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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Coping with trauma

 

Introduction

A sudden illness, an accident or an assault - these are all traumatic experiences which can upset and distress us. They arouse powerful and disturbing feelings in us which usually settle in time without any professional help.

This leaflet may be useful if:
  • you have been through a traumatic experience and want to understand more about how you are feeling.
  • you know someone who has been through a traumatic experience, and want to get a better idea of how they might be feeling.
It describes the kind of feelings that people have after a trauma, what to expect as time goes on, and mentions some ways of coping and coming to terms with what has happened.
 

What happens immediately after a trauma?

Shock - you feel:
  • stunned or dazed or numb
  • cut off from your feelings, or from what is going on around you.

Denial - you can't accept that it has happened - so you behave as though it hasn't. Other people may think that you are being strong, or that you don't care about what has happened.

 
Over several hours or days, the feelings of shock gradually fade and other thoughts and feelings take their place.
 

What happens next?

People react differently and take different amounts of time to come to terms with what has happened. Even so, you may be surprised by the strength of your feelings - you may feel:
 
  • Frightened …. that the same thing will happen again, or that you might lose control of your feelings and break down.
  • Helpless …. that something really bad happened and you could do nothing about it. You feel helpless, vulnerable and overwhelmed.
  • Angry …. about what has happened and with whoever was responsible.
  • Guilty ….. that you have survived when others have suffered or died. You may feel that you could have done something to prevent it.
  • Sad …. particularly if people were injured or killed, especially someone you knew.
  • Ashamed or embarrassed …. that you have these strong feelings you can't control, especially if you need others to support you.
  • Relieved …. that the danger is over and that the danger has gone.
  • Hopeful …. that your life will return to normal. People can start to feel more positive about things quite soon after a trauma.

What else might I notice?

Strong feelings affect your physical health. In the weeks after a trauma, you may notice:

  • sleeplessness
  • tiredness
  • dreams and nightmares
  • poor concentration
  • memory problems
  • difficulty thinking clearly
  • headaches
  • changes in appetite
  • changes in sex-drive or libido
  • aches and pains
  • heart beating faster

What should I do?

  • Give yourself time
    It takes time - weeks or months - to accept what has happened and to learn to live with it. You may need to grieve for what (or who) you have lost.
  • Find out what happened
    It is better to face the reality of what happened rather than wondering about what might have happened.
  • Be involved with other survivors
    If you go to funerals or memorial services, this may help you to come to terms with what has happened. It can help to spend time with others who have been through the same experience as you.
  • Ask for support
    It can be a relief to talk about what happened. You may need to ask your friends and family for the time to do this - at first they will probably not know what to say or do.
  • Take some time for yourself
    At times you may want to be alone or just with those close to you.
  • Talk it over
    Bit by bit, let yourself think about the trauma and talk about it with others. Don't worry if you cry when you talk, it's natural and usually helpful. Take things at a pace that you feel comfortable with.
  • Get into a routine
    Even if you don't feel much like eating, try to have regular meals and to eat a balanced diet. Taking some exercise can help - but start gently.
  • Do some "normal" things with other people
    Sometimes you will want to be with other people, but not to talk about what has happened. This can also be part of the healing process.
  • Take care
    After a trauma, people are more likely to have accidents. Be careful around the home and when you are driving.

What should I NOT do?

  • Don't bottle up your feelings
    Strong feelings are natural. Don't feel embarrassed about them. Bottling them up can make you feel worse and can damage your health. Let yourself talk about what has happened and how you feel, and don't worry if you cry.
  • Don't take on too much
    Being active can take your mind off what has happened, but you need time to think to go over what happened so you can come to terms with it. Take some time to get back to your old routine.
  • Don't drink or use drugs
    Alcohol or drugs can blot out painful memories for a while, but they will stop you from coming to terms with what has happened. They can also cause depression and other health problems.
  • Don't make any major life changes
    Try to put off any big decisions. Your judgement may not be at its best and you may make choices you later regret. Take advice from people you trust.

