Trauma

Potentially traumatic events are powerful and upsetting incidents that intrude into daily life. They are usually experiences which are life threatening or pose a significant threat to a person’s physical or psychological wellbeing.

Situations and events that can lead to psychological trauma include:

• acts of violence such as an armed robbery, war, or terrorism
• natural disasters such as bushfires, earthquakes, or floods
• interpersonal trauma such as rape, domestic violence, or child abuse
• traumatic loss of a loved one, including the suicide of a family member or friend
• experience of a life-threatening illness or injury
• involvement in a serious motor vehicle or workplace accident
• finding out that a close family member or close friend was involved in a traumatic event 

An event may have little impact on one person but cause severe distress in another. Other stressful situations which appear less severe may still trigger traumatic reactions in some people. It is important to focus on how a person experiences an event and the impact it has on them.

Many people have strong emotional or physical reactions following experience of a traumatic event. For most, these reactions subside over a few days or weeks.

For others, the symptoms may last longer and be more severe. This may be due to several factors such as the nature of the traumatic event, the level of available support, previous and current life stress, personality, and coping resources.

 Symptoms of trauma can be described as physical, cognitive (thinking), behavioural (things we do) and emotional (how we feel).

• Physical symptoms can include excessive alertness (always on the look-out for signs of danger), being easily startled, fatigue/exhaustion, disturbed sleep and general aches and pains.
• Cognitive (thinking) symptoms can include intrusive thoughts and memories of the event, visual images of the event, nightmares, poor concentration and memory, disorientation and confusion.
• Behavioural symptoms can include avoidance of places or activities that are reminders of the event, social withdrawal and isolation and loss of interest in normal activities.
• Emotional symptoms can include fear, numbness and detachment, depression, guilt, anger and irritability, anxiety and panic.

As long as they are not too severe or don't last for too long, the symptoms described above are normal reactions to trauma. Although these symptoms can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective.

With understanding and support from family, friends, and colleagues the stress symptoms usually resolve more rapidly. A minority of people will develop more serious conditions such as depression, posttraumatic stress disorder, anxiety disorders, or alcohol and drug problems.

Most people who experience a traumatic event will not require treatment. For others, treatment from a mental health professional will be required to help them process the experience safely.

Seek psychological assistance if the symptoms of the trauma are too distressing, or if they are impairing everyday activities such as work, study, family, and relationships.

Signs that psychological treatment may be helpful include:

• being unable to handle the intense feelings or physical sensations
• feeling numb and empty
• experiencing strong distressing emotions that persist
• being physically tense, agitated or feeling on edge
• disturbed sleep or nightmares
• lacking support from someone with whom you can share your emotions
• having relationship problems with friends, family, and colleagues
• increasing your use of alcohol or drugs.

Treatments include trauma-focused psychological interventions such as cognitive behavioural therapy (CBT), exposure therapy, and eye movement desensitisation and reprocessing (EMDR). These focus on education, stress management techniques, and helping the person to confront feared situations and distressing memories.

In some cases, medication such as antidepressants can be useful, alongside trauma-focused psychological approaches.

If the distress associated with a traumatic event has been affecting an individual’s work, school, or home life for more than two weeks, psychological assistance should be considered. Psychologists are highly trained and qualified professionals, skilled in diagnosing and treating a range of mental health concerns, including post-traumatic stress. A psychologist can help you to identify and manage the factors that contribute to your distress.

Psychologists usually see clients individually, but, where appropriate, can also include family members to support treatment and provide advice for others affected by the individual’s experience of trauma. Psychologists sometimes offer group-based treatment interventions involving a small number of people with similar difficulties.

There are a few ways you can access a psychologist. You can:

• Use the Australia-wide Find a Psychologist service or call 1800 333 497
• Ask your GP or another health professional to refer you.

If you are referred to a psychologist by your GP, you might be able to get a Medicare rebate. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details.

There are a number of ways you can help look after yourself after a traumatic event or situation:

Emotional coping:

• Recognise that you have been through a distressing experience and give yourself permission to be impacted by it, without judging yourself for feeling upset.
• Remind yourself that you are having a normal reaction to an abnormal situation.
• Avoid using alcohol or other drugs to cope with your experiences.
• Share your experiences with trusted others when opportunities arise. This may feel uncomfortable at times but talking to people you feel safe with rather than bottling up your feelings can be helpful.
• Avoid making any major decisions or life changes.

Social support:

• Let your friends and family know your needs. Help them to help you by letting them know when you are tired, need time out, or need a chance to talk or just be with someone.
• If the traumatic event has impacted the community (e.g. natural disaster), find ways to connect to and support the wider community to create positive healing experiences for yourself and those around you.
• Find others who have been through similar experiences, such as through a local support group.
• Seek out professional support if needed, including from a psychologist.

