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Understanding Post Traumatic Stress Disorder

Understanding Post Traumatic Stress Disorder

Understanding Post Traumatic Stress Disorder

Our little island nation has experienced much trauma in our long history, this last year and a half being no exception. With the devastating Easter Sunday attacks last year and the current COVID-19 pandemic, many of us are dealing with the loss of loved ones and the stress of financial instability. As COVID-19 cases continue to rise, the government has imposed curfews or severe restrictions on movement. The aftereffects of these actions have challenged Sri Lankans, some of us harder than others. 

Historically, Sri Lanka has not placed enough emphasis on the role of the emotional impact of traumatic events such as these on a person’s psyche. Our system lacks sufficient psychological & psychiatric support for people who’ve lived through traumatic circumstances, be it through the stress of the pandemic, Easter Sunday attacks, the 30 year long civil war that devastated our nation or the abuse happening in our own homes. 

To that end, we’ve compiled a short primer on one of the most prevalent disorders that arise out of such events in the hope that it will prove of worth to help a loved one or your own self. 

What is PTSD? 

People who have lived through a traumatic event can find themselves experiencing emotional challenges long after the event has taken place. 

PTSD can develop after either a single isolated event or more recurring traumatic experiences. 

Not everyone who has undergone a traumatic event is likely to suffer from PTSD. Some may have strong feelings of sadness, stress, helplessness or fear but these symptoms can lessen over time as they continue to heal. However, a person who struggles with PTSD can experience symptoms that continue to cause them significant emotional disturbances and distress. 

Symptoms of PTSD

A person who maybe suffering from PTSD may have 4 main types of difficulties:

  1. Re-living the traumatic event – the person relives the event through recurring nightmares or memories and feels as though the event were happening again. They can have strong physical responses such as increased heart rate, sweating or panic. 
  2. Avoiding reminders of the event – The person actively avoids thoughts, feelings, conversations, even people and places that remind them of the traumatic event. 
  3. Being overly alert – The person may experience sleeping difficulties, irritability, lack of concentration, becoming easily startled and constantly on the lookout for danger. 
  4. Feeling emotionally numb – the person may feel distant from others, a loss of interest in day to day activities and experience difficulty in positive feelings such as happiness or love. 

If these symptoms persist for longer than a month and are not due to medication, substance use or other illness, it is likely that the person is suffering from PTSD.

Coping with PTSD

Many people suffering from PTSD turn to unhealthy coping strategies such as alcohol or drug abuse or deliberate self-harm. As such, it is important to seek out a qualified professional to speak with – this may help bring back hope through the sharing of experience and helping learn healthy & effective ways of coping. 

What can I do to help if I see a loved one suffering from PTSD? 

Finding ways to support a loved one with PTSD can be complicated but one of the most helpful things you can do yourself is learn about the symptoms and trials of living with PTSD. Familiarising yourself with what your friend or family member is going through can make it easier for them to have conversations. 

Actively listening to your loved one instead of trying to “fix” their problems is helpful. Just give them a safe space free of judgement and criticism. 

Encouraging your loved ones to seek help from a trained professional is of paramount importance. There are also many online support groups in Sri Lanka (links below) that can help your loved one connect with others who may be going through similar traumatic experiences. 

What does PTSD look like in children? 

Adults are not the only ones to suffer from PTSD and given the recent cases of child abuse in the news with perhaps countless cases happening behind closed doors, it is useful to understand how we can determine whether a child is suffering from PTSD. Symptoms vary depending on age as described below. 

Preschool/Kindergarten

  • Cry or scream a lot
  • Eat poorly due to loss of appetite
  • Experience nightmares of night terrors
  • Overwhelming fear of being separated from parent or caregiver

School age

  • Have a hard time concentrating at school
  • Experience insomnia or nightmares
  • Have feelings of guilt or shame
  • Very anxious or fearful in certain situations

Teens

  • Eat poorly
  • Self-harm
  • Feels depressed or alone 
  • Takes alcohol or drugs
  • Engage in risky sexual behavior
  • Make impulsive dangerous decisions

How can we help children suffering from PTSD? 

