How to cope with a difficult day during recovery
Why recovery after a crash goes up and down, plus a plan for hard days
Imagine a 58 year old cyclist four months after a driver turned across her path. Last week she walked to the corner store on her own for the first time and felt proud. This morning she woke with a pounding headache, snapped at her partner, and could not face the stack of insurance mail. She wonders whether she is sliding backward.
Days like that are part of many people’s recovery after a crash. The National Center for PTSD describes recovery from trauma as a daily process that moves forward little by little, with no sudden cure [1]. That slow pace can be hard to accept when you want your old life back.
This article looks at why recovery tends to be uneven and why comparing yourself with others can mislead you. It also covers which coping skills have research behind them, how to build a plan for hard days, and when a change in how you feel calls for a professional.
Why recovery often goes up and down
Researchers who study trauma often follow groups of people for months or years and map the paths their symptoms take. A 2018 review pooled 54 such studies of people who had been through potentially traumatic events [2]. In at least one of them, most people had been in motor vehicle crashes [2]. Across the studies, four broad paths showed up again and again [2]:
- Resilience: steady mental and physical health with little disruption, seen in about 66% of people on average.
- Recovery: distress that lasts for a while and then slowly fades, seen in about 21%.
- Chronic: symptoms that stay high, seen in about 11%.
- Delayed: symptoms that rise to the level of a diagnosis after a significant delay, seen in about 9%.
The authors noted that the delayed path was the least common of the four [2]. They concluded that people vary a great deal in how they respond to hard events [2].
Real paths are bumpier than averages
An Australian study gives a closer look at recovery after injury. Researchers checked on 1,084 hospital patients, first on the ward and then at set points over six years [3]. Transport crashes had caused the injuries of two thirds of those still taking part at the end [3].
Most (73%) stayed resilient [3]. A smaller group of about 8% had trauma symptoms that climbed over the first two years and then dropped back to where they started by year six [3]. The team said this up and down pattern had not been described in earlier studies [3]. They suggested that the long stretch of injury, pain and rehabilitation might explain some of the worsening [3].
The study also found that women, people with recent stress in other parts of life, and people with a mild brain injury were more likely to follow a harder path [3]. The authors concluded that some people take far longer than others to adapt after an injury [3].
What can tip a single day
Within any path, individual days vary. A bad night of sleep or a flare of pain can make one day much harder than the one before. So can a news story about a crash, a near miss in traffic or a tense phone call. The VA lists worsening of ongoing medical problems among common reactions after trauma [4]. It also notes that reminders of trauma can feel overwhelming but often lose some of their power over time [1].
Comparing yourself with other survivors
It is natural to measure your progress against other people. A neighbor from your support group may be back at work. A cousin who was in a worse crash may post photos from a hiking trip. Those comparisons can leave you feeling behind.
Research gives good reasons to be careful with them. A 2016 analysis pulled together 24 studies of people injured in motor vehicle crashes. Each one measured distress against a group of uninjured people. Whiplash, a neck injury from a sudden jerk of the head, showed the largest gap in distress [5]. Spinal cord injury showed a smaller gap, and mild to moderate brain injury a smaller one still [5]. The authors could find no clear reason for whiplash to bring more distress than spinal cord injury [5].
Speed of recovery also differs for reasons you cannot see. The CDC notes that recovery from a concussion may be slower for older adults and young children, and for anyone with a past concussion or other brain injury [6]. Earlier stress, money worries, pain and family demands all differ from one person to the next.
Posts and stories show one moment
Recovery stories online, and even stories told in support groups, often describe a single moment. You rarely see the bad weeks before or after a hopeful post. If scrolling leaves you feeling worse, it is reasonable to mute some accounts for a while or save social media for your better days.
A fairer yardstick
The most useful comparison is you against yourself over a longer stretch. Looking back over a month or two shows more than looking at today alone. Some people keep brief notes on sleep, pain and mood. The National Center for PTSD offers PTSD Coach, a free phone app with tools for tracking symptoms over time [7].
