Post Traumatic Stress

These are the thoughts and feelings of two people who have Post Traumatic Stress Disorder (PTSD).

“I kept what happened to myself for a long time because I thought it was my fault. I have vivid images of the assault - I can see the attacker’s angry face. Their image jumps into my head from nowhere and terrifies me. Although it happened years ago, when I have those horrible images, it feels like it is happening again now. I get nightmares about people chasing me. I struggled to trust people and cut myself off. I feel like I have lost myself. Sometimes I feel like I am looking at the world through the wrong end of a telescope – everything seems so distant, and I am not part of it.  I coped with the memories for years. I pushed what happened to the back of my mind and got on with my life, but since my dad died, it is as if the assault has been let out of the box again - the images and fears from the assault are with me all the time now.”

“I had to get on and cope after the fire. I had no choice as there were things that needed to be done. I feel very guilty thinking that I should have done more to help them survive. I keep thinking, "if only I had done this”, “if only I had done that” and ask myself why did this happen to me and then feel guilty for thinking that because I am here and they are not. Even though I know it is over, I still relive moments of that day. I sometimes smell burning – it’s so real that I repeatedly check my home to make sure nothing is on fire – I know it’s in my head, but I can’t help myself.  I am on edge the whole time waiting for it to happen again. My friends tell me I need to relax – but I am uptight and on high alert.  I lose my rag far too often and feel very low and depressed afterwards; I sometimes harm myself. I am trying to get on with my life and spend time with my friends and family, but I feel disconnected and heavy, like I am carrying something that just won’t let me go.”

You are probably reading this because something terrible has happened. Trauma is a very personal experience and this is part of the reason why we feel so isolated by it. This guide has been written by psychologists who have helped people to overcome their traumas. It aims to help you understand common reactions to trauma and to offer some practical suggestions to help you cope.  We also hope it helps you to feel less isolated.

There is a lot of information, and this might feel overwhelming.  Please take your time, you can come back to the guide as often as you need to. There are lots of ideas about how you can help yourself – so perhaps review the guide and make a note of the sections that seem most relevant to you. Perhaps reading it with someone might help?

You may find some of the other guides in this series helpful such as those on depression and low mood and sleeping problems.  

A traumatic incident is a highly threatening or horrific event (or series of events) that would be deeply distressing to almost anyone. The traumatic event or events often leave people feeling extremely frightened, anxious, guilty, angry, ashamed, powerless or humiliated. Whatever the event/s, the impact is a deeply personal one and no one person will react in the same way.

There are many events and life circumstances that could be considered as traumatic. For example, a natural disaster, like a flood, a car accident, or a house fire. It might involve other people who threatened or belittled us, like being physically attacked, sexually assaulted or surviving war. Experiences of racism and discrimination within our communities can result in post-traumatic stress reactions.

Sometimes the people who we thought we could trust, or that should care for us or protect us became the source of trauma.  This happens in child sexual abuse, neglect or physical abuse.  
 
While many people naturally recover from the impact of trauma, it can for some people lead to different mental health problems either straight after the incident or later in life. Trauma can happen at any age.

By acknowledging what has happened to you and learning about the impact of these traumatic experiences, we hope you will develop a better understanding of yourself and figure out what you need to do to move on.

This guide focuses on Post Traumatic Stress Disorder (PTSD) and offers some ideas and practical suggestions to help you cope. If you survived multiple traumas or childhood trauma, this guide will still help, but you might also want to read about Complex PTSD. 

Resilience

When we struggle with our reactions to trauma it is hard to see our natural strength and resilience. You are here reading this – you are already showing your resilience. It might be helpful to ask yourself; how have I got through this so far, or what am I doing that is helping me to cope? Where are you finding your strength?  What is helping you to recover?
 

Common reactions to trauma

After a traumatic event our reactions may fall into the following groups:

• Repeatedly and uncontrollably remembering the trauma in your mind and body.
• Avoiding things to do with or related to the trauma.
• Feeling unusually tense, irritable or over-alert.
• Feeling lost, depressed, despondent and tearful.

