3. Questions. Questions. 1. How does trauma affect individuals? 2. How does it affect others? 3. What might be the consequences?

4. Trauma? What trauma? In The Times newspaper a doctor, speaking about trauma, was reported as having said: “The word shock should not be used by lay people. Instead they should use the words “The word shock should not be used by lay people. Instead they should use the words an unpleasant surprise”. an unpleasant surprise”.

5. Post-Traumatic Stress Disorder - 1980. Diagnostic symptoms from D.S.M. IV. Diagnostic symptoms from D.S.M. IV.Re-experiencing. Avoidance Behaviour. Arousal.

6. Living with P.T.S.D.  What is it like to have P.T.S.D.?  What is it like to live with someone who has P.T.S.D.? who has P.T.S.D.?

7. Reactions to Trauma. 1.Physical effects. (a)Listlessness / Fatigue. Sleeplessness or Sleeping. Exhaustion. Palpitations. Sweating. Headaches. Difficulty breathing. Pains in Stomach & Chest. Shaking. Imagined heart-attack. (b). Exaggerated Startle Response. Hyper-vigilance. Incessantly talking. Outbursts of Anger. Violence against objects or people. Murder ? (c) Lack of ability to communicate or make decisions. Not speaking. Confusion. Physical and Social withdrawal. No physical affection. Confusion. Physical and Social withdrawal. No physical affection. (d) Triggered sensory reactions - sights, sounds, smells, taste, touch. (e) Lack of care for self. Vagrancy. Not able to cope with work. Suicide. (f) Specific Physical illnesses – ‘Gulf War Syndrome’. “Why do I react like this? I must be going mad”. “Why do I react like this? I must be going mad”.

8. John’s Story. 1.

9. 2.Psychological effects. (a) Numbness. Disbelief. Fear. Acute Sadness. Panic attacks. “It can happen again!” Increased Anxiety & Vulnerability. “It can happen again!” Increased Anxiety & Vulnerability. Inability to Concentrate. Depression. Pointlessness. Inability to Concentrate. Depression. Pointlessness. (b) Helplessness. Shame. Remorse. Bitterness. Blaming. Guilt & ‘Survivor Guilt’. “I could / should be dead!” Apathy. Despair. Low self-esteem. Lack of Self-worth. (c)Little or no sense of having a Future.“I am going to die soon”. (c)Little or no sense of having a Future. “I am going to die soon”. “I am useless. My family would be better off without me”. “Nobody can understand or help”. “Nobody can understand or help”. Reactions to Trauma. Reactions to Trauma.

10. Mary’s & Jamie’s Story. 2.

11. 3.Social Effects. (a) Inability to express love or affection. Physical withdrawal. Sleeping alone. Becoming silent and remote. Not talking. Sleeping alone. Becoming silent and remote. Not talking. “It’s like living with a zombie or a time bomb waiting to explode” (b) Talking about or obsession with or avoiding the event. No interest in usual social context – hobbies, people, events. No interest in usual social context – hobbies, people, events. (c) Lack of sympathy. Acting out of character. Impulsive actions. Being unreasonable. Violence. Aggression. Anger. Being unreasonable. Violence. Aggression. Anger. (d) Flash-backs. Vivid Dreams. Frightening / Horrific Nightmares. (e) Inability to cope with work, relationships and life in general. Increased use of alcohol and tobacco and use of drugs. Increased use of alcohol and tobacco and use of drugs. “I just can’t cope. Nobody understands. Leave me alone”. “I just can’t cope. Nobody understands. Leave me alone”. Reactions to Trauma.

