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CHAPTER ONE

POSTTRAUMATIC STRESS DISORDER

“Almost every human body is under a great deal of stress, not because it is threatened by some external factor but from within the mind.”

— Eckhart Tolle, A New Earth

When we think of all of the external threats in our world today — worldwide pandemics, terrorist attacks, natural disasters, wars, motor-vehicle accidents, sex trafficking, bullying, workplace harassment, relationship and child abuse (mental, emotional, physical, and sexual), as well as other events that anyone would consider traumatic and extremely stressful — we cannot deny that trauma is part of many people’s lives at some point. While no one wants to believe PTSD can happen to them, the reality is that it can. Millions of people worldwide are affected by PTSD.

After a traumatic event, people want to “get over it” as quickly as possible and get on with their lives, but if you are suffering from PTSD, you haven’t been able to. Things are getting worse instead of better. The people in your life may not understand what you’re going through. Heck, you likely can’t make sense of it. You may have heard things to imply you’re exaggerating or being treated as “overly sensitive.” You may have heard, “What doesn’t kill you makes you stronger,” or “you just need to learn to deal with it”. This can be very frustrating and isolating as you find yourself fighting what seems to be a losing battle against the persistent, debilitating, and unpredictable “enemy” that is attacking you from within your own mind. The fact is, PTSD produces real, measurable changes to areas of the brain responsible for mediating stress, emotion, memory, as well as other cognitive and physiological functions. Although PTSD has many psychological effects, its basis is in your nervous system. However, this doesn’t mean there is nothing you can do about it. In fact, many do recover from PTSD to a point where they can live productive and meaningful lives, sometimes recovering to such a degree that they no longer experience symptoms or qualify for the diagnosis. Before talking about how to recover from PTSD, first it is important to understand what is happening to you. The aim of this chapter is to help you understand PTSD, trauma, signs and symptoms, risks and protective factors, as well as the duration, prognosis, and neurobiology of this condition. You may have already done your own research, in which case this chapter will serve as a review and will provide foundational knowledge for your recovery.

WHAT IS PTSD?

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most comprehensive, respected, and utilized resource in the classification and diagnosis of mental disorders. In the DSM-5, which is the most recent version, PTSD is classified as a stress- and trauma-related disorder. There are arguments suggesting that PTSD should instead be classified as a mental injury and not as a disorder because a person has to be psychologically injured by a traumatic event in order to develop PTSD. There are good points for and against dropping the word “disorder,” and I do believe this change may happen in future editions of the DSM.

Whether PTSD is viewed from an illness or injury perspective (or both), no one can argue that PTSD creates adverse long-term changes in emotion, thinking, and behaviour as a direct result of exposure to trauma. The symptoms of PTSD are persistent and can cause much “dis-order” in a person’s ability to function in several, or all, areas of life — mentally, emotionally, physically, spiritually, socially, financially, and professionally.

PTSD develops in response to a traumatic event that breaks down the stress management system and dysregulates the normal functioning of the nervous system, which includes two branches, the central nervous system and the peripheral nervous system.

What we now know as Posttraumatic Stress Disorder originates from the effects of combat on soldiers who fought in World War One. It was originally called “shell shock,” “combat fatigue,” or “war neurosis.” It wasn’t until 1980 that PTSD first appeared in the third edition of the Diagnostic and Statistical Manual (DSM-III), but evidence of PTSD dates back to long before the war or the advent of modern psychiatry. Even though PTSD was first connected to war trauma, it was soon discovered that you don’t have to be a soldier or veteran to have PTSD. It is now well recognized that other professions are also at high risk, namely firefighters, paramedics, police officers, doctors, nurses, and other health professionals, because they are much more likely to experience repeated exposure to trauma. However, they are not the only ones who develop PTSD. Over the last forty years, the diagnostic criteria for PTSD has changed substantially to reflect its current definition as a trauma- and stressor-related disorder that can develop in anyone who is directly or indirectly exposed to major trauma.

