1 00:00:05,060 --> 00:00:09,110 Great. Let's make a start. Thanks so much for joining us this morning. 2 00:00:09,110 --> 00:00:15,590 My name's Kathy Creswell. I'm from the departments of Experimental Psychology and Psychiatry here at the University of Oxford. 3 00:00:15,590 --> 00:00:21,570 And I'm really delighted to be hosting this series, which is hosted by the Department of Experimental Psychology. 4 00:00:21,570 --> 00:00:24,680 We're on our mental wellness. 5 00:00:24,680 --> 00:00:32,150 We've had a really great series of talks so far, and I'm delighted to introduce this one, which is focussed on coping with trauma. 6 00:00:32,150 --> 00:00:38,720 So just to tell you a little bit about how this all works, we'll have about 15 or 20 minutes talk, first of all, 7 00:00:38,720 --> 00:00:45,290 and then we're going to open up for a panel discussion because of the nature of the subjects that we're talking about, 8 00:00:45,290 --> 00:00:53,540 because we know there are a lot of questions and because we record and share this on YouTube, we don't have a live question answer session. 9 00:00:53,540 --> 00:00:57,230 So many thanks to those of you who've submitted questions in advance. 10 00:00:57,230 --> 00:01:02,780 We've collated those and pulled them together into themes that we'll be presenting to our panel. 11 00:01:02,780 --> 00:01:08,330 We'll be finishing at about quarter to eleven. And we deliberately leave it as 15 minutes to the hour. 12 00:01:08,330 --> 00:01:16,580 So there's a bit of time at the end, hopefully, for you to have a bit of a break before your next appointment or activity starts up, 13 00:01:16,580 --> 00:01:21,140 because obviously the issues that we are covering in this series, we understand, 14 00:01:21,140 --> 00:01:25,760 may raise difficulties for some people and give people lots to think about. 15 00:01:25,760 --> 00:01:31,650 So we want to give you a chance to take a bit of time, encourage you to give yourself a bit of a break, 16 00:01:31,650 --> 00:01:38,690 go for a bit of a walk or whatever would be helpful for you just to give yourself a little bit of time at the end of the session. 17 00:01:38,690 --> 00:01:44,330 Before we start, I also just want to highlight that we've had previous talks on some fantastic topics, 18 00:01:44,330 --> 00:01:52,130 including overcoming stress and anxiety, overcoming depression and low mood, overcoming problems with sleep and also with eating. 19 00:01:52,130 --> 00:01:57,170 So please do have a look at the Department of Experimental Psychology website or our YouTube channel, 20 00:01:57,170 --> 00:02:04,630 where you can watch back those talks, which have all been really, really useful and interesting sessions. 21 00:02:04,630 --> 00:02:12,620 And we also have another tool coming up shortly, which is focussed on overcoming paranoia, 22 00:02:12,620 --> 00:02:16,490 which will be led by Dan Freeman from the Department of Psychiatry. 23 00:02:16,490 --> 00:02:19,400 So please do so. Join us for that one. 24 00:02:19,400 --> 00:02:26,750 But without further ado, I'm really delighted to introduce Professor Anker, LSD from the Department of Experimental Psychology. 25 00:02:26,750 --> 00:02:32,330 Anchor is professor of Experimental Psychopathology and the Wellcome Trust Principal Research Fellow here, 26 00:02:32,330 --> 00:02:37,490 and is also co-director of the Oxford Centre for Anxiety Disorders and Trauma. 27 00:02:37,490 --> 00:02:41,490 Thanks ever so much for joining us today, anchor. Thank you very much, Kathy. 28 00:02:41,490 --> 00:02:46,820 Will your introduction and thanks everybody for joining us today. 29 00:02:46,820 --> 00:02:58,800 I'll quickly go to share my screen. And. 30 00:02:58,800 --> 00:03:09,500 Yes, so my topic is coping with trauma. But let's first look at what what do what do we understand what a trauma is in everyday language? 31 00:03:09,500 --> 00:03:16,850 We use of a broad definition of I don't talk about upsetting events, such as losing a job, 32 00:03:16,850 --> 00:03:28,220 failing a exam or a divorce as potentially as traumatic and met in medical science of trauma often refers to a physical injury. 33 00:03:28,220 --> 00:03:39,260 What I'm going to talk about is slightly different. It's a kind of narrower definition of upsetting events that cause a psychological trauma. 34 00:03:39,260 --> 00:03:42,770 And those traumas are extremely threatening events. 35 00:03:42,770 --> 00:03:55,220 So it can be a series of repeated events that often involve the threat to one owns one's own life or physical integrity or that of other people. 36 00:03:55,220 --> 00:04:00,900 And examples would be interpersonal violence, such as assault, torture and so on, 37 00:04:00,900 --> 00:04:05,960 severe accidents, natural and manmade disasters or war zone experience. 38 00:04:05,960 --> 00:04:18,040 But it's very broad. What what type of events that that's can can be called trauma because they involve the spread to life or physical integrity. 39 00:04:18,040 --> 00:04:25,910 And what is really important to highlight here is that what matters is the subjective experience at that time. 40 00:04:25,910 --> 00:04:34,070 So even people who are in the in the same event differ in whether they experience the event as a trauma. 41 00:04:34,070 --> 00:04:43,400 And to give you an example. And so let's say somebody is threatened with a toy gun in a mugging or something like that. 42 00:04:43,400 --> 00:04:49,550 And if the person at the time believes that's a real gun and they are about to be shot, 43 00:04:49,550 --> 00:04:58,310 this could be a psychological trauma, even though they might find out shortly afterwards that it was just a toy gun. 44 00:04:58,310 --> 00:05:04,070 So whether it's subjectively perceived as a threat to life or physical integrity. 45 00:05:04,070 --> 00:05:08,060 So my next question is, how common is this type of excrete appearance? 46 00:05:08,060 --> 00:05:12,530 And we have a quick poll prepared for you to get your opinion. 47 00:05:12,530 --> 00:05:22,190 Well, how many people do you think have experienced such an event in their lifetime? 48 00:05:22,190 --> 00:05:32,120 Thank you very much. The results coming in now, so so we we can see that most of you estimated between 30 and 60 percent. 49 00:05:32,120 --> 00:05:37,340 That's a very good guess. It is a common experience. 50 00:05:37,340 --> 00:05:43,190 And some of the second largest guess was between 60 and 90 percent. 