Trauma Incidents - psychological advice

Coping with stress following a distressing or frightening event or major incident

Introduction

Following or during a traumatic incident, you could be faced with a number of different reactions. It may be that the incident has had no immediate or obvious effect on you, or you may be severely affected and be left facing a number of strange and new emotions.

The goal of this guide is to support awareness of the impact that working under such conditions can have and offer advice on coping strategies that can be helpful.

Remember that the feelings that you may be experiencing are perfectly normal, it is the nature of the stressful incident that is abnormal.

What are traumatic incidents?

A traumatic incident is any event that can be considered to be outside of an individual's usual experience and causes physical, emotional or psychological harm.

We all respond in different ways to any event. This guide highlights the usual responses of individuals and may offer some help in relieving the anxiety such incidents cause, help in the healing process and give some assistance in identifying further sources of help.

The determining factor around the emotional responses for anyone involved in, or responding to, an incident can centre on challenges to core beliefs about ourselves or other people, or how we see the world.

It is important to remember that other factors in your life may contribute to your vulnerability to any incident, and the impact it has upon you.

In the early stages following such an event, psychological professional help is not usually necessary, in fact it can be unhelpful to act too soon.

A note to managers

For the first few weeks, it may not be helpful to arrange debriefing sessions about the incident. NICE guidance suggests that psychologically focussed debriefing sessions can interfere with the natural process of making sense of an incident, which in some cases leads to an increased risk of distress and ongoing difficulties.

Some processes need to happen after a difficult or traumatic event, including serious incident investigations. Investigation processes can understandably be distressing at times, and care should be taken to support colleagues during this time.

If you are a manager, it will be important to take time to think about how you can support your colleagues and yourself:

• Check in with your colleagues, reassure them that you will support any needs they might have

• Offer supportive one to one time for anyone who would like to talk about the incident - This can be facilitated by you as a manager or by someone else as appropriate

• Seek your own support or supervision if you feel you need it.

Your reactions

Reactions to a traumatic incident are likely to be worse if:

• There has been a death or somebody was severely injured

• There is a feeling of wanting to have done more

• There is little or no perceived support from colleagues, family or friends

• The incident follows closely on top of stress creating events in your life

• There is a marked increase in physical and/or psychological demands

• Decisions had to be made based on vague and uncertain information

• Communication within the team has become compromised

• A team is fragmented and/or poorly coordinated.

Normal reactions may include:

• Sadness (for example - for injuries or losses of any kind)

• Guilt (for example - or not having done more or something differently)

• Anger (for example - at what has happened, at whoever caused it or let it happen; Why me?)

• Shame (for example - for not having reacted how you would have wanted to or expected to react)

• Fear (for example - of something similar happening again)

• Memories (for example - of similar past events)

• Moral injury (moral injury is defined as the psychological distress which results from actions, or the lack of them, which violate your moral or ethical code)

Physical and mental reactions

You may have some physical reactions, with or without the feelings described above.

You may experience tiredness, loss of memory, palpitations (rapid heartbeat), dizziness, shaking, aching muscles, nausea (feeling sick) and diarrhoea, loss of concentration, breathing difficulties or a choking feeling in your throat and chest. Sometimes they may develop long after the event.

Mental reactions may include loss of concentration and/or motivation, poor memory, nightmares, flashbacks (feeling that it is happening all over again), hypervigilance (always on your guard), or being easily startled.

Irritability, loss of sense of humour and impatience with yourself and others are extremely common, and can put relationships with family and friends under strain. Try to remember that they too may be suffering additional stress, may feel left out, or do not understand how best to support you.

You may find yourself withdrawing from those closest to you, unable to express your feelings, rejecting what is offered.

Stop - and try to ask for what you want.

Remember

• Our bodies and minds will look after themselves - reactions are a natural process.

• Concealing feelings can prolong the recovery period.

Sometimes there is a sense that too little or the wrong things are being offered, or that you cannot live up to the expectations other people (or even you yourself) may have of you.

