TranslateCoping after a traumatic event
These pages provide information about:
- How people often feel after experiencing a traumatic event
- What people can expect in the longer term
- Ideas for things which might help people to cope
The information in this leaflet could be helpful if you or someone you know has experienced a traumatic event. This information is general; everyone is different and there is no ‘normal’ or ‘right’ way to respond.
If you feel that some of this information applies to you and your problems persist for over a month without improvement, you might consider contacting a healthcare professional to discuss your specific situation further.
What is a ‘traumatic event’?
A ‘traumatic event’ is a highly stressful experience, often involving death, injury or danger. It might be something which happens to you personally, or something you might witness or hear about happening to someone else. This could be someone you know or something you’ve seen through the media.
People who work in jobs where they repeatedly come into contact with death, injury or danger, such as healthcare workers, emergency services or the military, are therefore more likely than average to experience traumatic events and their psychological consequences.
‘Psychological trauma’ is the emotional impact of a traumatic event and can be thought of as a sliding scale with short-term, acute distress on one end of the scale and chronic Post Traumatic Stress Disorder (PTSD) on the other. Not everyone who is exposed to a ‘traumatic event’ experiences psychological trauma, and when trauma does occur it affects people differently. Millions of people in the UK will experience psychological trauma of some sort in their lifetime.
How do people often feel after a traumatic event?
Although everyone is different, there are some key features which define psychological trauma and distinguish it from other emotional reactions such as general anxiety or low mood/depression.
Reliving the event
People experiencing trauma often find they have intrusive thoughts about the event and can experience a lot of triggers or reminders which bring the event back to mind. Some triggers are specific to the event, such as seeing a story on the news about the event, and some are more general like hearing a song that was playing when the event was taking place. Lots of things can act as triggers including sounds, smells, images, memories, conversations, places, objects, dreams etc. People who have experienced trauma can feel like they are constantly being reminded about the event and this in itself can be very stressful.
People’s minds can also replay the event when they are asleep and this leads to one of the most difficult effects of trauma, nightmares about or related to the event. People sometimes don’t remember their dreams but wake up sweating or with their heart racing. They may then find it difficult to get back to sleep and may be afraid to try. Insomnia and general disruption to sleeping patterns is also common for people experiencing trauma.
People might also experience ‘flashbacks’ or intense, vivid memories while they are awake and can lose touch with the fact that the event is not actually happening again. This can be a scary experience for the person and anyone who is with them at the time, especially if they don’t know what is happening. Sometimes people experiencing trauma can feel like they are distant or in another world, for example they may be watching TV or having a conversation and then realise they have been thinking about the event the whole time without realising. They might not even remember what they have been thinking about and feel as if the time has been lost.
Feeling anxious, on edge and in danger
When people are exposed to triggers or memories of the event, their bodies can respond by releasing adrenaline and stress hormones which makes them feel anxious. Their heart rate and breathing rate go up, and they may start sweating or feel agitated or tense. They can also feel numb or detached from their environment. As mentioned, trauma can affect people quite differently. These responses to triggers are similar to the well-known concept of ‘fight, flight or freeze’.
People who have been exposed to a traumatic event can feel like they are constantly on-guard and find it hard to relax afterwards. They may feel vulnerable and afraid, and may notice themselves being easily startled by things like loud or unexpected noises.
Wider emotional and psychological effects
People who have experienced psychological trauma may notice more general mental and emotional effects as well such as feeling more irritable, sad or fatigued. They may have problems with concentration or memory, and just not feel like themselves. Trauma can also have an impact on how people think and feel about themselves. Feeling like a failure or a burden, feeling angry, guilty, lonely or isolated is common, for example.
All of these experiences combined can make living with trauma exhausting, frightening and very difficult.
What happens next?
For the majority of people experiencing psychological trauma, things gradually get better on their own. A process of natural adjustment and coming to terms with what has happened occurs in the background of their minds and bodies while they live their daily lives. Over the weeks and months they will notice their sleep and mood improving. They will feel less anxious and on-edge, and spend less time thinking about what happened to them.
For some people their problems last longer and might not improve as much as they would like. In these cases there is support available. Everyone is different, but if someone does not notice improvement or if things are getting worse for more than a month after they first experience problems, then it could be a good idea to talk with a professional. It is important to note that for some people, the onset of their distress may be delayed by up to six months from when they first had the traumatic experience and so their timeline of recovery will be different.
For members of Liverpool University Hospitals NHS Foundation Trust, the Staff Support Psychology and Counselling Service offer support and advice related to trauma (https://www.liverpoolft.nhs.uk/lft-extranet/occupational-health-and-wellbeing/staff-psychology-and-counselling-service/). Other local NHS services are also available to help with trauma and are accessible through your GP.
In some severe cases, people may feel unable to keep themselves safe or may have thoughts about harming themselves. If so they should contact a local crisis service
(https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/) or report to A&E.
There are a range of psychological therapies which are proven to be effective in helping people with chronic trauma, including PTSD, which are available on the NHS. The two most popular therapies are called Trauma Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR).
What can people do to help?
Although people experience psychological trauma differently, there are some general things which people often find helpful.
