IO 20 Trauma and PTSD Guide v2.2

An Essential Guide
to Trauma and PTSD
lettheinsideout.com
An Essential Guide to Trauma and PTSD 2
Introduction
Many of us will experience a traumatic event at some point

in our lives. The recent events surrounding the COVID pandemic and now
the war in Ukraine, can be described as ‘traumatic’ for those directly or
indirectly affected by them. With time, most people can recover fully
from their experiences without needing professional help. However, for
a significant proportion of people, the effects of trauma last for much
longer and can develop into a condition called post-traumatic stress
disorder (PTSD). It is thought that between 3 and 5 people out of every
100 will experience PTSD every year[1]. Fortunately, there are a range of
excellent psychological therapies to treat PTSD.
This guide will help you to understand what PTSD is, why it might not
get better by itself and what evidence-based treatments for PTSD are
available.
Copyright © InsideOut 2022

1
Defining Trauma

Defining trauma
We may go through life events that we find stressful, overwhelming,

threatening, frightening, or out of our control. Sometimes, our response
to such events can cause trauma. Trauma is an emotional response to a
situation that we find difficult to cope with.
Common traumas include: Other causes of trauma include:

• Being in a life-threatening situation, such • Global health pandemics e.g. Covid-19
as a war and civil unrest, a natural disaster, • Childbirth, including pregnancy loss
or a health emergency • Death of a loved one
• Being the victim of violence, such as being • Physical illness or injury
physicaly or sexually asaulted, imprisoned • Verbal domestic abuse
or tortured
• Being in an accident, such as a road traffic
accident, or an accident at work
• Witnessing violence towards another
person, or witnessing death.
Some traumas are isolated one-off events that are unexpected and happen ‘out of the blue’.
Other traumas are frightening in different ways: they are expected, anticipated and dreaded.
Some people’s jobs expose them to trauma, for example military or emergency service
personnel often experience, or witness distressing events. Children can experience trauma too.
The effects can be even more profound and long-lasting if the people who were supposed to
care for them were responsible for causing harm.

2
Understanding the different

Trauma response levels


1. Acute Stress Response

Symptoms usually develop quickly over minutes or hours in reaction to a highly stressful or
traumatic event. The symptoms usually settle fairly quickly but can sometimes last for several
days or up to 6 weeks. Symptoms of acute stress reactions may include the following:
Psychological symptoms such as: Physical symptoms such as:

• Anxiety, low mood, irritability, emotional • A ‘thumping heart’ (palpitations)
ups and downs, poor sleep, poor • A feeling of sickness (nausea)
concentration, wanting to be alone • Chest pain
• Recurrent dreams or flashbacks, which • Headaches
can be intrusive and unpleasant • Abdominal pains
• Avoidance of anything that • Breathing difficulties.
will trigger memories (people,
conversations, or other situations)
• Reckless or aggressive behaviour
that may be self-destructive
• Feeling emotionally numb and
detached from others


2. Post-traumatic Stress - (PTS)

PTS is a common response to experiencing a traumatic or stressful event. Common but
unexpected occurrences, like car accidents, where there is risk of harm, injury or death to
yourself or a significant other, can trigger PTS. More rarely, threats of abduction, aggressive
confrontations and witnessing or hearing about traumatic scenes can also cause PTS. A person
who experiences acute stress symptoms listed above, which persist for longer than 6 weeks
after a traumatic event, can be described as having post-traumatic stress response. The
symptoms have to include flashbacks or nightmares to be diagnosed with PTS.
The symptoms will overlap with those of acute stress response and PTSD, but may
resolve within 6 months and may not cause the same level of functional impact across
areas of the sufferer’s life.
3. Post-Traumatic Stress Disorder – (PTSD)

It is normal to be affected by traumatic experiences. If you have been through a trauma you
might feel shocked, scared, guilty, ashamed, angry, vulnerable or numb. With time most people
recover from their experiences, or find a way to live with them, without needing professional
help. However, for many people the effects of trauma last for much longer and may develop into
post-traumatic stress disorder (PTSD). Symptoms may continue to be present or escalate after
the acute stress response period has passed and for a smaller group of people, the symptoms
may be absent and appear after 6 months.
Symptoms of PTSD can be split into groups which relate to cognitions, intrusions,
emotions and behaviours [2]. People with PTSD describe having negative thoughts and
mood, re-experiencing what happened, hyper-arousal, hyper-vigilance and avoidance
of situations or circumstances that cause reminders. The next section explores causes
and risk factors for PTSD.


