A traumatic event is something no one is prepared to deal with. You may feel your mind and body are in a state of shock from the experience. You may have nightmares, feel jumpy, or find yourself re-playing the event in your mind. You may even feel disconnected from the world around you. What happened was traumatic, and any person would feel shaken up. This is natural and human.
For people who have enough resilience, the intense state of alarm will go away over time. They can sort out their thoughts and feelings, process what happened, and move on. It may take days or weeks, but the symptoms gradually decrease.
With post-traumatic stress disorder (PTSD) the feelings don’t go away. People with PTSD don’t experience getting a little bit better every day. In fact, trying to cope with the after-effects of severe trauma can be very difficult. New brain research and the hard work of survivors provides important insights for treatment and hope.
What Does PTSD Feel Like, and Who Can Experience It?
We often think of PTSD as a risk for soldiers, for people fighting in war, or those doing military service. Although it is a risk for them, PTSD can develop from any event that feels overwhelmingly threatening or scary to the person involved. It can happen to anyone, at any age, at home or anywhere.
Domestic violence, rape, child abuse and neglect, terrorist attacks, natural disasters, car accidents — these are just a few of the traumas that can lead to PTSD. It can also come from events that appear far less dramatic — such as ongoing bullying, a playground accident, or a medical procedure during childhood. It is important to recognize the myth that only obviously life-threatening events carry the risk of PTSD. Rather, PTSD is the result of the reactions and/or perceptions of the person traumatized.
The difference between PTSD and other types of traumatic experiences is that unwanted symptoms stay; they keep returning and intruding on one’s present awareness.
What are the Warning Signs and Symptoms of PTSD?
PTSD is a specific kind of stress-related disorder, diagnosed by mental health care professionals using a standard guidebook, known as the DSM.
No words can describe the debilitating impact of severe trauma on survivors. But a diagnosis can help people with PTSD seek appropriate treatment.
The DSM lists four clusters of symptoms:
- Negative thoughts and feelings
Flashbacks are the reactivated memories, sensations, and emotions that make a life-threatening or perceived threatening or frightening experience seem to be happening again. “Trauma continues to intrude with visual, auditory, and/or other somatic reality on the lives of its victims,” explains psychologist Babette Rothschild in her bestselling book The Body Remembers. “Again and again they relive the life-threatening experiences they have suffered, reacting in mind and body as though such events were still occurring.” Flashbacks may seem to come out of nowhere, or they may be triggered by something incidental in everyday life.
Flashbacks may occur with or without conscious memory of the traumatic event. They may involve memories that a person can recall at will, also known as explicit memories. They may also involve those formed unconsciously such as those that occur in early childhood. Therapists refer to these as implicit memories, which form mental models of how the world works, even though a person does not recall their origin.
Fortunately, perfect recall is not necessary when working in therapy. When overwhelming feelings occur in situations where they simply don’t fit, therapists can still help survivors resolve and manage them.
Avoidance is a coping strategy for PTSD survivors. Staying out of situations that trigger overwhelming stress is one strategy. Another way to avoid reactivating an experience is by “dissociating” or taking mental leave of the body. This happens to a degree that some PTSD survivors cannot even describe sensations going on. This coping strategy prevents many people with PTSD from living in the present and moving toward what they want in life – the right to feel safe and to pursue what is healthy and meaningful to them.
Some PTSD survivors experience hyperarousal — a feeling of always being on edge. They may feel anxious – become busy all the time, or seem unable to say no. There is intensive energy — a foot is shaking whenever the person tries to relax — or they may overreact at a sound like a balloon popping. They may dread making a mistake for fear something terrible will happen, even if part of them knows it isn’t rational.
It is as if the body’s self-defense system cannot be turned off. During the “fight, flight or freeze” survival response, the “senses become hypersensitive to better smell, hear, see and taste the danger… in preparation for further assessment and response,” explains sensorimotor psychotherapist and author Pat Ogden. “In the ideal resolution of the arousal, the level returns to the parameters of the optimum zone. However, this return to baseline does not always occur, which contributes significantly to the problems with hyperarousal that are characteristic of the traumatized person.”
Recent studies in neuroscience reveal new connections between brain, body, and the processing of severe trauma. These findings have enabled therapists to develop more effective approaches that help PTSD survivors better manage and resolve hyperarousal.
