Trauma and Post Traumatic Stress Disorder
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 PTSD and needs professional help.
Our treatment approach for trauma and PTSD
Our approach to treating PTSD at Nightingale Hospital London combines individualised treatment programmes with treatments based on current clinical evidence. Cognitive Behavioural Therapy is a way of helping you think differently about your traumatic memories, EMDR (Eye Movement Desensitisation and Reprocessing) can help process flashbacks and make sense of the traumatic experience and Group Therapy allows the sharing of experiences. EMDR and Gestalt therapies encourage an emphasis on personal responsibility and Biofeedback is the latest tool whereby patients are connected to ECGs which illustrate the connection between the physiological and the psychological helping you to manage the symptoms of stress and PTSD as you process memories.
PTSD Treatment tailored to you at Nightingale Hospital London
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.
PTSD and trauma specialists
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.
How does 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)
- Being taken hostage
- 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 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 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:
1. Flashbacks & 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.
2. Avoidance & 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.
3. 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.
Emotional reactions to stress are often accompanied by:
- Muscle aches and pains
- Irregular heartbeats
- Feelings of panic and fear
- Drinking too much alcohol
- Using drugs (including painkillers)
How can I tell if I have PTSD?
Have you experienced a traumatic event of the sort described at the start of this leaflet? If you have, do you:
- Have vivid memories, flashbacks or nightmares?
- Avoid things that remind you of the event?
- Feel emotionally numb at times?
- Feel irritable and constantly on edge but can’t see why?
- Eat more than usual, or use more drink or drugs than usual?
- Feel out of control of your mood?
- Find it more difficult to get on with other people?
- Have to keep very busy to cope?
- Feel depressed or exhausted?
If it is less that 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 like 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.
How do I know when I’ve got over a traumatic experience?
- Think about it without becoming distressed
- Not feel constantly under threat
- Not think about it at inappropriate times.
Children and PTSD
PTSD can develop at any age. Younger children may have upsetting dreams of the actual trauma, which then change into nightmares of monsters. They often re-live the trauma in their play. For example, a child involved in a serious road traffic accident might re-enact the crash with toy cars, over and over again.
- They may lose interest in things they used to enjoy
- They may find it hard to believe that they will live long enough to grow up
- They often complain of stomach aches and headaches
Therapies and medication for PTSD
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.
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-focussed psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.
Helping yourself with PTSD
- 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
- 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
What can interfere with getting better?
You may find that other people will:
- Not let you talk about it
- Avoid you
- Be angry with you
- Think of you as weak
- Blame you
These are all ways in which other people protect themselves from thinking about gruesome or horrifying events. It won’t help you because it doesn’t give you the chance to talk over what has happened to you.
You may not be able to talk easily about it. A traumatic event can put you into a trance-like state which makes the situation seem unreal or bewildering. It is harder to deal with if you can’t remember what happened, can’t put it into words, or can’t make sense of it.
Helping relative with PTSD
- 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
- Tell a survivor you know how they feel – you don’t
- Tell a survivor they’re lucky to be alive – they’ll get angry
- Minimise their experience – “it’s not that bad, surely…”
- Suggest that they just need to ‘pull themselves together’
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