• Reference Number: HEY1168/2020
• Departments: Major Trauma
• Last Updated: 4 April 2022

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

This information sheet aims to help you, your family and friends to recognise and understand the process of psychological recovery and common emotional reactions following a traumatic event.

You have been admitted to hospital following a traumatic event and are being cared for by the Hull Major Trauma service. Whilst you are here you have access to support from clinical psychologists as part of this team. Should you feel you would like to speak to a clinical psychologist please contact the ward staff who will be able to arrange a referral for you.

What do we mean by a traumatic event?

We know serious incidents such as accidents, assaults, natural and man-made disasters happen in the world, but we do not usually expect to be personally affected by them. We often think this way because life would be too overwhelming and stressful if we anticipated such events, and we understand they are unusual and unlikely to happen.

But sometimes they do happen to us, and that, along with the need for recovery, can come as a big shock. Traumatic events include sudden or unexpected circumstance, often involving an element of loss and injury, which comes with physiological and emotional adjustment challenges.

How can psychologists help me?

Often, when people experience a traumatic event, they experience an emotional reaction to the incident and its consequences and they may need some support in adjusting to injuries and their time in hospital. Everyone is different, and as such will have different needs, but here are some ideas of how a Psychologist can help you with common difficulties:

• Help you to better understand the emotional reactions you are experiencing
• Review your usual coping strategies, and offer guidance on developing some new approaches to help you cope in the early stages of recovery
• Provide a supportive space for you to discuss and explore thoughts, worries and beliefs that you have experienced as a result of you traumatic event
• Support you to discuss pre-existing psychological or mental health difficulties if you feel these are being impacted or worsened by your recent experience
• Support you with any distressing or unusual experiences you have had in hospital. This may include experiences related to medication, treatments or Intensive Care related symptoms
• Assess and understand any cognitive changes, such as difficulties in concentrating, thinking abilities and memory, particularly if your incident involved an injury to your head
• Work with your Multi-Disciplinary Team (MDT) to help them best understand your needs
• Assess your ongoing support needs and signpost you to local services for further support

Understanding the effects of traumatic events

When we experience a traumatic event it is outside of our usual expectations about life. Therefore, we may experience unfamiliar feelings, thoughts and reactions that fluctuate or feel more extreme or different to normal. These are normal reactions to abnormal event; it is your body’s response to shocking circumstances and how many of us process stress. It can feel strange, scary or like you’re not yourself, but remember it’s the circumstances that are strange, not you. There is no right or wrong way to react.

• Shock, “shaken up”, numbness, fear, confusion, gratitude for surviving and/or feeling it’d be better if you hadn’t survived
• Exhaustion, denial, anxiety, helpless, angry, relief, gratitude, irritable, hope
• Memories of trauma, personal growth, pride, life affirming, a positive opportunity to re-evaluate life

Common emotional and physiological responses include:

• Hyperarousal: feeling jumpy, panicky, or sensitive to particular sensations or sounds more than normal. This happens as your body is in a heightened state of arousal, paying more attention to your surroundings in an attempt to feel safe.
• Re-experiencing: You may experience dreams or flashbacks; in some cases you may see/hear/feel/smell the event again. It may feel very real at the time, like it is happening in the present moment, and these may come with no warning or seemingly no conscious control, making these experiences unpleasant and distressing at the time.
• Thoughts: You may find you become stuck on things you wouldn’t normally think or experiencing “what if…” thoughts. Our minds can feel over active as we try to process the distressing events we have experienced.
• Changes in mood: You may find your emotions are more changeable or rawer than usual or that you experience lots of different emotions in a short space of time. Some people feel numb or find it difficult to work out how they feel.
• Avoidance: Sometimes people wish to avoid reminders of the event. They may prefer not to think or talk about it, want to be alone, or avoid places or situations that cause distress.
• Depersonalisation: It may feel like you are disconnected from the event. You may feel aware of the event but you feel numb or as though it did not happen to you, perhaps dream-like or as though you watched it happen in a film. Sometimes, people’s stories can end up in the media which may exacerbate this feeling, as people read about themselves or their traumatic event through other people’s accounts. This depersonalisation and numb feeling may be a way of slowly and gradually opening up and feeling the distress of the event.
• Physical symptoms: As your body is processing the event and your injuries, you may notice physical symptoms such as palpations (feeling your heart beating strongly in your chest), changes to breathing, poor sleep, nausea, headaches, poor concentration, tension or pain.

How long might this last?

In most cases these reactions are short-term and will pass after a few days or weeks as your body adjusts, processes the stressful event and recovers. However, sometimes these reactions can last longer depending on your circumstances and emotional response. Factors such as length of your hospital stay, contact with reminders of the event, or the significance or meaning of the event to you could impact on your reaction. This is also normal in the early stages of recovery.

Delayed or longer-termed stress reaction

Sometimes, the common responses identified above can last for longer. This is still quite usual, but you may want to seek further help if you find they are persisting for more than four weeks or if feel you need support in managing the intensity of these symptoms in the early weeks after discharge home.