Coping skills that have research behind them
Some coping skills have been tested in many trials. Others are sensible advice that has been studied less. Much of the research below was done with adults who had depression or with mixed groups of people, not with crash survivors in particular.
Behavioral activation
Behavioral activation is a type of talk therapy that helps people get back into activities that matter to them. It usually involves planning activities ahead of time and keeping track of how they affect your mood [8]. It also works on cutting back the avoidance that keeps people away from rewarding parts of life [8].
A 2020 Cochrane review pooled 53 studies with 5,495 adults who had depression [8]. Behavioral activation did better than usual care in the short term, though that finding did not hold up in every check [8]. Compared with cognitive behavioral therapy (CBT), there was no evidence of a difference [8]. The reviewers said their confidence in the results was limited by the quality of the evidence [8].
On a hard day, the same idea can be scaled down. Choose one small activity that matters to you, such as calling a friend, stepping outside for five minutes or watering a plant. Do it, then notice how you feel afterward.
Self compassion
Self compassion means treating yourself in a way meant to help you, not harm you [9]. A 2019 analysis pooled 27 randomized trials of programs that teach it [9]. People in these programs had moderate improvements in stress, depression, anxiety and self criticism [9]. Gains in depression kept growing at follow up [9]. The authors also noted limits: the programs varied a lot. Studies with weak results may have gone unpublished [9]. On a hard day, self compassion might mean talking to yourself the way you would talk to a friend in the same spot.
Pacing after a concussion
If you have a concussion, the CDC advises rest in the first few days, when symptoms are usually at their worst [6]. After that, it recommends easing back into regular activities even if some mild symptoms remain [6]. If an activity makes your symptoms worse, cut back on it [6].
Calming skills
The VA suggests relaxation methods such as breathing exercises, muscle relaxation, stretching, quiet music and time in nature [1]. In a few people these methods raise distress at first. The VA says continuing in small, manageable doses usually helps [1]. Some people also use grounding, such as naming what they can see and hear, to come back to the present moment. Self help tools like these can support professional treatment. They are not a replacement for it [10, 7].
Comparison compiled by Safety Behind the Wheel Foundation
Coping approaches and the strength of the evidence
| Approach | What it looks like | What the evidence shows |
|---|---|---|
| Behavioral activation | Planning small activities that matter | 53 studies in depression; helpful, with limited certainty |
| Self compassion practice | Speaking to yourself with care | 27 trials; moderate gains; possible publication bias |
| Pacing after a concussion | Easing back in and cutting back if symptoms flare | CDC recovery advice |
| Calming and grounding skills | Slow breathing, stretching, noticing your surroundings | Coping advice that supports care and does not replace it |
Sources: Uphoff et al. [8]; Ferrari et al. [9]; CDC [6]; VA National Center for PTSD [1, 10]. The first two were studied in adults with depression or in mixed groups, not in crash survivors specifically.
Making a plan for hard days
On a hard day, it is harder to think clearly and remember what helps. A plan written on a calmer day does the thinking for you. The VA points out that good coping takes practice, so try your plan out before you need it [10].
These steps can form the backbone of a plan. Change them to fit your life.
- Name it. Remind yourself that this is a hard day, and that it is one day.
- Check the basics. Ask whether you slept, ate, drank water and took any medicines as prescribed.
- Shrink the list. NIMH suggests setting realistic goals and focusing on what you can manage [11]. Pick one or two tasks that truly must happen today and move the rest.
- Do one small thing that matters, even for five minutes [8].
- Reach out to one person. The VA encourages contact with your support circle even when you do not feel like it, because pulling away can make problems seem bigger [12].
- Use a calming skill you have practiced before [1].
- Skip alcohol and drugs as a way through the day. NIMH advises against using them to cope, and the VA warns that regular use can cause serious problems [12, 11].
- Rethink driving. If you feel foggy, shaky, panicky or very tired, wait, get a ride or use another option.
- Jot down what made today hard. Your notes can help your care team see patterns.
Keep your plan where you can find it, such as on the fridge or in your phone’s notes.
My hard day plan
Checklist from Safety Behind the Wheel Foundation
- Two people I can call or text, with their numbers saved.
- One small activity that usually helps a little.