The diagnosis and treatment of life-threatening illnesses such as cancer had been included in the fourth edition of the DSM as a traumatic stressor that can cause PTSD, but this has since been removed. The DSM-5 specifically states, “a life-threatening illness or debilitating medical condition is not necessarily considered a traumatic event. Medical illnesses that qualify as traumatic events involve sudden, catastrophic events.” As a result, many medical conditions no longer qualify for a diagnosis of PTSD. With that said, a disease like COVID-19 with mass worldwide infection and no vaccine or cure would be considered a “sudden, catastrophic event,” which has been compounded by things like social isolation, uncertainty, fear of transmission, lack of treatment and resources, negative media coverage, and immediate threat to life. This may leave those who have recovered, healthcare professionals, and family members at a high risk of developing PTSD.

Unfortunately, despite awareness campaigns and education efforts, many are still under the false impression that PTSD only occurs in those who have fought in wars. It is important to dispel this myth, since it can prevent people from recognizing they have PTSD, leaving them undiagnosed and untreated for far too long. Here is what a police dispatcher said:

I didn’t know I had PTSD for the first six years. I thought for sure I had cancer or some other serious physical illness. When my doctor diagnosed me with depression, it didn’t make sense. I had a good life. I’d never had depression before. I didn’t see myself as depressed, but I knew there was definitely something wrong. I couldn’t get out of bed for days. I felt intense guilt and shame. Things I’d heard during my eighteen years as a dispatcher were coming back in disturbing flashes. It was confusing, because these things had never bothered me the whole time I was working. It was the opposite; I’d get an adrenaline rush during times of crisis. I loved my job and never called in sick. But suddenly I had no energy or motivation. I didn’t know what was wrong with me.

When I was invited to a support group called “Wings of Change,” I didn’t think I belonged there because I didn’t think PTSD happened to dispatchers since we don’t actually see trauma; instead, we hear it. But when I heard another dispatcher sharing her story, which matched mine almost exactly, I had a huge sense of relief. It finally made sense. I knew what was going on with me and could start dealing with it.

Another woman said:

I was in a bad car accident and was lucky to survive. I had some physical injuries, which I mostly recovered from, but something was wrong in my head. I kept hearing the sound of the crash over and over. I had intense anxiety, panic attacks, and complete emotional meltdowns. People kept telling me I should be thankful to be alive, and I knew that, but I couldn’t control my thoughts and emotions. I ended up being diagnosed with anxiety and panic disorder, but eventually, as my symptoms worsened, a counsellor suggested I talk to my doctor about PTSD. I didn’t think I could have PTSD because I wasn’t critically injured in the crash. I honestly thought PTSD only happened to cops and veterans. But now that I know I have PTSD, I have been able to get the help I need.

Here is how an ICU nurse explained it:

There is a high mortality rate in the intensive care unit because we are treating the most critically ill patients. So, I guess I just got desensitized to people dying. I had no idea it was taking a psychological toll on me. When things started getting worse, I kept telling myself, “this is what I signed up for.” But you really can’t predict all the things you’re going to have to deal with. You don’t anticipate going to work fearing for your own life and that of your family. You don’t expect to run out of personal protective equipment while treating patients with a highly contagious, deadly disease. I was having anxiety attacks before work and getting more and more angry at how things were being handled. I was having other symptoms too, but I thought maybe I was having a burnout or that I was just highly stressed like everyone else. PTSD didn’t even cross my mind at first.

PRACTICAL EXERCISE — GET SUPPORT

If you suspect you may have PTSD, even if you’re not sure, reach out for support and talk to someone about what you’re experiencing. There are a number of reasons you may not want to get professional help. Maybe it’s not available or is too costly. Perhaps you don’t feel ready or fear being stigmatized. Or you may have had bad experiences in the past. Whatever the reasons, I strongly encourage you to reconsider, since there may be things you can’t deal with on your own. Trying to process your trauma alone can leave you feeling more confused and distraught than before, so reach out to someone who can provide you with support. If a counsellor is not an option, find a trusted friend you can confide in. If you wish to access services and don’t know where to start, contact your doctor’s office or local counselling centres. If they do not offer the services you need, they will be able to point you in the right direction. If you’re not ready to make the call yet, find the phone numbers so you have them on hand if, and when, you need them.

REFLECTIVE QUESTIONS

• If your PTSD had a name, what would it be?