Being kind, patient, and taking your time
It is important that people try their best to be patient and kind to themselves and take their time to get back into things after a traumatic event. Natural adjustment is the most powerful healing process for trauma. It is common for people to feel guilty or selfish for taking care of themselves and their needs but it is essential for recovery. Acts of self-care and kindness like allowing ourselves to rest, relax and have an ‘off day’ are crucial.
It is also common for people experiencing trauma to feel overwhelmed at times, particularly if they are in a busy place or have a lot going on around them or in their minds. Taking a short break and using one of the exercises at the end of this leaflet (relaxation breathing, anchoring or safe/calm place imagery) can help to provide some respite.
Being engaged
It is also important that, when they feel able, people continue to do things they care about, even if it might feel difficult to begin with. One of the most common ways people naturally cope with trauma is avoiding things which make them feel anxious or remind them of the traumatic event. Although this can help them feel better in the short term, in the long term it often makes anxiety worse and can leave them feeling even more isolated or disconnected. Setting goals to remain active is a powerful way to counteract the natural urge to avoid things which make us feel anxious.
Engaging in each of the following three categories of activities is known to be beneficial when adjusting to trauma:
Social activity- one of the main negative impacts of trauma is it can make people feel that they are alone. The experiences can be so unusual that people can feel like no one understands or that they are a burden to others. It is important then that people have positive experiences of social engagement during these difficult times.
This might be talking with other people who understand what they are going through, e.g. colleagues or professional support. It could also be spending time with people doing something completely unrelated and giving themselves a break from thinking about their problems. It is important to stay connected with others in whatever way works, even if it feels difficult.
Physical activity- trauma often makes people feel like they are in a battle with themselves. Having their body feel suddenly overwhelmed and tense or anxious because they saw a reminder of the traumatic event can make people feel that their body is working against them and they are fighting for control. This only adds to the exhaustion and the alienation of trauma and so it is important that people also have positive physical experiences where they and their bodies are working together.
Walking, dancing, aerobics, yoga or anything where we are coordinated with our bodies can give us this experience. When people feel they are ready, it is beneficial to the adjustment process for them to start to use their bodies in a constructive way again.
Mental activity- trauma can also make people feel that their mind is working against them, getting in the way of them doing what they want to do, not letting them relax or focus, or letting them down by forgetting things or losing concentration. It is important therefore that people seek out experiences where they are working together with their mind in harmony on a common goal.
Examples include reading, puzzles, meditation, arts and crafts and other creative activities, or whatever people find mentally engaging.
Being in the present moment
Another key reason why being engaged in things we care about is so important is because we are less likely to dwell on our problems when we are focused in the present moment.
Thinking a lot about what happened in the past is likely to make us feel worse. Noticing that we are dwelling and then choosing to refocus on something we’d rather be doing about can give our minds and bodies a break from stress.
It is important to note that dwelling for a longer period of time on our problems is not the same as having a thought pop into our heads or being triggered. We have no control over the initial thoughts that pop into our heads when we see a news story about the traumatic event, or someone brings it up in conversation. We do have some control over if we sit and think about it for an extended period later that evening, or if we spend our time and energy on something we enjoy or care about.
Mindfulness practice can help us to develop the ability to focus on the present, some popular apps are recommended at the end of this leaflet. YouTube is also a good source of exercises.
Links to exercises which people often find helpful
Relaxation breathing - click here for more information
There are many different flavours of this technique (e.g. box breathing, deep breathing, colour breathing) but essentially they all do something similar. When we are feeling tense and agitated and our heart rate or breathing is elevated, we can help to calm ourselves by making a conscious effort to breathe more slowly. This lets our minds and bodies know that we are safe and gives time for the anxiety to dissipate.
Anchoring - click here for more information
This exercise (sometimes called grounding or ‘5 senses’ etc) uses our senses and environment to detach from difficult thoughts and feelings, giving the mind and body time to come back down after a period of anxiety. There is nothing magical about the particular format and people should feel free to play around with what works for them and their situation (e.g. focusing on a single sense such as touch, or applying your 5 senses to a single object like a drink)
Safe/calm place imagery - click here for more information
Some people are very visual in their thinking style and by using their imaginations to think in vivid terms about a real or imagined place where they feel safe and/or calm, they can help their minds and bodies to relax.
Justin Havens dream completion technique-
This is a self-help technique which can assist people in reducing the frequency and intensity of their nightmares.
Although it is not for everyone, many people find mindfulness a helpful tool for a range of the topics discussed in this leaflet. There are several good phone apps and websites you can use as a guide including Calm, Headspace and Smiling Mind. YouTube is also a good source of mindfulness exercises.
Trauma-Focused Staff Resources
We are current working on a Trauma protocol and Focused resources. This will be available in April 2024. If you would like any to speak to anyone about this please email: sam.holder@liverpoolft.nhs.uk
The Trauma-Focused Well-being Plan and supporting documents are designed for staff who may be going through difficulties with their well-being because of trauma. It aims to help staff members think about how their difficulties may be impacting them and to identify any support that may be helpful in the workplace.
It aims to support staff to manage their wellbeing inside and outside of work and create a platform from which conversations about wellbeing and adjustments can happen
Web links to further information
A lot of the available information is about the more severe end of the trauma spectrum such as PTSD, but it can still be useful to people experiencing any degree of psychological trauma.
NHS brief leaflet on coping with stress after a major incident
Mental health charity Mind information about PTSD
Mental health charity Mind other contacts and sources of information