Trauma is a highly threatening and overwhelming experience in which we may feel out of control. It disrupts our internal sense of feeling safe; our nervous system reacts to this felt danger in a protective way. These responses are useful and help us to survive what can feel like impossible situations. Sometimes we feel guilty about how we responded, but please remember that our responses are instinctive responses that are out of our control.

Listed below you will find the most common reactions of the nervous system. To survive, the nervous system decides in the ‘blink of an eye’ to move between these reactions.

In the face of threat our nervous system activates automatically to assess the danger (freeze) and we fight or flee if possible, in response to it.

• Freeze reaction. At the early signs of potential danger our bodies move to a state of stillness while the mind might remain in a state of high alert in order to assess the situation and decide what to do next. 
• Fight reaction. If our brain considers it is possible to fight with the danger our bodies will mobilise. We will fight to survive through shouting and hitting out to deal with the threat.
• Flight reaction. If the fight reaction is not possible, our bodies get us ready to escape from the threat if possible. 

Where fight or flight are not possible, our nervous system helps us by very rapidly starting the shutting down response.

• Submit response.  Our body attempts to minimise harm and our survival depends on connecting with and pacifying the aggressor.  
• Play dead reaction. Our bodies play dead in order to survive the danger when we cannot escape or fight. 
• Shut down reaction.  When other defence reactions are not working, our nervous system can help us to survive by disconnecting from the source of danger; “as if it is not happening to me” experience. 
   

When we encounter trauma and survive by the automatic survival responses the usual way we remember information is also disrupted. The situation is often remembered in the form of sensations, feelings and emotions often without the words to describe the experience.

The most common symptoms are as follows:

• Our brain will continue to try to process the trauma by reliving the fragments of the remembered situation in the form of nightmares and/or flashbacks (the feeling like you are back there)
• Our mind and body will motivate avoidance of reminders of the trauma.   
• Our nervous system will be guided by the principle of ‘better safe than sorry’. We will remain in the state of a high alert just in case; but this means we might struggle to feel relaxed, safe or calm.
• We might experience difficulties in managing our emotions. We can go numb, have angry outbursts and intense sadness, guilt or shame.

These are the normal reactions of our nervous system to abnormal events. In the early weeks and months after a traumatic event it is common to have trauma symptoms – it is the mind and body trying to come to terms with what has happened.   

For most of us, we will naturally process the experience over time and the symptoms will settle. For some people however, the traumatic memory and the symptoms become stuck; this is when PTSD begins to be a problem.

Trauma reactions may not start immediately after the traumatic event but might begin after a delay; this can be many months or years later.

More detail about PTSD symptoms is on the following two pages. After the explanation of the symptoms you will find a symptom checklist. It may help to check-in and see if you are experiencing any of those symptoms.

It may help you understand how you are feeling by placing a tick next to those symptoms you experience regularly:

In addition to what has been said above, there can be many reasons why trauma leaves such a strong impact, here are a few of those additional reasons:

1. Trauma can radically change how we see our life: that prior to the trauma our life might have been fairly safe, secure and predictable, that it had a particular rhythm, meaning or purpose. Our life post-trauma can become almost unrecognisable. It may be that the image or idea that we had of ourselves was shattered, as we may have responded differently during the trauma from how we expected or wanted to behave. Or, our world view has been challenged, that the world is now felt to be unsafe and dangerous.
2. Trauma can occur suddenly and without warning giving us no time to adjust to this new experience. 
3. If the trauma is outside our normal range of experience, we may struggle to know what to do or how to behave. 
4. You may have felt you were going to die, people around you may have died, and you may have experienced shock. 
5. You may have been trapped in relationships, situations or social environments where you felt constantly belittled, neglected, scared or powerless.
6. You may have experienced discrimination like racism or sexism. Research tells us that this kind of abuse can result in traumatic reactions. 
7. You may have felt like you had to manage these difficult situations on your own as the people who should have been there for us were absent, neglectful or abusive. Or, people in power ignored your experiences or abused you. This repeated trauma can have a powerful impact on us.
8. You may have experienced trauma at a vulnerable time in your life. The trauma might have happened repeatedly and happened over many months or years.
9. You may have believed that what happened to you was happening to others and was ‘normal’ and was something that you should just put up with. You may have worked hard to live your life while carrying this burden. We can only see the true impact when we step away and speak about what happened and realise that this was not ok.    

