What is PTSD? Strategies to maintain health and wellbeing
Whenever something happens out of the ordinary, it can have a significant impact on people. A traumatic event is described as such because it overwhelm us – such as a car accident, natural disasters, or when a person is attacked or injured. In these situations, most people will experience symptoms as a reaction to the distressing event (Van der Kolk, 2015).
Our body reacts to the traumatic event as an automatic survival response. The event overpowers us, and we feel threatened – we do not feel safe, and it threatens our ability to trust that we can cope/protect ourselves and our families.
The traumatic event triggers the stress response. Our nervous system responds by releasing cortisol (stress hormone), accelerating our heart rate, increasing blood pressure and muscle tension. The body’s stress response reacts automatically to break down glucose to release energy immediately to manage the event. The body’s response returns to baseline when the situation normalises again.
We can experience fear and feel overwhelmed, confused, numb or disconnected during the event and after. We can also experience feelings of sadness and a sense of loss, particularly if someone we care about is injured or dies. The horror of the event can trigger feelings of shock and disbelief. It can be challenging to comprehend what has happened, and we may wonder why things had to happen to try to find a way to understand it.
It is a normal reaction to re-experience the traumatic event after it has happened. We can have flashbacks, nightmares or intense emotional and physical reactions. Many feel unsafe, nervous and can develop symptoms of anxiety. We are all different in our experiences, our way of life and our way of thinking and most people will restore balance (Van Der Kolk, 2015).
A noise or a smell, or someone describing a situation, can be a trigger that brings back the original traumatic event. However, most will experience some of these symptoms after the event and gradually will subside.
An instinctive reaction is to avoid the situation, so people may avoid going to places that feel unsafe and reduce their activities as a means of self-protection. In the first few days, this is a normal response to create a sense of safety. The body and brain need some time to settle and restore energy.
The event will have demanded a lot of energy, leading to experiencing tiredness and fatigue. It can also affect sleep as worry thoughts intrude when feeling it is not safe to sleep. The nervous system has been under enormous pressure, and the body is hyper-aroused and on high alert, making it more difficult to manage emotions. It is essential to take care and manage the stress symptoms to maintain health (McGonigal, 2015).
Feelings of nervousness, difficulty in concentrating and being forgetful are common. The brain is busy with thoughts and feelings about the event. It can lead to experiencing vulnerability and a sense of loss of confidence in our ability to deal with challenges.
Post-traumatic stress disorder is when the symptoms persist for a prolonged time and cause significant distress limiting normal day-to-day functioning. In this case, it is critical to seek medical advice and treatment.
What can we do to manage symptoms?
Prevention is key. Focusing on restoring a sense of safety and nurturing our body and mind will help prevent the initial reactions to the event from developing into symptoms of PTSD.
Practice self-compassion: It is essential to remind ourselves that our first response is a normal survival reaction. We are human beings, and we are vulnerable when faced with overwhelming events. Taking time to look after ourselves and those we care about is the priority. It can help to prevent the development of post-traumatic stress disorder.
By learning to accept we cannot change and focusing on what we can control, we can maintain our balance in these difficult circumstances. Being open-minded and having a flexible attitude to manage uncertainty can help us adapt to a changing environment. Connecting with our values enables us to identify what is meaningful and gives us a sense of purpose. These are the internal resources that allow us to navigate challenges, strengthening our resilience (Gilbert & Choden. 2013).
Allow time for recovery: it takes time to adjust to the experience. The intensity of the memories will gradually reduce. At first, it may seem impossible to deal with the aftermath of the event, and it may be challenging to deal with the thoughts and feelings related to what happened. Acknowledge these. They are part of the experience. Imagine you are supporting your best friend through a difficult time. What would you say? Do? Be kind to yourself and others. We all need time to process the event and restore our energy.
Restore a routine: The traumatic event will affect the daily routine making it difficult to adjust and restore normality. Simplify and reduce the number of tasks – the body and mind need to process the event and adapt to the changes it may have brought into your life. Focus on creating a structure, and restore healthy eating and healthy habits.
Set boundaries: evaluate commitments and responsibilities and assess what is realistic to manage right now. Whether at work, studying, or dealing with family commitments, assess priorities and discuss responsibilities and tasks with others. Taking care of health is the priority to heal and prevent adverse effects on your health and wellbeing.