After the incident - Individual strategies

• There are some strategies you can use to make things easier to manage after an incident. Your mind's defence mechanism may not let you feel the full impact of an incident straight away, often you are in shock. Your feelings will slowly unfold as the days go by.

• You may feel numb if your feelings are blocked and the event may seem unreal, almost dreamlike, and you may even wonder if it ever happened at all.

• Keeping yourself occupied with other things may help, your hobby, exercise, additional work, etc. However, when combined with the numbing effect, this can be over used and delay your recovery.

• Talking to friends or colleagues about the incident and how you feel.

• Dreaming about the event possibly repeatedly. This is a normal process of helping you to collate and absorb the information.

• Having the support of others can be invaluable. Try not to say "no", if it is offered. It may come from others who have had a similar experience.

• There are times when you may need to be alone with your thoughts and feelings. Again, this is natural.

Some DOs and DON'Ts of dealing with your feelings

• Don't bottle up your feelings

• Don't avoid talking about what happened

• Don't expect the memories to go away immediately, they may be with you for quite some time

• Don't be too hard on yourself; be kind to yourself and give yourself a bit of ‘slack’ whilst you adjust to what has happened

• Do express your emotions - to someone

• Do accept opportunities to share your experience with others - they may have something to offer

• Do make time to review the experience within yourself, but try to avoid isolating yourself

• Do take the time to be with your family and friends

• Do try and tell your family, close friends, colleagues and managers how you feel

• Do try to keep to your routines as much as possible

• Do be more careful - accidents are more likely to happen at this time

When to look for additional help

• If you feel you are not able to handle intense feelings, or physical reactions continue

• If you feel numb and your feelings are detached

• If you have to keep highly active in order to cope

• If you continue to have nightmares, or are sleeping badly

• If you have no one, or a group with whom to share your feelings, and you feel the need to do so

• If your relationships seem to be suffering badly, or sexual problems develop

• If you are having accidents, or your work performance is suffering

• If you are smoking or drinking to excess since the event

• If you are suffering from depression or exhaustion

• If you cannot control your memories of the event and they are affecting your sense of personal well-being

Lifestyle balance

There are many complimentary ways to restore your lifestyle balance. By adopting these lifestyle changes you will discover a path to regain your balance in the aftermath of being exposed to or witnessing critical/traumatic experiences.

Physical Self Care

• Eat regularly - breakfast, lunch, dinner

• Eat healthily

• Exercise

• Get enough sleep

• Seek help if feeling unwell

Psychological Self Care

• Make time for self-reflection

• Read literature that is unrelated to work

• Do something at which you are not an expert or in charge

• Attempt to decrease stress in your life

• Notice your inner experiences

• Listen to your thoughts, judgements, beliefs, attitudes and feelings

• Practice receiving help from others (help, advice, friendship)

Emotional Self Care

• Spend time with others whose company you enjoy

• Stay in contact with important people in your life

• Find a way to increase your sense of self-esteem

• Re-read favourite books

• Identify comforting activities, objects, people, relationships, places and seek them out

Spiritual Self Care

• Make time for reflection

• Be open to inspiration

• Cherish optimism and hope

Team strategies

• There are some strategies that you and your team can use to make things easier to manage during or after a traumatic incident

• Enhance communication between team members by creating time to talk

• Create a culture of genuine curiosity in regard to each other’s wellbeing through active listening

• Listen to each other’s concerns and validate them

• Provide periodic status updates to all the team and ensure that all information shared is clear and concise

Persistent symptoms

If your difficulties in relation to the major incident persist for several weeks, there are a number of ways you can access additional support, which include:

• Speaking to your line manager/ supervision to share your concerns

• Calling the Employee Assist Programme (EAP), which is available 24/7, on 0800 028 0199

• You can self-refer to Talking Therapies

• You can also access our Initial Response Service on 0800 953 0110 if you live within Lancashire and South Cumbria

• Visiting our Occupational Health Wellbeing website