It is important to understand that the reactions you are experiencing are very common following trauma, they are not a sign of ‘weakness’ or ‘cracking up’. Indeed it is your mind and body’s way of helping you cope. The following suggestions may help you begin to cope with the post-traumatic reactions. 

Starting to open up

As a rule of thumb, it is better to talk about difficult experiences with someone you trust, rather than avoiding it or locking it away. There is a saying “when I hear myself speak, I know what I think.” This means that talking can help you to become clearer about what you think and feel. While it can be hard, talking and voicing our experiences can be empowering. It might be especially difficult for you to speak if you tried to tell others about what happened to you before, but you were not believed, or the impact of the event was minimised.

Reaching out to others can help work against the isolation that people with PTSD experience.  Some people talk to a friend, family member or partner, others may approach voluntary organisations such as MIND or the Samaritans.  There might be local support groups in your area.  You can also approach your family doctor and ask for help in accessing counselling or psychological therapy.  

Reaching out to others can be very hard but there some things we can do for ourselves.  For example, some people have found that it helps to write down their experiences. There is research that suggests that writing our experiences down, or keeping a diary or a journal can have a positive impact on our wellbeing.

Try to spend a few minutes thinking of ways that you may be able to start to open up and make sense of what you have been through. Try and jot down some ideas: 

• Who could you reach out to? 
• Who might be a good person to talk it over with? 
• Would it help to write down your story? 
• Ask yourself questions: What has happened to me? What am I struggling with? How has the trauma impacted on my life? What have I stopped doing? How have I coped? 

People may find that they continue to be troubled by intrusive unwanted pictures, sounds or smells of the trauma (flashbacks).

Flashbacks and intrusive thoughts are triggered by reminders of the trauma. For example, sometimes just hearing raised and excited voices might remind someone of the shouting and anger of their trauma.

Time travelling

Once a flashback is triggered our ability to think and reflect is hijacked. In these terrifying moments we are ‘time travelling’ as the past (trauma) and the present (situation) overlap.

We can begin to separate the past from the present by noticing the differences between then and now. When we do this we are understanding the connections between the past (trauma) and the present (now). Making the connections and noticing the differences helps us to separate the traumatic memory from the present moment.

First recall a recent time when you had an intrusive memory or flashback. Then, see if you can work out what might have triggered it? Was there anything that might have reminded you of the trauma? And then ask questions about the differences between then and now. What could you do then (at the time of trauma) vs what can I do now? What could I hear then, what can I hear now? And so on. There is an example from someone who experienced a serious assault on the next page, notice that there are questions about all the senses.

Remember that while it feels like the trauma is happening again now (flashback) – it is not actually happening again now. This idea might help you to think about the similarities and differences.  Use the table overleaf to help you think this through.

Take a pen and paper and work through a recent flashback or intrusive thought. Use the structure of the table above to help.  Notice what triggered the traumatic memory. Notice the similarities and differences between the trauma (then) and the situation (now). Use practical differences like your age, the place, who you were with, where it happened, the smells, the sounds, the tastes, what you could not do then and what you can do now, the felt sense, or other differences.

Using this exercise will help you understand the triggers and help you feel more in control of them. Once you have worked on a few triggers using this table and can see the difference between then and now – the next time you have a flashback – remind yourself that something has triggered this, and say that was then this is now; I am safe now. And start to notice the differences and similarities.  
It helps to link this exercise to a grounding object (please see the section ‘Bringing yourself back from the past to the present’). The grounding object can help to settle you and then reminds you to work on the differences and similarities.

