The next instalment of Mental Health 101 is on PTSD. Dr Heather Bolton explains the neurological basis of it and how you can treat it.
Many people associate post-traumatic stress disorder (PTSD) with military settings, with terms such as “shell shock” and “combat stress” coined to describe the cluster of symptoms observed in veterans returning from war zones.
But the reality is that any trauma will leave the majority of us feeling shocked and disoriented and around a third of people who experience a serious trauma will develop PTSD. Common examples of trauma include accidents, assaults, traumatic births, or witnessing others endure serious harm, but can include any circumstance where a person experiences extreme fear.
In order to make sense of the symptoms of PTSD (which we’ll explore in a moment), it’s helpful to first understand the nature of memory, as it plays a crucial role in PTSD.
Think of your memory as being a bit like a filing cabinet: if someone asks you where you went on your last holiday, you’d be able to search through your memory archive and deliberately bring to mind your memory of that trip, even if it was some time ago. This is because your memories are stored neatly away in your mind, all with a time stamp. So when you deliberately recall that holiday, you also have a sense of how long ago it was, and you can then choose to let go of that memory without it randomly popping into your head.
But a traumatic memory is different: it’s not neatly filed away and crucially it doesn’t have that time stamp. When we’re exposed to a life-threatening or intensely fearful situation, our brain activates a threat response and goes into an automatic, defensive fight-or-flight mode. This means that we suspend normal sensory processing and we don’t properly store the memory of the trauma: the memory is fragmented into parts, without a clear beginning or end, and it doesn’t get filed away neatly with our other neutral memories.
Because of this lack of coherent processing, trauma memories are liable to get triggered by innocuous reminders - for instance, hearing about a car crash could bring back a memory or your own accident or smelling smoke could suddenly take you back to your memory of a serious fire.
Referred to as re-experiencing, these unwanted memories often come in the form of flashbacks or nightmares, where it feels as if the trauma is happening all over again. Flashbacks are often portrayed in movies with that classic, hazy-edged dream scene but in reality they’re extremely frightening and very vivid and can involve all the senses, including smell and touch. And because they don’t have a timestamp, when that happens it can feel like the trauma is happening once again in the here and now.
The nature of the trauma memory also creates a strong sense of ongoing threat. Because the trauma memory is easily triggered, and the brain’s threat system is primed to be overly sensitive to danger, it can feel as if the trauma is likely to recur. Even if a person rationally knows that their trauma can’t happen again (for instance, if the person who hurt them is in prison, or they’re far away from the place where the accident happened), they’re likely to feel as if it can. This often means feeling on edge, physically jumpy and overly-vigilant to any threats.
Linked to this, people with PTSD often avoid things related to their trauma. This might mean trying not to think about it, blocking any feelings associated with it, or avoiding reminders. This avoidance is understandable given the horror of re-experiencing but is in fact counterproductive as avoidance further interferes with memory processing.
There are numerous other symptoms of PTSD, including feelings of anger or shame, low mood, and sleep disturbance. And of course there can be an impact on interpersonal relationships, as people often find themselves withdrawing from others after experiencing a trauma.
In recent decades, clinical and academic understanding of PTSD has greatly advanced and there are now very effective psychological therapies, meaning that a large proportion of people who develop PTSD can recover, or can learn to manage their symptoms.
Cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) are two of the most effective approaches. Both of these involve helping the brain to process and update the trauma memory - essentially helping to file it away with the rest of the memories. This way it’s not forgotten but has a timestamp and a cohesive narrative, meaning it’s less likely to be triggered unexpectedly. Antidepressants can also be effective in managing the common symptoms of PTSD.
If you want to support someone after a trauma, be mindful that it’s normal to experience an emotional reaction following a trauma but don’t forget that the symptoms of PTSD can be incredibly frightening. Try to encourage the person to talk about their experiences if they feel comfortable, but most importantly encourage them to connect with professional help.
If you want to find out more information on PTSD and how to seek help, we’d recommend checking out the following sites:
A charity dedicated to raising awareness of PTSD, no matter the trauma that caused it.
A charity specialising in helping ex-servicemen and women.
A UK-based charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault.
An independent charity providing UK-based support and information to victims or witnesses of crime.
A charity providing support and information for people who have experienced bereavement.
If you’re an Unmind user, you can also visit our Help page to find information specific to your geographical location. You’ll find it by clicking on the lifebuoy icon in the top right of your app.