This document is a non-working example of a set of exploratory questions for post-traumatic stress disorder.
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Anxiety is the internal emotional and physical state that involves persistent worry and a prolonged, internal feeling of apprehension or dread around imminent or imagined future events that can persist even without a clear cause and can interfere with daily life.
Cognition is the umbrella term for how the brain takes in, processes, and makes sense of information to interact with and understand the world and symptoms of cognitive anxiety can include
- persistent worry about potential problems or negative outcomes and exaggerating potential consequences
- dwelling on negative thoughts or events, even when they are not directly present
- difficulty with racing thoughts, concentration, memory, and decision making
- panic attacks, overwhelming rushes of intense mental and physical symptoms that come on very quickly, often without any obvious trigger, and last a few minutes.
Somatic relates to the body and physiological refers to its normal functions, processes, and mechanisms. Somatic anxiety describes the physiological response to cognitive anxiety and symptoms can be single, multiple or varying and range from mild to severe, and can include
- dizzying or painful headaches
- a racing heart or chest pains
- intense breathing or shortness of breath
- abdominal pains, stomachache or an upset stomach
- uncontrollable bodily trembling or shaking
- profuse sweating, even when cold
- fatigue or weakness
- tight muscles and muscle tension
- aching in one or more groups of muscle
- panic attacks, overwhelming rushes of intense mental and physical symptoms that come on very quickly, often without any obvious trigger, and last a few minutes.
How would you describe the impact of mental anxiety or anxiety-driven physical stress on your daily functioning and emotional wellbeing?
A phobia is a potentially debilitating exaggerated or unrealistic sense of danger in relation to an object, place, situation, feeling or animal. A person may not experience symptoms until they come into contact with the source of the phobia or they may suffer from anticipatory anxiety, when thinking about the source of a phobia illicits feelings of anxiety and panic.
Examples include
- agoraphobia, the fear and avoidance of places or situations that might cause panic and feelings of being trapped or helpless
- amaxophobia, the fear of driving or riding in a vehicle such as a car, bus or plane
- erotophobia, which encompasses a broad range of anxieties and fears related to sex and physical intimacy
- gamophobia, the fear of commitment
- hoplophobia, the fear of weapons and in particular firearms
- mysophobia, the fear of germs and contamination
- somniphobia, an intense fear of sleep
- tokophobia, the fear of childbirth.
In addition to the emotional distress, a phobia can lead to significant daily disruption if it becomes so severe as to cause a person to organise their life around avoiding anything that causes them anxiety.How would you describe the impact on your level of anxiety from coming into contact with or exagerrated thoughts about the source of the most disruptive of your phobias?
Migraines include severe throbbing or pounding pain on one or both sides of the head, and can also affect the face or neck. They are debilitating enough to significantly impact daily activities.
Additional symptoms can include
- numbness or a tingling sensation on one side of the face or body
- dramatically increased sensitivity to light, sound, or smells
- having difficulty speaking or becoming incoherant
- feeling dizzy, light-headed or losing balance
- nausea, the medical term for feeling sick
- vomiting, the result of abdominal heaving, retching and forcefully ejecting the contents of the stomach and upper intestine.
How would you describe the regularity of your suffering from migraines?
This question is concerned with tension headaches. Do not include migraines, experiences associated with nausea, vomiting, or increased light and sound sensivity or headaches made worse by physical activity.
Tension headaches last from at least thirty minutes up to several days, but are typically only mildly or moderately painful and symptoms can include- dull aching pain on both sides of your head, face or neck
- a feeling of tightness or pressure across the forehead or on the sides your head
- tenderness or aching in the scalp, neck or shoulder muscles
- your head hurting more than usual if touched.
Typically you should be able to continue with most daily activities without making the headache worse.Should it apply to you then, when answering this question, try to exclude experiences that may have taken place as a result of consuming alcohol, illicit drugs, or over-the-counter or prescription-only medication.How much have you suffered from tension headaches?
The circadian rhythm controls the cycles your internal body clock repeats about every twenty four hours that tell you when it is time to sleep or wake.
Your body tries to synchronise your sleep-wake cycle to cues from the environment, such as seasonally adjusting to when it gets light or dark outside, when you eat, and when you are physically active.
Disruption of the circadian rhythm can affect- how well you sleep
- when you are able to sleep
- how well you function when awake.
Jet lag is a circadian rhythm sleep-wake disorder that occurs when your twenty four hour internal body clock does not match the local day-night cycle.Somniphobia describes an actual fear of sleep itself, driven by the pervasive sense of vulnerability to nightmares or unpleasant mental disturbances during a period of sleep.How would you describe any disruption to your sleep preparations as a result of a misaligned body clock or pre-sleep anxiety?
Sleep is a critical component of mental and physical health and disruption can create a self-perpetuating cycle where negative thoughts, emotions, and actions reinforce each other, leading to a worsening state of mental and physical wellbeing.
