What to Do After a Traumatic Event: Advice from a Psychologist

Dr Marianne Trent (: 00:00

Something awful has happened maybe to you, maybe to someone you care about. It might have been a car accident, a mugging or something distressing at work or witnessing something traumatic in everyday life. Whatever it was you or someone you care about has been left feeling a bit out of sorts, maybe jumpy, wired, tearful or exhausted or maybe you or they are not feeling much of anything yet and you are left wondering what's normal after something like this. I am Dr. Marianne Trent, a clinical psychologist, and in this episode we are going to be exploring how people often respond to trauma, what kind of reactions are common, what tends to help and how to tell when someone might benefit from additional support. My hope is that by the end of this episode, you will feel more confident in knowing what's normal, what's to be expected, and what might signal that someone needs a little more help. Hope you find it so useful.

(: 00:58

Hi, welcome along. I'm Dr. Marianne and I'm a qualified clinical psychologist. I'm also a specialist in trauma and often people will get in contact with me to say, this has happened, what do I do? This episode is all about that you might be working with people in post-traumatic situations or you might be someone that just loves or cares about or has experienced something really scary yourself. I really hope you find this content helpful. If you are finding the content helpful, I'd be so grateful if you drop me a like and a comment and even a subscribe if you're watching on YouTube. So firstly, when something big or scary happens, it's really normal or because we are human that we are going to respond to that. What we might think of as emotional aftershocks might happen immediately after the event or might be a bit delayed too.

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It can be helpful to group these responses into one of four categories and they are physical, emotional, behavioural, and cognitive. And what we know is that sometimes people might initially feel fine or say that they're fine, but that doesn't always mean that that's going to stay that way. And of course what we know about people is they may not always tell you the truth. So being able to tune into the person and looking out for these signs and symptoms might be really useful in helping you to work out whether you or someone you care about really is fine. Let's take a look at the physical symptoms that someone might experience from stress related or traumatic events. So they are fatigue, nausea, muscle tremors, twitches, chest pains, difficulty or changes in breathing, increased blood pressure, rapid heart rate, thirst, headaches, visual difficulties or changes, vomiting, grinding, teeth weakness, dizziness, profuse, sweating, chills, shock, fainting.

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A few of those are flagged for if you experience them or someone you care about, experiences them that medical advice should be sought and those were the ones like chest pains, difficulty or changes in breeding, a rapid heart rate, headaches, visual difficulties or changes, shock and fainting. The second of our groups of symptoms falls into the thoughts category and that might include things like blaming someone, confusion, poor attention, poor decisions, heightened or lowered alertness, poor concentration, memory problems, difficulty identifying familiar things or people, poor problem solving, loss of person, place or time orientation, disturbed thinking and nightmares. The third of our symptoms are grouped in the emotional category and they might include anxiety, guilt, grief, denial, severe panic, which can be rarer, fear, uncertainty, loss of emotional control, depression or low mood, feeling overwhelmed, intense anger, irritability being extra hypervigilant and flashbacks. The fourth and final group of our symptoms are in the behavioural category and they might include changes in level of physical activity, change in speech style or pattern withdrawal, emotional outbursts, suspiciousness, poor communication, increased alcohol intake, increased drug or medication consumption, inability to rest, antisocial acts and intensified startle reflex, pacing around erratic or jerky movements, agitation and apprehension.

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Now of course many of those signs and symptoms kind of do indicate what it is to be human, but you will know what is normal for you or what is normal for the person that you are concerned about. And so it's really tuning into what changes have happened from what we would call a person's normal baseline. So if somebody already consumes alcohol every day and they continue at the same pace, that's not necessarily an indication that they might be struggling. Whereas if they very rarely drink or they usually teetotal and after this traumatic or stressful event, they begin to consume alcohol on a daily basis or that you notice that they seem to suddenly start appearing drunk, that may of course indicate there's been a change. Similarly, if somebody usually struggles with migraines and they then get migraines at the normal interval for them, it doesn't necessarily mean that they're experiencing the traumatic event.

