Why your memory is poor, and what you can do about it.

Hint: It’s probably not Alzheimer’s. 

In February I posted a video on YouTube, “The link between stress and memory!”In this video I discuss why people who suffer from chronic stress tend to have memory problems. In a nutshell, when under stress, the memory center of the brain, called the hippocampus, can’t activate the way it needs to in order to encode memories well. This is because the hippocampus is covered in cortisol receptors, and when we’re under stress our cortisol increases, flooding the hippocampus and making it difficult to activate properly. In the short term the result is that we don’t encode very stressful or traumatic things as well as we otherwise would (hence the controversy behind eye witness testimony). Over the long haul, the chronic stress, which causes ongoing cortisol flooding of the hippocampus, leads to atrophy of the brain’s memory center. This in turn makes it difficult to encode not only traumatic events well, but any memories. Information can seem to “go into one ear and out ther other.”

Thus, for many people memory issues aren’t due to early onset of Alzheimer’s Disease, rather, the culprit is too much stress. So what can we do about it? The good news is that neurogenesis, which is the growing/regeneration of neurons, is possible in the hippocampus. Here are some quick recommendations to help your memory center become healthy and strong! The following have been shown to promote neurogenesis in the hippocampus:

1.     Get moderately-intense exercise: You don’t have to be a marathoner. Just get approximately 30 minutes of moderate exercise about three times per week.

2.     Eat chocolate and blueberries: Hippocampus neurogenesis has can be promoted by eating foods rich in flavonoids, such as cocoa and blueberries. 

3.     Practice mindfulness: Incorporating mindfulness practices, including yoga, meditation, and diaphragmatic breathing is another great way to strengthen the memory center.

4.     Get plenty of Omega-3s: Omega-3 fatty acids are a great way to increase neurogenesis in the memory center of the brain, and may also help manage depression.

Stress, anxiety, and trauma can wreak havoc on the brain. The best thing you can do for yourself if you believe you might be suffering from one of these conditions is to seek professional help from a licensed mental health provider. However, many people find that making small changes (I call them “one degree changes”) can make a large difference in how they feel over time. Think about it like this… If you are traveing in one direction and veer to the right by one degree, it won’t take you far off course in the short term, but 1,000 miles later you’d be in a totally different place. That’s the idea behind one degree changes. Slightly change your habits now, and reap the benefits later!



What is the insula? The important mental health brain structure you've never heard of.

I recently posted a vlog onYouTube about an area of the brain that is extremely important for mental health professionals to know about: The insula. To see the vlog go here! As promised, I wanted to also include a blog here describing this area of the brain, what it does, and why it's important!

The Insula Explained:

The insula, or the “Interoception Center,” is the main site of interoception. Interoception is one’s ability to feel into internal experience and connect with internal sensations. For instance, feeling hungry, warm, or jittery are all examples of interoception. This too-often overlooked area of the brain is extremely important because without a strong and regulated insula, emotion identification and regulation become very difficult. Imagine, for example, that a client suffers from panic disorder. If they cannot feel into the body and be aware of the physical sensations that part of their panic, it would be extremely difficult to treat their panic disorder! This is because the experience of emotion is not simply cognitive; Emotion is always experienced in the body.

When an individual is able to “feel into” the body and connect with internal sensations, those sensations provide critical information about the emotion the individual is experiencing. The ability to do this is often called “felt sense” by trauma expert Peter Levine (2009). In different mental health conditions, however, this can be difficult for clients. In several disorders the insula is underactive, meaning that it is difficult to feel into the body and be aware of emotional experiences. In some other disorders, the insula becomes overactive, leading to a misinterpretation of bodily sensations as dangerous or catastrophic.

Thus, one goal of trauma treatment is to build a strong but regulated insula that gives accurate information about internal states. With a more regulated insula, individuals improve interoception and experience fewer emotional outbursts and dissociative symptoms (including numbing). Additionally, with a strong insula individuals are better able to feel into their own bodies, identify the emotions they are experiencing, and regulate them. 

