Synopsis: Auto accidents are the largest cause of post-traumatic stress disorder. About 25 percent of people injured in car crashes will suffer from it. Accident survivors and one of the world’s foremost experts discuss variables that make PTSD worse and those that make recovery easier, as well as the essentials victims must carry out to recover.
Host: Reed Pence. Guests: Bill Hansen, car accident survivor; Dr. Edward Hickling, Professor of Psychology, University at Albany and co-author, After the Crash; Debbie Miller Koziarz, car accident survivor
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Car Crash PTSD
REED PENCE: One evening about 10 years ago, Bill Hansen was driving home from work on Chicago’s Eden’s expressway, and traffic was moving quickly. Then he had to brake for a sudden slow spot.
BILL HANSEN: And then I check in my rear view mirror, and I see that there’s traffic coming up behind me that is not slowing down. And as he was getting closer, I could see he wasn’t gonna stop in time, so I started panicking. It was just a moment of complete fright. IT was a terrifying moment really. And I remember yelling really loudly “No!” So, he slammed into me.
PENCE: Bill was miraculously unhurt, or so he thought. He walked away from the accident, but a few days later he started feeling strange.
HANSEN: I was just feeling this sense of unreality, like I was sort of in this dreamlike state. And I started to wonder if I was really dead. And you know, that kinda persisted. And I did start to get really scared by wondering if I was actually alive or dead.
PENCE: Bill realized he was in trouble and got help from a therapist. His feelings of unreality faded. But some of the scars remain.
HANSEN: It persists actually to this day when I’m in that same situation where traffic is slowing suddenly in front of me. I’m always looking behind me. I get tense. It’s like I’m reliving some of that terror of seeing this guy barreling up behind me knowing he’s not going to stop, knowing I’m gonna get hit and possibly hurt badly.
PENCE: Bill is far from alone. In fact, it’s unusual when someone who’s been in a serious car crash isn’t mentally shaken up.
EDWARD HICKLING: Within the first few days there are very strong reactions. Most of us have been in car accidents, and we kind of know what it’s like to be shook up at the scene. We know that when we get back in the car, some recollection, some anxiety is very, very normal. Some studies have shown almost 95 percent of all people have some reaction.
PENCE: That’s Dr. Edward Hickling, whose books, including After the Crash, have established him as one of the world’s foremost experts on psychological reactions to car accidents. He’s a Professor of Psychology at the University at Albany, and a psychologist with Capital Psychological Associates there. Hickling says nearly three million people are injured in serious car accidents each year in the United States, and for about 25 percent of them, the psychological symptoms don’t go away after a month or more. By then, it’s post-traumatic stress disorder. And car crashes are America’s number one cause of PTSD.
HICKLING: PTSD is a normal reaction to a really abnormal thing. We’re not supposed to be in life threatening situations. What do we do then to help these people who are reacting just the way we would react? It’s not like we would be any different. You think about it, you have dreams about it, you have flashbacks. You have those kinds of events going on and on that you can’t get rid of, and they’re out of your control. That can certainly interfere with your life, your concentration, your work. And if you’re having a lot of time recovering from a physical injury, lots of time to think about it. The second cluster of symptoms are called, kind of, “numbing estrangement.” So, this is where people basically can’t really feel like they used to feel, so they kind of feel cut-off or detached. You just don’t wanna do things. You don’t feel like your future’s gonna be there. You have alot of avoidance of people in situations that you used to enjoy.
PENCE: Many crash survivors also experience what’s called “hyperarousal.”
HICKLING: This is where your nervous system really gets turned on. You may not sleep very well. You may be irritable. You may be startling to, you know, very quick sounds that wouldn’t have done that to you before. If you see something, like a car crash on TV, or hear of a screech of tires next to you, you’re gonna be very jumpy and you’ll react to those things, which you would not have done before.
PENCE: PTSD after a crash can also show up in physical symptoms. For example, a person’s hair may start to fall out.
HICKLING: One of the hallmarks of post-traumatic stress disorder is not just a reactive, psychological disorder. There is a physiological change that happens, and the physiological change can affect what’s going on in our brain, in our body, in our stress responses. And so, while hair falling out is unusual, in terms of the sheer numbers of it, in terms of your body having a strong reaction, that’s not unusual at all, and in fact speaks very powerfully to the effect it can have on a person.