Nightmares are repetitive bad dreams that can wake us from sleep, sometimes they are directly about our trauma, or they can be related by an emotion or a theme. We often wake up before the worst moment, and then we might struggle to get back over to sleep, fearing that the nightmare might return. There is a helpful technique proven by research to help with nightmares – it is explained in this excellent video by Dr Justin Havens.

It is understandable that we want to avoid anything that triggers memories or painful emotions about our trauma. While avoiding can help us to cope in the short term, unfortunately it tends to keep our problems going and often means that we stop doing things that help us to feel better, for example avoiding meeting people socially.

Avoidance following a traumatic experience can take many forms. It can mean avoiding things inside ourselves – like avoiding getting upset, difficult feelings, thoughts or memories.

Or, it can involve avoiding things outside of ourselves such as avoiding anything or anyone or any situation that reminds you of the trauma. This avoidance can prevent you from ‘moving on’ and in some cases it can prevent you getting on with your life in a normal way.

Opening up by talking, writing or expressing how we feel might be that connection between the inside and the outside. It is sometimes the hardest step to take as we worry about what will happen or how it might make us feel. It is also one of the most powerful things we can do – to name it and say what happened to us out loud.  

Please consider this:  A person with PTSD said this of their avoidance of talking about their trauma - “I have tried not talking about it and that doesn’t work.” What they meant was that locking their trauma within for many years did not help them to heal and find peace.

Try to recognise the things you are avoiding, it may help to write them down:

While it is helpful to reflect on the trauma by talking or writing about it, sometimes we can get caught within an unhelpful cycle of overthinking about the trauma. It might be hard to stop those repeated thoughts and it can feel like they have a life of their own. A person with PTSD said that “trauma was a time thief.” They meant that flashbacks and overthinking robbed them of days and months and of being present in their life.

Overthinking usually has a question at its heart, why did this happen to me or what if it happens again. Sometimes we over think how things could have turned out differently asking and imagining endless ‘if only’ scenarios that we punish ourselves with. 

You might think things through again and again on purpose to try and figure things out or as an attempt to find closure. You might believe that if you stop overthinking you might miss something important or let something bad happen again. Sometimes we overthink to avoid feeling the pain of the trauma.  

It becomes easy to get caught up in our own thoughts and miss that dwelling on the trauma like this becomes unhelpful as we go around the same information over and over. A veteran once described this as “like being on a roundabout with no exits”. Going round and round takes up a lot of energy, leaving you exhausted and not having ‘mental space’ to do other things. We often disappear into our own heads and friends and family might tell us that we are distant and preoccupied.

It is natural and understandable that your brain is trying to make sense of what happened and prevent it from happening again. Moreover, thinking through things thoroughly might have helped you before and you are trying to cope in the similar way now.

But, spending a lot of time thinking, what if, why, or, if only, thoughts increases frustration, anxiety, anger or guilt. It can even trigger flashbacks which then in turn triggers more overthinking and feeling unsafe – stealing more time.  

I overthink, how can I help myself?
If you have noticed that you dwell on a past event or maybe you are an over thinker by nature, follow the simple ideas described below. You can follow them as they are listed or combine them in a different order. If some ideas are not helping, try another, or combine them with the other ways of coping that we have described elsewhere.

The first set of ideas is around noticing what happens and naming it. 

Notice where you are more likely to overthink? We tend to dwell on something when we are doing tasks that do not require our full attention, like cleaning or taking a shower. We might overthink while trying to go to sleep or in the early morning hours.

Be prepared and when you are in this place or situation, remind yourself you are likely to start overthinking. What can you use as a reminder? You could use a post it note, an object placed to remind you or an elastic band on your wrist? 

Allow some time to learn to notice when you are overthinking. This is much harder to do than it sounds as overthinking can become a habit that we are not even aware of.

Name it, perhaps begin by saying out loud – I am overthinking again. Try not to judge yourself for doing this; remember your brain is just trying to help you to manage the effects of what happened. 

Practice self understanding – when we feel tired, bored, vulnerable or physically drained we might overthink more. 

The second set of ideas is about making sense of your overthinking.

