When an event causes a lot of distress or makes us feel fearful for our or someone else’s safety, it is described as traumatic. Any situation that a person finds traumatic can cause PTSD. These can include serious road accidents, violent physical or sexual assaults, natural disasters, serious health problems or difficult childbirth experiences. 

Global literature estimates that approximately 70-80% of individuals have experienced at least one traumatic event in their lifetime. We all have different ways of making sense of, reacting to and coping with the traumatic event; no one person’s approach to the event is the same. 

A sub-section of people who experience a traumatic event can go on to develop Post-Traumatic Stress Disorder (PTSD), with around 1 in 10 people being diagnosed with PTSD at some point in their lives. 

Source: www.ptsduk.org

Types of trauma

If you have experienced a traumatic event and are experiencing some of the below symptoms, you may have PTSD: 

  • have vivid memories, flashbacks or nightmares and/or struggle to sleep because of these  

  • feel emotionally numb at times 

  • feel irritable and constantly on edge but can't see why 

  • feel out of control of your mood 

  • experience feelings of shame, guilt and worthlessness  

  • feel depressed or exhausted 

  • being “jumpy”, on edge or guard with others   

  • eat more than usual, or use substances more than usual 

  • avoid things that remind you of the event – e.g. try to push memories of the event out of your head when they pop in or avoid going to the location of the event 

  • staying away from specific people or places for fear they are dangerous 

  • use distraction techniques such as keeping busy to cope  

  • find it more difficult to get on with other people 

  • struggle with concentrating and remembering things 

  • self-harm or suicidal ideation 

If you feel like you need to talk about any of the above, please do get in touch with us, we can help support you. 

Whilst PTSD is very distressing it can be treated effectively with evidence-based psychological (talking) therapies that are available in the NHS. To access treatment or any further support you will need to be first assessed by a trained mental health professional. The NICE guidelines for PTSD recommend either Trauma-Focused Cognitive-Behavioural Therapy (TF-CBT) or Eye Movement Desensitisation and Reprocessing (EMDR). Both therapies are available in your local Talking Therapies services.

Video: Take a look at the video explaining some of the causes, symptoms and treatments associated with PTSD.

When people are faced with life threatening or traumatic experiences, they experience a mixture of emotions. After a traumatic event, it’s normal to act, think, or feel different. It’s also important to remember that this emotional state is not fixed and is also changeable.

In coping with trauma, there are behaviours that can either help or delay your recovery. For example, it might be tempting to drink/take substances or engage in more thrill-seeking behaviours (i.e., gambling or risky sexual behaviours), as these sorts of behaviours can prevent distressing or unwanted emotions surfacing. However, working through your feelings will be intricately more challenging if you are actively numbing them through such behaviours. 

Talk to your GP or seek psychological support if your symptoms are lasting longer than a month, are disrupting your daily life, or if you just need to talk through your experience. For those who do seek treatment, a large percentage of those do recover. Research statistics show that that 50% percent of individuals with PTSD recover within 24 months and 77% recover within 10 years. (Rosellini et al., 2019).

It's very normal to feel distressed after such experiences. People can initially feel shocked, numb, or confused but also experience fear and agitation.  

Do Don't

Return to your normal routine.

Don't be harsh or critical with yourself - trauma symptoms are not a sign of weakness. They are a normal reaction, which most people will experience when dealing with traumatic events.

Lean on those around you, let them support during this time.

Don't bottle up your feelings. You are not alone in your experience and if you choose to seek treatment, the outcomes have been successful for those who access therapy. 

Try relaxation exercises.

Don't avoid talking about it. 

Nourish your body and try and get some fresh air each day.

Don't expect the memories to go away immediately, they may be with you for quite some time.

Try not to actively avoid reminders of the trauma.

Don't expect too much of yourself. Practice self-compassion, be kind and gentle with yourself.

Take time to be with family and friends. 

Don't isolate yourself – lean on those around you for support.

Drive with care - your concentration may be poor.

Exhaust yourself by keeping too busy.

Try and encourage healthy habits around sleeping, eating and showering which might feel more difficult after your experience.


Know that your feelings aren’t fixed and recovery is possible.


Speak to your GP, your manager (if you feel comfortable in doing so) and make a referral to Occupational Health if you are continuing to experience symptoms after a month following the event.


Ensure that support is available at work- has a psychological debriefing session been offered to you and those involved within the first month after the event, if the event occurred in the workplace? It is best practice for a session to be offered to staff members exposed to a serious incident at work.


