Post-Traumatic Stress: Modern Day Shell Shock

An anxiety condition caused by 

intensely stressful or traumatic events.

Update: 13.01.21

Who Cares for the Carer? 

A recent study in the Journal of Occupational Health is being widely reported today after it found that out of the 709 NHS Intensive Care staff studied, 45% met the criteria for PTSD and other associated serious mental health conditions (depression, anxiety, problem drinking).

The impact of COVID-19 on mental health is going to roll on long after we have got the virus under control. Practical and emotional pressure are fertile ground for PTSD to establish itself. This is even more of a concern when we acknowledge the study was conducted in June and July 2020, before the current increase of hospitalisations

When we consider that trauma could be summed up are experiences that are unpredictable, uncontrollable and unmanageable we can see how the current situation is likely to lead to mental health problems.

Unpredictable: Even with all guidance, training and modelling of what would happen, no-one could have predicted the reality of the experience.

Uncontrollable: The increasing number of patients requiring hospitalisation makes it even harder to feel that you have any control over the situation.

Unmanageable: Growing number of patients, limited staff (for many reasons) and resources stretched to limit.

When these three elements are bumping up against a person’s desire to help the patients in their care, we can see how the risk of PTSD is increased.

Trauma experienced by staff, patients and their relatives, has to be processed otherwise it finds its own escape through mental health symptoms. Those who are prone to anxiety, depression e.t.c. are likely to also find a flare up in those symptoms.

PTSD symptoms can show themselves immediately or many months after the trauma. The effects are mitigated through support and therapy which allows a person to process their experience appropriately.

Processing, essentially thinking it through, is more than examining what happened, but also how it made the person feel. What was their interpretation? How has their experience affected their emotional response to other situations? Have other personal feelings and experiences become mixed with the current trauma?

It is easier to put to one side the importance of mental health, because we cannot hold up the test results or x-ray that shows the mental labour traumatic events require. However, if the long-term effects of that mental labour are addressed appropriately, the carer can go on to care again.

Read the blogpost below to find out more about PTSD

What are the ingredients that make an event traumatic?

Control: The level of influence we have over an event has an impact on our interpretation of how traumatic the event would be. The interpretation (perception) of control is as important as the actual control we have.

Predictability: Did we know that the event was going to take place? Did we have independent control? The warning of stressful or traumatic events occurring creates a safe period where we can prepare ourselves and reduce the negative impact.

The Problem... 

Most intensely stressful and/or traumatic events are neither easily controlled by an individual or expected, so the potential for them to have a long-lasting negative impact is greater. 

Unsurprisingly PTSD associated with the COVID-19 Pandemic is a real concern.
Global events that require significant changes to our day-to-day lives are difficult to independently control and we were unable to prepare for what has happened.

Very quickly what we could control and predict was altered and this can lead to feelings of intense distress.

Direct Experience as Trauma

Traumas can be a personal experience, for example, a serious car accident, being the victim of a crime or having experienced an abusive relationship or up-bringing.

During the current pandemic, it is possible that people who have been ill with the virus and who have subsequently recovered can still feel the effects of the trauma, even when the outcome is thankfully positive.

It is stressful to be separated from our families and friends for long periods of time. Many face the stress of financial uncertainty and realise the impact this will have on them for a significant time.

Vicarious Experience as Trauma

It is also possible to be affected by witnessing or coming into contact with the circumstances around which an event took place. For example, the distressing news report about a natural disaster or hearing reports of the number of people dying from the COVID-19 virus.

We watch the video online of the distressed family member describing trauma that they are experiencing. Even though we are not directly involved, we feel their distress and we find our emotions are stirred as if it was happening to us. 

Being a front-line worker in healthcare means you are faced with stressful and traumatic events. They have direct experience as part of their job as well as vicariously through the contact they have with patients and their families. They have supported their colleagues and vicariously feel their stress/trauma. 

Symptoms of PTSD

Psychologists suggest that the symptoms can occur very soon after the traumatic event, while in other cases months or years later.  The most common symptoms are:

Avoiding or distracting oneself from any reminder of the event: The individual may actually have a poor recall for the events but reminders of the trauma result in an extreme emotional response.

“I try not to think about it. It just makes me upset.” “I’m fine, don’t worry about me.”

Emotional Numbing: In contrast, there can be a numbing of emotions. An individual may struggle to feel positive about things they previously did. There is a lack of a desire to ‘move forward’; ’stuck’ by the trauma.

“I don’t feel anything about it. I deal with it on auto-pilot.”

Insomnia and difficulty concentrating: Hyper-vigilance. On the lookout for danger when there is no obvious threat. This is in contrast to how they behaved before the event.

“I can’t seem to switch off. I feel on edge like I’m waiting for something to happen.”

Learned Helplessness: The traumatic event appears too ‘confirm’ that they are helpless in being able to control events. They feel apathetic which is reflected in a low mood. They may also experience feelings of guilt and shame around the incident, no matter that logic does not justify such interpretations.

“I feel like I should have done more to stop what happened, even though I know I couldn’t.”

Anxiety Flare-Ups

Any pre-existing anxieties will be exacerbated by the traumatic event. The person who usually suffers from panic-attacks is quite likely to find an increase in their symptoms. The person who has a nerve-rash is going to find that they have a flare-up of their condition.

