REDS: Resources

Working together towards change

The REDS pathway is designed to support people who want to understand themselves better, manage emotions more effectively, and build healthier relationships. Psychological treatment can be a powerful experience, and one of the things that makes it most helpful is being open to the possibility of change.

That doesn’t mean changing who you are as a person. It means being willing to look at patterns, habits, or ways of coping that may once have been necessary, but are now getting in the way of the life you want.

Many people find this idea both hopeful and daunting. That’s completely understandable.

Why we talk about change

Our service is “change‑oriented” because psychological therapy works best when people feel ready to try something different—whether that’s a new way of responding to emotions, a new way of relating to others, or a new way of understanding themselves.

You don’t need to know exactly what you want to change before you start. Part of our work together is helping you explore that.

• Some people want to change how intensely they feel things.
• Some want to change how they react when overwhelmed.
• Some want to change how they communicate or how they see themselves.
• Others want to change the direction of their lives entirely.

Whatever it is, the change belongs to you.

Exploring what you want to change

You might find it helpful to reflect on questions like:

• What feels hardest for me right now
• What keeps happening in my life that I wish were different
• What would I like to feel more of—or less of
• If treatment “worked,” what would be different for me in six months or a year

There are no right or wrong answers. This is simply a starting point for thinking about what matters to you.

The importance of agency

Agency means recognising that you have a role in your own change. It’s about having a sense of influence over your life, your choices, and your direction.

We emphasise agency because:

• It helps you feel more in control
• It strengthens motivation and resilience
• It makes therapy more effective
• It supports long‑term change, not just short‑term relief

Agency doesn’t mean doing everything alone. It means working with us, rather than feeling that change is something that happens to you or is done to you.

Your readiness matters

People come to the REDS pathway at different stages of readiness. Some feel eager to begin making changes. Others feel unsure, ambivalent, or overwhelmed. All of these experiences are valid.

To benefit fully from the REDS DBT skills programme, however, you do need to be willing to consider change and be ready to take some small steps to make it happen.

If you’re not ready yet, that’s okay. We will be here when you are.

We aim to make REDS as inclusive as possible. We estimate that over one third of individuals accessing REDS are neurodivergent. To support accessibility, we have built in practices that help everyone feel comfortable, safe, and able to participate.

Clear rules and consistent structure: Sessions have clear group rules and a consistent structure, which is explained each time, so group members know what to expect.
Stable facilitation team: We try to keep facilitators the same throughout and let you know in advance if there is a change.
Minimised sensory distractions: We encourage group members to sit still and ensure microphones are on mute when not speaking to minimise sensory distractions.
Breaks built in: We have a 10-20 minute break halfway through each session. You can also turn your camera off and take a brief movement break if needed. 
Varied learning methods: We use a wide variety of visual, practical exercises, and videos to teach skills.
Workbooks provided: You will receive workbooks to accompany the group, which you can use to prepare for upcoming sessions or refresh your memory afterwards.
Regular check-ins: Facilitators frequently check in to see if the group have understood and will provide opportunities to ask questions in sessions.
Coaching calls offered: Alongside group, you can also access our coaching calls if you need personalised support to understand or apply a skill to your specific circumstances. 

Some aspects of group participation (for example, cameras on, speaking up) are necessary for safety and effectiveness but may feel demanding. Planning ahead can help you get the most out of the sessions.

Here are some suggestions:

• Sensory environment: Think about the room you will attend sessions from in relation to your sensory needs. Consider things like light, temperature, background noise and distractions. Can you have fidget toys or soothing items to hand?
• Reminders and preparation: Do you need to set up a calendar reminders for the sessions and to prompt you to do home practices? Would looking over session content in advance be useful?
• Breaks and recovery: Would it help you to block out some time after the group? What would be most helpful to do in the breaktime?
• Contribution strategies: What might support you to contribute in groups?

If it feels useful, we encourage you to complete the included SPACE card to help you think more about your neurodivergence in relation to Making Connections. If you would like group facilitators to be aware of your diagnosis and/or neurodivergent traits to help us better understand you, or if there are additional considerations related to your neurodivergence, please bring this up in your pre-group one-to-one session.

REDS is a needs-led psychological treatment service. The service is designed to work with people who share some difficulties in managing their strong emotions, and consequent difficulties in relationships. Most people accessing this service do not have a specific mental health diagnosis. A small number of people do have a mental health diagnosis, and these include (not exclusively); depression, anxiety, emotionally unstable personality disorder, complex PTSD, bipolar disorder. About 30% of the REDS service users have a diagnosis, or traits of, neurodiversity (including autism and ADHD). 

