PTSD

Many of us will experience some kind of trauma during our lifetime.

Sometimes, we escape with no long-term effects.

But for millions of us, those experiences linger,

causing symptoms like flashbacks,

nightmares,

and negative thoughts that interfere with everyday life.

This phenomenon, called post-traumatic stress disorder,

or PTSD,

isn’t a personal failing;

rather, it’s a treatable malfunction of certain biological mechanisms

that allow us to cope with dangerous experiences.

To understand PTSD,

we first need to understand how the brain processes a wide range of ordeals,

including the death of a loved one,

domestic violence,

injury or illness,

abuse,

rape,

war,

car accidents,

and natural disasters.

These events can bring on feelings of danger and helplessness,

which activate the brain’s alarm system,

known as the “fight-flight-freeze” response.

When this alarm sounds,

the hypothalamic, pituitary, and adrenal systems,

known as the HPA axis,

work together to send signals to the autonomic nervous system.

That’s the network that communicates with adrenal glands and internal organs

to help regulate functions like heart rate,

digestion, and respiration.

These signals start a chemical cascade

that floods the body with several different stress hormones,

causing physiological changes that prepare the body to defend itself.

Our heart rate speeds up,

breathing quickens,

and muscles tense.

Even after a crisis is over,

escalated levels of stress hormones may last for days,

contributing to jittery feelings,

nightmares,

and other symptoms.

For most people, these experiences disappear within a few days to two weeks

as their hormone levels stabilize.

But a small percentage of those who experience trauma

have persistent problems

—sometimes vanishing temporarily only to resurface months later.

We don’t completely understand what’s happening in the brain,

but one theory is that the stress hormone cortisol

is involved in the development of PTSD. Cortisol is released during times of stress and helps regulate the body's response to it. In individuals with PTSD, it is believed that the cortisol response is disrupted, leading to an imbalance in the stress response system. This imbalance may contribute to the persistence of symptoms and the difficulty in recovering from traumatic experiences. Further research is needed to fully understand the complex mechanisms underlying PTSD, but it is clear that it is a legitimate and treatable condition. With proper support and intervention, individuals with PTSD can find relief from their symptoms and regain control of their lives.

The body becomes its own corset.

Past, present, and future exist as a single force.

A swing without gravity soars to a terrifying height.

The outlines of people and things dissolve.

Countless poets and writers have tried to put words

to the experience of a panic attack—

a sensation so overwhelming, many people mistake it for a heart attack, stroke,

or other life-threatening crisis.

Though panic attacks don’t cause long-term physical harm,

afterwards, the fear of another attack can limit someone’s daily life—

and cause more panic attacks.

Studies suggest that almost a third of us

will experience at least one panic attack in our lives.

And whether it’s your first, your hundredth,

or you’re witnessing someone else go through one,

no one wants to repeat the experience.

Even learning about them can be uncomfortable, but it’s necessary—

because the first step to preventing panic attacks is understanding them.

At its core, a panic attack is an overreaction to the body’s

normal physiological response to the perception of danger.

This response starts with the amygdala,

the brain region involved in processing fear.

When the amygdala perceives danger,

it stimulates the sympathetic nervous system,

which triggers the release of adrenaline.

Adrenaline prompts an increase in the heart and breathing rate

to get blood and oxygen to the muscles of the arms and legs.

This also sends oxygen to the brain, making it more alert and responsive.

During a panic attack,

this response is exaggerated well past what would be useful

in a dangerous situation,

causing a racing heart, heavy breathing, or hyperventilation.

The changes to blood flow cause lightheadedness

and numbness in the hands and feet.

A panic attack usually peaks within 10 minutes.

Then, the prefrontal cortex takes over from the amygdala

and stimulates the parasympathetic nervous system.

This triggers the release of a hormone called acetylcholine

that decreases the heart rate and gradually winds down the panic attack.

In a panic attack, the body’s perception of danger

is enough to trigger the response we would have to a real threat— and then some.

We don't know for sure why this happens,

but sometimes cues in the environment that remind us

of traumatic past experience can trigger a panic attack.

Panic attacks can be part of anxiety disorders

like PTSD, social anxiety disorder, OCD, and generalized anxiety disorder.

Recurring panic attacks, frequent worry about new attacks,

and behavioral changes to avoid panic attacks

can lead to a diagnosis of a panic disorder.

The two main treatments for panic disorder

are antidepressant medication and cognitive behavioral therapy, or CBT.

Both have about a 40% response rate—

though someone who responds to one may not respond to the other.

However, antidepressant medications carry some side effects,

and 50% of people relapse when they stop taking them.

CBT, meanwhile, is more lasting, with only a 20% relapse rate.

The goal of CBT treatment for panic disorder is to help people learn

and practice concrete tools to exert physical, and in turn mental,

control over the sensations and thoughts associated with a panic attack.

CBT begins with an explanation of the physiological causes of a panic attack,

followed by breath and muscle exercises designed to help people

consciously control breathing patterns.

Next comes cognitive restructuring,

which involves identifying and changing the thoughts

that are common during attacks—

such as believing you’ll stop breathing, have a heart attack, or die—

and replacing them with more accurate thoughts.

The next stage of treatment is exposure to the bodily sensations and situations

that typically trigger a panic attack.

The goal is to change the belief, through experience,

that these sensations and situations are dangerous.

Even after CBT, taking these steps isn’t easy in the grip of an attack.

But with practice, these tools can both prevent and de-escalate attacks,

and ultimately reduce the hold of panic on a person’s life.

Outside formal therapy,

many panickers find relief from the same beliefs CBT aims to instill:

that fear can’t hurt you, but holding on to it will escalate panic.

Even if you’ve never had a panic attack,

understanding them will help you identify one in yourself or someone else—

and recognizing them is the first step in preventing them.

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