For two free insula strengthening tools you can start using right away, click HERE

Source: insula

Anxiety: The Perpetual Game of Mental Whac-A-Mole

Regardless of the type of anxiety you experience, you know it feels exhausting. This is for a couple of reasons. First, anxiety wears us out because it’s characterized by sympathetic nervous system arousal. This autonomic arousal, known as the “stress response” or the “fight or flight response,” is responsible for about 1,400 biochemical and psychophysiological changes in the body that make us feel tense, vigilant, nervous, and ready to act. While this can be helpful for short periods of time, such as when we swerve to avoid having a car accident, or when we can benefit from an extra boost of energy before an athletic competition, it can be unhelpful if we stay in this state too long or at the wrong time (such as when you’re trying to fall asleep at night). Unfortunately, it can be difficult to control when we feel anxious, and to what extent, and the result for some people is that they feel anxious or worried all the time.

Second, anxiety is exhausting because of how it impacts our thoughts. Anxiety tells us that there is always something that needs attention, or needs worried about, and it won’t let us relax until we’ve addressed all of those worrisome thoughts. But here’s the problem: It often feels as though you can never quite squash all of the thoughts you believe to be the cause of anxiety. This, too, contributes to a constant state of anxiety.

For people suffering from anxiety, worrisome thoughts seem to function like a never-ending game of Whac-A-Mole, the popular children’s arcade game where you hit plastic moles that keep popping up with a padded mallet. But unlike Whac-A-Mole, there is no end to the anxious thoughts that pop up. People suffering from this unending game of mental Whac-A-Mole can become very good at squashing each worry, one after another. However, while they become skilled at talking themselves out of believing each anxious thought, there is always another worry waiting to “pop up.” After a while squashing these anxious thoughts becomes exhausting, and ultimately it just doesn’t work.  

So what does work? To address mental Whac-A-Mole consider working on reducing the high stress response underlying the thoughts. While this may not be sufficient for stopping the Whac-A-Mole completely, it is often necessary, as it is frequently the case that underlying autonomic arousal fuels anxious thoughts. What happens is the nervous energy, which we can feel in our body, is picked up by our thoughts, which then try to make sense out of the anxiety. It does this by creating thoughts consistent with those anxious feelings. Thus, the problem is not always the anxious thoughts, rather, a big part of the problem can be the underlying arousal and anxious sensations. If you can tackle the stress response and the related physical and emotional reactions, it can be a major step toward managing anxious thoughts as well. Here are some techniques that can reduce a high stress response:

If your anxiety feels overwhelming or difficult to manage, consider seeking mental healthservices, as professional treatment for anxiety can be very effective for many people!


Originally published at: https://www.psychologytoday.com/blog/workings-well-being/201703/anxiety-the-perpetual-game-mental-whac-mole

My Therapist Keeps Telling Me To Breathe…. Why?

If you’re like a lot of people who’ve been to therapy, you’ve probably heard your therapist tell you to breathe. The recommendation might have been in passing, or perhaps they even taught you some specific diaphragmatic breathing exercises to practice at home. Either way, you may have asked yourself why this seems to be a thing. Why emphasize something you’re already doing? I’m breathing right now, and I bet you are too. I breathed yesterday, and the day before that, and I’ll breathe every day from now until I die.

When I’ve brought up breathing to clients, I’ve seen the initial, “I’m paying you for this?” look more than once. But breathing the right way is really good for you and might just help you reduce some of the symptoms that brought you to therapy in the first place. Let me explain.

Take Home Point 1: Normal breathing and diaphragmatic breathing are NOT the same thing.

This is critical to understand. Diaphragmatic breathing is when you fill your whole diaphragm with air, breathing fully in, and fully out. This is different from what most of our breathing tends to look like day to day, which is usually “chest breathing.” Chest breathing is faster and much more shallow, and does not utilize our entire diaphragm. Chest breathing can be associated with a heightened stress response, increased toxins in the body, and less oxygen in the brain, and is usually not very healthy. However, it’s what we’re all used to, and to create more healthy breathing habits takes training.

Take Home Point 2: In order to reduce your anxiety you must breathe through the diaphragm. All other breathing is pointless (other than it keeps you alive).