REDS grew out of the Personality Disorder Community Service, to provide a service to those experiencing some of the symptoms of personality disorder, but who may not have a diagnosis, may not want a diagnosis, or may not meet the threshold for a diagnosis but who non-the-less struggled with significant difficulties for which they wanted treatment. The service was therefore intentionally set-up to be trans-diagnostic (which means it was designed to meet specific needs or symptoms and was not designed specifically for people with a particular diagnosis).  

In addition to our ethos of being a trans-diagnostic service, it is important to be aware that diagnostic assessments are very time-consuming. We have therefore chosen to put our limited resources into providing more places on our treatment programme and have taken the difficult decision not to offer diagnostic assessments. 

We acknowledge that this is frustrating for some people, who would prefer to have a definitive diagnosis, typically of Emotionally Unstable Personality Disorder. Below, we have outlined some of our thoughts on diagnosis which we hope will be helpful in reflecting on your own situation. Please be aware that it is possible to pursue a diagnosis via a private provider.   

What is a diagnosis?

A diagnosis is the disease or condition that causes a set of symptoms. If you start struggling with a sore throat and feeling unwell, you may see your GP, who will arrange a blood test. From the results, your GP can identify the cause of your symptoms and make a diagnosis. Having a specific diagnosis tells the GP the cause of the sore throat and which treatment may work.

This is more difficult to do when someone is struggling with their mental health. There is a much wider, and less clear, set of factors that can lead to mental health difficulties. For most mental health difficulties there is no simple test to pinpoint an exact diagnosis, as there is no single cause.

When you seek help for difficulties with your emotional health, the mental health practitioner will listen to you talk about your current difficulties and they will ask you about some of your past experiences. They will try to piece together how your experiences may fit with certain known mental health conditions. Even with relatively straightforward diagnoses, such as depression or anxiety, it can still be hard to determine the cause, which then means we can’t be sure which treatment will be effective. For example, some people respond well to certain drugs, some respond better to psychological interventions, and some people find it more helpful to combine treatments.

Personality disorder is especially tricky, and therefore time consuming, to diagnose. It relies on knowing your history, which you may not be able to give fully or remember all the details of, such as how you behaved as a baby or recalling difficult past experiences. It also relies on a thorough understanding of your current situation so we can think about how and why this is. Thinking about the extent to which the difficulties are impacting you is also important.

Over time, our understanding of all mental health conditions is improving and evolving. Therefore, how a mental health professional makes sense of your diagnosis will be based on the information known at that time. 

What is known about the diagnosis of personality disorder is evolving at a faster rate than most mental health conditions. How we group and diagnose personality disorders has also changed over the years, and there is still debate on how the condition should be described and labelled. So, whilst a diagnosis has been helpful for some people, not everyone agrees with the diagnosis or wants to have one. 

Below we have listed some of the reasons for and against a diagnosis of personality disorder. We hope these points will help make some of the issues clearer for you and support you to think about whether a diagnosis may be helpful or unhelpful for you.

Why might a diagnosis of personality disorder be helpful for me?

After struggling and wondering “what’s wrong with me?”, getting a diagnosis of personality disorder can feel hugely validating and bring a sense of relief. It can help you feel seen and that the difficulties you’ve experienced are real.

Being able to identify with a diagnosis and connect with others with the same diagnosis can help you feel less alone. This peer support can be helpful in feeling accepted and understood by others. It can make it easier to communicate your difficulties and needs with others without having to talk through your experiences repeatedly to different people.

Some services may require a diagnosis to access them so this can be a barrier for some people. However, many services now offer support based on the difficulties you experience, rather than needing an official diagnosis, so it’s worth checking. A diagnosis is sometimes needed to be eligible for benefit schemes and financial support from the government.

However, as above, not every scheme requires a diagnosis, such as the Personal Independence Payment (PIP) which looks at the impact of difficulties on your day-to-day life. Learning that you have a disorder can help you to have compassion towards yourself and the difficulties you’ve experienced.

Why might a diagnosis of personality disorder be unhelpful or unnecessary for me?

The label ‘personality disorder’ can lead to stigma due to past misconceptions and unhelpful portrayals in the media. Some people may feel ashamed or embarrassed to say they have a personality disorder because of this. Other people may make negative judgements towards those with a personality disorder. Being diagnosed with a ‘disorder’ can make you feel like there is something ‘wrong’ with you, rather than recognising your difficulties as making sense based on how you’ve learned to cope through previous experiences.