PTSD-related insomnia can surface through- distressing dreams, nightmares or night terrors
- overthinking or rumination, the repetitive and persistent thinking for more than a few idle minutes that usually involves repeating a negative thought or trying to solve an evasive problem
- racing thoughts, which are fast-moving and often repetitive thought patterns that bounce around the mind uncontrollably without allowing time to fully process or complete any single thought
- intrusive thoughts, persistent unwanted, distressing and disturbing thoughts that often revolve around specific fears, themes, or concerns and can be graphically explicit or violent and upsetting
- earworms, songs or parts of songs that become stuck in your head and are difficult to dislodge.
Common symptoms include- difficulty falling asleep and staying asleep
- unsatisfying sleep and trouble waking up in the morning or waking up fatigued and unrefreshed
- excessive daytime tiredness and difficulty focusing or being motivated
- mood changes, particularly depression or being easily upset.
Should it apply to you then, when answering this question, try to exclude experiences that may have taken place as a result of consuming alcohol, illicit drugs, or over-the-counter or prescription-only medication.How would you describe the impact on your daily functioning and emotional wellbeing of disrupted sleep and any resulting emotional or physical tiredness?
Depression differs from occasional misery by being a prolonged mental state of sadness and low mood which significantly interferes with all aspects of daily life.
Symptoms can include- being uncharacteristically weepy or crying with little or no obvious cause
- an increase in the number and severity of mood swings or becoming uncharacteristically irritable
- a lack of enthusiasm for things that would normally bring pleasure
- seeming overly tired or having less energy than usual
- expressing feelings of extreme tiredness that are actually indicators of severe emotional exhaustion and a desire to escape emotional pain
- increasingly severe or frequent repetitive and compulsive behaviours
- self-harm or suicidal thoughts or urges.
How much of your time awake was typified by a mental state of sadness and low mood?
Have you been exposed to a single event that had a significant negative impact on your thoughts and emotions or your physical abilities?
Have you experienced any repeated or prolonged exposure to events that had a significant negative impact on your thoughts and emotions or your physical abilities?
This question may concern a difficult subject but it is very important for maintaining historical context. In terms of any single deeply upsetting personal experience that lasted for a short period of time and took place at least one month prior to this assessment, please try to rate its ongoing influence on your emotional and mental wellbeingIn terms of any single deeply upsetting personal experience that lasted for a short period of time and took place at least one month prior to this assessment, rate its ongoing influence on your emotional and mental wellbeing?
This question may concern a difficult subject but it is very important for maintaining historical context. In terms of any repeated or prolonged deeply upsetting personal experiences that took place at least one month prior to this assessment, please try to rate their combined ongoing influence on your emotional and mental wellbeingIn terms of any repeated or prolonged deeply upsetting personal experiences that took place at least one month prior to this assessment, rate their combined ongoing influence on your emotional and mental wellbeing?
Uninvited and unsettling loops of persistant overly-detailed thinking can take the form of rumination, specifically concerned with past events and what happened in the time around them, or overthinking, which focuses on current events or future scenarios.
Ruminative thinking dwells on particular but abstract segments of a past event timeline and common themes include questioning- your actions at the time of the event, both in the context of what you did and what you did not do
- whether you should have done something differently and if so how that might have changed the outcome
- the reasons that you think provide evidence of you being responsible
- the reasons that you think provide evidence of someone or something else being responsible
- whether and how much you will recover and what life will be like then
- whether you are losing control of yourself as a result of intrusive thoughts and memories.
Overthinking is a state of excessive and repetitive thinking about a present happening or imagined sequence of future events or actions to try to predict outcomes or find solutions. It can result in analysis paralysis, whereby the person becomes so bogged down in overanalysing a situation that it becomes impossible for them to make a decision or take action.Neither rumination or overthinking lead to a complete and successful resolution of a problem despite repeated mental re-running.
How would you describe the level of interference of uninvited mental analysis of previous experiences, present events, or future scenarios on your everyday life and ability to relax or sleep?
Intrusive thoughts can happen quickly and often. They usually revolve around specific fears, themes, or concerns and can be graphically explicit or violent and upsetting.Intrusive memories enter the mind spontaneously without being deliberately recalled. They contain strong sensory components such as seeing images, hearing sounds, or feeling physical sensations and emotions associated with all or fragmented parts of a previous experience.
Intrusive repetitive negative thinking describes- the negative aspect of thinking when in a calm or contemplative state by repeatedly replaying past actions, unresolved conflicts, or conversations, analysing what was done or said, then imagining different outcomes or responses
- the repetition of a particular thought, often in response to a trigger or stressor and potentially contributing to repetitive behaviours and routines.
Intrusive negative automatic thought patterns include- excessive worrying about tasks that need to be completed and potential negative outcomes, even if the task is neither imminent nor urgent
- focusing on the same thoughts repeatedly through boredom as a way to pass the time or distract themselves from their feelings or their current situation.
Intrusive aggressive thoughts include- dark thoughts that vividly imagine horrifying or violent events being inflicted on themselves, things they hold affection for, or things that are fragile and easily damaged
- intrusive sexual thoughts, fantasies and urges, potentially leading to above-average or unusual sexual behaviours and interests.
