Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult.

Transcription

1 Impact of crime Firstly it is important to say that most people who have been a victim of crime recover fully and get back to their normal selves soon after. However, following the event initial reactions may include numbness, followed by anger, anxiety and depression. This is a normal reaction to a stressful and traumatic event. What follows are some details on feelings of anxiety, depression and post-traumatic stress which will hopefully aid in understanding the feelings that you may be experiencing. Descriptors of feelings What is anxiety? Anxiety is a normal human feeling. We all experience it when faced with situations we find threatening or difficult. A sudden response to an immediate threat, like looking over a cliff or being confronted with an angry dog, may result in fear. In your case, being a victim of crime has triggered symptoms that you experience in your body. For example, having your purse or wallet snatched and having your wellbeing threatened is likely to be upsetting to most people, but this also results in a number of physical symptoms. Anxiety, however, may also be a result of a continuing problem, such as a group of people hanging around and you wondering what might happen we call that worry. Normally, both fear and anxiety can be helpful, helping us to avoid dangerous situations, making us alert and giving us the motivation to deal with problems. If the feelings become too strong or go on for too long, however, they can stop us from doing the things we want to and can make our lives miserable. The very solutions we use to deal with our fears and worries become problems themselves. For example, we may stop going out shopping and engaging in our usual every day activities, but stay at home and worry; this in turn affects our quality of life. Some people can become housebound or dependent on others to go about their everyday tasks and, thus, they lose their independence. There are a variety of symptoms that you may experience when anxious. Page 1

2 In the mind: Feeling worried much of the time, feeling tired, unable to concentrate, feeling irritable and sleeping badly. You might have a fear of going mad, passing out or losing control. In the body: Irregular heartbeats (palpitations), sweating, muscle tension and pains, breathing heavily, dizziness, faintness, indigestion and diarrhoea. These symptoms are easily mistaken by anxious people for evidence of serious physical illness their worry about this can make the symptoms even worse. Sudden unexpected surges of anxiety are called panic, and usually lead to the person having to quickly get out of whatever situation they happen to be in. Anxiety and panic are often accompanied by feelings of depression, when we feel glum, lose our appetite and see the future as bleak and hopeless. Page 2

3 Phobias A person with a phobia has intense symptoms of anxiety, as described above. But they only arise in the situation that frightens you. At other times they don t feel anxious. If you have a phobia of dogs, you will feel OK if there are no dogs around, if you are scared of heights, you feel OK at ground level, and if you can t face social situations, you will feel calm when there are no people around. A phobia will lead the sufferer to avoid situations in which they know they will be anxious, but this will actually make the phobia worse as time goes on. It can also mean that the person s life becomes increasingly dominated by the precautions they have to take to avoid the situation they fear. Sufferers usually know that there is no real danger, they may feel silly about their fear but they are still unable to control it. A phobia is more likely to go away if it has started after a distressing or traumatic event. Are they common? About one in every ten people will have troublesome anxiety or phobias at some point in their lives. Most will never ask for treatment. Some of us have these feelings for much of the time without knowing what is causing them, and so not knowing when they might end. This is much harder to cope with and will usually need some help from somebody else. People will sometimes not want to ask for help because they think that people might think that they are mad. In fact, people with anxiety and fears hardly ever have a serious mental illness. It s much better to get help as soon as you can rather than suffer in silence. People with anxiety and phobias may not talk about these feelings, even with family or close friends. Even so, it is usually obvious that things are not right. The sufferer will tend to look pale and tense, and may be easily startled by normal sounds such as a doorbell ringing or a car s horn. They will tend to be irritable and this can cause arguments with those close to them, especially if they do not understand why the sufferer feels that they cannot do certain things. Although friends and family can understand the distress caused by anxiety, they can find it difficult to live with, especially if the fears seem unreasonable. Page 3

