3 Lessons PTSD Treatment Teaches About Stress Management
Even if our lives are trauma free, we all need ways to better manage stress.
Posted May 29, 2013
The extreme tragedies like the shooting in Newtown, the bombs at the Boston Marathon, and the collapsed factory building in Bangladesh are the traumas that none of us can ever forget. Most of the time, though, the greatest sources of stress are day-to-day stressors that take a heavy toll even though they’re not life threatening or indelibly shocking.
PTSD begins as an adaptive reaction to life threatening or horrifying stressors. PTSD’s symptoms, like disturbing memories and flashbacks, sleep and memory problems, and feeling so emotionally on edge or shut-down that we find ourselves avoiding people or activities that used to be pleasurable, are classic stress reactions. They are absolutely normal when our survival is threatened, because they are the result of calls from our brain’s alarm to put everything else aside and mobilize our body to deal with the threats or dangers facing us.
The key to therapy for PTSD therefore is learning to recognize and re-set these survival-based stress reactions that begin in the brain and can keep the body on edge well past our ordinary point of exhaustion. The reason familiar stress management techniques such as conscious breathing, relaxation, positive thinking and visualization, and pleasant activities too often aren’t sufficient to overcome PTSD is that they even if they relax our body, they don’t reset the alarm in our brain.
Having the alarm center on constant high alert is why trauma often seems to never end for many people suffering from PTSD, even though they objectively know that it is over. After weeks, months, or even years of living in a state of alarm, the stress reactions no longer protect us, but instead actually have the unintended effect of making the noxious memories of past traumas more present and vivid.
Thankfully, that is not the end of the story. There are a number of excellent options for PTSD therapy that can free the traumatized individual from endlessly replaying trauma memories and experiencing persistent stress reactions*. In different ways, these therapies retrain the person’s brain to shift out of the alarm state that creates both hyperarousal and shut-down stress reactions. Although these therapies take many forms, what they have in common is showing the trauma survivor how it is possible to re-set the alarm in their brain by focusing not only on danger but also on what they value most in life.
And what we've learned about treating the worst kind of traumatic stress can help you too, even if you’ve never had PTSD.
First, stress is not a bad thing. The changes in the body and brain that are triggered by traumatic survival threats are not entirely different from changes that occur in our bodies and brains when we’re having an ordinary stress reaction in daily life. As we describe in our book, “Hijacked by Your Brain,” the alarm system in the body and brain can take over and go on automatic pilot even when there really is no threat to our survival. That’s when otherwise minor or manageable stressors can seem like the end of the world, or just make us feel so lousy that life seems like a struggle or a dead end.
While not the extreme kind of stress reaction that occur in PTSD, these normal stress reactions can be very intense and can cause serious problems in our relationships, at work or school, or in our health. Just knowing how the brain works and that the feeling of stress is normal and self-protective often helps trauma survivors and also people who are dealing with daily stresses. Stress is not something to be feared, and it need not cause us to feel defeated or humiliated by our own natural stress reactions.
Second, after understanding and accepting stress reactions as normal adaptations, we can each actively do something to re-set that alarm going off in our brain: recognize stress. You can’t ignore stress. Avoidance is a hallmark of PTSD, and understandably so because it is only natural to want to avoid remembering terrible events or extreme states of distress. However, whenever you try not to pay attention to a stress reaction, it doesn’t go away. Even when distractions such as extremely absorbing activities or chemicals that reduce our awareness of anxiety seem to solve problem, they really only give us the illusion of a solution by providing temporary relief.
We’ve learned from treating those with PTSD that ignoring stress actually makes its symptoms worse. The body’s stress/alarm systems operate based on the principle of “no news is bad news.” Your brain will signal your body to release more stress hormones if you ignore the feeling of stress. The alarm in your brain can be muzzled temporarily, but in the long run it will make you feel worse until you pay attention and deal with the stress. Recognizing that you feel stress is, in fact, what begins to turn down the flood of chemicals in the body.
Third, you can choose what you think about, even under conditions of extreme stress. When stress reactions occur all we tend to think about is the problem or how to escape or avoid what seems to be the problem—that’s the alarm system in our brain keeping us zeroed in on figuring out what we need to do to deal with the situation. Unfortunately, when we only think about the problem, we can get stuck in revolving door of feeling too stressed to think clearly. Then we obsess and ruminate but never come up with (or put into practice) good solutions. We all know what it’s like to feel too angry or frustrated to be able to calmly deal with a problem, just when being calm and thinking clearly is exactly what is needed to solve the problem.
What’s missing in these kinds of self-perpetuating stress reactions, whether they stem from trauma and PTSD or from chronically not dealing with ordinary stressors, is an expansion of our focus to include not only the problem but also what is most meaningful and valuable in our lives. That is exactly what perpetuates PTSD: being so stuck in an extreme alarm state of terror or rage or despair that we can’t activate our brain in ways that help us to feel secure, confident, and hopeful.
When our brain melts down for good reason or its alarm simply gets stuck in the “on” position too often for too long, there’s nothing fundamentally wrong, we’re just not paying attention to the alarm in our brain. Chronic stress, like PTSD, can make anyone feel like they’re going crazy, but the truth is we’re just failing to deal with the fundamental problem.
As long as no life-threatening trauma is actually happening, the problem is simply that we’re not doing what we need to in order to re-set the alarm in our brain. That is easier said than done, but it’s also not rocket science. And we're not helpless either, as long as we know how to recognize stress reactions and signal to the alarm in our brain that we know not only how to survive but also how to preserve and enjoy what we most value in our lives.
*For more information, a good summary of the therapy options for even the most complex forms of PTSD can be found in the book “Treating Complex Trauma,” published by Guilford Press, co-authored by Dr. Ford and Dr. Christine Courtois.