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Cycling, psychology and accidents

As a Clinical Psychologist, I spend much of my time with people who have been through highly stressful experiences/incidents/accidents; either in assessing their symptoms for legal proceedings, or working therapeutically with them to overcome these symptoms.

Unfortunately, this involves meeting with a steady stream of cyclists who have had close encounters with cars and other vehicles. Following such accidents, there is often a large focus on the physical injuries sustained and, not infrequently, the damage to their beloved bikes. Psychological symptoms are often not thought about, and not routinely asked about by medical professionals involved. Sadly, there also still exists a stigma about mental health/psychological issues, which means that people don’t like to ask or to talk about them, and they suffer in silence while worrying about what is happening to them. I meet with a lot of people who have never encountered mental health professionals before, are uncomfortable about being in a room with me, and very suspicious of what I might do or say. For the record, I don’t have a beard, they don’t lie on a couch and I don’t section anybody! I think most people actually leave an assessment feeling relieved that their symptoms are not uncommon, they have a name and there are effective treatments.

I sincerely hope that nobody reading this article has the misfortune to be involved in an accident on their bike, but in the event that you do, I hope this can at least be helpful in giving some basic information about what you can expect to happen from a psychological point of view following such events, what is normal, at what point you should be concerned, and what to do about it if you are.

Most people have certain beliefs and expectations about the world and the people in it. “I’m safe enough, bad things happen to other people not me, I deserve good things, the world is safe enough, other people are generally ok, the future will be fine” etc etc. We know that these are not absolute truths, but they are actually adaptive beliefs that enable us to live our everyday lives without excessive anxiety. If we didn’t believe these things, then we would probably think twice about leaving the house every day, take all sorts of precautions to stay safe and would be far less trusting and friendly to the people we encounter in everyday life. The trouble is, when some kind of traumatic or distressing incident happens such as getting knocked off your bike, it doesn’t fit with those beliefs because suddenly it actually wasn’t safe enough to be out on the roads, the injuries you have mean you aren’t made of rubber and springs, and other people were not ok because they just knocked you off your bike and are now trying to tell you that it was somehow your own fault for not getting out of their way. Once you are over the initial shock and in a place of safety, all of that needs some getting your head around, because it just doesn’t fit with how life was supposed to be and it makes the future less certain.

There are a large number of symptoms that are quite common after such events. Some of them relate to this idea of trying to get your head around what has happened, or as we in the business like to call it: “processing”. Your mind finds all kinds of ways to get you thinking about it, which means thoughts and images of it popping up into your mind out of the blue and also when you see or hear anything that reminds you of it. Some people go back over it repeatedly, and some find they have dreams or nightmares about it. Some people talk about it a great deal, often knowingly repeating the same things over and over again. And often there is a focus on trying to make sense of it – “why did it happen? Why me? Why didn’t he see me?” Not forgetting the what-ifs – “what if I had set off five minutes sooner or later? What if I had gone the other route that I’d originally been intending to do? What if I had just decided to stay in bed after all and leave the other early birds to it?” And then the what-ifs about how it could have been worse – “what if I had landed on the other side of the road in the oncoming traffic? What if I wasn’t wearing my helmet? What if I had been killed?” This is all extremely unpleasant but actually quite normal because part of processing what happened involves processing what didn’t happen.

Such unpleasant experiences lead to a different set of symptoms related to avoidance. This involves things such as trying not to think or talk about it and trying to avoid anything that reminds you of what happened. Often for cyclists, this makes getting back on the bike or out on the roads hard, and particularly going back to where the accident happened. It can be hard to admit to your family or fellow cyclists that you actually feel quite scared of being back out on the bike. Then, when back out on their bikes, it is quite normal to have a period of time where they feel on edge and are looking for risks and danger, particularly when back where the accident happened or at similar places.

There are a large number of other quite normal symptoms, and I won’t be exhaustive, but they involve things like feeling angry or guilty (even when you know it was not your fault), being irritable, having disrupted sleep, being jumpy, startling to loud noises and finding it hard to concentrate because your mind keeps taking you back to what happened. All of this can be made worse by pain or limits on mobility or activities due to any physical injuries sustained.

In the usual course of events, all of these symptoms will reduce over the weeks and months, and most people are pretty much back to normal by about six months after the accident. You can help yourself by not avoiding the thoughts. If you are thinking about the accident, it is for a reason; it is because your mind needs to make sense of it and process what happened and what it means. So let it. Go back over it, talk about it, write about it or draw it if you need to. Maybe even visit the site where it happened and work out what happened where. We have all heard the advice about getting back in the saddle, and this is good advice following trauma, and quite literal when it comes to cycling. Get back out there riding as soon as you feel able, even if you need to start off gradually and in environments where you feel safer. It can take time to re-learn that it is safe enough, but the more you return safely home after rides, the more confident you will feel that this is true.

For a minority of people and for a variety of reasons, the symptoms can be very intense and distressing. For some, they don’t reduce and may even get worse, or new difficulties arise. Sometimes they develop into diagnosable conditions such as Post Traumatic Stress Disorder, Adjustment Disorders, depressive or anxiety disorders. My advice if there are any concerns in this regard is to see your GP. GPs don’t often ask about psychological symptoms, so you may need to be the one to bring up what you have been experiencing. They probably won’t do anything for the first few weeks unless the symptoms are really severe, as best practice guidelines advise a period of “watchful waiting” in order to allow for normal healing. However if there is no improvement then they can prescribe medication to help and/or refer you to the appropriate mental health service or professional to undertake some psychological therapy. There are some very effective psychological therapies that have a good evidence-base and which work well.

Safe riding!


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