4 What is depression? Clinical depression is not just feeling a little down, it is an illness. The central feature of clinical depression is a lowering of mood, but other symptoms must also be present. In addition to low mood, there is loss of interest and pleasure, plus some of the following: feelings of hopelessness or guilt, impaired concentration, loss of energy and tiredness. Thoughts that life may not be worth living are not uncommon and can in themselves be upsetting. There is often loss of appetite and weight, sleep problems and increased irritability. These symptoms are usually present for most of the time for a minimum of two weeks. Depressive symptoms in older people are similar to those experienced by other ages, but certain features may be more apparent, for example, disturbed sleep and health worries. Reduction in Energy Motivation Appetite Weight Sleep Concentration Interest Increase in Worry Irritability Fatigue Hopelessness Guilt Pessimism Tearfulness How common is depression? Estimates of depression among older people vary considerably, particularly with increasing awareness of the extent of the problem. Community studies have estimated that about 12% of older people are depressed, with numbers doubling in those attending their GP. Unfortunately, only a small number of older people with depression are specifically treated or referred to appropriate specialists, such as counsellors, psychologists, psychotherapists, community nurses and psychiatrists. Indeed older people are more likely to miss out on good care by not being referred. Page 4

5 Untreated depression not only affects a person s psychological wellbeing, but also their physical health and also causes worry to people around them. Causes of depression Depression may have a range of different causes. In this case, we have identified being a victim of crime as contributing to your depression. A number of other events, however, such as bereavement, a lack of social support and physical illness may be important. Depression may also run in families. Although you may think depression is an understandable reaction to your circumstances, clinical depression is a serious illness that needs treatment if full recovery is to be brought about. Part of the management of depression is to identify triggers where possible. Some of the factors listed below may be relevant to you. (Note, this is not an exhaustive list.) Potential causative factors in victims of crime include: 1. A major trauma in which you have suffered a loss or been under threat. This may be having been a victim of crime, loss of property and loss of a sense of security. 2. Physical illness and deteriorating health due to illnesses, such as arthritis or heart disease that may be made worse by stress. There may also be loss of independence for a variety of reasons, such as physical disability. 3. The crime may be associated with a decision to move house because of inability to cope and this, in turn, can be a very stressful change in your life. 4. If you have recently lost an important person, such as a husband/wife or partner, sibling, or child, you may also feel more vulnerable following a crime. 5. Using excessive amounts of alcohol following a crime may make depression worse and result in arguments and make your relationships difficult. This will further lower your mood. 6. Financial worries resulting from the crime, by having to repair the damage and worrying about how to claim on insurance may add to your stress and worries about how to pay bills. 7. Personal attitudes; blaming yourself and identifying yourself as a victim and weak does not help and, with shame, these feed into depressive ideas. 8. Changing your behaviour and activities may result in you going out and doing less, meeting fewer people and becoming more isolated. Lack of activity has a direct effect in lowering your mood. Page 5

6 An understanding of post-traumatic stress (PTS; from Ehlers, 2000)* Post-traumatic stress is a normal reaction to abnormal events. Introduction A traumatic event is an emotional shock. It is not easy to take in what has happened and to come to terms with it. After a severe upset, it is quite normal to experience all kinds of unpleasant feelings, emotions, and body sensations, which may take some time to die down. In the meantime, memories and images of the upset, and thoughts about it, come into your mind, even when you try to shut them out. These experiences may be confusing and even frightening. You may wonder if you will ever get over the trauma, if you are losing control or going mad. These worries are entirely understandable. You will discover from this handout, however, that the thoughts, feelings and sensations you are experiencing are a normal reaction to stress, and show that your body and your mind are working to come to terms with the traumatic event. Each person reacts to trauma in their own unique way. Nonetheless, there are common reactions which many people share. This handout describes some of these common reactions. You may find that you have experienced, or are experiencing, some of them. Please read the handout carefully and see which parts apply to you. The handout is yours to keep, so feel free to underline or highlight particular passages or make notes on the margin. You will have an opportunity to discuss your reactions to the handout with your therapist when you next meet. 1. Fear and anxiety The most immediate and striking reactions people experience after a trauma are fear and anxiety. Sometimes these feelings occur as a result of being reminded of the trauma; at other times they seem to come out of the blue. Fear and anxiety can be understood as reactions to having been in or witnessed a dangerous, life-threatening situation. A trauma often leads to changes in how people view life and how safe they feel. After * Ehlers A, Clark D. (2000) A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy 38: Page 6

