Trauma risk management

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Trauma risk management (TRiM) is a method of secondary PTSD (and other traumatic stress related mental health disorders) prevention. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM training provides practitioners with a background understanding of psychological trauma and its effects. [1]

TRiM is a trauma-focused peer support system [2] and the way it works is wholly compliant with the PTSD management guidelines produced by the National Institute for Health and Care and Excellence. [3]

Trauma risk management Practitioners are trained to carry out an interview which identifies a number of risk factors which, when present, increase the likelihood that an individual may suffer poor longer term mental health as a result of a traumatic event. The initial TRiM interview takes place with an individual, 72 hours after a traumatic incident. People who score highly on this initial interview are provided with extra support by colleagues, and where appropriate, line managers. A follow-up TRiM interview is then carried out approximately one month later to assess how well people have come to terms with the traumatic event at that point. Individuals who are found to have persistent difficulties at this point are encouraged and assisted to seek a professional assessment in order to access any specific treatment they require. [1]

TRiM originated within the UK military after previously-used reactive single session models of post incident intervention, such as Critical Incident Stress Debriefing, were subject to scientific scrutiny and shown to not just lack effectiveness but also have the potential to do harm. [4] Professor Neil Greenberg was one of the team at the forefront of developing peer-led traumatic stress support packages, now known as TRiM. He is an academic psychiatrist based at King's College London UK and is a consultant occupational and forensic psychiatrist.

Although it was first developed in the UK military, trauma risk management is now used by a range of public and commercial organisations. [5] This includes charities, emergency services, security firms, risk management organisations, UK Government departments including the Foreign and Commonwealth Office, [6] the oil and gas industry, transport organisations and media companies including the BBC. [7]

Evidence and research

A large number of research papers have been published about the use of TRiM and its effectiveness and acceptance. This includes research about the use of TRiM by Cumbria Constabulary, following the Cumbria shootings in 2010. This research [8] showed that the officers and staff who received a TRiM response fared better than their colleagues who did not and were less likely to be absent from work than colleagues who did not receive a TRiM intervention.

Research has shown that the use of TRiM may assist in increasing the psychological resilience of military personnel through the facilitation of social support. [9]

A review of TRiM research was published in the Journal of Occupational Medicine in April 2015 [10] and since that time a further 2017 paper has shown that TRiM improves help-seeking after traumatic incidents. [11]

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder, but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress disorder (PTSD).

Acute stress reaction and acute stress disorder (ASD) is a psychological response to a terrifying, traumatic or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, reflective listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

Critical incident stress management (CISM) was a controversial process of psychological first aid which focused solely on an immediate and identifiable problem. It included pre-incident preparedness and acute crisis management through post-crisis follow-up. The purpose of CISM is to decrease the likelihood of post-traumatic stress disorder developing after a crisis.

Debriefing is a report of a mission or project or the information so obtained. It is a structured process following an exercise or event that reviews the actions taken. As a technical term, it implies a specific and active intervention process that has developed with more formal meanings such as operational debriefing. It is classified into different types, which include military, experiential, and psychological debriefing, among others.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

<span class="mw-page-title-main">Military psychology</span> Specialized field in psychological science

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Incident stress is a condition caused by acute stress which overwhelms a staff person trained to deal with critical incidents such as within the line of duty for first responders, EMTs, and other similar personnel. If not recognized and treated at onset, incident stress can lead to more serious effects of posttraumatic stress disorder.

Bessel van der Kolk is a Dutch psychiatrist, author, researcher and educator. Since the 1970s his research has been in the area of post-traumatic stress. He is the author of The New York Times best seller, The Body Keeps the Score.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

Psychological first aid (PFA) is a technique designed to reduce the occurrence of post-traumatic stress disorder. It was developed by the National Center for Post Traumatic Stress Disorder (NC-PTSD), a section of the United States Department of Veterans Affairs, in 2006. It has been endorsed and used by the International Federation of Red Cross and Red Crescent Societies, Community Emergency Response Team (CERT), the American Psychological Association (APA) and many others. It was developed in a two-day intensive collaboration, involving more than 25 disaster mental health researchers, an online survey of the first cohort that used PFA and repeated reviews of the draft.

