PTSD: getting help after trauma

14 March 2024

Post-traumatic stress disorder (PTSD) is prevalent in the transport frontline. If you have PTSD, you are not alone, and there is help if you need it.

broken mirror

PTSD develops in response to one or more traumatic events. In transport this might include harassment and assault, or witnessing an accident or incident. A near miss can be traumatic.

Someone’s experiences outside of work may also make them vulnerable to developing PTSD when exposed to a traumatic event. Everyone is different. What isn’t traumatic to one person, might be to another. We never know everything that’s happened or is happening in someone’s life.

A 2020 survey of rail workers by Rail Safety and Standards Board* found that 10% of participants reported symptoms consistent with clinical PTSD, which is over double the rate in the general population. Of those, 7% reported symptoms of complex PTSD (C-PTSD), and 3% reported symptoms of PTSD. The higher rate of C-PTSD may be a result of repeated exposure to traumatic events. A quarter of respondents who had experienced a traumatic event later developed PTSD. Half of the workers surveyed had been in a public-facing role during the pandemic.

The RMT union shared in 2023 that around half of bus workers** had experienced incidents of workplace abuse in the previous two years. Abuse can increase the risk of PTSD.

What is PTSD?

When there is a traumatic event, your brain responds differently. Three main parts of the brain are involved in an emotional or traumatic event: the amygdala, the prefrontal cortex, and the hippocampus. The amygdala is like a signaller, watching out for information and deciding whether you do or don’t do something. Like an operations manager, the prefrontal cortex makes decisions and plans. The hippocampus is like a control room, storing records of what’s happened, or memories.

In an emotional event, the amygdala tells the prefrontal cortex something’s happening. The prefrontal cortex contacts the hippocampus to work out if you’ve seen this threat before and how you dealt with it or what you learnt. Then it decides what to do.

In a traumatic event, the body and brain flood with stress hormones. The amygdala basically panics and shuts down other areas of the brain, including the prefrontal cortex and hippocampus. The trauma memory can’t be filed in the past, so it still feels like it is happening.

The National Health Service says PTSD is estimated to affect about one in every three people who have a traumatic experience. Not everyone who experiences trauma develops PTSD.

Recognising symptoms

A hallmark of PTSD is flashbacks or nightmares, as though the event is happening again. Flashbacks can take many different forms and include seeing the traumatic event in your mind, re-experiencing emotions felt at the time of the event or having physical sensations similar to those experienced during the traumatic event.

People with PTSD may also find it hard to be confronted with reminders of the event, including places or people, which may make it hard to return to work. They may feel jumpy and on edge, with physical symptoms of the fight-or-flight response, such as a fast heart rate, trembling, pale or flushed skin, dilated pupils, or an unsettled stomach.

Is prevention possible?

Employers can try to reduce exposure to traumatic events through risk assessment and safety measures. Adequate support following an incident can reduce the likelihood of PTSD. But trauma can happen at any time, anywhere, to anyone.

We all have limits. Trying to cope with too much means we have less ability to recover and look after ourselves if something traumatic happens. If you are going through something affecting your mental health, including stress or bullying, can you get help? Being mentally and physically healthy can reduce the likelihood of developing PTSD following a traumatic event.

What help is there?

Lots of people recover by themselves. Most people do get better, so there is hope.

It is normal to feel distressed following a traumatic event and, in many cases, people recover naturally. Delayed reactions can also occur where you might feel fine until something triggers you with a reminder of the event. Statistics show 20% of people get better within three months, 50% in two years and 77% in 10 years. However, you should speak to your GP if your symptoms persist for more than a month or get worse.

Evidence-based therapies for PTSD – recommended in national clinical guidelines - include trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR).

If you think you have PTSD, it is important to seek support from a professional. Remember that if you are struggling to cope and want help, it is there. Your GP can support you in accessing treatment. You may wish to ask a friend or family member to help support you through your recovery process. Having someone who understands what you are doing and who can offer practical help where needed, such as driving you or booking a taxi to and from your appointments, can be helpful.

Importantly, be compassionate to yourself during recovery.

*https://www.rssb.co.uk/about-rssb/key-industry-topics/health-and-wellbeing/mental-wellbeing/how-is-the-mental-health-of-rail-employees
**https://www.rmt.org.uk/news/bus-workers-survey-reveals-nearly-half-have-experienced-abuse/