12. David’s Story. 3.

13. Possible Responses from Partners & Others. (a) Anger. Anxiety. Frustration. Fear. Apathy. Shame. Guilt. Sadness. Helplessness. Hopelessness. Depression. (b) Distancing. Ignoring. Avoiding. Rejecting. Self-blame. Bitterness. Despair. Confusion. Questioning sanity of self. (c) Questioning sanity of the person. “He’s / she’s going mad”. Breakdown of relationships. Bitterness. Separation. Divorce. The symptoms can be similar to the symptoms of P.T.S.D. “There’s nothing I can do. Trying to help doesn’t work”. “There’s nothing I can do. Trying to help doesn’t work”. “Nobody can help us - nobody can help me”. “Nobody can help us - nobody can help me”.

14. Things said by those with PTSD. (a) “If I talk to someone I love or know, they will think I am pathetic and weak. Others might not or cannot understand or might become distressed. If I talk about it, it might also become too distressing for me and I don’t want to descend into being an emotional wreck and, again, be seen as weak – so I just keep it all bottled up inside”. (b) “What’s the point of carrying on when you have seen what I have seen and experienced? Life’s just a sick joke without any reason or purpose”. (c) “I should be dead. Why did I survive when they didn’t?”

15. Things said by those who live with them. “He’s useless, hopeless and a nightmare to live with. Why should we have to put up with his behaviour? I get so angry and depressed and can’t see any future for us.” “If I change anything in the house or do almost anything different, he goes mad, throws things around and walks out”. “It’s the drinking, dark moods and the anger I can't stand. Sex has gone out of the window. He just isn’t bothered any more and sleeps in the spare-room. I don’t want him near me anyway”. “He never bothers with the children and just lives in a world of his own. It’s as though he’s surrounded by a wall of silence. He ignores me and the children but, worst of all, I’m terrified of his anger and violent behaviour. He hasn’t hit me or the children but he almost goes out of his mind when he loses his temper”.

16. What about the children?

17. Children’s Reactions to Trauma. Said in 1979 by an Indianapolis boy, age 16 years, to the psychiatrist Dr Charles Figley: “I wish my dad had been killed in Vietnam. My friend’s dad was killed and he came home in a body-bag, but he came home a hero. My dad came back but he is so different. He’s a bastard. We can’t live with him”.

18. Children’s Reactions to Trauma 1. Effects will depend on age and development. Effects will depend on age and development. 1.“Infection by association”. Hearing, seeing and feeling reactions. Holocaust survivors. Listening to stories and descriptions of the traumatic event. 2. Changes in behaviour. At School and Home. Fear. Confusion. Anger. Violence. Disruption. Sleeplessness. Dreams and Nightmares. Bed wetting. Thumb sucking. Depression. Sensitivity to criticism. Crying. Tantrums. Withdrawal. Rejecting affection. Being uncooperative. Demanding affection. Clinging. Sleeplessness. Dreams and Nightmares. Bed wetting. Thumb sucking. Depression. Sensitivity to criticism. Crying. Tantrums. Withdrawal. Rejecting affection. Being uncooperative. Demanding affection. Clinging.

19. Children’s Reactions to Trauma 2. 3.Acting out through play. (They don’t have the words). Bullying. Aggression. Disruptive behaviour. Playing alone. Drawings, paintings and play can express hidden emotions. Drawings, paintings and play can express hidden emotions. 4.Blaming self. “It’s my fault”. “I’m bad”. “Nobody loves or can love me”. 5.Physical illness. Generally feeling unwell. Headaches. Tummy aches. Various pains! Psychosomatic reactions. Children’s needs often ignored. “Children are not affected!”. Children’s needs often ignored. “Children are not affected!”.

20. Possible Reactions & Effects. Physical and Psychological reactions can have a devastating effect on the quality of life of individuals and on those who live or work with them. There will also be Social effects and reactions from those around them including partners, family, friends, neighbours and work colleagues. These inter-related reactions can destroy relationships, family life and the ability of those involved to maintain and sustain a positive, happy and successful life.

