Coping after a traumatic event

Many people will experience traumatic events throughout their lives. About one in three adults in England say they have experienced at least one major traumatic event during their lifetimes.

Below are some examples of ‘typical’ traumatic events. It’s important to remember that these are just examples. Many other experiences can also feel traumatic. If your experience is not listed here, it is still valid and important, and you should seek help and support.

Traumatic events can include, but are not limited to:

• seeing someone die or thinking you were going to die yourself
• being seriously injured, or believing you were going to be
• experiencing sexual violence, or believing that you were going to experience it.

You can be exposed to a traumatic event in one of the following ways:

• Directly – It happened to you.
• Witnessing – You saw it happen to someone else.
• Learning – You found out that the event had happened to someone very close to you.
• Threatened – You experienced a ‘near miss’ event that you thought was going to lead to a serious, terrifying or horrific outcome, but did not. For example, a severe malfunction or incident on a plane where you and other passengers believed the plane was going to crash.

We also know that some people who are exposed to traumatic events through social media, television, film or pictures can experience mental health difficulties. This is particularly the case if the exposure occurs as a result of their work.

While some people experience just one traumatic event, unfortunately many people experience multiple traumatic events.

There are a huge number of traumatic events, but here are some examples:

• witnessing a violent death
• serious accidents, e.g. a car crash
• physical or sexual assault or abuse
• serious health problems, being in intensive care and other traumatic healthcare experiences
• complicated or life-threatening childbirth experiences
• being diagnosed with a life-threatening or life-changing illness
• war and conflict
• terrorist attacks
• natural or man-made disasters, e.g. tsunamis or fires. Man-made means that something is caused by a person or group of people and does not occur naturally.

Some people have jobs that mean they are more likely to experience traumatic events at work. These jobs include:

• emergency service workers (e.g. police officers, firefighters or paramedics)
• social workers
• healthcare professionals (e.g. intensive care staff or midwives)
• military personnel and other professionals and volunteers working in war zones
• train drivers who experience a death on the track
• professional online content moderators who have to view distressing material as part of their job.

Everyone reacts differently to traumatic events, and your reaction will be personal to you. However, after a traumatic event, it is common for people to experience some of the following things:

Memories, dreams and flashbacks

You might have distressing memories, dreams or nightmares about the event. When you are awake, you might also re-live the event as if it is happening again. This is known as a flashback, and can feel completely real.

Feeling upset when reminded of the event

You might feel emotionally overwhelmed when you are near where the event happened or in an environment that reminds you of the event. You might not always realise when these emotions have been triggered in you, or what has triggered them.

Avoiding feelings and situations

You might avoid memories, thoughts, feelings, things, people and places associated with the event. This is sometimes called ‘avoidance’.

Loss of memory

You might be unable to remember parts of the event. If you try to remember parts of the event, you might start to feel disconnected from yourself or the world around you. This is called dissociation.

Difficult feelings

These can include:

• Negative thoughts about yourself, others or the world.
• Blaming yourself or others for what happened.
• Intense fear, anxiety, panic, horror, anger, guilt or shame. You might feel angry with other people or yourself, even if neither of you have done anything wrong.
• Finding it very hard to feel happiness, satisfaction or love towards others.

Changes in your behaviour

These can include:

• Not doing or being interested in things you used to enjoy.
• Feeling detached and distant from other people.
• Acting impulsively, or in ways that are risky or self-destructive. For example, going into potentially dangerous or violent environments.
• Being angry and aggressive towards people or things.
• Being hypervigilant, ‘on guard’ or easily startled by noises or sudden movements.

What about PTSD?

Some of these symptoms are also found in post-traumatic stress disorder (PTSD), or complex PTSD. However, having these symptoms does not automatically mean that someone has PTSD or complex PTSD.

It is really important to recognise that most people who experience a traumatic event do not develop PTSD. In fact, most people who experience a traumatic event find that the negative effects go away over time.

As we are all unique, there is no set timeline for healing and recovering from a traumatic event. It can take days, weeks, months or even years to completely recover from a traumatic event. You might also find that your difficult feelings come and go as you recover.

If you are still experiencing some distress after a month, but things are slowly improving, there’s a good chance that you will get better and not need treatment.