Re-establishing safety:

• Try to maintain a normal routine. Keep busy and structure your day. Remember that regular exercise is important but do allow yourself time to rest if you are tired.
• Maintain a regular sleep schedule and be mindful of avoiding caffeine or alcohol, especially later in the day.
• Keep regular meals and maintain a healthy and balanced diet where possible.
• Make time to practise relaxation. Use a formal technique such as progressive muscle relaxation, or just make time to absorb yourself in a relaxing activity such as gardening, cooking, art making, or listening to music. This will help your body and mind to re-establish a sense of safety.
• Use grounding techniques such as guided breathing exercises, or the five-senses grounding technique (name five things you can see, four things you can hear, three things you can touch, two things you can smell, and one thing you can taste).

1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
2. Australian Centre for Posttraumatic Mental Health. (2020). Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. Melbourne, Victoria: ACPMH.
3. Barbano, A. C., van der Mei, W. F., Bryant, R. A., Delahanty, D. L., deRoon-Cassini, T. A., Matsuoka, Y. J., Olff, M., Qi, W., Ratanatharathorn, A., Schnyder, U., Seedat, S., Kessler, R.C., Koenen, K.C., & Shalev, A. Y. (2019). Clinical implications of the proposed ICD-11 PTSD diagnostic criteria. Psychological Medicine, 49(3), 483-490. doi: 10.1017/S0033291718001101
4. Goenjian, A., Steinberg, A., & Pynoos, R. (2022). Long-Term Course of PTSD and Depression Among Adults, Mediating and Moderating Factors in Recovery, and Current Trends for Treatment. In A. Goenjian, A. Steinberg, & R. Pynoos (Eds.), Lessons Learned in Disaster Mental Health: The Earthquake in Armenia and Beyond (pp. 111-136). Cambridge: Cambridge University Press. doi:10.1017/9781108877992.008
5. Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, B.P.R., de Jong, J.T.V.M., Layne, C.M., Maguen, S., Neria, Y., Norwood, A.E., Pynoos, R.S., Reissman, D., Ruzek, J.I., Shalev, A.Y., Solomon, Z., Steinberg, A.M., & Ursano, R. J. (2007). Five essential elements of immediate and mid–term mass trauma intervention: Empirical evidence. Psychiatry, 70(4), 283-315. doi: 10.1521/psyc.2007.70.4.283
6. Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., Hyland, P., Maercker, A., Ben-Ezra, M., Coventry, P., Mason-Roberts, S., Bradley, A., & Hutton, P. (2019). Psychological interventions for ICD-11 complex PTSD symptoms: Systematic review and meta-analysis. Psychological Medicine, 49(11), 1761-1775. doi:10.1017/S0033291719000436
7. Lee, J. S. (2019). Perceived social support functions as a resilience in buffering the impact of trauma exposure on PTSD symptoms via intrusive rumination and entrapment in firefighters. PLoS One, 14(8), e0220454. https://doi.org/10.1371/journal.pone.0220454
8. Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. https://doi.org/10.1080/20008198.2020.1729633
9. Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., Bhutani, G., Grey, N., Leach, J., Greenberg, N., Katona, C., El-Leithy, S., & Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: A network meta-analysis. Psychological Medicine, 50(4), 542-555. doi:10.1017/S0033291720000070
10. McGreevy, S., & Boland, P. (2020). Sensory-based interventions with adult and adolescent trauma survivors: An integrative review of the occupational therapy literature. Irish Journal of Occupational Therapy, 48(1), 31-54. doi: 10.1108/IJOT-10-2019-0014
11. Peterson, A. L., Foa, E. B., & Riggs, D. S. (2019). Prolonged exposure therapy. In B. A. Moore & W. E. Penk (Eds.), Treating PTSD in military personnel: A clinical handbook (pp. 46–62). The Guilford Press.
12. Raghavan, S., & Sandanapitchai, P. (2020). The relationship between cultural variables and resilience to psychological trauma: A systematic review of the literature. Traumatology. Advance online publication. https://doi.org/10.1037/trm0000239
13. Tortella-Feliu, M., Fullana, M. A., Pérez-Vigil, A., Torres, X., Chamorro, J., Littarelli, S. A., Solanes, A., Ramella-Cravaro, V., Vilar, A., Gonzalez-Parra, J. A., Andero, R., Reichenberg, A., Mataix-Cols, D., Vieta, E., Fusar-Poli, P., Ioannidis, J., Stein, M. B., Radua, J., & de la Cruz, L. F. (2019). Risk factors for posttraumatic stress disorder: An umbrella review of systematic reviews and meta-analyses. Neuroscience & Biobehavioral Reviews, 107, 154-165. https://doi.org/10.1016/j.neubiorev.2019.09.013
14. World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/