Section 7: Coping with shock and emotions, and getting support

Shock reactions can feel powerful, overwhelming and frightening. People in shock may go quiet, or scream, or moan or stutter. People may shake, or struggle to move. People may feel all kinds of heightened emotions and feel nervous, or jumpy, and find loud noises distressing.

People in shock may find it very hard to concentrate or do normal things. This may feel frustrating and upsetting. Understanding these things are happening because of shock can help people cope.

If suffering from shock, it is important to be somewhere safe and warm, to keep hydrated (with water or warm drinks) and have people around you. It is important to only do one thing at a time. If in shock, it is important not to drive, nor do anything else that requires concentration and carries risks, nor make big decisions you may later regret.

Some people find they have a level of distress that causes panic. If someone is suffering panic, it is important for them to be somewhere safe, and with people who understand what has happened and who can offer support.

This breathing exercise may help someone who is having a panic attack, so long as they have normal lung capacity.

• Breathe in slowly and deeply through your nose
• Hold your breath for a count of five
• Breathe out slowly and deeply through your mouth
• Hold your breath for a count of five
• Repeat for a few minutes.

If you are part of a family, it helps to remember that different family members may react in different ways, at different times.

It helps to try to accept each other’s reactions, even if someone is behaving in a way that feels challenging, or you would not normally expect.

It is important that children and young people feel supported within families.

Like everyone, children need to feel loved, informed of what is happening in ways they can understand, and feel that their reactions are accepted.

How you react, or how anyone else reacts, is normal at this time.

Sometimes, family and friends find it challenging to share thoughts with each other because they are trying to be ‘strong’, or for other reasons.

For help finding more support for families, including children and young people, call the National Road Victim Service.

It is normal and helpful to ask for help from other people you know at this time. This could be friends, neighbours or others in your community, such as a faith or club you belong to. It is important to reach out and seek support. People may want to help, but not know they are needed, or not know how to help.

Even small things, such as a weekly phone chat, can be very helpful.

It also helps to talk to any employer, or a school a child attends, so they can provide emotional support too.

It is common to feel you need to talk to someone confidentially about how you are feeling, particularly if you are trying to support others, or feel you cannot talk to people close to you.

The National Road Victim Service can help you cope and find more help. If you need to talk to someone urgently, call Samaritans on 116 123 any time, day or night.

I can’t believe it has happened, and if only…

Some people feel bewildered. It may feel hard to believe the crash happened.

It is common to mull over the circumstances leading up to the crash and wonder if you, or others, could have done anything to stop it happening. It may feel so unfair. ‘If only…’ is a particularly painful thought process.

It may be particularly hard to bear at night, when tired, or alone, or if people around you are sleeping. It can be upsetting on waking to realise, once again, that the crash has happened. This realisation can feel like another shock.

Anxiety or worry

It is common to feel anxious or worried. You may worry about the safety of yourself or other loved ones, particularly on the road but also generally. You may be scared about what the future may hold.

Stresses previously taken as being part of life may feel less bearable. You may get upset at small things as well as the big things. You may feel tense, wound up or restless. You may also find you forget things.

Treat yourself gently. Give yourself the time and space you deserve. Think about what helps you be calm – and do that. For example, listening to music.

Anger

It is common to feel angry if someone is being held responsible for the crash.

It is common to feel angry with society if you feel road safety is not treated seriously enough. It is also common to feel angry at other people who say things that you consider inappropriate or who do not offer help at this time. You may feel that ‘nobody understands’. Anger can be particularly hard to bear if you are not used to feeling angry.

Some people feel like they are on a rollercoaster of emotions, or out of control. It may help to remember that emotional reactions are normal, and some days may feel less hard than other days.

People don’t understand

You may feel guarded. It may feel hard to talk about what you are going through, particularly if you are worried people might ask questions or say things that may feel invasive, or might upset you in other ways.

You may feel that well-meaning people don’t listen enough, or say things that could feel inappropriate, such as ‘it will be OK’, or ‘that’s terrible’. They may talk about their own, or someone else’s injuries or illness, when you do not want to listen to someone else’s story, or think their story is different to your situation.

These things can feel understandably upsetting.

You can show someone this book to help them be more thoughtful of your needs and more considerate of what to say and how to help.

If you feel that someone is not being supportive, you may find it easiest to make a gentle excuse to leave a conversation that is upsetting you and seek support elsewhere.

I feel ignored

You may feel your emotional needs are not being met. This can feel painful – as though people are not recognising your need for help, or are rejecting you. You may feel that other people affected by the crash are unfairly getting more emotional or practical support than you.

If people are ignoring you, it may be because they are afraid they might say the wrong thing, or don’t know they can help, or don’t know how to help. Some people might not know what has happened.

More should be done to help

Some people feel a sense of unfairness. For example, it may feel that not enough medical or social support is being provided, or that a traffic offender has not been punished enough, or that a road safety problem is not being addressed by the authorities.