Many people view the difficulties linked with personality disorder as a natural, human response to stressful life experiences, and so find it upsetting when people use a ‘disorder’ label. Although people with personality disorder meet the same criteria, every individual is different. However, some people have a fixed idea of what personality disorders look like, focusing just on those sets of difficulties, and overlook you as a person with a unique story and experience.

Having a diagnosis of personality disorder can make it feel like there’s no hope for the future, that it’s something you will always ‘have’ and always struggle with, there is actually plenty of support available that can help you to cope with the difficulties you experience and reach your full potential. There are a lot of similarities between different mental health conditions, and it can often be difficult to know which diagnosis is the right one. This means people are sometimes diagnosed with a personality disorder incorrectly, preventing them from accessing the right kind of support.

The process of seeking a diagnosis can be long and difficult. The assessments require you to be open about your current difficulties and could ask about past experiences which may be triggering for you. Seeking a diagnosis also doesn’t mean you will receive a diagnosis, which can be upsetting and confusing to go through.

Sometimes an official diagnosis is not needed to enter a service so it’s not always necessary to wait for this before accessing support and/or treatment. Many services now offer support based on the difficulties you experience, rather than needing an official diagnosis.

A diagnosis is not always needed to access financial support or government benefits, such as the Personal Independence Payment (PIP) which instead looks at the impact of difficulties on your day-to-day life. The support and treatment available for the difficulties linked with personality disorders are the same regardless of whether you have a diagnosis or not.

How can I move forward without a diagnosis?

You can make sense of your experiences and the difficulties you have through a process called formulation. This is a process where you piece together your previous experiences and the impact these have had on how you have become who you are now. Some people like to think of it as developing your story. Formulation is something you can have a go at yourself.

• You can include: The good and bad things that have happened to you, how you understand those experiences and how they have affected you.
• Your relationships, the good and the bad parts, and how they impacted on you. For example, what do you do now that you may have learned from someone else as you grew up? Is that helpful for you or unhelpful?
• The things that help you be the best version of you now and the things that are not so helpful now.
• If you are working with a psychologist or a therapist, they can encourage you to build your formulation and to think about the things you would like to change to improve your life.

Many people experiencing the difficulties linked with personality disorders have gone through previous experiences that were difficult or distressing. We can think about how someone may have responded during that time to stay safe and whether this had an unhelpful impact on how they see themselves, other people, and the world around them. We can then make links between these beliefs formed through the stressful experience and how someone is managing in their current situation.

This can be helpful in validating someone’s current difficulties without judgement and making sense of their experiences without labelling them. If you are working with someone, they can encourage you to move towards a place where you feel more able to accept those things that have happened in the past that you cannot change. (Notice that accepting something does not mean you have to agree with something that has happened in the past.)

When you complete your formulation, you may find that you have trouble coping with strong emotions. You may relate to feeling that other people have not always seemed to understand you in the past and sometimes they have dismissed the way you feel. You might notice that your relationships bring conflict rather than happiness. And sometimes, the distress you feel leads you to act impulsively, without thinking, and do things you regret later. These are experiences that we find are common to people seeking help for Personality Disorder – with or without a diagnosis. Many services have, or are working on, treatments which focus specifically on these difficulties.

Will I meet the criteria for a personality disorder diagnosis?

The questions below can help you work out whether you may meet the threshold for a personality disorder diagnosis. Even if you don’t want to seek a diagnosis, the checklist can help you identify which difficulties you may want support with. 

Please note that this checklist focuses on those traits related to a borderline pattern – also known as borderline personality disorder and/or emotionally unstable personality disorder.

Checklist

• Do you find yourself arguing or breaking-up a lot in your close relationships?
• Have you hurt yourself physically or tried to end your life? For example, punched yourself, cut yourself, burned yourself.
• Have you struggled with being impulsive and acting without thinking? For example, binge eating, spending sprees, drinking too much, verbal outbursts.
• Do you find it difficult to cope with emotions or feel things intensely? Do your moods feel like they change suddenly?
• Do you find yourself feeling angry a lot of the time? Do you often respond with anger or sarcasm?
• Do you find it difficult to trust others?
• Have you often felt that you or the things around you are not real?
• Do you often feel empty or numb?
• Do you often feel that you don’t know who you are or that you have no identity?
• Have you acted in a desperate way to avoid feeling abandoned or to stop someone leaving you? For example, calling someone lots to check they still care, begging someone not to leave you, clung to them physically.

