Major Trauma Psychology Service

Common early reactions to trauma

We never expect to witness, or be part of, a sudden accident, incident, or major disaster. In the days and weeks that follow, you may experience unfamiliar emotions and physical reactions due to shock. These can include acute stress symptoms, such as repeated and distressing flashbacks to the event, disturbing dreams or nightmares, low mood, or heightened anxiety.

These symptoms can be intense, confusing, and frightening. We can help you understand these acute stress reactions and find ways to manage these whilst you are in hospital. It is important to remember that after a traumatic event, it is normal to experience these early reactions to trauma and they usually fade with time.

However, some people may develop longer-term reactions such as post-traumatic stress disorder (opens in a new tab) or depression (opens in a new tab). If your symptoms last for more than one month after the incident, it is important to seek further advice. The good news is that persistent symptoms can be treated with evidence based talking therapies and/or medication. You may also want to watch the below video on understanding acute stress.

See our service leaflet (opens in a new tab) to find out more on common reactions to trauma.

Understanding acute stress following trauma - Barts Health NHS Trust

Link: https://youtu.be/fevM72cNaLM?si=dXlE-tmUISx6Pg1Y

How we can help

While you're in hospital (inpatients)

While you are in hospital, we can visit you at your bedside. We provide information about psychological reactions to trauma and advice about how to manage any psychological symptoms you may be having.

The first meeting will involve finding out about you and how you are currently managing. We will also ask about any mental health difficulties or treatment you may have had in the past. We understand that it can be difficult to answer some of these questions, especially in a ward environment. Any information you feel comfortable sharing helps us understand how we can best support you. At the end of this meeting, we will provide you with a summary of our conversation and discuss what support we can offer. This might involve seeing you again in the hospital, providing you with signposting information, or arranging a follow-up appointment in our outpatient clinic after you have been discharged. If you are already under an existing mental health service, we will aim to link you back with this team in the first instance.

Your first inpatient psychology appointment will usually last for around an hour. Subsequent appointments are likely to be shorter. The duration of all appointments will depend on how you are feeling. We can take breaks or meet later if needed.

If you would like to speak to us during your admission, please ask your trauma nurse or ward staff to make a referral to the Adult Liaison Psychiatry Team.

When you are at home (outpatients)

Where possible and appropriate, we may offer follow up appointments in our outpatient clinic after discharge. In some instances, we may not be able to offer an outpatient follow-up appointment but can provide signposting information instead.

If we saw you in hospital, and arranged an outpatient follow-up, this meeting will focus on how you have been coping since you got home and any challenges you are facing now. If we did not see you whilst you were in hospital but are meeting you for the first time as an outpatient, we will complete a full assessment. This will include asking about current difficulties, how things were prior to your hospital admission and about any mental health difficulties or treatment you have had in the past.

In both cases, we will ask you to complete some online questionnaires. These ask about your current mood, levels of anxiety and post-traumatic stress symptoms. Your answers help us understand the severity and impact of your symptoms.

At the end of the meeting, we will provide you with a summary of our conversation and discuss treatment options. This is also a chance for you to ask any questions. We will also write a letter to you and your GP.

Our outpatient appointments take 1-1.5 hours. We offer virtual appointments using Attend Anywhere (opens in a new tab) but can also arrange in-person appointments at our clinic in S2 Psychological Medicine Services (opens in a new tab) at Addenbrooke's Hospital.

If you would like to speak to us after you have been discharged, please contact the Adult Liaison Psychiatry Team on 01223 216167. If you need any special arrangements, such as an interpreter or wheelchair access, please let us know before the meeting.

Non-urgent advice: Urgent support

Please be aware that we are a routine service. If you need urgent mental health support:

Contact your Community Mental Health Team
Call 111 (select the option for mental health) or visit 111 online
Go to your local A&E
Make an urgent appointment with your GP

More information on where to get urgent help for mental health can be found on the NHS website.

Non-urgent advice

Non-urgent advice: Helping yourself or supporting a loved one

We provide patients on the Major Trauma pathway with a Major Trauma pack. This contains information on strategies to help you manage anxiety and flashbacks. Please see the “useful resources” section below, as well as practical suggestions below on what you can do to help psychological recovery in the early days after a traumatic event.
You may find that you or your loved one doesn’t want to discuss what happened at first and this is ok. When you do feel ready, it helps to talk about your experiences with someone you trust. Allow yourself to express your feelings about what has happened.
Looking at accounts of the event on (social) media may not be very helpful, especially soon after the event. It is helpful to limit this if you notice it is making you feel worse.

