Understanding traumatic stress
How do we react to traumatic stress?
Terrible events are difficult to deal with; while some people may recover naturally from a catastrophic life experience, others will find the after-effects much more painful, often feeling permanently changed by the impact of what has happened. Feelings of extreme fear, horror or helplessness can lead to a pattern of reactions that are constantly repeated and can be very disruptive to daily life. The sufferer may become numb, feeling themselves shut off from those around them, or grief or guilt may constantly weigh them down. Memories of horrifying scenes they have witnessed may intrude into their waking hours, while their sleep may be disturbed by vivid, unpleasant dreams.
When traumatic events cause emotional injury and damage a person's normal coping resources, this is known as Traumatic Stress. The continuing physical and psychological reactions to the trauma are known as Traumatic Stress Responses (which include Post Traumatic Stress Disorder). These reactions can be so strong and overwhelming that the sufferer may feel they are 'going mad' or 'losing control'; indeed, the symptoms of these reactions can interact with each other in a kind of 'vicious circle' of responses, which keep the cycle going.
To overcome the effects of trauma it is necessary to change these reactions and begin to see events in a different light.
What is a traumatic event?
An event is usually considered traumatic if a person has experienced or witnessed actual, or threatened, death or serious injury. Traumatic events range from common incidents to large-scale disasters and include:
- Transport disasters such as road or rail accidents
- Violence in the home or on the street
- House fires
- Natural disasters such as earthquakes or floods
- Combat experiences for both military personnel and civilians
- Terrorist attacks
- Rape and sexual assault
Other more 'typical' life events can also be so overwhelming for some people that they are experienced as traumatic incidents. These may include:
- Job loss or redundancy
- The end of a long-term relationship or divorce
- The death of a loved one
An experience can generally be described as traumatic when a person's normal ability to cope has been completely overwhelmed by a terrible event.
How is traumatic stress manifested?
Reactions following trauma can be divided into three main symptom groups:
1) Re-experiencing the event (intrusive reactions)
These are intrusive memories that are experienced as the traumatic event happening all over again; they can occur during waking hours or be experienced as dreams or nightmares during sleep. Flashbacks can be extremely disturbing, as all the physical sensations associated with the trauma are usually experienced again.
Not all individuals will experience flashbacks, although most people will have trouble switching off their recollections of a traumatic event. Simple things in daily life (for example being pushed in a crowd) can become triggers that subconsciously set off a train of traumatic associations.
2) Arousal reactions
Disturbed sleep is the after-effect most commonly reported by people who have experienced trauma and manifests itself in various ways, including heavy sweating, nightmares or recurring dreams, and waking in the early morning.
Bad temper and lack of concentration
Increased adrenaline often impacts the sufferer's mood and they may find themselves becoming very negative, argumentative or easily irritated.
Hyper-alertness and exaggerated concern for safety
Sudden and dramatic trauma can result in increased awareness of environment - a continual assessment of potential danger. Being on such constant 'red alert' can also be extremely draining.
Exaggerated Startle Response and panic attacks
Sudden noises and unexpected movements may startle sufferers severely, resulting in feelings of nervous agitation, shakiness, light-headedness, or even a full-blown 'panic attack'. Panic attacks can occur seemingly without warning, producing symptoms such as shortness of breath or hyperventilation, severe chest pains, dizziness and faintness; they are quite terrifying, but can be tackled and managed with the right approach.
3) Avoidance reactions
Avoidance behaviour translates as avoiding any person, place or thing that may be a reminder of the trauma, in particular anything that may have already served as a 'trigger' for anxiety or overwhelming feelings.
Another form of avoidance behaviour, although much less easy to identify, is emotional numbness. The traumatized person may feel as though the 'feeling' part of them has been removed; this can affect their capacity to laugh, feel happy, or even cry.
Alienation, disconnection and difficulty with intimacy
A difficulty in getting close to, or communicating with, other people. Feelings of detachment or disengagement are common, while some may also find themselves unable to cope with physical intimacy.
Alcohol, drugs and comfort eating
Some people use alcohol or drugs to escape or block out painful reactions connected to their trauma, while others use comfort eating as alleviation.
Other Reactions Following Trauma
In addition to the common reactions above, people who have experienced trauma may also find themselves affected by:
Depression and traumatic grief
It is very common for those who are grieving to go through a stage of depression, although some find it difficult to emerge from this, instead sinking further into depression. Symptoms can include feelings of negativity and worthlessness, and overwhelming fatigue.
Guilt and self-blame
Many people take personal responsibility after a traumatic event, blaming themselves for all or part of the incident, or feeling guilty for surviving when others didn't.
Decreased self-esteem and loss of confidence
Self-blame can lead to feelings of worthlessness and very low self-esteem.
While it is likely that many of these symptoms will be present immediately after a traumatic event, for most people they usually subside during the next few days or weeks. If your reactions do not subside, but instead recur repeatedly, this is indicative of a Post-Traumatic Stress Reaction.
Post Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder is the term given to a particular range and combination of the above reactions following trauma. The diagnosis will depend on how many reactions you are experiencing, and how frequent, severe and disabling they are to you.
Management and treatment
In recent years a range of cognitive behaviour therapies has been developed for treating psychological problems. These work by addressing the patterns of thinking that are associated with a person's problematic behaviour and symptoms, and offering strategies and techniques for breaking these negative thought processes. CBT therapy has proved to be a highly successful treatment for depression, anxiety disorders, phobias and low self-esteem, and offers an effective approach to managing Post Traumatic Stress.
Treatment is usually conducted by a therapist, but many of the CBT mechanisms have also been adapted into the form of self-help manuals. These manuals help the sufferer to recognise and address the range of reactions, thoughts and feelings that they may be experiencing, and offer a systematic programme of treatment which the sufferer is advised to work through to overcome their difficulties. For a great many people, cognitive behavioural self-help manuals provide a lifeline to recovery and a better future.
Overcoming Traumatic Stress is a CBT-based self-help book which demonstrates, with practical advice and tested exercises, how to find new and effective ways of coping with. and eventually of overcoming, traumatic stress.
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