
and coping with your feelings following a traumatic eventThese are the thoughts and feelings two people who have experienced traumatic events.
"I feel terrible, very restless and irritable. This is not like me at all. The car crash happened 6 months ago but I still can't feel safe in a car, I feel so fearful I avoid travel wherever possible. Pictures of the accident come flashing into my mind, they won't go away and even at night my dreams are more like nightmares with scenes of the crash happening again and again ... I'm exhausted by it ..."
"My whole view of life has changed, I keep thinking why us? I feel very guilty thinking that I could have done more to save my friend who died in the fire. I relive the experience all the time, I keep thinking "if only I had done this, if only I had done that..." I am very low and depressed some of the time... I think I could have died ... I can't think of the future ... I feel helpless ..."
If you have suffered from a traumatic experience yourself you may have had similar feelings. This leaflet, written by psychologists, aims to help you understand these reactions and offers some practical suggestions to help you cope.
What is a traumatic Incident?
A traumatic incident can be anything that is out of the ordinary range of daily events and is deeply distressing to someone.
Many things can have this impact: a fire, an accident, a robbery or burglary, an attack, being a witness to a traumatic event such as a death. It can be large scale such as a major disaster involving many people or a personal event involving yourself, friends or family members.
What reactions do people have following a traumatic incident? The following are some of the reactions you may experience after a traumatic event. In general people's reactions will fall into the following three groups: • Re-experiencing the trauma in your mind. • Avoiding things associated with or related to the trauma. • Feeling more tense, irritable or over alert than usual.
It may help you to check to see if you are experiencing any of these symptoms.
Re-experiencing the
trauma in your mind
|
Avoiding things related to the
trauma and numbing
|
The post-traumatic stress reactions can affect us in at least four different ways:
- How we feel
- The way we think.
- The way our body works.
- The way we behave.
It may help you understand how you are feeling by placing a tick next to those symptoms you experience regularly:
| How do you feel ? | How do you think? | What you do? | Common thoughts | ||||
| Anxious, nervous worried frightened? | Constant worrying? | Pace up and down? | "It was my fault" | ||||
| Feeling something dreadful is going to happen? | Can't concentrate? | Avoid things that remind you of the trauma? | "I'm cracking up". | ||||
| Tense, uptight, on edge unsettled? | Flashbacks - pictures of the trauma coming into your mind? | Can't sit and relax? | "I'm going to have a heart attack" | ||||
| Unreal, strange, woozy, detached? | Blaming yourself for all or part of the trauma? | Avoid people? | "It's controlling me". | ||||
| Body aching? | Thinking it will happen again? | Avoid being alone? | I can't cope". | ||||
| Panicky? | Not being able to make a decision? | Snappy and irritable behaviour? | "I'm going to faint". | ||||
| Depressed, low, at a loss? | Regret, shame or bitterness? | Spoil relationship? | "Why did it have to happen?" | ||||
| Feeing angry? | Thoughts racing? | Drink/smoke more? | "I can't see the point anymore". | ||||
| Depend on others too much. | |||||||
| What happens to your body? | |||||||
| Heart races and pounds? | |||||||
| Chest feels tight? | |||||||
| Muscle tension/stiffness? | |||||||
| Tiredness/exhaustion? | |||||||
| Dizzy, light headed? | |||||||
| Jumpy or restless? | |||||||
| Stomach churning? | |||||||
| Sleep problems/nightmares? | |||||||
| Easily startled? |
Why do we react so strongly to trauma?
There are many reasons why trauma leaves such a strong impact on us emotionally.
Firstly, it often shatters the basic beliefs we have about life. That life is fairly safe and secure, that life for us has a particular form, meaning and purpose. It may be that the image that we have of yourself is shattered, we may have responded in crises differently to how we expected or wanted to behave.
Secondly trauma usually occurs suddenly and without warning. We have no time to adjust to this new experience, it will usually be outside our normal range of experience and we are faced with not knowing what to do or how to behave. You may have felt you were going to die, people around you may have died, you are shocked. In the face of this danger our mind holds on to the memory of the trauma very strongly, probably as a natural form of self protection to ensure you never get into that situation again. The result of this is that you are left with the post-traumatic reactions described above.
What can I do to help myself overcome the trauma?
It is important to understand that the reactions you are experiencing are very common following trauma, they are not a sign of "weakness" or "cracking up". The following suggestions may help you begin to cope with the post-traumatic reactions. Things that we describe which may help you are:
- Making sense of the trauma
Try and find out as much as you can about what really happened. This will allow you to more clearly piece together a picture and understanding of the event which can help you in your recovery. If others were involved, talk to them and ask them their views of events. Other victims, helpers from the rescue service, or passers by may all be people who would help you gain a broader view of what happened. The rescue services are usually happy to help you in these circumstances. It may help you to think it through with other people, you may feel the trauma has altered you whole view of life, it is helpful to try and clarify how you now feel, talking can help you do this. Some people talk to a friend, family member or partner, others may approach their doctor to seek some counselling.
