PTSD - A Better Understanding

Take Back Control – Better Understanding Can Help Us Manage PTSD

San Diego Veterans Magazine spoke with Robert ‘Bob’ Cuyler, PhD, psychologist and trauma expert, about better managing PTSD.

1. How do we recognize signs and symptoms of PTSD?

It’s not always easy to recognize if you or someone close to you has PTSD. Issues around stigma, while we have made progress, can still be a barrier to acceptance. Among veterans, service-related trauma is widely recognized, but the civilian world is unfortunately full of traumatizing risks. Intense reaction to triggers and reminders and nightmares are widely recognized signs of PTSD, but irritability, emotional numbing, and isolation are also in the mix.

Living with PTSD can greatly interfere with relationships and daily life, as that irritability and isolation can affect family and work relationships. You can find yourself reliving a traumatic situation again and again, and sometimes you may not even be aware you’re doing it. It’s an automatic reaction, and the memories of these events can be as vivid as when the trauma occurred.

People often ask me, “That was years ago, why is it still affecting me?” And then they think, “I’d rather keep this under wraps than let people know I’m still struggling with it.” This adds to that sense of isolation that can disrupt functioning.

2. What causes triggers that lead to PTSD episodes?

Seemingly random things can trigger someone with PTSD – a car backfiring, loud sounds from the TV, crowded areas, what you read in the news, an overturned garbage can that looks like an IED. It can be something someone says that sparks a vivid memory, or losing a friend from the service to injuries, illness or suicide. When U.S. troops withdrew from Afghanistan, the news was triggering for many members of the military who had served there. There’s also a sensitivity about the unfairness of something – that a buddy was killed when you survived. Or if you were injured in a mission and you question its necessity.

3. Why is PTSD disruptive for someone looking to assimilate back into civilian life?

Triggers like this can take someone back to a time when they were in extreme danger, even if that was many years ago, and put you in fight-or-flight mode. At that moment, your brain is focused on survival, but those necessary survival skills that worked in the field can backfire now.

So much of what makes up PTSD are really adaptations to extreme circumstances that carry over to daily life. If you can’t react to danger, you can’t survive. But that learned adaptation becomes problematic when we’re back to civilian life. When our brain is in survival mode, a lot of the tools we can call on ordinarily like seeking support, thinking before acting, and so on, recedes to the background and we go into fight or flight mode. If you’re keyed up and constantly alert, it makes it hard to relax, enjoy life or relate to people around you.

4. What are some coping mechanisms?

Everyone resorts to different coping mechanisms and sometimes these can backfire. Take someone who avoids crowded places or is constantly scanning for danger - these are understandable responses to being embedded in the battlefield. Being on edge or on guard all the time is what the brain wants you to do, but then this hypervigilance can dominate life.

Good quality sleep is essential for our emotional and physical health, but nightmares can disrupt sleep. This can lead to unhealthy coping mechanisms such as drinking or substance use which may help in the moment to numb feelings or help you fall asleep, but the use of alcohol or drugs risks turning temporary coping methods into substance use or dependency.

5. How can veterans get a sense of self-control back?

Building skills that veterans can use to cope with the surge from traumatic reminders is key to tackling PTSD. There’s good evidence that talk therapy is effective in treating PTSD, but many don’t want to revisit the trauma as a way of getting desensitized to it. Medications can also help but are slow to act and tend to moderate symptoms rather than resolve them. So the current treatment options have limitations, which is why too many veterans go untreated or are reluctant to seek treatment.

There are non-medication alternatives to consider. Research shows that during a panic attack or PTSD episode, our breathing gets dysregulated, so learning how to regulate it consciously can help reduce hypervigilance and other symptoms. At Freespira, something we hear over and over from veterans who use this intervention is that they feel a sense of control again.

One recent example: “I was tired of living at the mercy of my episodes and now I feel like I can go back into the world again. I took my five-year-old daughter to the movies for the first time this month.”

Cuyler is chief clinical officer of Freespira, an FDAcleared non-medication treatment that helps people with panic and PTSD manage their symptoms by learning how to regulate their breathing.

WOUNDS WE CANNOT SEE

Post Traumatic Stress Disorder does not always allow the affected to seek help. Lend a hand and provide them with methods of help, listen and be a friend.

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