Dealing with trauma

Reactions to trauma

People can react to trauma in a whole range of ways. This might include:

• Strong feelings – include anxiety and fear, sadness, guilt, anger, vulnerability, helplessness or hopelessness. These feelings will not just apply to the event, but to many other previously normal areas of life as well.
• Physical symptoms – include headaches, nausea, stomach ache, insomnia, bad dreams, changed appetite, sweating and trembling, aches and pains, or a worsening of pre-existing medical conditions.
• Thinking is affected – include difficulties with concentrating or thinking clearly, short-term memory problems, difficulty planning or making decisions, inability to absorb information, recurring thoughts of the traumatic event, thinking about other past tragedies, pessimistic thoughts or an inability to make decisions.
• Behaviour changes – include a drop in work or school performance, turning to changed eating patterns, using drugs or alcohol, being unable to rest or keep still, lack of motivation to do anything, increased aggressiveness or engaging in self-destructive or self-harming activities.

Offering support

It’s always good to ask the person who has experienced a traumatic or distressing event what you can do to
support them. It’s ok if they are not sure about what they need. Here are some suggestions for things that you could do:

• Make time to be with the person and make it obvious that you are available and are without judgement when they are ready.
• You can help by reassuring the person that their reactions are normal.
• Offer practical support such as cooking meals, doing some house work tasks or providing some childcare.
• Encourage the person to take good care of themselves, for example, by eating well, avoiding alcohol or other substances, and by attempting to maintain a good routine around sleep.
• Let the person have time alone if they would find it helpful.
• Suggesting to a person that they maintain regular daily routines and habits can be helpful.
• Try and encourage them to do something active every day. Activities like walking, swimming or going to the gym are all great ways of reducing the physical impact of stress and can help with sleep.
• Don’t insist they get professional help, especially in the immediate aftermath of an event. Not everyone needs it and it may lead them to believe they are not reacting “correctly” and stop talking or begin isolating themselves.

Be mindful of...

• Don’t feel you need to avoid talking about the event.
• Try not to tell the person how they should think, feel or behave. Everyone’s response is different.
• Avoid using general phrases such as ‘look on the bright side’ or ‘look for the silver lining’, but help them think more specifically about what they do have.
• Don’t judge their thoughts or feelings – being accepted helps put things in context.
• Try not to be impatient or expect them to ‘get over it’ in a certain time. It can take months or longer to recover from an event.
• Don’t insist they need professional help. Not everyone who experiences a distressing event needs treatment. It will be more effective if they get it when they want it, even if that is later than is ideal.
• Try not to take their feelings to heart. They may be irritable, depressed, angry or frightened. Strong feelings and emotional outbursts are common. It is important to recognise that they have had a stressful experience and that their reactions are normal and will subside in time.

How to talk about what has happened

Being able to open up and talk about what has happened is a vital part of being able to move through a traumatic event and start feeling better again.

However, listening to some one you love talk about such distressing events is difficult and it is important that you also seek to look after your own wellbeing. Here are some suggestions for how to enable someone to talk to you:

• Allow the person to talk about what happened, even if they become upset. Just be calm yourself and listen carefully.
• Don’t insist on talking if the person doesn’t want to. They may need time to be alone with their thoughts. Tell them you are there to listen whenever they feel ready.
• Reassure them you care and want to understand as much as possible about what happened to them.

Reaction to trauma in families

People within families are all individuals, with their own social support, experiences and coping strategies. It is therefore really normal that they might react quite differently to a traumatic event.

The focus should be around ensuring that there is good communication in order to deal with any challenges that different reactions might bring to the dynamics of the family.

It’s important to remember that lots of families look back and perceive their communication and relationships to be stronger following a traumatic event and it's okay to reach out for professional help if your family needs support through this difficult time.

When to think about seeking help from a health professional

Traumatic stress can cause very strong reactions in some people and may become chronic (ongoing). You should suggest the person you care for seek professional help if they:

• Are unable to handle the intense feelings or physical sensations.
• Don’t seem to display normal emotions or reactions, seeming flat a lot of the time or on edge/easily startled.
• Feel that they are not beginning to return to normal after three or four weeks.
• Continue to have physical symptoms of stress, such as headaches, muscular stiffness.
• Continue to have disturbed sleep or nightmares or avoids particular places or activities.
• Seems unable to talk about what has happened or how they are feeling.
• Notice the communication in the family has changed and not recovering.