Less intense than flashbacks, which involve reliving the past, and unlike typical memories, which are the result of an experience being processed and encoded into a coherent recollection, intrusive memories are often poorly integrated. They can feel like highly disturbing snippets of an event and are capable of causing significant emotional distress.How would you describe the impact on your daily functioning and emotional wellbeing of intrusive thoughts or sensory-provoking memories?
Traumatic flashbacks are involuntary memory intrusions where the mind spontaneously re-experiences all or part of a traumatic event with accompanying physical and emotional distress that is often so vivid as to create a palpable feeling of actually reliving the past as a present-day experience.
Intrusive flashbacks are often triggered by sensory cues from the surrounding environment that act as reminders of a traumatic event. They primarily involve re-experiencing sights, sounds, and emotions associated with a previous happening in a way that is so vivid as to make the person feel as if they were back at the original scene and actually reliving all or part of it.Emotional flashbacks primarily cause a person to re-experience the intense emotions associated with a traumatic event and become overwhelmed by fear, sadness, anger, or shame, often without a clear understanding of why such feelings were triggered.
How would you describe the impact on your daily functioning and emotional wellbeing of flashbacks?
A nightmare is a terrifying or disturbing dream that is vivid, causes strong negative emotions and often results in sleep being severely disrupted. Post-traumatic psychological injury can cause nightmares to transform from recreating original events into gross or shocking abstract dreams.How would you describe the impact on your sleep patterns of bad thoughts, bad dreams or nightmares?
Social interaction is a dynamic and unpredictable sequence of social actions between individuals or groups and post-traumatic stress can make it an emotionally intense and isolating experience.
Social anhedonia describes a significant lack of interest in social contact coupled to a reduced ability to derive pleasure from social situations, and symptoms include- social withdrawal or isolation
- reduced interest in social contact and interaction
- a reduced ability to derive pleasure from interpersonal experiences
- a lack of close friends and intimate relationships, and decreased quality of those relationships
- difficulty adjusting to social situations
- depressed mood.
Social fatigue can occur after having engaged in full social interaction, and markers can include- an onset of tiredness or exhaustion shortly after a social activity
- wanting or needing time away from social situations to recharge after a social activity
- experiencing heightened post-activity anxiety and stress, such as
- headaches
- difficulty concentrating
- difficulty sleeping
- increased moodiness.
- post-activity meltdown
- post-activity onset of depression.
The feelings of a social interaction “hangover” can range from mild fatigue through to exhaustion and last from a few hours to days after the event has finished.How would you describe your approach to allowing regular social interaction to form a normal part of your everyday life?
How would you describe any need to avoid particular people, places, events, or objects directly because of their association with a past experience?
Learned helplessness occurs if a person experiences a stressful situation repeatedly and comes to believe that they are unable to control or change it so stops trying, even if opportunities to break the negative cycle become available.
Causes can include- being subjected to training using strong negative reinforcements such as humiliation and ridiculing
- being seen as “won't do” rather than “can't do” and punished for unintended mistakes or labelled as inept, stupid, useless, etc
- regular or ongoing marginalisation, intimidation, and bullying.
Learned helplessness can lead to an abnormally low level of general functioning in a person that are much lower than they might otherwise be capable of.How would you describe the effect of previous failure or disempowerment on your motivation and confidence?
How would you describe any urges to keep busy, regardless of the actual value or necessity of the task you were occupied with?
Depersonalization-derealisation occurs when a person feels as if they are seeing themselves from outside their body or have a sense that things around them are surreal. Whilst sometimes described as seeing the world in a dream-like state, the associated feelings can be emotionally disturbing and significantly disrupt daily activities and relationships.
Depersonalisation is a mental state where a person has the feeling of being outside themself and observing their actions, feelings or thoughts from a distance and not always in full control of their body movements.Symptoms can include- feeling as if your body or self is unreal or separate
- feeling like an observer who is experiencing yourself as if watching a movie or looking in from the outside
- feeling like a robot and having a sense of being controlled by an outside force or lacking control over your actions.
Derealisation is a mental state where a person feels detached from their surroundings and sees the world as unreal, dreamlike, or distorted.Symptoms can include- feeling as if the world is unreal, dreamlike, or foggy
- familiar places seeming foreign or strange
- feeling physically disconnected from your surroundings and people
- objects seeming to be distorted, such as appearing larger, smaller, blurry, or flattened
- time feeling distorted by speeding up or slowing down
- sounds seeming muffled or unusually sharp
- vibrant colours appearing muted or washed out.
Dissociative flashbacks are often characterised by a feeling of detachment from oneself or the world in such a way as to feel as if observing a traumatic event from a distance or even experiencing it from a third-person perspective. Dissociative flashbacks can lead to a sense of numbness, confusion, and disorientation.Should it apply to you then, when answering this question, try to exclude experiences that may have taken place as a result of consuming alcohol, illicit drugs, or over-the-counter or prescription-only medication.How would you describe any strange or surreal experiences of feeling detached from yourself or disconnected from the reality of the world around you?
