The latest newsletter from the VA National Center for PTSD is available at http://www.ptsd.va.gov/professional/newsletters/ctu-online/ctu_V5N4.pdf
This edition contains the latest news and research on treatment, traumatic brain injury, OEF / OIF veterans and more
For people who have lost 1 or 2 days of memory of a trauma such as
a major road accident, how necessary is it for that person to recall the
forgotten memories in order to completely heal?
This is a complicated issue as memory loss following a traumatic
event may be caused by many different things, including brain injury,
dissociation and severe shock or stress. Having worked with several people who
have some form of memory loss during and following an incident, I have seen a
variety of effects. Some people recall the forgotten memories during therapy,
some don’t, and this does not appear to have had a significant impact on their
recovery. Each person is individual and it may be worth seeking a
neuro-psychological assessment (your doctor should be able to advise on this) in
order to assess your particular needs.
The Human Memory website is a useful source of information
Will I ever get over the event and move on with my life?
There are some very effective treatments for psychological trauma so there is every chance that you will. In the UK, EMDR and trauma-focused Cognitive Behavioural Therapy are the only proven clinically effective treatments for PTSD. See http://krtraumasupport.co.uk/kr_theraputic_support.html
Whichever therapy you choose, there are certain things that you should expect
Although working with traumatic memories will be difficult, your therapist should be providing a safe, structured environment for this.
- You should be clear about their way of working and understand the rationale behind this
- You should be an active, informed participant in therapy. It shouldn’t be something that you don’t understand or have any control or say in
- And you should be able to ask questions and be given good explanations about things like the trauma response and the management of symptoms
There is also increasing evidence that some people will actually become stronger following a traumatic event and research is increasing into this Post-Traumatic Growth.
“How to reduce stigma related to getting help”
This is a question that we could write a book on!
Stigma is still an issue for many people, particularly in the uniformed services.
Recent research shows that 55 – 62% of soldiers and Marines meeting screening criteria for major depression, generalised anxiety or PTSD were “uninterested in receiving help” (Dickstein et al, 2010)
Research has consistently shown that those who are more functionally impaired are less likely to be receiving mental health services and that stigma, shame and attitudes towards treatment are important factors in this.
There are other barriers to people getting support such as
- Lack of trust in mental health professionals
- Not knowing where to get help from
- Practical problems such as time or transport required to attend appointments or financial constraints
- Concerns about impact on career, insurance, social standing
- Lack of confidence in effectiveness of treatment
Where possible, mental health services need to address these barriers and educate potential service users about what is available, treatment efficacy and de-mystify the whole process of therapy. Direct contact with people with mental health issues has also been shown to help break down stigma. There are several campaigns that seek to end stigma
However, addressing issues of stigma in society may be easier than addressing self-stigma.For many people, there is still a belief that mental health issues are nothing to be ashamed of – until they happen to us!
How best to manage clients returning to work after experiencing trauma
Listen to what the real anxieties are about (it’s not always what we assume it is!) and encourage managers to take concerns seriously
Avoidance of triggers is a major problem after a traumatic event at work. The whole workplace can become associated with the trauma – colleagues, environment, work-clothes etc. Gently encourage the person to face their fears but avoid panic / overwhelm.
Encourage them to maintain contact with colleagues and managers
Use graded exposure for workplace triggers. Remember, slower is faster!
Ensure the person has a support system when they return.
Ensure person has ongoing access to professional support if appropriate/required. The first few weeks are crucial.
Phased return to work and/or temporary change of role are helpful if possible but should not be open-ended or ambiguous. Document phased recoveries with clear goals and timelines.
Follow the link for a feature in Soldier Magazine on stigma in the military
What sort of things should we be thinking about “just in case”?
Organisations who are at risk of encountering a traumatic incident can ask themselves the following questions:
Have I identified the possible risks of a traumatic incident and who may be affected?
Can I put any measures in place to reduce these risks? Do I need to build resilience or consider secondary trauma?
If a traumatic incident occurs, do I have a clear procedure for personnel to follow? Will managers and other responsible employees know what is expected of them?
Are my human resources and supervisory employees aware of how to help affected members of staff immediately after the incident? Am I confident that they know the right things to say or do?
Do I have trained in-house services that can support staff and guide me through the incident? If I need an external specialist, do I know how to contact them and what they can do for me?
Do my supervisory staff know how best to support affected staff in the days and weeks after the incident and how to manage an effective recovery and rehabilitation to the workplace?
Preparation is a key ingredient to successful recovery and can increase the resilience and “bounce-backability” of both the affected individuals and the organisation.