7 experiencing trauma, it takes a while to feel secure again. You may feel that life is full of risks, and that you can never be sure when trouble may reoccur. This heightened sense of danger may be partly because the trauma has made you more aware of real risks. It may also be because fear has led you to overestimate and exaggerate how dangerous life is. Let us take the trauma of an assault as an example. Although you know muggings happen, you may never really have believed that one would happen to you. After a mugging, it is as if an accident is waiting to happen at every roundabout and junction, and around every corner. Even as a passenger, you cannot afford to take your eyes off the road for an instant. In actual fact, an accident is not more likely than it was before. But in your mind it seems extremely likely that history will repeat itself. Naturally enough, these changes in how you see things lead to heightened fear and anxiety. In therapy, you will have the opportunity to discuss and reduce your heightened sense of danger with the help of your therapist. Typically, after a trauma, fear and anxiety are experienced in two main ways: a. Continuing to re-experience memories of the trauma (you will find more detail about this in Section 2) b. Feeling physically on the alert, hyped up and jumpy (you will find more detail about this in Section 3). Sometimes particular triggers or cues may remind you of the trauma. When this happens, you will automatically respond with fear. Some triggers are obvious and closely resemble the original traumatic event (for example, returning to the site of a road traffic accident). Others, however, may in themselves seem quite trivial and bear only a distant or vague resemblance to the trauma (for example, a flash of a particular colour, a certain smell, a change in the light, a shift in temperature or a tone of voice). Such subtle triggers are often more difficult to spot. Once you have identified them with the help of your therapist, your automatic fear reaction will make better sense. You will also learn to realise that what you are responding to is a memory. This will help you to realise more and more quickly that you are not currently in danger when you encounter the triggers, and bring your anxiety down. Because fear and anxiety are distressing, people often attempt to reduce them by trying to avoid places, people and other reminders of the trauma or by distracting Page 7

8 themselves from upsetting memories and thoughts. These strategies may well help you to feel better in the short-term, but in the longer term they will actually slow down recovery and keep the problem going. This point is explained in more detail in Section Re-experiencing People who have undergone a traumatic event often re-experience the trauma. You may find that you are having flashbacks, when visual images of what happened suddenly pop into your mind. Sometimes flashbacks can be so vivid that you may feel as if the trauma is actually happening all over again. You may also find that you are re-experiencing the trauma through nightmares. Or you may re-experience the trauma emotionally, or in your thoughts, without having a flashback or nightmare. These experiences happen whether you want them or not, and you may well come to feel that you have no control over what you are feeling, thinking and experiencing, day or night. Trying to push flashbacks and memories out of your mind will not stop them from coming back, and may in fact make them all the more persistent. Your therapist will help you to find other ways of dealing with them. Your therapist will also explain to you that these re-experiencing symptoms are the result of how the traumatic event is laid down in memory. It has been stored in a 'raw', unfinished form and is not fully processed (put together) like other memories from your life. This has the effect that the memories of the trauma appear to happen in the here and now rather than being something from the past. In therapy, you will learn to experience the trauma as a past event. You will do this by working through the event with your therapist. This will be done in a controlled way that does not overwhelm you, but lets you process what happened to you. This way, a more complete trauma memory is formed. When this is accomplished through therapy, when you remember the event, you will no longer feel like you are back in it reliving it as if it was happening again. Instead, when you remember the event, it will feel like something that happened to you in the past. 3. Physical arousal Another common reaction to trauma is physical arousal, for example, feeling jittery or agitated, overly alert, trembling, being easily startled and having trouble Page 8

9 sleeping. You may have trouble getting to sleep, you may wake repeatedly during the night, sleep restlessly or have troubled dreams. Feeling tense and jumpy all the time may lead to feelings of irritability, especially if you are not getting enough sleep. You may find yourself snapping at people close to you, or losing your temper for trivial reasons. Symptoms of arousal are a result of fear. When we are in danger, our body prepares us for running away or fighting by releasing more adrenaline in our blood, which makes our heart pound and our muscles ready for action. The same thing happens when we are afraid or startled. Another bodily reaction to extreme danger in animals and humans is to freeze. You may have noticed that, when approached by a dog, a cat will crouch down and keep very still when it is afraid. The same thing happens to many people during trauma, or when they are suddenly reminded of it. After a very frightening trauma, your body may stay constantly on the alert, prepared for instant action, even though this is no longer necessary. The trauma has forced you to realise that there is danger in the world, and you are all set to deal with it. It is as if your body has failed to realise that the danger is past. It continues to react as if you were still under threat and might need at any moment to fight, flee or freeze. This is why you may feel constantly keyed up, tense and irritable. Once you start working through the trauma memory with your therapist, and learn to respond differently to reminders of the event, your arousal will decrease. 4. Avoidance You may find that you are avoiding things that remind you of the trauma, for example, the site where it happened. You may also avoid thinking about the trauma and may be blocking off or avoiding the feelings that are triggered by reminders. Avoidance is a strategy to protect yourself from things that you feel have become dangerous, and from thoughts and feelings that seem overwhelmingly distressing. Sometimes the desire to avoid memories and feelings about the trauma may be so intense that you find you have forgotten aspects of what happened. Or you may find yourself 'blanking out' or 'switching off' when reminders of what happened occur. Emotional numbness (the loss of the ability to feel anything very much, including affection and pleasure) is another common way of trying to cope with painful Page 9