Auditory hypersensitivity, which covers a number of conditions, describes a heightened responsiveness to sensory stimulation caused by sound. If a sound is linked to a harrowing experience it can lead to emotions such as anxiety and stress, disgust or irritation, anger and rage, or possibly trigger a flashback.
Hyperacusis causes the sufferer to experience everyday sounds as seeming much louder than they should, leading to pain and discomfort, for example- blue-light sirens
- dogs barking
- electrical devices such as phone ringtones, washing machines, or vacuum cleaners
- running water
- walking on leaves or gravel.
Misophonia is a disproportionate emotional reaction to certain everyday sounds that should be relatively easy to filter out and is often triggered by- mouth, nose and throat sounds, particularly those produced by chewing or eating and drinking
- repetitive environmental sounds produced by other people or objects
- sounds produced by animals.
Ligyrophobia is a fear of devices and activities that can suddenly emit loud sounds, such as speakers or fireworks. Certain occasions, such as parades and carnivals, that are accompanied by very loud instruments can lead to agoraphobia, a fear and avoidance of places or situations that might cause panic and feelings of being trapped or helpless.How would you describe any heightened level of distress or irritation as a result of an increased sensitivity to loud or penetrating sounds?
Hypervigilance is a potentially exhausting condition in which the nervous system becomes chronically dysregulated, causing a release of excessive stress signals that lead to inappropriate and exaggerated responses. It can lead to a person finding themself in a state of high alert and almost endlessly scanning their environment for potential risks or threats, even in safe situations.
Often brought on as a result of real-world experiences, hypervigilance can lead to- heightened suspicion and a tendency to misinterpret other people's actions or intentions as being threatening
- a feeling that nowhere is safe
- obsessive behaviour patterns and difficulty with concentration
- problems with social interaction and relationships.
How would you describe any experiences of feeling extremely alert and suspicious, watchful or on your guard?
Hyperarousal is a potentially exhausting state of the body's “fight-or-flight” response being stuck in a high-alert mode and is typified by a heightened startle reflex and overactive aggressive-defensive response, even in the absence of immediate danger.
Racing thoughts, also known as “brain chatter”, are fast-moving and often repetitive thought patterns that bounce around the mind uncontrollably without allowing time to fully process or complete any single thought. They can be about any subject, real or imagined and can focus on a single topic or represent multiple different strands of thought at the same time.Thought interference can be further increased by a previous conversation or speech, segment of text, piece of music, or parts thereof, looping in the brain as an unwanted and persistent underlying background “noise”.
The negative externalised distress spectrum includes a variety of disinhibited behaviours, such as- oppositional defiant disorder, or ODD, where a person might display behaviours such as
- being prone to anger and short temperedness
- often being argumentative with authority figures
- being stubborn or noncompliant, often defying or refusing to comply with instructions
- regularly annoying other people or getting easily annoyed with yourself
- becoming resentful, spiteful or vindictive, and often blaming others for your mistakes.
- conduct problems and antisocial behaviour
- displays of excessive physical aggression.
A person might also develop a habit of swearing or becoming verbally abusive.Hyperarousal can be long-lasting as a way of adapting to complex trauma or it can be a temporary state triggered by perceived threat, traumatic memories and reminders, or specific emotions.How would you describe any experiences of being in a heightened state of anxiety to the point of feeling jumpy or easily startled and unable to relax?
Paranoia involves feelings of distrust, suspicion, and behaviours that support them that are not based on reality and lacking in evidence and reason.
Examples of paranoid thoughts and beliefs include- assuming that others have malicious or negative intentions, even when there is no real evidence
- believing that a secret plot or conspiracy is happening to make you look bad, harm you, or exclude you
- feeling that people, organisations, or government entities are constantly watching or tracking your movements
- harbouring a persistent belief that people are somehow trying to take advantage of you or steal your money, possessions, or ideas
- misinterpreting innocent remarks or subtle gestures as secret threats or messages designed to harm or belittle you.
Examples of paranoid behaviours include- being overly defensive and reacting to situations or criticism with hostility or aggression and a need to protect yourself
- finding it difficult to trust other people, and in particular those close to you, and obsessing over their loyalty or intentions
- firmly believing in widely disproven or unfounded conspiracy theories, such as elaborate plots by governments or secret organisations
- harbouring persistent grudges involving anger or resentment over perceived slights or harms
- keeping people at a distance or avoiding certain individuals or places altogether as a result of due to a feelings of suspicion or being targeted.
Should it apply to you then, when answering this question, try to exclude experiences that may have taken place as a result of consuming alcohol, illicit drugs, or over-the-counter or prescription-only medication.Describe your experience of hard-to-prove but unshakeable thoughts or beliefs that people are deliberately trying to cause you problems or that you are the subject of persistent, intrusive attention by others?
Emotional dysregulation describes an inherent inability to control the intensity of stress reactions, in particular to ordinary everyday events. It results in habitually excessive negative behaviours that are significantly out of proportion to the situation that triggered them.