Be aware of the support options available to you. We can arrange a referral to an IAPT service on your behalf, please fill in the referral form here to arrange this. 



When we experience traumatic or stressful life events, we may find ourselves in a state of fight or flight. The fight or flight response is an automatic physiological reaction to an event that is perceived as stressful or frightening. Those who experience traumatic events and are diagnosed with post-traumatic stress disorder have a higher likelihood of experiencing symptoms attributed to an extended fight or flight response. However, you can lower your stress by activating the parasympathetic nervous system with the following techniques. The opposite to the fight or flight response is known as rest and digest.  When the parasympathetic nervous system is activated it aids digestion, lowers blood pressure, and slows our heart and breathing rates.

This is by no means an exhaustive list and just some suggestions of things that might help to lower your stress and activate your rest and digest system (parasympathetic nervous system).

  • Time outside in green spaces – Immerse yourself in nature, really take in your surroundings. Nature therapy can help your body achieve a physiological reaction, even lowering cortisol levels and your blood pressure in as little as a fifteen-minute walk.
  • Breathwork/deep breathing – Breathwork is a powerful tool in stimulating your vagus nerve. There are many breathing techniques that can be beneficial to your health. Here is one to try:
    • Breathe slowly and don’t try to force it. You might find it helpful to count – breathe in for the count of four seconds and out for the count of four seconds. As you get the hang of it, try and slow it down even further. Find a pace that works for you.
    • Remember, your belly should be moving more than the top of your chest.
    • If you feel a bit dizzy or spacey it simply means you are breathing too fast and too heavily. Try breathing a bit more gently and slowly. Imagine that you are inhaling very slowly through your nose, counting to 5, exhale slowly through your nose, counting to 5. Wait 5 seconds and repeat the process 3 more times.
  • ​​​​​​​Cuddle a human or a pet – Cuddling someone you love releases serotonin, dopamine and oxytocin. Next time you get home give your loved one or your beloved pet a squeeze it is helping you more than you think.
  • Gardening – Get outside in the nature and sunshine, plant something and watch it grow in time for summer.
  • Sunshine exposure – Getting some sun increases your serotonin and Vitamin D has been associated with improved emotional regulation. In particular, in the morning, getting a boost of sunshine improves your concentration and sets you up for the day. Next time the sun makes its appearance, go and have ten mindful minutes in the sunshine.
  • Meditation – The impact of meditation is well renowned in multiple studies, not only in increasing focus and your learning concentration but also reducing stress and anxiety levels.
  • Mindfulness – Mindfulness treatments have also been shown to reduce symptoms of anxiety and depression and there is compounding evidence that mindfulness can help you manage stress better, increase your attention and focus and lead to better concentration. Try one of our mindfulness classes with Peter Helmer, our mindfulness practitioner.
  • Reading – Reading has a number of benefits to our mind and body, including reducing stress, lowering your blood pressure and heart rate, fighting depression symptoms and preventing cognitive decline. Bring a book with you on your commute or aim to read before you go to bed, it will not only aid in your sleep readiness but will also have a number of benefits for your mind and body.
  • Yoga – Yoga has multiple benefits, not only does it improve your flexibility, it can help with stress relief, aid in depression recovery, reduce anxiety and can help to improve your sleep. There are multiple free yoga classes available on YouTube for all sorts of levels and duration.
  • Sleeping (sufficiently) – It is recommended that you get between 7-9 hours of sleep each night, however don’t underestimate the role sleep has in your life. Sleep can greatly impact your attention span and concentration. Getting an adequate amount of sleep can reduce your stress levels and help you to manage your emotions and mental health symptoms better. Take a look at our managing sleep support page
  • Gratitude – Gratitude is strongly and consistently associated with higher levels of happiness. The act of savouring good experiences, acknowledging more positive emotions, improved self-esteem, and physical health. Ideas of how to cultivate gratitude:
    • ​​​​​​​​​​​​​​​​​​​​​Write a thank-you note: You can make yourself happier and nurture your relationship with another person by writing a thank you note or email expressing your enjoyment and appreciation of that person's impact on your life. Send it, or better yet, deliver and read it in person if possible. Make a habit of sending at least one gratitude letter a month. Once in a while, write one to yourself.
    • Thank someone mentally: No time to write? It may help just to think about someone who has done something nice for you, and mentally thank the individual.
    • Keep a gratitude journal: Make it a habit to write down or share with a loved one thoughts about the gifts you've received each day.
    • Count your blessings: Pick a time every week to sit down and write about your blessings — reflecting on what went right or what you are grateful for. Sometimes it helps to pick a number — such as three to five things — that you will identify each week. As you write, be specific and think about the sensations you felt when something good happened to you.
  • Therapy – It’s important to acknowledge that the symptoms of distress and being in a prolonged state of fight or flight or hypervigilance can be difficult and overwhelming. Although these are ideas to in general prioritise your well-being, and advocate for self-care, they are by no means a treatment plan in treating PTSD. If you found the contents of this trauma section has resonated with you, or the symptoms of PTSD you identify with, please feel free to speak with us. Having a space to discuss your thoughts and feelings openly and honestly can be an incredibly validating and supportive experience.