(For more information on dealing with media (attention) after a major incident, please see the Department of Media, Digital, Culture, Media and Sport website. )

Try to keep daily routines going, where possible.
Make time to do things that you enjoy.
Spend time with people you feel close to.
Look after yourself:
- eat sensibly
- establish a healthy sleep pattern
- exercise if you can
- reduce alcohol and caffeine
Trauma memories are often fragmented and confusing. When you're ready, it can help to learn more, from reliable sources, about what actually happened to help you make sense of it.

Other sources of psychological help for anyone affected by a traumatic event

The Major Trauma Psychology service can only support patients who are or were admitted to Addenbrookes Hospital on the Major Trauma Pathway. However, the emotional effects of a major trauma or incident will not just be felt by those directly affected, but also by their families, friends, emergency and health care workers, bystanders, witnesses, or the general public.

Anyone affected by a traumatic event who is registered with a GP in England can self-refer to your local NHS Talking Therapies Service. You can search for your local service on the NHS website (opens in a new tab) or speak to your GP about a referral.

If you do not feel that the Talking Therapies Team are right for you, you can make an appointment to speak to your GP about a referral to alternative local mental health services. This includes your local adult community mental health team.

There are also other support options provided by the voluntary or public sector. This includes but is not limited to organisations such as:

Major Trauma Signposting Partnership (opens in a new tab) for carers, or family members of patients on the Major Trauma pathway
Blue Light (opens in a new tab) for members of the emergency services or health care worker.
East Anglian Air Ambulance Aftercare service (opens in a new tab) for bystanders or witnesses to a major incident or medical emergency, including major trauma, attended by an EAAA crew.

Supporting children and young people

As with adults, children and young people experiencing some distress in the first few days following a frightening event is entirely normal. Common reactions you may notice in children and young people that differ slightly from adults include:

They may appear to be reverting to younger behaviour like bed wetting or thumb sucking
Feeling very sad or withdrawn
Having nightmares and disturbed sleep
Fearfulness
Feeling angry or easily upset
Becoming more clingy with parents and carers
Physical complaints like headaches or tummy upsets
Trouble in school
Disruptive behaviour
Having lots of worrying thoughts and feeling like they cannot stop thinking about worries
Difficulty concentrating
Drug, tobacco and alcohol use in older children

If you notice any of the above, let them know that you understand their feelings. Give them the opportunity to talk, if and when they want to and respect their pace. Help them understand what happened by explaining the main details truthfully, if they ask, and reassure them that they are safe. Try to keep to usual routines and keep them from seeing too many frightening pictures. For more information on how to support children, and young people after a frightening event, see the below:

If you are concerned about your children or young person’s wellbeing, please speak to your GP and/or contact your local mental health support team (MHSTs) (opens in a new tab).

Dealing with Bereavement

Bereavement and trauma affect people in different ways. Grieving is a natural part of recovering from a bereavement, and everyone’s experience of grief is different. There are no rules about what we should feel and for how long, but people may experience any of the following:

sadness
shock - particularly if the death was unexpected
numbness
relief, if the death followed a long period of illness
guilt and regret
anger
anxiety
despair and helplessness
depression

These feelings may be very intense, particularly in the early days and weeks, and especially if a death was sudden or violent, if remains were not recovered, or if many people died. This is sometimes described as traumatic grief. However, for most people feelings of grief become less intense over time. Talking about grief is an important part of getting through a bereavement. Please see below for further sources of advice and support:

Key staff

Dr Zoe Martin - Principal Clinical Psychologist in Major Trauma

Dr Amanda Burren - Principal Clinical Psychologist in Major Trauma

Dr Julia Gillard - Principal Clinical Psychologist in Major Trauma

Dr Vanessa Shearing - Principal Clinical Psychologist in Major Trauma

Dr David Christmas - Consultant Psychiatrist, Adult Liaison Psychiatry

Useful resources

Below are a number of links to organisations that support individuals affected by major trauma. You may also want to see our leaflet for more information here.

Grounding techniques for PTSD - The Traumatic Stress Clinic

Link: https://www.youtube.com/watch?v=PeO5fqHdU08

Learn how to Stop PTSD Nightmares with Dr Justin Havens

Link: https://www.youtube.com/watch?v=lv38dzpcxfA

Coping with scary and distressing memories

Link: https://youtu.be/F5CrmanerlY