4. Complex PTSD – (CPTSD)

Research has shown that the kinds of symptoms that survivors of trauma have differ
depending on the level of trauma that a person has experienced. A bigger ‘dose’ of trauma
tends to result in more complex symptoms. In addition, the type of trauma e.g. interpersonal
trauma (trauma deliberately inflicted by another human being) tends to have more complicated
effects compared to trauma that occurs as the result of accidents.
The time, or stage of life when the trauma happens, can be significant. Trauma that is
experienced earlier in life can have significant effects upon what happens to you later on.
People who experienced a lot of trauma, have experienced trauma early in their lives, or have
experienced trauma as a result of things that were done by their parents or caregivers, often
have extra symptoms in addition to PTSD. For example, some people who have PTSD may also
be diagnosed with Emotionally Unstable Personality Disorder (EUPD), as the symptoms often
overlap.
CPTSD symptoms can include:

• Severe problems in managing your emotions. Psychologists call
this a problem of ‘affect regulation’ or ‘emotion regulation’
• Strong beliefs about yourself as diminished, defeated, or worthless.
These might be accompanied by deep feelings of shame, guilt,
or failure related to your traumatic experiences
• Difficulties in sustaining relationships and in feeling close to others. This
makes sense if you have experienced trauma at the hands of others.
When people experience these symptoms as well as PTSD, mental health professionals
might label it Complex PTSD [3, 4].

3
Identifying the Causes and

Risk Factors for PTSD

Identifying the Causes and

Risk Factors for PTSD
The main cause of PTSD and Complex PTSD is being exposed to traumatic,
life-threatening or frightening events. It is important to note that not
everybody who experiences a trauma goes on to develop PTSD. If you
think you may be currently suffering from it, or have done in the past, it
certainly does not mean you are weak or have done anything wrong.
The level of support you receive directly after the traumatic event can influence whether you
go on to experience PTSD and if so, to what degree. Psychologists have found that people with
higher levels of social support are less likely to develop PTSD following a trauma. If you have
people to talk to, with whom you can make sense of and accept that a trauma happened, it can
act as a ‘protective shield’ from the effects[5].
Another risk factor is the way

your brain processes memories
of your trauma.
Memories in PTSD are different from ‘normal’

memories. They are usually much more vivid
and intense and have the ability to ‘trick’ you
into thinking that the trauma is happening
again, even many years after the trauma
is over[6]. Scientists think that there are
differences in the way that your brain encodes,
stores, and retrieves trauma memories, which
mean that some people are more likely to
develop PTSD than others[7].
There is also some evidence that genetic

and biological factors can influence who
develops PTSD following a trauma. For
example, some psychologists argue that
the size of the hippocampus and amygdala
(highlighted in blue and red respectively in
the diagram) is thought to influence whether
trauma memories cause you to develop PTSD[5].

4
Combatting long-term
effects of PTSD

Combatting long-term effects of PTSD
By working out what factors contribute to keeping problems going, we can

use we can use self-help or treatments to break this vicious maintenance
cycle. Psychologists Ehlers and Clark researched what it is that causes PTSD
to endure. They focused on understanding why people with PTSD feel a
current sense of threat even though the terrible thing has already happened.
The three main reasons identified were[8]:

• Unprocessed memories
• Beliefs about trauma and its consequences
• Coping strategies, including avoidance
Thoughts / Images / Memories
Any reminder of the trauma
Feelings
Anxiety, terror, anger

Relief
Physical sensations of
Short term… adrenaline response
Re-experience all the

feelings of that time
Behaviour
Escape the situation
Avoid the triggers

In order to accept aspects of the trauma we often try to make sense of what has happened to
us. You will have beliefs about yourself, what you or others involved did and what others might
think of you. If you have PTSD, your beliefs might keep you feeling threatened. Your memories
of the trauma can be so strong that they make you believe the danger is still present. You might
blame yourself for things that are not your fault. You might think that the symptoms of PTSD
mean that you are unable to cope and are “losing your mind”.
Psychologists think that memories of traumatic events are processed and stored in the brain
differently to non-traumatic memories. The result is that memories of your trauma can enter
into your mind uninvited while you are awake or asleep. They may be vivid and emotionally
powerful. They may make you think and feel that the trauma is happening again right now,
and that you are in danger.
How PTSD overlaps with depression and anxiety
Despressed mood
most of the day
Exposure to trauma
Markedly diminished Substance use