• How would you describe your PTSD? If it had its own personality apart from yours, what would it be? For example, how does it sound? What does it say? How does it think?

• Draw a picture of your PTSD. Don’t worry if you’re not much of an artist; you can find a photo online that would be a good representation. Once you have your image, put it in a safe place, because you will need it again in later chapters.

WHAT IS TRAUMA?

Trauma comes from the Greek word “wound,” which implies injury. Some widely accepted definitions for trauma include:

• a deeply disturbing and distressing experience

• an injury to living tissue caused by an extrinsic agent

• disordered psychic or behavioural state resulting from severe mental or emotional stress, or physical injury

While everyone is exposed to stressful events at some point in their lives, it is important to note that PTSD does not result from exposure to typical everyday stressors, like the pile of work on your desk, a stressful conversation with your boss, midterm exams, or even more stressful things like a cheating spouse, financial hardship, or other stressors that we can reasonably expect to encounter over the course of our lives. Rather, according to the most current edition of the Diagnostic and Statistical Manual (DSM-5), in order to be diagnosed with PTSD, “a person must be exposed to a traumatic event where death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

• Direct exposure

• Witnessing the trauma

• Learning that a relative or close friend was exposed to a trauma

• Indirect exposure to aversive details of the trauma, usually in the course of professional duties.”

When traumatic events are experienced, the stress response is activated and the survival part of your brain takes over to get you through the crisis. Once the crisis is over, the stress response spontaneously shifts back to its pretrauma state over a relatively short period of time. However, with PTSD, the survival part remains in charge, and your stress response stays on high alert. The result is a whole host of debilitating mental, emotional, and physical symptoms that continue long after the traumatic event.

PRACTICAL EXERCISE — MEET YOUR TRAUMA

Take the time to reflect back on the traumatic experience that triggered the development of PTSD. There may be several traumatic experiences that contributed, but see if you can find the event that you most associate with developing PTSD. If you are not able to pinpoint just one, take the event that haunts you the most. Turn to the section in your workbook (or use your journal) and write everything you recall about this event without filling in any of the blanks in your memory. It is common not to remember certain aspects of your trauma. Some people have told their traumatic story many times and can talk about it from a detached emotional state. However, if you haven’t faced your trauma before, this exercise may be very difficult, so make sure your support person is available before starting. If you are worried about facing your trauma, remember that it is already haunting you, and trying to hide from it has not been successful. Take it slow. This does not need to be done in one session. If your fear, stress, anxiety, or physical symptoms become too unbearable, take a break. But make sure to come back to it later.

REFLECTIVE QUESTIONS

• What was the duration of your trauma? How long did it last (in hours, weeks, months, or years)?

• How much do you think about this event on an average day? In other words, how much does this traumatic event consume your thoughts?

• What do you think you’d be thinking about if PTSD wasn’t consuming you?

PTSD SYMPTOMS

It is completely natural to have an intense reaction during and after a traumatic event, but as the shock of the experience starts to wear off, most people return to a state of psychological and physiological balance. As they process their thoughts and emotions surrounding the traumatic event, their nervous system starts to settle down until it returns to its normal prestress state, a state often referred to as homeostasis or baseline. Those who develop PTSD, on the other hand, stay in a state of psychological shock, and as a result, their nervous system remains in a reactive survival state and several neurological systems become dysregulated.

Everyone experiences PTSD differently based on their unique nervous system, genetic makeup, and past experiences. Even when two people are involved in the same event, it can be experienced very differently, both at a perceptual level as well as at a biological level. For those who develop PTSD, their symptoms can vary widely, but there is a set of symptoms that must be present in order to meet the diagnostic criteria for PTSD:

• Symptoms must be present for at least one month.

• At least six months has passed since the trauma.

• Symptoms cannot be caused by medication, substance use, or other illnesses.

• Symptoms must be severe enough to create impairment in the person’s ability to function in several areas of their lives.

According to the DSM-5, these symptoms fall into four symptom clusters:

1. Intrusion symptoms

• Unwanted and involuntary thoughts, memories, flashbacks, and nightmares causing emotional distress and/or physical reactivity.

2. Avoidance

• Avoiding trauma-related thoughts, feelings, and external triggers (e.g., people, places, things, and situations that act as reminders of the trauma).

