Do you… ?
- Find that you are often bothered by recurrent thoughts, memories or nightmares about a distressing past event?
- Have experiences of dangerous, life threatening events in your life?
- Find that you are alert all the time, as if you are on the lookout for danger?
- Avoid things that remind you about a distressing event?
- Have problems sleeping or concentrating?
- Have feelings of isolation, irritability and guilt?
- Find that these problems haven’t reduced in the last 3 months?
What is Post Traumatic Stress Disorder (PTSD)?
PTSD is a response to a traumatic and profoundly distressing event. It is a normal reaction to an abnormal situation. PTSD can develop immediately after a traumatic event or it can occur weeks, months or sometimes years later. It can occur after events such as military combat, serious accidents, natural disasters, terrorist attacks, personal attacks, witnessing violent death or any event where a person feels extreme fear, horror or helplessness.
PTSD is characterised by unexpected vivid recollection of a distressing event through nightmares, intrusive thoughts and flashbacks. A flashback may not be a complete memory but can be a single aspect of a past event such as a sound, a powerful feeling, or an image. Sometimes people feel like they are watching a video of what happened to them or they have the sense that they are re-living the experience all over again. These experiences are usually triggered by something, which brings back bad memories, for instance smelling something, hearing a noise, seeing something, reading something, having a physical sensation, or having an uncomfortable feeling. Some people also experience dissociation*.
These traumatic experiences can be extremely distressing and people often try to keep their mind busy by distracting themselves. People will often make efforts to avoid thoughts, feelings, conversations, activities, places or people that remind them of the traumatic event. People with PTSD often report feeling more tense and irritable and being ‘on guard’ all the time, as if on the lookout for danger.
Other symptoms can include:
- Feeling depressed
- Difficulty in sleeping
- Difficulty in concentrating
- Exaggerated startled response
- Intense distress at exposure to reminders of the event
- Loss of interest in significant activities
- Feelings of detachment or estrangement from others
- Restricted range of affect
- Sense of foreshortened future
*Dissociation is a term that is used to describe a range experiences involving a sense of detachment from your surrounding and emotions. Sometimes people feel they have ‘tuned out’ or have periods of time that feel unreal or dreamlike.
How common is it?
Although not everyone who experiences a trauma will develop PTSD nearly everyone will have some symptoms for the first month or so. This is called an acute stress reaction. Over a few weeks most people will find their symptoms start to disappear but a proportion of people will carry on experiencing symptoms and develop PTSD. PTSD affects around 9.2% of people at some point during their life. PTSD can occur at any age, including during childhood.
What can I do about it?
PTSD can be successfully treated, even when it develops many years after a traumatic event. The National Institute for Health and Care Excellence recommends watchful waiting where symptoms are mild or less than 4 weeks after trauma to see whether the symptoms improve or get worse without treatment. After this psychological therapy such as such as trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing (EMDR) are recommended.
If you would like help, please contact us. Alternatively, you may wish to speak to your GP about a referral to our service.
How can I help myself?
There are a number of self-help books, support groups and organisations, and websites listed below that you may find useful. There are also some general things that you can do that are helpful and some strategies for helping with flashbacks, nightmares and dissociation.
After a traumatic event it is important to establish a sense of safety and security and take one day at a time. It is important to take time to rest, and to look after yourself by eating regularly and taking moderate exercise. Also, it is best to avoid using alcohol and drugs as this will stop you coming to terms with what has happened.
Often people will avoid talking about what has happened to them or how they are feeling. It is normal to have strong feelings, to feel upset or to cry when talking about a traumatic experience. It is important to try not to bottle up your feelings and talk to somebody you trust when you feel ready and comfortable to. Try to allow yourself to have memories about the trauma in amounts that you can tolerate and manage. It is OK to use distraction when memories feel overwhelming but using distraction too much can make it harder to deal with the memories in the long run.
Often people try to avoid reminders of the traumatic experience. Although this may help to reduce distress in the short term it can cause more problems in the long run. Try to re-establish your normal routines such as going to work or school and spending time with family and friends who can support you through this difficult time. Children will need support and reassurance from adults they trust who can help them feel safe and to talk about their fears and worries as they wish.
Coping With Flashbacks, Nightmares & Dissociation
If you are experiencing flashbacks, nightmares or dissociation first try to notice the types of situations and triggers that lead to them. This is likely to be things that remind you of the event such as people, places, or feelings. Times of high stress or times when you are not busy may also be triggers. In order to try to control flashbacks or dissociation try to notice the first signs they are starting. This may be a feeling you get in your body. When you notice signs that you are going to experience a flashback or dissociate some of the strategies below may be useful.
- Refocus your attention. Try to concentrate really hard on something in your environment: the colours, shapes and textures of objects around you (e.g. the feel of the arms of a chair, the titles of books on a shelf, a passage from a book, which you carry around with you). Describe these things to yourself in detail in your head.
- Find a “grounding” object – a comforting, tangible object, which you can carry around with you and squeeze when you ‘space out’, to bring you back into the present. A stress ball can be very effective.
- Develop a “grounding” phrase, a few words or a tune, which is affirming, and a reminder that you are surviving in the present.
- Phrases can range from a brief “I am OK” to lengthy statements like: “I have survived, I am strong, I believe in me and I will go on surviving”.
- Smell can be very powerful in bringing you back to awareness of the present (‘grounding’). Try to find a relatively strong but pleasant smell that you can carry around with you. For example put some aftershave or perfume on a handkerchief or use an aromatherapy oil.
- Develop a “grounding” image. Rehearse a soothing image, one which helps you to feel in control and safe.
- Using Visuo-spatial skills can sometimes be a helpful way of grounding yourself for example playing a game on your mobile phone.
- Tell someone close to you how they might recognise that you are dissociating or having a flashback or nightmare and tell them a word or gesture which you think will interrupt the experience, for example ask them to use your name or touch your arm.
By using these strategies you can begin to take control over flashbacks, nightmares and/or dissociation but remember that this will take practice and it will take time. The more you rehearse such strategies when you are feeling OK and relaxed, the more easily and naturally you will be able to switch to using them when you start to dissociate or have a flashback.
I Can’t Get Over It, Aphrodite Matsakis, 1996
Can be ordered from Airlift Books: 0208 8040400
Understanding your Reactions to Trauma: a Guide for Survivors of Trauma and their Families (revised version), Claudia Herbert, 2002
Blue Stallion Publications
Overcoming Traumatic Stress, Claudia Herbert and Ann Wetmore, 1999
Robinson Publishing Ltd
Support groups and caring organisations
Offers a 24-hour helpline for those in crisis
Tel: 08457 90 90 90
Cruse – Bereavement Care
Offers counselling, advice and support throughout the UK
Provides support and guidance to those affected by disasters
Tel: 01483 799 066
Assist Trauma Care
Offers telephone counselling and support to individuals and families in the aftermath of trauma
Tel: 01788 560800 (Helpline)