Traumatic events

Our lives may be under threat or we feel in danger or see other people dying or injured. This may occur as a single event such as an assault, a road traffic accident, a natural disaster, an experience of being physically unwell and hospitalised, or the murder or suicide of a loved one. People such as soldiers, Blue light workers (police, ambulance workers and firefighters) asylum seekers and refugees, or victims of domestic violence may suffer multiple episodes of trauma over a period of time. Childhood experiences of physical or sexual abuse will also be traumatic and may continue to have a significant effect into adulthood.

After any traumatic event it is normal to experience a number of stress reactions. The outward signs may vary widely. Some people may initially appear unaffected, only to develop symptoms later. Common early reactions include:

• Tearfulness
  
• Feeling frightened
  
• Feeling angry or irritable
  
• Feeling guilty or somehow to blame
  
• Difficulty sleeping
  
• Feeling cut off or distant form others
  
• Difficulty concentrating
  
• Feeling jumpy or restless
  
• Nightmares about the event
  
• Flashbacks – vivid memories of the event spontaneously coming into your mind, almost as though you were there again
  
• Loss of interest / pleasure in usual activities
  
• Feeling low or down in mood
  
• Strong feelings related to previous loss
  
• Feeling tired or unusually drained

These reactions are normal and understandable and will usually reduce over time.

What you may do to help:

• Take each day at a time
  
• Make use of the supports around you – maintain contact with friends, family, social or work groups. You may find it helpful to seek other supports such as voluntary agencies including the Samaritans
  
• Express your reactions in the way you feel most comfortable
  
• Look after your physical health – eat well, exercise regularly and try to get sufficient sleep. Smoking, alcohol and illicit drugs are likely to make these reactions worse. Avoid sedatives or tranquillizers
  
• Return to your usual routine as soon as possible.
  

For many people after a single episode of trauma, this will be sufficient and life will slowly settle into something different but manageable over time. For some people, and especially those who have had repeated or childhood traumas, things may not settle and this may lead to a diagnosis of Post-traumatic stress disorder (PTSD) for single events and Complex PTSD for multiple or complicated traumas.

PTSD is more likely to occur if you already have a history of trauma yourself or in your family, or a history of mental illness. You are also more at risk if your support network is limited. The diagnosis of PTSD would only be made at least a month after the trauma and would include the kinds of symptoms described above as well as:

• Avoiding anything that reminds you of the trauma or may trigger a flashback
  
• Becoming emotionally numb
  
• Feeling life is no longer worth living
  
• Unable to see a future
  
• Feeling on guard all the time
  
• Feeling very anxious and panicky
  
• Temper outbursts

Complex PTSD (from multiple traumas over time or during childhood) might also cause:

• Problems with relationships
  
• Mood swings
  
• Losing time
  
• Having amnesia (forgetting) the trauma
  
• Physical symptoms
  
• Difficulties in day to day life with work, family and so on
  
• Thoughts of suicide

How the Tavistock and Portman can help

The Tavistock Trauma Service sees adults who have traumatic experiences that have caused PTSD or Complex PTSD. We work with people to begin to understand the impact of the trauma and what has made it difficult to move forward after the event. We usually treat individuals but will also see traumatised couples, families or groups. We have a psychoanalytic approach but may find it useful to offer trauma focused treatments such as trauma-focused Cognitive behavioural therapy (tf-CBT) or Eye Movement Desensitization and Reprocessing (EMDR). We have also recently piloted a project that used a Yoga / Body Awareness group alongside the talking therapy.

Treatments are individually tailored and flexible to best meet the needs of the traumatised individual. There will be an opportunity to work with one of the service’s experienced clinicians and to think through what the best options are. Individual and group psychotherapy therapy may be part of the treatment package.