The error a lot of people make when practicing breathing exercises is that they don’t actually breathe through the diaphragm. Maybe it’s because they don’t know how to, or perhaps they erroneously think they are (but actually aren’t). For most people, there seems to be a lack of understanding regarding how important this actually is, so I want to emphasize this. If you are not breathing through your diaphragm during a mindful breathing exercise, you’re wasting your time.

Take Home Point 3: Breathing through the diaphragm activates the vagus nerve; vagus nerve activation is what reduces your anxiety.

When you breathe through your diaphragm, something amazing happens: You activate your vagus nerve, which tells your brain to stop producing anxious feelings and start relaxing. Here’s a depiction of the vagus nerve – it’s the bright yellow band running from the brain to the organs.


So here’s what happens when you breathe through the diaphragm:

1.     You inhale fully, expanding your diaphragm.

2.     As your diaphragm fills with air, the diaphragmatic wall pushes downward, like a balloon that is filling up.

3.     When the diaphragmatic wall drops, it begins to squish your internal organs a liitle bit.

4.     Wrapped around your internal organs is the vagus nerve, so as the organs are getting slightly compressed, so is the vagus nerve.

5.     When the vagus nerve is pressed, such as when you breathe through your diaphragm, it activates!

6.     After activating, the vagus nerve sends a signal upward, through the spine to the brain, telling the brain to stop the stress response and activate the relaxation response.

7.     The brain can then reduce the stress response and everything associated with it (fast heart rate, that nervous jittery/buzzing sensation, foggy thinking) and replace it with the relaxation response!

This whole process takes about 45 seconds. That’s right – we can literally calm down and reclaim a sense of control over our emotions, thanks to how our bodies are naturally built, in less than a minute. Amazing, right? So, the next time you’re told to breathe, consider trying it, but make sure you’re breathing through the diaphragm!

If you aren’t sure whether what you’re doing is diaphragmatic breathing, and want to ensure you’re breathing optimally, click HERE to request my free mini-guide, “Diaphragmatic Breathing 101: Five Ways To Breathe Well.” It contains five breathing strategies that take the guesswork out of diaphragmatic breathing.

Here’s Your Brain on Trauma

Approximately 50% of the population will experience a traumatic event at some point in their lives. While reactions to trauma can vary widely, and not everyone will develop Post Traumatic Stress Disorder (PTSD), trauma can change the brain in some predictable ways that can be useful to be aware of if you are struggling to cope after trauma. With an increased awareness of what is going on in your brain, you can seek treatment to address your symptoms and learn skills that will actually rewire your brain for recovery! Additionally, knowing what’s going on can be immensely helpful because you may realize that you’re not crazy, irreversibly damaged, or a bad person. Instead, think of a traumatized brain as one that functions differently as a result of traumatic events. Just as your brain changed in response to your past experiences with the world, it can change in response to your future experiences as well. In other words, the brain is “plastic,” and you can change it!

Three brain areas to know:

Trauma can alter brain functioning in many ways, but three of the most important changes seem to occur in the following areas:

1.     The prefrontal cortex (PFC), called the “Thinking Center”

2.     The anterior cingulate cortex (ACC), called the “Emotion Regulation Center,” and

3.     The amygdala, called the “Fear Center”

A visual depiction of these three areas appears below.


As you can see, the Thinking Center (PFC) of the brain is located near the top of your head, behind your forehead. The Thinking Center is responsible for many abilities that we possess, including rational thought, problem-solving, personality, planning, empathy, and awareness of ourselves and others. When this area of the brain is strong we are able to think clearly, make good decisions, and be aware of ourselves and others.

The second region, the Emotion Regulation Center, is located next to the Thinking Center, but is deeper inside your brain. This area is responsible (in part) for regulating emotion, and (ideally) has a close working relationship with the Thinking Brain. When this region of the brain is strong, we are able to manage difficult thoughts and emotions without being totally overwhelmed by them. While we might want to send that snarky email back to a coworker, the Emotion Regulation Center reminds us that this is not a good idea, and helps us manage our emotions so that we don’t do things we regret!

