“A hero is an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles.” -Christopher Reeve
Approximately 8.5 million adults suffer from Post-Traumatic Stress Disorder (PTSD). Less than half are receiving any type of treatment and over one-third of all cases are classified as “severe”.
According to the Mayo Clinic, PTSD is defined as a “mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it.”
More and more attention is being focused on returning military veterans and with good reason. Eleven percent of Afghanistan vets and one out of every five soldiers who were deployed in Iraq have returned with diagnosed PTSD.
Most startling is that 22 veterans commit suicide every day.
In addition, undiagnosed or untreated PTSD traumatizes people who have been victims of sexually assaulted or abused. It’s most apparent on college campuses where 80% of students who are sexually assaulted do not report that it occurred, compared to 67% of the general public.
According to the Centers for Disease Control, one out of every five women have been raped and 6 million children are abused annually (one report of child abuse made every 10 seconds).
Every day, an average of five children will die in this country from abuse and neglect.
Just as concerning are the recent studies that report that state agencies may be undercounting the number of these fatalities by at least 50%!
The Reach of PTSD
The financial and sociological impact of PTSD reaches further than most people realize:
- Two-thirds of those in treatment for drug abuse report being abused or neglected as children;
- 14% of all men and 36% of all women in prison were abused as children (twice as high as the general population);
- Victims of child abuse and neglect are nine times more likely to get involved in crime;
- The life span of people who have had six or more traumatic childhood events is twenty years shorter than those who have had none; and
- 80% of 21-yr olds who were child abuse victims have at least one psychological disorder.
The list goes on and on. The more frequent or complicated the trauma, the greater the long-term impact on the individual, caregiver institutions and society.
What PTSD Looks Like
It’s clear to see that the effects of trauma last far beyond the actual event.
The manifestations of trauma read like a glossary from psychiatric diagnostic manual:
- Emotional dysregulation (i.e., abnormal psychological regulation of feelings)
- Hyperarousal by movements/sounds in the environment (e.g., light, sound, physical sensations)
- Avoidance/Suppression of painful emotions and memories
- Numbing (deprivation of feeling or responsiveness)
- Feelings of isolation
- Short temper; frequent angry outbursts
- Impatience and irritability
- Chronic relationship conflict and tension
- Loss of interest in activity
- Feelings of hopelessness
In addition, PTSD sufferers experience more frequent urges to abuse drugs, blame themselves for how they’re feeling and have higher than normal heart and respiration rates.
Trauma Literally Rewires the Brain
Of course, any discussion of how the human mind works ties to how we’re wired neurologically and that starts with the limbic system which houses the structures that are concerned with memory, learning and emotions.
For PTSD victims, the mind has been altered by traumatic experiences and now operates at the two ends of the behavioral continuum. Put differently,
the coping skills that the mind has created to manage PTSD emotions have now become the unhealthy default.
On one end of that continuum, the limbic system’s monitor (pre-frontal cortex) is bypassed so that emotional reactions go unchecked. In other words,
PTSD sufferers are now not wired to effectively filter and soften raw feelings.
As a result, many of the previously listed symptoms become glaringly apparent, such as impatience, tension and overall anxiety.
On the other end are those who engage in higher-risk behavior as a result of increased levels of dopamine and adrenaline.
These victims, especially those who served in the military, are likely to search for experiences that bring back that feeling of living on the edge (such as being involved in substance abuse) that is characterized by blunted emotional expression.
Mindfully Managing the Effects of Trauma
Mindfulness helps bring focus to stressors in the present moment and, with practice, can help us move away from automatically reacting to those stressors in a harmful way and move toward the choice of healthier responses.
Most people, including PTSD victims, don’t consciously connect their thoughts to how they act on them.
For example, if we hear a car backfire, we might flinch at the noise but we don’t hear the backfire and then contemplate whether or not to flinch. They seem to happen simultaneously.
In other words, our minds and bodies our linked in such a way that we find it unimaginable that someone could be scared by a loud sound and not react physically, at least in some small way.
In early research on trauma victims, mindfulness showed great promise as a supplemental or stand-alone treatment. Decreases in depression, avoidance, numbing and other symptoms were documented. In fact,
one study showed that 47.7% of veterans with PTSD showed “clinically significant improvement” after being introduced to the practice of mindfulness.
