PTSD impacts the lives of people directly and indirectly on a daily basis.  It causes great physical, emotional and mental distress in the person who has it, and it also takes its toll on the people around them.  I want to start by emphasizing that PTSD is a normal reaction to an abnormal situation.  Let’s take a look at what PTSD really is and what you can do to deal with it.  In the simplest sense, PTSD or Post Traumatic Stress Disorder can result when a person experiences or witnesses a horrific event over which they have little or no control .  While it is important to remember that not everyone who experiences such an event develops PTSD, some people will.  Further, if the event is repetitive such as may occur in war, child abuse or law enforcement, then the chances for PTSD to develop increase dramatically.  People are just not meant to experience that level of horror on a regular basis.

But what IS PTSD?  It is a cluster of symptoms which is thought to result from changes in the traumatized brain.  Why is this important?  Because it is vital for those with PTSD and their loved ones to realize it is not just something they can “snap” out of.  It is not “just” a nightmare, and they are not “crazy.”   It is somewhat interesting though to consider the symptoms of PTSD and assess how they represent the mind’s best attempt at coping and protecting the body and itself.

• Re-Experiencing the traumatic event, intrusive memories, flashbacks, night terrors
  • Okay, this part really sucks, but why does it happen?  It is possible that the brain is trying to assimilate something that it does not know how to deal with.  It is also possible that these memories are coming back as the mind’s way of saying “Okay, that was awful.  Make sure we don’t do that again.”  When faced with a traumatic event, our natural response is to fight or flee.  When you can do nothing, your mind cannot figure out what to do with that…which brings us to…
• Avoidance of Reminders of the Trauma
  • Like reminders of pleasant things bring back pleasant memories, reminders of the trauma bring back memories of the horror and helplessness. So, yeah, it is natural to avoid reminders of the trauma.  Unfortunately, reminders come in sights, smells, places, people, dates, noises etc.  Eventually avoiding these things can lead the person to avoid leaving the house or sobering up.
• Subjective Numbing.
  • The trauma and its effects have overwhelmed your coping skills and permeate most areas of your life.  Even if you had enough energy to be happy, it just hurts too much to feel anymore.  Some people just turn it all off and simply exist.  Others use substances or other activities to forget or numb the pain.  This numbing prevents husbands from “connecting” with their wives, parents from being emotionally available to their children and often is one of the biggest culprits for relationship problems.    “He’s just going through the motions.”  “He does not seem to care about anything anymore.”
• Hypervigilance, feeling jumpy and easily startled
  • Many of us know people who seem to be like robots with extra sensitive sensors.  They do not seem to feel anything, but they always seem to be aware of everything that is going on.   For people with PTSD, they cannot relax.  They are always on guard—even when they are sleeping.  If you have ever taken care of a group of toddlers, you might begin to grasp how exhausting it can be to always have to be “on.”  This exhaustion can negatively impact relationships that can be supportive, can increase the flashbacks and can lead to a greater sense of helplessness and irritability.  In extreme cases, people can become paranoid, reclusive and overprotective.  I see this a lot in law enforcement officers.  One deputy once told me, “After a while,  I just assumed the worst out of every black male between the ages of 18 and 25.  I could be out with my family and see someone matching that description and suddenly be in cop mode.  Heck, I cannot go to Home Depot without bringing my gun. ”
• Increased anxiety and emotional arousal, difficulty sleeping, concentrating, irritability and anger outbursts
  • Think back to the last time you were sick or exhausted—maybe right after you brought junior home from the hospital?  Were you more emotional?  Did seemingly silly things stress you out? Did you get Mommy-Brain—The inability to remember more than 1 thing at a time for more than 5 minutes?  All of these things can happen when you are tired.  The mind itself is mounting a fight or flee campaign.  It is trying to force you to get some rest.  It is telling you it cannot handle one more thing (hence the Mommy-brain).  When we feel this way and try to fight it, we get irritable.  We  often feel like we “should” be doing _____.  However, we just cannot seem to get it together enough to do so.  We get frustrated with ourselves and often lash out at others. (We also might be inadvertently pushing people away to stop them from putting any demands on us).

Okay, so we can see how these symptoms may be the mind’s way of protecting us, but how do we fix it.  People with PTSD cannot live in a state of exhaustion and hyperarousal forever.  The first step for many people is finding a way to reduce their anxiety and hypervigilance enough that they can get some sleep.  Although I have known some people to push through the early stages of recovery without medications, a short course of something like Zoloft and/or BuSpar may be in order.  I try to encourage people to stay away from super intense benzodiazepines like Valium or Xanax because they are highly addictive, and people with PTSD are at high risk for developing substance use issues.  Other things that help are limiting caffeine or alcoholic beverages after 2pm, drinking plenty of water, exercising and setting a routine so your body knows when it is time to sleep and when it is time to be awake.

The second thing we work on is developing a strategy for handling reminders of events and flashbacks. I encourage people to know what situations are likely to trigger flashbacks and prepare before the storm.  For example, one person I worked with was a trooper who watched a trucker burn alive, trapped in the cab of his truck.  We talked about how hearing the tones for a priority call, driving on the interstate, smelling gasoline fumes and seeing semis could all trigger flashbacks for him.  Likewise we practiced something called systematic desensitization in the office, so encountering these things would not be so overwhelming.

Systematic desensitization involves gradual exposure to a stimulus until the point people are feeling anxious or agitated.  Then they are coached through a calming sequence.  For many the calming sequence is a phrase or set of phrases to help them get control back.   Over time, the stimulus arouses much less of a reaction.   Think about the first time you asked someone out on a date.  It was terrifying, but you told yourself that you could do it.  Each time after that it got a little easier.  Or, remember the first time you hear the tones for a hot call when you were a rookie—tunnel vision right?  But after your 5^th year on the force, tones aroused no more of a reaction than your morning alarm clock.   Same principle here.  Once people have practiced talking themselves down a few times, then when it happens in real life, they can more easily identify what is triggering them and talk themselves down.

Now this is not the end of treatment by any means.  It is only the beginning.  The above suggestions are simply those steps that can be taken to help you get on level ground so you can start dealing with the trauma.  Oh, and for any counselor types reading this…some people prefer the word “reaction” to “feelings.”  If you find that your patient is not responding well when you ask about how he felt in a situation, ask what his reaction was.

Good  luck and stay tuned for more mental health tips.