Examples of dysregulated emotions include- frequent negative moods and crying
- refusal to engage in social activities, including a lack of interest in maintaining existing friendships or making new friends
- the loss of friends due to unpredictable or unsocial behaviour
- aspects of intermittent explosive disorder, such as
- long angry speeches or heated arguments
- easily-provoked frustration and irritation
- volatility and hair-trigger outbursts
- threats or shows of aggression, including shoving, pushing, slapping, or physical fights
- severe temper tantrums or meltdowns
- obvious physical signs of heightened anxiety, such as shaking or chest tightness.
- struggles within the home environment
- developmental delays, including substandard academic performance and attendance.
Uninterrupted dysregulated emotions can become increasingly crippling and potentially lead to behaviours that could be interpreted as habitually harmful, self-harmful, or reckless and self-destructive.How would you describe the regularity of surges of emotional upset that could reasonably be considered excessive and difficult to calm down from, particularly in response to everyday events or conversations?
Obsessive-compulsive disorder is a long-lasting condition in which a person experiences unwanted obsessions and reactive complusions.The obsessions are intrusive anxiety-inducing thoughts, mental images, or urges that occur over and over again. The compulsions are rituals a person feels obliged to act out in order to relieve the distress caused by the obsessions.
Examples of obsessions include- a preoccupation with things being straight, correctly arranged or in the correct place
- an extreme obsession with germs, dirt, illness, injury, or coming to harm
- excessive worrying about whether someone could get sick, hurt, or die
- heightened fear and anxiety that bad thoughts might come true.
Examples of compulsions include- needing to touch, tap, or step in unusual ways
- arranging particular objects or sets of objects over and over again
- repeating particular words, phrases, or questions over and over again
- washing themselves far more often than necessary or cleaning excessively
- having difficulty making relatively simple choices
- taking an abnormally long time to complete activities such as getting dressed or eating
- repeatedly ask for reassurance
- insisting that you say or do something a set number of times or in a set way.
A person suffering from obsessive-compulsive disorder might also show signs of aggressive behaviour or inwardly experience thoughts about- acts of violence, including hurting or killing themselves or another person
- committing offensive sexual acts or indulging in forbidden or taboo behaviours.
How would you describe the level of interference of obsessive thoughts or compulsive behaviours on your everyday ability to function?
Post-traumatic psychological injury can lead to an increase in unhealthy behaviours and thought patterns as coping mechanisms to deal with excessive stress or difficult emotions.
Habitually harmful behaviours that are not isolated recreational pursuits include- regular and excessive alcohol intake outside socially acceptable occasions
- frequent use of drugs that are manufactured, obtained, or sold illegally and that may be impure or highly addictive
- misuse of prescription or over-the-counter drugs
- having unsafe sex.
Self-harming behaviours include- hair pulling
- forceful head shaking
- head banging on floors, walls or other surfaces
- face or head slapping
- eye gouging
- hand or arm biting
- bodily burning or cutting
- uncontrollable skin rubbing, picking, pinching, or scratching
- punching the self or hard objects
- swallowing sharp objects or drinking hazardous liquids.
Reckless and self-destructive behaviours include- frequent dangerous driving
- embracing risks, especially those that could lead to bone fractures
- exercising excessively
- feeding and eating disorders, in particular bulimia nervosa, a serious and potentially life-threatening eating disorder where someone binge eats in one sitting, often in secret, then tries to purge their body of the food, usually by vomiting or misusing laxatives.
How would you describe your involvement in what could reasonably be interpreted as harmful, self-harmful, or reckless and self-destructive habits?
The word “victim” is used here to describe any person who has been subjected to considerable emotional or physical harm. As time passes the victim might also become a “survivor” through the emergence of a recovery process.
The theory of the “ideal victim” is seen as someone who is most easily recognised as legitimate because they conform to a set of assumed stereotypes, but this can lead to misunderstanding and exclusion, and examples include- occupational non-recognition, where an employee is not recognised as having valid claim to being a victim because of workplace expectations around being able to cope with stressful situations that fall within the remit of the job
- professional non-recognition, where formal systems such as education, healthcare, law enforcement and legal institutions fail to recognise or take the sufferer sufficiently seriously due to established or entrenched theories of victim status that do not allow for variation
- societal non-recognition, when individuals or social groups refuse to recognise someone as being worthy of victim status for reasons including
- an attitude that the lived experiences of suffering are exclusive to people from certain social classes or ethnic backgrounds
- ignorance based on the sufferer being seen as ethnically, intellectually, physically, or socially inferior and therefore not to be considered as a person of relevance
- inverted snobbery related to a sufferer's perceived success, greater wealth or higher social status.
How great has the negative effect on you been of obvious, subversive or subconscious hostile attitudes from others towards what you believe is your legitimate right to have your suffering taken seriously?
Being alone is the neutral physical state of being by yourself without any other person in proximity. Loneliness is a complex individually experienced and highly personal emotion that manifests as a state of feeling disconnected and misunderstood, regardless of the availability of relationships or company.
