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Supporting Staff through Trauma-Informed Practices

It is believed that the pandemic has increased the risks of traumatisation for many people including health care leaders and their teams. This article is an introduction to trauma and how it is experienced. It includes some useful research-based practices that can aid transition through the trauma experience and introduces the concept of becoming a trauma informed organisation.  

Dr Bessel van der Kolk writes in his book The Body Keeps the Score: Brain, Mind Body in the Healing of Trauma: “Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside. They learn to hide from themselves.”  

Trauma is present in the individual, it is not a memory or a story, it is a visceral feeling that seems locked in the body and changes the way the brain reacts to any imagined, perceived, or actual threat. The brain and body can remain in a constant state of hyper arousal with the accompanying chemical responses it needs to be safe to fight, to escape, or freeze. Persistent symptoms that do not decrease in severity indicate trauma has developed into post-traumatic stress disorder (PTSD). People who experienced trauma as a child have been shown to be more susceptible to trauma and PTSD in adulthood however everyone’s experience will be different. As Auschwitz survivor and psychologist Dr Edith Eger says: “There is no hierarchy to trauma”.  

Vicarious or secondary trauma  

The BMA describes vicarious trauma as a process of change resulting from empathetic engagement with trauma survivors. It goes on to state that anyone who engages empathetically with survivors of traumatic incidents is potentially affected, including doctors and other health professionals.  

You or your staff may be struggling with vicarious trauma if you notice the following (based on BMA guidelines): 

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

Unresolved trauma can have a long-term effect on physical wellbeing as well as mental health with incidents of autoimmune conditions, cardiac illnesses and gastrointestinal complaints being intricately linked to trauma and PTSD. 

Supporting yourself if you have experienced trauma 

Just because you know why you feel the way you do, does not mean you now have rational brain control of your thoughts and feelings. Van der Kolk describes the risks of not addressing your trauma in this way: “As long as you keep secrets and suppress information, you are fundamentally at war with yourself… The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.” 

  • Seek help from someone who you can be honest and open with while feeling absolutely safe. Recognising and then expressing your feelings is the first step to helping yourself. This may start with a peer, buddy, friend or family member however you may need professional trauma experienced support.  
  • Explore tai chi, chi gong, yoga or another system of gentle body posture and movement to begin to feel more in control and reengage awareness of your own body sensations.  
  • Singing in unison can help people to feel calm and safe. Making music together allows you to be in tune and sync with others and is also a way to overcome feelings of isolation.  
  • Eye movement desensitisation process (EMDR) is a proven technique to reduce the symptoms of noncomplex PTSD. 

Selfcare at times of potential trauma and vicarious trauma, and in preparation for ongoing adversity 

  • Be informed by and stay alert to your own feelings, thoughts and emotions. 
  • Seek support before you need it by talking to trusted allies if you have concerns for yourself or others. Debrief sooner rather than later. 
  • Take care of your emotional and physical needs and wellbeing. 
  • Take breaks and be realistic about what you can reasonably achieve in a day. 
  • Commit to having a healthy work life balance and nurture your creative, social and rest activities.   
  • Try to keep emotional distance between yourself and others experience of trauma. Giving them the tools to care for themselves rather than taking on that load yourself.  

Trauma informed practice 

Staff and patients will exhibit behaviours that may be labeled or diagnosed as anti-social, difficult, or perhaps aggressive without recognition that this may come from a current or past episode of trauma. If we apply a lens of being trauma aware, we do so with the acknowledgement of the complex impact of trauma and other forms of adversity on the person. We also acknowledge that everyone’s experience of trauma will be unique. 

A systematic trauma informed approach can help staff have confidence in their effectiveness with patients and each other, as well as provide self-care tools.  

To be trauma informed and trauma responsive, organisations need to be trauma resilient as well. Health Education England are currently scoping staff training in trauma informed practice. Other aspects of the process should include:  

  • Recognising the prevalence and impact of psychological trauma and adversity 
  • Being informed by lived experience 
  • Promoting wellbeing services to staff and ensuring easily accessible routes to support 
  • Aiming to respond in a way that prevents further trauma or harm 

Responding to reduce the risk of re-traumatisation and so trauma resilient incorporates enabling choice for individuals and not making assumptions, giving staff a voice. Empowerment to regain self-efficacy and self-worth.  Collaboration and mutuality between all parties, building trust to enable individuals to feel safe and resilient. 

Below are some links to further reading: 

https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/treatment

nationaltraumatrainingframework.pdf (transformingpsychologicaltrauma.scot) 

Vicarious trauma: signs and strategies for coping (bma.org.uk) 

Brené with Dr. Edith Eger on Recognizing the Choices and Gifts in Our Lives | Brené Brown (brenebrown.com) 

References:  

Aujla, R. (2020) How to Heal a Moral Injury – Helping Healthcare Workers Heal Mental Wounds in the Aftermath of Coronavirus with Dr Dominic Murphy. The Doctor’s Kitchen Podcast. [Podcast]. [Accessed 23 March 2021]. Available from: https://thedoctorskitchen.com/mental-health/51-how-to-heal-a-moral-injury-helping-healthcare-workers-heal-mental-wounds-in-the-aftermath-of-coronavirus-with-dr-dominic-murphy 

Eger E (2020) The Gift: 12 lessons to save your life. Ebury Publishing. ISBN: 9781846046278 

Kaszniak AW, Rushton CH & Halifax J (2018) “Leadership, morality and ethics: Developing a practical model for moral decision-making.” MindRxiv. MindRxiv Papers | Leadership, morality and ethics: Developing a practical model for moral decision-making (accessed March 2021) 

Perry G, Polito V, Fforde Thompson W (2016) Chanting Meditation Improves Mood and Social Cohesion. Dept of Psych. Macquarie Uni Aust. Chanting meditation improves mood and social cohesion — Macquarie University (mq.edu.au) (accessed March 2021)  

Van der Kolk B (2014) The Body Keeps the Score. Penguin Books Ltd.