You may find that your emotions and stress reactions begin to feel manageable whilst in hospital, but symptoms may re-remerge or become more overwhelming once you leave. This can be due to the changes you are experiencing that can make you feel less safe and certain, you may be re-exposed to triggers (such as driving after being in a road traffic collision), and likely will have new challenges to adjust to (e.g. returning to normal routines). Trauma symptoms at this stage are still resolvable, but can benefit from psychological input.

What can I do to help?

• Remember your reaction is normal.
• Allow yourself the time to process and accept what has happened. It is similar to other times of loss, you may need to grieve for the changes in your life and take time to heal.
• Talk to people about your experiences; simply sharing your feelings can help you process them and help your body calm. You may find it helpful in time to find out more about what has happened.
• Rest and eat well. This will have been a physically and emotionally exhausting experience, and you will benefit from taking time to rest and let your body get sufficient sleep, and maintain energy by having a good diet (this may be managed for you by the hospital staff).
• Think about some activities that you usually enjoy and return to these when possible. If this is not possible whilst you’re in hospital perhaps you could try something new or plan these positive events for your recovery. Some people also find having a structure or routine around them helpful.
• Allow yourself to feel this range of emotions and think it over. Do not worry about crying or if you are struggling to make sense of it all to begin with.
• Seek help and ask for support, either from the staff here or from your doctor if you are worried about your symptoms and experiences.
• When we feel high moments of distress try grounding yourself to the present moment. A simple technique for doing this is the 54321 method: thinking of 5 things you can see, 4 things you can hear, 3 things you can feel, 2 things you can smell, and take 1 deep breath.
• Welcome relaxation, try spending 2 minutes taking some slow deep breaths, and try visualising somewhere that makes you feel calm and comfortable. This helps our bodies feel safe and relaxed so that our energy can go towards healing our physical injuries.

Things that are best avoided

• Try not to distract yourself from thinking about it, for example by being very active, taking on too much or going back to work very quickly. This again may prevent you from processing what has happened; instead take some time to help you come to terms with any changes.
• Avoid alcohol and manage medication well. Other ways people may try to distract themselves is by using alcohol or medication to “numb the pain” and avoid thinking about the traumatic event. Your brain is needing to process the traumatic event, and a high level of distraction or avoidance can disrupt this process.
• Do not bottle up your emotions. We are sometimes taught to manage our emotions and not “let it all out”, but emotions are a physiological natural response to circumstances around you. Allowing ourselves to feel and express them can help give us a sense of relief.

Accessing support after you leave hospital

Your local Improving Access to Psychological Therapies (IAPT) NHS Service can continue to help you should you feel you would benefit from some emotional wellbeing support. These services offer support to people with common mental health difficulties, such as anxiety, depression, stress and some types of trauma.

The support they provide ranges from guidance on self-help material, psycho-educational groups, and more individual one-to-one sessions either over the phone or in person.

You can gain access to this support through your doctor, or you can easily refer yourself by phoning them directly. To find out how, you can search online for your local service. Below are the contact details for some of the local services:

Urgent Mental Health Support

If you require urgent mental health support to keep yourself or others safe, you can access this by calling the following services in your local area, or by calling 999 or attending your nearest Emergency department.

Additional Helpful Numbers

• Mind Info line- 0300 1233393
• Samaritans- 116 123 (free at anytime, from any phone)
• HEADWAY brain injury association 0808 800 2244 or 07395 571398 for Hull & East Riding’s branch (headway.org.uk)
• Limbless Association (Amputee Charity Helpline) – 0800 6440185 (limbless-association.org)
• PAUL for Brain Recovery – 01482 620229 (paulforbrainrecovery.co.uk)
• Cruse Bereavement – 01482 565565 / 0808 808 1677 (cruse.org.uk)
• Spinal Injuries Association – 0800 980 0501 (spinal.co.uk)
• Hull DAP (Domestic Violence) – 01482 318759 (hulldap.co.uk)
• DVAP (East Riding Domestic Violence support) – 01482 396330
• Citizens Advice – 0344 411 1444/0800 144 88 48 (e-advice@hull-eastridingcab.org.uk)
• CGL Renew Hull (Drug and Alcohol service) – 01482 620013 (hull@cgl.org.uk)

For additional information about services in your locality please contact your doctor.

Information about you

We collect and use your information to provide you with care and treatment.  As part of your care, your information will be shared between members of the healthcare team, some of whom you may not meet.  Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service and to help with research.  Wherever possible we use anonymous data.

We may pass on relevant information to other health or social organisations that provide you with care.  All information is treated as strictly confidential and is not given to anyone who does not need it.  If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You. www.hey.nhs.uk/privacy/data-protection

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

This leaflet was produced by the Major Trauma Department, Hull University Teaching Hospitals NHS Trust and will be reviewed in June 2023.

This leaflet has been produced by the Hull University Teaching Hospitals NHS Trust and is available as a download:

Download the “Major Trauma Psychology Service” leaflet