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Patient Health Education

Post Trauma

Psychosocial Reaction to Trauma
A traumatic event, such as a motor vehicle crash, assault, fall or natural disaster is something which many people may not have experienced before. It is outside the range of normal day to day experience. Traumatic events can be experienced directly (by the victim) or indirectly (eg by a witness). Such traumatic incidents can be extraordinarily stressful.

Sometimes a traumatic event crisis leads to people questioning what is happening to them. Some of these questions may be, Why did this happen to me? Why has this happened now? Where should I go from here? These issues are very valid. Dealing with these issues may be a way of trying to make sense of this experience. A major life event can lead to new directions.

Although everyone’s experience is an individual and personal one, many people report that they experience physical, psychological and behavioral changes that they may not have experienced before. These experiences are sometimes called critical incident stress, acute stress reactions or post trauma reactions. For most people these experiences will lessen in intensity and disappear after a few weeks. Although these signs and symptoms of a stress reaction to trauma can be unpleasant and distressing, they are common and understandable responses to a traumatic event. Many of these symptoms are part of the normal process of recovery. Possible reactions to traumatic experiences are listed below:

Emotional Effects

• disbelief at what has happened
• feeling stunned, confused
• numbness, sense of unreality

• of a recurrence
• for the safety of oneself or one’s loved ones
• apparently unrelated fears
• of losing control
• of going crazy
• of being overwhelmed

• at who caused it or allowed it to happen
• at the injustice and senselessness of it all
• general anger and irritability
• asking "why him/her?", "why me?"

• about destructiveness
• loss of belief that our life is safe and predictable
• about past losses and grief
• crying

• for having appeared helpless or emotional
• for not having behaved as you would have liked

• for support, encouragement and reassurance
• for information
• not wanting to be alone

• feeling responsible
• self doubt

Physical Effects Linked to Psychological Reactions

• unable to sleep, waking during the night
• thoughts that keep you awake
• feeling tired and fatigued
• jerking awake
• restless sleeping
• disturbed dreams

Physical Problems
• easily startled by noises
• general agitation and muscle tension
• palpitations, sweating and trembling
• headaches, aches and pains
• clumsiness, bumping into things, dropping things
• nausea or gastric upset
• tightness in chest
• dry mouth
• dizziness or light-headedness
• hot flushes or chills
• appetite disturbances

Managing Your Reactions to Trauma

There are many things you can do to lessen unpleasant responses to trauma. Firstly, it is important that you look after yourself and give yourself space and time to work through these reactions. It is also important to remember that these reactions are to be expected and will lessen over time.

Physical Symptoms Linked With Psychological Reaction

Sometimes after a traumatic event people report that they experience unusual physical sensations, such as feeling disconnected from their body, a racing pulse and other sensations detailed earlier. There are strategies that can help you with these:

• Try to rest more, even if you cannot sleep.
• Make time for relaxation – perhaps this is a good time to learn! Breathing exercises, meditation and yoga can be very useful.
• If possible, continue with regular exercise; exercise and relaxation will help you reduce nervous tension and feeling ‘hyped up’. If unsure about whether you should exercise because of injuries, please seek medical advice.
• Sometimes you will want to be alone, but try not to become too isolated as distressing feelings can appear greater when you are by yourself.
• Reduce your intake of stimulants such as tea, coffee, cola, chocolate and spicy, hot food as these can make you feel more uptight.
• Avoid street drugs and alcohol; numbing or suppressing feelings and unusual physical sensations may create problems in the future. You may be tempted to increase your use of tobacco, but try to resist this, as contrary to popular opinion, nicotine is actually a stimulant.
• Maintain a regular lifestyle and eat regularly and healthily even if you don’t feel like it; familiar routines may be very comforting and provide a framework for you to deal with some of the disruptions to your life.

