CFYP Advice and Signposting: post traumatic stress symptoms

Understanding Post-traumatic Stress Symptoms

Post traumatic stress symptoms are present for some people who have experienced a trauma. A traumatic event can be a big event or a series of smaller events that made you feel physically or emotionally in danger. At the time of the event (s), your brain stepped in to protect youby switching off your thinking part of thebrain and switching on your emotional/survival part of the brain. This response goes back to the times of cavemen. If a caveman was faced with a sabre-toothed tiger and they stopped to think about what type of tiger it was, or whether it was friendly or not, what do you think would have happened? That's right, they would've been eaten! Instead, the caveman needed the emotional part of thebrain switched on to survive. This triggered their bodies to release a hormone called adrenaline which made their bodies get ready for either fighting the tiger, running away from it or freezing; known as the 'fight-flight-freeze' response. These days, people don't need to worry about sabre-toothed tigers, but the warning system is still there to protect us.It would have been activated during your traumatic event(s), because you needed it to stay safe.

At the time of your traumatic event, because the emotional part of the brain was switched on (and the thinking part switched off) it processed the event as an emotional memory. This means that there is no time stamp to say when the event happened and only parts of the event are included in the memory. So, when the traumatic memory is triggered, it is often distressing because it feels like the event is happening now. This can be experienced through memories, flashbacks or nightmares. We call these 'intrusions'and they are experienced through some or all of our five senses: sight, touch, taste, smell and hearing.

Even though you are now safe, it can still feel extremely distressing to feel like you are experiencing the traumatic event again. You may feel fear, anxiety and anger as well as the physical sensations of the adrenaline response. Rs these are unpleasant, you may try hard to avoid these feelings; usually through avoiding any reminder of the traumatic event.

Avoidance often helps to relieve the uncomfortable Feelings in the short-term, but in the long-term it often makes them stronger. That's because when you avoid your thoughts about the traumatic  event,  the brain does not  get  a chance to work out that it's a memory  of  a past event. So instead, the  experience remains a current problem.

NOTICING Intrusions...

Because trauma memories are not time-stamped For the p ast, they tend to pop up in our minds against our control because the brain hasn't been able to organise them. Intrusions may appear in the Form of thoughts, images or memories.

(Brewin, 2001)

To help manage your post-traumatic stress symptoms, you will First need to explore them. This might Feel scary at first, but you need to know what you're avoiding and why, before you can work out how to overcome it.

Post-traumatic stress Vicious Cycle

Start by using the 'Intrusion Diary' worksheet to log your intrusions, Feelings and safety behaviours (what you do to Feel more safe when you Feel anxious) over the next week. The 'FERR'  acronym may help you think about which types of responses (behaviours) you choose:

Find 'help'... get someone to rescue you...

Escape the situation...by Foot or by distraction

Avoid... going to the situation or things associated with it

Reassurance... check everything's OK by asking or repeating

You can use the 'Feelings' worksheet to help pick the emotions that best describe how you Feel. You can also complete the 'How Do My Big Emotions Affect My Body' worksheet to help you notice the physical symptoms that you experience. The worksheet 'How intrusions and big emotions can affect the body' will give you ideas of many possible physical Feelings people get in threat mode and the reasons why. Then, at the end of the week, use the information you have logged to help you complete the 'Post-traumatic Stress Vicious Cycle' worksheet. This should help you see how your thoughts, Feelings and behaviours are linked, and how avoidance is maintaining the distressing Feelings.

 

Intrusions Diary worksheet

Keep track of your intrusions, feelings and behaviours over the next week.

At the end of the week, look for any themes to your intrusions or patterns to your behaviours.

Day & Time ...........................

What was going on just before the intrusion? ...........................

Intrusion Describe the intrusion. which senses did the intrusion engage? (sight, sound,

smell, touch, taste)  ...........................

'Nowness' Out of 7 00%, how much did it feel like it was happening now? (0 % - not now, 10 0 % - now) ...........................

Feelings/ Emotions  What  emotions/feelings and physical body sensations did you experience? ...........................

Distress 0-100% ...........................

