Effective Management of Psychological Trauma

What is Trauma?
Most Australians will be exposed directly or indirectly to at least one potentially traumatic event (PTE) in their lifetime (Nursey, Lau, & Forbes, 2016). PTEs can be one-off events, such as a home or workplace accident, physical or sexual assault, a natural disaster, act of terrorism, or repeated or persisting events such as domestic violence, childhood abuse or neglect, military and emergency services work or refugee and war experiences (Nursey et al., 2016). The emotional impacts often include feelings of fear, shame, guilt, terror, anger, numbness, powerlessness or hopelessness (DSM-5).
For most people, the intense emotional distress dissipates within a number of weeks. However some will experience ongoing distress and potentially develop a trauma-related mental health condition such as posttraumatic stress disorder (PTSD), depression, an anxiety disorder or a substance use disorder (Nursey et al., 2016). People who experience repeated trauma, and those who suffer ongoing abuse are at higher risk of adverse physical, mental health, and social impacts (Nursey et al., 2016).
The Role of Clinical Psychologists in Managing Trauma Impact:
Within the context of trauma management, the role of a clinical psychologist is to: (a) recognise the signs of trauma impact, and (b) be aware of the best practice approaches to supporting people who may present at different time points along their post trauma recovery process.
The role of clinical psychologists in managing trauma impact is to provide information, psycho-education, and emotional support. Such an approach may assist the client in understanding ways to manage distress. The clinical psychologist is responsible for monitoring clients who maintain significant distress or are at risk of developing a trauma-related mental health disorder.
Strategies for Managing Trauma-Related Distress:
The strongest evidence base in the treatment of trauma related mental health concerns exists for Cognitive Behavioural Therapy (CBT). CBT is a model of psychological treatment routinely used to assist individuals in managing the distress associated with various mental health disorders. Within this framework, a range of strategies in the physical, cognitive and behavioural domains may be utilised.
Physiological arousal is a fundamental feature of traumatic stress. Physically oriented strategies are an ideal starting point while the individual is still feeling vulnerable, as they not only produce rapid results but also are easy to learn. Regular exercise, dietary improvements (including reduction in stimulants such as nicotine and caffeine) and getting enough rest can do much to reduce arousal. A simple controlled breathing strategy (e.g., observing the in and out breath) is also a good first step.
The use of cognitive strategies may also provide some degree of control over intrusive memories and rumination. It is important for the individual to feel a sense of control over the thoughts such that they do not dominate every waking hour. Distraction techniques can be used both to reduce arousal and to control intrusive memories. Anything from counting backwards from 100 in 5s to describing current surroundings in intricate detail can be helpful. Involvement in more organic activities such as art, crafts and other creative activities will be most helpful in that they require a person’s full attention, which is helpful for neutralising unhelpful thoughts.
Guided self-dialogue is also an important strategy for managing strong emotions. Preparing coping statements may be useful when approaching the situation (e.g., ‘don’t focus on how I feel: think about what I can do about it’), entering the situation (e.g., ‘one step at a time, I can handle this’), coping with feelings of anxiety and distress as they arise (e.g., ‘I expect my fear to rise, but I can manage it through breathing’), and positive reinforcement after the event (e.g., ‘I did it – I got through it; each time it will be easier’). Statements relating specifically to the trauma are also useful (e.g., ‘I am safe now’).
Behavioural strategies usually involve scheduling activities and structuring a daily routine. Resuming a ‘normal’ routine (i.e., the routine of an individual prior to the traumatic event) as quickly as reasonably possible following a trauma is often beneficial. Pleasant activities should also be incorporated into a daily plan, as the effects of trauma are likely to produce loss of interest and a lack of motivation. Undertaking activities with family and friends will assist in reducing social withdrawal and maintaining healthy relationships.
Nursey, J., Lau, W., & Forbes, D. (2016). Management of psychological trauma across service settings and contexts. InPsych, (38), 30-31. Melbourne: Australia.