Uncomfortable Feelings

• You don’t have to feel everything at once – you can deal with unpleasant feelings and memories one at a time.
• Feeling this bad can be very unpleasant, but try not to overreact when feelings seem ‘out of control’ or overwhelming.
• Give yourself permission to ‘feel lousy’ from time to time, after all you have been through a difficult experience; also give yourself permission to distract yourself with pleasant activities.
• Where someone has been killed in the trauma, attending funerals, memorial services and other rites can help you get in touch with your feelings about the traumatic event; recognizing and naming your feelings are the first steps in working through them.
• Try not to act on unpleasant feelings and make major life decisions until you have recovered from your injuries – your judgment may be impaired.
• Feelings are strongly influenced by thoughts and beliefs; by monitoring your negative thoughts/beliefs and evaluating their usefulness to you in your recovery, you can begin to master unpleasant emotions.
• Fight against boredom, look for ways to re-motivate yourself so that you can get your life back on track.
• Learning and applying relaxation techniques may reduce tension and anxiety.

Distressing Thoughts

• After a traumatic event, distressing thoughts, dreams and ‘flashbacks’ are very common; don’t try to block them. They will decrease in frequency and become less painful over time.
• Continue to talk to your family, friends and others in your life about your trauma, your reactions and feelings as this will help you master your distressing symptoms. Even though you feel detached from other people, do not reject their support.
• Writing down thoughts in a diary or writing letters you may not send can almost be as good as talking about them.
• Identifying negative and self-defeating thoughts can lead to mastering them and enable you to think straighter and more rationally.
• Distraction techniques can help you gain control over unwanted recurrent thoughts that are disturbing/distressing. For example, using a thought stopping technique such as saying STOP silently to yourself whenever a troublesome intrusive thought enters your mind.

How Can Relatives and Friends Help

• Listening carefully;
• Spending time with the traumatized person, especially in the early days following the event;
• Offering your assistance even when they have not asked for it;
• Reassuring them that they are safe, that distressing symptoms will pass and that these reactions are understandable given what you have experienced.
• Giving them time and space;
• Allowing them to grieve for lost abilities, good health or the loss of or damage to material possessions;
Not taking their anger or moodiness personally;
Not telling them to ‘buck up’ or ‘they are lucky it wasn’t worse’ - traumatized people are rarely consoled by such statements;
• Offering practical help.

Trauma involves the whole family.
Although family and friends may have escaped actual injury they also may feel:

• shocked • angry
• anxious • fearful
• overwhelmed • tired
• frustrated • depressed
  • numb

Where life seemed stable and predictable before the trauma, changes have taken place, sometimes dramatically, sometimes forever. Career paths, emotional well-being, financial stability, family roles may all change. There may be stress and confusion where families try to process new information (particularly medical and technical terms). It is important to feel free to ask for explanations, even if you ask the same question many times. Health professionals understand that it is difficult to take in new information when under stress.
While family and friends will differ in their responses to the trauma survivor, many find it difficult to treat the patient ‘normally’. They may hide their true feelings in an effort to distance themselves from distress or to spare the patient. Families may also cover up negative feelings which they may see as potentially harmful to the patients (eg anger, blame). It is, however, important for communication to remain open and for deception to be avoided even if it initially appears to protect the patient.

Recovery from Traumatic Injury

Serious injury is a complex phenomenon and in the early stages of treatment and recovery the patient is often in an emotional and beahvioral fog induced by pain, medication and unfamiliarity with the hospital system.
These are some ideas that may help:
• To recover, making your own well-informed decisions about your treatment is important. This can be difficult at first when you may feel helpless and disoriented.
• Be open and assertive with health professionals about your concerns. It’s OK to take time out to make important decisions or request a second opinion.
• Your injury, treatment program and recovery are unique to you. It is important that you refrain from comparing yourself to others.
• Emotional turmoil is to be expected in this early phase of recovery. It may feel overwhelming at times, this may reflect adjustments your injury demands.
• Self blame and guilt can increase pain and distress by increasing stress levels.

This information should not replace the expert advice and care of qualified healthcare providers. Rapid advances in the medical field may cause this information to become outdated, incomplete, or subject to debate.