How to cope with trauma after a distressing event

How to cope with trauma after a distressing event

By Tara Yewers

Distressing events in life – whether expected or unexpected – can trigger a trauma response in all of us. Common unexpected events include being assaulted or robbed, being in a car or bike accident, having a traumatic medical experience (e.g. childbirth, invasive surgery), or bullying at work. Even where the distressing event is expected, as is the case with certain occupations such as first responders (e.g. police, firefighters, ambulance officers and paramedics) and frontline healthcare workers (e.g. nurses, doctors), the events they attend can lead to trauma.

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What is trauma?

Trauma is a psychological, emotional, and physical response to an experience that is deeply distressing or disturbing. It can happen just once – as in a car accident or a very difficult childbirthing experience, or it can be repeated over time in the case of abuse, war, and torture. Fear, helplessness, and horror are reactions that we see in trauma, and it can affect you at the time it occurs, or emerge later on.

Everyone responds differently to traumatic events, and our reactions are shaped by our prior life experiences, personality, how supportive our network is, and whether we have been exposed to past traumas. Despite this, there are some common symptoms that we all experience.

Tips to help you cope with Common reactions following a traumatic event

After a critical and traumatic incident, it’s likely that you’ll experience some of the following reactions:

• Immediately: Shock, numbness, or disbelief.

• Over the next few days and weeks: Shock and disbelief are likely to fade, and other thoughts and feelings take their place. This can be fear, helplessness, anger, guilt, sadness, even relief or hope. You may find yourself reliving the events, or having nightmares. You may even find yourself more on edge, and trying to avoid reminders of the incident.

While these are unpleasant, they are considered ‘normal reactions’ in the weeks after the critical incident that you have experienced. To help ease your distress in the short-term try the following tips:

1. Maintain your usual routine which will give you a sense of stability. Even though you may feel out of sorts, trying to retain some routine and predictability about your day will help.

2. Connect with others – supportive family and friends can act as a powerful buffer against posttraumatic stress and depression. [1] Sometimes just being surrounded by others even if you don’t feel like talking about it can help.

3. Take the edge off how you feel. A critical incident can heighten your distress, so try relaxation, meditation, or mindfulness to take the edge off how you feel. Maximising self-care during this challenging time will help decrease your overall level of distress.

4. Seek professional help from a health professional (like me!). If you find that the trauma persists, reach out to a trained mental health professional who can help you process what has happened to you.

Certainly, everyone’s response to a traumatic event is different and is shaped by personality, coping mechanisms, support, and prior trauma experiences. Sometimes the stress you experience following a challenging event can turn into Posttraumatic Stress Disorder. Below we outline what to look out for, and following that, we have our tip sheet on Tips for Coping with Trauma (scroll below!).

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WHEN STRESS TIPS INTO POSTTRAUMATIC STRESS DISORDER

Overall, Posttraumatic Stress symptoms are indicated if you continue to experience the following around four weeks after the incident [2]:

• Intrusive images, thoughts, flashbacks, and nightmares of the event, coupled with feeling anxious when these intrusions occur;

• Changes to your thoughts and moods including negative views of yourself, others, and the world; loss of interest in activities, low mood, excessively blaming yourself or others';

• Changes to your reactivity including being hypervigilant, being more easily startled, problems concentrating, problems sleeping, and increased irritability, and risky behaviours;

• Avoidance of reminders of the incident. This may be cognitive avoidance (e.g. distracting yourself, trying to suppress the thoughts), or behavioural avoidance (e.g. avoiding going near the incident site, avoiding behaviours linked to the event such as driving or seeing doctors);

• The distress has a significant negative impact on your life and daily functioning, so you’re not living the life that you did prior to the incident.

Depending on the incident that you were involved in, below are some common examples we have seen when these ‘normal reactions’ tip into Posttraumatic Stress. If you notice that what you’re experiencing gets in the way of you living your life as you usually would, perhaps it’s time to reach out to speak to a qualified mental health professional.