3. Negative alterations in cognition and mood

• Overly negative thoughts and assumptions about oneself, others, and the world, as well as persistent negative moods and difficulty accessing positive emotional states.

4. Arousal

• Hypervigilance (always being “on guard”) and heightened startle reaction (very jumpy).

In addition to the symptoms in these four categories, a person must also experience either derealization (the experience of feeling detached, disconnected, and dissociated from your surroundings) or depersonalization (the experience of feeling detached, disconnected, and dissociated from oneself, like an outside observer).

The ways PTSD can affect you can seem endless; therefore, the next chapter focuses not only on the symptoms listed in the DSM-5, but also other common effects of PTSD such as suicidality, physical health effects, and problems in daily living.

PRACTICAL EXERCISE — RECOGNIZE YOUR SYMPTOMS

You may have spent a lot of time and energy trying to avoid your symptoms of PTSD, but the more you resist, avoid, and try to suppress these symptoms, the more persistent they will get. Start by writing in your workbook or journal about the symptoms you’re experiencing. To do this, just put your pen to paper and let whatever comes out, come out.

REFLECTIVE QUESTIONS

• Of the symptoms listed above, which can you relate to most? Which can you relate to least?

• Are there symptoms you are experiencing that are not listed? If so, what are they?

• Of the symptoms you are experiencing, which are most distressing to you?

DEVELOPMENT AND DURATION

PTSD starts with an acute stress reaction following a traumatic event. Symptoms may start immediately, or there may be a delay, usually not more than six months. Sometimes it is not until many years later when another traumatic event or a reminder of the original trauma triggers PTSD. In fact, I have met several people who experienced trauma early in life and then functioned relatively well for many years before developing PTSD. For some, it developed after exposure to further trauma, while for others, it was triggered by an accumulation of what would be considered typical life stressors. Although PTSD is not caused by “normal” stressors, there are times when situations of high stress, including what would be considered “normal” stress, can trigger PTSD in those who have a history of trauma. This can be very confusing to the person as they struggle to understand why they were able to function well for so long and then suddenly develop PTSD so many years after the precipitating trauma. Here is an example:

I experienced a lot of childhood trauma, but I was doing well in life. I went to college, was married, had two healthy kids, and was working full-time as a respiratory therapist. Then I had a string of bad luck. I broke my arm and needed surgery. I couldn’t work for a time when we were already having money problems. This caused problems in my marriage. By the time I went back to work after recovering from surgery, I was very stressed and anxious. On my third day back, I had to withdraw a dying patient’s ventilator while her husband and ten-year-old son stood at the bedside. Seeing the look on her son’s face broke me. I had a complete mental and emotional breakdown. As time went on, I continued to get progressively worse. A year later, I was diagnosed with PTSD.

Here is an example of delayed onset caused by a reminder of the original trauma:

I was a teacher, functioning well in life. I was successful by all standards — married, kids, financially stable, healthy — I had everything. Then one day I came face-to-face with a man who had been there the night I was raped. He wasn’t involved in any of the things that happened. He is a really good guy, but he was at that party all those years ago, and I hadn’t seen him since. Memories came flooding back. The nightmares started. I felt anxious and scared. I didn’t know what was going on with me. My principal noticed the change in my stress level and suggested I take time off work, but I was stubborn. I thought I could work through it, but a few months later I completely broke down. I was diagnosed with PTSD soon after.

PTSD can also develop as a result of extreme repeated trauma that is not recognized as trauma. Here is an example of this:

