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The Dose Transcript for June 6, 2024

Host: Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Well, here's something I didn't know. Nearly two thirds of us will experience a traumatic event in our lives. And that's according to numbers from Statistics Canada. Worldwide, the WHO puts the figure at 70%. For some, exposure to trauma is the first step towards developing post-traumatic stress disorder or PTSD. But not everyone goes that route. So this week, we're asking, how can I handle a traumatic event? Hi, Margaret. Welcome to The Dose.

MARGARET MCKINNON: Thank you so much, Brian. It's a pleasure to be here.

BRIAN GOLDMAN: I can tell you probably the top one or two traumatic events in my life, witnessing car accidents right in front of my eyes. Somebody else having an automobile collision or two, two cars colliding. What's the most traumatizing event you've experienced?

MARGARET MCKINNON: In 2001, I was on board a plane that was travelling to Portugal for my honeymoon. And while we were on board, that plane ran out of fuel midway over the Atlantic. We were then prepared for 25 minutes for the ditching of the aircraft at sea.

BRIAN GOLDMAN: Wow! So do you remember that episode with all kinds of incredible clarity?

MARGARET MCKINNON: Parts of the event I remember quite well and parts I don't remember at all. There was a countdown to the ditching of the aircraft at sea, and I don't remember that countdown. I did do a study where we studied passengers’ memories for the event. For myself, I find that there are pockets that are very vivid and parts that I simply don't remember.

BRIAN GOLDMAN: And you're an expert on the subject, so I'm looking forward to our conversation. But before we begin, can you give us a hi, my name is? Tell us what you do and where you do it.

MARGARET MCKINNON: My name is Margaret McKinnon. I’m the Homewood Research Chair in Mental Health and Trauma, and a professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University.

BRIAN GOLDMAN: How do psychologists define a traumatic event?

MARGARET MCKINNON: A traumatic event is defined as an event that involves either a potential for loss of life or serious injury. It is one which we have oftentimes varying forms of reactions to. So we may, for example, have that event occurring to ourselves as I did. We may witness that event happening to others, including those who we care for. We may learn about the event through news and media coverage as an example. Or we may work at a profession like police or firefighters, where we're routinely exposed to traumatic events, and those can give rise to a secondary type of trauma.

BRIAN GOLDMAN: From what you're saying, we don't have to personally experience an event for it to traumatize us. But is one more powerful than the other, you know, experiencing it yourself versus witnessing it?

MARGARET MCKINNON: I think that very much depends on the individual. It's common sense that when it occurs to ourselves, it would be more likely to have a traumatic impact. But for many people, witnessing the harm or the potential for harm to someone who we care about or to someone else who’s just a member of the public can be tremendously traumatizing and have long term impacts on mental health.

BRIAN GOLDMAN: Thinking about first responders and their high predilection to PTSD, this is secondary trauma to them. They're witnessing events, but they're horrific, aren't they?

MARGARET MCKINNON: They certainly are. We know, for example, that throughout the COVID 19 pandemic, both our healthcare workers in the country, along with our public safety personnel, were exposed to tremendously traumatic events and often highly stressful incidents, and those predated the pandemic. We recently saw exacerbation of some of those exposures over the course of the pandemic that occurred recently.

BRIAN GOLDMAN: You're an expert. How do human beings typically react to traumatic events? I guess there's a psychological and there's a physiological dimension.

MARGARET MCKINNON: There are a series of responses. We could start, for example, with the emotional reaction. So people may have a sense of anxiety or severe fear. They may experience guilt, including a sense of survivor guilt if they survived and others didn’t. Others may experience anger, sadness, helplessness. And what we often don't talk about is that trauma can also involve difficulty experiencing positive emotions. So difficulty experiencing, for example, happiness or pride or joy. Certainly, we see a series of behavioural reactions which could include, for example, startling very easily, feeling very restless, engaging in avoided behaviour. So avoiding friends and families because you're having difficulty connecting with other individuals, and also avoiding traumatic reminders. So reminders of the event, right, so the people who were there. We could also see physical reactions. So many people also experience a sense of nausea or distress. They may find they're experiencing muscle tremors or uncontrollable shaking, elevations of heartbeat. We do have normal traumatic responses, of course, but if these persist over time, then we should all be concerned around the possibility that the individual’s developed a post-traumatic stress injury.

BRIAN GOLDMAN: How long do the symptoms typically last?