51 00:05:43,190 --> 00:05:49,880 So. So you are very much on target. It is actually, even though these are extreme events. 52 00:05:49,880 --> 00:05:55,180 They are actually common. And if we are now go to two. 53 00:05:55,180 --> 00:06:01,730 Oh, my. Next. Next slide. Then we we can sew it. 54 00:06:01,730 --> 00:06:05,270 I can't. So hopefully you see that. 55 00:06:05,270 --> 00:06:13,780 See, you know, some examples from from recent events that were reported widely in the media. 56 00:06:13,780 --> 00:06:22,950 So you from accidents, from fire, terrorist attacks, natural disasters and so on are very common. 57 00:06:22,950 --> 00:06:32,830 And the research actually shows that most people will experience at least one traumatic event in their lifetime. 58 00:06:32,830 --> 00:06:39,400 For example, a large study recently contacted by the World Health Organisation interviewed 59 00:06:39,400 --> 00:06:47,350 nearly 70000 people in 24 countries and 70 percent in the studies reported trauma. 60 00:06:47,350 --> 00:06:57,730 And actually, on average, it was three traumas per person. The most common events reported were in this survey were unexpected death of 61 00:06:57,730 --> 00:07:06,840 a loved one or witnessing happen to other people and road traffic accidents. 62 00:07:06,840 --> 00:07:11,580 How do people respond to trauma? What happens in the aftermath? 63 00:07:11,580 --> 00:07:22,170 There is a set of typical symptoms and this is one of the reasons why the definition of trauma in psychology and psychiatry is quite, 64 00:07:22,170 --> 00:07:24,510 quite and has been narrowed down. 65 00:07:24,510 --> 00:07:36,020 But amongst the most common symptoms after such events are re experiencing symptoms where people experience moments from the event memories, 66 00:07:36,020 --> 00:07:43,650 dreams or just the emotions of body sensations from the trauma as if they are ever happening again right now. 67 00:07:43,650 --> 00:07:51,780 So people that may have pictures from the event popping into their mind or they may dream about them. 68 00:07:51,780 --> 00:08:01,110 And amongst body sensations, they experience could be that like the heart racing or death, the physiological responses during the event. 69 00:08:01,110 --> 00:08:10,710 And it really feels as if the trauma is happening now. And if you have such unpleasant memories of the event that are highly distressing, 70 00:08:10,710 --> 00:08:16,830 it is very understandable that people will go out of their way to avoid reminders of the event. 71 00:08:16,830 --> 00:08:20,730 This could be similar situations like going to the site of the event. 72 00:08:20,730 --> 00:08:32,220 People who were involved or even thinking or talking about the event is extremely distressing and therefore is avoided very commonly. 73 00:08:32,220 --> 00:08:40,680 And finally, there's many symptoms of being in a state of high alert, being on edge, 74 00:08:40,680 --> 00:08:48,600 looking out for danger, being easily started with also difficulty sleeping and concentrating. 75 00:08:48,600 --> 00:08:55,110 And that's very understandable after an upsetting event such as the ones I described. 76 00:08:55,110 --> 00:09:03,930 And what is important to emphasise here that these symptoms are entirely normal after a traumatic event. 77 00:09:03,930 --> 00:09:14,070 And most people will have some re experiencing symptoms soon after the event and some avoidance and some might how arise? 78 00:09:14,070 --> 00:09:18,840 That doesn't mean necessarily that this is a clinical condition developing. 79 00:09:18,840 --> 00:09:24,070 It's just a normal response to an abnormal situation. 80 00:09:24,070 --> 00:09:31,650 But for some people, it can become a more chronic problem that they have these kinds of symptoms. 81 00:09:31,650 --> 00:09:36,330 And this is what we then call post-traumatic stress disorder. 82 00:09:36,330 --> 00:09:41,340 And this disorder is characterised by exactly the same symptoms that everybody would 83 00:09:41,340 --> 00:09:47,460 experience and also offer negative thoughts about the self or feeling quite numb, 84 00:09:47,460 --> 00:09:54,000 being losing interest and things people used to enjoy and having lots of negative emotion, 85 00:09:54,000 --> 00:09:59,650 including sadness, anger, feeling guilty or ashamed and so on. 86 00:09:59,650 --> 00:10:09,940 But none of that immediately after the trauma is is is is a cause of concern, because as you will see on my next slide, 87 00:10:09,940 --> 00:10:17,200 that people are often resilient and recover from these symptoms on their own devices. 88 00:10:17,200 --> 00:10:23,020 And a slide from the same study, study that I just mentioned from the World Health Organisation. 89 00:10:23,020 --> 00:10:33,430 And people were answering questions of how long after the event their symptoms persisted and what you can see. 90 00:10:33,430 --> 00:10:39,610 And the plot just highlights different types of trauma. So let's just look at the overall picture. 91 00:10:39,610 --> 00:10:49,990 You can see that in the first year. And what's plotted here is years after the traumas in the first year, we see a really very steep recovery. 92 00:10:49,990 --> 00:10:54,550 So so quite of lot of people, 25 to 40 percent, 93 00:10:54,550 --> 00:11:04,270 will fully recover from the PTSD symptoms in the first year after the trauma and even after that recovery is still ongoing. 94 00:11:04,270 --> 00:11:11,080 You see a one as one group where whether the recovery takes longer. 95 00:11:11,080 --> 00:11:21,810 And this is from was on related trauma. So, so but for all other traumas, it's quite a fast recovery in the first year. 96 00:11:21,810 --> 00:11:24,530 So this now raises the question so. 97 00:11:24,530 --> 00:11:32,070 So if we see that many of these symptoms are quite normal after the event, it's an abnormal event and we react to that. 98 00:11:32,070 --> 00:11:38,950 We have to readjust our lives after having feelings like this. 99 00:11:38,950 --> 00:11:42,180 And many people will recover on their own. 100 00:11:42,180 --> 00:11:50,850 So what do we know about what helps recovery so that we that what prevents people from being stuck in this recovery process, 101 00:11:50,850 --> 00:12:01,620 which is while we understand developing PTSD? So one big factor there is support from family, friends and colleagues. 102 00:12:01,620 --> 00:12:11,190 So if we have support from other people that are close to us, that care about us, that that will be helpful. 