The last area listed is the amygdala, which is a tiny brain structure deep inside our brain. This subcortical area, which is outside of conscious awareness or control, serves as the Fear Center of the brain. Specifically, its primary job is to receive all information – everything you see, hear, touch, smell, and taste – and answer one question: “Is this a threat?” The main purpose of the Fear Center is to detect danger and threat and, if present, produce fear in us. When this area is activated, we feel afraid, reactive, and vigilant.

So what’s going on in a traumatized brain?

Traumatized brains look different from non-traumatized brains in three predictable ways:

1.     The Thinking Center of the brain is underactivated,

2.     The Emotion Regulation Center of the brain is underactivated, and

3.     The Fear Center of the brain is overactivated.

Here’s what it looks like:


What this shows is that oftentimes, a traumatized brain is bottom-heavy, meaning that activation of lower, more primitive areas of the brain (called subcortical areas) are HIGH, including the Fear Center, while the higher areas of the brain (called cortical areas) are underactivated.

In English, what this means is that if you are traumatized, you may experience chronic stress, vigilance, fear, and irritation. You may also have a hard time feeling safe, calming down, and sleeping. These symptoms are the result of a hyperactive Fear Center.

At the same time, individuals who are traumatized may notice difficulties with concentration and attention, and often report they can’t think clearly. This, not surprisingly, is due to the Thinking Center being underactivated.

Finally, survivors of trauma will sometimes complain that they feel incapable of managing their emotions. For example, if someone spooks them, they may experience a rapid heart rate long after the joke is up, or may have a hard time “just letting go” of minor annoyances. Even when they want to calm down and feel better, they just can’t. This is in large part due to a weak Emotion Regulation Center.

What can you start doing now?

Changing the brain takes effort, repetition, and time. The best gift you can give yourself, if you’re serious about rewiring your brain for health, is psychotherapy. If you’re ready to start that journey, look for a psychologist who specializes in trauma and PTSD, and who uses evidence-based methods that change the brain by working with both the body and the mind.

Also, consider adding a body-based or mindfulness-based technique to your daily routine, in order to begin de-activating the Fear Center. This is a fantastic first step to healing, as when we are able to quiet the Fear Center, we are better able to work on strengthening and activating the Thinking Center and Emotion Regulation Center. Two Fear Center de-activating exercises include diaphragmatic breathing and autogenic training, and you can access free, guided practices of these techniques here. The recommendation is to practice these techniques, or similar ones, for short periods of time multiple times per day. Remember, practice makes progress!

Post-Election Stress Disorder in Women

“Post-Election Stress Disorder” (PESD) is not one of the mental illnesses listed in psychologists’ overly verbose diagnostic manual, the DSM-5, but it is a phenomenon that feels real nonetheless. Countless Americans are reporting feeling triggered, traumatized, on edge, anxious, sleepless, angry, hopeless, avoidant of connection, alone, and suddenly haunted by past traumas they believed they had buried. Of course, there is not just one type of American who has been experiencing these types of symptoms, and there is not just one reason for it. What is clear, however, is that there seems to be a sort of collective trauma (or at least stress) response occurring.

Over the past three days I have received more emails and calls from female clients suffering from PESD-like symptoms than I have in the prior three months combined. Moreover, I have read many complaints of these symptoms from female friends on social media. After a while they begin to look the same…

“I haven’t slept in two days…”

“I can’t stop sobbing…”

“I am having nightmares…”

“This reminds me of when I was sexually assaulted…”

“I thought I was over all of my past abuse but now it’s back…”

“I can’t sleep, can’t eat, can’t function…”

From what I am hearing and reading, many women are experiencing these symptoms (to varying degrees) and more right now. This is not to say that other groups are not also suffering, but as a trauma psychologist who works primarily with women, this is the demographic I see the most. So what are these symptoms all about?

Look at the Facts

First, let’s create some context with numbers, with a focus on women.