Try to keep your child’s schedules and lives as similar as possible to before the traumatic event. This might mean having your child continue with school and other activities with little time off in the beginning. 

Let them talk about the traumatic experience when and if they feel ready. Encouragement and praise helps them talk about their feelings but be careful not to force the issue if they don’t feel like sharing. If not through speaking, drawing and writing may help. 

Validate and reassure them that their feelings are normal. 

Seek out professional help immediately if you have any concern that a child has thoughts of self-harm. Thoughts of suicide are serious at any age and should be treated right away.

Build their self-confidence by encouraging them to make everyday decisions where appropriate. Children suffering with PTSD can feel powerless and helpless, so making decisions, however minor, can help them get control over some parts of their lives. 

Tell them that the traumatic incident is not their fault. They can talk about their feelings of guilt or shame but don’t let them blame themselves. 

Stay in touch with caregivers. It’s important to talk to teachers, babysitters, and other people who are involved in your child’s life.

Resources & References

Sri Lankan Resources

You can get in touch with medical professionals on the oDoc app who are trained to help people suffering from PTSD. You can even purchase an oMind subscription package which gives you unlimited access to mental health professionals. 

http://www.pulse.lk/everythingelse/psychological-support-sri-lanka/

http://marcelderoos.com

http://www.themorning.lk/the-ohana-project-leaving-no-one-behind/

Information

https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/ptsd

https://kidshealth.org/en/parents/ptsd.html

https://www.verywellmind.com/an-overview-of-ptsd-2797638

Online Support Groups

https://www.reddit.com/r/ptsd

https://www.myptsd.com

https://www.7cups.com

https://www.betterhelp.com

PTSD Blogs

http://www.healmyptsd.com

https://psychcentral.com/disorders/ptsd/

https://ptsdblogger.com

Mindfulness Apps

https://www.developgoodhabits.com/best-mindfulness-apps/

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Breaking out of the cycle of anxiety

Breaking out of the cycle of anxiety

Sudden heaviness in the chest, an unsettled feeling you can’t place, your heart beating over time and you feel frozen in the moment. Hands start to clam up, your gut feels funny and breathing becomes short and shallow. 

For over 280 million people around the world suffering from an anxiety related disorder, this is often a reality. Triggered by a sound, a photograph, a smell, a memory – the options that revert our bodies back to the ancient fight or flight mode are endless.

What is anxiety?

Anxiety is defined by the American Psychological Association as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.” Normal feelings of anxiety are common given the complex situations we find ourselves in however it is important to identify the difference between regular anxiety and an anxiety disorder to seek the help we need.

Anxiety is an important emotion to keep us safe from harmful situations – since the ancient days, when our ancestors encountered a dangerous situation, e.g. a sabre-tooth tiger, an internal danger alarm has been triggered. The alarm releases a rush of the hormone adrenaline in the brain and adrenaline’s main task is to facilitate the “flight or fight response” against the impending threat. 

Noticable signs of the flight or fight response is an elevated heartbeat, sweating and increased sensitivity to surroundings. Blood is diverted away from processes such as digestion towards the muscles of the limbs to allow the body to flee the situation if needed.

The limbic system

The limbic system is a group of brain structures (i.e. hippocampus, amygdala, hypothalamus) that work to elicit our behavioral and emotional responses, in particular those we’ve required for survival from ancient times (i.e. eating, sleeping, taking care of our young, staying alive).

When our eyes see danger, they send information to the amygdala which is responsible for emotional processing. The amygdala processes the information and if there is perceived danger, it sends a signal to the hypothalamus (or the command centre). The hypothalamus communicates with the rest of the body by releasing hormones that affect the autonomic nervous system. It can either push gas to the pedal via the sympathetic branch of the autonomic nervous system OR it can press the brakes via the parasympathetic branch. When sensing danger, its gas to the pedal via release of adrenaline (hormone) to trigger the flight or fight response to give the body enough energy to flee the danger. 