Family life following the event

Every family is different but, there are some more common reactions within families that you might notice. This could include being more worried about each others safety and seeking reassurances about where individuals are and seeking more frequent contact when not together. It might be that it is suddenly difficult to talk to each other about what has happened or that some members of the family want to talk more than others. This can lead to feelings of overwhelm or insecurity and you might notice that there are more arguments or misunderstandings in daily life.

It is likely that individual relationships within the family as well as the wider dynamics of the family functions may change for a time. This might be because no one really understands how to help each other. This can be especially difficult when thinking about how to talk with younger children. Previous routines and structures in the home may not be maintained, it may be that no one wants to go to work our school, household chores are not being done, meal times are disrupted or avoided, or some roles within the family change, such as the children feeling pressure to pick up more of the household tasks.

It is important to remember that it is normal for people to respond in diff erent ways to distressing events. However, within a family sometimes people’s responses can clash. One person may withdraw and need time to themselves, while the other needs company and wants to talk about it. This can be really tricky to manage living in the same environment, however it’s important to try and find a way to enable each member to work though what they need.

Family life - weeks, months or years later

Family relationships may change weeks or even months after the event. Because time has passed, family members sometimes don’t realise how changes are directly linked to the event. Sometimes, the response to a distressing or frightening event may take a long time to show.

In some cases, it may take years for problems to surface. This can happen especially if the person is very busy helping others or dealing with related issues, such as insurance, rebuilding, relocation, legal processes or financial problems. When things have returned to normal, their reactions
may show up.

Family members may become short-tempered or irritable with each other, which can lead to arguments and friction.

• They may lose interest in activities or perform less well at work or school.
• Children may be clingy, grizzly, demanding or naughty.
• Teenagers may become argumentative, demanding or rebellious.
• Individuals may feel neglected and misunderstood.
• Some family members may work so hard to help loved ones, they neglect to look after themselves.
• Individual family members may feel less attached or involved with one another.
• Parents may experience emotional or sexual problems in their relationship.
• Everyone feels exhausted and wants support, but cannot give much in return.
• The experience may be relived when faced with a new crisis.
• Problems may seem worse than they are and be more difficult to handle.
• Changes to family life that occurred in the days, weeks or months after the event may become permanent habits.
• Family members may cope differently with reminders of the event. Some may want to commemorate the anniversary or revisit the scene of the event, while others may want to forget about it.
• Conflict in coping styles can lead to arguments and misunderstandings if the family members aren’t sensitive to each other’s needs.

Helpful strategies

Some things you can do to reduce complications and support family recovery include:

• Recovery takes time. Prepare the family members to go through a period of stress and cut back on unnecessary demands to conserve everyone’s energy.
• Don’t just focus on the problems. Make free time to be together and relax, or else the stress will not subside.
• Keep communicating. Make sure each family member lets the others know what is going on for them and how to help them.
• Ask for help when needed – if someone feels they need to talk more than other members are able to tolerate currently, think about friends, extended family or professionals who might be able to offer a listening ear.
• Plan regular time out and maintain activities you enjoyed before – even if you don’t much feel like it. Enjoyment and relaxation rebuild emotional energy.
• Keep track of your family’s progress in recovery and what has been achieved. Don’t just keep thinking about what is still to be done.
• Stay positive and encouraging, even if at times, everyone needs to talk about their fears and worries. Remind yourself that families get through the hard times and are often stronger.

Looking after yourself

It’s important to look after yourself. If you are not well, either physically or emotionally, then it makes it very difficult for you to care for someone else. If you are struggling it is important to seek help.

Below are a few tips that you may find useful to support your own wellbeing.

• Take time for yourself and do something that you like, even if it is for 30 minutes or an hour a day (e.g. read a book or have a relaxing bath).
• Find someone to talk to. Having a friend or peer to offload to can be really beneficial to your own mental health. You could also join LPFT’s carers WhatsApp group, which consists of LPFT carers who support each other and will understand what you are going through. Email donna.bradford@nhs.net to join.
• Join LPFT’s carers education and support group and learn about your relative’s condition, how services are run, and meet others in similar situations to you. Email donna.bradford@nhs.net to join.
• Email the LPFT carers email address and let us know that you need some support - lpft.carers@nhs.net
• Ask about family therapy available through the Trust.
• Take courses through Lincolnshire Recovery College. There are lots of courses suitable for carers.
• Remember our Mental Health Helpline (0800 001 4331) or the Samaritans are also available if you need support.