Rachel Swanick’s, senior therapist at Chroma, recent blog (find here) about how therapists, and parents, can speak to children about the disasters or tragedies they are exposed to through the media, raised a lot of questions. In particular, how to take these ideas and use them when talking about trauma, more specifically for people who have experienced their own disasters and the injuries, both mental and physical, that these leave.

The impact of a brain injury is notoriously hard to predict – some seemingly mild concussions can have devastating consequences, whilst others may walk away from something that seems terrible and recover quickly. The emotional impact is equally unpredictable and unique to each individual and each set of circumstances and does require ongoing assessment. Professionals and families need to be aware of psychological trauma. This may be in the form of post-traumatic stress disorder (PTSD), which typically involves flashbacks and invasive thoughts.

It can also be more subtle, with changes in mood, with the impact on questions of one’s identity that may come about through dealing with the a ermath of an injury, and around motivation, as well as loss and grief.

The mental health of family members can be a ected too, from PTSD – especially if someone has witnessed a traumatic event- to the impact of loss, change to their own identity as a carer for instance, and the ongoing challenges of supporting someone in rehab.

Psychological therapies, be that psychotherapy, arts therapies or cognitive behavioural approaches, are key to working with this, and a key part of any rehab. The mental health element can prevent someone from engaging in rehab, or it may well be the most important part of recovery. As well as the psychological therapy input, there is a key role for anyone working in rehab to be able to think and talk about trauma.

The approaches in Rachel’s blog are really helpful, but first we need to think about regulation: Trauma can’t become a taboo subject, but equally we must not overwhelm someone. Trauma can have the effect of leaving someone completely dysregulated.

This is the fight, flight or freeze response being triggered by traumatic memories or feelings, leading to hyper- or hypo-arousal. In these states the thinking brain is shut down, so having a conversation at this stage is pointless. We need to help people to be in what is called ‘the window of tolerance’, which is when they are able to think about the traumatic feelings or memory, without that triggering.

The key is being able to recognise when someone might start to move into these states. Hyper-arousal is the flight or fight mode, so someone’s heart rate might start to race, they may become agitated, pupils may dilate, skin becomes pale and cold or clammy, and their cognitive processing becomes disorganised.

Hypo-arousal is the freeze mode, so the heart rate may slow, skin colour may become ushed, dry and warm to the touch, and cognitive processing becomes disabled. In these states someone simply needs help to regulate themselves – this is not the time to discuss anything connected to the trauma.

A therapist may well work on widening the window of tolerance in order to enable trauma work, thereby building up someone’s ability to manage and regulate themselves. For anyone else, the focus is more on recognising when someone is in a fit state to talk about difficult things, and when to step back and concentrate on helping someone feel calm and in control.

For children suffering from long term distress following any traumatic event, it could be worth trying some creative therapy, which focuses on the nonverbal elements of communication in a safe place, such as:
• Worry dolls – put your worries in the doll and put her in the box
• A positive pot – each day, write something lovely that has happened on a post-it and pop it in a pot. Read them back every few months or when your child is feeling sad.
• Worry time – a ten minutes slot each day where you can write down all of your worries.

Anyone affected by these issues can contact Chroma Therapies via sayhello@wearechroma.com or 0330 440 1838.