​​​​​​​​​​​​​​(Harvard, 2021)

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. A person needs to have experienced persistent symptoms of this condition for more than one month following the traumatic event to get a diagnosis of PTSD. 

Exposure to the traumatic event can be direct (witnessing/being actively involved in the event), by learning that the event occurred to a close family member or friend or repetitive to aversive details of the event (e.g. first responders collecting human remains). 

PTSD is characterised by the feeling that the person is back in the traumatic incident and “reliving” the experience. This can be in: 

  • Flashbacks 

  • Nightmares or dreams related to content of the event 

  • Body sensations 

  • Emotions 

It can develop immediately after someone experiences a disturbing event, or it can occur weeks, months or even years later. PTSD is estimated to affect about 1 in every 5 people who have a traumatic experience, but it's not clear exactly why some people develop the condition and others do not. 

It is common for people to try and avoid reminders of the trauma, including, talking about it, people, places and things that bring back the memories of their trauma. People suffering from PTSD can often feel more negative about themselves and the world in which they live. It is also common to be more vigilant to danger and this tend to lead to increased startle reactions, irritability and reduced concentration.  

PTSD and trauma have several interlinking components however they are in fact different.  There are many misconceptions surrounding what constitutes trauma and over the years the definition of trauma has expanded to be inclusive of a variety of events. 

According to the American Psychological Association (APA), trauma is an emotional response to a distressing event. Trauma can occur once or on multiple occasions and an individual can experience more than one type of trauma (APA, 2021). In comparison, PTSD is a mental health disorder in which re-experiencing the event, hyperarousal and avoidance are all key characteristics of its diagnostic criteria.  It’s important to remember that there is no ‘right’ or ‘wrong’ way to feel in reacting to a traumatic event. People react in different ways to all types of trauma. The diagnostic criteria for PTSD can be found here. 

If you identify with some of the symptoms above, or feel affected by any of this content, speak to one of our team members by calling 0300 123 1705, email us or make a self-referral to our service.  

Vicarious trauma and secondary traumatic stress refer to indirect trauma which can occur through exposure to second-hand distressing stories and disturbing images.

  • Vicarious traumatisation is a term coined by Pearlman and Saakvitne (1995) and refers to the development of trauma responses in individuals exposed to working with others who have experienced psychological trauma.
  • Secondary Traumatic Stress describes the symptoms of stress the person working with the trauma survivors experiences, such as sleeping difficulties, hypervigilance, nightmares and flashbacks of traumatic experiences relayed.

Empathy is often a process implicated in vicarious trauma, leading to the person’s world view changing in shift of their patient’s beliefs. Individuals in health and social care professions can be particularly susceptible to vicarious trauma reactions, including therapists and doctors. Hearing of traumatic stories and images, as well as witnessing content and material related to the traumatic experience can lead to psychological, social, emotional and behavioural changes typical of a trauma response.

Laurie Pearlman provides a description of vicarious trauma in the short video below:

The British Medical Association have produced a list of common signs of vicarious trauma, as well as tips and strategies on how to prevent it:

  • experiencing lingering feelings of anger, rage and sadness about patient's victimisation
  • becoming overly involved emotionally with the patient
  • experiencing bystander guilt, shame, feelings of self-doubt
  • being preoccupied with thoughts of patients outside of the work situation
  • over identification with the patient (having horror and rescue fantasies)
  • loss of hope, pessimism, cynicism
  • distancing, numbing, detachment, cutting patients off, staying busy. Avoiding listening to client's story of traumatic experiences
  • difficulty in maintaining professional boundaries with the client, such as overextending self (trying to do more than is in the role to help the patient).

