Trauma, flashbacks, and why talking can sometimes help...

What is Trauma?
 
Trauma is an emotional response to a difficult event. Every person will have a different way of viewing events in their life, and every person will also have different responses to trauma. Trauma, however, indicates an event which someone finds very stressful. Some examples of trauma might include witnessing or being in an accident, being exposed to violence, or experiencing a natural disaster. Some people may even find the experience of lockdown during a Covid-19 pandemic traumatic. Trauma does not result in PTSD. There is a misconception that PTSD is very common, but the evidence actually supports that most people are resilient to traumatic events, when the right factors are in place. 

Not every stressful event will result in trauma.

Trauma can be broadly categorized in three ways: acute, chronic, and complex trauma.

• Acute trauma is where a one-off traumatic event occurs, such as a car accident.
• Chronic trauma is where a person is repeatedly exposed to a traumatic event, such as domestic violence.
• Complex trauma is where a person is exposed to multiple different traumatic events over time, such as a paramedic attending different incidents.

 
What are some signs of Trauma?
 
Because trauma is an emotional response, there will be a range of different experiences that people have to trauma. Emotions are also linked to our body, so people who experience trauma may also have physical experiences at the same time.
Some common emotional/psychological responses to trauma include:

• Feeling numb/shutting down
• Feeling overwhelmed
• Feeling emotional
• Feeling anxious and/or depressed
• Denial
• Feeling irritable
• Feeling hopeless
• Difficulty concentrating
• Difficulty with memory
• Withdrawing
• Feeling sad
• Feeling angry

 
Some common physical responses to trauma include:

• Racing heart
• Exhaustion
• Breathless ”on edge”
• Shakiness
• Sleep difficulties
• Feeling ‘on high alert’ (hyperarousal/hypervigilance)
• Headaches

 
What is a Flashback?
 
A flashback occurs, when re ‘re experience’ the traumatic event, even though it is no longer happening. Flashbacks may include:

• Experiencing sensations associated with the event, such as smells or sounds
• Feeling the same emotions that were experienced when the event happened
• Seeing images of what occurred
• Having physical responses, such as racing heart.

 
Because trauma can affect memory, sometimes during a traumatic event, memories do not process efficiently. The brain is also wired to protect us from future trauma, so flashbacks are often ‘triggered’ by something which reminds the brain of the past traumatic event.

Flashbacks can happen for a very short moment or can go on for a long period of time. Flashbacks are a way of reminding a person of what has happened by activating protective mechanisms. These mechanisms are a way of keeping a person safe, although they are involuntary, and can sometimes become disruptive and distressing.

What will my trauma be like?
 
Each person’s way of responding to trauma will be completely unique. The meaning a person makes of the event, combined with past traumatic experiences, physical wellbeing, and personality will all contribute to a person’s trauma response. Research suggests that all people have different pre-existing vulnerability to stress, so that means each person will respond differently. The most important things are that a person doesn’t negatively evaluate their responses, and that they notice changes in normal ways of feeling or behaving.
 
 
Why do we need to debrief traumatic events?
 
Research has established that providing immediate post-traumatic support assists in people to:

• Feel supported
• Identify opportunities to get additional clinical support if needed
• Experience social cohesion
• Identify and reduce negative/harmful responses (eg: alcohol abuse)
• Reduce levels of sick leave
• Improve workplace performance
• identify any opportunities for post traumatic growth

 
Ideally, a trauma should be debriefed between two and ten days after the event. 

References 
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Campfield, K.M., & Hills, A.M. (2001). Effect of timing of critical incident stress debriefing (CISD) on posttraumatic stress symptoms. Journal of Traumatic Stress, 14(2). http://web.a.ebscohost.com.ezproxy.navitas.com/ehost/pdfviewer/pdfviewer?vid=1&sid=42ffdc55-b59c-46db-8289-9780c835be1d%40sdc-v-sessmgr03
Creamer, M. C., Varker, T., Bisson, J., Darte, K., Greenberg, N., Lau, W., et al. (2012). Guidelines for peer support in high-risk organisations: an international consensus study using the Delphi Method. Journal Trauma Stress 25(1), 134–141. DOI: 10.1002/jts.21685
Macdonald, B., Salomons, T.V., Meteyard, L., & Whalley, M.G. (2018). Prevalence of pain flashback in posttraumatic stress disorder arising from exposure to multiple traumas or childhood traumatization. Canadian Journal of Pain, 2(1), 45-56. DOI 10.1080/24740527.2018.1435994
Mitchell, J. T. (1983). When disaster strikes – the critical incident stress debriefing process. J. Emerg. Med. Serv. 8, 36–39.
Richins, M.T., Gaunlett, L., Noreen, T., Hesketh, I., Weston, D., Carter, H., & Amlot, R. (2020). Early post-trauma interventions in organizations: A scoping review. Frontiers in Psychology, 11(1), 1164-1078. DOI: 10.3389/fpsyg.2020.01176   
Scheeringa, M.S. (2020). Reexamination of diathesis stress and neurotoxic stress theories: A qualitative review of pre-trauma neurobiology in relation to posttraumatic stress symptoms. DOI: 10.1002/mpr.1864
Spencer, S.A., Nolan, J.P., Osborn, M. & Georgiou, A. (2019). The presence of psychological trauma symptoms in resuscitation providers and an exporation of debriefing practices. Resuscitation, 142, 175-181. DOI:10.1016/j.resuscitation.2019.06.280
Weiss, D.S., & Marmar, C.R. (1997). The Impact of Event Scale-Revised. In J.P. Wilson, & T.M. Keane (Eds.), Assessing Psychological Trauma and PTSD: A Practitioner’s Handbook (pp. 399-411). Guilford Press.