103 00:12:11,190 --> 00:12:15,960 Also generally looking after ourselves, self care. 104 00:12:15,960 --> 00:12:27,990 So really watching out to eat eat well after an event like this, to not use substances excessively, not to let not drink too much alcohol and so on. 105 00:12:27,990 --> 00:12:31,870 Get some exercise and also generally be kind to yourself. 106 00:12:31,870 --> 00:12:37,800 And don't don't feel you have to really back to and be back to normal in a few days. 107 00:12:37,800 --> 00:12:42,060 This isn't a very upsetting event that shakes people up and. 108 00:12:42,060 --> 00:12:44,490 And we won't be able to overcome it in a day. 109 00:12:44,490 --> 00:12:52,950 But as if we let the natural recovery with the support of our friends and colleagues and and family take place, 110 00:12:52,950 --> 00:13:03,690 then then then we have a good chance of recovering. The other tip I would give from our clinical work on post-traumatic stress disorder. 111 00:13:03,690 --> 00:13:15,540 That often people who end up having a post-traumatic stress disorder give up a lot of activities that were important to them before and they enjoyed. 112 00:13:15,540 --> 00:13:22,470 And that could be a direct effect of the trauma. Let's say they were injured and can't do certain activities. 113 00:13:22,470 --> 00:13:32,070 But even then, if the injuries are healed and they can could resume this active often, then don't quite get around to doing this. 114 00:13:32,070 --> 00:13:43,530 And so what one of advice I would give is step by step, trying to reclaim activities that bring meaning and enjoyment to our lives. 115 00:13:43,530 --> 00:13:52,080 And even if one might not feel like this immediately after an event, you might feel, oh, it's it's there's no point to it. 116 00:13:52,080 --> 00:14:02,840 I really getting back into a daily routine where this is a part and this may need to do involves finding some alternatives. 117 00:14:02,840 --> 00:14:06,900 If if you can't do certain things any longer after trauma. 118 00:14:06,900 --> 00:14:13,980 So for so for instance, let's say somebody has a leg injury and can't play football any longer. 119 00:14:13,980 --> 00:14:19,800 They may still be able to do some form of exercise, like go to the gym or go swimming and so on, 120 00:14:19,800 --> 00:14:27,960 that that really ticks the same box in in and bringing meaning and enjoyment to their lives. 121 00:14:27,960 --> 00:14:35,520 That's obviously easier said than done. But so it takes a little bit of a decision to get going again with these activities. 122 00:14:35,520 --> 00:14:45,550 But we find them extremely helpful. The other point I wanted to consider is what gets in the way we weigh in the way of recovery. 123 00:14:45,550 --> 00:14:52,570 So how do some people get stuck and develop PTSD after trauma? 124 00:14:52,570 --> 00:14:59,530 And one thing I wanted to mention is that people can get stuck in vert, 125 00:14:59,530 --> 00:15:08,410 vicious cycles between the threat that they've taken from the trauma threatening meanings of the trauma. 126 00:15:08,410 --> 00:15:14,320 And it's and and also its aftermath, including the symptoms of PTSD themselves. 127 00:15:14,320 --> 00:15:25,090 So I will give some examples in a minute. And the second is, when you have one, you feel that trauma is still posing a threat in your life. 128 00:15:25,090 --> 00:15:31,900 So let's say you feel you're going to be attacked again. You will take measures to prevent this. 129 00:15:31,900 --> 00:15:39,130 And and the crux here is that some of these very understandable strategies 130 00:15:39,130 --> 00:15:44,260 that people take to control the threat they are now perceiving in their life, 131 00:15:44,260 --> 00:15:54,490 too, will actually backfire and either increase symptoms or or maintain the problems or so that you kind of keep stuck in this vicious circle. 132 00:15:54,490 --> 00:16:02,920 And as an odd way to introduce us, I just wanted you to do a little experiment with me for just a short moment. 133 00:16:02,920 --> 00:16:09,330 So if in the next few moments, I would like you to you can think about anything you like, 134 00:16:09,330 --> 00:16:16,530 but there is one particular thing I would add under no circumstances should think about. 135 00:16:16,530 --> 00:16:23,470 And this is a black and white cat sitting on my shoulder so you can think about anything else. 136 00:16:23,470 --> 00:16:32,530 But don't think about that cat. So what? 137 00:16:32,530 --> 00:16:42,080 What happened? I would hope that it would have illustrated to you that it's really hard not to think about it, 138 00:16:42,080 --> 00:16:50,180 something so many people who do this experiment will say, well, immediately an image of a cat popped into my mind. 139 00:16:50,180 --> 00:16:59,080 And this is exactly what what seems to be going on in people who develop PTSD after trauma as well, 140 00:16:59,080 --> 00:17:06,560 that they will have many unwanted memories of the trauma popping into my mind, as I explained. 141 00:17:06,560 --> 00:17:09,650 This is a normal experience after trauma. 142 00:17:09,650 --> 00:17:16,730 But if they then think this means something bad about themselves, for instance, they might think I'm going crazy. 143 00:17:16,730 --> 00:17:27,560 I'm not. I'm losing it. I won't be able to my do my job and ever again, they will then try very hard to push these memories out of their mind. 144 00:17:27,560 --> 00:17:36,650 But as hopefully you will explain yourself. This actually has a paradoxical effect that actually these these memories pop into your mind more. 145 00:17:36,650 --> 00:17:43,730 So it kind of increases the chances of finding unwanted memories, which then confirms them. 146 00:17:43,730 --> 00:17:47,810 And that idea that they might be going crazy and losing it. 147 00:17:47,810 --> 00:17:54,070 And it's why push even harder. And and they got tons of get stuck in this vicious circle. 148 00:17:54,070 --> 00:18:00,680 So so we would want to break through these these vicious circles after trauma. 149 00:18:00,680 --> 00:18:08,750 Another example here where it's more about some a meaning that a person took from from that trauma. 150 00:18:08,750 --> 00:18:17,960 In this case, let's imagine somebody who was treated in hospital during the course of a pandemic. 