Other people have found that it helps to write down their experiences. Try to spend a few minutes thinking of ways that you may be able to make sense of what you have been through. Try and jot down some ideas:- People to speak to to find out more.
- People to talk it over with.
- Things you may do yourself, eg write down your experiences.
- Dealing with flashbacks and nightmares
Many people try to put the experience of trauma behind them by attempting not to think of it. Although this may seem a natural thing to do, it does not always help them to overcome the problem. People may find that they continue to be troubled by intrusive unwanted pictures of the trauma in their mind (flashbacks) and by unpleasant dreams or nightmares related to the trauma.
One of the best approaches which has been found to reduce flashbacks and nightmares is to make time each day for reviewing and going over the unpleasant memories or nightmares. Many people have found that if they put 20 minutes aside to calmly think over, talk over or jot down notes on the trauma, that their unwanted flashbacks and nightmares will gradually become less powerful and less frequent. If you have nightmares, it may help to do this soon before you go to bed. This process can allow you to regain some control over these thoughts rather than them intruding upon you. It is important to try and remember to focus on some of the positive parts of your current situation when looking back over the trauma you have experienced. Try the following approaches:- Write down details of the flashbacks or nightmares you experience.
- Find of a time of day when you could think over what has happened, this should be in a safe calm environment.
- Think of some positive things about your current situation: for example, "I survived it and I'm still here", "I have good friends to support me", "I can now begin to plan for a new future".
- Overcoming tension, irritability and anger
Tension, irritability and anger are common aspects of a post-traumatic reaction. Many physical symptoms may go with their feelings including breathlessness, heart racing, over-breathing, dizziness and muscle tension. Try the following ways of reducing physical symptoms. In order to reduce the severity of physical symptoms it is useful to "nip them in the bud", by recognising the early signs of tension. Once you have noticed early signs of tension you can prevent anxiety becoming too severe by using relaxation techniques. Some people can relax through exercise, listening to music, watching TV, or reading a book.
For others it is more helpful to have a set of exercises to follow. Some people might find relaxation or yoga classes most helpful, others find tapes useful. You can obtain a relaxation tape from your GP, and there are also a wide number of relaxation tapes available in the shops. Relaxation is a skill like any other which needs to be learned, and takes time. Relaxation exercises teach deep muscle relaxation, and many people find it very helpful in reducing overall levels of tension and anxiety.
Whilst relaxation, breathing exercises and distraction techniques can help reduce anxiety it is vitally important to realise that anxiety is not harmful or dangerous. Even if we did not use these techniques, nothing awful would happen. Anxiety cannot harm us, but it can be uncomfortable. These techniques can help reduce this discomfort.
It may be worth talking over your feelings of anger with those around you. Your anger is not really directed at them but may at times be `taken out` on them. Let them know that the anger is because of what you have been through and ask for their patience until the anger and irritability passes, tell them not to `take it personally`. - Overcoming avoidance
Avoidance following a traumatic experience can take many forms. It can involve avoiding talking about the trauma, avoiding becoming upset about the trauma, it can also be that you avoid anything anyone or any situation that reminds you of the trauma. This avoidance prevents you from "moving on" from the trauma and in some cases it can prevent you getting on with your life in a normal way.
| Try to recognise the things you are avoiding, it may
help to write them down:
|
Set yourself very small goals to tackle these fears. We call this an `anxiety ladder`, where those situations that we only fear a little are at the bottom and our worst feared situations are at the top.
- Overcoming low mood
It may help to look at this example:
Mary was held up at gunpoint when she worked as a cashier at a bank. She can no longer go into small offices in public places, she avoids all television programmes and newspapers where there may be reports about violent incidents. She has made up the following anxiety ladder:
| Least feared: 1 | Looking at newspaper reports about the attack. |
| 2 | Looking at the 6 o'clock news |
| 3 | Watching `Crime watch`. |
| 4 | Standing outside local building society. |
| 5 | Going into local building society. |
| 6 | Going into bank in busy area. |
| Most feared: 7 | Going into bank where attack occurred. |
It may help to try and make your own anxiety ladder. Remember you may feel anxious at first, but if you are able to stay in the feared situation you will gradually begin to feel calmer.