Po
Nightmares and
r
interest or pleasure
rde
st-T
problems sleeping
Recurrent suicidal
epressive Diso
raum
Weight gain or loss ideations

when not dieting Avoidance of trauma-related
stimuli after the trauma
atic Stress D
Negative thoughts
Psychomotor agitation or feelings
or retardation Re-experiencing of the
traumatic event
jor D
Significant distress or
Diminished ability to social impairmements
i
a
Flashbacks
s
think or concentrate
M
orde
Anxiety
r
Manic or hypomanic episodes Trauma-related arousal

and reactivity
Fatigue or loss of energy

The trauma memories of people who have PTSD have some unique qualities.
These include:
• Feeling like they are happening right now • They are especially detailed and vivid.
in the present moment. Psychologists You might re-experience trauma
sometimes call this ‘nowness’ memories in any of your senses:
• They are intrusive and involuntary. sight, sound, touch, smell or taste
They pop into your mind unexpectedly • They are often fragmented. You might
and are unwanted. They are easily only remember parts of the trauma,
triggered by things around you or even just an image or a feeling.
Psychologists think that trauma memories have these special properties because your brain
did not have a chance to ‘process’ and store them properly at the time[7]. Until your brain has
completed the job of ‘processing’ your trauma memories, you might continue to suffer from
re-experiencing symptoms.
Some psychological theories say that the way we think and act affects the way we feel.
Strong events, like traumas, can produce equally strong beliefs, which result in strong feelings.
Psychologists believe that one of the most important jobs of trauma therapy is working with
the meaning that you made of your trauma[9].
As always, it is important to talk and open up about how you are feeling and what you have
experienced. The sooner you do, the less likely you are to experience PTSD. Journaling, drawing
and writing may also help lessen symptoms. That said, you should always seek professional
support if you feel you or someone close to you is experiencing PTSD. Signposting channels
are available at the end of this guide.

5
Understanding how
PTSD is diagnosed

Understanding how PTSD is diagnosed
A diagnosis of PTSD can only be confirmed by a specialist mental health

professional, a GP, or a psychiatrist. However, answering validated
screening questions can give you an idea of whether you might find it
helpful to have a full professionally administered assessment.
First ask yourself this
Have you ever experienced something unusually or especially

frightening, horrible or traumatic?
If you answered yes, now think about whether, in the last month, you have
had flashbacks (triggered by your 5 senses — sight, smell, sound, touch
and taste) or nightmares? If you have answered yes to both questions, you
can check if you might have PTS or PTSD by doing this online tool, ‘Impact
of Events Scale’.[9] If you score 33 or above, you may wish to speak to your
GP, healthcare professional or a mental health professional about how you
are feeling. We have included a copy in the appendix if you would prefer
to print a copy to do this today.
To diagnose PTSD, doctors and healthcare professionals will use The

Diagnostic Statistical Manual (DSM)[10].This diagnostic guide lists a set of
criteria from A to H (see below). The healthcare professional will ask a
series of questions and will use the answers you provide
to diagnose whether or not you have PTSD.

To diagnose PTSD, doctors and healthcare professionals will use The

Diagnostic Statistical Manual (DSM)[10].This diagnostic guide lists a set
of criteria from A to I (see below). The healthcare professional will ask
a series of questions and will use the answers you provide to diagnose
whether or not you have PTSD.
A. A Stressor or Trauma Has Occurred C. Avoidance Behaviours

