As our health services struggle to manage our physical health need, a new and significant threat to our mental health is taking hold. Whether you have been affected by Covid or some other traumatic experience, here we talk about how to recognise and manage trauma.
For many, feelings of stress and anxiety through the pandemic, the loss and isolation, and powerlessness to support or care for loved ones have been overwhelming and traumatic. Being severely ill, experiencing or witnessing invasive medical procedures or losing loved ones can often lead to trauma. In response, our lives no longer feel normal. Our heightened anxiety levels mean we see threat everywhere and we want to withdraw from our normal lives. The more we avoid, the more we feel the world is a dangerous place. And the harder it can become to get back to normal.
For the majority of us, frightening or traumatic experiences will not have a lasting impact. If we turn to friends, remain engaged with work, we can gradually adjust and adapt to what has happened.
However, a more significant and enduring trauma response is emerging as a result of the pandemic. It is estimated that around 30% of patients who have experienced severe Covid will develop Post-Traumatic Stress Disorder (PTSD). In view of these estimates, a group of psychologists and psychiatrists at University College London are calling for the urgent screening of all patients affected by severe Covid. It is also important to consider that PTSD will affect many of those who have witnessed someone severely ill or dying from Covid.
What is PTSD?
PTSD is a normal reaction to an abnormal event. We are at risk of developing it if we face a situation in which we fear for our life, or we witness someone else in such a situation. Extremely powerful emotions and physiological arousal are experienced at the time of the event. The thinking brain switches off and the body takes over, focusing all our attention on self-protection and survival.
A person who develops PTSD is likely to experience heightened anxiety and arousal when they encounter reminders of the traumatic event. They feel on edge and fearful, continually on the lookout for further threat. They might try to push the memories of the event away. But the more they do this the more the reminders bounce back in the form of nightmares, flashbacks or intrusive memories.
These symptoms are extremely distressing, but the more the person tries to cope by pushing the thoughts away, avoiding reminders of the event and withdrawing from activities, the more difficult it becomes to manage.
How to recognise a trauma reaction
PTSD can interfere with everyday activities, undermining our ability to function at work and at home. So it is important to recognise the signs and symptoms to spot when PTSD is becoming a problem.
Symptoms to watch out for:
Repeated disturbing memories, thoughts or images of a stressful experience from the past
Feeling very upset when something reminds you of a stressful experience from the past
Avoiding activities or situations because they remind you of a stressful experience from the past
Feeling distant or cut off from other people
Feeling irritable or having angry outbursts
Having difficulty concentrating
If these symptoms have been troubling you for several days or increasingly over the last 2 weeks, it might be time to consider seeking some help or advice. In particular, if the difficulties you have identified make it hard for you to do your work, take care of things at home or connect with other people, then it is important that you access some support.
How to manage trauma reactions
Care about how you are feeling
It is important to show yourself patience and care and be sensitive to what you need. It is too easy to blame ourselves for getting upset or not coping. Try taking time to acknowledge the awfulness of what you have been through. Perhaps write an account of what happened and how you got through it. Recognise that it has had an impact on you. And try telling yourself that it is ok and normal to feel this way. Remember, it would be abnormal not to be moved by this experience.
Tolerate distress
Being aware of your negative emotions and their triggers is the first step to learning how to tolerate them. Whilst the urge to push difficult emotions away is normal, over the longer term this can keep our trauma reactions going. As we battle against our emotions they gain a hold over us. Learning to accept the emotions, to stop railing against them is like taking the wind out of their sails and they will gradually feel less powerful. As we learn to accept and tolerate distress when it arises we teach our brains that we can manage these difficult emotions. Using a mindfulness exercise aimed at accepting emotions can help.
Self-compassion
Being kind to ourselves helps us to learn to accept difficult emotions. We all experience things differently and it’s important to be ok with how we feel. Try to imagine what you would say to a friend or how a caring friend or nurse might comfort you. Try self-soothing, reconnecting with your inner sense of calm and safety through the use of grounding objects. Perhaps carry something with you that reminds you of home, an object that is calming to touch, or a smell that brings back positive memories.
Let go of judgement
When we encounter a trauma our brains naturally keep wanting to replay it, trying to work out what we could have done differently. We can end up beating ourselves up for what we did or didn’t do. And it can be easy to criticise ourselves for our reactions, thinking we should be able to cope better. Try to remember that there is no yardstick for measuring how we reacted in the situation or afterwards. Often our reactions in the moment are about self-protection, our body takes over and we respond without thinking. We cannot blame ourselves for this. Judging ourselves harshly only makes us feel worse and this further undermines our ability to cope. Try this mindfulness exercise to step back from self-judgement and self-criticism.
Connect with others
As the saying goes, ‘a problem shared is a problem aired’. Giving yourself permission to speak to someone else about how you are feeling will create space for you to acknowledge the difficulties and challenges. Talking it out reduces the likelihood that you will continue to experience trauma over the longer term or after the current crisis passes.
How to access help & support
Talk to friends or family
This is a good place to start. Opening up with the people you trust will help you feel supported and less alone with your worries. Another person’s perspective often helps us see things in a different way and reconnects us with what is important.
See your doctor
When the problems go on for a long time and are unremitting it is important to access professional help. Make an appointment to speak to your family doctor. Sharing your concerns with a professional will help you make sense of what is going on for you and will bring some initial relief. Your doctor will know what to do and will make suggestions. They may ask you to keep in regular contact with them, offer self-help materials or guidance, or refer you to an organisation offering specialist counselling or talking therapies.
Self-refer
In the UK you can access some key NHS services via self-referral. These services, known as Improving Access to Psychological Therapies services, draw on a number of evidence-based therapy models to help people manage and overcome common mental health difficulties, such as trauma, depression and anxiety.
Remember, with the rise in mental health difficulties over recent months it is important that we all become more alert to the signs and symptoms of mental distress. Supporting one another to recognise and tackle trauma when it strikes will be key to getting through this difficult time. And sharing our experiences will reduce stigma and increase our ability to cope.