All this feels like: increased heart rate, more blood to muscles, heart and other vital organs, higher blood pressure, quicker breaths to allow more oxygen uptake, senses become sharper. And all this can happen in a second which is why before you’ve even truly clocked onto the car that’s coming at you, you’ve already jumped out of its way.

When does it become a problem?

So whilst the limbic system controlled flight or fight response may no longer be required to flee from predators, sustained exposure to modern day stressors like traffic jams, work pressure or family issues could cause the stress response to overfire and result in an anxiety disorder. 

As a result, some people become stuck in a cycle of stress which they are unable to break leading to chronic stress. Chronic stress or anxiety results in elevated levels of certain hormones that can harm the body in the long run. 

5 tips to break the cycle

As the limbic system reflex is so quick that we suddenly feel all the reactions in our bodies before we even know what’s happened, it’s important to rely on the basics to activate the parasympathetic nervous system (“PNS” or the brakes) which literally calms your body. The focus is on activating the vagus nerve (one of the main nerves of the body and part of the PNS) which has an effect on the breath, heart rate and digestive system and vice versa.

Here are five tips that are known to help calm the brain during episodes of anxiety:

1. Take deep breaths

Given the shallow breathing that’s associated with anxiety, taking the time to focus on taking deep breaths allows the body to stop the sympathetic nervous system in its tracks. This pause two fold benefits: 1) deep breathing stimulates the vagus nerve and 2) focussing on the breath allows the mind to hone in on a repetitive soothing pattern. 

Close your eyes if possible. Inhale for a count of 3, opening up your rib cage as the air flows in (like its a balloon), hold the breath for a count of 3 and slowly exhale through the nose for a count of 3.

Can be done anywhere you feel anxiety is being triggered: in the car, in the middle of a meeting or whilst shopping. 

 

2. Hum or sing to yourself (or to others!)

As the vagus nerve is connected to your larynx (or vocal chords) and the muscles of your throat, the gentle vibrations associated with humming activates these muscles and stimulates the nerve. Humming also forces you to control your breath and we know how much this helps!

 

3. Exercise

Physical activity is important for a myriad of reasons and helping you break the stress cycle is just one of the many. Exercise releases our happy hormones, or endorphins which counteract the effect of elevated adrenaline in the body. Physically moving the body allows for the dissipation of the built up tension in the muscles but also forces the body to breath deeply. 


4. Journal

Making your mind stop and take notice of the present helps it re-evaluate the threat level (and often realise, there’s nothing around to truly trigger this response). However, if there is something that is triggering the response, journaling also helps provide perspective to yourself. 

Take a note pad, a piece of paper or even your phone and write out everything you are feeling and thinking. Continue till you have written it all out. The act of writing takes our thoughts out of our mind and acts as a form of release. 


5. Speak to someone

Counsellors and psychologists are trained to help us decipher our thoughts, patterns and behaviours in a way that’s not possible alone. They provide perspective, ask questions and customise activities to help us break out of cycles that are causing us harm. 

With oDoc you can speak to a certified counsellor, psychologist or mental health professional from the safety and privacy of your own home via our app. 

2020 has been a year that has thrown most of our plans in the year, created numerous situations that could trigger anxiety and as such, what you feel is perfectly okay. You are, after all, human. Having to continue to suffer under the hand of an invisible threat is not the best way to live your life. Take hold of these ideas, speak to a professional and take control of your mind, body and your life! We are rooting for you!

 

Sources

The Limbic System, Queensland Brain Institute  

Understanding the Stress Response, Harvard Health Publishing

Calming Your Brain During Conflict, Harvard Business Review

This Might be the Simplest Scientific Way to Get Rid of Stress You’ve Ever Heard Of, Inc Publishing

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