Trauma following a car / bike (or other vehicle) accident

If a road accident has triggered a trauma response it’s common to see changes including:

• Changes to your driving routine such as avoiding driving altogether, or changing your cycling route to avoid the accident site or ‘threatening’ routes;

• Flashbacks and intrusive thoughts/images of the accident;

• Heightened anxiety and hypervigilance when on the road or around traffic, along with being less trusting of other road users;

• Heightened anxiety when aware of accidents in news reports/movies.

Trauma following a difficult childbirth process or other medical traumas

Following a traumatic medical experience you may find you:

• Avoid seeing medical professionals, visiting hospitals and clinics, and reading or hearing about the medical procedure;

• Experience heightened distress and intrusive thoughts about the medical procedure, and may feel guilt and self-blame and/or anger towards the medical practitioners.

Following a difficult pregnancy or childbirth, you may even find it hard to bond with your child because of the reminders of the trauma, which in turn can trigger guilt.

Trauma following assault or as a victim of crime

Around 30% of Australians have reported being a victim of crime[3]. Trauma following assault or crime can be exacerbated in situations where the incident is random/unexpected, where the crime was highly personal in nature (e.g. sexual assault, torture). The process of reporting and dealing with the criminal justice system can also heighten the distress experienced.

You may notice trauma symptoms that look a bit like this: [3]

• Avoiding crowds and intoxicated people, or the site of the incident;

• Feeling anxious and constantly on edge, and experiencing nightmares and flashbacks;

• Increased mistrust of others and their intentions; this is often coupled with always being on the lookout for danger even if you know the threat is not present;

• A fundamental shift in your world view that the world is unsafe and others mean to cause you harm.

TRAUMA FOLLOWING NATURAL DISASTERS

Depending on where you live in the world, natural disasters (e.g. bushfires, earthquakes, floods, tsunamis, hurricanes) may be part of your lived experience. Trauma symptoms following natural disasters may include:

• Changes to your behaviour that are excessive and disproportionate to the risk, for example excessively checking weather and emergency reports even if a risk is not imminent, or excessive preparation and stocking up on items.

• Flashbacks, intrusive images, and nightmares about the disaster(s).

• Cognitive changes including an inflated risk of danger or hypervigilance (leading to excessive checking of weather reports).

• If faith is an important part of your life, there can be feelings of betrayal by your god or deity.

Trauma following a work incident

Sometimes incidents happen at work that have the potential to lead to trauma above and beyond ‘regular’ job stress. Examples may include witnessing a fatality or serious injury in a warehouse or construction site, or assault in a customer service role.

Signs of not coping include avoidance of work or fear of returning to the workplace/incident site, flashbacks to the incident, anger and guilt at colleagues or at management, problems carrying out usual duties due to poor concentration and a heightened state of anxiety, as well as an ongoing fear of threat when going about your usual role.

Certain occupations also mean you’re more likely to be exposed to trauma as part of your role, as is the case for first responders (fire and emergency services, police, ambulance and paramedics), and emergency medicine.

For these professions, in addition to the above signs of not coping there may also be ongoing doubt as to your decision-making processes when it comes to assisting others.

VICARIOUS TRAUMA and secondary traumatic stress/compassion fatigue

Whilst some occupations are more likely to be directly exposed to distressing events (e.g. first responders), vicarious trauma and secondary traumatic stress may also emerge through indirect exposure to distressing events: [4]

• Vicarious trauma (VT) refers to cumulative effects of working with trauma survivors;

• Secondary Traumatic Stress (STS) is not specific to those working with trauma survivors but includes individuals who, through their work, witness or hear about traumatic events. This term is often used interchangeably with Compassion Fatigue [4]

Vicarious trauma, Secondary Traumatic Stress, and Compassion Fatigue are distinct from the related concept of Burnout (which reflects general work-related emotional exhaustion, overwhelm, and detaching from the work role). Rather, they involve changes in world views (e.g. of safety, death and dying) as a result of the work that they do.