  • 10% of women suffer from PTSD (4% of men)
  • 31% of women suffer from an anxiety disorder (19% of men)
  • 12% of women suffer from depression (6% of men)
  • 4.8% of women suffer from an eating disorder (2% of men)
  • 25% of women will experience sexual assault in their lifetime
  • 33% of women report having experienced sexual harassment in the workplace
  • Approximately 100% of women report experiencing some type of sexual harassment in their lifetime (this finding is consistent across multiple studies)

Add to those numbers a small sampling of not-so-fun facts:

  • Women more often experience traumatic events likely to lead to the development of PTSD (such as sexual violence, assault, and abuse) than men
  • Rape within marriage was legal until the mid-1970s
  • A whopping 96% of sexually objectifying imagery is of women’s bodies
  • Only 20% of political offices are occupied by women
  • Only 4.4% of Fortune 500 CEOs are women

What does this mean? Women are more likely than men to suffer from mental illnesses such as anxiety and PTSD, and they are more likely to have been sexually assaulted. Also, the numbers show us that women have not historically enjoyed the same power and privilege as men. For some women, the result may be a subtle but constant sense of vulnerability and vigilance.

Additionally, recent research has introduced the world to epigenetics, which tells us something about how our experiences can impact gene expression. Through epigenetic research we are beginning to learn how the experience of trauma to be communicated to future generations. Though beyond the scope of this post, what you need to know about epigenetics is that when a traumatic event is experienced, it can lead to methyl binding, which may increase stress sensitivity in future generations. This, in turn, increases an individual’s vulnerability to developing disorders such as PTSD in response to traumatic events.

The Role of Intersectionality

Finally, research tells us that a person’s vulnerability to stress and trauma are linked to more than just gender. Other aspects of a woman’s identity such as race, ethnicity, sexual orientation, gender identity, and disability status may play a role. For instance, take a look at the following:

  • A (CIS, non-transgender, gender-conforming) White woman is 4.5 times more likely to be sexually assaulted than a man.
  • Native American women are three times more likely to be sexually assaulted than Caucasian women, substantially increasing their risk.
  • Women of color who are also transgender are four times more likely to be sexually assaulted than White transgender women. For more information, read this

What we see here is an example of intersectionality, which means that our various social identities and the systems of oppression in which we live influence one another, mingle, and “intersect.”

Why We Can’t Just Get Over It

While the outcome this election means different things to different people, it is no secret that many of the words, values, and behaviors Americans have heard and seen during this election have deeply affected many people, including women (with a magnified impact on people of color, immigrants, LGBTQQA communities, differently-abled individuals, the religiously diverse, etc.). Moreover, in the past 72 hours since the election we have heard of several instances of violence and harassment committed toward women and other marginalized groups across the country. Some of the instances have included the perpetrators invoking the name of the President-Elect.

Mark Twain once said, “I am an old man and have known a great many troubles, but most of them never happened…” Twain is clearly referencing anxiety here, and we chuckle a bit at his statement because it highlights how silly worries can be. Sometimes.

But some tragedies have happened, and they have happened to an overwhelmingly high percentage of women. Not only that, but several Americans have been given the clear message that trauma will continue. This is what America needs to realize as we see so many of our citizens suffering in what appears to be intense or even extreme ways. The panic and desperation we see is not due to the bad things that have never happened, or would likely never happen. This collective fight-or-flight response is a reflection of all that has in fact happened, and reflects for many a legitimate fear of what might happen.

Why We Shouldn’t Just Get Over It

As women, the accumulation of our past traumas, and remnants of those our mothers and grandmothers suffered before us, remain with us and shape our perception of, and reaction to, danger. These reactions do not reflect weakness; rather, these memories and traces are gifts that have helped us to survive. The accumulated traumas that we carry, for better and for worse, may remain dormant most of the time if we are lucky, but our brains are wired to remember, and react strongly to, perceived threats that resemble the original trauma(s) in some way.

For many women, hearing about a powerful leader’s many sexual assault accusations will feel threatening and triggering, as it may remind them of their own traumas. The brain will recognize these stories of victimization as being similar to past experienced trauma, and the woman may feel triggered, on guard, and anxious. Similarly, listening to a tape recording of a powerful leader endorsing sexual violence will also likely be triggering. Witnessing the American public elect this leader to the highest position of political office in the United States, creating a scenario in which the daily lives of millions of women (and others) will undoubtedly be influenced, and in which many women will face daily reminders of their past victimizations and threats of future victimizations, will produce an even more intense trigger response. Remember what the statistics show: Millions of women have suffered sexual harassment and assault (100% and 25%, respectively). Thus, we should not be shocked as we witness a collective fight-or-flight reaction, we should expect it. Also, the stress response should not be viewed as irrational or maladaptive when the danger is not imaginary.