How would you describe your experiences of feeling lonely and isolated?
“The self” refers to an individual's concept of identity. It develops over time and is shaped by personal experiences, social interactions, and internal thought processes.
Reduced self-worth can lead to negative views of both the self and the world and can play a key role in both increasing the symptoms of and functional problems associated with post-traumatic feelings and behaviours, including- low self-esteem, a depleted way a person feels about their inner self as a person, for example
- feelings of worthlessness and a belief of being “not good enough” or deserving of affection and care
- making comparisons with others that lead to feelings of inferiority or inadequacy
- avoiding social interaction and feeling like an outsider
- unnecessarily accepting responsibility for things that go wrong and excessive apologising.
- low self-confidence, a lack of trust in personal abilities, capacities, and judgments, for example
- having noticeably reduced motivational drive or enthusiasm to pursue goals
- avoiding new challenges as a result of a persistent conscious or subconscious fear of failure
- questioning personal abilities, decisions, and self-worth
- downplaying achievements or having difficulty accepting compliments
- being an overly harsh critic of the self.
Low self-worth can also incubate negative thoughts about the self or the world that are not always based in reality and can maintain fear or distress, for example- strong feelings of anger, fear, guilt, horror, and shame
- threat-oriented patterns of thought and behaviour, developed through experience, that lead to a heightened sense of threat and a loss of trust in others
- a sense of worthlessness or helplessness leading to a loss of confidence
- inflexible thoughts that prevent a person from processing events naturally and reduce their ability to manage their emotions.
Focusing on any negative beliefs or expectations you hold about yourself, rate their combined impact on both your self-esteem, the way you feel about yourself as a person, and your self-confidence, the trust you have in your abilities and your capacity to make good decisions and successfully do things?
Following disturbing and overwhelming events a person can experience a prolonged and greatly reduced ability to feel any sort of emotion in a way sufficient to bring forth a meaningful reaction or response from them.
Positive feelings are emotions associated with pleasant or desirable states that expand our awareness, enhance resilience, and foster creativity. Examples include affection, hope, interest, joy, love, pride, and serenity.Emotional numbing cover both positive and negative emotions and symptoms can include
- lessened or lack of emotional responses through the use of facial expressions
- a reduced ability to smile and laugh
- a sense of inner emptiness or flatness
- underlying feelings of irritability or nervousness
- difficulty accessing or experiencing positive emotions
- difficulty accessing or expressing feelings
- feeling distant or detached from other people
- preferring to be alone rather than engaging with others
- a loss of interest in doing things
- a loss of interest in favourite activities.
How would you describe your experiences of feeling emotionally numb, flat or hollowed out?
The word “chronic” describes a condition, typically harmful, that continues over an extended period of time and is long-lasting or recurs frequently.
Personal non-recognition of legitimacy occurs when a person sees themselves as not being worthy because they believe that they are somehow incompatible with the common image of what constitutes a victim.Rationalised non-recognition occurs when the individual feels a need to rationalise being trapped in a controlling or abusive relationship, with examples including- resorting to self-blame or creating excuses for their continued involvement
- defaulting to denial because there seems to be little or no chance of escape
- anxiety surrounding the possibility of severe consequences for them or their dependents if they try to escape.
Bereavement is the experience of losing a close person or animal, and it can trigger grief, the natural emotional and physical response to that loss. Traumatic bereavement occurs when a traumatic death disrupts the grieving process, leading to a sense of helplessness, fear, or danger, and can be linked to- loss that is sudden or unexpected and may involve circumstances that were shocking or unforeseen
- death that was a result of an accident, violence, or a natural disaster
- having been denied the opportunity to say goodbye.
There is no “normal” way or timescale to grieve and the periods of suffering can have a lasting negative impact on emotional wellbeing and everyday functioning.How strong is your conviction that, regardless of the opinions of others, your experiences qualify you as having the right to be recognised as someone living with chronic emotional suffering?
Post-traumatic growth is the positive psychological transformation that can occur after a harrowing experience alongside post-traumatic stress disorder. Whilst it does not minimise the impact of PTSD on the individual, it can lead to new positive understandings of the human experience.
Key areas of change include- an increased appreciation for life
- personal relationships growing stronger through a feeling of greater connectivity to other people
- an improving and greater sense of personal strength
- an increased awareness of new possibilities
- a move to a more positive view of personal experience and acceptance that the past cannot be changed
- uplifting spiritual or philosophical change.
Despite the possible influence on you of new sorts of positive thinking that you may have developed as a result of previous experiences, how would you describe your ability to enjoy everyday life?
This question is not concerned with “where the blame lies” or who is actually responsible for any previous or active unresolved event. It is solely concerned with how you are emotionally affected by the possibility of being seen as the culprit by others.
Blame-shifting within a blame culture is an environment where, when mistakes and errors happen, the primary focus is on finding any individual or group to hold responsible rather than on identifying the root cause and making the improvements necessary to prevent a recurrence.The habit of scapegoating by transferring responsibility for failure or frustration onto a seemingly vulnerable target, often as a means of deflecting guilt or blame, can exist within families, social or occupational groups, or organisations of any type and size.
