PTSD is, of course, post traumatic stress disorder. So, if one were to experience traumatic stress, is there a way to avoid a disorder?
It seems to me that experiencing traumatic stress is damn near inevitable for most people, even if their metric for what constitutes such an event might be unique to them.
And we all hope to get to the “post” part; whatever the stress, we ideally want to survive it.
So, if a person gets to that point - they have just survived a traumatic event- what should they do so it doesn’t haunt their dreams, ruin their sleep, sabotage their relationships, lead to self medicating, or whatever else PTSD does to people?
Sometimes after something awful they will bring in grief counselors. Are they doing things to help ameliorate PTSD?
(Oh, and for what it’s worth, I’m not personally experiencing any trauma. Just curious).
Based on what I can find, your personal psychological makeup has a lot to do with it, as well as your personal background. Things like anxiety, depression, prior PTSD and past trauma is more conducive, while stuff like healthy emotional regulation, coping strategies, and social support make one more resistant to it.
And it’s by no means a 100% thing. Even among combat vets, it’s still only around 20-30% at most have it. Most do not go on to suffer from it.
So to answer your question, it sounds like being mentally healthy is a good prophylactic measure.
If it’s in the immediate wake of the trauma, like you just survived a workplace shooting, one often-touted method is to immediately play a game like Tetris that distracts your brain during its PTSD-formative phase, the minutes right after the trauma.
If it’s longterm, one oft-recommended method is psilocybin, which helps approach the traumatic incident from a whole new angle. It also helps to journal about your trauma in third person, writing about it as if it had happened to someone else.
Yes, debriefing (which must be voluntary) helps. Also, during the event, making decisions and being active (which might mean deciding not to do something, too). Perceiving yourself as agentive rather than passive/only acted upon seems to mske a difference). Writing about the traumatic experience seems to reduce the PTSD effect as well. EMDR and similar therapies may reduce the neurological effects.
The first must be almost immediate. Propranolol and hydrocortisone have been used to reduce adrenaline-driven emotional response to trauma. (simplifying, of course) Apparently, they’ve lost favor in the scientific community, and the DoD guidelines no longer recommend them. According to co-pilot,
In the first 2–3 days, the best approach is usually safety + sleep and physical recovery + supportive people + practical assistance + gentle psychological support, without forcing the person to relive the event.
As far as treatment, experts I talk to say the best evidence-based approach is EMDR
I’m not going to pretend to speak for anyone else. Over the course of my life I have experienced several traumatic events, including a couple that are unimaginable for a lot of people. Those things have shaped who I became as a person, and informed how I deal with other people. In my experience, the best way to deal with trauma is openness and being willing to talk about it.
As an example, when I was 11 years old my father shot himself. While I was in the house. This was in the late 70s and I’m not even sure that grief counselors were even a thing back then. But I do remember talking about it openly, in spite of the fact that the main emotions I felt were a deep sense of shame and embarrassment. That came before grief. Long before. I think the first time I ever cried about it I was 17. By that time, the shame and embarrassment were gone because I had already talked about it with anyone who was important to me.
I don’t know that this is or should be an example for anyone else, it’s just my experience.
My bad car wreck (deer vs beck) a few years ago, the actual wreck I have no memory of.
My memory starts after I was located and being removed from the car.
I don’t recall the pain but I recall screaming coming from myself.
I felt like I was silently screaming but I’m told I was very loud.
Anyway, I got to a hospital and got fixed up.
I dream about screaming all the time. No one hears me. It’s very disconcerting. It took me a fair amount of time to decide it was PTSD.
I don’t know what I could’ve done to prevent PTSD from getting in my head.
I decided to take the dreams as a cautionary thing. Now I obsess over the drivers around here. “Watch for Deer” frequently comes out of my mouth. And I get the roll eyes from all.
Just yesterday me and Ivy came upon a wreck on the road. Two drivers in ambulances and one dead deer.
I thought nothing more than “dang, this is holding us up”.
Over night I screamed and screamed in my dreams.
Apparently the wreck we saw triggered a thing in my noodle I wasn’t even aware of.
Not real long on facts, but a bit of useful background info for at least how this outfit handles that situation. Other pilot unions have followed the same basic script since. The general feedback from folks who’ve been through first an event and then the support described in the article is that it’s real helpful.
I guess the visual aspect of the game makes it harder for the visuals of the experience from forming into deep memories.
I can imagine that having your feelings validated is important. There might naturally be self doubt about what just happened, so a reassurance that it was real, and the response warranted, probably helps stave off those issues later.
A counselor can also suggest things like noticing where the person made decisions, cognitive-behavioral tools like not catastrophizing, breathing exercises, etc.
However in the long run you can try things like the following:
EMDR. Trauma overwhelms the amygdala and hippocampus, so the memory can’t be processed into long term storage. bilateral stimulation helps activate the amygdala and hippocampus so when you combine bilateral stimulation with thinking about trauma, it helps it process the memory through the limbic system so it can be processed as a past memory by the frontal cortex
Progranolol therapy - I had a lot of good luck with this. Everytime you relive a traumatic memory, your brain has to pull it out of storage. For the next 6 hours, the memory is more fragile because your brain had to pull it out of memory (don’t ask me how it works, I have no idea). However in order for the brain to put the memory back into storage, it has to attach adrenaline to adrenaline receptors in the brain. So you take 40mg of propranolol, then you wait an hour, then you do intensive exposure therapy where you discuss your trauma. Then 2 hours after your session you take another 40mg of propranolol. These 2 doses of propranolol will block the adrenaline receptors in your brain, so your brain has trouble putting the memory back into storage after it takes it out.
Stellage ganglion block - There is a bundle of nerves in the neck that communicates with the amygdala. When you numb the nerves, the brain senses ‘theres no danger, we can pare back the neural connections in the sympathetic nervous system’.
I wrote a thread about some of this stuff here.
For me, propranolol therapy and a stellate ganglion block were both very helpful for my PTSD.
A big part of PTSD therapy is down regulating the sympathetic nervous system and upregulating the parasympathetic nervous system. Thats not all there is to it, but its a major factor.
There is also vagus nerve stimulation, which can help with this too.
Having a safe and loving childhood is a major protector against developing PTSD after an adult trauma. Childhood trauma wires your brain’s threat response to be overreactive and to respond more strongly to stress and threats.
It’s a fact that the more traumatic experiences someone has, the more likely they are to develop PTSD. For example, combat veterans who were abused as children are more likely to develop combat-related PTSD.
Some of the biggest risk factors for PTSD are a) the nature of the trauma and b) what else is going on at the time. People who have strong social support at the time of the trauma are less likely to develop PTSD. I actually personally think a) is tied to b). What type of trauma is most likely to result in PTSD? Generally, sexual assault. What type of trauma is least likely to result in strong social support? Take a guess.
I think this is a much more important factor than childhood trauma, although it certainly plays a role. But PTSD is a complicated condition and there are multiple factors involved. I don’t think anyone can say that A + B = PTSD. And I again I stress that my own experiences are anecdotal and I’m not saying they are demonstrative of anything.
I wasn’t saying childhood trauma means you’re guaranteed to get PTSD after trauma, just that your chances of getting it are higher.
This study found that veterans with 4+ adverse childhood experiences (various kinds of abuse, neglect and trauma in childhood) are about 3x more likely to develop PTSD after combat vs people with no childhood trauma. Not that none of the people w/o childhood trauma developed it, or that everyone with childhood trauma developed it. Just that the odds are higher.