What You Can Do To Help Others

If it is not helpful to tell people to calm down, or that everything will be okay, what can we say and do to be helpful? Here are a few suggestions for those wanting to support fellow Americans who are suffering right now.

  1. Ask them what they need. Some people may know right away what is most helpful, and some won’t, but this is a good starting point. Asking this question communicates to the person that they are important to you, that they can be trusted to know what is best for themselves, and that you are willing to listen to them.
  2. Avoid playing “devil’s advocate. There is a time and a place to debate political issues in a cool, calm, and collected manner. If the other person is in a triggered state where they are feeling anxious and unsafe, now is not that time. When the brain is in fight-or-flight mode the rational, thinking areas of the brain dull as the body and subcortical areas of the brain rev up to prepare to the person to cope with danger.
  3. Help the person regulate their stress response. Instead of starting a deep conversation during a high anxiety state, consider ways that you can help the person manage their stress response. There are many techniques that can help with this, such as deep breathing, meditation, getting out in nature, yoga, eye contact, and physical contact (when appropriate and wanted by the other person). For more ideas about how to manage election-related stress, read this.
  4. Contribute to worthy organizations. Another way to help others is to donate time and/or money to organizations that work to preserve (or gain) the rights your loved one values. Knowing that there are organizations, movements, and other groups that are “in their corner” can help reduce a person’s stress and provide some peace of mind. Here are some organizations for your consideration. 
  5. Keep your privilege in check. While it is natural - and even loving - to want to understand what the other person is experiencing, be careful not to communicate to the other person that your support of them is contingent on your full understanding of the situation. Those of us who enjoy various types of privilege are accustomed to our opinions and viewpoints being very important and, well, privileged. This can make put us at risk of asserting our privilege in high stress situations where we demand explanations for others’ feelings, and in the process use privilege to override another person’s suffering. Also, keep in mind that belonging to a privileged group may make it impossible to fully “get” what others are feeling, as your experiences may be very different. It is okay if there are aspects of a person’s experience that do not resonate with you. Offering support is powerful regardless of whether you have had the same experiences in life!
  6. Remind the person they have options. You may have noticed that when you feel very stressed, the world seems to narrow. Problem solving becomes more difficult, concentration seems impossible, and creativity dulls. This means that the person experiencing PESD symptoms may benefit from others reminding them of their options. For example, while it would not be helpful to pressure or goad a person into a meditation practice, it might be helpful to simply suggest it, along with other stress management options. For instance, you might say to the person, “We could relax at home for a while, or do a breathing exercise, or walk the dog. What sounds best?” Remembering that options exist can be empowering, as it means that the person is not totally helpless and out of control.
  7. Hold space. To hold space means to create a safe and welcoming environment for someone you care about, so that they can feel free to come to you to express and process their pain. When we hold space for others we meet them where they are, listen to them attentively, and connect with them and their pain without an agenda to change them. For more information on how to hold space, read this article.

Finally, if you or other people in your life are experiencing severe post-election stress, consider asking for professional help from a psychologist. A list of professionals in your area can be found on Psychology Today.  

Recognizing the Signs of Post-Traumatic Stress

How do you know if you need help?

During the past year the United States has suffered several tragedies, including the Oklahoma tornados, the Boston Marathon bombing, the Sandy Hook School massacre, Hurricane Sandy, and the Aurora, Colorado shooting. With each passing year these events will be pushed further into our country’s collective past, but our sadness will never diminish. Although less than 20% of those exposed to traumatic events are expected to develop Post-Traumatic Stress Disorder (PTSD), a large percentage of victims will suffer from distressing post-trauma reactions that interfere with life.