Negative Thoughts and Feelings
One of the most difficult symptoms of PTSD is a negatively altered mood. Some people with PTSD may lose interest in things that they want to enjoy, be unable to concentrate, or feel that they are wandering through life like a ghost. It is normal for anyone to get swept up in dark moods at times. But with PTSD treatment, it is possible to learn new ways to cope and observe the waves of emotions without getting lost in them.
No matter how grim things look, know that these symptoms are part of the disorder. Brain research is shedding light on changes in the brain’s structure and function following the aftermath of trauma. This information helps explain why emotions and other symptoms occur the way they do. It also leads to treatments that can help PTSD survivors manage symptoms and even strengthen brain structures for the better.
PTSD and the Brain
Neuroimaging studies have revealed important structural and functional differences between the brains of people with PTSD and the brains of individuals without PTSD. Research has studied changes in three particular parts of the brain and their role in the stress response: the hippocampus, ventromedial prefrontal cortex (ventromedial PFC) and amygdala.
The Hippocampus In PTSD Survivors
The hippocampus may change the most after severe traumatic stress. It regulates memory, and the ability to distinguish past from present. It stores and re-activates memories in response to certain stimuli. The hippocampus of PTSD survivors is measurably smaller, and does not separate past and present or read cues from one’s surroundings as it otherwise would. This change may explain the experience of flashbacks, or sudden panic attacks. Fortunately new ways to cope can be learned.
The Amygdala and Ventromedial PFC in PTSD Survivors
The amygdala interacts with ventromedial PFC — the part of the brain involved in response to emotions and self-awareness. This latter area becomes smaller and less able to regulate the amygdala’s “fight-or-flight” signals. This may explain feelings of panic or terror with PTSD in response to seemingly harmless everyday events.
These findings help all of us understand why PTSD survivors respond so differently to stress and stimuli than people who do not experience PTSD. The findings guide new medical treatments and behavioral therapies to help rebuild other strengths in the brain and better coping skills.
What Does Treatment and Recovery Look Like?
Therapy and recovery for PTSD is about calming the brain. It is a careful journey tailored to the needs of each person, so only general ideas can be outlined here.
Just as the experience of trauma changes the brain, therapeutic experiences can promote the growth of new connections in the brain, help resolve traumas and help repair the brain’s abilities to function. These therapeutic and healing experiences can be learned in mindfulness training, or mindsight, a term coined by Dr. Daniel Siegel.
Mindfulness or Mindsight
“The brain changes physically in response to experience, and new mental skills can be acquired with intentional effort,” says psychologist Dr. Daniel Siegel in the book, Mindsight: the New Science of Personal Transformation. “Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds. It helps us be aware of our mental processes without being swept away by them, enables us to get off the autopilot of ingrained behaviors.”
Siegel has found that for PTSD survivors, understanding something about how the brain works often demystifies the experience of symptoms and can make survivors feel less alarmed or “crazy” by what is happening. It also creates a framework for developing new calming and self-regulatory skills that enable survivors to live more fully.
Psychiatrist and researcher specializing in treating PTSD Bessel Van der Kolk sees the goal of treatment as helping people with PTSD resolve the disconnect caused by the trauma. “If we can help our patients tolerate their own bodily sensations, they’ll be able to process the trauma themselves,” he says. He supports the use of a number of therapies that help survivors become more mindful of their own physiological states, including
- Trauma-informed yoga, or restorative yoga
- EMDR, or Eye Movement Desensitization and Reprocessing
- Sensorimotor therapy (developed by Pat Ogden, using neuroscience and other therapies to incorporate body awareness as a resource in psychotherapy)
The therapist’s work is to help clients maintain a sense of being allied together in therapy in the present, safely address a traumatic experience, and begin to leave it in the past. It is possible to spend time with friends, family and loved ones and remain in the present.
PTSD survivors can develop new strengths and learn how to live more fully and peacefully in the present.
Do you have any experience with PTSD? What are your thoughts?!
Robyn E. Brickel, MA, LMFT is the director and lead therapist at Brickel and Associates, LLC in Old Town Alexandria, Virginia, which she founded in 1999. She is deeply committed to clinical practice, professional education and better public awareness of mental health issues. You can connect with her via her website HERE, on Twitter @RobynBrickel and on Facebook.