In the U.S., post-traumatic stress disorder (PTSD) is most often associated with combat veterans, up to 17 percent of whom have experienced the flashbacks, hypervigilance, and avoidance of traumatic memories that characterize this distressing anxiety disorder. However, PTSD also affects many non-veterans: People of all backgrounds and ages in the general population commonly develop the disorder. Fortunately, it can be successfully treated with psychological therapy, medications, and mind-body interventions like meditation.
WHAT YOU CAN DO
These tips may help you improve your ability to deal with stress associated with anxiety and PTSD, and to bounce back from adversity:
- Social connectedness Develop close ties with others, especially positive people; turn to close friends or family for advice and support. Pets also provide supportive companionship.
- Optimism Focus on what can be done, rather than what can’t; entertain a hopeful view of the future; encourage, rather than discourage, yourself when you are faced with a stressor. Negativity compounds stress.
- Acceptance Change is inevitable; acknowledge when your actions cannot affect a situation, make the best of it, and move on.
- Realism Try to face stressful situations without illusions; respond to reality; frankly acknowledge your own characteristics, goals and needs.
- Flexibility Strengthen your ability to adapt, find new ways to respond, and change expectations in the face of challenge.
- Perspective Try to adopt a longer view of stressful situations rather than getting swept away by immediate circumstances. Adopting a philosophical or spiritual view also helps diminish the negative impact of stressful events.
- Self-care Pay attention to your own mental and physical welfare so you can stay strong in the face of stress. Adopt a healthy lifestyle with time out for yourself. Avoid stimulants that exacerbate hypervigilance, and alcohol and other drugs that can lead to addiction.
- Stress avoidance When possible, avoid stress-inducing situations and people. For example, instead of going out to a night spot with strobe lights and a rowdy clientele, choose a pleasant waterside venue with a piano bar.
Many Risk Factors
Vulnerability to PTSD is affected by the type and severity of the trauma and the number of traumatic experiences an individual is exposed to. In addition to the widely-discussed risk presented by military combat, some of the many risk factors for PTSD include:
- Childhood abuse
- Female sex
- Prior trauma exposure
- Physical injury
- Perceived fear of death
- Experiencing an intentional assault that results in injury
- Prior mental disorder
- Personality factors, such aneuroticism
- Severe pain
- Traumatic brain injury
- Financial stress
- Low social support
According to a recent review conducted by the U.S. Department of Veterans Affairs, the lifetime prevalence of PTSD in the adult population is about eight percent. Four percent of people over 60—and possibly more—are included in this population.
“As people age, the chances increase that they will have been in a life-threatening accident, experienced a natural disaster, lost a loved one, or lived through some other traumatic occurrence,” explains Gregory Fricchione, MD, Director of MGH’s Division of Psychiatry and Medicine. “For example, we see a lot of older patients with medical issues, such as a stroke, in the ICU. For them, that can be a harrowing experience complicated by confusion, hallucinations, confinement, and medications that change their mental state. Physicians are now starting to track post-ICU patients to assess their vulnerability to PTSD. This is an area of intensive interest.”
Tenacious Emotional Memory
When an individual is deeply frightened, the primitive emotional center of the brain called the amygdala activates. Normally, the prefrontal cortex—a brain region responsible for regulating complex thinking, behaviors, and emotions—helps keep the amygdala in check. But after a particularly harrowing experience that generates feelings of intense fear, horror, or helplessness, signals from the amygdala may overwhelm the prefrontal cortex.
As a consequence, the individual may be prone to re-experiencing the feelings generated by the trauma. He or she may suffer symptoms such as flashbacks, frequent sleep disturbances and nightmares, numbness, depression, uneasiness, irritability, problems concentrating, excessive worry, anger, and feelings of disassociation from other people or events. Thinking and mood may become more negative.
“In older adults, while experience can buffer against stress, vulnerability to PTSD may increase over time for a variety of reasons,” explains Dr. Fricchione. “The older brain is changing, and the aging prefrontal cortex becomes less able to tame the amygdala, increasing susceptibility to PTSD symptoms.”
Although an estimated 70 to 90 percent of adults over 65 have been exposed to at least one potentially traumatic event in their lifetimes, the majority do not develop PTSD. Certainly, personal history, genetic factors, personality traits, and other individual characteristics are associated with susceptibility to the disorder. Resilience—the ability to bounce back from adversity—is also an important personal quality that helps protect against PTSD. (See What You Can Do on how to increase resiliency.)
Without treatment, long-term PTSD can increase risk for a number of physical and mental problems. Researchers have linked the disorder with greater vulnerability to depression, substance abuse, and higher risk for heart attacks, gastrointestinal, arterial, dermatological, and musculoskeletal problems.
Fortunately, for those people who do develop PTSD, there are a number of treatment options that have been shown to be effective. They include:
Meditation “Spending 20 minutes a day in meditation can be very helpful for people with PTSD as an adjunctive way to help reduce focus on past traumatic memories and on future worries,” says Dr. Fricchione. “The approach essentially helps to detoxify the amygdala’s influence, reducing stress and helping to lessen reactivity to events. Through meditative awareness, individuals can observe their reactions and feelings in a mindful way, and work to see events from a calmer, more positive perspective.”
A 2016 study found that in a group of veterans with combat-related PTSD, meditation was linked with positive changes in areas of the brain associated with the processing of threats.
Psychological therapy Psychotherapy is the most common treatment for PTSD, and is considered by some researchers to be more effective than medications.
Medication People with PTSD are often treated with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), and sometimes with additional medications that address associated problems, like sleeplessness.