One or more of the events must have A normal human way of dealing with physical
occurred either: or emotional pain is to avoid it, or to distract
1. directly to the person, or ourselves. When you have PTSD you might try
2. they witnessed it directly, or to avoid people, places, or any other reminders
3. they heard a close relative or friend of your trauma. You might try very hard to
was exposed to the trauma, or distract yourself in order to avoid thinking
4. the person is indirectly exposed about what happened.
to the details of the trauma —
through their occupation or seeing / Avoidance symptoms include:
hearing it via the media. • Avoiding reminders of the trauma
• Trying not to talk or think
B. Re-experiencing about what happened
Re-experiencing the trauma means that • Feeling ‘numb’ or like you have no feelings.
memories of the event play over and over in
your mind. These memories can come back as D. Negative thoughts and mood.
‘flashbacks’ during the day, or as nightmares at Trauma has a powerful effect on how we think.
night. The memories can be re-experienced in Many people with PTSD blame themselves for
any of your five senses – you might see images what happened, even when it was not their
of what happened, or experience sounds, fault. They might replay parts of the trauma
smells, tastes, or body sensations associated and think “what if …?”, or “if only …”. Many
with the trauma. Emotions from the trauma people with PTSD also experience depression.
can also be re-experienced and trauma
survivors say that it can feel as though the Negative thoughts and low mood
events are happening over and again. related to the trauma might include:
• Thinking negatively about yourself
Re-experiencing symptoms include: • Feeling guilty or ashamed about what
• Upsetting memories of the event happened or blaming someone else
intruding into your mind • Feeling helpless or withdrawn
• Having nightmares about the event • Feeling that no-one can be trusted.
• Feeling physical reactions in your body
when you are reminded of the event
• Dissociation and feeling disconnected
from the present moment.
E. Hyper-Arousal G. Disorder
In relation to excessive nervous system arousal There is significant impairment of social,
symptoms, it is common to feel ‘on edge’ or occupational or relational functioning.
‘on guard’. For people who have PTSD, these
feelings tend to persist for even longer than H. Exclusion of other causes
normal. You might find it very difficult to Symptoms are not caused by medication,
relax, or find that your sleep is affected. substance or other illness,
Hyper-arousal symptoms include: I. Specific Dissociation Sub-Types

• Always looking out for danger. There are two specific sub-types of this PTSD
Psychologists call this ‘hypervigilance’ symptom category that can be diagnosed.
• Feeling ‘on edge’ or easily startled
• Having difficulty falling or staying asleep PTSD with dissociation is diagnosed
• Having difficulty concentrating. and sometimes referred to as
complex PTSD, if one of these types
F. Duration & Onset of dissociation symptoms occurs:
Symptoms last longer than 1 month. For 1. Depersonalisation - feeling of
some people the PTSD starts within weeks. being an outside observer of
In the case of delayed on-set PTSD the yourself, like being in a dream.
symptoms remain dormant for 6 months or 2. Derealisation - experience of unreality as
more (sometimes years) before appearing though things are distorted or unreal.

6
Living with PTSD:

Case Study Examples

Living with PTSD: Case Study Examples
Word of warning
Some people find that reading about other people’s trauma can be
upsetting, so feel free to skip this section until a time comes when
you feel more able. Remember, though, that learning about trauma
cannot harm you — it is the first step in overcoming PTSD.
People with PTSD experience strong unwanted memories of their

trauma, to the point where it can feel as though the trauma is
happening again right now in the present moment. As a result,
people with PTSD often feel on-edge and on the lookout for danger.

Case study
…I couldn’t keep eye

contact. I had to know
what was happening
…My mind seemed to around me…
switch off when I needed
it most…
…Sometimes I would
…Everyday
become so angry.
felt surreal…
Why did this have to
happen to me?…
…I felt like I was
watching from the
sidelines…
…I felt like I was …It was

watching things as though I
from above… wasn’t there…
…time was
standing still…
…My legs would

…I was so start to tremble
tired all of and giveway…
the time…

Case study
Jared, 45
Jared was diagnosed with delayed

onset PTSD 9 months after a
(no fault) car accident where his
young son had been seriously injured.
I was incredibly nervous the first time I sought help for my PTSD. I was
really doing it for my family and didn’t see how talking would help, but
when I spoke to my counsellor and met other people with my diagnosis, I
realised I wasn’t the only one. My counsellor taught me how to relax when
I got scared or angry, and gave me the tools to deal with everyday life. I
was then referred to an EMDR specialist where we started talking about
what happened. Mapping out my trauma events was really hard to start
with, but it got easier after a while. While we were doing the eye-movement
treatment, I talked a lot about the flashbacks I was having and how that
made me feel angry. We worked on resolving or accepting some of the
unanswerable questions that had been plaguing me, such as: How could
this have happened to me? Why couldn’t I sleep? Why couldn’t I stop the
nightmares and thinking about the accident, the burning wreckage and the
chaos of the aftermath? These were not the kind of questions I could talk to
my friends or partner, about, but it felt good talking to someone about it and
each time we used talking therapy and EMDR, my distress began to drop
away. It’s been a difficult road for me and my family, but the treatment has
worked and at last my future is looking brighter.

