No one is prepared to deal with a traumatic event. The experience leaves the mind and body in a state of overwhelm. Survivors may have nightmares, feel jumpy or find themselves re-playing the event in their minds. They may even feel disconnected from the world. What happened was traumatic and any person would feel shaken up. This response is natural and human.
For people who have enough resilience and support, 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.
Recognizing PTSD and How People 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.
We know extreme events can lead to PTSD symptoms. 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.
However, It can also come from events that appear far less dramatic — such as ongoing bullying, a playground accident, emotional neglect 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, perceptions and biology of the person traumatized.
Women are twice as likely to develop PTSD than men. Experts estimate that just under two in 25 people, or 7.8 percent of people in the US will experience PTSD during their lifetime.
The Neurobiology of PTSD
PTSD is a specific kind of stress-related disorder, with biological and behavioral changes. Mental health care professionals diagnose it according to DSM criteria.
No words can describe the debilitating impact of severe trauma on survivors. But a diagnosis can help people with PTSD seek appropriate treatment.
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 therapeutic approaches to help PTSD survivors manage symptoms and even strengthen brain structures that support recovery.
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 situation 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.
Goals for Therapy
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.
Written by Robyn Brickel, MA, LMFT