The methods they had used to deal with stress in the past, for example, exercise, smoking and drinking, are likely to increase with greater intensity than ever before. They will struggle with the compulsion to indulge in these behaviours to the point where they are self-destructive. Unfortunately, those intensified methods of stress-management are not as effective this time. The stress/trauma is too great.

How does our mind deal with trauma?

We have to make sense of what has happened and the emotions it created. Our mind has to processes it. We already made the point that the impact of the trauma was influenced by our interpretation of the event, so we have to think it through and understand it in a factual way rather than through the filter of how we usually see the world.

In an ideal world, we would think it through, talk about it, discuss our personal view of the event, but so often we avoid doing that because we are worried it will make us or others upset. We push it out of our thoughts and carry on as best we can.

‘Keep Calm and Carry On’?  

Perhaps it should be ‘Keep Processing and You Can Carry On”

… not as catchy though!

What happens if you avoid thinking about it?

It’s going to creep into your thoughts with increasing regularity. You’ll be driving home and suddenly find the image of that terrible event pop into your thoughts. You are also likely to feel panic or become anxious and tearful at the memory of that event.

Your mind is not going to wait for a convenient time to interrupt your thoughts with the memory of that trauma, it is going to demand you think about it now!

The traumatic events crop up in our dreams so our sleep is disturbed and we are woken with a panic.

Even the smallest indirect reference to the unprocessed trauma can trigger a stress response. 

The person who was mugged while waiting for the bus under the street lamp suddenly finds they feel a surge of panic when that bus passes, and the thought of being outside after dark becomes more distressing. 

Each reminder of the event (both what happened and the emotions created at the time) are our mind’s way of trying to process what happened. The flashbacks are our mind’s way of forcing us to think about it. Thinking through the event and the emotions created, mean that we can understand it in a way we were not able to at the time.

Processing Trauma and Talking Therapy

Broadly speaking, talking therapy helps the person process the event. They are able to discuss, think through and feel the bottled emotions in a safe environment. The purpose of talking therapy is to understand events and the interpretations we made at the time.

Sometimes people will say: “I know that is was upsetting. What’s the point of talking about it?” The point is unless they have processed the interpretations they made of events at the time, they haven’t fully processed it and the symptoms are likely to continue.

We also have to understand how those interpretations, where once useful, may now be doing more harm than good.

Don’t we do that with friends and relatives anyway? Yes, and this is the way we deal with minor upsets. But when an event is intensely distressing, talking to our friends and family means they become mixed up in it. This is a problem…There is no escaping those thoughts when the discussion is over, those people are still there.

The time spent with your therapist is a place where those conversations can be parked and revisited in a controlled and useful manner.

Hypnoanalysis combines both Psychotherapy and Hypnotherapy. 

Psychoanalysis using Hypnosis, by its very nature, encourages a person to process events from their life. It asks that they talk about them without censorship and does not shy away from the emotions created by traumatic events. The use of hypnosis means that not only is it easier to remember events, but also the unhelpful interpretations made at the time and the emotions they created.

The cathartic effect of re-thinking through past trauma results in the intensity of the emotion being reduced and the events re-interpreted with the benefit of hindsight.

We may not be able to change the events that happened, but we can change how we feel about it now and the impact it continues to have.

A study published recently published in the journal Biological Psychiatry 

has identified a particular social psychological factor which may mitigate the genetic risks for PTSD: a person's attachment style. 

Attachment Style?

Our attachment style is established in our early years and is shaped by the quality of the relationship we had with our caregivers. Attachment theory suggests that we learn what love, care and affection is and how to show it from the early experiences we had with those that cared for us.  The more stable and lacking in disruption those early experiences were, the more likely a person is going to show signs of what is a termed a secure attachment style. 

Those with a secure attachment tend to have more stable relationships in later life (a mirror of their early caregiver relationships).  They tend to have a positive self-perception, believing that they are worthy of trust and love. They also have learned the skills to elicit help from others. 

If someone had a more unstable upbringing they are more likely to exhibit characteristics of the insecure attachment style.  This attachment style is associated with anxiety or avoidance with intimacy, as well as finding it difficult to seek help from others. 

Back to the research...

The study found that the ability to form loving and trusting relationships with others, which is characterised by a secure attachment, were less at risk of developing PTSD symptoms when faced with trauma.  If someone was characterised as having a secure attachment style, the collective effects of the established genetic risk were neutralised. 

Even more interesting... the above was true in one particular gene variant associated with synaptic plasticity (the creation and severing of neural connections) in areas of the brain that have been associated with change as a result of PTSD.  

What does this tell us...?

It suggests that there is a stronger role for nurture in the potential risk of PTSD than previously assumed. Perhaps, the combined effect of both biological and socio-psychological factors need to be considered when thinking about the measured risk an individual has for developing PTSD.

It also suggests a greater value in focusing on interpersonal relationships in psychological treatments as a way of mitigating the effects of biological predisposition to PTSD.

Is that why those with PTSD who go through a course of Hypnoanalysis tend to work through the emotion associated not only with the triggering trauma but also find themselves resolving the unhelpful aspects of their early caregiving? 

Find out more about how Hypnoanlaysis can help with anxiety here...