- Overcoming low mood, following trauma
People often experience low mood following trauma. This can sometimes give rise to feelings of low self worth, reduced confidence, helplessness and guilt.
It is important not to let any gloomy or negative thoughts go unchallenged. Following trauma people tend to think and expect the worst of themselves, their life and the future. Don't just accept these thoughts try to:- Identify when your mood is very low.
- Jot down the unpleasant thoughts you are having during that time.
- Try and counter these thoughts by writing down arguments against them. Imagine what you would say to a friend if they had such negative thoughts about themselves. This is particularly important if you are feeling guilt.
It may help to keep a diary of things you have enjoyed or achieved during the week. This can help you to concentrate on the good things rather than than the bad things in your life.
Do something active Physical activity is particularly helpful. Walk, run, cycle, skip; anything which begins to increase your activity can help to improve how you feel. Plan 15 or 20 minutes of activity every day, or every other day to begin with. This kind of physical activity can actually begin to make you feel less tired, and can lift your mood.
Find something that interests you and spend some time on it. Plan to focus on things you usually enjoy and build some time into each day for these activities. You might find it helpful to take up a new interest. Some people find that creative activities such as painting, writing poetry or playing music that helps them to express their feelings, can help them to feel better.
Look after yourself. Resist the temptation to cope with your low mood by drinking alcohol, misusing medication or turning to illegal drugs. These may give some immediate relief but quite soon create further health and psychological problems for you to cope with. Eat well; a good diet can help to keep you in good health so recovery is easier.
Try and `treat` yourself to things you normally enjoy.
When should I ask for further help?
We hope the suggestions made in this booklet have been helpful to you. Distress following trauma usually fades with time, however if you feel that you are making little progress then other help is available to aid you in overcoming your problems. Consider this in particular if your work performance or relationships are being badly affected, you feel you are no longer coping or you have had any thoughts of harming yourself. If your feelings are not improving after some months then it is also worth considering seeking further help. Your GP is the best person to talk to in the first instance. He or she will have information about local services which may be able to help. Your practice nurse or health visitor will also be able to help.
Victim support is an organisation which offers support and counselling to people who have experienced trauma. Their local offices are:
- Ashington: 83a Station Road. (Tel: 01670-812082)
- Castle Morpeth: Tower Buildings, Oldgate, Morpeth. (Tel: 01670-510259)
- North Northumberland: 22 Bondgate Without, Alnwick. (Tel: 01665-602863).
- Tynedale: 1 Meal Market, Hexham. (Tel: 01434-600117).
The following people will also have information about these services:
- Northumberland Community Health Council (The Old Stables, Grey's Yard, Morpeth - 01670-504562).
- Northumberland User Voice, Amble House, St George's Hospital (01670-512121, ext 2694).
The following organisations and help lines may also be useful:
- CRUSE Bereavement Line - help line for bereaved people and those caring for bereaved people. Tel: 0181-3327227. (Local Cruse: 01670-353710, Blyth Group).
- Disability - DIAL - UK network of disability information and advice services run by people with direct experience of disability. Tel: 01302-310123.
- Domestic Violence - Refuge - 24 hour crisis line providing practical advice and emotional support for women experiencing domestic violence. Tel: 0181-9954430.
- Legal - Accident Legal Line for people who have suffered an injury in an accident. Will refer onto local solicitors if appropriate. Free call: Tel: 01550 192939.
- Mind - Northern - 158 Durham Road, Gateshead, Tyne and Wear, NE8 4EL. Tel: 0191-4900109.
- NHS Direct - Telephone help line/information. Talk confidentially to a nurse. Calls at local rate, tel: 0845-1888.
- Rape and Sexual Abuse. Rape Crisis Centre - help line for women and girls who have been raped or sexually assaulted. Tel: 0171-8371600.
- Relate Northumberland and Tyneside - help with marital or relationship problems - Mea House Ellison Place, Newcastle. Tel: 0191-2329019.
- Samaritans, 25 North Seaton Road, Ashington. Tel: 01670-814222. Linkline (local rate). Tel: 0345-909090. Confidential support for anyone in a crisis.
Some useful books that you may like to buy or borrow from your library:
- Ivy Blackburn (1987). Coping with Depression. Chambers.
- David Burns (1980). Feeling Good, The New Mood Therapy. New American Library. New York.
- Hodgkinson, P.E., and Steward, M. (1991). Coping with Catastrophe. Routledge.
- Kinchin, D. (1994). PostTraumatic Stress Disorder - A Practical Guide to Recovery. Thorsons.
- Matsakis, A. (1992). I can't get over it - A handbook for trauma survivors. Harbinger.
- Parkinson, F. (1993). Post Trauma Stress.