10 feelings and thoughts about the trauma. It may include feeling alienated from people you care about. Because they have not experienced what you have, it is as if they cannot possibly understand what you are going through. As we have already said, avoidance is often a good way of reducing distress in the shortterm. When it is successful, it reduces distressing feelings. But it is not always the best long-term strategy for getting over the trauma. Firstly, it is difficult to avoid one's own thoughts and feelings successfully. They keep coming back, and indeed trying to avoid them actually makes them more frequent and persistent and increases the sense of being out of control. Secondly, avoidance is usually a result of predictions that if you face what you fear, disaster will occur, for example, that your feelings will overwhelm you, or that you will be attacked again. It makes perfect sense to avoid things that you believe will harm you. But avoidance stops you from discovering that your fears may be exaggerated, and that the world is not as dangerous as it seems. As a result, your life may become more and more restricted. In therapy, you will work with your therapist on reclaiming your life and on mastering situations that you have avoided. 5. Feeling low Another common reaction to trauma is sadness, feeling down or depressed. You may have feelings of hopelessness and despair; frequent crying spells, and sometimes even thoughts of hurting yourself and suicide. Loss of interest in people and activities you used to enjoy often follows trauma. Nothing may seem much fun to you anymore. You may also feel that life is no longer worth living and that plans you had made for the future no longer seem important or meaningful. With therapy, as you work through the memory of your traumatic event and start reclaiming your life again, you will find that your mood will also improve. 6. Difficulty concentrating You may also find that you have trouble concentrating. This is another common experience after a trauma. It is frustrating and upsetting to be unable to concentrate, pay attention to or remember what is going on around you. This experience too may lead to a feeling that you are not in control of your mind or that you are going crazy. It is important to remember that these reactions are temporary. They are a result of intrusive and distressing feelings and memories about the trauma. In an attempt to Page 10

11 make sense of what happened to you, your mind is constantly going over the trauma, bringing it back up, chewing it over and trying to digest it. Naturally this means that you have less mental space available to concentrate on other things. In therapy, you will find that when your re-experiencing symptoms become less severe, you dwell less on what has happened, and your sleep improves, this will also improve your concentration. 7. Loss of control During the trauma your life, and the lives of those you care about, may have been threatened. You may have felt that there was absolutely nothing you could do to prevent the worst from happening. You may have felt that you had no control over your feelings, your body, your physical safety or your life. This feeling may also re-occur when you are reminded of the trauma, or when images and other sensations from the event pop into your mind. Sometimes the feelings of loss of control may be so intense that you may feel as if you are going crazy or losing it. It is important to realise that these experiences are very common after a traumatic event and are trauma memories, not a sign that you are going crazy. 8. Guilt and shame Trauma often leads to feelings of guilt or shame. These may be related to something you did, or did not do, in order to survive or cope with the situation. It is common for people to go over and over what happened in their minds. You may find yourself going over steps you might have taken to prevent the trauma from occurring, or different ways you might have reacted. It is as if you are trying to put things right in your mind after the event if only you had done such-and-such or if only you had not done something else it would all have been different. You may also blame yourself for not having been able to put the trauma behind you and get back to normal. Perhaps you see this as a sign of weakness or inadequacy in you, rather than understanding your symptoms as a normal, human reaction to intolerable stress. Furthermore, blame sometimes comes from family and friends because often people wrongly place responsibility on those who have been hurt or victimised, rather than on those who have done the hurting. Equally, others may not understand the nature of post-traumatic stress, and give you the message that you should be pulling yourself together and getting on with life. Self-blaming thoughts are a real problem, because Page 11

