Understanding and managing psychological trauma

What is a potentially traumatic event?

Potentially traumatic events are powerful and upsetting incidents that intrude into daily life. They are usually defined as experiences which are life threatening, or where there is a significant threat to one's physical or psychological wellbeing.

The same event may have little impact on one person but cause severe distress in another individual. The impact that an event has may be related to the person's mental and physical health, level of available support at the time of the event, and past experience and coping skills.

Situations and events that can lead a person to experience psychological trauma include:

• Acts of violence such as an armed robbery, war or terrorism
• Natural disasters such as bushfire, earthquake or floods
• Interpersonal violence such as rape, child abuse, or suicide of a family member or friend
• Involvement in a serious motor vehicle or workplace accident.

Other less severe but still stressful situations can also trigger traumatic reactions in some people.

What are the symptoms of psychological trauma?

Many people have strong emotional or physical reactions following experience of a traumatic event. For most, these reactions subside over a few days or weeks. For some, the symptoms may last longer and be more severe. This may be due to several factors such as the nature of the traumatic event, the level of available support, previous and current life stress, personality, and coping resources.

Symptoms of trauma can be described as physical, cognitive (thinking), behavioural (things we do) and emotional.

As long as they are not too severe or last for too long, the symptoms described above are normal reactions to trauma. Although these symptoms can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective. With understanding and support from family, friends and colleagues the stress symptoms usually resolve more rapidly. A minority of people will develop more serious conditions such as depression, posttraumatic stress disorder, anxiety disorders, or alcohol and drug problems.

Tips on managing psychological trauma

There are several things you can do to look after yourself and promote recovery from a traumatic event or situation. The following points provide some general advice.

• Recognise that you have been through a distressing experience and give yourself permission to experience some reaction to it. Don't be angry with yourself for being upset.
• Remind yourself that you are not abnormal and that you can and are coping.
• Avoid overuse of alcohol or other drugs to cope.
• Avoid making any major decisions or big life changes.
• Do not try to block out thoughts of what has happened. Gradually confronting what has happened will assist in coming to terms with the traumatic experience.
• Don't ‘bottle up' your feelings - share your experiences with others when opportunities arise. This may feel uncomfortable at times, but talking to understanding people that you trust is helpful in dealing with trauma.
• Try to maintain a normal routine. Keep busy and structure your day.
• Make sure you do not unnecessarily avoid certain activities or places.
• Allow yourself time to rest if you are feeling tired, and remember that regular exercise is important.
• Let your friends and family know of your needs. Help them to help you by letting them know when you are tired, need time out, or need a chance to talk or just be with someone.
• Make time to practise relaxation. You can use a formal technique such as progressive muscle relaxation, or just make time to absorb yourself in a relaxing activity such as gardening or listening to music. This will help your body and nervous system to settle and readjust.
• If the trauma that you experience stirs up other memories or feelings from a past unrelated stressful occurrence, or even childhood experiences, try not to let the memories all blur together. Keep the memories separate and deal with them separately.
• Express your feelings as they arise. Whether you discuss them with someone else or write them down in a diary, expressing feelings in some way often helps the healing process.

When to seek professional assistance

You should seek professional assistance if the symptoms resulting from the trauma are too distressing or last for more than a couple of weeks. Warning signs may include:

• Being unable to handle the intense feelings or physical sensations
• Feeling numb and empty
• Continuing to experience strong distressing emotions
• Continuing to have physical symptoms of being tense, agitated, and on edge
• Continuing to have disturbed sleep and/ or nightmares
• Having no-one to support you and with whom you can share your feelings and emotions
• Having relationship problems with friends, family and colleagues
• Increasing your use of alcohol or drugs.

How is psychological trauma treated?

Most people who experience a traumatic event will not require treatment. Most will work through their anxiety with support from close friends and family. However, for some people the response to the trauma can be debilitating and treatment from a trained mental health professional will be needed to help the person to recover.

Treatments for a severe trauma response include trauma-focused psychological interventions. These focus on providing education, stress management techniques, and helping the person to confront feared situations and distressing memories. Medication, particularly some of the new antidepressant drugs, can often be useful alongside trauma-focused psychological approaches.

Posttraumatic Stress Disorder (PTSD)

PTSD is a clinical condition that may develop in some people following exposure to a traumatic event. PTSD involves three main groups of symptoms:

• Re-experiencing the trauma in the form of intrusive memories, nightmares or flashbacks
• Avoidance of reminders and numbing of emotional responsiveness
• Hyperarousal - feeling jumpy and on edge.

PTSD is very distressing and can lead to serious ongoing problems with social relationships and the ability to work or carry out normal daily activities. PTSD usually requires professional assistance as these problems tend not to resolve by themselves with the passage of time.

Depression, anxiety disorders (such as panic, phobias, and general anxiety) and alcohol or drug disorders may also develop following trauma in some people. These conditions may occur with, or in the absence of, PTSD.

Other resources on psychological trauma and PTSD

The Australian Centre for Posttraumatic Mental Health (www.acpmh.unimelb.edu.au) website contains useful information for trauma survivors, their families, and health practitioners. Free copies of consumer and practitioner versions of the Australian  Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder can be downloaded. (These guidelines are also available from www.nhmrc.gov.au/publications/synopses/mh13syn.htm).

The US National Center for PTSD (www.ncptsd.va.gov) website also contains a range of useful resources for consumers and practitioners, as well as links to several other useful sites.

Seeking professional assistance

If you feel unable to cope following a trauma you can seek help from an APS psychologist. An APS psychologist is trained to assess trauma and to help the person to better understand and manage their responses to the trauma by developing effective coping strategies and techniques. An APS psychologist can also help a person to manage other problems that may be associated with the trauma, such as depression, stress, drug and alcohol use, or personal relationships.

To talk to an APS psychologist, speak to your GP about a referral or phone the APS Find a Psychologist service on 1800 333 497. Alternatively, you can locate a psychologist in your area by visiting the APS Find a Psychologist website - www.findapsychologist.org.au.