Therapy to Understand Trauma After a Critical Incident
- Apr 15
- 6 min read
Critical incident trauma therapy | Post-traumatic stress Chamonix
There is a particular disorientation that follows a critical incident. Not just the shock of what happened — but the strangeness of what comes after. The way the world looks the same and feels entirely different. The replaying. The hypervigilance. The moments of apparent calm punctuated by responses that feel completely out of proportion. The sense, sometimes, that you should be over it by now.
A critical incident is any event that falls outside the range of ordinary human experience — sudden enough, overwhelming enough, or threatening enough that the normal capacity to process and integrate what has happened is temporarily exceeded. Road accidents. Medical emergencies. Mountain accidents or rescues. Witnessing violence or sudden death. A fire. A natural disaster. An assault.
These events are not rare, particularly in environments like the Alps where the landscape itself carries a level of inherent risk. And the psychological aftermath — however it presents — deserves to be taken seriously.
What happens in the body and mind after a critical incident
To understand trauma responses, it helps to understand what the brain and nervous system are actually doing during and after a threatening event.
When we perceive danger, the brain's threat detection system — centred on the amygdala — activates before the thinking, reasoning part of the brain has time to process what is happening. Stress hormones flood the body. Heart rate increases. Muscles prepare for action. Attention narrows. This is the survival response — fight, flight, or freeze — and it is extraordinarily effective at keeping us alive in moments of genuine danger.
The difficulty is that this system does not always switch off cleanly once the danger has passed. In the aftermath of a critical incident, the nervous system can remain in a state of heightened alert — continuing to scan for threat, continuing to respond as though the danger is ongoing, long after the event itself is over. This is not a malfunction. It is the system doing exactly what it was designed to do. But it is exhausting, disorienting, and — if it persists — genuinely harmful.
At the same time, traumatic memories are stored differently from ordinary memories. Rather than being processed and filed as past events, they can remain fragmented — sensory, visceral, immediate — in ways that make them feel present rather than historical. A sound, a smell, a particular quality of light can activate a response that feels indistinguishable from the original experience. This is the mechanism behind flashbacks and intrusive memories: not a failure of willpower, but a feature of how overwhelming experience gets encoded.
What trauma responses actually look like
Trauma responses after a critical incident vary considerably between people, and they do not always look the way popular culture suggests. Not everyone has flashbacks. Not everyone breaks down. Some people feel numb. Some feel oddly fine for days or weeks before symptoms emerge. Some people find themselves functioning apparently normally while quietly carrying something very heavy.
Common responses in the days and weeks following a critical incident include:
Intrusive symptoms — unwanted memories, flashbacks, distressing dreams, or intense emotional and physical reactions to reminders of the event.
Avoidance — steering clear of people, places, situations, or even thoughts and feelings associated with what happened. This is the nervous system's attempt to protect itself from reactivation, and it is understandable. Over time, though, avoidance tends to maintain and entrench the trauma rather than resolve it.
Hyperarousal — persistent difficulty sleeping, irritability, difficulty concentrating, an exaggerated startle response, a sense of being constantly on edge. The body remains mobilised for a threat that is no longer present.
Emotional and cognitive shifts — a changed sense of the world as safe or predictable, feelings of shame, guilt, or self-blame that may not be rationally grounded, emotional numbing or detachment, a loss of interest in things that previously mattered.
Somatic responses — trauma lives in the body. Unexplained physical symptoms, chronic tension, fatigue, gastrointestinal disturbance, and changes in appetite or libido can all be part of the physiological aftermath of overwhelming experience.
It is also worth noting that trauma responses are not confined to the person directly involved. Witnesses, bystanders, emergency responders, and those who provide first care at the scene of a critical incident can all be significantly affected — sometimes in ways they do not immediately recognise as trauma-related.
When does a trauma response become PTSD?