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I've put together an entirely fictional case study which might give us a better idea about what kinds of things we might experience and notice and how this plays out in reality. As I said, this is entirely a fictional account and not based on anyone that I know or have worked with. Jordan is a 3-year-old marketing manager and they were involved in a multi-car collision on a motorway. Although they weren't physically injured, they witnessed someone being taken away in an ambulance and were badly shaken by the experience. In the days following the incident, Jordan noticed themselves being unusually tearful, often crying without a clear reason, especially when recalling parts of the event normally quite sociable. They started avoiding phone calls and skipping social plans, preferring to stay at home alone. Jordan also found it difficult to fall asleep and was waking up several times during the night, sometimes feeling panicked or sweaty, loud noises, especially car horns or sirens.

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Started making them jumpy and tense and they began scanning the road obsessively when driving again to try and cope with the tension and the poor sleep. Jordan started drinking more alcohol in the evenings than usual, telling themselves it was just to take the edge off. In our case study, we are looking a little further ahead with Jordan, whereas of course you might find that the event has happened right now, but these are useful things to look out for. So for example, when Jordan went back to work, they were functioning relatively okay, but found that they felt distracted and exhausted and had started to wonder whether what they were feeling was normal and whether they should seek help. So whilst this is not based on an individual known to me, these are a really common collection of signs and symptoms post-trauma, we'll often see people who perhaps have experienced the birth of a child or in birthing their own child will experience some post-trauma.

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It is so, so common, but it's often not flagged as being a trauma response. So these are really important signs and symptoms to look out for. So what are the helpful things to be able to do after a traumatic event? Firstly, spending time with people that you feel and trust or being around trusted people that might be family, it might be friends, it might be loved ones. There can also be some value in spending time with people who are also involved in that experience to help to debrief it a bit too. Where possible. Maintaining your usual routines can actually be protective of your mental health and functioning that it might involve when you get up, when you go to bed, when you rest, when you exercise, when you eat, if you don't usually exercise. Gentle movement or being outside or taking part in physical activity can also be really, really important.

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Of course, if you've been physically injured as a result of the traumatic instant, that might be problematic. And so if you have, please do get yourself signed off by your medical practitioner before attempting any physical activity. So limiting alcohol and certainly not drinking more than you usually would is absolutely advised as well as talking to someone either a mental health professional or a friend or family about your experiences can be so protective of mental health. Only taking medication as prescribed and not being swayed by any unprescribed or recreational drugs can be so important. If you find that you symptoms are not being managed by what you are already prescribed, please do contact your prescribing clinician as soon as possible knowing that the way that our brains work is that we will process things. It might feel like we're feeling really intense reactions right now, but knowing that these are likely to pass and we won't always feel this way can be so powerful too.

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Let's talk about some of the things that I recommend to people post-trauma, which can be really helpful. Firstly is our before, during, and after approach, this is where we split the chunks of time around the incident into three. So the before section would be maybe from when you first woke up that day and everything was normal, all the things you did or they did, which ran up until the time when just before you noticed something was different. So for example, in the case of Jordan, they got up that day, got showered, got breakfasted, dropped children off at school, then got in the car and listened to the radio and was driving. Perhaps you tune into the memory of the songs or the stories that were being discussed and then even before the first thing that happens, and that is the before section. The during section starts as soon as you begin to notice that something is not normal.

(: 11:15

So again, with Jordan's example, it might be suddenly seeing a stopped queue of traffic in front of them and then needing to put your brakes on. So that is during section runs up until you're kind of out the other side really. So that might be when you get home again, perhaps after being checked out by hospital or it might be when you get dropped off by the car recovery firm for example, but it's when that kind of section of action is over, that's when the during section spans. I guess one interesting point about the during section is that sometimes when we're assessing people in clinic is that people really begin to make it clear in the way that they're talking about things or the way that they are describing what happened is that they still think it's happening now. They haven't got that sense of safety, which has kind of triggered to them that it's not now that they're safe, that this has passed.