The American Psychiatric Association’s Diagnostic and Statistical Manual-V2 classifies PTSD as a trauma- and stress-related disorder that includes four symptom clusters: intrusion symptoms, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. While a mental health professional’s assessment is required for a diagnosis of PTSD, the first steps toward a diagnosis (and therefore treatment) are 1) an improved understanding of the signs of PTSD, 2) a self-evaluation of the post-trauma reactions negatively affecting you and those you love, and 3) a willingness to ask for help. After all, we cannot address problems we do not recognize!

Post-trauma reactions occur after exposure to traumatic events such as motor vehicle accidents, sexual assault, terrorist attacks, natural disasters, and many other tragedies. During these events individuals experience terror, and they often feel helpless to stop the event. In the weeks, months, and even years following a trauma, substantial changes in a person’s thoughts, emotions, and behaviors may occur. Because such changes can be warning signs of PTSD or other serious post-trauma reactions, it is crucial for trauma survivors to be aware of how the trauma has affected them. How do you know if you or someone you love might be suffering from post-traumatic stress? Eight of the most common cognitive and emotional indicators of PTSD include:

1. Sleep Difficulties: Problems may include falling asleep, staying asleep, or experiencing frequent nightmares.

2. Anger: The person may feel irritable, and may experience frequent anger outbursts that are difficult to control.

3. Numbness and Disconnection: Trauma victims may feel disconnected from others. They may also feel numb and have difficulty accessing the loving feelings they know they have for loved ones.

4. Depression: Depressed mood, hopelessness, and a loss of interest in previously enjoyed activities are common.

5. Chronic Anxiety: Individuals often report feeling on guard and hypervigilant, and they have difficulty relaxing and “unwinding.”

6. Reliving the Trauma: Highly distressing thoughts and memories of the event may repeat in the mind, despite the individual’s attempts to avoid or stop them.

7. Feeling Unsafe: The person may experience intense feelings of fear or impending doom even when no danger is present. They may also feel as though it is impossible to ever feel safe again.

8. Thoughts of Suicide: Suicidal thoughts may be active, with an intention and plan to commit suicide (“I will purchase a firearm to shoot myself”). Conversely, these thoughts may be passive (“Things would be better if I just weren’t around anymore”).

In addition, many trauma survivors exhibit significant behavioral changes after suffering a traumatic event. Such changes in behavior may become apparent in several domains of a person’s life, some of which include:

1. Relationships with Others: Increased conflict with others, withdrawal from relationships, and decreased trust and intimacy are common PTSD indicators.

2. Self-Esteem/Relationship with Self: Changes may also take place in an individual’s relationship with themself. Self-harm behaviors, thoughts of suicide, and reduced self-care and self-esteem can be signs of a serious post-trauma reaction.

3. Work Performance: Those suffering from PTSD often experience difficulty concentrating, sometimes due to thoughts about the trauma, or to lack of sleep. This in turn may compromise one’s ability to complete daily tasks or to perform well at work.

4. Lifestyle: After a trauma some individuals go to great lengths to avoid reminders of the event. For instance, they may isolate and give up hobbies or activities they used to enjoy. The purpose of this may be to feel safer and less vulnerable, and to reduce reminders of the trauma. For example, a combat veteran who was bombed in a crowd oversees may avoid concerts despite his love of music, in order to feel safe.

5. Coping: Ineffective coping strategies may be adopted after trauma. For instance, an individual may begin drinking alcohol or using drugs to cope with their symptoms. Often, these unhealthy ways of coping help the individual temporarily avoid reminders of the traumatic event.

In the first few weeks following a trauma, most people will experience at least a few post-trauma reactions and symptoms. However, if you experience these changes for more than one month, if they interfere with your daily life, or if you have thoughts of hurting yourself, it is important to seek professional help as soon as possible. The following websites offer assistance to those looking to connect with a mental health professional:

• Substance Abuse and Mental Health Services Administration, Disaster Distress Helpline: disasterdistress.samhsa.gov/

• Psychology Today: therapists.psychologytoday.com

• GoodTherapy.org: www.goodtherapy.org/

• NetworkTherapy.com: A Mental Health Network: www.networktherapy.com


1. Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048-1060.

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

This article was originally published on Psychology Today on 7/04/2013.