- Tasks that can safely wait until tomorrow.
- A calming skill I have practiced on a better day.
- A kind sentence I will say to myself.
- My care team’s phone number and the signs that mean I should call.
- 988 saved in my phone, and 911 for emergencies.
- A backup way to get where I need to go if I should not drive.
When changing symptoms need a professional
Some setbacks pass within a day or two. Others are a sign that something new is going on or that your care needs to change. Treating every setback as harmless can delay help you need.
Mood and stress symptoms
NIMH suggests self care for mild symptoms that have lasted less than two weeks [13]. If self care does not help or symptoms get worse, it advises talking with a health care provider [13]. Severe symptoms lasting two weeks or more are also a reason to get help [13]. The VA gives similar advice for trauma symptoms that do not start to ease or that grow worse over time [1].
NIMH lists signs that call for professional help, especially if they are not improving or are getting in the way of daily life [11]. These include flashbacks, nightmares, avoiding people or places that bring back memories, and pulling away from family and friends [11]. Feeling hopeless and having thoughts of death are both signs of depression [14]. Thoughts of suicide or of hurting yourself call for help right away, using the options in the box below [13].
Drinking or drug use
Drinking more or using more drugs is a common reaction after trauma [4]. It can feel like relief. But the VA warns that regular use can cause serious problems and counts it among quick fixes that can make things worse over time [12, 10]. If you notice you are drinking or using more, tell your provider. The 988 Lifeline also takes calls about alcohol and drug concerns [15].
Physical and head injury symptoms
After a concussion, the CDC advises telling your provider if you do not seem to be improving or your symptoms get worse. The same goes for symptoms that flare once you return to regular activities [6]. Some symptoms can take hours or even days to show up [16]. The danger signs in the box below need emergency care.
Medicines
If you think a medicine is causing problems, talk with your provider or pharmacist before making any change. NIMH advises talking with a health care provider before you begin or stop any medicine [14].
Get help right away
If thoughts of suicide or of harming yourself come up, reach out today. Help works. You are welcome to use it before things reach a breaking point.
- The 988 Suicide and Crisis Lifeline is free and available around the clock. You can call or text 988, or use the chat at chat.988lifeline.org [17, 18].
- If you are a veteran or worried about one, dial 988 and then press 1. Texting 838255 also works [4, 17].
- For a Spanish speaking counselor by phone, dial 988 and then press 2 [17].
- Call 911 right away if anyone is in immediate danger [13].
After a head injury, anyone with you should call 911 or drive you to the nearest emergency department without delay if you [16]:
- Have a headache that keeps worsening and does not go away.
- Notice weakness, numbness, decreased coordination, convulsions or seizures.
- Vomit again and again.
- Have slurred speech or act in unusual ways.
- Have one pupil larger than the other.
- Do not recognize people or places, or seem confused, restless or agitated.
- Pass out, appear very drowsy, or cannot be woken.
Questions to ask yourself on a hard day
Question checklist from Safety Behind the Wheel Foundation
- What is different today: sleep, pain, a reminder of the crash, stress, or something else?
- Is this one hard day, or have I felt this way on most days for two weeks or more?
- What is the one task that truly has to happen today?
- What small activity has helped me before, even a little?
- Who could I contact today, even with a short text?
- Am I safe to drive today, or should I wait or get a ride?
- Is anything new or getting worse that my care team should know about?
- Am I having thoughts of harming myself, and do I need to call or text 988 now?
Frequently asked questions
Is it normal to feel worse months after the crash?
It can happen. In a long study of injury survivors, about 8% had symptoms that rose over two years and then eased again [3]. A review of trauma studies found symptoms that start after a delay in about 9% of people [2]. Worsening symptoms still deserve a call to your provider [1, 13].
Why am I struggling more than someone who was hurt worse?
How badly a person is hurt does not neatly predict how distressed they feel. Distress after whiplash, for example, stood out more than distress after spinal cord injury in one large analysis [5]. People also differ widely in how they respond to hard events [2].
Should I rest or push through on a bad day?