What did you do to feel safer? ...........................

 

Feelings Wheel

Search the feelings wheel for the words that best describe how you feel.

Use this to help you complete your Worry Diary.

Find the feelings wheel here

(Developed by Gloria Wilcox, 1982)

 

How intrusions and big emotions can affect the body

Here are many of the ways that ourbodies can be affected when our emotional part of thebrain has taken over. They all have a role to play in keeping ourselves safe.

This is our body's way of protecting us. Are you surprised by some of these?

Feeling dizzy or lightheaded. This is from not using up the extra oxygen we have produced for fight or flight.

Change to vision. Tunnel vision or vision becoming sharper to focus on the threat.

Dry mouth. This is because the digestive system has shut down.

Breathe fast and shallow. Helps us take in more oxygen and make our body more able to fight or runaway.

Sweaty palms. The body sweats to keep cool and this makes the body become more efficient to carry out an action.

Coldhands and feet. The blood rushes away from these in order to supply the large muscle groups (in arms and legs) that will be usedin fight or flight.

Thoughts racing. Helps us to assess threat quickly and make rapid decisions.

Bladder urgency Muscles in the bladder relax so we might feel the urge to pass urine.

Muscles tense. Ready to fight or runaway they may also shake or tremble.

 

How do my big emotions affect my body?

Everyone experiences emotions in their bodies in slightly different ways. Label or draw on the person below how anxiety affects YOUR body ...

Post-traumatic stress Vicious Cycle Worksheet

Fill in the boxes using the information gathered in your Worry Diary

Thoughts Images Memories --->

Managing your intrusions can feel like a huge mountain to climb. But with the right knowledge (which you now have), and the right skills (which you're about to learn), you can gradually make your way to the top. We can't choose how we feel and how distressing these feelings are. We can't choose when our intrusions pop up. But we can choose more effective ways of managing them.

Skills to use when distress and 'nowness' are high

Sometimes, your intrusions can be very powerful and very distressing. They take you to the past when the traumatic event happened and make you believe it is happening now. When this happens it is important to keep a check on the emotional part of your brain and get back into the present moment. Then you can get your thinking part of the brain back online again. You can do this using grounding techniques.

When the emotional part of thebrain is switched on, we feel this in our bodies, and it can feel like we are experiencing the trauma all over again. So, to re-balance it, we need to do something behavioural using our five senses (touch, taste, sight, hearing and smell). Once a behavioural grounding technique has been used, we now need to get the thinking part of the brain back online. We can do this using verbal grounding techniques. The idea is that thetasks are straightforward but also mentally challenging. Have a look at the worksheet 'Examples of grounding techniques'. In section R there are examples of behavioural grounding techniques. In section B there are examples of verbal grounding techniques.

Select a  few from each section that youwould like to  try  and  write them in the worksheet 'My Grounding Techniques'. You may want to put this on the wall or somewhere you can easily see it. This will remind you, and those around you, what to do when your intrusions have become really distressing.

Examples of grounding techniques worksheet

Remember: We do a behavioural technique first (see section A) and a verbal technique second (see section B).

Section A

Behavioural TechniquesRemember, these involve our Five senses

GROUNDING OBJECTS

Find an object that hasnonegative reminders of the past. This can be a stone, a keyring, a cuddly toy. It can be anything as long as it has smooth edges. It is better if it can be carried around with you. You can then use it to touch, squeeze, focus on, describe.

SMELLS

Smells are a powerful way of coming to our senses. If you are really paying attention to a smell, you are truly in the present moment. Again, make sure it has no negative connection to the past. You could use: essential oils, dried flowers, perfume-soaked cotton wool, cooking spices.

TASTES

Try tastes that have a strong flavour such as a strong mint or very sour sweets. When we are in threat mode (i.e. when the emotional brain has taken over), our mouth tends to go dry. By drinking wa ter, we can reassure the brain that there is no threat.

MOVEMENT

Doing something physical can help people reconnect with the present. It slowly closes down the emotional system and calms the physical reactions of the adrenaline response. You can: play catch, do lunges, do squats, throw a ball against the wall, do hand tension and release, or star jumps.