However, if you are experiencing significant distress that is not improving at all after one month, or is still present after more than three months, you might need extra support. This might also be a sign that you are experiencing PTSD.

Here are some things you should try and do after experiencing a traumatic event. You do not have to do them all at once.

Give yourself time

It can take time to recover from a traumatic event. It might take a while for you to accept what has happened or to learn to live with it. If someone has died or you have lost something significant to you, you might also need to grieve. Try not to put pressure on yourself to feel better straight away.

Talk about the event

After a traumatic event you might want to avoid things that remind you of the event, and avoid talking about what happened. However, research has shown that talking about the event and your feelings can help you to become more resilient. Avoiding memories and feelings has been shown to make people feel worse. Put simply, you should try to ‘avoid avoidance’.

Speak to others who have experienced the same thing as you

It might help you to speak to other people who experienced the same traumatic event as you, or who have had similar experiences. However, people recover and react to similar events in different ways, and there is no ‘right’ or ‘wrong’ way to react. Try not to compare your own recovery to someone else’s. If you feel able to support others who have been affected by the event, that can be helpful too.

To do this, you could find a charity that works with people who have experienced the kinds of things that you have. Ask if they have any ‘peer support’ opportunities or support groups. We have suggested some charities at the end of this resource that you might find helpful.

Ask for support

Seeking support from friends, family or someone that you trust can help you to cope after a traumatic event. They might be able to offer you emotional support, help you with practical tasks, or simply spend time with you doing ‘normal’ things.

Try to stay connected with people that you trust

Being around other people has been shown to make you less likely to experience poor mental health after a traumatic event.

If you live alone you might want to try to spend more time with family or a close friend after a traumatic event. You could even consider moving in with friends or family temporarily, though this might not always be possible. If you can’t spend time with people in person, try to stay in contact with them over the phone or through video calls.

If you find that you cannot be alone at all without thinking about the event, consider speaking to a professional.

Stick to your routine

It might take time to get back to a routine that is similar to the one you had before the traumatic event. However, try to keep to your previous routine as much as you can, even if that feels difficult at first.

For example, after the event you might find that your eating and exercise habits change and that you find it hard to sleep. These changes can cause you to feel unfit, tired or hungry, which can negatively affect your mental health. If possible, try to eat and exercise regularly, and get enough sleep. This can help to support your mental health. Take a look at our resource on sleeping well for more information.

Notice how you’re feeling

For the first few months following a traumatic event, you might want to pay attention to how you are feeling. If you don’t feel like you are getting better, or if you start to feel worse, you should speak to your GP. Also pay attention to how you’re behaving. If your routine has changed a lot since the event (for example, if you have stopped socialising) you might find it helpful to speak to a professional.

Ask for support from your employer

If you experienced the traumatic event as part of your job, your workplace might have support systems in place to help you. If you experienced the traumatic event outside of work, you might want to let your employer know what has happened. This will give them the opportunity to support you and be aware of how you might be feeling.

You could also ask them to make reasonable adjustments to your workplace. For example, ensuring your work does not expose you to further trauma or intense stress, or adjusting your hours. See the section for employers further on in this resource.

Take care

After a traumatic event, people are more likely to have accidents. This is possibly because experiencing a traumatic event can make it hard to concentrate, and can cause you to be startled easily and to feel tense. Take extra care around the home and when you are driving.

Avoid using alcohol or drugs to cope following a traumatic event. While they can make you feel better in the short-term, they can make recovery more difficult in the long-term.

Avoid consuming too much media about the event

After experiencing a traumatic event, it can be tempting to watch or read lots of things about it on social media or in the news. It can be harder to avoid if the event was very public at the time. For example, terrorist attacks or natural disasters. However, it is best to avoid watching, listening to or reading lots of media related to the event, especially if it causes you distress.

On social media, you could ‘mute’ words related to the event. Or you could put a limit on the amount of time you spend on social media apps.

Consider seeking professional help

You don’t have to seek professional mental health support straight after experiencing a traumatic event. It can be helpful see whether things improve on their own first.

However, if you are persistently very distressed, you might find it helpful to speak to a professional about what has happened to you. This can be especially helpful if you don’t have a friend or family member that you feel comfortable speaking to.

