In the UK, 3 in every 100 people experience Post-Traumatic Stress Disorder (PTSD). And yet, worryingly, many people either know very little about it or have misconceptions about who, and how, it impacts. I suspect this is why I often see people in my clinic who are totally unaware they have PTSD.
PTSD – Isn’t that What Soldiers Have?
Yes, PTSD is often associated with soldiers who have been at war. Sadly, a huge number of veterans do suffer horrifically with the illness. However, PTSD can and does affect anyone who has experienced a traumatic event. I would argue everybody experiences some form of traumatic event at some point in their life. And any single harrowing experience can cause PTSD.
How we respond to trauma depends on our interpretation of the event at the time and just afterwards. It also depends on our previous experiences of trauma, our support networks, current life stressors, and the things we do to cope. The symptoms of PTSD can start immediately or there may be a delay of weeks or months.
I firmly believe our psychological health needs the same care and attention as our physical health. If you broke your leg, you would give it time to heal, adjust your lifestyle, get more support, rest, and allow nature to take its course. We should do the same after psychological trauma. Our brain has had a shock and needs time to heal.
What is a Traumatic Event?
A traumatic event can be defined as experiencing a situation where you fear for your safety or the safety of someone you love. So, if you see a loved one trip down a step and fear they could be seriously injured, this could lead to some trauma symptoms even if they are perfectly fine.
Some examples of traumatic events:
– Road traffic accidents
– Verbal, physical or sexual abuse
– Falls, accidents or injury
– Terrorist attacks
– Witnessing the death of a loved one
– Military combat
– Natural disasters
– Being stuck in lifts or confined spaces
– Dog bites or attacks
– Robbery or muggings
– Difficult experience of giving birth
– Serious illness (including COVID-19) and/or the associated treatment
What are the signs and symptoms of PTSD?
In the first few weeks following a traumatic event, it is common to experience a number of symptoms that are consistent with PTSD. This is a normal part of recovery and can be understood as the mind’s way of trying to process and come to terms with what’s happened. These symptoms are generally at their worst during the first month and can be clustered into three main categories:
Intrusive symptoms – flashbacks of the event, nightmares, intrusive images or memories.
Avoidant symptoms – the trauma feeling ‘unreal’, dream state, blunted emotions, shut down, low in mood, not wanting to talk about the event, being unable to talk about it, avoiding any reminders of the trauma, loss of interest in things, loss of enjoyment.
Arousal symptoms – anxiety, palpitations, feeling on high alert, heightened sensitivity to noise and/or light, anger, irritability, feeling scared, sense of impending doom, poor sleep, unable to concentrate, bad memory, loss of appetite.
This initial period after a traumatic event is sometimes called ‘watchful waiting’. It’s important to look after yourself and keep an eye on your symptoms, but you may not need any treatment. Your threat system will have had a shock, so the antidote is to prioritise calming activities.
Some people need to talk about the event to help them process it. Others don’t. If this type of person is encouraged to talk when they are not ready, it can be unhelpful. Initially, it’s important to try and honour what you feel you need.
Ten Ways to Self-Manage Symptoms of PTSD
Self-compassion – Care for yourself as you would a friend.
Mindfulness – Use this technique to settle your mind and relax your body
Find your ‘safe place’ – Use relaxation techniques and imagery to create a ‘safe place’ in your mind that you can go to whenever you feel the need.
Create a narrative of the event – Write down what happened with a start, a middle and an end. Our brain likes things in order and often traumatised memories can be disorganised.
Remind yourself it’s over – Keep doing this and telling yourself that you are totally safe now.
Look after your physical health – Eat well, stay hydrated, avoid alcohol and drugs, exercise, and make sure you get enough sleep.
Stay connected – See and speak to friends and family as much as possible. Share your experiences with others and talk about what happened.
Try not to avoid reminders of the event – The exception to this is if they will totally overwhelm you.
Reduce rumination – Whilst you should talk about what happened and try not to avoid reminders of the event, it’s equally important to try not to constantly think about it. Where possible, turn your attention to other things.
Routine – Maintain a good routine and daily structure
When to Seek Professional Help
In many people, these early symptoms will naturally reduce after the first month. However, if you’re still experiencing them after four to six weeks, I would strongly advise you to seek professional help. This may be the only way you’ll manage to process your experience and move forward. This advice especially applies if you have any of the following symptoms:
– Feeling upset and fearful most of the time
– Constantly feeling emotionally overwhelmed
– Acting very differently to before the trauma
– Not being able to work or look after the home and family
– Deterioration of relationships
– Using drugs or drinking too much
– Feeling very jumpy
– Being unable to stop thinking about the incidents
– Not enjoying anything
– Impaired day-to-day functioning
– Poor sleep
The most effective psychological treatment for PTSD is trauma-focused EMDR and CBT, both of which are in the NICE guidelines for the treatment of trauma.
Cognitive Behavioural Therapy (CBT)
CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle. CBT aims to help you deal with overwhelming problems in a more positive way by breaking them down into smaller parts. You’re shown how to change these negative patterns to improve the way you feel. CBT looks for practical ways to improve your state of mind on a daily basis.
Eye Movement Desensitisation and Reprocessing (EMDR)
EMDR is a form of therapy that integrates the successful elements of a range of therapeutic approaches. It combines them with eye movements or other forms of bilateral stimulation in ways which stimulate the brain’s information processing system.
Normally, people process traumatic experiences naturally. However, if you are subjected to an overwhelming event or repeated distress, this healing process may become overloaded, leaving the original disturbing experiences unprocessed. These unprocessed memories can be stored in the brain in a ‘raw’ form where they can be continually re-evoked when experiencing events that are similar to the original experience.
EMDR utilises the body’s natural healing ability and allows the brain to heal psychological problems at the same rate as the rest of the body heals physical ailments. Because EMDR allows the mind and body to heal at the same rate, treatment can be rapid. The number of sessions required for EMDR treatment will vary according to the complexity of the issues being dealt with. In general, the more isolated the traumatic memory being treated, the shorter the treatment tends to be.
The most important thing to remember is that PTSD is treatable. We can’t erase difficult traumatic memories from our minds, but we can store them in a way that doesn’t impact our lives, relationships and emotional wellbeing.