Some people find it helpful to join a road safety charity, such as Brake, or a charity representing the rights of people with particular injuries.

For a list of organisations that support road crash victims, go to www.brake.org.uk/orgs

Sleep, dreams and nightmares

It is common to have difficulty going to sleep, or staying asleep. Some people have vivid dreams or nightmares, due to their thoughts being in overdrive.

This may be followed by distressing feelings when you wake up, particularly if you wake up suddenly in the night.

Lack of sleep and nightmares can lead to physical exhaustion and it can be harder to manage emotions if exhausted too. Try to sleep when you can, even if this includes taking naps when you normally would be awake.

Other physical symptoms

A shock and distressing situation can cause intense and prolonged pressure, in addition to any injuries.

It is normal to suffer physical symptoms, occasionally or frequently.

• Energy levels may vary enormously.
• Heart palpitations, feeling faint or dizzy, excessive sweating, tremors and choking sensations are common.
• Muscles may tense up, causing pains, such as headaches.

• Digestive problems may occur.
• Women may suffer extra pain during menstruation.

Physical symptoms caused by emotional distress are painful and upsetting but should fade and disappear over time. If you are worried, talk to your GP.

Substance abuse

Some people faced with a shock or distressing situation find they want to turn to substances such as alcohol or cigarettes, or illegal drugs. This can damage mental and physical health and is not a helpful way to manage reactions.

It is harder to identify and address emotional and physical feelings if they are masked by the effects of substances.

Despair, or having suicidal thoughts

For some people, everything can feel bleak, or too hard to bear. For some people, this can be a fleeting thought that floats in and out, and then goes away. For others, it can be a lasting sense of despair or desperation that can lead to feelings that the future is too hard to face. This can lead to suicidal thoughts.

When in despair or having suicidal thoughts, it is hard to imagine feeling differently. It may help to know that many people who have experienced despairing and suicidal thoughts, have moved on, over time, to feel very differently and live a full and positive life.

Often, these people have received help from others.

Please, reach out for help.

It is a sign of strength, not weakness, to ask for help you need.

• Tell people you trust how you are feeling.
• Ask someone, or several people, to look after you closely.
• Read our advice on these pages about getting mental health help.
• Call Samaritans any time, day or night, on 116 123.

If you think you may be struggling with your mental health, it is important to seek an assessment and diagnosis so you can be helped. It is not a sign of failure to seek help, and it is important to do so.

You may be diagnosed as having anxiety or depression. Sometimes, people affected by a crash are diagnosed with post-traumatic stress disorder (PTSD).

It is normal to be offered therapy, provided by a specialist professional.

Therapy is often talk-based. Sometimes other kinds of treatment are offered too, such as medication.

When and how to seek an assessment of mental health

If it is a month or longer since the crash, it is appropriate to seek an assessment of mental health if:

• Your shock reactions are the same or worsening.
• You have new and distressing reactions emerging.

• You are suffering flashbacks or nightmares of what happened, or could happen, real or imagined.
• You feel numb, or unable to feel anything positive, or you feel depressed.
• You constantly think about what has happened, to the exclusion of everything else you need to think about, or feel anxious.
• You cannot eat or sleep normally.
• You are having suicidal thoughts.

These things are a guide only, and do not enable you to self-diagnose. If you have any reason to think you might need help, it is important to seek help.

You can seek help at no charge from NHS mental health services by visiting your GP and asking to be referred to an NHS mental health service for an assessment of your mental health needs.

You can also self-refer to NHS mental health services using the IAPT system (Improving Access to Psychological Therapies). Go to www.nhs.uk and search for IAPT.

For a list of organisations that can help you access private therapy, go to www.brake.org.uk/orgs

If you are supporting a family that has suffered a serious injury, your help is valuable, however small. These tips help you to help, better.

DO:

Do expect a range of reactions, as described in this section. This is okay, as long as people are kept safe.

Do ask open-ended questions relating to someone’s health and safety and to inform help you provide, for example:

• “Who is helping you / talking to you this week?”
• “What help have you been given so far?”
• “What shopping do you need?”
• “When would you like me to call you?”

Do listen patiently to their story, respecting diversity. Tell someone “You matter.” Let them talk, if they want. Let them be silent, if they want.

DO NOT:

Do not talk about your own injuries or illnesses that are nothing to do with the crash. This is not active listening.

Do not say “you will feel better soon”. This can imply serious injury is trivial. Do not expect to make things better, soon. The task is to keep people safe and feel supported.

Do not ignore signs someone may be at risk. For example, from suicide, or being unable to look after themselves, or being harmed by someone else. If immediate risk, dial 999.

Always prioritise your own welfare. It is possible to be traumatised by other people’s experiences or be psychologically damaged by thinking you did or said something wrong when trying to help. Take time out for yourself. Eat, sleep, relax and exercise. Get support from family, colleagues and friends.