Trauma and Post Traumatic Stress Disorder (PTSD) treatment at Nightingale Hospital

During our lives we can all have an experience that is overwhelming, frightening, and beyond our control; a car crash, be the victim of an assault or see an accident. Police, fire brigade, ambulance workers and military personnel often have to deal with horrifying scenes.

Most people, in time, get over experiences like this without needing trauma treatment. In some people though, traumatic experiences set off a reaction that can last for many months or years. This is called Post Traumatic Stress Disorder (PTSD) and requires professional help.

How does Post Traumatic Stress Disorder (PTSD) start?

PTSD can start after any traumatic event. A traumatic event is one where we can see that we are in danger, our life is threatened, or where we see other people dying or being injured.

Some typical traumatic events would be:

  • Serious road accidents
  • Military combat
  • Violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
  • Having being involved in a hostage situation
  • Terrorist attack
  • Being a prisoner-of-war
  • Natural or man-made disasters
  • Being diagnosed with a life-threatening illness
  • Even hearing about an unexpected injury or violent death of a family member or close friend can start PTSD.

When does Post Traumatic Stress Disorder (PTSD) start?

The symptoms of PTSD can start after a delay of weeks or even months. They usually appear within 6 months of a traumatic event.

What does Post Traumatic Stress Disorder (PTSD) feel like?

Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience.

As well as these understandable emotional reactions, there are three main types of symptoms produced by such an experience:

  • Flashbacks and nightmares

You find yourself re-living the event, again and again. This can happen both as a “flashback” in the day and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind but may also feel the emotions and physical sensations of what happened – fear, sweating, smells, sounds, pain.

Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback.

  • Avoidance and numbing

It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crossword or jigsaw puzzles. You avoid places and people that remind you of the trauma and try not to talk about it.

You may deal with the pain of your feelings by trying to feel nothing at all – by becoming emotionally numb. You communicate less with other people, who then find it hard to live or work with you.

  • Being ‘on guard’

You find that you stay alert all the time as if you are looking out for danger. You can’t relax. This is called ‘hypervigilance’. You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable.

Other symptoms of trauma or Post Traumatic Stress Disorder (PTSD)

Emotional reactions to stress are often accompanied by:

How can I tell if I have Post Traumatic Stress Disorder (PTSD)?

Have you experienced a traumatic event of the sort described above?

If you have, do you:

If it is less than 6 weeks since the traumatic event, and these experiences are slowly improving, they may be part of the normal process of adjustment.

If it is more than 6 weeks since the event, and these experiences don’t seem to be getting better, it is worth talking it over with your doctor.

Why is PTSD often not recognised?

  • None of us likes to talk about upsetting events and feelings
  • We may not want to admit to having symptoms, because we don’t want to be thought of as weak or mentally unstable
  • Doctors and other professionals are human. They may feel uncomfortable if we try to talk about gruesome or horrifying events
  • People with PTSD often find it easier to talk about the other problems that go along with it – headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems

Treatment for trauma and Post Traumatic Stress Disorder (PTSD) at Nightingale Hospital

Our trauma and PTSD treatments here in London can be as an outpatient, day patient or inpatient. We have the PTSD expertise to approach the support and treatment we offer in a personal and flexible way to benefit you the most in your recovery.

We have a dedicated Stress & Trauma Service to tackle the marked rise in the number of patients manifesting symptoms of Post Traumatic Stress Disorder (PTSD) and other stress-related conditions. A unique combination of therapies is recommended offering you the chance to tackle your trauma and stress efficiently and permanently.

Our approach to treating PTSD at Nightingale Hospital London combines individualised treatment programmes with treatments based on current clinical evidence.

Psychotherapy

All the effective psychotherapies for PTSD focus on the traumatic experiences that have produced your symptoms rather than your past life. You cannot change or forget what has happened. You can learn to think differently about it, about the world, and about your life.

You need to be able to remember what happened, as fully as possible, without being overwhelmed by fear and distress. These therapies help you to put words to the traumatic experiences that you have had. By remembering the event, going over it and making sense of it, your mind can do its normal job, of storing the memories away and moving on to other things. If you can start to feel safe again and in control of your feelings, you won’t need to avoid the memories as much. Indeed, you can gain more control over your memories so that you only think about them when you want to, rather than having them erupt into your mind spontaneously.

All these treatments should all be given by specialists in the treatment of PTSD. The sessions should be at least weekly, every week, with the same therapist, and should usually continue for 8-12 weeks. Although sessions will usually last around an hour, they may sometimes last up to 90 minutes.

