Post Traumatic Stress Disorder symptoms?
Debriefing or trauma counselling - really needed?

Post-incident: PTSD or post-trauma stress?

I have listed the 'post traumatic stress disorder' symptoms you may be experiencing if you have been involved in, or witnessed, a traumatic event.

If you are suffering from these symptoms - please don't jump to the conclusion that you have PTSD.  Read the rest of the page, so that I can help you to understand what may be going on for you and whether trauma counselling can help.

Perhaps I can reassure you and you may not even need to find out about PTSD treatment.

I have written all of my pages with terms that are more likely to relate to 'the general public' (... horrible term, but I hope you know what I mean).  These terms may not always be those a professional would use.

Common symptoms

• images of the traumatic event coming to mind against your will
• recurrent nightmares
• flashbacks - suddenly feeling as if you were in the middle of the event again
• intense distress when confronted with reminders of the trauma
• stress, anxiety, panic
• avoiding anything associated with the event - can't watch that programme, go down that road, read a newspaper, watch a news bulletin - in case ...
• inability to recall a significant parts of the trauma
• feeling detached from others - feeling you are trapped in a 'bubble' and cannot ‘connect' with people
• feeling numb (see above)
• little interest in the things you used to enjoy 

These symptoms, however distressing, are normal immediately after a traumatic event.  No trauma counselling needed.  I would only be concerned for you if you had an acute stress reaction: a continued totally panicky feeling with a high level of distress, feeling your heart thumping and your breathing shallow and fast.  In that case some early professional help, which you might call trauma counselling, would be a good idea.

What exactly is PTSD?

The diagnosis of Post Traumatic Stress Disorder needs to be made by a mental health professional.

PTSD is diagnosed by way of an assessment with the use of a recognised questionnaire, such as the Impact of Events Scale or the Post-trauma Check List, and a face-to-face consultation.  The results are measured against the specific criteria set out in the Diagnostic and Statistical Manual.

However, as a practitioner, it matters much more to me how distressed you are.  How the PTSD symptoms are affecting you personally is more important than whether or not you fit the precise ‘label’ of PTSD.  However, I do appreciate that in some quarters that diagnosis can be really important as it may enable you to access appropriate services services much more quickly and your insurance/health service may cover the cost of treatment.

ARTICLE for war veterans The charity PTSD Resolution offers free help, read more on my page: Military Post Traumatic Stress

How quickly will you recover after an incident?

'Post traumatic stress' symptoms mostly subside post-incident within a matter of days.  More severe symptoms take a bit longer to subside, which mostly they do very gradually. Most likely you will feel much better and possibly have recovered completely after about 4 - 6 weeks.

You will need is the reassurance of supportive people and familiar (safe) surroundings.  Only if your symptoms remain troublesome - they don't appear to subside, or there are residual symptoms of various degrees after a couple of month, would I advice you to seek help.  In that case go to your doctor and/or ask for help from a trauma counsellor.  If you continue to suffer from severe/accute anxiety symptoms in particular, then I would suggest you get some help sooner.

'Emotional’ trauma?

You could feel traumatised by an emotional blow, through what you have heard, witnessed or been through!  The same counts: you are likely to settle within 4-6 weeks if not long before.  (Trauma) counselling can be really helpful if you are really struggling.  De definition of what 'trauma' is can be a very personal one.

When to seek help for post-traumatic symptoms

About 4 - 6 weeks following the traumatic event, trauma counselling may be helpful if several of the following apply to you*).

• You were already stressed before, perhaps there were already difficulties at home or at work

• You have been traumatised before - in your personal or working life

• You felt your life was in danger - that could be because of your job, an attack, a medical emergency or an accident

• You wish you had done more - for instance, in a situation where lots of other people were involved, you may feel that your could have saved someone

• You wish you had acted differently - for instance, you may have thoughts like: if only you had not done this or that, you would not have been there, or someone else would not have been there

• You feel ashamed about something.

• You continue to feel very angry, maybe feel that someone is to blame for the event and you cannot get rid of that thought

• You do all you can to avoid being confronted with (aspects of) the event - you avoid thinking, talking about it, people connected with it, programmes about it.

• You have little accessible support - maybe you have friends and family, but you don't perceive them as very supportive, or maybe you have few people you know, like and/or trust.

• You cannot get on with your life, you feel stuck - even if the event happened ages ago, other people think you should have got over it by now, but to you it seems it happened only yesterday.

• You cannot cope with ‘normal’ day-to-day activities - they seem so mundane in comparison with what you have been through, or you just cannot concentrate on the job in hand, or cannot be bothered, or just seem completely 'incapable' for some reason.

• You are drinking more alcohol than you would normally.  Perhaps it is helping you to get to sleep, or maybe it helps to dampen the impact of the images or at least slow down your constantly whirring thoughts.