151 00:18:17,960 --> 00:18:23,110 In an ICU unit. And nobody was allowed to visit them. 152 00:18:23,110 --> 00:18:36,050 As you well know. But people when they are sick and in a state of being being very sick and also having lots of medication and so on. 153 00:18:36,050 --> 00:18:46,640 They might get into a kind of confusion state and be very confused about what's happening and not fully understand why nobody came to visit them. 154 00:18:46,640 --> 00:18:54,520 And they might feel quite abandoned. And they may take from this fear the meaning or do what he really cares about me. 155 00:18:54,520 --> 00:18:57,500 They would have come if they cared about me. 156 00:18:57,500 --> 00:19:08,600 And then in the aftermath, when friends were trying to reach out to them and invite them or phone them, they may actually avoid them. 157 00:19:08,600 --> 00:19:14,690 And made really was drawn socially and and not returned phone calls, 158 00:19:14,690 --> 00:19:22,340 which then means the friends will take that as a sign that this contact is unwanted and they get fewer 159 00:19:22,340 --> 00:19:30,200 invitations and fewer fewer calls and which then confirms for for this person or nobody cares about me. 160 00:19:30,200 --> 00:19:37,910 So they might get in a vicious cycle like that. And we see that a lot of us people that we treat for post-traumatic stress disorder, 161 00:19:37,910 --> 00:19:44,450 that breaking through these vicious cycles about meanings that people take from the 162 00:19:44,450 --> 00:19:52,160 trauma then influences understandably and a logical way you could say that behaviours. 163 00:19:52,160 --> 00:20:01,910 But that then prevents them. We only fight from protesting out that that that meaning and finding evidence against it. 164 00:20:01,910 --> 00:20:10,860 So it seems to confirm the behaviour seems to lead to to a confirmation of these these meanings, just distressing meanings. 165 00:20:10,860 --> 00:20:17,760 So breaking through this vicious cycles, spotting them and breaking through these vicious cycles and then behaving 166 00:20:17,760 --> 00:20:23,520 differently to test out these meanings is an important way to get over trauma. 167 00:20:23,520 --> 00:20:27,510 One more example. What gets in the way of recovery? 168 00:20:27,510 --> 00:20:33,150 I don't have a lot of time to think about it, to talk about the nature of trauma memories. 169 00:20:33,150 --> 00:20:42,280 That would be a lot to say about that. But but of we we don't have time for going into debt discussions about that. 170 00:20:42,280 --> 00:20:49,350 But what I would like to highlight is the sense of fear now that trauma memories have soon after the trauma. 171 00:20:49,350 --> 00:21:00,150 And and if people have chronic PTSD continuing for years and years, moments on the trauma popping into their mind when they don't want one, too. 172 00:21:00,150 --> 00:21:10,530 And one important lesson we learnt when treating patients with this disorder and also from research is that it is useful to know about 173 00:21:10,530 --> 00:21:20,910 the triggers of these memories because they can be quite difficult to spot because they often don't have meaningful relationships. 174 00:21:20,910 --> 00:21:25,950 It's just about sensations that were around at the time. 175 00:21:25,950 --> 00:21:30,930 And and it's it's really often just one particular sensation. 176 00:21:30,930 --> 00:21:37,320 So it could be a particular colour, a particular smell, a sound or taste. 177 00:21:37,320 --> 00:21:46,320 It could be it touches someone, the body or a particular movement that they perceived or that they made themselves. 178 00:21:46,320 --> 00:21:55,680 And these can automatically trigger these very distressing memories that appear to be in here now. 179 00:21:55,680 --> 00:22:07,080 And it's also the case that because these memories are so distressing, people would usually then look away or try to avoid this situation. 180 00:22:07,080 --> 00:22:15,870 And that makes it very difficult for them to spot any differences between the reminder that that's in the current situation, 181 00:22:15,870 --> 00:22:23,120 that that's not dangerous. And the original trauma KUZE. 182 00:22:23,120 --> 00:22:30,040 And what we can do then and that's what we would also do in treatment when we treat people with PTSD, 183 00:22:30,040 --> 00:22:36,820 is really working with the person on what are the the individual triggers. 184 00:22:36,820 --> 00:22:45,110 So and something we can see, hear, smell, taste or feel in our body when a memory is triggered. 185 00:22:45,110 --> 00:22:53,510 And let's say was the example of the person who was treated in intensive care. 186 00:22:53,510 --> 00:23:01,610 So if there were many, many triggers, what one of them, for instance, was the blue colour that the NHS logo has. 187 00:23:01,610 --> 00:23:05,990 As a kind of particular type of blue and red. 188 00:23:05,990 --> 00:23:15,200 And for this person, anything that had this colour blue would trigger intrusive memories of the I say use this day. 189 00:23:15,200 --> 00:23:21,010 So, for instance, somebody walking on the street with a t shirt and the same colour would be a trigger. 190 00:23:21,010 --> 00:23:26,050 But there is no meaningful connexion that the t shirts are not dangerous. 191 00:23:26,050 --> 00:23:28,100 And but still, 192 00:23:28,100 --> 00:23:38,060 spotting this relationship then would would then help us to really look at what are the differences between them then the time of trauma. 193 00:23:38,060 --> 00:23:44,640 And now a person with a blue t shirt. And and it's a completely different situation. 194 00:23:44,640 --> 00:23:48,690 They are now recovered of it and they are better. 195 00:23:48,690 --> 00:23:52,950 They are not ill. It's a person on the street. They are not in hospital. 196 00:23:52,950 --> 00:23:57,930 So lots of differences. And and then so. 197 00:23:57,930 --> 00:24:05,720 So really, zooming in, directing our attention to the differences can be really helpful in overcoming this 198 00:24:05,720 --> 00:24:12,410 automatic reaction of being triggered by these cues in everyday life at a harmless. 199 00:24:12,410 --> 00:24:18,410 And and I linked with a trauma through this kind of sensory connexion that we want to break. 200 00:24:18,410 --> 00:24:23,390 And this takes some practise. But but people find it really helpful. 201 00:24:23,390 --> 00:24:33,530 The last one I wanted to mention is dwelling on the trauma. And I think Jennifer Wilde has already talked about the negative effects of dwelling. 