We need to talk about trauma

Trauma is at the heart of much mental distress and many problems of living, including those that have their roots in conditions and events at work. But many are unaware of how trauma has impacted their lives, or what to do about it. In some cases, the result can be acquired neurodiversity and hidden disability, requiring changes to work and lifestyle, as well as medical intervention. Dr Steven Shorrock, psychologist and ergonomist working in aviation, shares his personal experience of PTSD and sheds light on what is known about traumatic stress, psychological injury, and recovery, including learning from behaviour change science.

Shorrock, S. (2022, 6-8 November). Invited keynote: We need to talk about trauma. Association for Simulated Practice in Healthcare – ASPiH Conference 2022: All things being equitable. Diversity, inclusivity and simulation, 6-8 November, Birmingham, UK. https://aspih.org.uk/event/conference-2022/

Transcript

1. Steven Shorrock 8 November 2022 | ASPiH Conference 2022| Birmingham humanisticsystems.com | anchor.fm/steven-shorrock | ptsdays.home.blog @stevenshorrock 1
4. Physical injuries? Neurological damage? Trauma and psychological injury?
7. “Simulation that includes patient death has the potential to evoke a strong emotional or psychological stress response.” “Current simulation debriefing models are not explicitly intended to process strong feelings and emotions.”
9. Conflict & Violence Accidents & Disasters Sickness & Death
10. Keeping Up Appearances What friends said they saw What I thought friends saw High performing Hard working Responsible Friendly Bit of a joker Liked to party Friend 1: Happy, fun, thoughtful, anxious, focused, studious Friend 2: Confident, intelligent, friendly, hard working, fun, anxious Friend 3: Conscientious, dedicated, disciplined, helpful, funny as f*#k
11. Tics Grief Anxiety Depression Flashbacks Nightmares Hyper vigilance Self medication Nineteen Going Under
12. Achilles’ Heel 12 By Dr.K. CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=25907139
13. “PTSD” The feeling builds in seconds / The reptile brain it beckons / No immediate threat is near / Just an old response to fear // A presence behind me / Someone I can’t see / A tap on the shoulder / I react like a soldier // The threat isn’t real / But that’s how it feels / The body says to fight or flee / So please don’t stand behind me // Steven Shorrock (2018) ptsdays.home.blog Thoughts lead to feelings / Feelings lead to pain / Agonising screenings / Ice picks to the brain // The body coils in defence / Hollow but for fear / Frozen feelings too intense / Old memories still near // Sudden, without warning / Or lured back to mind’s eye / A mind and body warring / No real threat nearby// Just another flashback / Replayed on repeat / Frozen pain on playback / Cues the body to retreat // Steven Shorrock (2018) ptsdays.home.blog
14. 14 Why am I doing this?
15. “A couple of weeks before I started medical school, I admitted to a trusted mentor that I was worried about how my posttraumatic stress disorder would affect my education. He looked me in the eyes and said, ‘Don’t let anyone find out. That place will eat you alive.’” “I believe that the single most powerful way in which educators can support students is by leading by example.”
16. Alongsider Healer Educator Mental health helping triangle (Shorrock, 2022)
17. Alongsider Healer Researcher Educator Advocate Organiser Regulator Mental health helping hexagon (Shorrock, 2022) Connector
18. 3.7% Men https://cks.nice.org.uk/topics/post- traumatic-stress-disorder/background- information/prevalence/ 5.1% Women 12.6% Women 16-24