When should I get professional help?

Family and friends will probably be able to see you through this difficult time. However, you may need to see a professional if your feelings are too much for you, or go on for too long. You should probably ask your GP for help if:

  • you have no one to share your feelings with
  • you can't handle your feelings and feel overwhelmed by sadness, anxiety, or
  • nervousness
  • you feel that you are not returning to normal after six weeks
  • you have nightmares and cannot sleep
  • you are getting on badly with those close to you
  • you stay away from other people more and more
  • your work is suffering
  • those around you suggest you seek help
  • you have accidents
  • you are drinking or smoking too much, or using drugs to cope with your feelings.

What professional help is available?

Your GP might suggest that you talk with someone who specialises in helping people cope with traumas. They will usually use a talking treatment, such as counselling or psychotherapy. For example, a talking treatment called cognitive-behavioural therapy has been shown to be helpful. You may find that there is a support group for people who have been through a similar trauma to yourself. It can be helpful to hear that others have had similar feelings and experiences.

Can my doctor prescribe any medication to help me cope?

Medication can sometimes be helpful following a trauma, but it is still important to see your doctor regularly to check how you are doing.

Tranquillisers
There are drugs that can help to reduce the anxiety that can follow a trauma. They can also help you to get off to sleep. They are often called "tranquillisers". Common ones include diazepam (Valium), lorazepam (Ativan) and temazepam. In the short term tranquillisers can help you to feel less anxious and to sleep. However, if they are used for longer than a couple of weeks:
  • Your body gets used to their effect and they stop working
  • You have to take more and more to get the same effect
  • You may get addicted to them

Antidepressants
You can become ill with depression following a trauma. Depression is different form normal sadness - it is worse, it affects your physical health and it goes on for longer. Depression can be treated with either antidepressant medication, or with talking treatments such as counselling or psychotherapy.

Useful web links

  • UK Trauma Group has links to a selection of materials which helpful information for the general public and for health professionals about Post Traumatic Stress Reactions.
  • David Baldwin's Trauma Pages website: up-to-date comprehensive information about trauma including leading articles.

Further reading

  • Understanding your reactions to trauma by Claudia Herbert (2002) Blue Stallion Publications.
  • Overcoming traumatic stress by Claudia Herbert and Ann Wetmore (1999) Constable and Robinson.
References
  • Adshead G., Canterbury R., & Rose S. (1994). Current provision and recommendations for the management of psychosocial morbidity following a disaster in England. Criminal Behaviour and Mental Health, 4, 181-208.
  • Bisson, J.I., Roberts, N. & Macho, G. (2003). The Cardiff traumatic stress initiative: an evidence-based approach to early psychological intervention following traumatic events. Psychiatric Bulletin, 27, 145-147.
  • Bonanno, G.A. (2004). Loss, trauma, and human resilience. Have we underestimated the human capacity to thirve after extremely aversive events? American Psychologist, 59, 20-28.
  • Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., & Vlahov, D. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982-987.
  • Hobbs, M., & Adshead, G. (1996). Preventive psychological intervention for road crash survivors. In M. Mitchell (Ed.), The aftermath of road accidents: psychological, social and legal perspectives (pp.159-171). London: Routledge.
  • Mellman T.A., Bustamante V., David D., et al. (2002). Hypnotic medication in the aftermath of trauma. Journal of Clinical Psychiatry, 63, 1183-1184.

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This leaflet was produced by the Royal College of Psychiatrists' Public Education Editorial Board and the Faculty of Liaison Psychiatry. Series Editor: Dr Philip Timms, Expert Reviewer: Dr Jim Bolton
 
For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, Telephone: 020 7235 2351x 2552
 
Charity registration number (England and Wales) 228636 and in Scotland SC038369.

© January 2006 Royal College of Psychiatrists.
 
This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from the Head of Publications. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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