Case study
Deb, 35
Deb, is a 35-year-old Afghanistan war

veteran, who had been experiencing
PTSD symptoms for many years after
witnessing the death of her comrade
who had stepped on a mine.
I constantly went about avoiding all the triggers I could like any images
related to the army, and warzones. I came off social media and was not
watching the news. Even then I was really badly disturbed by a repeating
nightmare where I could see the trauma again and again from various
angles as though it was through a drone. Over the years, I became
extremely withdrawn and began using alcohol on a daily basis to help mask
the PTSD symptoms. I was so exhausted from lack of sleep and rest that I
missed many days off work and lost my first civvy job. I also felt very numb
around my wife and disconnected from the loving feelings I had before.
When my wife Lynn told me I was having many night terrors, where I would
call out and thrash around in my sleep, I knew it was time to get help.
Deb was able to use a combination of medication to help her sleep,

Trauma-Focussed CBT to desensitise her from triggers and reduce
her alcohol consumption, and Art Therapy to assist her in reaching
some closure around the horrors she had witnessed. Part of this
required her to relinquish her feelings of self-blame and accept
there was nothing she could have done to prevent it.

7
Unhelpful Coping Strategies:

Safety Behaviours

Unhelpful Coping Strategies:

Safety Behaviours
Avoidance is a natural response to things that we find anxiety

provoking and upsetting, but that doesn’t mean that it is helpful.
People with PTSD tend to avoid things such as:
Avoiding your memories of the trauma

(which means they stay ‘unprocessed’)
Avoiding reminders of the trauma
Using alcohol or other substances to

block out memories or feelings
Not talking about what happened.
Although these choices can feel helpful in the short-term, it means that
your trauma memories don’t get a chance to be ‘processed’, and your
negative beliefs about your trauma don’t tend to change. Here, your safety
behaviours only offer you very short-lived bursts of perceived safety
and do not address the underlying cause. In the next section, we have
detailed how our “BEST-SELF”© model offers you plenty of healthy ways
of recovering from PTSD.

8
Treatments for PTSD

Crisis Support
Word of warning
If you or anyone you know is in a crisis or immediate danger related

to PTSD, please call emergency services, or help get them to the
nearest A&E department.
For urgent psychological support

in the UK, please call one of the
numbers here:
Samaritans Mind
􀌾 116 123 􀌾 0300 123 3393
The Samaritans are available 24 hours a The team at Mind (mind.org.uk) provide
day, 365 days a year. If you need a response information on a range of topics including:
immediately, it’s best to call them on the types of mental health problems, where
phone: 116 123. Alternatively, writing an email to get help and medication and alternative
can be a calm and safe way to work through treatments. They will look for details of help
what’s on your mind. Especially if it feels and support in your own area. The lines are
too upsetting to talk about on the phone. open 9am to 6pm, Monday to Friday (except
Samaritans volunteers answer each email that for bank holidays)
comes through to jo@samaritans.org.
ASSIST Trauma Care
Shout 􀌾 01788 551919
􀪳 CONTACT to 85258 􀤆 assisttraumacare.org.uk
A free, confidential, 24/7 text messaging Experienced therapists who are trained to
support service for anyone who is struggling work with Post Traumatic Stress Disorder
to cope. Shout launched publicly in May (PTSD) and the after-effects of trauma in line
2019 and they have had more than 500,000 with current evidence-based practices. If you
conversations with people who are anxious, or a member of your family have experienced
stressed, depressed, suicidal or overwhelmed a traumatic incident and would like to discuss
and who need immediate support. whether therapy from ASSIST can help you.

Self Help
If the symptoms are brief (less than 14 days), acute stress episodes
are best managed by watchful waiting and self-care.
Mind – PTSD and Complex PTSD PTSDUK.org
If you are worried that you or This is also a great website

someone you know might have any resource that you can visit for
of the trauma responses you have information about accessing
read about here, you might benefit treatments and support for any
from reading this information of the symptoms or conditions.
leaflet by the charity Mind.
Please see the appendix (p.32)

for a self-help tool to aid you in
capturing and making sense of
and intrusive thoughts or images.

InsideOut’s BEST-SELF© Model
Understanding the links between our physical, nutritional, environmental,

financial and psychological health allows for a proactive and preventative
approach to be taken to managing our wellbeing.
Bio
Eco
SELF
T3
S o cio
At InsideOut we use our proprietary BEST-SELF© model to help you

consider the holistic components that can contribute to enhancing your
recovery from mental illnesses such as PTSD. Visit the InsideOut App to
access self-help tools.