Try to approach overthinking with more self-understanding and curiosity. If you dwell on something when you don’t want to it can be frustrating. However, it is rarely helpful to feel frustrated with yourself. It might be like there is a part of you that needs to overthink things and a part of you that doesn’t want to, and these parts can be in conflict.

How is the part of you that is overthinking trying to help? Has overthinking been helpful in the past? For example, in the past it might have helped to think about all the ways that things could go wrong and prepare for the worst.

Am I overthinking on an emotional wound? Perhaps no one was there for you in the past, or that you were unfairly blamed for something?

The final set of ideas is about how to practically tackle overthinking. 

Get back on track. Once you have noticed that you are overthinking - can you bring your attention back to what you were doing just before you started to overthink?

If overthinking persists you could do the following: 
Observe your thoughts mindfully – just let them pass through your mind. You can imagine standing on a railway platform and seeing thoughts as trains that come and go. You do not have to get on those trains, just let them pass.

Write it down. Writing down exactly what you are overthinking can be helpful as it gets it out of your head and onto the page.  Doing this helps to get a little distance from your thoughts. Then pause and reflect. Take a 10 minute break and then come back to what you have written. Ask yourself these questions: How is overthinking like this helping me? What am I trying to understand by overthinking like this? What am I trying to achieve by overthinking this? Is there a better way to achieve this?

How can I distract myself?
Distract yourself by focusing your attention on something else.  Playing Tetris or Solitaire on your phone can help. Distraction doesn’t usually work instantly, and you may need to work at this for at least three minutes before symptoms will begin to reduce. 

Note about distraction: it is not about trying to push thoughts of the trauma out of your mind (see above). Neither is distraction about avoidance, but is a technique that can help us control where we wish to focus our mind and try to limit the amount of time we spend over thinking. 

Other techniques for managing overthinking can be found on the following pages.

If you are struggling with flashbacks, overthinking or feeling detached from the here and now you can use grounding techniques to help you move back into the present moment and foil the time thief. 

Grounding object:  Find an object that helps to remind you that you are in the here and now, it should not be connected in any way with the trauma. The object should feel nice to hold, it could be a small seashell, a pebble or an acorn. An object that engages as many of the five senses as possible is better. 

Spend a few minutes each day looking at the object and feeling its weight, look at its colour and size and connect this with the idea that this object represents the here and now. Practice saying to yourself that was then, this is now. When you have a flashback, or find yourself overthinking, take out the object and remind yourself of where you are and say, that was then, this is now. Carry the object with you. You could use the ‘time travelling’ exercise described in this guide to help you when you are drawn into the past.

Using our senses to ground us:  Approach each of the senses with a sense of curiosity and dwell on them for 2-3 minutes; as if you are experiencing them for the first time. Noticing that you are here and now with these senses – that was then, this is now.

• Sight – you could focus on things around you, the colours and the textures. Or maybe a photograph on your phone of something recent, or a pet, friend, or family member to bring you back into the present moment. 
• Sound – bring your attention to music, perhaps listening to the bassline of a song, or the drums. Or listen to soothing music, white noise, birdsong, the sound of waves or the voice of someone you trust.
• Touch – touch whatever is in front of you right now – explore the warmth, coolness, smoothness, texture, etc. of whatever it is.
• Smell – sniff a strong smell which can bring you in to the present – perfume or nice smelling oils, or herbs. If possible keep them with you.
• Taste – try tasting something strong – a strong mint or chilli or lemon can bring you in to the here and now.

Three objects exercise: try looking around you and choosing three objects and slowly and on purpose study each of them for three minutes, notice the details, the colour, shape, edges, texture of these objects. Dwell on these objects and notice being present with them.

The following exercise teaches deep muscle relaxation, and many people find it helpful in reducing overall levels of tension and anxiety.

Deep muscle relaxation - it is helpful to read the instructions first and eventually to learn them. Start by selecting a quiet, warm, comfortable place where you won’t be disturbed. Choose a time of day when you feel most relaxed to begin with. Lie down, get comfortable, close your eyes. Concentrate on your breathing for a few minutes, breathing slowly and calmly: in, two-three and out, two-three. Say the words “calm” or “relax” to yourself as you breathe out. The relaxation exercise takes you through different muscle groups, teaching you firstly to tense, then relax. You should breathe in when tensing and breathe out when you relax. Starting with your hands, clench one tightly. Think about the tension this produces in the muscles of your hand and forearm.