Someone experiencing difficulties that may meet the threshold for a personality disorder diagnosis is likely to have ticked a minimum of five items, and more likely seven or more.

There are some other difficulties that you may be experiencing that could be in line with a personality disorder diagnosis. Previously these difficulties may have been grouped as different types of personality disorders, but now we tend to think about the severity of your difficulties and traits you may have, rather than a specific diagnosis type. 

If you relate to any of the difficulties listed below, these may be linked with personality disorder traits, and you may wish to talk about them if you seek support. Please note that some of these traits can occur in other mental health conditions too.

• Do you tend to feel badly rather than have good feelings? Are these ‘bad emotions’ often intense? For example, worry, sadness, fear, anger, guilt, or shame.
• Do you think badly of yourself or that you are worthless? Do you find it difficult to be confident?
• Do you avoid social situations, making friends, or talking with other people?
• Do you avoid talking about how you feel?
• Do you find yourself wanting the attention of others or for them to admire you?
• Do you struggle to think about the needs of others? Have you sometimes hurt others to get what you need?
• Do you find it difficult to stay on task or get things completed in time?
• Do you often do things that may be unsafe? Or the opposite, do you have to plan each detail to make sure something is safe? For example, driving too fast, climbing somewhere high up.
• Do you think a lot about things being perfect, having control over everything, and keeping things organised? Do these thoughts get in the way of completing everyday tasks?

Thinking about the severity of personality disorder

Since January 2022, personality disorders are diagnosed based on how severe the difficulties appear to be. The severity of personality disorder is determined by the impact difficulties have across aspects of personality functioning and the distress or impairment they cause in personal, family, social, educational, occupational, or other important areas of functioning. Personality functioning refers to how you view yourself and others, how you connect with others in relationships, your ideas for the future, and how you cope with, or behave in, different situations.

Mild personality disorder: Difficulties affect some areas of personality functioning but not others. For example, you may find it difficult to control how you behave but are able to create a sense of stability in your life, know who you are, and your worth. Your difficulties may not occur in all situations. You may experience notable difficulties in many relationships with others and when in occupational and social situations, but you can maintain some relationships and/or some roles. In mild personality disorder, you may not cause substantial harm to yourself or others.

Moderate personality disorder: Difficulties affect multiple areas of personality functioning. For example, you may find it difficult to know who you are, form close relationships, or control how you behave. However, some areas of your personality functioning may be less affected by your difficulties. You may experience clear difficulties in most relationships with others and when in occupational and social roles, having a large impact on you across many situations. In moderate personality disorder, you likely have a history of harm to self or others, but it has not caused long-term damage or nearly ended your life.

Severe personality disorder: Difficulties affect most, if not all, areas of personality functioning. You may experience severe difficulties in your personality functioning. For example, you may not have a sense of who you are and may value yourself poorly or criticise yourself harshly. You may experience severe difficulties in relationships with others which impact all areas of your life. Your difficulties in social situations and with other people may be serious and you may struggle, or be hesitant, when in social or occupational roles. In severe personality disorder, you likely have a history of severe harm to self or others that has caused long-term damage or could have ended your life.

Keywords list

Assessment – working with you to find out your needs and what support could be helpful. 
Diagnosis - the disease or condition that causes a set of symptoms.
Experiences – what has happened to you in the past or things you have gone through.
Formulation – a process to make sense of your past experiences and the impact these have had on you to become who you are now.
Impulsive – doing something quickly without thinking much about it first and that you may regret doing later.
Mental health practitioner or professional – people who work in mental health and may be giving you support.
Occupational – related to work, your job, and how you spend your time.
Personality disorder – difficulties in personality functioning (see below) that impact on your everyday life.
Personality functioning - how you view yourself and others, how you connect with others in relationships, your ideas for the future, and how you cope with, or behave in, different situations.
Psychological interventions – different types of support you may be given aimed at helping you with your mental health and/or emotions.
Roles – your job or part in a situation.
Severity – how serious something is or the impact it has on you.
Stigma – feeling shame and thinking poorly about something, often due to other people’s beliefs about it as well.
Threshold – criteria that needs to be met for a condition to be ‘true’.
Traits – something about you that you experience or that you can see about others. 
Validating – showing support for something and believing something to be true.