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Treatment options for trauma and posttraumatic stress disorder (PTSD)

What makes for an effective treatment when it comes to trauma and Posttraumatic Stress Disorder has been extensively researched. The most effective components (the ‘gold standard treatments’) draw on cognitive and exposure-based therapies (CBT), including eye moment desensitisation and reprocessing (EMDR).[5],[6] 

Trauma-focused cognitive therapies help shift unhelpful thinking and negative reactions resulting from the traumatic experience. It generally also includes gradually facing the traumatic memories in a safe environment and gentle exposure to the triggers of fear and distress until the fear decreases. That is, you are learning through slowly facing your fears, that the ‘threat’ is not as great as you believed, and you are better able to cope with reminders of the traumatic event.

EMDR takes an alternative approach in that it does not require repeated in-depth discussion of the traumatic event or prolonged exposure to fear-inducing stimuli, yet provides desensitisation to the trauma.  EMDR is based on the idea that overwhelming emotions during a traumatic event interfere with normal information processing, resulting in flashbacks, nightmares, and other distressing symptoms. 

During EMDR, the psychologist works with you to identify a specific area of focus (e.g. a distressing image) for the treatment session.  You then bring about this image and the psychologist will then begin eye movements (to induce bilateral stimulation).  These eye movements are used until the memory becomes less distressing and is paired instead with a more positive thought and belief.[7]

Which is a more suitable treatment option for you? The answer is “it depends” - based on your own individual circumstances and your coping styles, so be sure to discuss this with your mental health professional rather than just ‘jump in’ and ask for a specific treatment. You can be assured that both of these treatment options are considered ‘gold-standard treatments’ by Phoenix Australia, an organisation that is leading the way in trauma research in Australia.

If you’re looking for assistance with trauma symptoms and are based in Perth, Australia, why not book an appointment so we can help you get started?

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REFERENCES

[1] Bryant, R.A., Gollagher, H.C., Gibbs, L., Pattison, P., MacDougall, C., Harms, L., Block, K., Baker, E., Sinnott, V., Ireton, G., Richardson, J., Forbes, D., & Lusher, D. (2017). Mental health and social networks after disaster. American Journal of Psychiatry, 174, 277-285. https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/appi.ajp.2016.15111403

[2] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Publishing.

[3] Phoenix Australia - Centre for Posttraumatic Mental Health. (2019). Australia Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder: Specific Populations and Trauma Types: Victims of crime and PTSD. Phoenix Australia. Melbourne, Victoria. https://www.phoenixaustralia.org/wp-content/uploads/2019/03/Phoenix-Gidelines-Victims-crime-and-PTSD.pdf 

[4] Devilly, G.J., Wright, R., & Varker, T. (2009). Vicarious trauma, secondary trauma, or simply burnout? Effect of trauma therapy on mental health professionals. Australian and New Zealand Journal of Psychiatry, 43, 373-385. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.838.2495&rep=rep1&type=pdf

[5] Phoenix Australia – Centre for Posttraumatic Mental Health. (2020). Australia Guidelines for the Prevention and Treatment of Acute Stress Disorder, Posttraumatic Stress Disorder and Complex PTSD. Phoenix Australia. Melbourne, Victoria. https://www.phoenixaustralia.org/wp-content/uploads/2020/07/Chapter-6.-Treatment-recommendations.pdf

[6]Australian Psychological Society. (2018). Evidence-based Psychological Interventions in the Treatment of Mental Disorders: A Review of the Literature (4th Ed.). https://www.psychology.org.au/getmedia/23c6a11b-2600-4e19-9a1d-6ff9c2f26fae/Evidence-based-psych-interventions.pdf

[7] Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols and Procedures (3rd Ed.). New York: The Guilford Press.

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