Coping with the stress of a traumatic incident

How you might be affected

After any traumatic incident, it is normal to experience a number of stress reactions, which may continue for some weeks.

Traumatic events are shocking and emotionally overwhelming situations, and may arouse some powerful or upsetting feelings.

This leaflet is designed to give you some understanding of these common reactions and feelings, and to help you gain more control over them.

Overall people tend to be resilient and most people will recover without needing any professional help. However, this leaflet may be useful to you if you have recently experienced a traumatic event and are still trying to make sense of what has happened.

When traumatic events take place, our bodies react strongly. Because we are not calm or relaxed but feel under threat, our memory of events can be stored in a different way, and in a different place to other day-to-day memories. This can lead to trauma memories being easily triggered, and sometimes recalled in a way which makes it feel like the event is happening all over again (re-experiencing).

The team at Barts Hospital have made this short video, which explains this and is particularly relevant to those in hospital or who have recently left hospital after an injury.

Initial reactions

Reactions commonly experienced within the first few weeks of a traumatic incident include:

• Unpleasant thoughts or images about the event popping into your mind
• Nightmares about the event
• Not wanting to talk about what happened
• Sleep difficulties and tiredness
• Feeling helpless, angry or irritable
• Wanting to avoid people, places or activities that remind you of the event
• Feeling guilty or to blame for what happened
• Concentration and memory problems
• Headaches and bodily pain
• Tearfulness and sadness
• Fear and anxiety
• Feeling numb or detached

Re-experiencing

Re-experiencing (for example flashbacks, intrusive thoughts and nightmares) may:

• Be triggered by places, people, emotions, sounds, smells, tastes, physical sensations or images
• Disturb daily living by happening when you are not expecting them and cannot control them
• Make it feel like you are watching events as they happen to you

These reactions are normal, understandable and usually reduce gradually over time.

What can I do that might be helpful?

• Reminding yourself that re-experiencing is normal following a traumatic event
• Remember that the worst is over—the traumatic event happened in the past and is not happening to you now
• Breathe deeply, slowly and calmly in through your nose and out through your mouth
• Some people find it helpful to talk to those that they feel close to so that they can help when needed—they might be able to remind you of coping techniques, and that you are safe now
• Remember: ‘My mind is doing its best to make sense of what happened’
• Use grounding techniques (see below)

Coping skills

Grounding techniques

The main goal of grounding is to use your senses to focus your attention on your present surroundings. This give you a safe way to feel greater control of what you are thinking and feeling, and allow you to find a balance of feeling emotions too much or too little.

Grounding techniques can be used during a flashback or after a nightmare to help bring you back to the ‘here and now’.

• Explore the space around you using all your senses. Describe objects, sounds, textures, colours, smells, shapes, numbers and temperature. For example, do not just notice ‘the chair is green’, but look at it more closely. Is it textured? Is it fabric or plastics? What shade of green is it? How would you describe the shape?
• Switch on yours body’s relaxation response by swallowing your saliva. You can do this by eating a mint, sweet, or by sipping some water. Try describing the flavours to yourself in detail.
• Notice the sensations in your body as you tense and relax different parts.
• Pick out things in the room that are the same colour, or things that are spelt with the same first letter.
• Use your own grounding object – a small, comforting, physical object which you can carry with you. You can focus on the detail of this object when you are re-experiencing.
• Use a grounding phrase (or song) – a few words which are positive and remind you that you are surviving in the present. For example, ‘I am safe’ or ‘I am ok’.

Looking after yourself

• Be patient with yourself—it may take time to process what has happened
• Try to re-establish your usual routines
• Spend time with people who make your feel safe and supported during this time
• Take good care of yourself physically including exercising regularly, reducing alcohol/drug use and getting enough sleep—drugs and alcohol may briefly numb your feelings or give immediate relief, but will also stop you from processing what has happened and soon create further physical and psychological problems for you to deal with
• Talk to someone when you feel ready—this can help you piece together the event and understand things more clearly which may help in your recovery
• Self-compassion—a helpful question might be: ‘What would you say to a friend who was in your situation?’

Coping with the stress of a traumatic incident

Most people who have encountered a traumatic event find that their symptoms subside over time. However, reactions and recovery times vary for different people.

If your symptoms do not improve after 4-6 weeks, or If you feel like they are getting worse, please contact the Chelsea and Westminster Burns Psychology Team on 020 3315 2504 or chelwest.burnspsychology@nhs.net so that we can help.

Useful organisations

For information on understanding and coping with trauma visit the International Society for Traumatic Stress Studies and The Royal College of Psychiatrists, and Assist Trauma Care (link to http://assisttraumacare.org.uk)

The following organisations can also be called to support individuals and families affected by trauma in times of acute distress:

• Samaritans: 116 123