21. Positive Effects? (a) Increased Sense of Value. Life becomes more precious with increased feelings of purpose and meaning. Ability to empathise with others. A sense of peace and satisfaction. Previous anxieties pale into insignificance. (b) Deeper Appreciation of Life. Valuing life, self and loved-ones more. Mutual support in families and relationships. People and work become more meaningful. (c) Sense of Achievement. Increase in personal resources - discovering inner strengths and a rise in confidence in self and in others. Sense of achievement. “It’s good to be alive”. “I’m a survivor – not a victim!”

22. “Those who suffer can feel neglected, abandoned, misunderstood and rejected by Society at large, but, especially for ex-Service personnel, by the organisation to which they have, literally, dedicated their service and their lives. What they seek is the dignity of recognition of their plight and appropriate treatment and help - preferably in a military environment”. Frank Parkinson.

23. Any Questions or Comments? Especially from your own Experiences.

24. P.T.S.D. SYMPTOMS (can also be found in P.T.S.). P.T.S.D. SYMPTOMS (can also be found in P.T.S.). 1. RE – EXPERIENCING. The Intrusive symptoms. 1. RE – EXPERIENCING. The Intrusive symptoms. Flash-backs. Dreams & Nightmares. Re-living the experience. Recollections of the event. Distress at exposure to reminders. Re-experiencing sensory impressions. Talking about the event. 2. AVOIDANCE BEHAVIOUR. Avoiding places, people, memories associated with event. Not talking about the experience. Isolation from others. Inability to recall major aspects of the event. Disinterest in family, work, life in general. Inability to express affection. Little sense of a future. 3. AROUSAL. Difficulty sleeping. Staying asleep. Difficulty concentrating. Irritability. Outbursts of anger or violence. Hyper-vigilance. Irritability. Outbursts of anger or violence. Hyper-vigilance. Exaggerated startle response. Exaggerated startle response.

25. Trauma Support – General Aims. 1. INTEGRATION - to encourage the process. 2. NORMALISE - reactions to the event. 3. TALK – to allow people to talk about any reactions. 4. UNDERSTANDING - the event and any reactions. 5. RESTORE - group or individual confidence /solidarity. 6. INFORMATION – to give information about: Possible Reactions – during and after the event - and now. Possible Reactions – during and after the event - and now. The need for ongoing monitoring - of self and others. The need for ongoing monitoring - of self and others. When and how to seek help – the 4 week rule. When and how to seek help – the 4 week rule. Internal & External Resources available for support & referral. Internal & External Resources available for support & referral. 7. To respond to the ‘Duty to Care’.

26. Brain Research. The ‘Limbic System’ - Research into the workings of the brain suggest that in P.T.S.D. there are changes in the way the brain processes information. The Limbic System is responsible for managing the autonomic nervous system and reactions to events, especially in face of threat. The Amygdala - is the body’s early warning and alarm system which releases hormones, such as cortisol, leading to the ‘Fight, Freeze or Flight’ response. Hormones can be released into the system even when there is no threat. The Hippocampus - helps to process information and, under certain conditions, can lose its ability to function correctly. The Hypothalamus - exerts control of the ‘Sympathetic Nervous System’ - body temperature, glucose levels in the blood and might be involved in regulating sleep, sexual desire and mood. It indirectly controls the pituitary and thyroid glands.

27. P.T.S.D. Treatment – General. P.T.S.D. Treatment – General.  Psychotherapy.  Cognitive-Behavioural- Therapy (C.B.T.).  Psychodynamic counselling  Group / Individual Counselling or Therapy.  Family Therapy and Support.  Education and Giving Information.  Medication and drugs.  Relaxation. Exercise. Massage.  Drawings. Painting. Collages. Music.  Eye Movement Desensitising and Reprocessing.  Imaging Techniques.  Tape-Recording/writing stories – listening to/reading the story.  Flooding - Expressing Emotions - Exercise - Diet.  Exposure Therapy. Systematic Desensitisation. Flooding.  Talking techniques - Defusing & Debriefing.  Use of cultural rituals - Indian Smoke Lodge (USA). Religious rituals. Reunions. Memorial services. Religious rituals. Reunions. Memorial services.