Study the tension for a few seconds and then relax your hand. Notice the difference between the tension and the relaxation. You might feel a slight tingling, this is the relaxation beginning to develop.

Do the same with the other hand.

Each time you relax a group of muscles think how they feel when they’re relaxed. Don’t try to relax, just let go of the tension. Allow your muscles to relax as much as you can. Think about the difference in the way they feel when they’re relaxed and when they’re tense. Now do the same for the other muscles of your body. 

Each time tense them for a few seconds and then relax. Study the way they feel and then let go of the tension in them.

It is useful to stick to the same order as you work through the muscle groups:

• Hands – clench your fists, then relax.
• Arms – bend your elbows and tense your arms. Feel the tension, especially in your upper arms. Remember, do this for a few seconds and then relax.
• Neck – press your head back and roll it from side to side slowly. Feel how the tension moves. Then bring your head forward into a comfortable position.
• Face – there are several muscles here, but it is enough to think about your forehead and jaw. First lower your eyebrows in a frown. Relax your forehead. You can also raise your eyebrows, and then relax. Now, clench your jaw, notice the difference when you relax.
• Chest – take a deep breath, hold it for a few seconds, notice the tension, then relax. Let your breathing return to normal.
• Stomach – tense your stomach muscles as tightly as you can and relax.
• Buttocks – squeeze your buttocks together, and relax.
• Legs – straighten your legs and bend your feet towards your face. Finish by wiggling your toes.

Don’t try too hard, just let it happen. You may find it helpful at first to get a friend or family member to read the instructions to you. 

To make best use of relaxation you need to:

• Practice daily.
• Start to use relaxation in everyday situations.
• Learn to relax without having to tense muscles.
• Use parts of the relaxation to help in difficult situations, e.g. breathing slowly.
• Develop a more relaxed lifestyle.

There are a wide range of relaxation CDs available to buy. There are also many websites where you can download relaxation instructions for free. Some examples can be found at the end of this guide.

Remember, relaxation is a skill like any other and takes time to learn. Keep a note of how anxious you feel before and after relaxation, rating your anxiety on the scale from 1 to 10, where 1 is no anxiety and 10 is the highest level of anxiety.
 

Tension, irritability and anger are common aspects of a post-traumatic stress reaction. Often we feel angry about what has happened, why it happened or how unfair it was. We might be very angry with ourselves or other people. We might be frightened by our anger as we worry we could hurt the people we care about or push them away. Sometimes we just don’t understand why we feel so angry. 
 
Our feelings of anger could be closely linked to the automatic fight threat response and/or overthinking mentioned earlier in this guide. It makes our anger an understandable and natural post-traumatic reaction. 
 
Feeling angry does not make you a bad person. However, some people recognise it as an issue, especially when they do or say things they did not want to. If feeling angry has been a problem for you try to follow the ideas below to learn how to better manage your anger. Encouraging calmness is important – so prepare and practice these ideas.
 
The first set of ideas and questions will help you to pay attention to your anger. 

The second set of ideas is about trying to be curious about your angry responses.

• Last time you felt angry - what was ‘pushing your buttons’? For example, did the situation feel unfair or threatening, or did you feel hurt or not ‘heard’?
• How did getting angry help in this recent situation? Although you might have not liked the fact you got angry, getting angry might have given you more energy, confidence or strength? Did getting angry have any positive benefits for you? What were they? On the other hand, what were the costs of your anger? 
•  How has getting angry been useful for you in the past? For example, you were able to defend yourself, speak up or stand up for yourself? 
•  How do you want your behaviour to be different? For example, do you want to be able to speak calmly and express your thoughts clearly even though you might feel anger? Describe how you want things to be different. 

The final set of ideas is more active management of anger. 