Take regular breaks: It is essential to take time to restore your energy. Plan in breaks, take time to connect with others. If you are working in front of a computer, take breaks from the screen, stand up and stretch. Go outdoors, if possible. Being in nature has a positive effect on our nervous system and whole body.
Pay attention to sounds, looking at nature, feeling the fresh air and absorbing natural daylight. Natural light is essential to support our normal functioning – it improves mood and sleep.
Exercise: Movement helps to relax our muscles and regulate our energy level. It enables the nervous system to restore balance and our sense of confidence as our strength increases.
Practice relaxation exercises: After a traumatic event, it can be challenging to concentrate on daily tasks. They may seem irrelevant given the enormity of what has happened. Allow time for your body and mind to adjust to the new situation. It is not possible to erase the event, but we can manage how we react to it.
Take time and keep in mind that the body and mind need time to process the event. If you do not feel able to focus on a challenging task, leave it for a bit and do something nurturing. Then, when you feel ready to talk about your experience do so with trusted others. If symptoms persist it is essential to consult a health professional to deal with symptoms early.
Pay attention to breathing and noticing physical sensations. Unplug from digital devices and focus on ways that help you to reconnect with your body.
Practice mindful breathing: A technique that helps to calm and restore balance. First, settle in a comfortable, quiet place, without distractions. Then, inhale for four counts, hold for four counts, and exhale for four counts. Adapt the pace to what feels comfortable.
The aim is to pay attention to each breath, notice sounds, smells, how the chair you are sitting on feels, or put your hands over your chest and notice the gentle movement of the air going in and out (Neff & Germer, 2018).
Protect sleep time: It may seem that sleep is the last thing you want to do when not feeling safe, or it just may be too difficult to sleep due to restlessness, worry thoughts or fear of having nightmares. Remind yourself that your body is reacting to protect you and that it helps to acknowledge it as a normal response in a critical event. Then, do something relaxing to soothe and protect your body and mind.
Create a sleep routine, starting by dimming the lights about 1hr before bedtime. Our body reacts to the signals in the environment, indicating that it is nighttime. Keep the bedroom cool and dark. Also, go to bed and get up at the same time each day of the week, and limit stimulants like nicotine, alcohol and coffee. It is recommended to have the last coffee by 2 pm to reduce its effect on sleep. Another helpful strategy is to turn off digital devices about 1hr before bed to reduce distractions and prevent the backlight from disrupting sleep (Walker, 2018).
Ground yourself: When feeling overwhelmed, it helps to restore internal balance by connecting with the present. For example, find a comfortable place to sit on a chair, place your feet on the ground, and lean against the chair to rest your back. Practise the mindful breathing exercise (above). Next, look around your space and notice your immediate environment – is there a window so you can look outside? Do you have an indoor plant? Nature calms our senses, and it helps to restores balance.
Focus on restoring confidence: PTSD can leave people with a sense of helplessness and feeling vulnerable. Consider engaging in social activities, volunteering, and helping others. Taking action can restore a sense of self-efficacy.
Connect with others: PTSD symptoms can trigger a feeling of being disconnected, and often people tend to withdraw from social contact. It is essential to establish social connections to restore normal functioning and reduce the sense of isolation. Reach out and talk to others about everyday things to restore a sense of normality. You may not wish to talk about what happened, and that is ok. Seek trusted others who are willing to listen and can be supportive.
Seek professional help: If the symptoms persist, causing significant distress, it is essential to contact your GP for advice and treatment. Early intervention is key to recovery.
“Things falling apart is a kind of testing and also a kind of healing. We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart. Then they come together again and fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy. When we think that something is going to bring us pleasure, we don’t know what’s really going to happen. When we think something is going to give us misery, we don’t know. Letting there be room for not knowing is the most important thing of all.”
(Pema Chodron, “When things fall apart”)
Chodron, P. (2016) When things fall apart. Heart advice for difficult times. London: Thorsons
Gilbert, P. & Choden (2013) Mindful compassion. London: Robinson
Macgonigal, K. (2015) The upside of stress. London: Vernillion
Neff, K. & Germer, C. (2018) The mindful self-compassion workbook. A proven way to accept yourself, build inner straight, and thrive. London: The Guildford Press.
Van der Kolk, B. (2015) The body keeps the score. Mind, brain and body in the transformation of trauma. London: Penguin Books.
Walker, M. (2018) Why we sleep. The new science of sleep and dreams. London: Penguin Books.