MARGARET MCKINNON: I'm going to reframe that slightly. So what we see in some individuals following exposure to a highly traumatic event is that we see an increased arousal. So those may be some of those symptoms that I was talking about earlier in terms of feeling agitated, angry, having strong reactions to reminders of the event. We also have flashbacks in the form of memories that come in voluntarily. Other individuals show a pattern of diminished arousal. So what we're seeing in those individuals is that they may feel as though they’re not present in their own bodies or present in the world around them. They may appear and feel very numbed out to their surroundings. So that's really a way of escaping inescapable stress. For some individuals, these symptoms will persist up to two months after the event. And during this time, they may be having what is perceived, what is thought to be, rather, a normative response to stress. At that one month period, however, if this is interfering with daily life activities, with interactions with family, friends, at work, or these feelings are simply so overwhelming, we start to become very concerned about the onset of a post-traumatic stress injury or post-traumatic stress disorder.

BRIAN GOLDMAN: I understand that there are four categories of PTSD symptoms.

MARGARET MCKINNON: Yeah, there are four different categories. And so when we think about this, we can think, for example, about avoidance of people or places, activities that remind oneself of the event. There are many also with changes in mood and thought processes. So for example, I talked earlier on about the guilt that people may experience as a survivor. We can also see the onset of those hyper arousal type responses. So easily startling, seeming quite irritable. And finally, we can see as well the onset of nightmares or flashbacks where you're involuntarily recalling that memory. And that, of course, can be very distressing. And it occurs not only in reliving visual images associated with the event, but your body may also feel as if you're reexperiencing the event. A good example of that would be with someone who’s suffered an attack. They may involuntarily feel the same bodily sensations that they felt when that attack was occurring. And people often don't know where that's coming from, and it could be quite disturbing for them. Similarly, feeling not connected to your body or to the world around you. Some people even describe floating above the body, having that sensation while a traumatic event has occurred. And that perception could continue on while passing a traumatic event. It could be quite frightening for people if they don't know what's happening.

BRIAN GOLDMAN: You've already alluded to it. Which kinds of traumatic events are most likely to lead to PTSD?

MARGARET MCKINNON: So some events that are most likely to lead to PTSD include events that are highly uncontrollable. They often involve high levels of arousal. They may see, for example, weather events like environmental disasters or a very uncontrollable, unpredictable event, as well events with which we’re in closer proximity to. So the closer we are in proximity to the event, the more likely we are to develop post-traumatic stress injury.

BRIAN GOLDMAN: I said off the top that a lot of people are exposed to traumatic events and not a lot of people get them. What are some of the personal factors that people have that might predispose them to PTSD?

MARGARET MCKINNON: At any given month, about 2.4% of Canadians will be experiencing symptoms of PTSD that would meet criteria for a diagnosis. Over the course of our lifetime, nearly one in 10 of us will experience PTSD. We know that for individuals who have a previous history of a mental health condition, this can make them, for example, more vulnerable to developing a PTSD. Myself, when I experienced the event on board the plane, I had a history of depression, and I knew that that made me more vulnerable to develop PTSD, which I did. It could also be individuals who are exposed to combat stress and trauma, individuals who are younger. There's a variety of different characteristics that make us more vulnerable. Women, of course, suffer greater rates of PTSD than do men, and that's thought to be due in part to the greater explosion of women, exposure, rather, of women to traumatic incidents like sexual assaults.

BRIAN GOLDMAN: What are some of the things that people can do after they've been exposed to a traumatic event that might help them ward off heading down that road towards PTSD?

MARGARET MCKINNON: One of the most important pieces of advice that we can give, and this includes, for example, during the wildfires that are occurring today across Canada, is really to be able to put that oxygen mask on yourself before you're able to assist others. I worked quite a bit with health care workers, for example, during the pandemic, and what that means really is allowing yourself the time that you need to grieve, to prioritize healthy habits like eating, sleeping and exercising, and really taking things one step at a time. We can also think about, you know, when the case of a major emergency occurring, for example, like the wildfires, trying to maintain a daily routine as much as possible and thinking back to things from the past that have helped you. So we all likely have something or a series of activities that we do when we’re feeling upset or distraught. That could be, for example, reaching out to a friend, taking a hot bath. And as much as possible, we want to be able to keep those routines and keep those pleasurable activities part of our lives and think about previous coping strategies that helped us. You know, as much as possible, eating healthy foods, getting plenty of fluids, lots of sleep if at all possible. We have to, you know, of course, be realistic around this and exercise. It may also be very helpful to set small goals, the things that will give you a sense of accomplishment and really also signal that you're taking care of yourself and taking care of others. It could be helpful to also use techniques like visualization. So to pay attention to all senses and visualize positive images. So imagining, as an example, the sounds, smells and sights of a calming sea. It's also really important, of course, to keep ourselves informed during or following a traumatic event. And really, here, we want to focus on reliable sources of information. And really, the same time, limit exposure to television and social media content about the disaster to really avoid increasing our distress, right? So it's important to have reliable information that keeps us safe but to avoid overexposure. And finally, I just want to say really be kind to yourself. And we know from decades of research that the single greatest predictor of who develops PTSD following a traumatic incident is the presence of social support systems. So this is the time to really reach out to your family members, to your close friends, bolster one another, support one another, and keep in touch as much as possible.