202 00:24:33,530 --> 00:24:40,010 People may, after trauma, think about the questions like why did it happen to me? 203 00:24:40,010 --> 00:24:44,480 What if I only hadn't done this or if I had done this? 204 00:24:44,480 --> 00:24:49,890 And this can be a fear, quite compelling. They feel they should really to think about it more. 205 00:24:49,890 --> 00:24:54,860 And it can kind of to come back in the kind of circular thinking about the trauma, 206 00:24:54,860 --> 00:25:01,430 which can really negatively affect people's mood and also can keep them and risk going. 207 00:25:01,430 --> 00:25:10,580 And we advise to to try to spot that when you're getting into these ruminative circles early, 208 00:25:10,580 --> 00:25:14,660 because it's easier to interrupt them when you're when you're early on. 209 00:25:14,660 --> 00:25:19,130 We do spot them and then take them as a sign to get active. So even if it's something simple, 210 00:25:19,130 --> 00:25:28,550 like getting a cup of tea or doing a little bit of exercise and to really get out of the vicious circle of a dwelling, 211 00:25:28,550 --> 00:25:38,210 and some people find it really useful to label that, like I have a picture of a carousel because as somebody who thought that was a good image. 212 00:25:38,210 --> 00:25:47,480 All of that thoughts go in circles or so I get to you, thinking was was another good label, somebody that we saw came up with. 213 00:25:47,480 --> 00:25:55,010 It's kind of all twisted up and and leads nowhere. It's kind of all of the spaghetti together. 214 00:25:55,010 --> 00:25:59,540 So so spotting dwelling can be very helpful. 215 00:25:59,540 --> 00:26:07,910 But I would also I would like to finish now with saying if if somebody gets stuck in this natural recovery, 216 00:26:07,910 --> 00:26:14,780 that is that is a very and also very understandable consequence of trauma. 217 00:26:14,780 --> 00:26:17,210 And the good news is that help is available. 218 00:26:17,210 --> 00:26:27,350 So effective psychological treatments are available in the NHS and psychological treatments, other first-line treatments for this condition. 219 00:26:27,350 --> 00:26:37,130 If you're interested in and in that, those are the nice guidelines have been published in 2018. 220 00:26:37,130 --> 00:26:41,290 You can look them up on the Internet if you want. 221 00:26:41,290 --> 00:26:47,660 I think you might need some help. You can discuss with those your GP who can advise about the best options. 222 00:26:47,660 --> 00:26:55,130 You can also self refer to your local. Improving access to psychological therapy service in Oxford. 223 00:26:55,130 --> 00:27:00,470 That's called talking space plus. And there's a service finder on the Internet. 224 00:27:00,470 --> 00:27:12,920 If you Google, I services NHS and then you can find a website where you put in your postcode and find your the services that are closest to you. 225 00:27:12,920 --> 00:27:22,500 And there's also various specialist trauma services and psychological treatment services in the NHS, depending on where. 226 00:27:22,500 --> 00:27:23,570 You live? 227 00:27:23,570 --> 00:27:34,490 Oh, well, they can offer longer treatments, especially for people who have very severe post-traumatic stress disorder or more complex problems, 228 00:27:34,490 --> 00:27:41,310 was with several, several problems that need to be addressed. Thank you very much for your attention. 229 00:27:41,310 --> 00:27:47,940 Great. Thank you ever so much indeed. I'm now delighted to introduce our fellow panel members. 230 00:27:47,940 --> 00:27:52,800 So I'd like to introduce you to Maine if it's our who's associate professor in 231 00:27:52,800 --> 00:27:56,700 child and adolescent psychiatry in the Department of Psychiatry here in Oxford, 232 00:27:56,700 --> 00:27:58,160 and also Morten Cringle back. 233 00:27:58,160 --> 00:28:04,290 He's associate professor of neuroscience at the Department of Psychiatry and Senior Research Fellow at Queens College, London. 234 00:28:04,290 --> 00:28:08,680 Thanks for Queenscliff chocs. Sorry. Thanks for joining us. 235 00:28:08,680 --> 00:28:13,240 I think I've read them in different made their apologies. 236 00:28:13,240 --> 00:28:18,240 And so we've received a number of questions which we're going to talk through. 237 00:28:18,240 --> 00:28:20,220 So just to start with, I'd like to come to you, 238 00:28:20,220 --> 00:28:27,690 Morten and Backspaces picks up on what Frank was saying about the range of different traumatic experience that people may happen, 239 00:28:27,690 --> 00:28:36,180 the different effects they may have on different people. And so there were some questions about what distinguishes kind of trauma with a capital 240 00:28:36,180 --> 00:28:42,030 T and other distressing experiences that we might not typically classes trauma. 241 00:28:42,030 --> 00:28:45,510 And the labour questions really about what research can tell us about this. 242 00:28:45,510 --> 00:28:49,890 So are there specific effects of the sort of capital T traumas? 243 00:28:49,890 --> 00:28:57,220 And I guess ultimately, would we need to manage these different sorts of distressing events differently? 244 00:28:57,220 --> 00:29:02,410 I mean, I think these are great questions. And, of course, we are still looking at them. 245 00:29:02,410 --> 00:29:05,800 And it is wonderful talk sort of gets to the heart of that. 246 00:29:05,800 --> 00:29:11,980 Remember when she showed the first slide, she said trauma is the psychological experience of having trauma. 247 00:29:11,980 --> 00:29:18,070 Obviously, there are degrees of the kind of trauma that you can go through if you see it in a in an accident. 248 00:29:18,070 --> 00:29:19,420 You may also hit your hit. 249 00:29:19,420 --> 00:29:25,750 So, of course, that could both be the things that changes your brain, but also the things that changes your brain structurally. 250 00:29:25,750 --> 00:29:33,310 So obviously that would have a larger impact. And May could well be what some people will classes trauma with a capital T. 251 00:29:33,310 --> 00:29:40,750 But the other thing that Oncor so pointed out in our talk, which I think is a very important one, is the natural course of the disease, 252 00:29:40,750 --> 00:29:47,410 namely that lots of lots of traumas will eventually go away or at least become better with time. 253 00:29:47,410 --> 00:29:51,000 And so what can neuroscience tell about it? Well, again, unclear. 254 00:29:51,000 --> 00:29:58,930 It provided a wonderful sort of answer to that, namely that one of the things that goes away is the enjoyment of things. 