Describe the emotional impact of knowing or privately believing that other people were openly, subversively or subconsciously heaping blame on you for any previous or active deeply distressing or disturbing event?
This question is not concerned with “where the blame lies” or who is actually responsible for any previous or active unresolved event. It is solely concerned with how you are emotionally affected by any difficult-to-control urges you harbour to attribute blame to others.Describe your urges to openly, privately or subconsciously attribute blame to someone or something else for any previous or active deeply distressing or disturbing event?
Describe the strength of any of your internal feelings of upset, regret, or shame in relation to any previous or active deeply distressing or disturbing event which you see yourself as bearing significant responsibility for?
As an emotion, guilt is not a judgement but the self-directed internal feeling of distress, regret, or shame over an action, event or lack thereof which the individual, rightly or wrongly, sees themselves as bearing significant responsibility for.How would you describe any feelings of deep regret or sorrow that you experienced, either for past actions or for times when you wish you had acted but did not?
Compassion fatigue refers to the emotional, psychological and physical exhaustion that develops as a consequence of prolonged periods caring for individuals who are in psychological distress or have been psychologically traumatised.
Occupational areas where it can be particularly prevelant include- doctors and nurses who are exposed to repeated patient emergencies
- palliative and end-of-life care workers
- blue light responders and emergency service workers
- social workers and child protection officers
- veterinarians and animal welfare workers
- teaching and student affairs professionals
- formal leaders within established religions.
Non-occupational areas where it can be particularly prevelant include- the overwhelming parental stress of caring for a child that has been involved in a traumatic event, or is sick or injured
- family members and other caregivers of people who are suffering from a long-lasting health condition, particularly those that may not have a cure.
Functional symptoms include- feeling overwhelmed and exhausted by external demands
- feelings of helplessness and powerlessness when faced with suffering
- feelings of numbness and emotional detachment
- a reduced ability to feel empathy and sensitivity and emotional disconnection
- a decreased sense of purpose and a reduced level of performance, including difficulty concentrating and making decisions.
Wellbeing symptoms include- increased levels of sadness, anger and irritability
- decreasing ability to relax and increasing insomnia
- increased anxiety and physical symptoms such as headaches, nausea, upset stomach and dizziness
- increasing conflict and difficulties in personal relationships
- withdrawal and self-isolation
- self-contempt and a neglect of personal self-care
- an increase in substance use as a form of self-medication.
In the context of suffering, sympathy can be thought of as caring about someone's suffering, empathy as feeling someone's suffering and compassion as wanting to relieve someone's suffering.To what extent have your emotional stability and mental health been compromised by the demands placed on you to provide sympathy, empathy and compassion for people suffering from psychological distress or trauma?
Moral injury describes the psychological pain or wounding a person suffers after they act, fail to act, or bear witness to but do not influence events that contradict their own moral beliefs and professional standards or ethics.
Non-specific examples include- being asked to act, or not act, in ways that conflict with your moral compass, training or sense of duty
- feeling that leadership provided negligent instructions or inadequate supplies but being unable to challenge it
- witnessing and being unable to prevent morally or ethically wrong behaviour by other people
- witnessing unethical behaviour or betrayal by trusted people in high-stakes situations
- being frustrated by hierarchical imbalances that prevent you from challenging an action or decision from a more senior individual
- being restricted by legal requirements which prevent the necessary course of action from being available.
Military-specific examples include- harming or killing combatants or civilians when it goes against your sense of right and wrong or during situations with unclear rules of engagement
- being unable to save a fellow service member or an injured civilian due to lack of resources or overwhelming circumstances
Healthcare-specific examples include- experiencing betrayal by leaders or colleagues regarding patient safety or well-being
- having to deal with resource limitations whilst knowing that some patients will suffer as a result
- workload being such that the quality of care provided falls well below the minimum standard that you would consider good enough.
How would you describe your personal feelings of distress, guilt, shame, disgust, or anger as a result of your required occupational role in events that you felt should or could have been managed differently?
Emotional dissonance is the process of managing your feelings and expressions for the benefit of a task when your true inner emotions are in conflict with the required outward emotional expression that you are expected to present.
Occupational examples include- a healthcare professional having to hide their fear or frustration and project an image of patience and empathy when dealing with a difficult patient or situation
- a law enforcement officer feeling empathy for an offender but having to appear stoic and emotionally neutral
- a retail, hospitality or customer services worker having to remain polite and helpful when dealing with a difficult customer despite feeling bored or upset
- a salesperson having to appear enthusiastic and optimistic about a product or service despite struggling with doubt or negativity surrounding its quality.
Non-occupational examples include- a parent having to appear strong and composed for their child even though they are overwhelmed with fear or worry
- cultural dissonance, where a person experiences conflict between differing cultural values, beliefs, or practices, impacting their sense of self and belonging in multicultural environments.
