In considering the effects of stress on your personal and work lives, we need to discuss Post Traumatic Stress Disorder (PTSD) At first glance, you might think this is questionably relevant. You say, “I’ve never served in the military”. However, three things are true. One is that you do not have to be a combat veteran to suffer PTSD. Second, PTSD affects your brain. Third, you may be working with or living around someone with PTSD. In our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056, we discuss all aspects of stress. For more information about the book, authors, and website, please visit our website at www.manageyourhealthandstress.com. For now, let’s look at PTSD in more depth.
So what is PTSD? PTSD is a pathological anxiety disorder resulting after exposure to a traumatic event. An estimated 8% of the U.S. adult population matches the criteria for PTSD with women more likely to develop symptoms than men. While PTSD cases commonly involve combat or assault experiences, there is a wide range of events capable of triggering PTSD symptoms. Trauma events frequently associated with the development of PTSD include the following:
Physical, emotional, or sexual abuse
Combat experiences
Terrorist attacks
Natural disasters such as tornados, floods, earthquakes, or fires
Life-threatening accidents, such as automobile accidents, airplane crashes, or boating accidents both experienced or witnessed
Violent crimes, both experienced or witnessed
As you can see, there are a wide range of non-military events associated with the onset of PTSD. Unfortunately, given the frequency of violent shooting events as well as natural disasters, there is increasing risk of the development of PTSD. There is growing research around the topic of even vicariously witnessing traumatic events as well. With the explosion of violent traumatic events in the news of late, there is more interest and concern about the impact of these on people not directly accosted.
So what are common symptoms of PTSD? There are four:
Intrusion: Recurrent recollections of the event
Numbing: Emotional distancing from surrounding people and events
Avoidance: Fear and avoidance behavior
Arousal: Agitated state of constant wakefulness and alertness
What happens in the brains of people with PTSD? Suffice it to say, there is no use telling them to get over it because PTSD changes the brain's structure.
Extensive neuroimaging studies on the brains of PTSD patients show that several regions differ structurally and functionally from those of healthy individuals. The amygdala, the hippocampus, and the ventromedial prefrontal cortex play a role in triggering the symptoms of PTSD. Together, these regions impact the stress response mechanism in humans. Consequently, PTSD victims, long after their experiences, continue to perceive and respond to stress differently than someone who does not suffer the results of trauma.
What happens in the brains of people with PTSD? Suffice it to say, there is no use telling them to get over it because PTSD changes the brain's structure.
Extensive neuroimaging studies on the brains of PTSD patients show that several regions differ structurally and functionally from those of healthy individuals. The amygdala, the hippocampus, and the ventromedial prefrontal cortex play roles in triggering the symptoms of PTSD. Together, these regions impact the stress response mechanism in humans. Consequently, the PTSD victim, long after their experiences, continues to perceive and respond to stress differently than someone who does not suffer the results of trauma.
The most significant neurological impact of trauma is seen in the hippocampus. PTSD patients show a significant reduction in the volume of the hippocampus. This area of the brain is responsible for memory functions. It helps us record new memories and retrieve them later. The hippocampus also helps us distinguish between past and present memories.
PTSD patients with reduced hippocampal volumes lose the ability to discriminate between past and present experiences. They have extreme stress responses when facing situations that only slightly resemble something from their traumatic past. I have treated numerous patients who were victimized by physical and/or sexual abuse whose responses were overdetermined to current situations, often benign, as though the current situation was the one which had traumatized them initially. This can occur decades after the initial traumatic event.
Severe emotional trauma causes lasting changes in the ventromedial prefrontal cortical region of the brain. This area is responsible for regulating emotional responses triggered by the amygdala. Specifically, this region regulates negative emotions like fear. PTSD patients show a marked decrease in the volume of ventromedial prefrontal cortex. This explains why people suffering from PTSD tend to exhibit fear, anxiety, and extreme stress responses even when faced with situations not connected, or only remotely so, to their experiences from the past.
Traumatic events appear to increase activity in the amygdala. This region of the brain helps us process emotions and is also linked to fear responses. PTSD patients show hyperactivity in the amygdala in response to stimuli that are somehow connected to their traumatic experiences. Sometimes, they show hyperactivity even to stimuli not associated with their trauma.
Hyperactivity of the amygdala also is positively related to the severity of PTSD symptoms. To a large extent, this is a result of the hypoactivity of the hippocampus and the dysfunction in the ventromedial prefrontal cortex in controlling the amygdala. The excessive reactivity of the amygdala helps explain some of the major signs of PTSD - startle responses to the most harmless of stimuli and frequent flashbacks or intrusive recollections.
However, there are promising treatments for PTSD and these treatments have been shown in some studies to correlate with brain changes. We certainly now know that the brain can regenerate more than we thought in the past. Some drugs and behavioral therapies have been shown to increase the volume of the hippocampus in PTSD patients. Two of the evidence based behavioral therapies approved by the Veterans Administration in the treatment of PTSD include cognitive processing therapy (CPT) and prolonged exposure therapy (PE therapy). First developed to treat the symptoms of PTSD in sexual assault victims, CPT focuses on the impact of the trauma. In CPT, the therapist helps the patient identify negative thoughts related to the event, understand how they can cause stress, replace those thoughts, and cope with the upsetting feelings. PE therapy has been shown to be effective in 60% of veterans with PTSD. During the treatment, repeated revisiting of the trauma in a safe, clinical setting helps the patient change how he or she reacts to memories of traumatic experiences, as well as learn how to master fear- and stress-inducing situations moving forward. There is some experimental work using virtual reality to treat PTSD. Currently, sertraline and paroxetine are the only drugs approved by the Food and Drug Administration (FDA) for the treatment of PTSD. All other medications for PTSD are used off-label and have only empirical support and practice guideline support
So, if you or a loved one suffer from PTSD, or if you work with someone who appears to suffer from such a stress related disorder, get help as it is available. There is no reason to suffer needlessly. There is hope and you can change. However, as usual, change starts with a mindset which recognizes that change is possible.
No matter what has happened, you can change your thoughts, your life, and your response to stress.
Good luck on your journey.
Dr. Paul Longobardi
For in formation on these and related topics, please visit my website at www.successandmindset.com