PTSD: Facing the Past to Live in the Now

Fight, Flight, or Freeze?

Have you ever experienced any of these scary situations? You slam on the breaks when the car in front of you suddenly stops. You involuntarily punch your buddy in the face when he jumps out to scare you. Your mouth goes dry, face gets red, and mind goes blank when you stand to give a speech. You quickly lunge forward to catch a falling child. You hold your breath and stop dead in your tracks when you see a grizzly bear near your campsite. When the bear starts chasing you, you run away as fast as you can. These are all examples of the fight, flight, or freeze response system we are all born with to keep us safe from perceived danger. When activated, we react in one of three ways:¹

• Fight the threat
• Flight (escape) from the situation
• Freeze and stay in place

We usually react without even thinking about what we’re doing until the moment has passed. We respond instinctively to the threat to preserve our safety and survival. When the danger is gone, the fight-flight-freeze response system is deactivated, and life gradually goes back to normal. Maybe after some choice expletives aimed at the driver in front of you, traffic starts to move again, and you drive on. You apologize to the friend you just punched and have a good laugh. You tell tall tales around the campfire about the bear that almost ate you and sleep with your flashlight under your pillow. But for those of us whose experiences didn’t end so safely, moving on might not be easy.

After the Danger

Some of us have trouble getting past the scary situations we’ve witnessed or experienced, especially if it involved prolonged terror, horror, or life-threatening fear. We relive the moment in an effort to solve it, which activates the fight-flight-freeze response again, even when the original experience is over. Some may start to associate similar places or situations with the past traumatic experience. For example, if you lived through a supermarket robbery where a gun was held to your head, your fight-flight-freeze response may be triggered every time you go shopping for groceries. Others have memories, flashbacks, or dreams that force them to repeatedly relive the traumatic experience. A prolonged or ongoing fight-flight-freeze response may require your body to constantly activate the system, creating chronic stress and anxiety.                                

Post-traumatic stress disorder (PTSD) is a mental health disorder that may occur in people who have experienced, witnessed, or been exposed to a traumatic event(s), such as an accident, death, crime, combat, natural disaster, or abuse. Otherwise known as “shell shock” or “combat fatigue” after World War I and II, PTSD is marked by intense, disturbing thoughts and feelings related to  traumatic experiences in the past.³ Thankfully, only 8% of women and 4% of men who experience trauma develop PTSD. This is a small portion of the 60% of men and 50% of women who have experienced trauma at least once in their lives. As of 2021, PTSD affects about 6% of the total U.S. population or 15 million people.⁴

Do I Have Post-Traumatic Stress Disorder?

PTSD symptoms usually begin within three months of the traumatic event; however, they may not appear until several months or even years later. To be diagnosed with PTSD, a varying degree of the symptoms below persist for at least one month and are severe enough to interfere with relationships or work.^{3, 5, 6, 7}

1. Re-experiencing:

• Recurring, intrusive memories of the traumatic event.
• Upsetting dreams or nightmares about the traumatic event.
• Reliving the event as if it were happening again.
• Severe emotional distress or physical reactions toward whatever reminds you of the traumatic event.

2. Avoidance:

• Staying away from places, people, events, or objects that remind you of the traumatic experience.
• Trying to avoid remembering, feeling, or thinking about the event(s), even to the point of losing the ability to remember important aspects. This may also include a diminished interest or participation in significant events and/or detaching or estranging from others.

3. Hyperarousal/Reactivity:

• Mental/Emotional. Feeling tense or irritable, always on guard for danger, and having trouble sleeping and concentrating.
• Reckless, self-destructive, and/or aggressive behavior. These may also include angry outbursts and being startled or frightened easily.

4. Negative Thoughts and Moods:

• Distorted Beliefs. Persistent and distorted negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous”). This could also include persistent, distorted blame of self or others about the cause or consequences of the traumatic event(s).
• More Negative/Less Positive. Ongoing fear, horror, anger, guilt, or shame, along with feeling numb, worried, and/or depressed. You may experience less interest in activities previously enjoyed and less ability to experience positive emotions, like happiness or satisfaction.

Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.⁷ Many people recover naturally with time. Other less severe disorders may develop after experiencing a traumatic event(s) that closely resemble PTSD symptoms but do not last as long. Acute Stress Disorder (ASD) symptoms occur between three and thirty days after the event(s) and Adjustment Disorder (AD) symptoms last between three to six months after the traumatic event.³ If you think you may have PTSD, take this preliminary QUIZ,⁸ which includes some of the questions a professional would ask to make a correct diagnosis. Share your answers with a mental health professional who can discuss a diagnosis and treatment with you based on your unique situation.

How to Face the Past to Live in the Now

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean facing past events that scare you, practicing new coping techniques, or seeking out a mental health professional for a brief course of therapy. Whatever your situation, PTSD can be healed. It starts by facing the past to live in the now. Below are some effective strategies proven to help overcome PTSD.

1. Coping Techniques

• ⁹ Mindfulness is the practice of becoming more focused and aware of senses, thoughts, and feelings in the current moment without judgment. This helps with some PTSD symptoms, such as avoidance and hyperarousal/reactivity, by learning to exercise more compassion and less criticism as thoughts and feelings naturally come and go. Learn more about mindfulness¹⁰ and try the Mindfulness Coach¹¹app with exercises, progress tracking, and reminders to promote mindfulness.
• Peer Support Groups.¹² Discussing the issues of PTSD with those who have also been through trauma can give us a sense of connection and a greater desire to open up and cope with the symptoms. We can learn tips about how to handle PTSD challenges, while gaining a connection with others who understand. Although peer groups are not an effective substitute for treatment, they can help us cope with PTSD. Find a local PTSD Support Group.¹³ Visit AboutFace, a website created by the National Center for PTSD to learn about PTSD and treatment through stories from real veterans and their family members, along with advice from VA clinicians who have treated thousands of veterans with PTSD.
• PTSD Coach Online.¹⁴ This is a website devoted to providing free instruction to anyone who wants to learn how to deal with PTSD symptoms, such as worry, anger, hopelessness, sleep issues, and disconnection. The online exercises and instructional videos guide you through mindfulness, relaxation, goal setting, and many other useful topics.

2. Psychotherapy

• Prolonged Exposure (PE). Prolonged exposure is an effective form of cognitive behavioral therapy that focuses on helping those with PTSD stop avoiding trauma reminders. Recalling the details, talking about the trauma experience, and confronting trauma triggers promotes recovery. PE usually lasts about three months with 1.5-hour weekly sessions and some manageable assignments to do at home. Read more and watch this video to learn about PE.^{15, 16, 17}
• Cognitive Processing Therapy (CPT). This is another effective form of cognitive behavioral therapy that teaches how to evaluate and change negative thoughts due to trauma. CPT addresses the distorted beliefs and inaccurate thinking that keep us stuck in PTSD. Weekly 1.5 hours sessions usually last for three months and include some writing and worksheets between sessions. Read more and watch this video to learn about CPT.^{15, 18, 19}
• Eye Movement Desensitization and Reprocessing (EMDR). Talking about the experience is not necessary with EMDR, but patients are asked to recall the trauma memories while paying attention to a back-and-forth movement or sound to process the past in a healthier way. EMDR is one of the most effective methods of healing for PTSD, but the mechanisms behind it are not well understood yet. EMDR treatments last about three months. Read more and watch this video to learn about EMDR.^{15, 20, 21}

3. Medication

• Medications called selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used for symptoms of PTSD, anxiety, and depression. These medications affect the levels of naturally occurring chemicals in the brain called serotonin and norepinephrine, which affect how we feel. Recommended antidepressants for PTSD include Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine (Prozac), and Venlafaxine (Effexor).¹⁵ Like all drugs, PTSD medications may cause side effects. Careful consideration and monitoring with your mental health professional will help to find the best medication and dosage for you. Watch this video to learn more about PTSD medications.²²

When to See a Professional

If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your doctor or a mental health professional. If you or someone you know has suicidal thoughts, call the suicide hotline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor. If you think you may hurt yourself or attempt suicide, call 911 immediately.