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So that is an interesting one to look out for as well. The after section would be anything after, so anything from once that person is home again until right in this present day, and you can recount this in as much or little detail as you want. The theory behind this is that when something traumatic happens, our brains don't always realise that it's not. Now this has had a beginning section, a during section and an after section, so helping to really get that flow going can help the sequential processing and help make the body and the mind realise that this is over. This is not. Now what happens before we do the before, the during and after is that you might struggle to get a coherent order. All of the different bits and pieces about the car crash, for example, in Jordan's example, might feel like you kind of go from A to D to B to Z to T to R to Q.

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And doing this sequential before, during, and after can really help the body and the mind to process and assimilate and make sense of the order that this happened in. What can be also really nice, especially if you're working with a child, is to get them to draw their before there during and thereafter. Try not to judge or criticise. Just be open to conversations about what it is that the person has drawn and that's regardless of age. It's not just children that draw. Sometimes being able to tap into different ways of doing as well as the spoken word can really help the body and the mind to process all of this. Similarly, you might find it helpful to write your experiences in terms of before, during, and after too. If you're finding it very distressing to do this before, during, and after section, it's okay to pop it away and come back to it when you feel stronger or to go through it with somebody that you trust or maybe even with a mental health professional too, when might be an indication that you or someone you care about might need to seek additional help.

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So signs that this might not be settling might be prolonged anxiety or worsening anxiety, nightmares, flashbacks, intrusive thoughts and hypervigilance. It might be a sign that someone's functioning has been severely impacted on all the things that they would do, such as dropping children at school, going to work, doing all the different jobs in their family have stopped or changed in some way, and that can be a real indication that all is not well. If this affects their work, their sleep, their relationships. This is an indication that additional help might be required. It's really important to reassure people that seeking help is not a sign of weakness. This is just the way our tricky human brains work and that it's entirely normal. Getting help as early as possible is likely to give you a really great chance of recovery. Technically speaking, we are allowed to respond to tricky, challenging, stressful events without this necessarily meaning.

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This results in a post-traumatic stress disorder presentation. You have this with grief as well. It's only really after a couple of months of prolonged experiences of these signs and symptoms that we might begin to think this is cropping up outside of normal limits and that this is becoming complex complicated grief or PTSD. Basically, if you are concerned about anyone about the risk to themselves or others, please do make contact with mental health services and or police services too if required. If this is something that's happened as a result of a crime, it's also important to get this reported and victim support might well be able to support you too. There are of course specific mental health treatments and approaches such as cognitive behavioural therapy such as EMDR, such as compassion focused therapy, which really can make a very big difference for how people are feeling and getting this traumatic event to lay flat and to be better assimilated into their life.

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So last but not least, trauma reactions are all part of being human. Often when I've been through the tricky brain kit exercise with people, they absolutely then understand the theory, but do wish perhaps there are real benefits to being human. One of which being that you can get 10 pounds off the price of a tricky brain kit by using the code YouTube 10 at checkout hope is so important. Recovery is possible. Help is available if you have been through something traumatic or challenging or someone you care about, has this can feel really derailing and so my heart goes out to you. Please do look after yourselves. Please do try and rest. Please do try to talk about your experiences. I would love it if you found this helpful, if you would like it, if you would drop me a comment if you would share with others too. Perhaps if you've been through something traumatic and come out the other side might be really helpful and empowering if you were able to drop a comment on YouTube to let others know that this is possible. Thank you so much for watching or listening to this episode. I will be along with the next episode from 10:00 AM on Saturdays on YouTube, and wherever you get your podcast from. 6:00 AM on Mondays. Please do take care of yourself and I'll see you very soon.

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