19. 12.6% 22/27% Probable PTSD at peak COVID among EM, Anaes, and ICM doctors (UK) ICU nurses/ED nurse ED resident/Paramedic Pos. PTSD risk (US) Luftman K, Aydelotte J, Rix K, et al. PTSD in those who care for the injured. Injury. 2017;48:293–6. Roberts, T., et al (2021). Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study BMJ Open 2021;11:e049680. 18% Obstetricians and gynaecologists (UK) clinically significant PTSD symptoms Slade, P, et al. Work-related post- traumatic stress symptoms in obstetricians and gynaecologists: findings from INDIGO, a mixed- methods study with a cross-sectional survey and in-depth interviews. BJOG 2020; 127: 600– 608. 24-29% ICU nurses work- related PTSD symptoms (19% gen nurses) (US) Mealer, M. L., et al. (2007). Increased Prevalence of Post-traumatic Stress Disorder Symptoms in Critical Care. American Journal of Respiratory and Critical Care Medicine, 175(7), Apr, 633-745. 29/44%
21. SOME CONCEPTS §Traumatic Event §Trauma §Psychological Injury §Post-Traumatic Stress Injury (PTSI) §Post-Traumatic Stress Disorder (PTSD) §Complex Post-Traumatic Stress Disorder (C-PTSD)
22. enter your presentation title 22 PTSD Changes the Brain Anatomical (amygdala, hippocampus, prefrontal cortex, anterior cingulate cortex, right frontal gyrus) Neurochemical and hormonal (catecholamine, serotonin, amino acid, peptide, opioid, cortisol, endocannabidoid, epinephrine, norepinephrine)
23. enter your presentation title 23 PTSD Changes the Brain Right frontal gyrus – emotional regulation and response inhibition (high-risk activity) Anterior cingulate cortext (ACC) – fear conditioning, threat sensitivity & response, conflict monitoring Prefrontal cortex – emotional regulation, attention regulation, decision making, interpreting emotion, voluntary behaviour Hippocampus – memory (esp. consolidation, context) Amygdala – threat sensitivity, fear conditioning, emotional memory
24. enter your presentation title 24 The Experience of PTSD 24 Re-experiencing (dreams, images, memories, feelings) Avoidance (external, internal) Sense of current threat (hypervigilant, easily startled, FFFF) Impact on life (relationships, parenting, work, social life, etc)
25. enter your presentation title 25 Additional Symptoms 25 Dissociation, derealisation, depersonalisation Depression & difficulty experiencing joy Destructive & addictive behaviour Physical symptoms Sleep disorder
26. Acquired Neurodivergence Hidden Disability
29. enter your presentation title 29 Neuroplasticity!
30. Wellbeing: The Biopsychosocial Model (Engel, 1977)
31. enter your presentation title 31 Investing in Your Mental Health 31 Reflect on your whole situation Identify you needs and prioritise them Research Make a plan Try it, observe what happens, and adjust
32. Psychotherapy & Medication 32
33. Rhythmical, Aerobic Exercise
34. enter your presentation title 34 Regular Connection with Nature
35. Peer Support and Social Connection
36. Yoga, Meditation and Mindfulness
37. enter your presentation title 37 Other Things from Experience 37 Noticing and adjusting to your environment Make wise decisions about activities Find awe and wonder NEVER GIVE UP
38. Post Traumatic Growth Stronger and deeper relationships Different perspective on life with new opportunities Unknown strengths revealed More grateful for people and things in life Greater understanding of life and how to live it (Joseph & Shorrock, 2021)
39. Adapted from Prochaska and DiClemente (2005) Pre- contempla- tion Contempla- tion Preparation Action Mainten- ance Relapse Transtheoretical model
40. § Get the facts about healthy behaviour § Pay attention to your feelings about unhealthy and healthy behaviour § Create a new self-image § Notice the effect on others of unhealthy behaviour § Notice public support of the healthy behaviour § Decide and make a commitment to change and prepare to take action § Get support from people who support the change § Use substitutes for unhealthy ways of thinking and acting Expanded from Prochaska and Velicer (1997)
41. § Use rewards for positive behaviour, reduce from negative behaviour § Manage your environment to encourage healthy behaviour § Focus on success instead of failure § Set goals that are specific and incremental § Plan the behaviour change, including tackling barriers and solutions § Identify difficult situations and practise solutions § Accept setbacks, understanding they are normal and can be overcome Expanded from Prochaska and Velicer (1997)