You could ask your GP to refer you for talking therapy, or you might be able to refer yourself. Alternatively, you might choose to access private talking therapy. If you do this, you should ensure that the therapist you choose has the appropriate qualifications to help people affected by trauma.

Everyone deals with traumatic experiences differently. Many people will be able to recover from a traumatic event over time, with the support of family, friends and their workplace.

Even when you have recovered from a traumatic event, you probably won’t forget about it. You might still feel negative emotions about it or find it upsetting to think about from time to time. However, these feelings shouldn’t be overwhelming or stop you from enjoying life.

You should ask your GP, or another healthcare professional, for help if:

• your symptoms are affecting your quality of life and
• they don’t seem to be getting better

If your symptoms are very bad and are having a significant impact on your life after one month, you should speak to your GP.

If your symptoms aren’t as bad but have been going on for more than three months and don’t seem to be going away, you should speak to your GP.

While many people do not develop post-traumatic stress disorder (PTSD) after experiencing a traumatic event, some people do.

PTSD is a serious mental health condition, and is not a sign of weakness. Instead, it is an understandable consequence of experiencing something overwhelming and traumatic.

People who have PTSD may have more severe symptoms from the start and their distressing thoughts and feelings will not go away on their own. These symptoms can make it difficult for the person to live their life as they used to.

You can find out more about the symptoms, causes and treatments for PTSD in our resource.

How common is PTSD?

A national survey found that one in 20 adults in England screened positive for PTSD. ‘Screened positive’ means that a person completed a mental health symptoms questionnaire to check for the symptoms of PTSD. Their answers to this questionnaire suggested that it is likely they had PTSD.

If you have experienced a traumatic event and have persistent difficulties, or if you develop PTSD, your GP might refer you to a specialist. This will be healthcare professional who specialises in helping people cope with trauma. For example, a psychotherapist who provides trauma-based psychological therapies.

There are several different treatments for PTSD. These include psychological therapies (talking therapies) like:

• trauma-focused cognitive behavioural therapy (TF-CBT)
• eye movement desensitisation and reprocessing (EMDR).

You might also be offered antidepressant medication:

• alongside psychological therapy
• instead of psychological therapy
• if you are waiting for psychological therapy, or it is not available
• if psychological therapy is not working for you.

You can find out more about all of these treatments in our PTSD resource.

Medication can sometimes be helpful following a trauma. However, you should discuss this with your doctor. They should check whether any medication they give you is helping, and review your progress regularly.

Sleeping medications

If you are struggling to sleep following a traumatic event, your doctor might prescribe you medication to help you sleep. For example, zopiclone or zolpidem. Usually, you will only be offered these medications for a short time as they are not a permanent solution and they can be addictive. You can find out more about sleeping medications in our sleeping well resource.

Medications for other conditions

If you develop PTSD or another condition you might be offered other medications. For example, if you develop depression, you might be offered antidepressants.

Things you can do

The following things can help to support someone who has been through a traumatic experience:

Be there

Offer to spend time with them. If they don’t want to see you, it can help to let them know that you will still be there if they change their mind. While you should avoid pressuring them, you may need to ask them more than once before they accept your support.

Listen

Try not to pressure them into sharing what happened to them if they do not feel able to share. If they do want to talk, try to listen and don’t interrupt or share your own experiences. While sharing your own experiences can be done with good intentions, it can sometimes feel invalidating.

Ask general questions

If you do ask questions, try to make them general and non-judgemental. For example, you might want to ask, ‘Have you spoken to anyone else about this?’ or ‘Can I help you to find some extra support?’

Offer practical help

They may find it more of a struggle to look after themselves and keep to a daily routine. You could offer to help with practical things, such as cleaning or preparing a meal.

Look after yourself

If you’re supporting someone, make sure you are looking after yourself too. Supporting someone who has experienced a traumatic event can be emotionally challenging.

Things to avoid

Telling them you know how they feel

Even if you have experienced something similar, people experience situations very differently. It can be unhelpful to make comparisons. Remember, even if you know a lot about what someone has experienced, they might not have told you everything. Because of this, the comparisons you are making might not be accurate.