PENCE: Some people recover much more quickly and completely than others after an accident, and Hickling says there are many variables that determine that. Injuries are one. The longer it takes to physically recover, the more the reminder that life can change in an instant. And the more an injury affects everyday life, the more likely the mental effects. For example, a shattered ankle that robs a woman of mobility.
HICKLING: Each day when she can’t stand, each day when she has to dress differently or can’t put a shoe on, is a reminder. When she has pain, when she takes medicine for the pain, it’s a reminder. It’s a reminder not just of what she’s lost and can’t do, but it’s also what happened to her and all the things that come with that.
PENCE: Hickling’s studies also show that the type of accident and who was at fault are important to mental recovery.
HICKLING: If it was not your fault, there actually was a greater incidence of PTSD then if you were responsible for the crash. Now, again, it gets complicated, ‘cause we looked at that, what we found was that, obviously, if you’re doing nothing wrong, and the world is kind of out of your control, and this terrible thing happens to you, that sticks with you. As opposed to, “Well, I was tired. I fell asleep. I drove off the road. I can fix that by having some coffee.” How people thought about the incident, whether they could do something about it, either slow down, get different tires on my car, watch what I’m doing–it gave them some sense of control over it, which for a lot of these accidents, there’s really no control and a lot of it, when it happens, is that sense of helplessness that there’s nothing you can do at that instance. A car coming at you at full speed, there’s nothing you can do to avoid it; that will stick.
PENCE: Similarly, if a survivor never sees the crash coming and has no idea why they’re waking up in the hospital, they may feel helpless in a world out of their control. That’s what happened to Debbie Miller-Koziarz of Chicago’s North Shore in 1981 when her car was hit by a drunk driver. She endured nine surgeries to her face during a six year recovery. One lasting effect is a change in her confidence in the world.
DEBBIE MILLER-KOZIARZ: Changes in just feeling more secure that everybody was in their place doing what they’re supposed to do, and there wouldn’t be some sudden surprise over which I have no control. And I think it still is eating at me, because I am a fairly anxious person and I worry about stuff I really don’t have control over.
PENCE: PTSD is also more likely if a person believed that they were going to die as the crash was occurring. Those who delay getting back into a car again are also prone to PTSD that gets worse and worse. But getting back on the road can be very difficult.
MILLER-KOZIARZ: I was very anxious being in the vehicle and I started having super anxiety if, for instance, it was dark outside and lights from another vehicle would shine into the car, as they do when people make turns or you’re in the city. And if those lights would just rake across me when I wasn’t thinking about it, sometimes I would get so anxious and worked up that I’d try to, like, jump out of the car.
PENCE: Hickling says when a survivor is forced to be merely the passenger once they try to get back in the car…it’s much more difficult. For example, if injuries prevent someone from driving.
HICKLING: It’s actually harder to be a passenger than a driver following a car crash. So, why would that be? And the answer is you’re really out of control and you’re also seeing everything differently, so there is no brake or gas that you can touch and you see things, cars are coming at you; they appear to be coming closer. And so, as anxiety mounts, now you’re gonna react differently. Now, you’re partner, who is being very nice next to you trying to drive safely, also may have different driving habits than you. So, it leads to great fights within the car which again, would not have been there before the accident, but the anxiety is very, very commonly worse as a passenger than as a driver for, what we believe is that you don’t have you don’t have your hands on the wheel, you can’t control being in the right lane versus the fast lane, you can’t watch other drivers as well, you don’t have the rearview mirror. So, it’s a much more vulnerable spot to be in. So, when someone’s been in a vulnerable position where they’ve been hurt, all those ideas will flare up in their head.
PENCE: As those fears feed on themselves, crash survivors may feel more and more uncomfortable with risk of any kind. They may stay home rather than going out into the world as they used to, which is what they need now. Family members may unwittingly make it worse by running errands for a survivor who’s physically capable of doing them. But even if they’re suffering, many motor vehicle accident survivors with PTSD don’t seek help, they try to get better on their own. Hickling followed such a group for two years to see what happened.