This handout will help you think about the impact that experiences of trauma may have had on you, current difficulties this may relate to, and ways that the REDS pathway can be helpful in coping with these.

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Quick read summary:

• You may have experienced trauma or distressing events in your life.
• Trauma impacts everyone in different ways.
• You may have difficulties coping with emotions, managing relationships, how you view yourself, flashbacks and distressing memories, hearing voices, and dissociation.
• The REDS pathway can be helpful in learning skills that help you cope better, build a sense of safety, and set goals for moving forward.
• The REDS will be most helpful if your difficulties include difficulties coping with emotions or managing relationships.
• For some people, the REDS may be a useful first step towards more trauma- focused options, as it may help you learn skills that are recommended by the UKPTS (UK Psychological Trauma Society) in the phased based approach to trauma.

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The Relational and Emotional Difficulties Service (REDS) is a treatment pathway to support people who struggle to cope with emotions or find managing their relationships difficult.
You, like so many others experiencing these difficulties, may have experienced trauma or stressful events in your life. These are events or experiences that are distressing and feel unsafe. You may not have used the word ‘trauma’ before or you may sometimes struggle to make sense of your previous experiences and how they have impacted you.

Some examples of common traumatic experiences include:

• Adverse childhood experiences, which includes physical, sexual, and emotional abuse, and neglect.
• Domestic abuse in relationships as an adult, either by a partner or family member at home.
• War and combat.
• Bullying by peers or other people.
• Accidents, such as a road traffic or house fire.
• Physical or sexual assaults or injuries.
• Natural disasters, such as earthquakes or hurricanes.
• Experience of death to those close to you, maybe through accidents, suicide, or illness.

You may have experienced these directly or watched it happen to someone else. The impact of trauma is different for everyone as we all respond differently. It’s less about the event itself but how we make sense of it and interpret it. We may be more vulnerable or more resilient in how we cope through trauma, and this may be dependent on a range of factors, such as our age, the threat, if it is repeated or one- off, our support network, our natural sensitivity, and coping skills we have already developed.

The impact of trauma (a brief introduction)

When we experience trauma, our brain and body respond to cope with the threat. It does this in different ways to help us stay safe and avoid harm. Our brain releases hormones that get the body ready to act and stops us from being able to think it through first. Often in traumatic situations, we don’t have time to think, so this is good in keeping us safe. But this also means we don’t get to choose how we respond in that moment. The response is natural, automatic, and we have no control over it. How we act when faced with threat is known as a threat response.

Threat responses include:

• Fight – our body gets ready to act and engage with the threat.
• Flight – our body gets ready to escape or get away from the threat.
• Freeze – our body keeps still and/or hidden from the threat.
• Appease – we submit or give in to the threat.
• Collapse – our brain shuts down to protect us from the pain of the threat.

When we have had to use a threat response, our threat system is active and remembers how we needed to act. We remember trauma differently to everyday memories so that we can stay alert to signs of that threat again and can protect ourselves. This means our brain and body adapts based on how we have learned to survive at the time. If we experience repeated trauma from a young age and the threat was constant or unpredictable, we learn that we cannot be sure we are safe, and our threat system may learn that it needs to be active all of the time. So even when we are no longer in that threatening situation, our brain thinks “better safe than sorry” and may keep our threat system active. This means we may be more sensitive to ‘triggers’, quicker to feel distressed but feel less able to cope or calm ourselves, and struggle to move forward. We know the impact of trauma will be different for everyone; it will relate to how you survived at the time and the responses you learned to keep safe. 

Therefore, everyone will experience a variation of difficulties and so, will find different treatment options more or less helpful.

How can REDS be helpful?

The REDS pathway is based on Dialectical Behavioural Therapy (DBT). DBT is a ‘trauma-informed’ model of treatment. It can help develop skills to help you feel stable and safe. You can develop a safety plan to think about your triggers and what skills may help you cope. The skills may help you to calm your body and reduce how you experience the impact of trauma. It can help you to manage your everyday life, such as improving sleep and keeping a routine. The group sessions allow you to meet other people and develop relationships in a safe space. You will be supported to develop goals and think about how you can move forward to live a life meaningful to you.

We can think of DBT as part of a ‘stabilisation’ phase. It focuses on helping you cope in the ‘here and now’. It is not about talking about the past or your trauma. It is essential that you can keep yourself safe and build ways to cope before you start to tell your story or look more closely at the trauma. Besides, some people may find that being able to cope better is helpful enough in moving forward, and do not want to re-visit the trauma at all afterwards.