Often the answer is somewhere in between. After a concussion, the CDC advises easing back into activity and cutting back on anything that makes symptoms worse [6]. Research on behavioral activation, a talk therapy for depression, suggests that planning small activities can help mood [8].
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Hard days are a common part of recovery after a crash. Research shows that people’s paths differ widely. For some people symptoms rise and fall over months or years. A setback on its own does not tell you where your recovery will end up. Comparing yourself with other survivors can hide how different each path is.
A plan made on a calmer day can carry you through a rough one. When symptoms are new, getting worse or frightening, or when you have thoughts of harming yourself, reach out to your care team, 988 or 911 [13, 17].
Sources and further reading
- 1National Center for PTSD, U.S. Department of Veterans Affairs. Coping with traumatic stress reactions. Updated March 26, 2025. ptsd.va.gov/…/coping_stress_reactions.asp
- 2Galatzer-Levy IR, Huang SH, Bonanno GA. Trajectories of resilience and dysfunction following potential trauma: a review and statistical evaluation. Clinical Psychology Review. 2018;63:41-55. tc.columbia.edu/…/2018_Galtzaer_Levy-Huang-Bo…
- 3Bryant RA, Nickerson A, Creamer M, et al. Trajectory of post-traumatic stress following traumatic injury: 6-year follow-up. British Journal of Psychiatry. 2015;206(5):417-423. cambridge.org/…/BF901F6CD762ED0666C6FABA635…
- 4National Center for PTSD, U.S. Department of Veterans Affairs. Common reactions after trauma. Updated September 25, 2026. ptsd.va.gov/…/common_reactions.asp
- 5Craig A, Tran Y, Guest R, et al. Psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis. BMJ Open. 2016;6(9):e011993. bmjopen.bmj.com/content/6/9/e011993
- 6Centers for Disease Control and Prevention. What to do after a mild TBI or concussion. Updated September 15, 2025. cdc.gov/…/index.html
- 7National Center for PTSD, U.S. Department of Veterans Affairs. PTSD Coach. Updated April 21, 2026. ptsd.va.gov/…/ptsdcoach_app.asp
- 8Uphoff E, Ekers D, Robertson L, et al. Behavioural activation therapy for depression in adults. Cochrane Database of Systematic Reviews. 2020;CD013305. doi:10.1002/14651858.CD013305.pub2. eprints.whiterose.ac.uk/165234
- 9Ferrari M, Hunt C, Harrysunker A, et al. Self-compassion interventions and psychosocial outcomes: a meta-analysis of RCTs. Mindfulness. 2019;10:1455-1473. link.springer.com/10.1007/s12671-019-01134-6
- 10National Center for PTSD, U.S. Department of Veterans Affairs. Self-help and coping. Updated May 28, 2026. ptsd.va.gov/gethelp/selfhelp_coping.asp
- 11National Institute of Mental Health. Coping with traumatic events. Last reviewed May 2024. nimh.nih.gov/…/coping-with-traumatic-events
- 12National Center for PTSD, U.S. Department of Veterans Affairs. Negative coping and PTSD. Updated June 29, 2026. ptsd.va.gov/PTSD/gethelp/negative_coping.asp
- 13National Institute of Mental Health. My mental health: do I need help? Revised 2025. nimh.nih.gov/…/my-mental-health-do-i-need-…
- 14National Institute of Mental Health. Depression. NIH Publication No. 24-MH-8079. Revised 2024. nimh.nih.gov/health/publications/depression
- 15988 Suicide and Crisis Lifeline. Home page. Accessed October 2026. 988lifeline.org
- 16Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/index.html
- 17988 Suicide and Crisis Lifeline. Get help. Accessed October 2026. 988lifeline.org/get-help
- 18988 Suicide and Crisis Lifeline. Texting the 988 Lifeline. Accessed October 2026. 988lifeline.org/faq/texting-the-988-lifeline
This article reflects the safety priorities of emotional recovery after road crashes and road safety education. It shares general information and is not medical or mental health advice. Research and services change over time, so check official sources for current details. For guidance about your own symptoms or treatment, talk with your care team or another qualified professional. Reviewed October 2026.
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