Emotional dissonance can affect members of certain groups and organisations where more extreme behaviours are expected, for example- feeling pressured to project an image of strength and fearlesness whilst inwardly experiencing anxiety, fear, or vulnerability
- having to display aggressive or callous behaviour that does not align with true inner feelings.
How would you describe your sense of unease as a result of a requirement to present yourself publicly in a way that conflicts with your inner feelings?
A panic attack is a sudden episode of intense fear that triggers severe physical reactions, despite there being no obvious danger or apparent cause. Anxiety tends to reach its peak about ten minutes after an attack begins then usually lasts a further five to twenty minutes, although elevated distress can continue for a few hours.
A panic attack as a consequence of post-traumatic psychological injury can occur as a result of a person, place, object, memory, or discussion that triggers reminders of a harrowing experience.Symptoms are similar to those of anxiety-driven bodily stress, can be single, multiple or varying and range from mild to severe, and can include- dizzying or painful headaches
- a racing heart or chest pains
- intense breathing or shortness of breath
- abdominal pains, stomachache or an upset stomach
- uncontrollable bodily trembling or shaking
- profuse sweating, even when cold
- fatigue or weakness
- tight muscles and muscle tension
- aching in one or more groups of muscle
- fear of losing control or dying.
Panic attacks can be extremely frightening but individuals normally show some response to standard calming techniques and coping strategies.How would you describe the effect of panic attacks on your daily functioning and emotional wellbeing?
A meltdown as a consequence of post-traumatic psychological injury is an involuntary and uncontrolled response whereby something trips a reminder of a previous experience and difficulty with emotional processing causes a surge to such a severe level of distress as to trigger a nervous system overload.
There are three main phases to a meltdown- the rumbling phase: the initial phase after the person's sense of calm and order has been interrupted by a trigger. They may start to display signs of rapidly increasing anxiety such as
- pacing, twitching, shaking, rocking or becoming very still
- showing agitated speech patterns such as talking more quickly or more loudly than usual.
- the rage phase: the person is totally emotionally overwhelmed and excess rage, panic or despair is released as a meltdown, example behaviours being
- unrestrained crying, shouting or screaming
- uncontrolled kicking, flapping or stomping about
- repetitive movements or zoning out.
- the recovery phase: the person may be tired or sleepy, apologetic or embarrassed, deny or have no recollection of the meltdown.
Meltdowns are distinctly different from temper tantrums, which are brief purpose-driven episodes of largely deliberate extreme behaviour in response to frustration or anger at not getting or being allowed to do something. Whereas a tantrum will typically subside when the person is either rewarded or realises that their behaviour is pointless, after a meltdown individuals cannot usually respond to standard calming techniques and recovery takes an extended period of time.How would you describe the effect of meltdowns on your daily functioning and emotional wellbeing?
A shutdown as a consequence of post-traumatic psychological injury is a quietly-expressed involuntary and uncontrolled response that is often triggered by feeling threatened, recounting trauma, or even a perceived threat. The individual is totally emotionally overwhelmed and withdraws mentally and physically.
Example behaviours include- fleeing the trigger or completely freezing
- being unable to move or speak
- withdrawing to a quiet, dark space
- experiencing sudden exhaustion
- suffering a loss of coordination or slowed movement
- suffering a loss of communication skills.
A shutdown will continue until the person feels able to cope again and, once the initial shutdown lessens, they may show signs of exhaustion, confusion, or detachment. A shutdown can follow a meltdown if exhaustion reaches crisis level.How would you describe the effect of shutdowns on your daily functioning and emotional wellbeing?
A post-traumatic psychological injury can lead to a deep, persistent state of low physical and mental energy in response to the body's psychological and physiological resources being overworked for an extended period of time.
If the fatigue continues uninterrupted it will lead to burnout, a state of physical, mental, and emotional exhaustion following a chronic episode of severe stress and physiological disruption and markers include- increased prevalence of exhaustion, depression and a potentially increased risk of suicidal ideation or intent
- increased levels of anxiety and stress, including suffering from headaches, gastrointestinal problems or physical pain
- increasingly disrupted diet, rest and sleep patterns
- noticeably increased sensory sensitivity
- increased difficulty with concentration, memory or making choices
- becoming increasingly withdrawn and isolated, possibly to the point of physically shutting down
- an increase in both the number of meltdowns and the time needed to recover from them.
An overwhelm “hangover” refers to the lingering physical, emotional, and psychological effects on the body's mental and physical resources and symptoms include- profound feelings of fatigue or exhaustion
- lethargy, tiredness and sleepiness
- bodily aches and pains and muscle soreness
- trembling and shaking
- headaches or brain fog
- pain in the chest region
- gastrointestinal discomfort
- a strong desire to isolate from others
- a persistent sense of discomfort or unease.
Recovery time can vary according to the individual, but often lasts anything from several hours to a few days or, in more extreme cases, over a week.As a result of the mental and physical demands of coping with past experiences, how would you measure your ability to function as your best self in terms of your general energy levels, confidence and motivation?
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