255 00:29:58,930 --> 00:30:04,180 And one of the best things one can do is to actually enjoy things in psychological lingo, we call it. 256 00:30:04,180 --> 00:30:08,980 And he donia and a volition the the lack of pleasure and the leg up wanting to do anything. 257 00:30:08,980 --> 00:30:13,920 And of course, what is happening in the brain is that those circuits are being changed. 258 00:30:13,920 --> 00:30:20,130 And the question, of course, then is, are they changed differently because you may have hit your head at the same time. 259 00:30:20,130 --> 00:30:22,990 There may be structural consequences of that. 260 00:30:22,990 --> 00:30:30,850 And the answer is absolutely certain things where you experience trauma potentially on a daily basis, like the military experience. 261 00:30:30,850 --> 00:30:32,200 It's really a difficult one. 262 00:30:32,200 --> 00:30:39,760 And of course, I think the key issue here, depending on what it is that we experience, is how do we avoid going from acute to chronic. 263 00:30:39,760 --> 00:30:46,680 And this is exactly where the kinds of of treatments that the uncle has outlined is exactly what is needed. 264 00:30:46,680 --> 00:30:51,220 Then, of course, it's very different if you trying to treat somebody who is experiencing a chronic 265 00:30:51,220 --> 00:30:55,210 trauma every day of the week compared to somebody who's only had a one off. 266 00:30:55,210 --> 00:31:00,620 So those are the kind of research questions that we are actively pursuing. Thanks very much. 267 00:31:00,620 --> 00:31:05,780 What's it mean? I don't know if you want to add anything in relating this question about different thoughts. 268 00:31:05,780 --> 00:31:09,730 The former and distressing events? Well, absolutely. 269 00:31:09,730 --> 00:31:14,860 So I think what I talked about, about the subjective experience being crucial is that, you know, 270 00:31:14,860 --> 00:31:22,120 there are so many different events that could potentially lead one to subjectively experience that it's traumatic. 271 00:31:22,120 --> 00:31:29,410 And I do think that it's an incredibly exciting time for research as well, because I think research is something that has always played a key role. 272 00:31:29,410 --> 00:31:36,490 But it's really started to help unpack in the natural course of what people experience. 273 00:31:36,490 --> 00:31:39,880 And also the different types of interventions that might be able to help. 274 00:31:39,880 --> 00:31:45,850 And this is that's really grabbing. They're really incredible innovations and we're learning a lot. 275 00:31:45,850 --> 00:31:55,120 They're not set as well as kind of across different institutions. And so I think it's a key time for research to have different vulnerabilities. 276 00:31:55,120 --> 00:32:04,000 There's also kind of neurodiversity and had different types of kind of brains and personality types might react to different events. 277 00:32:04,000 --> 00:32:08,910 And then, you know, what I'm interested in is then what does that mean on the ground? 278 00:32:08,910 --> 00:32:21,520 Interventions like what does that mean for how services can better adapt so that we become easier for a person who, as I can really clearly described, 279 00:32:21,520 --> 00:32:27,250 is in avoidance is such a key part of this study that no matter how much we understand about what's going on, 280 00:32:27,250 --> 00:32:33,430 if a person is just going to avoid coming through the door to get an intervention, what can we do to help that side? 281 00:32:33,430 --> 00:32:45,340 I think there's so much so many different ways that present in our society, so much we can learn about how we can tailor interventions to really help. 282 00:32:45,340 --> 00:32:52,870 Thank you. Martin. He told there about neuroscience and the contribution of neuroscience to our understanding of trauma. 283 00:32:52,870 --> 00:32:55,390 I wondered if there anything else you wanted to add on that, 284 00:32:55,390 --> 00:33:00,430 because we did certainly have some specific questions about the contribution of neuroscience, 285 00:33:00,430 --> 00:33:05,080 sort of as distinct from psychology and how it is contributing to our understanding. 286 00:33:05,080 --> 00:33:12,660 One of my former students now postdoctoral Marina Bulkier Ballester Shakira was also a student of Ankit. 287 00:33:12,660 --> 00:33:17,280 So we supervised a project which she'd taken some of anxious interventions, 288 00:33:17,280 --> 00:33:22,420 and uncle had scanned the participants patients before and after the intervention. 289 00:33:22,420 --> 00:33:29,320 So now we were able to track over time what happened to the brains as they were initially just looking at what 290 00:33:29,320 --> 00:33:35,830 happened when they had a traumatised images and then happened after they had successfully been been changed. 291 00:33:35,830 --> 00:33:40,380 And very much like what Uncap demonstrated with that wonderful example with the black cat, 292 00:33:40,380 --> 00:33:46,630 which of course, one of the key issues in trauma is that you keep basically doing what? 293 00:33:46,630 --> 00:33:51,660 And of course, biggity thinking this this idea that you are stuck in a rut. 294 00:33:51,660 --> 00:33:56,250 And the interesting thing was that once you had carried out this very carefully. 295 00:33:56,250 --> 00:34:01,140 And what you found in the brain was that suddenly the patients were able to disconnect 296 00:34:01,140 --> 00:34:05,760 from these traumatising pictures instead of just taking over like the black. They went away. 297 00:34:05,760 --> 00:34:08,490 And of course, we now know exactly where that is happening in the brain. 298 00:34:08,490 --> 00:34:13,980 And we not only do we know where it's happening, but we also know the networks of how different things are communicating. 299 00:34:13,980 --> 00:34:18,660 And then I think it's an exciting piece of work that should be replicated in those communities. 300 00:34:18,660 --> 00:34:22,320 It's important that this actually has real effect on the ground. 301 00:34:22,320 --> 00:34:30,350 But again, taking into account the more diversity the media mentioned, I think it's crucially important and key, a really fascinating area. 302 00:34:30,350 --> 00:34:34,680 And I mean, there are a lot of questions really about the variation of experiences, the variation. 