People often experience low mood following trauma. This can sometimes give rise to feelings of low self-worth, reduced confidence, helplessness and guilt. Like anger and avoidance, it also drives us towards isolation.

Following trauma, people tend to think and expect the worst of themselves, their life and the future. If this is the case for you, don’t just accept these thoughts. Remember, a thought isn’t a fact, and thinking something doesn’t mean it’s true. To re-evaluate your thoughts try to:

• Identify when your mood is very low.
• Jot down the unpleasant thoughts you are having during that time.
• Try and balance these thoughts by writing down other ways of seeing things.   
• For example, imagine what you would say to friends if they had negative thoughts about themselves. What might a loved one say to you if they knew what you were thinking?

It may help to keep a diary of things you have enjoyed or achieved. This can help you to notice the good things that are happening in your life as well as the bad. Take a journal and at the end of every day write down the things that went well for you, the things that you were pleased about or proud of. These will mostly be small everyday things, but don’t forget the bigger things.

You can look at the NICE website for further information about these treatments.  There are other websites, listed in the references, that might be useful such as the British Association for Behavioural and Cognitive Psychotherapies (BABCP) or the EMDR Association UK (EMDR UK).

As mentioned, your GP is the best person to talk to in the first instance. They  will have information about local services which may be able to help. In addition the following organisations and information may be useful.

• Assist Trauma Care
  www.assisttraumacare.org.uk
  A support organisation for people suffering from PTSD.
• British Association for Behavioural and Cognitive Psychotherapies
  Email: babcp@babcp.com
  www.babcp.com
  Information and advice for people about behavioural and cognitive psychotherapy (CBT).
• Combat Stress – The veterans’ mental health charity
  Helpline: 0800 138 1619
  www.combatstress.com
  Provides outreach support to Ex-servicemen and women and their families.
• CRUSE Bereavement Support
  Tel: 0808 080 1677
  www.cruse.org.uk
  Helpline for bereaved people and those caring for bereaved people.
• EDMR UK
  https://emdraassociation.org.uk
  EMDR Association UK is the professional body for EMDR clinicians and researchers in the United Kingdom.
• Healthwatch
  www.healthwatch.co.uk
  If you use GPs and hospitals, dentists, pharmacies, care homes or other support services, we want to hear about your experiences. As an independent statutory body, we have the power to make sure NHS leaders and other decision makers listen to your feedback and improve standards of care.
• Men’s Advice Line
  Tel: 0808 801 0327 (freephone)
  www.mensadviceline.org.uk
  The Men’s Advice Line is a confidential helpline for all men experiencing domestic violence.
• Mental Health Matters
  Tel: 0191 516 3500
  Email: info@mhm.org.uk
  www.mhm.org.uk
  A national organisation which provides support and information on employment, housing, community support and psychological services.
• Mind Infoline
  Tel: 0300 123 3393
  Email: info@mind.org.uk
  www.mind.org.uk
  Provides information on a range of topics including types of mental distress, where to get help, drug and alternative treatments and advocacy. Also provides details of help and support for people in their own area.  Helpline available Mon - Fri, 9am - 6pm.
• Miscarriage Association
  Helpline: 01924 200 799
  www.miscarriageassociation.org.uk
  Provides information support if you have been affected by miscarriage, ectopic pregnancy or molar pregnancy.
• NHS Talking Therapies
  www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/nhs-talking-therapies/
  Provides details on how to access local talking therapies services.
• Rape Crisis 
  Tel: 0808 500 2222
  www.rapecrisis.org.uk
  Helpline for women and girls who have been raped or sexually assaulted. 
• Refuge
  Tel: 0808 200 0247 (Freephone)
  Email: helpline@refuge.org.uk
  www.refuge.org.uk
  24 hour crisis line providing practical advice and emotional support for women experiencing domestic violence. 
• Relate
  www.relate.org.uk
  Help with marital or relationship problems. 
• Rethink
  Advice service: 0808 801 0525
  Email: advice@rethink.org
  www.rethink.org
  Provides information and a helpline for anyone affected by mental health problems.
• Samaritans
  Tel: 116 123
  www.samaritans.org.uk
  Email: jo@samaritans.org
  Post: Freepost SAMARITANS LETTERS
  Confidential support for anyone in a crisis. 
• Victim Support
  Tel: 0808 168 9111
  www.victimsupport.org.uk
  An organisation which offers support and practical help to people who have experienced trauma. 
   