BRIAN GOLDMAN: When should people seek help for PTSD?

MARGARET MCKINNON: It's really helpful to know the symptoms of PTSD, to have a sense of mental health literacy. So to recognize, for example, that you may be feeling very hyper aroused and have those symptoms I described earlier, or very numbed out and not present. When these symptoms become overwhelming, and also when you find that they're interfering with your ability to complete everyday tasks, to go to work, to interact with your family, we would really encourage you to reach out for help. People can also experience, you know, symptoms that while they don't meet full criteria for PTSD, they're still incredibly distressing, overwhelming. So we really want you to be able to gauge for yourselves the impact this is having on you, the impact this is having on your activities. And often, that first step is reaching out to your family physician for supports, recognizing here that many Canadians do not have access to a family physician. So they may also want to go to other places like an urgent care centre or a clinic to seek these supports, and to either have management by the family doctor or to be referred for appropriate supports.

BRIAN GOLDMAN: What are the most effective treatments out there for PTSD and for handling traumatic events?

MARGARET MCKINNON: There's often a perception that to treat PTSD, we need to travel back in time and relive previous traumatic incidents. So recollecting in great detail, processing those thoughts and feelings. In some instances, that is done. But we also know from work that reviews a series of different scientific articles that present centred therapies can be equally as effective. For example, teaching skills around interpersonal relationships, about managing symptoms of stress and anxiety, being able to be present in situations that remind you of the traumatic event. And that's called exposure therapy, where we repeatedly throw the individual to the site of where the trauma occurred, or reimagine the trauma and gradually build resilience to those memories by taking them very slowly, one at a time. We also want to have the systems processing our emotions around these events. So many people, for example, could experience a foreign moral injury, and what that is is either feeling as if one has been involved in situations that violate our moral and ethical values. And this was described very eloquently by Roméo Dallaire when he came home from Rwanda and talked about standing down, a big order by the UN to stand down during the Rwandan genocide. He talked about these moral and ethical challenges that he faced, as well as feeling betrayed by an organization or an individual that has a duty of care to you. General Dallaire has talked very eloquently about how he felt that sense of betrayal by the United Nations. And having spoken to him, he will say it is some moral injury that has stuck with me.

BRIAN GOLDMAN: I'm comforted by the fact that while most of us experience traumatic events, most of us don't get PTSD. So let me turn it around as a final question. Why is it that most of us don't get PTSD?

MARGARET MCKINNON: The reasons for that are poorly understood. We certainly do know those are predictors of who will develop PTSD, as we talked about earlier. So, you know, resilience is often associated with having a strong social support system, having access to care, not having had a previous history of mental health conditions. Basically, the most important message that we can offer people today is really to reach out for help when you need it, to put that oxygen mask on yourself first, which will allow you to care not only for yourself, but also for others. And when you are having symptoms that are overwhelming or interfere with your everyday activities, please reach out for help. I know myself, I reached out for help, and I'm so grateful that I did because there is so much hope for recovery.

BRIAN GOLDMAN: Margaret McKinnon, thank you very much for speaking with us on The Dose.

MARGARET MCKINNON: It’s my pleasure. Thank you.

BRIAN GOLDMAN: Margaret McKinnon is a professor in the Department of Psychiatry and Behavioural Neurosciences at McMaster University. Here's your dose of smart advice. The World Health Organization says around 70% of people will experience a potentially traumatic event during their lifetime. Just 5.6% of them will go on to develop PTSD. The point is that while many people go through potentially traumatic events, most recover naturally without developing PTSD. Women are more likely than men to experience PTSD. So are people who experience trauma at a younger age. Other risk factors include lower levels of education and a family history of mental health conditions such as anxiety and depression. Rates of PTSD are higher among those exposed to violent conflict and sexual violence. Experiencing or witnessing traumas that come with physical injuries carry greater risk. Repeated traumas have a stronger impact than a single event. The symptoms of PTSD include repeated and unwanted recollections of traumatic events, which make people feel as if they're happening all over again. Other symptoms include a heightened sense of danger and greater vigilance even when there is no danger. People with PTSD avoid situations, activities, thoughts or memories that remind them of traumatic events and don't want to talk about them. There are effective psychological treatments that involve gradual re-exposure to traumatic memories, and even returning to the place where the traumatic event happened. Self-care is important for reducing the risk. That means sticking to your daily routine, connecting with people you trust, avoiding or at least cutting down on alcohol and illicit drugs, getting regular exercise, developing healthy sleep habits and stress management techniques, including breathing and muscle relaxation. The best hedge against PTSD comes from reaching out to family and friends. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you liked this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Sameer Chhabra. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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How can I handle a traumatic event? - Transcript

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