The University of Michigan conducted a breakthrough study connecting mindfulness therapy and successful treatment of PTSD in 2013. You can read the results here.
One of the key characteristics of PTSD is the seeming inability to think about the specific traumatic episode that triggers the deepest emotional reactions.
The minds of victims typically avoid those memories and focus on something else. For example, a vet may avoid news coverage of the war or an abuse victim may choose to plan driving routes to avoid seeing the location where the abuse occurred.
In the long-term treatment of PTSD, it is important to be able to revisit those memories and, in the Michigan study, 73% showed decreases in avoidance symptoms after exposure to Mindfulness-Based Cognitive Therapy. In fact, they became better able to stay with those difficult thoughts and not blame themselves, another key symptom of PTSD.
In time, those same individuals became less likely to view the world as a dangerous place.
As mentioned earlier, our minds tend to blindly follow our bodies. However, with mindful practice, it’s been shown how to separate them. Specifically, by improving our awareness of the present moment, we have the ability not to automatically react a certain way to stressors (e.g., flinching at the sound of a backfiring car).
The most famous example of this was Paul Ekman’s test of the “startle response”. Ekman used a test sound (loud explosion) that was barely tolerable by humans. He first tested police officers (remember – cops are used to the sound of loud gunfire). They couldn’t avoid flinching when they heard the very loud test sound.
The same test was then performed on a Tibetan Lama who had obviously been practicing mindfulness most of his life. Not a single muscle twitch was recorded when the test sound went off. In fact, the Lama said after the test that the explosive sound seemed like “a bird crossing the sky”. What a showoff!
Even though the Lama had a lifetime of training, the study did show that the startle response can be dramatically diminished with practice. In other words, mindfulness practice helps disconnect the integrated mind/body response by simply being aware and regarding the test sound as something benign.
PTSD victims have the ability to develop this level of awareness and, as a result, rewire their minds so that they are not slaves to their body’s triggers.
Staying on that neurological path, we now know that mindful practice can return the heart and breathing rates of PTSD victims to normal levels. We also know that the monitor for our limbic systems is (re)activated and returns to its role as the mind’s middle man for processing emotions.
As a result, scientists are able to measure the time it takes the brain to respond mindfully to a stressor (300 milliseconds) compared to the original, unfiltered and damaging reaction (20 milliseconds). That improvement by a factor of 15 means that the mind has more time in the “space between” to recognize that, for example, the backfiring car is not an Iraqi I.E.D.
Most experts consider the use of mindfulness as a tool in the toolbox for therapists and counselors who work with PTSD victims. The V.A. has been utilizing mindfulness for years as a way to prepare patients for other modalities of treatment, including Cognitive Processing Therapy and Prolonged Exposure.
By practicing mindfulness in advance of other therapies, patients become more confident in their ability to confront their stressors and less likely to avoid them.
They report a greater willingness to proceed with further therapy because the process of discussing the specific trauma doesn’t feel as scary.
I’ve talked about the use of mindfulness with regard to organizational leadership in past posts and similar learnings can be gleaned from its use with PTSD victims:
- Learning how to become more aware of the present moment helps us be more willing to confront whatever stressors are in front of us, whether it’s beginning to address the residual effects of sexual assault or a looming conversation with a challenging employee (puts the latter in some perspective too!).
- Self-awareness is a critical component of emotional intelligence. Being able to observe how our minds and bodies are connected allows us to learn how to face the most difficult challenges in a healthier way, not only for ourselves but for others too.
- Becoming more compassionate is also an outgrowth of mindfulness practice, whether that compassion is directed toward ourselves or others. By learning how to be less self-critical, we chip away at the judgments we attach to others.
The statistics presented at the beginning of this post should be unacceptable to any rational human being. Others can argue the politics surrounding the causes of PTSD but, for the rest of us, we must continue to let victims know of the efficacy of mindfulness and other modalities of treatment for this disorder.
The victims of PTSD desperately need a way to call timeout in their minds so that, like a sports team, they can rest and plot out improvements. Mindful awareness provides that timeout and allows the fragmented mind heal and reintegrate so that healing can begin.