Handling trauma, and the best treatments for PTSD
Consultant clinical psychologist, David Trickey, is a trauma specialist who is unlike others in his field. What sets David apart is his extensive expertise in helping children who have witnessed one parent murder the other.
He’s spent almost 20 years working with traumatised children and families, and also acts as an advisor to the police and an expert witness in court cases.
Shortly before meeting David to film HealthHackers episode 30 - all about handling trauma, a study - described as the first of its kind - was published suggesting that nearly a third of young people experience trauma during childhood.
It also showed that one in four of those young people had been affected by post traumatic stress disorder (PTSD) by the age of 18, and had higher odds of suffering from other mental health problems and drug addictions too.
If you’ve only really associated the term ‘PTSD’ with war veterans suffering the after effects of horrific things that happened on the battlefield, you should know that emotional trauma can be triggered by a number of experiences including accidents, abuse, neglect, prolonged bullying, or bereavement.
What makes an experience ‘traumatic’?
In episode 30, David described how a traumatic event is subjective.
“The most important thing is what it means to that young person,” he said.
How “big or bad the event was,” he told me, and how afraid the person felt, can dictate whether they become traumatised.
David said it could be a one-off event or a string of them ”that are so overwhelming that the person can’t cope with them and they have a reaction to those events that outlast the actual events.“
“It might be you get run over and months later you’re still having nightmares, you’re still finding it difficult to sleep and you don’t want to cross the road.“
“Or it might be that you’ve had years and years of domestic violence which has changed your view of the world and the way that people are and the way the you are and that is then causing problems.”
Research also shows that a person doesn’t even need to be directly involved with an event to be traumatised by it.
In my earlier mentioned study, the most commonly reported traumas were those ‘affecting someone in the participant's network that they learned details of, but did not directly experience or witness’.
What does PTSD look like?
David explained that symptoms of PTSD can include flashbacks and nightmares - you might find yourself reliving the trauma through volatile memories that are highly sensory; you can feel it or smell it.
“When the event’s gone, you stay on edge for weeks, months, even years later. You can’t sleep, you can’t concentrate, you’re hyperaroused all the time.”
“…it takes the slightest little thing to make you lose your temper, and you lose your temper much more strongly than you will have done before,” he told me.
Loved ones can notice dramatic changes.
“I spoke to one woman who’s husband had been in the Navy and she said: ‘I’ve had two husbands; the one that went off to war and the one that came back,’ because his personality had changed so much.
“The friends and the extended family didn’t see that side of him. So it looked as if he was coping well but in fact he had post traumatic stress disorder.”
It’s not uncommon for a person to avoid discussing it, trying to push it away - although, David warned this can make the feelings return even more.
It’s also possible to have PTSD and not know it, due to the way our bodies hang on to traumatic memories - even from when we were babies.
He gave the example of a person who was abused as a one-year-old by a man wearing a specific aftershave. The victim might have no explicit memory of the abuse but more than 10 years later, they could walk past a man in the street wearing that same aftershave and it hits them.
“They don’t go, ‘Oh this reminds me of that abuse,’ but their body remembers, so they freeze and they panic and they may not know why.”
Why do some people get PTSD while others don’t?
According to David, factors that can increase your likelihood of suffering from PTSD include: a lack of social support after the event and attempts to push down the memory by “deliberately thinking of something else.”
Women and girls, plus those who have a history of psychological problems, or of difficult experiences, are also slightly more likely to suffer with the disorder.
And for a child, witnessing a parent struggling with the effects of trauma can contribute to his or her PTSD.
Later this year sees the release of David’s book aimed at parents and carers trying to help children deal with trauma, loss or change.
“Quite often the meaning a person makes of an event is based on their parent’s reaction and stories told within the family.”
He credits his own dad for helping prevent him from developing PTSD after being beaten up by eight men when he was 14.
“When I got home my dad answered the door and I think that’s one of the things that made it non-traumatic because… he’d closed the door behind him so my mum couldn’t see the mess I was in and he said something that validated I’d had a horrible experience but wasn’t melodramatic. He said: ‘You look like you’ve had quite a night. Shall we go to hospital?’”
Advice for parents
“I’ve worked with a number of children who, following car crashes, had been told either in the ambulance or at hospital: ‘Oh you’re lucky, you could have died,”’ David said.
Comments like that can change the way a child views an event and could make it feel far worse, according to David.
You can hear his key advice for parents and carers in episode 30, but some steps include:
Making the child feel safe - which could involve minimising watching distressing TV programmes.
Helping them to calm down - this could be by having a bath or playing football (the aim is to reset their physiological stress response system.)
Validating what has happened to them without dismissing it with comments like: “Yeah, but you didn’t die, did you? You’re fine.”
He told me: “Help them to tell the story rather than give them the story,” and try using questions such as: ‘What happened next?’
The best treatments for PTSD
The aim of allowing a child or adult to talk about their traumatic event is to help them put it into a story. This means they are processing the memory.
If a person does not tell their story, pushes it away and avoids discussing the matter, then the trauma memory “stays in its raw data format - and that’s the problem,” David explained.
If you think you have PTSD, you should recognise it for what it is.
“This isn’t just anxiety that’s come out of nowhere, it’s anxiety that is the result of things that have happened to you,” he said.
The main treatment for PTSD is trauma-focused cognitive behaviour therapy (TF-CBT) - a type of therapy that focuses on challenging the thoughts and beliefs that have been negatively impacting your behaviour, and helps you to develop coping skills.
“The revision of the NICE guidelines for PTSD said do trauma-focused CBT first and if that doesn’t work, or the person doesn’t like it, then do some EMDR,” David explained.
Eye movement desensitisation and reprocessing (EMDR) is a unique, perhaps even seemingly mysterious, therapy technique that requires a patient to recall their traumatic moments while watching the practitioner’s fingers moving back and forth in front of them.
It looks odd, but David told me it does work and there’s enough evidence to support it.
“We don’t know how it works and people that say they do know how it works, I think, are guessing.”
What happens if PTSD is left untreated?
If a person chooses not to get help for their PTSD, “it becomes their personality rather than just a reaction to the event,” David told me.
That means the bad temper, the nightmares, the intrusive images and other symptoms will continue.
David acknowledged people are still dealing with PTSD decades after a traumatic event.
“…because people don’t share, they don’t talk about it, they don’t want to admit they’ve got difficulties, they deny themselves the opportunity to get the cure, to get the intervention that helps.”