303 00:34:34,680 --> 00:34:40,440 The trick is both of the variation of people's responses and say there were particular questions about 304 00:34:40,440 --> 00:34:47,520 psychosomatic symptoms and whether we might see the impacts of trauma three psychosomatic symptoms, 305 00:34:47,520 --> 00:34:51,610 for example, pain. And if so, how best to cope with that? 306 00:34:51,610 --> 00:34:57,300 I mean it. Can I come to a festival? Yes. So, you know, as we become aware today, 307 00:34:57,300 --> 00:35:05,250 there's all these emotional and cognitive reactions within these expenses can also cause physical symptoms such as headaches, 308 00:35:05,250 --> 00:35:10,560 digestive problems, nausea or diarrhoea or fatigue or feeling jumpy. 309 00:35:10,560 --> 00:35:16,360 So there's a whole range of ways that the body can also kind of respond. 310 00:35:16,360 --> 00:35:19,590 And I think the first thing that I would say is that, you know, 311 00:35:19,590 --> 00:35:26,670 if you're getting headaches because of this, that these are really painful, truly experience symptoms. 312 00:35:26,670 --> 00:35:38,200 And so pleasant is that this is not to dismiss this idea that this is not a real headache because it's causes to get some organic psycho pathology. 313 00:35:38,200 --> 00:35:44,280 And so the first thing is that you need to be aware that trauma can affect everybody differently. 314 00:35:44,280 --> 00:35:48,540 And for some people, that might have manifestations in these physical symptoms. 315 00:35:48,540 --> 00:35:56,590 But then what to do about it? I think to know that there's no magic bullet that actually understanding that this is actually quite common, isn't it, 316 00:35:56,590 --> 00:36:06,520 in a helpful what we call psycho education is such a basic part of starting to address it that we often say this is really you think, 317 00:36:06,520 --> 00:36:09,900 well, it's a software problem rather than a hardware problem. 318 00:36:09,900 --> 00:36:19,650 And so, you know, we can actually through a range of different methods and in a way, a very multidisciplinary approach. 319 00:36:19,650 --> 00:36:25,290 We would talk about it in services, really help a person overcome it. 320 00:36:25,290 --> 00:36:31,920 And so a lot of our uncle already talked about, said not to kind of forget the really important, 321 00:36:31,920 --> 00:36:37,260 just basic principles of the importance of all those self things, 322 00:36:37,260 --> 00:36:42,240 the importance of interpersonal relationships and the roles of friends of fabric, 323 00:36:42,240 --> 00:36:52,050 maintaining your social networks, but also just believing that these kind of ways just help adapt, adapt better. 324 00:36:52,050 --> 00:36:55,860 It's not saying that that headache isn't that is not saying that it's not painful. 325 00:36:55,860 --> 00:37:06,240 It's just saying the way we can help the body cope better, the way we can shift that software in a problem a little bit is by ensuring that you 326 00:37:06,240 --> 00:37:12,900 maintain that breadth of other activities that could maybe a system that overall recovery. 327 00:37:12,900 --> 00:37:17,700 Thanks very much. We have several questions about issues relating to stigma. 328 00:37:17,700 --> 00:37:18,180 And I mean, 329 00:37:18,180 --> 00:37:27,420 that's something that obviously comes up across a lot of sessions that people may feel stigma themselves because of that the experiences that the 330 00:37:27,420 --> 00:37:31,590 traumatic events they've had and or because of the expenses they've had 331 00:37:31,590 --> 00:37:36,770 subsequently or may feel that they've experienced stigma from others around them. 332 00:37:36,770 --> 00:37:40,410 Say there were some questions really about what research can tell us about the 333 00:37:40,410 --> 00:37:45,270 impact of stigma associated with trauma and what people can do to be able to, 334 00:37:45,270 --> 00:37:50,880 say, capable or overcome that same anchor. Can I come to you first for your thoughts on this? 335 00:37:50,880 --> 00:37:53,910 So I think we can look at it at two levels, as you said. 336 00:37:53,910 --> 00:38:03,680 One is the perceived stigma that the person themselves, as they may feel that what if they talk about the trauma to others, 337 00:38:03,680 --> 00:38:15,510 that maybe they might feel quite ashamed about it and might then not disclose it to other people and they might think people would look down on them? 338 00:38:15,510 --> 00:38:26,860 That's maybe a common and understandable. And and what we would advise that is that a. 339 00:38:26,860 --> 00:38:32,290 It is possible that that is one of a vicious cycle that I talked about that that we just 340 00:38:32,290 --> 00:38:38,770 assume that people would look down on us or would would not think about it so and so, 341 00:38:38,770 --> 00:38:48,610 too, to really cheque it out and and and try to talk to some trusted friend and and do and 342 00:38:48,610 --> 00:38:53,830 often you people will find that people are much more understanding than they thought. 343 00:38:53,830 --> 00:39:01,170 But I don't want to deny that there is still some society to a stigma. 344 00:39:01,170 --> 00:39:06,340 I think it's getting better about mental health in general and also particularly about trauma. 345 00:39:06,340 --> 00:39:11,800 Many people start not speaking out about 12 months they experienced. 346 00:39:11,800 --> 00:39:17,530 And I think this will cause a shift in the perception of trauma. 347 00:39:17,530 --> 00:39:21,970 And also, I think the numbers that we've seen that it will happen to most people in their lifetime. 348 00:39:21,970 --> 00:39:26,320 So it's not and only happened to a few a few people. 349 00:39:26,320 --> 00:39:30,400 So it is. It is. But that's. That needs more work. 350 00:39:30,400 --> 00:39:37,750 And also, the reactions of other people are not always helpful. 351 00:39:37,750 --> 00:39:39,530 I mean, most most people will be happy. 352 00:39:39,530 --> 00:39:48,820 But we can't deny that some of the people, at least the ones that we've seen and treatment, have reported with negative actions from other people. 353 00:39:48,820 --> 00:39:57,060 And I think education about the effect of trauma has to be also part of a packet. 354 00:39:57,060 --> 00:39:59,070 Thank you. Thanks very much. 355 00:39:59,070 --> 00:40:06,970 We've got one last question and not to come to each of you feel for any final thoughts and reflections stimulated by this question. 356 00:40:06,970 --> 00:40:13,770 So I'll come to Mina Moulton and then anchor. And this was really relating to the question about recovering it. 357 00:40:13,770 --> 00:40:20,920 Obviously, Yankee presented that said graph, which very clearly showed the sort of natural pattern of recovery. 