Returning to Work After Trauma

1. Returning to Work After Trauma Vivienne Brunsden Emergency Services Research Unit Vivienne.brunsden@ntu.ac.uk

2. The nature of traumatic events PTSD stressor criterion Involves direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity OR witnessing an event that involves those things to another OR learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. AND the person's response to this involves intense fear, helplessness, or horror.

3. But what does this definition ignore? Vicarious trauma Cumulative exposure Lay perceptions of trauma

4. Immediate reactions A sense of shock Can not believe it is happening Misconceptions of the event It feels unreal Feelings may be numbed Distress Euphoria Behaviour is automatic (on auto pilot) Behaviour is usually logical and rational Actions to reduce harm to self or others Strong physical reactions (heart rate, nausea, shaking, fainting etc) Time seems to slow Feelings of helplessness Fight, flight or freeze reactions Surrender to the inevitable Often focus on one thing May experience overwhelming sensory impressions Actions may be irrelevant Poignant thoughts (i.e. of loved ones)

5. Short term reactions Emotional reactions Fear of re-occurrence Anger and irritability Guilt and shame Helplessness Isolation Anxiety Outrage Vulnerability Sadness Grief Intolerance Physical reactions Hypervigilance (most common) Crying Fatigue Nausea Physical pain Easily startled Sleep disorder Increase or loss of appetite Nightmares Accident prone Loss of libido

6. Short term reactions Cognitive reactions Unwelcome intrusive thoughts Vivid recollections Re-experiencing sensory impressions Confusion Concentration problems Indecisiveness Loss of belief Disruption of cause and effect Suicidal thoughts Behavioural reactions Avoidance (most common) Alcohol and other substance misuse Aggressive behaviour Intolerant behaviour Withdrawal Risk taking Self harm

7. The change cycle

8. Positive reactions: growth following adversity Greater appreciation of, and satisfaction with, life Increased awareness of personal capabilities and strength Increased emotional warmth and empathy Greater appreciation of relationships, and increased intimacy Altered priorities Recognition of new possibilities for one�s life direction Increased spiritual development and appreciation of own faith systems

9. Key issues for workplace support When should support occur? Before, during or after the event? How quickly after? What constitutes support? Formal and informal structures Internal and external to workplaces Who should deliver support? External or internal Peers or �experts�? How is support accessed? Forced or voluntary? Mixed model? Who should be supported? Employees only? Relatives and loved ones? The wider community?

10. Thinking beyond the workplace Those directly exposed to the event. Those with loved ones at the event. Rescuers and helpers. The wider affected community. Vulnerable individuals who react strongly to minimal stress: passers-by; those previously exposed to other traumas Those people who could have been, but were not, involved