For many people, the acute responses to a critical incident are time-limited. With adequate support, rest, and the gradual return to normal life, the nervous system regulates and the symptoms reduce. This is the normal process of recovery, and it does not require formal intervention.
Post-traumatic stress disorder (PTSD) is diagnosed when symptoms persist beyond a month, are severe enough to significantly interfere with daily functioning, and meet specific diagnostic criteria around intrusion, avoidance, negative cognitions and mood, and hyperarousal.
It is important to note that PTSD is not a sign of weakness, and that its development is not straightforwardly predicted by the severity of the incident. Individual factors — including prior trauma history, the presence or absence of social support, the meaning the person makes of the event, and neurobiological variables — all play a significant role. People with strong social support and a secure attachment history tend to recover more readily, not because they are stronger but because they have more relational resources available.
Complex PTSD, which arises from prolonged or repeated trauma rather than a single incident, has a somewhat different clinical picture and requires a different therapeutic approach — though there is often overlap, particularly when a critical incident activates earlier traumatic experience.
Professional and emergency contexts
Critical incidents take on a particular weight for people whose work puts them regularly in proximity to danger, injury, and death. Mountain rescue teams, guides, ski patrol, medical first responders, and others in emergency and high-risk professions face an occupational exposure to potentially traumatic events that is qualitatively different from civilian experience.
For these professionals, several additional factors complicate the aftermath. There is often a strong culture of stoicism and self-reliance — the sense that seeking support is incompatible with competence, or that what one experiences is simply part of the job. There is frequently a lack of dedicated psychological support in the aftermath of incidents. And there is the cumulative weight of repeated exposure — each individual incident may be manageable, but the accumulation over months and years can be significant.
This does not mean that trauma is inevitable in these roles. Many people in high-risk professions develop genuine resilience through experience, good team support, and effective personal and professional coping strategies. But it does mean that when something breaks through — an incident that is particularly difficult, or a moment when the accumulated weight becomes too much — it deserves the same quality of attention as any other trauma.
What helps
The research on trauma recovery is reasonably consistent. Several things make a meaningful difference.
Social support is one of the most robust protective factors. Being able to talk honestly — without minimising, without having to protect others from the reality of what happened — to people who are genuinely present and not overwhelmed matters significantly. This does not have to be professional support, though it can be.
Restoring a sense of safety in the body and in daily life is a necessary precondition for deeper processing. Trauma treatment that moves too quickly into the content of the traumatic memory without first establishing sufficient nervous system regulation tends not to help and can sometimes make things worse.
Trauma-informed therapy — of which there are several well-evidenced modalities — offers a structured, safe way to process what happened and integrate it into a coherent narrative. This is different from simply talking about the event. Effective trauma therapy works with the nervous system, not just the mind.
In my work I draw on relational Transactional Analysis, which is well-suited to trauma — particularly when the traumatic event has activated earlier relational wounds, or when the person's relationship to themselves and others has shifted as a result of what they experienced.
When to seek therapy for trauma
There is no threshold of severity that qualifies a person for support. If what you experienced is affecting your sleep, your relationships, your capacity to work, or your sense of yourself — and if it has been doing so for more than a few weeks — it is worth speaking to someone.
Early intervention following a critical incident tends to produce better outcomes than waiting. This is not because time makes things worse in all cases — for many people, time and support from those around them is enough. But when the symptoms are persisting rather than resolving, getting help sooner rather than later is generally advisable.
If you are a professional in a high-risk field and are finding that something is not sitting right after an incident — even if you cannot quite name what it is — that too is worth bringing to a therapeutic space.
I work with individuals in Chamonix and online across France, and have a particular interest in supporting people in high-risk and emergency professions. Sessions are available in English and French.
Fleur Jaworski-Richards Fleur is a UKCP-registered psychotherapeutic counsellor based in Les Houches, Chamonix valley. She works bilingually in English and French with individuals and couples in person and online across France, drawing on relational Transactional Analysis psychotherapy.
