Coping after a traumatic
A sudden illness, an accident or an assault, or a natural
disaster - 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.
A traumatic event occurs when a person is in a situation where
there is a risk of harm or danger to themselves or other people.
Situations like this are usually frightening or cause a lot of
stress. In such situations, people feel helpless.
What is a traumatic event?
Examples of traumatic events include:
- serious accidents
- being told you have a life-threatening illness
- violent personal assault, such as a physical attack, sexual
assault, robbery, or mugging
- military combat
- natural or man-made disasters
- terrorist attack
- being taken hostage
- being a prisoner of war.
What happens immediately after a trauma?
Immediately after a traumatic event, it is common for people to
feel shocked, or numb, or unable to accept what has happened.
Shock - when in shock you
- stunned or dazed or numb
- cut off from your feelings, or from what is going on around
Denial - when in 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 and
denial gradually fade, and other thoughts and feelings take
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. It is normal to experience a mix
of feelings. You may feel:
- Frightened … that the same thing will happen
again, or that you might lose control of your feelings and break
- Helpless … that something really bad happened
and you could do nothing about it. You feel helpless, vulnerable
- 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
- 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 find that you:
- cannot sleep
- feel very tired
- dream a lot and have nightmares
- have poor concentration
- have memory problems
- have difficulty thinking clearly
- suffer from headaches
- experience changes in appetite
- experience changes in sex-drive or libido
- have aches and pains
- feel that your heart is 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
- 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
- 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
- Do some 'normal' things with other
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
- 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. Many people find that the feelings that they
experience after a traumatic event gradually reduce after about a
month. 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,
- you feel that you are not returning to normal after six
- 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 is post-traumatic stress disorder?
Following a traumatic event, some people experience a particular
condition called post-traumatic stress disorder
(PTSD). Symptoms that are most
commonly experienced by people with PTSD include:
- re-experiencing the trauma through vivid and distressing
memories or dreams
- avoiding situations that remind them of the traumatic
- feeling numb, as though they don't have the same range of
feelings as normal
- being in a state of 'alertness' - watching out for danger.
If you are experiencing problems that might be PTSD, you should
seek professional help.
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
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.
You can become ill with depression following a
trauma. Depression is different form normal sadness - it is worse
as 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.
How can I help after a traumatic event?
It can be helpful just to spend time with someone, even if they
don't want to talk about what happened. Let them know you are
available to listen and offer to visit again.
They may find it helpful to talk about what happened. Don't
pressure them - let them take things at their own pace.
They may find it more of a struggle to look after themselves and
keep to a daily routine. Offer some help, such as cleaning or
preparing a meal.
Useful web links
Overcoming Traumatic Stress by Claudia
Herbert and Ann Westmore is a self-help book. It is based on
cognitive behavioural therapy and demonstrates, with practical
advice and exercises, how to find new and effective ways of coping
with and overcoming traumatic stress. Published by Constable &
- 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.
- Bisson J.I., Bolton J., Mackway-Jones K. and Guthrie E. (2007)
Major disaster planning, in Handbook of Liaison
Psychiatry, Eds. Lloyd G.G. and Guthrie E. Cambridge
- Bisson J.I. & Collings I. (2012) Disaster Management, in
Seminars in Liaison Psychiatry, Eds. Guthrie E., Rao
S. & Temple M. Royal College of Psychiatrists.
- 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.
- Mellman T.A., Bustamante V., David D., et al. (2002). Hypnotic
medication in the aftermath of trauma. Journal of Clinical
Psychiatry, 63, 1183-1184.
- National Collaborating Centre for Mental Health (2005).
Post-traumatic stress disorder: the management of PTSD in adults
and children in primary and secondary care. London?Leicester:
Gaskell and the British Psychological Society.
This factsheet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board and the Faculty of
This leaflet reflects the best available evidence at the time
Series Editor: Dr Philip Timms
Lead authors: Dr Jim Bolton, Professor Jonathan Bisson, Professor
Elspeth Guthrie, Mr Steve Wood.
Expert reviewer: Dr Jim Bolton.
© August 2016. Due for review: August
Royal College of Psychiatrists.
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