Post-traumatic Stress

A trauma is any significant and negative event very different from our normal experience, requiring resources beyond those usually required. Traumatic incidents involve actual or threatened death, serious injury, or sexual violence. Such incidents can occur in assaults, natural disasters, war, accidents, or being a victim of or witness to a crime. It is normal to have a range of physical and emotional reactions for some time after an event such as these.

REACTIONS TO TRAUMA

Reactions to trauma depend on a number of factors including:

• what happened
• the context (place, time, etc)
• how we interpret the incident
• previous exposure to similar events
• supports available to us
• our personality
• coping skills
• how much control we feel we had

Emotions commonly experienced include:

• fear: of future similar events, of losing control, of injury to self or loved ones, of being alone, of the dark
• helplessness
• sadness
• guilt: for things done or not done, for having survived
• resentment
• shame: for not having reacted ideally
• anger: at people / God / the universe / life
• regret: for what has been lost, “if only …”

These feelings might be uncomfortable, but are normal. It is healthy to acknowledge them, rather than denying them or bottling them up.

Various physical sensations can accompany these emotions, including difficulty sleeping or excessive sleep, nightmares, tiredness, trouble concentrating or remembering things, difficulty making decisions, dizziness, shakes, loss of appetite, tearfulness, distrust of people, sensitivity to noise, sweating, difficulty breathing, a choking sensation, nausea, diarrhoea, headaches, back ache, and muscle pain. These reactions resolve over time.

‘Flashbacks’, memories, and nightmares might occur frequently in the first few weeks after a trauma. This can be frightening but can be part of healing; the mind replays the event to make sense of it and come to terms with it. Flashbacks etc gradually decrease in frequency and intensity, but recovery often involves the occasional re-emergence of flashbacks after a time of very few flashbacks for some time.

After a trauma, it is common to have strong reactions to events or objects associated with the trauma for some time. For example, breaking out in a cold sweat at the sound of a car horn, or flinching whenever someone raises his voice. Although these reactions might be unpleasant or embarrassing, they are normal and generally disappear over time.

STRATEGIES FOR RECOVERY

People differ in what helps them recover, but strategies found to be useful include:

• Re-establish a normal schedule as soon as possible – it helps you feel grounded and back in touch with reality.
• Exercise every day, because physical exercise helps integrate the experience, lifts mood, improves sleep, and helps you return to normal.
• Eat whether or not you feel hungry. Keeping your blood sugar relatively stable with frequent small amounts of healthy food throughout the day will help you feel better and think clearer.
• Limit caffeine, alcohol, nicotine, and sugar intake, as they can make you feel worse. Using alcohol or medications to numb you will extend the healing time and create other problems.
• Allow yourself time with others and time alone.
• Talk about, and/or write about, what happened, and how it is affecting you. Allow flashbacks to happen – don’t fight them, but don’t dwell on what happened either.
• If you’re not sleeping well, reassure yourself that rest without sleep is also good for you. If you can’t relax enough to rest, get up and do something enjoyable.
• Allow people who care about you to support you in whatever ways work for you, from the practical (cooking meals), to the physical (hugs, back rubs), to the emotional (listening to you talk, holding you as you cry).
• Cut off all blame; blame cannot change what has happened, but can reduce your ability to cope with the future. To avoid thinking that everyone is against you or that life is all bad, remind yourself of the good things in life.
• Engage in activities that you used to enjoy, even if they don’t seem important any more. Music, gardening, social groups, and sport can be helpful in regaining a sense of self.
• Structure your time so that the day doesn’t stretch out endlessly before you. The structure can be as simple as going for a walk every morning and going to the library in the afternoon, or making a phone call once you finish the crossword. The sense of having achieved something is valuable, and structure provides a sense of movement, which is important when recovering.
• Laugh whenever possible. It can be difficult to see the funny side of life after a traumatic event, so seek it out by watching cartoons, reading comics, and watching favourite comedies.
• Engage in spiritual rituals that have comforted you in the past or develop new ones. For example, spend time in the bush or walk along the beach, play or listen to music, use essential oils, or light candles or incense.
• Be creative, in whatever form suits you – such as drawing, photography, woodwork, cooking, crafts, pottery, or dance.
• Avoid major decisions and life changes until you feel more yourself. Decisions made under stress are often later regretted.
• Don’t avoid everything associated with the trauma because this can cut off so much that is important in life and feed anxiety.
• Remember you’re not alone. There are always supports and people that will understand or at least listen. Consult a psychologist if problems persist or if your support people tend to be over-ready with advice.