Psychological Therapy Treatments
If PTS symptoms persist for longer than two • Work to change meanings
weeks, trauma debriefing may be helpful to This means examining how you made
prevent escalation to a more chronic level sense of what happened to you and seeing
of distress. However, if PTSD symptoms whether these perspectives are fair or
last for longer than 6 weeks and impair the helpful. Research into trauma-focused
functioning of the sufferer, professional help therapies shows that if we can change the
should be sought. There are several, evidence- meaning of the trauma, we can change how
based, psychological and psychotherapeutic we feel [15, 17, 18].
treatments which can be highly beneficial.
• Reduction of unhelpful coping strategies
These include: Reducing avoidance helps you to challenge
• Cognitive Behavioural Therapy (CBT) unhelpful beliefs, gain new ‘data’ to
Trauma-focused CBT[12,13] reappraise your ability to cope and to begin
• Eye Movement Desensitisation and reclaiming your life.
Reprocessing (EMDR)[12]
• Cognitive Processing Therapy (CPT)[13] Any of the treatments that are effective
• Prolonged Exposure (PE)[13] for PTSD are also effective for people with
• Narrative Exposure Therapy (NET)[14] Complex PTSD.
Although the specifics of these therapies differ Whilst there is a less substantial research body
slightly, they all contain similar components: on creative therapies for trauma treatment,
some people find these more creative
• Exposure to memories techniques are helpful, especially if they
Trauma therapists sometimes call this struggle to talk about the trauma. Techniques
‘trauma memory processing’. Almost all developed for trauma work with children can
evidence-based treatments for PTSD also benefit adult PTSD sufferers too. Art
include at least some talking about (or Therapy should be delivered by a registered
facing) what happened to you, although professional but many other therapists are
they can differ in terms of how this is done. skilled in techniques such as narrative therapy,
It is suggested that exposure may allow sand tray work and empty chair work which
“aspects of the trauma to become clearer, may also be helpful techniques.
new pieces of the puzzle may emerge, and
new perspectives may be gained” At the
same time the flashbacks and nightmares
become less frequent and the distress they
cause diminishes[15].

Medical Treatments for PTSD
The UK National Institute of Health and Care Excellence (NICE) guidelines for PTSD[12] found
that there is evidence that an antidepressant class of medications called selective serotonin
re-uptake inhibitors (SSRIs) e.g. sertraline and other types, such as venlafaxine, are effective
in treating PTSD. However, these medications are less effective than psychological treatments
and the NICE guidelines recommend that they should not be offered as a first-line treatment
for PTSD. The NICE guidelines also found some evidence that antipsychotic medication may be
helpful as an adjunct to psychological therapy in some cases, e.g. where there are dissociation
episodes. Some people find that medications prescribed to help with sleep can alleviate
nightmares and the associated exhaustion from lack of quality sleep.
Medication can be taken on its own to alleviate symptoms, however there is evidence that it
is most effective when used in combination with talking therapies. Taking medication alone
is like putting a plaster on a deep physical wound. If you take the plaster off, it may need to
start healing all over again. Talking therapy helps to process the trauma, be free of/minimise
symptoms and find a way towards a happy and positive future.
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8. Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. 17. Kleim, B., Grey, N., Wild, J., Nussbeck, F. W., Stott, R., Hackmann, A., … & Ehlers, A.
Behaviour Research and Therapy, 38(4), 319-345. (2013). Cognitive change predicts symptom reduction with cognitive therapy for
9. Impact of Events Scale - Tehrani, N., Cox, S. J., & Cox, T. (2002). Assessing the posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 81(3),
impact of stressful incidents in organizations: the development of an extended 383.
impact of events scale. Counselling Psychology Quarterly, 15(2), 191-200. 18. Gallagher, M. W., & Resick, P. A. (2012). Mechanisms of change in cognitive
10. DSMV - American Psychiatric Association, D. S., & American Psychiatric Association. processing therapy and prolonged exposure therapy for PTSD: Preliminary evidence
(2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). for the differential effects of hopelessness and habituation. Cognitive Therapy and
Washington, DC: American psychiatric association. Research, 36(6), 750-755.