GROUNDING STATEMENTS

Intrusions can take us back to the past. Try writing a statement that reminds you that you're in the present. Examples: "I am safe. It is [date, time]. My trauma happened a long time ago and I survived"; "My trauma happened in the past. I am only remembering it now. It is not  happening now. My memory cannot hurt me"; "It is [date, time]. My name is [your name], I am in [location], I am now XX years old and I am okay."

Section B

 

My Grounding Techniques worksheet

List some grounding techniques that arehelpful for you.

Some work better than others for different people, so you might want to test them out to see if they are helpful for you.

My behavioural grounding techniques:

1.

2.

3.

4.

5.

 

My verbal grounding techniques: 

1.

2.

3.

4.

5.

Keeping in the Present Moment

Our minds have a tendency to drift into the past, or Fast-Forward into the Future. The more we can redirect our minds back to the present and stay focussed in the present, the less likely it is that our intrusions overwhelm us. We can do this using mindfulness techniques.

Mindfulness techniques are a way of slowing our thinking down and letting our minds settle a little. People often Feel calmer as a consequence. Mindfulness is about Focussing on the present moment and noticing things around us - both inside and outside our bodies - without making judgements about them.

Mindfulness techniques are most effective either after your grounding techniques (once the thinking part of your brain has come back online), or before your intrusions get so overwhelming that the emotional part of your brain takes over. Mindfulness can be practiced in many different ways, and different people like different things. Have a go at some of the  different activities Found on the worksheet 'Examples of Mindfulness Techniques'. It is best to practice them when you're calm. Learning them is the same as learning a new skill, such as riding a bike or learning an instrument; it takes time and practice to get better.

Once you have found the  mindfulness techniques that help you, fill out the worksheet 'My Mindfulness Techniques', to act as a reminder.

Examples of mindfulness techniques worksheet

Below are some of the ways you can practise mindfulness.

NOTICE

Just notice your experience in the present moment. What is going on? Look for details.

 

DESCRIBE

Label what you see. Describe only what you see with words. What is happening?

 

PARTICIPATE

Lose yourself completely into an activity. Fully experience your feelings without being judgemental.

 

MINDFUL ACTIVITY

Routine activity can be a mindful one. Just notice what we normally do not notice. Become aware of your thoughts, feelings and bodily sensations as you do the activity.

 

MINDFUL BREATHING

The purpose is to allow thoughts and feelings to come and go without getting caught up in them.

1. Sit comfortably with your eyes closed, your feet on the floor and your spine straight.
2. Direct your attention to your breathing. You don't need to change your breathing.
3. When thoughts, emotions, sensations, or physical feelings pop up: accept them, allow them, don't judge them or get too involved in them. Just notice them.
4. When your attention drifts (and it will!), just note this has happened and bring your attention back to your breathing. No matter how many times this happens just bring your attention back to your breathing.

 

THE ENVIRONMENT

As you are walking or sitting quietly somewhere, start to notice things as though you were a new visitor to this place. Notice the sights, smells, and sounds as if for the first time. Be curious and really pay attention.

 

THE BODY

Imagine being in your body for the first time. Notice what it feels like. What sensations do you notice? How does it feel to move around, stretching your muscles, standing up, sitting down? What do your hands feel like as you move them about, stretching and wiggling your fingers and clenching your fists?

 

MINDFULNESS OF THE HAND

Here is a great exercise you can try .

 

TAKING FIVE BREATHS

Take slow, deep breaths. Focus on breathing out as slowly as possible and allow your lungs to refill naturally. Notice the sensations of your lungs emptying and refilling. Notice your rib cage rising and falling. Notice the gentle rise and fall of your shoulders. See if you can let your thoughts come and go.

 

DROPPING ANCHOR

Plant your feet firmly on the floor. Push them down, notice the floor beneath you, supporting you. Notice the muscle tension in your legs as you push your feet down. Notice the feeling of gravity flowing through your head, spine and legs into the floor.

 

HEARING

Listen to music. Really listen to the song. Tune in to key instruments or pay attention to the lyrics.