Have a look through the following difficulties that people often experience after trauma, read through the ones you relate with, and find out how the REDS pathway may be helpful for you:

Difficulties coping with emotions

You may experience overwhelming emotions that seem to change quickly. Experiencing trauma increases the intensity of emotions. If you learned to be ready to respond to threat at any moment, then it makes sense that you may have needed to go from 0 to 100 really quickly. It may not have been safe for you spend time feeling calm or content, needing to be in your threat system more often than not. Depending on your experience of trauma, you may have never been shown how to identify or cope with your emotions in healthy ways. You also may not have learnt that uncomfortable emotions are often temporary.

Though you may no longer be in the same unsafe situation, you may struggle to spend much time feeling calm or feel unable to cope with everyday life. You may have learned different ways of coping that are no longer helpful for you and may cause more harm. For example, you may harm yourself, use substances or alcohol, or act violently towards others. 
You may find that you switch (or do things to change how you feel) between intense, overwhelming emotions and feeling numb or empty.

The REDS pathway can help you to understand more about your difficulties managing these emotions, learn about the ‘window of tolerance’ model, and try out different coping skills that you may find more helpful with practice.

Difficulties in relationships

You may find that you struggle to make and keep relationships. Relationships may bring more conflict than happiness. These difficulties may span across your personal relationships and professional relationships.

Your experience of trauma may have involved other people. Sometimes these people may have been close to you, someone you trusted and who should have been caring for you. This can impact the way you think about others and can make it difficult to form healthy relationships. How you feel in a relationship now may also trigger feelings previously felt during the trauma, which can cause distress and difficulties coping in the relationship. For example, being on-edge at the sign of conflict, difficulties in sexual relationships, or falling into a passive role.

It makes sense that if people have hurt and betrayed you, that you may struggle to trust others. The world may seem a dangerous place and you may feel suspicious of other people, making it hard to work out what is true and what is not. People may cope with this in different ways. You may find that you keep people at a distance, that getting close to people feels unsafe, and you struggle to connect with others. You may feel that you cannot cope alone, that you always need someone nearby, and can become dependent on those close to you. You may want to get close to people but fear that they may hurt you, so act in ways to prevent this. For example, you may leave the relationship first, do something to end the relationship, or act in desperate ways to stop them from leaving.

The REDS pathway can help you to learn skills to use in relationships based on what your goal is in the situation. You will learn skills to cope with emotions which can help you manage difficult situations in relationships better too. You may be able to improve your understanding of your own feelings and actions as well as other people’s feelings and actions, to help you cope better in building healthy relationships.

Your sense of self

Sense of self refers to how we think, feel, and behave towards ourselves. You may find it difficult to know who you are, feel that you are ‘bad’ or ‘worthless’, and may cope by punishing yourself.

If you have needed to use your threat system and it’s been unsafe to feel calm, you may not have had the opportunity to develop your identity, such as what you do and don’t enjoy, what you’re good at, or what you want to achieve. You may not have had the chance to learn to soothe yourself and therefore learn that you can cope. How you view yourself may be due to what you were told or how you were made to feel as part of the trauma experience. 

You may have felt invalidated, or not listened to, which can lead to you feeling like you don’t matter or that no one understands you. You may feel a sense of shame or maybe blame yourself for your experience. (Remember, how you respond to trauma is automatic and out of your control; your brain and body act to keep you safe at the time).

The REDS pathway can help you develop your sense of self and challenge how you view yourself. You may be able to develop your identity and understand who you are and what made you who you are today. You will be supported to set goals for moving forward, improve your motivation, and start to make positive changes.

Flashbacks and distressing memories of the trauma

Trauma is not remembered in the same way as everyday memories. This is because the response needs to be immediate to keep you safe, so the brain doesn’t get to process it in the same way. Instead of being remembered in a structured story that you can make sense of, it gets stored as the sensory experience you felt in your body at the time. This means that the memory can be triggered by any of your senses (for example, images, sounds, smells, how you feel), which can be difficult to identify.

You may experience flashbacks, where you have an intrusive memory that feels very vivid, as if the trauma is happening now. This can be very distressing and overwhelming, and it may feel random or incomplete. It may be a memory, like watching a movie in your head, or a feeling in your body, a change in emotion, or a sense of danger. They can feel so real, that your brain sends signals to your body to react as if it is happening again. You may find that you act in ways that kept you safe during the actual event or in different ways that you weren’t able to before. However, because the triggers can be so subtle and difficult to identify, your response can appear to be sudden. You may struggle to understand your reaction yourself and it can appear too intense for the situation. 