• You smoke more - perhaps that is how you have always dealt with stress and now you need that more than ever. You are taking (illegal) drugs/medicine to cope with all the above.

• You are suffer from acute stress symptoms - you may experience panic attacks and nightmares.

*) Adapted from the Trauma Risk Management (TRiM) programme initially developed by British army mental health professionals Major Norman Jones and Capt. Peter Roberts OBE (Retired), introduced into the Royal Navy and Royal Marines by Prof Neil Greenberg and Cameron March MBE Royal Marines (Retired).  Click here for an article I wrote for the British Association for Counselling and Psychotherapy (BACP) Journal.

Capt. Peter Roberts is still treating traumatised soldiers every day.  Both Major Norman Jones and Prof Neil Greenberg are at the forefront of research into trauma and TRiM at the King's Centre for Military Health Research.

During my years with a large UK Police Service I was the Lead TRiM Co-ordinator.  See testimonials for link to Chief Constable's Certificate of Merit and testimonial from Police Federation of England and Wales.

Trauma Risk Management - TRiM

The National Institute for Clinical Excellence (NICE) states that brief single-session interventions should not be routinely offered.

However, people do value some kind of an intervention after a work-related traumatic incident and TRiM fits in well with the NICE guidelines.

Untill the end of Aug 2012 I was the Lead for TRiM in a large UK police service, where together with a great team police officers and support staff, we introduced TRiM at all levels, liaising with, training, supporting and advising staff and officers of all ranks.

This unique cooperation has strengthened the link between the force's Health Services, police officers and support staff, which we expect will ultimately result in increased referrals at the right time, rather than years after a traumatic incident.

TRiM Practitioners

TRiM Practitioners are specially selected police officers and police support staff, who have volunteered for the role.  They are at the forefront of helping to ensure that individuals on their team or in their policing area remain well after a potentially traumatic work-related incident.

TRiM Practitioners can refer people at the right moment, when they appear to continue to be affected by an incident.  The Welfare and Counselling Department ensures that these individuals are treated in the shortest possible time.

Debriefing?

‘Debriefing’, using the Mitchell model has been shown at best to be ineffective and at worst harmful for psychological trauma.  This is in part because someone could potentially be re-traumatised by made to re-experience the sights, sounds and feelings of the original incident.  This type of intervention interferes with the natural healing process.

In addition, Critical Incident Stress Debriefing offered only a single intervention.  There was no way of knowing how people were really doing after a potentially traumatic event.  Whereas a TRiM assessment offers a baseline against which the outcome of further individual assessments can be compared.

Symptoms of PTSD or full-blown PTSD, but not recovering?

I is far more likely that you don't suffer from full-blown PTSD.  According to research conducted by the Centre of Military Health Research only 5.4% of British soldiers returning from Afghanistan suffer from PTSD.  However, many are left with post-traumatic stress symptoms, which can be severe, but don't fall under the exact criteria for PTSD.

The percentage number of course will mean little to you if you are personally suffering from those potentially horrendous symptoms.  However, for people that have recently been exposed to a potentially traumatic event it may be a sign, that even after such horrendous exposure, recovery as indicated above is very likely.

If after time has passed and you continue to suffer from those hugely distressing post-trauma symptoms, you will want to know about how to cope and what treatment is available.  PTSD symptoms can be treated - there is every chance that you will recover. 

Post traumatic growth

I have often witnessed how people have come through really traumatic circumstances/events and the dreadful emotional and mental fall-out from that - absolutely shining!  They have changed their perspective of the world, and not only adapted to that, but found meaning in it.  When you have been through something life-changing, which trauma almost invariably is, it can be seen - in time - as an opportunity to really reassess what is and what is not important to you.

We can let the circumstances of our lives harden us so that we become increasingly resentful and afraid, or we can let them soften us, and make us kinder.  We always have the choice." Dalai Lama

You may also be interested in:
PTSD treatment Hypnotherapy - does it work? Human Givens Therapy Depression questionnaire List of human emotions Birth trauma Brain injury symptoms and your relationship

---

---

Other helpful links:

Psychology Today - Post-traumatic growth

---

News:

21 Sept 2012 - PsychCentral: Can you simply 'erase' fear from the brain?
10 Sept 2012 - ScienceDaily: Suicide prevention expert outlines new steps to tackle military suicide
30 July 2011 - The Independent: Therapy can drive you mad - study on 9/11 counselling
BBC News - Norway: Oslo bombing and island (Utoeya) youth camp shootings

Images courtesy of: 1, 2 Billy Alexander; 3 Simon Cataudo; 4 Glenda Otero; 5 Asif Akbar; 6 Piotr Bizior; 7 Konrad Baranski; 8 Anton Malan

---