<span class="mw-page-title-main">Neil Greenberg</span> British academic psychiatrist

Neil Greenberg is an academic psychiatrist, who is a specialist in the understanding and management of psychological trauma, occupational mental ill-health and post traumatic stress disorder. Greenberg works with King's College London and served as the President of the UK Psychological Trauma Society from 2014 to 2017. He also runs the psychological health consultancy March on Stress. During the 2020 COVID pandemic, Greenberg was part of the NHS England and Improvement Wellbeing Team and contributed to the national response to protect the mental health of NHS workers.

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<span class="mw-page-title-main">Trauma and first responders</span> Trauma experienced by first responders

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References

  1. 1 2 Greenberg, Neil; Brooks, Samantha; Dunn, Rebecca (2015-04-22). "Latest developments in post-traumatic stress disorder: diagnosis and treatment: Table 1". British Medical Bulletin. 114 (1). Oxford University Press (OUP): 147–155. doi:10.1093/bmb/ldv014. ISSN   0007-1420.
  2. ↑ Creamer, Mark C.; Varker, Tracey; Bisson, Jonathan; Darte, Kathy; Greenberg, Neil; Lau, Winnie; Moreton, Gill; O'Donnell, Meaghan; Richardson, Don; Ruzek, Joe; Watson, Patricia; Forbes, David (2012). "Guidelines for peer support in high‐risk organizations: An international consensus study using the delphi method". Journal of Traumatic Stress. 25 (2). Wiley: 134–141. doi:10.1002/jts.21685. ISSN   0894-9867.
  3. ↑ "Post-traumatic stress disorder". NICE. 2018-12-05. Archived from the original on 2024-05-13. Retrieved 2024-07-14.
  4. ↑ Rose, Suzanna C; Bisson, Jonathan; Churchill, Rachel; Wessely, Simon (2002-04-22). "Psychological debriefing for preventing post traumatic stress disorder (PTSD)". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD000560. PMC   7032695 . PMID   10796724.
  5. ↑ "March on Stress >> Clients". Archived from the original on 2015-12-05. Retrieved 2015-07-21.
  6. ↑ "Trauma Risk Management - TRiM" (PDF).
  7. ↑ "Psychological Trauma Support & Trauma Risk Management (TRiM)". Archived from the original on 2017-01-16. Retrieved 2015-07-21.
  8. ↑ Hunt, E.; Jones, N.; Hastings, V.; Greenberg, N. (2013-10-30). "TRiM: an organizational response to traumatic events in Cumbria Constabulary". Occupational Medicine. 63 (8). Oxford University Press (OUP): 549–555. doi:10.1093/occmed/kqt113. ISSN   0962-7480.
  9. ↑ Frappell-Cooke, W.; Gulina, M.; Green, K.; Hacker Hughes, J.; Greenberg, N. (2010-10-01). "Does trauma risk management reduce psychological distress in deployed troops?". Occupational Medicine. 60 (8). Oxford University Press (OUP): 645–650. doi:10.1093/occmed/kqq149. ISSN   0962-7480.
  10. ↑ Whybrow, D.; Jones, N.; Greenberg, N. (2015-04-16). "Promoting organizational well-being: a comprehensive review of Trauma Risk Management: Table 1". Occupational Medicine. 65 (4). Oxford University Press (OUP): 331–336. doi:10.1093/occmed/kqv024. ISSN   0962-7480.
  11. ↑ Jones, Norman; Burdett, Howard; Green, Kevin; Greenberg, Neil (2017). "Trauma Risk Management (TRiM): Promoting Help Seeking for Mental Health Problems Among Combat-Exposed U.K. Military Personnel". Psychiatry. 80 (3): 236–251. doi:10.1080/00332747.2017.1286894. ISSN   1943-281X. PMID   29087252. S2CID   22368392.
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