For example, you may react with anger (fight) in a disagreement because the sense of conflict triggered your feeling of being at risk; or you may zone out (collapse) when a perfume scent reminds you of the smell during your trauma; or you may switch over a channel (flight) when the content is similar to your experiences.

You may find it more difficult to know if a trigger is a real threat if you are already experiencing high stress and are in your threat system. This will make it harder for your brain to recognise what is really happening right now and so is more likely to respond as if the threat is happening again, causing you to be more vulnerable to flashbacks. Compared to when you’re feeling calm and content, when you may be more able to check things out and cope with the situation in the here and now.

Whilst the REDS pathway doesn’t talk about flashbacks and distressing memories, it can help you to identify triggers, notice changes in your body when you’re starting to feel distressed, and learn ways of coping when experiencing the threat responses. 

We will teach you how to gain some control over your emotions so that you can stay in your window of tolerance which will reduce the likelihood of you experiencing flashbacks.

Hearing voices (and other sensations)

Hearing voices that other people around you do not is a fairly common experience. It is not always a negative experience, and many people find comfort in their voices. However, voices can be hostile for some people and understandably cause distress, which is more often the case for those who have experienced trauma. If you have experienced trauma, you are also more likely to experience hearing voices.

Some people make sense of their experience of hearing voices as a memory of the trauma. The voices may sound like a past abuser, say things an abuser may have said, or express emotions we hold as a result of the trauma (such as a guilt or shame). Your voices may occur due to your overactive threat system which causes you to be highly sensitive to potential threat. Perhaps the voices warn you that people are going to harm you or that you must harm others to protect yourself. Your active threat system leads you to believe that you are unsafe and so the voices often reflect this.

Have a listen to Eleanor Longden’s TED talk about her experience of hearing voices here: Eleanor Longden: The voices in my head | TED Talk

If you feel that hearing voices is your main difficulty, the REDS pathway is less likely to be able to help you with this experience. But, whilst the REDS pathway does not directly address voice hearing, it can be helpful in ways that are linked and help you feel more able to cope with the experience. For example, the distress you experience when hearing voices is impacted by how you make sense of it, the power and control you believe the voice has, your own self- esteem, how you respond to the voices, and lifestyle factors (e.g., sleep, drinking alcohol). You may find these improve in the REDS through learning skills to tolerate distress, feeling more confident and assertive, using less harmful ways of coping, and accepting what you can’t control. It may also be helpful by learning how to regulate your threat system so that your threat alarm does not keep going off.

Dissociation

Dissociation refers to an experience of ‘shutting off’ or feeling numb to what’s going on around you. Everyone can experience this to some extent, such as ‘auto pilot’ or daydreaming. However, if you have experienced trauma, you may have responded by dissociating or ‘shutting down’ (the ‘collapse’ response) as a way of protecting yourself. You may have learned that responding in this way numbs you from pain, overwhelming emotions, or distressing memories, and so continue to respond in this way.

People experience dissociation in different ways. You may find yourself feeling ‘zoned out’, time passing without noticing, feeling unreal or ‘dreamlike’, not being able to remember things, feeling as though you are outside of your body, or feeling like there are different parts of yourself. This can make things difficult for you as you may find yourself struggling with feeling numb often, difficulties remembering things, feeling disconnected from yourself and others, and reduced awareness of dangers around you.
If you feel that dissociation is your main difficulty, the REDS pathway is less likely to be able to help you with this experience. Some of the skills may be helpful if you experience dissociation as part of your difficulties, such as learning to be present in the ‘here and now’, tolerating distress, and setting goals based on what’s important to you in life.

Further support

If you would like further information on the difficulties mentioned or the REDS pathway, you can find more information here: Course: Self-Help, Support and Guidance for Relational and Emotional Needs or call the team on 01733 746800.

If reading this information has been difficult for you and you feel unable to cope or keep safe, please contact the First Response Service by calling 111, option 2 (24/7).

If you require this information in another format such as braille, large print, or another language, please let us know.