If you are experiencing any of these signs, this could indicate that you are suffering from vicarious trauma. You can have a free confidential chat with one of our wellbeing practitioners to discuss.

There is much debate as to whether compassion fatigue and burnout are aspects of vicarious trauma, however it is usually considered that vicarious trauma is separate. Watch a talk by Amy Cunnigham on her experience of vicarious trauma:

Frontline healthcare workers are at a much higher risk of Depression, anxiety, and PTSD symptoms, due to repeated exposure of traumatic and stressful situations within their work environment. 

A study undertaken by University of Roehampton on nearly 3,000 NHS workers from 52 NHS Trusts found the following:

  • Rates of severe depression amongst healthcare workers rose from 5% pre-Covid to 21% post-Covid

  • Rates of severe anxiety increased from 8% to 36%, and severe stress rates increased from 11% to 46% in the same time-frame 

  • Frontline workers were twice as likely to report severe PTSD symptoms in comparison to non-frontline workers  

  • Healthcare workers who had experienced a personal loss due to Covid-19 had a 150% higher risk of developing PTSD 

  • Frontline workers who had colleagues with Covid tripled the risk of having high PTSD symptoms 

  • Healthcare workers in managerial roles were over 5 times more likely to report high PTSD symptoms

Furthermore, a study by University of Oxford found that many healthcare staff reporting emergence of PTSD symptoms during the Covid-19 pandemic had an occupational or personal trauma pre-pandemic to which the PTSD symptoms were linked. Findings from this study highlighted large rates of PTSD amongst healthcare workers at 44%, with 52% of staff attributing the PTSD symptoms to an occupational trauma and 48% of staff stating that their symptoms were in response to a personal life trauma.  

There are many reasons why healthcare workers may be more likely to develop PTSD in comparison to the general population. Some risk factors for PTSD development are below: 

  • Being female: approximately 75% of the NHS workforce are female 

  • Belonging to an ethnic minority group: there are many reasons why individuals from an ethnic minority are at an increased risk of developing PTSD. One such reason is that staff members from BAME backgrounds are more likely to be subjected to bullying, racist abuse and discriminatory behaviours in workplaces, which can have a significant impact on mental health. You can find out more about the link between racism and mental health outcomes here

  • History of traumatic incident (s) 

  • History of mental health difficulties across the lifespan 

  • Exposure to ongoing and repeated stressors: low staffing levels, witnessing patient deaths, managing difficult conflicts with staff members and patients, failing to save a patient’s life are just some stressors specific to healthcare environments. 

  • Increased exposure to risk: Health and Social Care associate professionals and health professionals had a higher-than-average risk of threat and violent assault in the workplace at 3.9% and 3.3% respectively, in comparison to the average risk of 1.4% across all populations.

  • Nature of the job role and duties: for example, the University of Roehampton study found that if a staff member was asked by patients if he/she was going to die, this increased the risk of having severe PTSD by 110%. Similarly, performing resuscitation on a patient led to a 125% increased risk for high PTSD symptoms. 

  • Lack of social support 

  • Significant changes to beliefs about the self, others and the world: for example thinking that you were “helpless” during the event, self-blame feelings, believing that others can’t be trusted and that the world is a dangerous place 

  • Unhelpful coping responses: for example consuming more alcohol/taking drugs to numb feelings, avoiding thinking about or speaking about the trauma or ruminating on it excessively 

Video: Watch the news report in the video below of one nurse’s experience of developing PTSD during the Covid-19 pandemic. 

We recognise that our healthcare colleagues in North West London are from a variety of culturally-diverse backgrounds, with many cultures having unique and specific interpretations of mental health disorders. There are some free trauma psychoeducation resources translated into a number of languages for our colleagues. 

Good Thinking workbook

Provides psychoeducation and techniques to help you cope with your trauma, including what to do when flashbacks and nightmares arise. Read and download here.

Just Ask a Question (JAAQ) website

Get answers on mental health from world leading experts and those with lived experience on the JAAQ website, over 50,000 questions on over 60 health and wellness topics. 

NHS: coping after a major incident

The NHS have created a helpful leaflet on coping with stress after a major incident.

Post Traumatic Stress: an NHS self help guide

In this self-help guidebook they provide information on what a traumatic incident is, how people react afterwards, why we react so strongly to trauma, what we can do to help overcome symptoms of trauma, advice on taking prescribed medication, and further help and resources. An easy read version is also available to download here.

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