Mind Spa recommends our mental health treatment for individuals with PTSD. Our licensed therapists and medical professionals are dedicated to providing patients with safe and effective mental health treatment that teaches them how to properly heal their symptoms. Contact Mind Spa today for personalized treatment options.

References

¹ Lennon, A., Gepp, K. (2021, June 22). Fight, flight, or freeze: What Is the stress response for? https://psychcentral.com/blog/fight-flight-freeze-stress-response#what-is-it

² U.S. Department of Veterans Affairs National Center for PTSD. (n.d.). What is PTSD? https://www.media.eo.va.gov/ptsd/mp4/what_is_ptsd.mp4

³ American Psychiatric Association. (2020, August). What is posttraumatic stress disorder? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

⁴ U.S. Department of Veterans Affairs National Center for PTSD. (n.d.). How common is PTSD in adults? https://www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=About%2015%20million%20adults%20have,100%20men%20(or%204%25)

⁵ National Institute of Mental Health. (2019, May). Post-traumatic stress disorder. https://nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd#:~:text=Post-traumatic%20stress%20disorder%20(PTSD,danger%20or%20to%20avoid%20it.

⁶ National Alliance on Mental Illness. Posttraumatic stress disorder. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Posttraumatic-Stress-Disorder

⁷ Mayo Clinic. (2018, July 6). Post-traumatic stress disorder (PTSD). https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

⁸ Anxiety & Depression Association of America. (2021, October 19). Screening for posttraumatic stress disorder (PTSD). https://adaa.org/screening-posttraumatic-stress-disorder-ptsd

⁹ U.S. Department of Veterans Affairs National Center for PTSD. (n.d.). Mindfulness practice in the treatment of traumatic stress. https://www.ptsd.va.gov/gethelp/selfhelp_coping.asp

¹⁰ Veterans Health Administration (2014, August 19). What is mindfulness? YouTube [Video]. https://www.youtube.com/watch?v=JbGe9BpniJo

¹¹ U.S. Department of Veterans Affairs National Center for PTSD. (n.d.). Mindfulness coach. https://www.ptsd.va.gov/appvid/mobile/mindfulcoach_app.asp

¹² U.S. Department of Veterans Affairs National Center for PTSD. (n.d.). Peer support groups. https://www.ptsd.va.gov/gethelp/peer_support.asp

¹³ Meetup. PTSD. https://www.meetup.com/topics/ptsd/

¹⁴ U.S. Department of Veterans Affairs National Center for PTSD. (2013, August). PTSD coach online. https://www.ptsd.va.gov/apps/ptsdcoachonline/default.htm

¹⁵ Anxiety & Depression Association of America. (2021, June). Treatment and facts: post-traumatic stress disorder. https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/treatment-facts

¹⁶ U.S. Department of Veterans Affairs National Center for PTSD. Prolonged exposure for PTSD. https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp

¹⁷ U.S. Department of Veterans Affairs National Center for PTSD.  Cognitive processing therapy. https://www.media.eo.va.gov/ptsd/mp4/Whiteboard_PE.mp4

¹⁸ U.S. Department of Veterans Affairs National Center for PTSD. Cognitive processing therapy for PTSD. https://www.ptsd.va.gov/understand_tx/cognitive_processing.asp

¹⁹ U.S. Department of Veterans Affairs National Center for PTSD. Cognitive Processing Therapy for PTSD. [Video]. https://www.media.eo.va.gov/ptsd/mp4/Whiteboard_CPT.mp4

²⁰ U.S. Department of Veterans Affairs National Center for PTSD. Eye movement desensitization and reprocessing. https://www.ptsd.va.gov/understand_tx/emdr.asp

²¹ U.S. Department of Veterans Affairs National Center for PTSD. EMDR for PTSD. https://www.media.eo.va.gov/PTSD/mp4/VA_Video01_EMDR_VFinal_NoAudioDescribe.mp4

²² U.S. Department of Veterans Affairs National Center for PTSD. Medications for PTSD. https://www.media.eo.va.gov/PTSD/mp4/VA_Video02_Meds_VFinal_NoAudioDescribe.mp4

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