• The Body Keeps the Score; Brain, Mind, and Body In the Healing of Trauma.  
  Bessel van der Kolk (2014)
  Viking
  This is a broad and well-informed book about how we understand trauma and treat it.  Aimed at the general reader, but useful for all.
• Trauma and Recovery: The Aftermath of Violence - From Domestic Abuse to Political Terror
  Judith Herman 2nd Ed. 2022
  Basic Books
  An important work in our understanding of trauma.  Well written with the voices of people with lived experience throughout.
• Breaking Free: Help for survivors of childhood sexual abuse
  Kay Toon and Carolyn Ainscough
  Sheldon Press 4th Edition (2022)
  The books has helped thousands of people who have suffered with childhood sexual abuse. It’s well written and put together by two clinicians who have helped people with their trauma. 
• Trauma is really strange
  Steve Haines
  Singing Dragon; Illustrated Edition (2015)
  This is an excellent self-help book that uses artwork to tell the story of trauma and help make sense of it. It is easy to understand and well informed. There are other titles in this series that you can find online. 
• Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists
  Suzette Boon, Kathy Steele and Onno van der Hart
  Published by W. W. Norton & Company (2011)
  Helpful detail on understanding and managing disconnection and dissociation. 
• 8 Keys to Safe Trauma Recovery: Take-Charge Strategies to Empower Your Healing (8 Keys to Mental Health)
  Babette Rothschild. W.W. Norton (2010) 
• Recovering from PTSD
  Martina Mueller
  Oxford Cognitive Therapy Centre
  This booklet offers trauma survivors tried and tested tools to help them  recover from PTSD. The methods explained here can be used alone or with help from a friend or therapist.  
• Overcoming Trauma through Yoga; Reclaiming Your Body
  David Emerson and Elizabeth Hopper
  North Atlantic Books (2012)
  How we might approach our trauma using trauma sensitive yoga. 
• Post traumatic stress disorder: the invisible injury
  David Kinchin
  Success Unlimited (2004)
  A former sufferer of PTSD, David Kinchin tells his story and those of ten others. He describes what it is like to suffer from PTSD and explains all the complications the disorder can include. He gives advice on treatments and seeking help. 
• Understanding your reactions to trauma: a guide for survivors of trauma and their families (2nd revised edition)
  Claudia Herbert
  Blue Stallion (2002)
  This guide has been written to help you understand what goes on when you have been in a trauma and how to get over it. 
• At War with Yourself: A Comic about Post-Traumatic Stress and the Military
  Samuel C. Williams
  Jessica Kingsley Publishers (2016)
  In this illustrated conversation between the author and his friend, Matt, they talk candidly about Matt's struggles with PTSD. This comic will offer support and understanding to anyone who has been affected by PTSD. 
   

• www.franticworld.com – Mindfulness: Finding Peace in a Frantic World – Free meditations and mindfulness resources.
• www.headspace.com – A free taster of mindfulness, with an opt-in to buy further sessions.
• www.freemindfulness.org – A collection of free to download meditations.

• www.cntw.nhs.uk/relaxation
• www.wellbeing-glasgow.org.uk/relaxation
   

A full list of references is available on request by emailing pic@cntw.nhs.uk

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Original guide written by Dr Lesley Maunder and Lorna Cameron, Consultant Clinical Psychologists

The guide was reviewed in 2024 by Dr Kevin Meares, Consultant Clinical Psychologist in Trauma and Tatiana Kishka, Senior Clinical Psychologist, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust has developed this resource with the support of NHS
healthcare staff, service users and local voluntary sector groups.

Published by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

2024 Copyright PIC/99/0324 March 2024 V5

Review date 2027