Appendix: Impact of Events Scale

Below is a list of comments made by people after stressful life
events. Please check each item, indicating how frequently these
comments were true for you during the past seven days.
Not at all A little bit Moderately Quite a bit Extremely
1 Any reminder brought back feelings about it 0 1 2 3 4
2 I had trouble staying asleep 0 1 2 3 4
3 Other things kept making me think about it 0 1 2 3 4
4 I felt irritable and angry 0 1 2 3 4
I avoided letting myself get upset when

5 0 1 2 3 4
I thought about it or was reminded of it
6 I thought about it when I didn’t mean to 0 1 2 3 4
7 I felt as if it hadn’t happened or wasn’t real 0 1 2 3 4
8 I stayed away from reminders about it 0 1 2 3 4
9 Pictures about it popped into my mind 0 1 2 3 4
10 I was jumpy and easily startled 0 1 2 3 4
11 I tried not to think about it 0 1 2 3 4
I was aware that I still had a lot of feelings

12 0 1 2 3 4
about it, but I didn’t deal with them
13 My feelings about it were kind of numb 0 1 2 3 4
14 I found myself acting or feeling like I was back at that time 0 1 2 3 4
15 I had trouble falling asleep 0 1 2 3 4
16 I had waves of strong feelings about it 0 1 2 3 4
17 I tried to remove it from my memory 0 1 2 3 4
18 I had trouble concentrating 0 1 2 3 4
Reminders of it caused me to have physical reactions, such

19 0 1 2 3 4
as sweating, trouble breathing, nausea, or a pounding heart
20 I had dreams about it 0 1 2 3 4
21 I felt watchful or on-guard 0 1 2 3 4
22 I tried not to talk about it 0 1 2 3 4
Total

Appendix: Intrusive image and thought tracker

Practice noticing the moment and our coping strategy helps us figure out what emotions or
feelings we are disconnecting FROM, and what different coping strategies we might try instead.
Situation / Units of distress What was the intrusion Coping strategy/

Trigger/ Cause Reaction
0–10 (0: none, 10: worst) (Event, feelings, thoughts, (Behavioural strategies,
body reaction) thoughts, feelings, analysis
of the situation)
Flashback to the time I was

robbed; became nauseous; Left, knocked someone over
Walked down a dark alley 7 tingling in my hands and arms; on the way out by accident;
felt “on alert”; anxious; wanted felt guilty; felt like a failure.
to turn around and leave.

Appendix: Intrusive image and thought tracker
Notice any patterns? Overall themes based What can you

on the patterns learn from this?
I don’t deal well with feeling anxious

Environment triggers me; I feel
and I beat myself up for this. I feel
Being out alone triggers me; dark spaces alone and vulnerable; this never
guilty about my reactions more than
trigger me; I have always left/escaped. triggers when I am with someone else;
the actual event that first happened.
My body reacts very strongly. I feel overwhelmed very quickly;
If I can react differently I might be
I don’t like feeling anxious.
able to get it under control

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An Essential Guide

to Trauma and PTSD

Many of us will experience a traumatic event at some point

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We may go through life events that we find stressful, overwhelming,

Common traumas include: Other causes of trauma include:

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Understanding the different

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Understanding the different

1. Acute Stress Response

Psychological symptoms such as: Physical symptoms such as:

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Understanding the different

2. Post-traumatic Stress - (PTS)

3. Post-Traumatic Stress Disorder – (PTSD)

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Understanding the different

4. Complex PTSD – (CPTSD)

CPTSD symptoms can include:

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Identifying the Causes and

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Identifying the Causes and

Another risk factor is the way

Memories in PTSD are different from ‘normal’

There is also some evidence that genetic

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Combatting long-term effects of PTSD

By working out what factors contribute to keeping problems going, we can

The three main reasons identified were[8]:

Any reminder of the trauma

Anxiety, terror, anger

Re-experience all the

Escape the situation

Avoid the triggers

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Combatting long-term effects of PTSD

How PTSD overlaps with depression and anxiety

Markedly diminished Substance use

Weight gain or loss ideations

Manic or hypomanic episodes Trauma-related arousal

Fatigue or loss of energy

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Combatting long-term effects of PTSD

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Understanding how PTSD is diagnosed

A diagnosis of PTSD can only be confirmed by a specialist mental health

First ask yourself this

Have you ever experienced something unusually or especially

To diagnose PTSD, doctors and healthcare professionals will use The

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Understanding how PTSD is diagnosed

To diagnose PTSD, doctors and healthcare professionals will use The

A. A Stressor or Trauma Has Occurred C. Avoidance Behaviours

Understanding how PTSD is diagnosed

Hyper-arousal symptoms include: I. Specific Dissociation Sub-Types