Keywords list

DBT – Dialectical Behavioural Therapy – a model of therapy that develops skills in; mindfulness, coping with emotions, tolerating distress, and managing relationships.
Dissociation – feeling ‘shut off’ or disconnected from what is happening now.
Experiences – what has happened to you in the past or things you have gone through.
Flashbacks – a vivid experience as though the trauma is happening now. Invalidation – denying, rejecting, or dismissing someone’s feelings or experience. Resilient – more able to cope and less likely to experience harm.
Sense of self – how you think and feel about yourself. Stabilisation – becoming more able to cope and feel more stable.
Threat – something or someone that could cause harm or makes you feel unsafe. Trauma – a distressing, stressful experience that has a lasting impact.
Vulnerable – more likely to experience harm and less able to cope.

REDS offers most of its active treatment in groups. We do this because we know we can bring about the most amount of positive change for individuals by working in groups. However, it is common for people to have some reservations about this approach to treatment. This information sheet explains why we think groups can help you or those you love.

Why are you with our service?

The two biggest reasons for seeking treatment are to build control over emotions and to improve the quality of relationships, in order to achieve a fuller life. These two areas of difficulty are closely tied together because our emotions often influence how well we get along with others. They also have a really important effect on how we feel about ourselves. It makes sense then that the most effective way to work on emotions and relationships is with other people.

How might I feel about groups and why?

We understand that joining and then being in a group may feel frightening and daunting. Often people coming to our service have had difficult experiences with people in the past; problems in the family, perhaps bullying through school, maybe a sense of being different to peers, or of failing at work. For others there have been many tough, traumatic, and abusive experiences with other people. And many will share the feeling of being abandoned or neglected by people you needed to help you at the right time. These experiences may have left you feeling unsafe around other people and fearful of experiencing harm or rejection in the future, including perhaps from us.

If we think about this together it is natural and understandable that joining a group of people who you do not know will bring feelings of anxiety. Your brain will automatically think that people in the group might react in the same way as others have done in the past.  You may experience some strong emotions that you do not like.

What is happening in the brain when I meet people?

To survive unsafe or unstable relationships in a world we may find threatening or confusing, our brains must resort to being on ‘high alert’ any time other people are around.  When your brain is prioritising, looking out for danger, it is difficult to relax, be soothed, and receive help. When you live on high alert you feel the need to focus on spotting danger early and trying to get through it or avoid it. 

The relationships we have had in the past form templates which cause us to expect things to happen in the same way they have in the past. This influences how we react to new relationships and how others may then react to us. This means that when you are in a new relationships whether this be a friendship, or a romantic relationship or a therapy relationship, the same threat system tends to jump in first.  To learn new skills your brain must be calm and soothed. If you are constantly preoccupied with threat, it means you cannot learn these skills well and might end up feeling worse about yourself.
So, by working in specially designed treatment groups with professionals in charge so that the group stays safe, we can understand what it is that gets triggered in us, how that works, what tends to follow – and how things could be different in the future.

In treatment groups, the members really do support each other

Groups members often provide support, connection, validation, and a sense of connection that individual members have missed out on in the past. Many people in treatment have experienced very stressful early environments where they have not felt part of a family or friendship group where they could trust and share their thoughts, emotions, and experiences with others. If a person does not regularly check out their experiences with others, they can grow up believing that their own reactions and thoughts are wrong.  Therefore, they continue not to share things and then they miss out on other people ‘getting them’, sharing their similar experiences and giving them ideas.  People who attend groups often say they feel less isolated and more connected to others by the end of the group. 

Groups are places to practice your new skills, build new abilities, and learn from others

The purpose of coming to treatment is to bring about a positive change in your life.  In treatment you can learn things about yourself, be offered skills, and experience the care of therapy.  But it is also true that treatment is hard work. You need to put in as much of yourself as you can, and to do that the support of others makes a very great difference if you are to have a go at making change. Treatment groups are the place to do this with opportunities that individual therapy cannot provide. You can be supported to experiment and have a go at being who you want to be. We also notice that group members share information and strategies, and it can be helpful to learn from people who have similar challenges. Observing others can also help us to understand why the people around us act the way they do.  We learn how to make sense of other people, and this helps us make sense of ourselves and get meaning into our lives. Groups are also a great place to break down stereotypes and correct misconceptions and misinformation about our experiences of mental health.  

Groups are more effective

Scientific research shows us that most people who attend groups that treat emotional and relationship difficulties, particularly around personality disorder difficulties, actually do best in reaching their long-term goals. All our groups start with introductory sessions and our facilitators are all trained to be aware that new groups members are likely to have some anxieties. We will do our best to make you feel at ease, to support you, and to help you undertake this work of treatment.