The policeman and the barking dog behind PTSD

What is Post-Traumatic Stress Disorder (PTSD)?

Post-Traumatic Stress Disorder (PTSD) can occur after you have been through a traumatic event where you may have felt that your life or someone else’s life was in danger or under serious threat. The main feeling that characterises PTSD is that of intense fear and helplessness.

Symptoms – How do i know i have PTSD?

Symptoms of PTSD can be terrifying, disrupting your daily activities and even making it hard to get through the day. In order to be diagnosed with PTSD, and in line with DSM-IV criteria, symptoms must be present for over a month and involve all or some of the following:

♦️ Re-experiencing (need 1 or more): flashbacks (reliving the trauma as if it was happening now); nightmares of the traumatic event; intense distress when faced with reminders of the event; and/or physiological reaction at reminders      

♦️ Avoidance (need 3 or more): avoidance of thoughts and talking about the traumatic event; avoidance of the place where the trauma took place or people who were associated with the event; disinterest in activities; memory loss; detached feeling; hopelessness / futility; loss of emotions. 

♦️ Hyperarousal (need 2 or more): sleep disruption; lack of concentration; hypervigilance; being on edge; irritability.

If you have any of the above symptoms this is NOT YOUR FAULT, but your brain’s way of dealing with traumatic events.

Why do I have PTSD?

I often find that when I see clients with PTSD symptoms one of the first things they ask is “why do I have this?”. Other than reassuring them that this is a normal reaction to something that was very traumatic, I always find that offering an explanation of how our brain works in such cases in a simple – understandable – manner is always the most successful way in truly answering that question. So here it goes.

Our brain has two parts that play a significant role in the development of PTSD:

 ♦️ The Hippocampus OR “the policeman” as I like to describe it, who likes to keep the order 👮‍♂️ This is the part of our brain which is responsible for organising and recalling our memories in chronological order. Under normal circumstances, our “policeman” lets us know when and where everything took place and can identify each memory as something in the past. However, when under severe stress – such as experiencing a significant trauma – the policeman can be described as “asleep” / not working and so he is not able to store those memories in any order at all, thus storing them in the wrong place, the amygdala.

♦️ The Amygdala OR “the barking dog” for our purposes. This is part of our alarm system that aims to keep us safe and prepares us for action through “fight or flight”. It is very sensitive and picks up on ‘real danger’ as well as memories about danger. It has no sense of time so is unable to separate the two. Therefore, when we are confronted with a reminder of our trauma, that dog will start barking and set off the alarm bell making us feel that the traumatic event is happening again.⠀

How can i get over PTSD?

In essence what we aim to do through therapy is help the policeman “wake up” again so he can respond to the alarm set off by the barking dog and place the memory of the trauma where it belongs, in the past. CBT has been proven to be the most effective course of treatment for PTSD, enabling the sufferer to process the traumatic event in detail and thus promoting a good partnership between the “policeman” and the “barking dog” 👮‍♂️❤️🦮. 

Once the brain is able to set the traumatic experience in the past where it belongs, it is also able to realise that the threat is over and that there is no need to be constantly on guard, by being hypervigilant or avoiding specific places/people/conversations. The CBT treatment for PTSD is a very demanding process (as are the treatments for most disorders!) but one that has been proven the most effective in helping sufferers break free from their trauma and regain a sense of control over their lives. 

‘Always remember, if you have been diagnosed with PTSD, it is not a sign of weakness but a sign of your strength, because you have survived’

Mental health and social isolation

As human beings we are social creatures and therefore having a social life is important for our mental wellbeing. It is not by chance that throughout history, people would hunt in groups and socialise or else would often suffer negative consequences. Research has proven that being socially connected to others gives us a sense of belonging and self-worth whilst also increases our levels of happiness. A meta-analytic review of 148 studies also reported a 50% increase in our chances of survival when part of a social group. On the contrary, lower levels of social connection have been associated with greater risk of mental health disorders such as anxiety and depression.

So, what is the impact of the current climate and the recommended “social distancing” as a measure to limit the spread of COVID-19?

Whilst it is of utmost importance to follow the government guidelines in order to protect our physical health and that of others, it is equally important to keep in mind the impact of these measures on our mental health and how we can minimise this so as not to allow room for a different kind of epidemic that is already characterising our modern world – that of “loneliness” – to grow even more. As human beings our brains are wired to be social, and therefore when we feel isolated or lonely our brains react in a negative way thus leading to poor mental health and even premature death.

”Social distancing” or “physical distancing”?

One topic that has recently started to emerge and is creating differing opinions has to do with the term “social distancing” that has widely been used during the current pandemic. Concerns have been raised about the wrong messages that this may be sending to people around the world when in essence, “physical distancing” would be a more accurate term. Dr Maria Van Kerkhove, a COVID-19 technical lead (World Health Organisation) In a recent briefing said that she and her colleagues are exchanging “social distancing” for “physical distancing” “because while keeping physical distance from people is essential for mitigating the spread of COVID-19, that doesn’t mean that socially we have to disconnect from our loved ones, from our family”.

So, what can I do to protect my mental health during lockdown?

The most common emotional reactions to the current lockdown include: anxiety, fear, anger/frustration, loneliness, and boredom. Here are some tips to help you through:

1. Routine: It is very important to maintain a routine, especially now when you will be spending the majority of your time indoors. Setting your alarm clock for a specific time each morning, setting yourself specific breaks throughout the day and having a set bed-time are all crucial to maintaining stability and better physical as well as emotional health.

2. Sleep: sleep is likely to be affected during such stressful times so sticking to a routine as mentioned above is likely to reduce the chance of sleep disturbances. If you notice that you are tossing and turning in bed, then get up and go do something in another room – only return to bed when you feel you could actually fall asleep. Reducing time spent in bed awake strengthens the association between bed and sleep and conditions your body so as to know that when you go to bed it is time to sleep!

3. Boundaries: When working from home it is almost too easy for boundaries to become blurry, often leading to long-hours of work and limited room for relaxation or other leisure activity. As a result, the balance is compromised increasing the chances of increased anxiety levels and low mood. Set yourself a specific time to close your work and move on to something different.

4. Sense of achievement and pleasure: It is of vital importance to maintain a healthy balance between the two. Even if it is something small such as sending an email you have been postponing or sorting out your whole wardrobe, getting a sense of achievement will give you a good psychological boost. Equally, make sure you engage daily in an activity that gives you pleasure whether this is cooking or creating a piece of art, as this will also make you feel good.

5. Social interaction: from a distance of course! In times like these it becomes even more important to stay connected to our loved ones as that is big part of our identity and helps us feel safe and “not lonely”. Thanks to technological advances, it is possible to stay in touch in so many different ways so find what works best for you and your family/friends and make sure to schedule regular catch ups.

6. Limit news intake: whilst it is understandable that you will probably want to stay up to date with the developments of the current situation, it is also true that constant exposure to the news can have an adverse impact on anxiety levels. Try and set specific times in the day where you will catch up with news and try and avoid this near bedtime as it may impact on your sleep. 

7. Exercise: government guidance suggests up to one hour a day outdoors for physical exercise so try and find a space (park or other) that does not get over-crowded and make sure you get that exercise in. Whether it is a run or just a casual walk it will still do you good and release those endorphins that will keep you going! You can also do exercise indoors by yourself or following live streaming instructors – there is a lot on offer nowadays from yoga to Zumba so choose what works for you!