HICKLING: Within six months about half showed an improvement in their symptoms if we knew the people had PTSD. Now, if you have PTSD and you improve, that doesn’t mean you’re all better. Only about 17 out of 50, so call it you know 40 percent, were symptom free. Others showed improvement in that 50 percent and the other 50 percent were not improving. We followed them for a year. When we get to a year we get a little bit more improvement and now we’re up to almost 60 percent improvement and then after that nobody really gets better.
PENCE: But Hickling says for those who aren’t getting better on their own…treatment works. It has about a 75 percent effectiveness rate. And it starts with a little education.
HICKLING: You need to know why this is happening to you. And there are reasons why it is happening. You’re trying to make sense of something that doesn’t make sense and your body’s reacting in a very predictable, understandable way. Hyperarousal, for instance, makes sense if you just got attacked, to be on guard makes sense. It doesn’t make sense after the attacks over, after the crash is over. But, it certainly made sense there, it made sense to kind of keep you alive. So, we give them a background for understanding what’s happening to them.
PENCE: Hickling also teaches relaxation techniques. Then a crash survivor has to face their fear. They can’t avoid it. But for them, even talking about it can be agony.
HICKLING: This conversation we’re having is often difficult for someone who’s talking about their traumatic experience. They don’t wanna stir up those memories. They don’t want the feelings. So, when you’re talking to them about what happened to them, it’s not a small conversation. So, even people passing saying, “How are you doing?” is often avoided because again, it brings the whole flood of memory back. So, treatment; however, found that you have to somehow approach the things they don’t want to talk about. So, whether that’s having them write them down, read them, talk into a tape recorder, listen to them, come to a therapist, talk about them. Sometimes they need to face the thing they don’t wanna face.
PENCE: It’s most important to try to get back to normal. That’s one place where family and friends are most helpful. Hickling says the importance of a survivor’s relationships is often overlooked.
HICKLING: Just think about it for a second. I mean, you’ve had this terrible thing happen and you’re not feeling right. So, you’re not driving as much as you used to be or you’re affected by it. So, you’re irritable. You’re kind of self-absorbed. Things are going on. And people around you wanna help. You know, one of the best predictors of doing well actually is a strong social network. So, if you have good friends, good family; that’s the strong thing, but you’re also trying to push them away, so they need to be the right kind of support. For the people that don’t have that support; they’re at much greater risk of having continued symptoms, not getting back on track. The impact on one’s social life is considerable. A crash doesn’t just affect an individual, it affects their work relations, personal relationships. Every part of their life is touched by this. And their family’s life is also touched because now they have to do different things. And it becomes important what they do.
PENCE: Many patients need to gradually break themselves into being in a car again. Hickling may have the person start by simply sitting in the car in the driveway a few times. Once their anxiety lessens, they may graduate to driving around the block, and work their way up from there. Hickling says psychologists also need to help survivors deal with how their view of life has changed. Often, they see the world as much more dangerous, and believe that life will never get better. However, some people can go through the same crash, with the same injuries and life disruption, and recover easily. Or they may never have PTSD at all. Hickling says several factors are at work.
HICKLING: One of those is the kind of optimistic view about the world. You know, basically if you can hold yourself in a more positive way or looking for things that help. Relationships, again, are really important. Good, good friends, people who you can rely on is terribly important. Getting into this thinking again. You don’t wanna see the crisis as insurmountable. You know, you basically break it down, you try to get through and find steps you can take and while difficult, not something that is beyond you. And through the flexibility that’s part of resilience, which is, you see this change, even when it’s bad at first, as a necessary part of living.
PENCE: For them, in other words, “It is what it is.” Resilient people are able to accept what life hands them and move on. And we can all learn a lot from that. Hickling says it’s also important to find some meaning in such a horrible, seemingly senseless event. Maybe it’s in climbing over adversity. Maybe it’s in simply still being alive. You can find out more about Dr. Edward Hickling and his books, including After the Crash, on our website, radiohealthjournal.net. You can also find archives of our programs there, as well as on iTunes and Stitcher.I’m Reed Pence.