12 they can lead to feeling helpless, depressed and bad about yourself. In therapy, you will discuss these thoughts with your therapist, and learn to be less hard on yourself. You will discover that you had good reasons for the way you behaved at the time. 9. A n g e r Anger is also a common reaction to trauma. The anger is often directed at the person responsible for causing you the physical injury, abusing you or disrupting your life. But, feelings of anger may also be stirred up by the presence of people or circumstances that remind you of the trauma, even if they had nothing to do with it. Many people also find they are experiencing anger towards those they love most: family, friends, their partners and their children. Sometimes you may lose your temper with the people who are most dear to you. This may be confusing, but it is a normal response after trauma. There are several possible reasons. High arousal and poor sleep may make you more irritable than usual, so that you may react more strongly to small things than before the trauma. You may also feel that nobody really understands what you are going through. Finally, being close to others may feel good. But it can also lead to feelings of dependency, vulnerability and helplessness. Having those feelings may make you feel angry and irritable because they remind you of the trauma. Sometimes you may feel so angry that you want to hit someone or swear. If you are not used to feeling angry these feelings may feel foreign to you, and you may not know how to deal with them. In therapy you will be able to explore your anger and what you are angry about in a safe environment with your therapist, who will understand and support you. You will learn that the anger is often triggered by subtle reminders of the trauma, and by your thoughts about the unfairness of the trauma, and you will learn ways of dealing with these memories and thoughts. 10. Self-image and negative thoughts about other people and life in general Your self-image can also suffer as a result of a trauma. You may tell yourself, 'I am a bad person, and bad things happen to me, or If I had not been so weak and stupid, this would not have happened. Or, you may be hard on yourself for not coping Page 12

13 better with what has happened why can you not just put it behind you and get on with living? Both the trauma itself and the feelings you experience afterwards can be a source of self-criticism and self-doubt. This is a very understandable reaction after such a shattering experience. Some people feel the trauma was the last straw. It seems to them to prove things they always knew, for example, that they cannot trust themselves or that they are the sort of people who cannot handle even the slightest difficulty. You may also develop negative thinking about other people and about life in general. The world, previously seen as safe and rewarding, may suddenly seem a very dangerous place. You may feel for the first time that you cannot trust anyone. People often say that the trauma has changed them completely. They say, for example, before the trauma I was not afraid of anything. I could cope with any kind of stress, no matter how difficult the situation was, and I could get along with others. And now I am afraid of my own shadow, and I cannot cope with even trivial problems. On the other hand, for people who have had previous bad experiences and negative beliefs about themselves, the world and other people, the trauma may confirm preexisting ideas, such as the world is a dangerous place and no-one can be trusted. Your therapist will discuss your negative thoughts with you, and encourage you to test how accurate they are. Through the discussions and the experiences you will have in therapy, you will get a new, more positive perspective and improve your self-image. 11. Reminders of the past Finally, the trauma may remind you of similar experiences in the past. You may suddenly recall incidents that previously you had forgotten, and which may be as disturbing to you as the memory of your recent trauma. The reminders may be physical aspects of the trauma (for example, a cold sensation in your body or a man s angry voice). Or, it may be that you are reminded of other experiences that have a similar meaning to the trauma, for example, other times when you saw yourself as vulnerable or helpless or believed your life to be at risk. As we said in Section 1, the triggers for past memories may be very subtle, and so difficult to identify and make sense of. Page 13

14 Memories of past experiences may be stirred up to such an extent that it becomes difficult for you to think of any experiences or situations in the past that were not negative. It may even become very difficult to believe that you will ever feel happy again, get back to normal or enjoy life. But you will. It is possible to put these painful experiences behind you. Conclusion In this handout you have read about common reactions to trauma, and will have had an opportunity to identify those that particularly fit how you have been feeling. The main message of the handout is this: the feelings, thoughts and body sensations you have been experiencing are entirely normal. They are a natural, human reaction to extreme stress. This is why the problems you are experiencing are called post-traumatic stress disorder. They are a signs that you have not yet been able to come to terms with what happened to you. It is as if the trauma continues to happen over and over again in the here and now. Through therapy you will come to understand how this happens, and you will learn ways of dealing with your upsetting thoughts and feelings gaining perspective on the trauma and how it has affected you. This will help you to take the heat out of your memories and to put the trauma in the past, where it belongs. Page 14