Telling them they are lucky to be alive or uninjured

People who have experienced traumatic events often don't feel lucky. People can sometimes feel guilty for:

• being alive if others have died
• not being injured
• not being injured as badly as others were.

Telling them they have been lucky can encourage them to make comparisons between themselves and others. Or it can cause them to feel ashamed by the response they have had.

Minimising their experience

Avoid suggesting it could have been worse, even if you are trying to make them feel better. This can make people feel as though their feelings aren’t justified.

Making suggestions

Avoid making suggestions, even if you have found that these have worked for you in the past. All people are different and the person you know may have already tried what you are suggesting. If you are unsure if the person you are speaking to is looking for suggestions, ask them.

Sometimes traumatic events happen while people are at work. As mentioned previously, some jobs make people more likely to experience a traumatic event. Whether someone has experienced a traumatic event in or outside work, a supportive work environment can help them while they recover.

If you are an employer, and a person or multiple people who work for you have experienced a traumatic event there are some things you can do to support them:

Talking about what happened

If the traumatic event happened at work, it can help to talk openly about the event. It can also help to tell the people who work for you where they can seek support if they are struggling. For example, from their GP or from a work therapy or counselling service, if your workplace has one.

Checking in

Speak to the person or people you employ about how they are feeling. This can help you to find out if they have the support they need, and to notice any changes in them. Be wary of accepting ‘I’m fine’ as a response if you suspect that someone is not doing well. Especially if the person’s behaviour suggests that they are not okay.

Creating a supportive atmosphere

Encouraging positive relationships in teams can support a positive atmosphere in the workplace. Encourage staff to attend mental health support workshops or use any support systems your workplace offers.

Making reasonable adjustments

Speak to your employee to find out what reasonable adjustments at work might make them more comfortable. This could include things like flexible hours or small changes to the working environment. Always ask your employee what they need rather than assuming you know what will be helpful.

Maintain confidentiality

It is important that you do not share information about the traumatic event your employee experienced if you do not have their consent to do so. Maintaining confidentiality can help to create a safe and supportive workplace.

All of these actions can have a positive impact on employee wellbeing.

• Coping with stress following a major incident leaflet (PDF), NHS – An NHS leaflet for people who have been involved in, or affected by, a traumatic incident.
• Overview of PTSD, NHS – Information from the NHS on PTSD.
• PTSD, Mind – Information from the charity Mind on PTSD and complex PTSD.
• Overview of complex PTSD, NHS – Information from the NHS on complex PTSD.
• Coping with trauma, Mind – Information from the charity Mind on coping with trauma.
• How can friends and family help? Mind – Information from the charity Mind on how you can help someone you know who has PTSD.
• Useful contacts, Mind – Links to other charities and organisations that offer support to people with PTSD.

Helplines

• Samaritans – Samaritans are a charity that offer listening and support services to anyone who needs them.
• Shout – Shout is a free, confidential and 24/7 text messaging service for anyone in the UK who needs support.

Charities

Here are some charities that offer support to people who have experienced traumatic events, or who have PTSD:

• PTSD UK – A UK charity dedicated to raising awareness of PTSD.
• Combat Stress – A UK charity for veterans’ mental health.
• Cruse Bereavement Care – A charity offering support for bereaved people in England, Wales and Northern Ireland.
• Cruse Bereavement Care Scotland – A charity promoting the well-being of bereaved people in Scotland.

Rape Crisis – There are three Rape Crisis charities that support people across the UK who have been affected by sexual violence and abuse:

• Rape Crisis - England and Wales
• Rape Crisis - Scotland
• Rape Crisis - Northern Ireland

Victim Support – There are three victim support charities that support people across the UK who have been victims of crime and traumatic incidents:

• Victim Support - England and Wales
• Victim Support - Scotland
• Victim Support - Northern Ireland

There are many organisations that support people who have gone through different experiences, and we have not included all of them here.

This information was produced by the Royal College of Psychiatrists’ Public Engagement Editorial Board (PEEB). It reflects the best available evidence at the time of writing. 

Special thanks to PTSD UK, who kindly offered their feedback on this resource.

Expert editor: Professor Neil Greenberg 

Experts by experience: Autumn Foord, Brian Hayden and Ellie Wildbore

Full references for this resource are available on request.