358 00:40:20,920 --> 00:40:26,100 But I but one question that we received was whether it's ever possible to really 359 00:40:26,100 --> 00:40:31,050 reach a stage where your unaffected by severe trauma that you've experienced, 360 00:40:31,050 --> 00:40:34,850 including possibly trauma that you've experienced in childhood, 361 00:40:34,850 --> 00:40:40,110 and whether you can ever get to a point where you're unaffected by that and say it mean it. 362 00:40:40,110 --> 00:40:45,030 Can I come to a festival for your thoughts on that? Yeah, those really important question. 363 00:40:45,030 --> 00:40:49,830 I think it comes at the heart of know many people have experienced children that they might 364 00:40:49,830 --> 00:40:54,180 be more worried about hearing that it's always going to affect them negatively rather than, 365 00:40:54,180 --> 00:40:57,600 you know, just looking at the reality of their life and how it's affected them. 366 00:40:57,600 --> 00:41:01,590 I would say that, you know, all experience affects you. 367 00:41:01,590 --> 00:41:09,240 So I would be really nervous to say you're unaffected. But the assumption that that effect is negative, we just have to question. 368 00:41:09,240 --> 00:41:16,800 So I do think that we don't want to minimise people's pain and suffering of the impact of losses that might have caused trauma. 369 00:41:16,800 --> 00:41:24,300 And many people are very negatively affected. But we also have to respect the fact that some people, as a result of terrible events, 370 00:41:24,300 --> 00:41:30,030 do shift their world view in a way that they later perceive in a more positive light. 371 00:41:30,030 --> 00:41:35,310 So so I think everyone is likely to be affected. I'm affected by almost everything that happens. 372 00:41:35,310 --> 00:41:41,030 Good, bad. Sue somewhat Monday. So not to worry about being affected them. 373 00:41:41,030 --> 00:41:44,670 And I'm also not a psychiatrist like we all traditions here. 374 00:41:44,670 --> 00:41:52,590 So I do actually think that in the most severe cases are there are treatments that exist that are incredibly effective. 375 00:41:52,590 --> 00:41:56,590 And so even you know, that that actually is is it? 376 00:41:56,590 --> 00:41:59,950 These are, you know, interventions that can help. 377 00:41:59,950 --> 00:42:03,510 But it's important that people who are the most negatively affected. 378 00:42:03,510 --> 00:42:09,370 Often, you know, are able to access these treatments because I do think that can help. 379 00:42:09,370 --> 00:42:15,370 Thanks so much, man there, Martin. Yeah, I think neuroscience clearly shows that your brain will be changed by everything. 380 00:42:15,370 --> 00:42:24,280 Some others. But I think the evidence is also that you can shift constantly thinking about that cat on your shoulder to actually use that something. 381 00:42:24,280 --> 00:42:31,060 And I think it's also important, like Mina said, to remember that true flourishing is often very closely associated with suffering. 382 00:42:31,060 --> 00:42:37,380 It's often by going through terrible things that we come to new ways of actually appreciating. 383 00:42:37,380 --> 00:42:41,790 And flourishing in this life. So, yes, I think they are very effective treatments. 384 00:42:41,790 --> 00:42:47,900 We need to know more. Obviously more research is needed. But I think there is a possibility to change. 385 00:42:47,900 --> 00:42:52,650 Thank you. And finally to you, Frank. Yeah, I agree. I agree with being on boards. 386 00:42:52,650 --> 00:43:00,600 Said you can't really race. Well, always it will always stay a memory of a bad event. 387 00:43:00,600 --> 00:43:06,890 And I think what I can add is that it might also be helpful to be prepared that 388 00:43:06,890 --> 00:43:11,580 that there might be particular reminders like the anniversaries and so on, 389 00:43:11,580 --> 00:43:19,350 that will come with a temporary phase. Well, one thinks more about it and feel and remember the bad events, 390 00:43:19,350 --> 00:43:32,970 but then also take us as a sub taking that as a sign we engaged with life and and and what what life brings now and and also some potential growth. 391 00:43:32,970 --> 00:43:39,400 Like Morton said, people report that they feel they are more they've seen positive changes in themselves, 392 00:43:39,400 --> 00:43:45,000 like being more empathetic of other people, enjoying the good times more. 393 00:43:45,000 --> 00:43:49,410 So that can also be an outcome and that's important. 394 00:43:49,410 --> 00:43:58,350 Obviously, we also have to acknowledge that some people lost in the trauma may loss, have lost people they loved and and that will always be lost. 395 00:43:58,350 --> 00:44:02,910 That has changed our life forever. We have to accept reality. 396 00:44:02,910 --> 00:44:12,480 But that doesn't mean that we have to be stuck in the intrusive memories and the symptoms of PTSD much. 397 00:44:12,480 --> 00:44:16,050 Sure. That brings us to claeys today. So I'd just like to say huge. 398 00:44:16,050 --> 00:44:19,980 Thank you to all our speakers and panellists for joining us today for a really 399 00:44:19,980 --> 00:44:25,340 interesting and I hope very useful session for everyone who has joined us. 400 00:44:25,340 --> 00:44:29,370 Also here, thanks to everybody who joined us and also to Caia and Hally, 401 00:44:29,370 --> 00:44:33,780 who've done lots of work behind the scenes to make this whole run really smoothly. 402 00:44:33,780 --> 00:44:38,430 And, of course, thanks to the pattern of experimental psychology for hosting this series. 403 00:44:38,430 --> 00:44:42,270 As I mentioned, do you have a look at the experimental psychology department Web site? 404 00:44:42,270 --> 00:44:46,830 To our YouTube channel, four past talks and this tool will also be available there. 405 00:44:46,830 --> 00:44:54,840 And just the last reminder that on the 20th of May at 2:00 p.m., we'll be running the next session on overcoming mistrust and paranoia. 406 00:44:54,840 --> 00:44:59,760 So please stay join us for that. I'm sure it'll be a really interesting session. Thank you so much. 407 00:44:59,760 --> 00:45:03,720 Please do take a little break now before you move on to what you need to be doing 408 00:45:03,720 --> 00:45:08,100 next and give yourself a bit of time for a scratch or a walk or a cup of tea, 409 00:45:08,100 --> 00:45:12,290 whatever would be good for you. And we look forward to seeing you again. Thanks ever so much. 410 00:45:12,290 --> 00:45:23,213 Goodbye.