Cognitive Behavioural Therapy (CBT) is a way of helping you to think differently about your memories, so that they become less distressing and more manageable. It will usually also involve some relaxation work to help you tolerate the discomfort of thinking about the traumatic events. For further information, see our factsheet on CBT.

EMDR (Eye Movement Desensitisation & Reprocessing) is a technique which uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience. It may sound odd, but it has been shown to work.

Group therapy involves meeting with a group of other people who have been through the same, or a similar traumatic event. The fact that other people in the group do have some idea of what you have been through can make it much easier to talk about what has happened.

Body-focussed Therapies can help to control the distress of PTSD. They can also reduce hyperarousal, or the feeling of being “on guard” all the time. These therapies include physiotherapy and osteopathy, but also complementary therapies such as massage, acupuncture, reflexology, yoga, meditation and tai chi. They all help you to develop ways of relaxing and managing stress.

Medication

SSRI antidepressant tablets will both reduce the strength of PTSD symptoms and relieve any depression that is also present. They will need to be prescribed by a doctor.

This type of medication should not make you sleepy, although they all have some side-effects in some people. They may also produce unpleasant symptoms if stopped quickly, so the dose should usually be reduced gradually. If they are helpful, you should carry on taking them for around 12 months. Soon after starting an antidepressant, some people may find that they feel more:

These feelings usually pass in a few days, but you should see your doctor regularly. If these don’t work for you, tricyclic or MAOI antidepressant tablets may still be helpful.

Occasionally, if someone is so distressed that they cannot sleep or think clearly, anxiety-reducing medication may be necessary. These tablets should usually not be prescribed for more than 10 days or so.

Effectiveness of treatments

At present, there is evidence that EMDR, cognitive behavioural therapy and antidepressants are all effective. There is not enough information for us to say that one of these treatments is better than another. There is no evidence that other forms of psychotherapy or counselling are helpful to PTSD.

Which treatment first?

The National Institute for Clinical Excellence (NICE) guidelines suggest that trauma-focused psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.

PTSD and trauma specialists at Nightingale Hospital

Nightingale Hospital London has a number of Consultant Psychiatrists and Therapists that can help you through your PTSD. It is vital you find a Trauma specialist that you can trust and work with on your recovery. If you cannot find the information you need on PTSD specialists and PTSD treatment programmes we would welcome your call so you feel secure in the decisions you make moving forward.

Helping yourself with PTSD

Do:

  • Keep life as normal as possible
  • Get back to your usual routine
  • Talk about what happened to someone you trust
  • Try relaxation exercises
  • Go back to work
  • Eat and exercise regularly
  • Go back to where the traumatic event happened
  • Take time to be with family and friends
  • Drive with care – your concentration may be poor
  • Be more careful generally – accidents are more likely at this time
  • Speak to a doctor
  • Expect to get better

Don’t:

  • Beat yourself up about it – PTSD symptoms are not a sign of weakness. They are a normal reaction, of normal people, to terrifying experiences
  • Bottle up your feelings. If you have developed PTSD symptoms, don’t keep it to yourself because treatment is usually very successful
  • Avoid talking about it
  • Expect the memories to go away immediately, they may be with you for quite some time
  • Expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened
  • Stay away from other people
  • Drink lots of alcohol or coffee or smoke more
  • Get overtired
  • Miss meals
  • Take holidays on your own

How do you know when you have ‘gotten over’ a traumatic experience?

  • Think about it without becoming distressed
  • Not feel constantly under threat
  • Not think about it at inappropriate times

Advice for loved ones of someone suffering from trauma or PTSD

Do:

  • Watch out for any changes in behaviour – poor performance at work, lateness, taking sick leave, minor accidents
  • Watch for anger, irritability, depression, lack of interest, lack of concentration
  • Take time to allow a trauma survivor to tell their story
  • Ask general questions
  • Let them talk, don’t interrupt the flow or come back with your own experiences

Don’t:

  • Tell a survivor you know how they feel, especially if you don’t.
  • Tell a survivor they’re “Lucky to be alive.”
  • Minimise their experience by saying things such as, “It’s not that bad, surely…”
  • Suggest that they just need to “pull themselves together”

 

“When you have a problem and you drink, take drugs or gamble, the problem won’t go away. Stay and tackle the problem”
#TherapistTipoftheWeek