I’d been working in the prison system for eighteen years. I’ve seen lots of things. Things you can’t unsee. But the thing is, I had no reaction to it, except maybe in the first few weeks of starting the job. I was very quickly desensitized. I really didn’t think it was having an impact on me. I slept like a baby. Never had nightmares or fears. I had good, respectful relationships with my colleagues and the inmates. I was calm and levelheaded, no matter what chaos was happening in the jail. I was a high-energy person, motivated, athletic, with relatively healthy habits. Then last summer I started feeling unwell. I had no energy, couldn’t sleep, and was moody. My normally optimistic outlook turned negative. Everywhere I looked, it was shit. My tolerance level for anything and anyone crashed down. I was angry and pissed off for no reason. Things that normally wouldn’t have phased me were bothering me a lot. Then one day at work, inmates were arguing (an everyday occurrence), and I just blanked out for a second and then walked right out. Nothing major happened. I just couldn’t do it anymore. It was like Pandora’s box opened, and I’ve been having flashbacks and nightmares ever since. I wake up drenched, in a panic, and can’t lie back down for hours. I haven’t slept decently in over six months. I’ve been diagnosed with PTSD and haven’t been able to work or be productive since. I’ve been off work for three months and already had four medication changes. After talking with other people who’ve gone through this, they said it can take years to find the right combination of medications. I seriously don’t think I can handle years like this. It’s so frustrating. I just want to get better and get back to my old self.

The severity and duration of PTSD symptoms cannot be summed up into a logical formula. We cannot say that all people who experience a certain type of trauma will have X symptoms for Y amount of time. It is similar to when someone is diagnosed with a certain type of cancer. Doctors can only give an educated guess as to the progression of the disease and the prognosis, but there is no certainty with respect to how each individual will respond to the illness or to the treatment. The factors at play are just too complex and too vast. The reality is there are no set timeframes, and unfortunately no one can accurately predict how intense your symptoms will be or how long your trauma reaction will last.

PRACTICAL EXERCISE — GIVE YOURSELF PERMISSION

There is no right way to react to a traumatic event, so give yourself full permission to process your trauma. Avoid telling yourself things like: “I should be over this by now,” “I should be stronger,” “I can’t live like this,” etc. Putting pressure on yourself will not help. Comparing, judging, and criticizing yourself will hinder your healing. Be as patient and gentle with yourself as possible. Give yourself permission to take the time to heal. At least twice a day (morning and night), stand in front of a mirror and say, It’s okay to not be okay. Maintain eye contact with yourself for at least thirty full seconds afterward. Be aware of your thoughts and see if you can turn any negative thoughts into positive ones, the way you would if you were talking to a close friend or family member.

REFLECTIVE QUESTIONS

• What are you afraid might happen if you give yourself full permission to process your trauma in your own unique way? What good might come of it?

• In what ways might you be keeping yourself stuck in your trauma reaction by fighting it?

• How would your life be different if you were more patient with yourself and talked to yourself the way you would talk to your best friend?

THE NEUROBIOLOGY OF PTSD

Although there is still much to learn, we know that there are several key differences in the brain structures, neuronal activity, synaptic connections, and neurochemistry of those who have PTSD when compared with those who don’t. Commonly identified differences include (but are not limited to):

• Reduced hippocampal volume

• Less connection between hippocampus and prefrontal cortex

• Less activity in the prefrontal cortex

• Overactivity in the amygdala and a larger right amygdala

• Altered function of the HPA axis

• Atypical hormone and neurotransmitter levels, including:

• Low cortisol at time of trauma

• Elevated epinephrine and norepinephrine levels

• Low GABA levels

• Alterations in glutamate levels

These brain structures and neurotransmitters will be explained in more detail in later chapters, but for now I will briefly describe some of their key functions related primarily to PTSD:

1. Key Brain Structures

• Hippocampus: Responsible for consolidating memories (forming and storing new memories) and reconsolidating old memories (retrieving a memory from long-term storage, bringing it into working memory, and then re-storing it). The hippocampus has a high number of stress hormone receptors, which is critical for the proper functioning of the stress response.

• Amygdala: Detects threats and alerts other brain structures and systems within the body.

• Prefrontal Cortex: Involved in a variety of complex executive functions, including planning, analysis, judgement, and decision-making.

• Hypothalamic Pituitary-Adrenal Axis (HPA axis): The HPA axis a term used to represent the interaction between the hypothalamus, pituitary gland, and the adrenal glands. The HPA axis plays an important role in regulating the stress response (turning it on and off).

2. Hormones and Neurotransmitters:

• Cortisol: This hormone plays a critical role in activating, as well as deactivating the stress response.

• Adrenaline and norepinephrine: Stress hormones that also act as neurotransmitters and are highly involved in the stress response.

• GABA: The brain’s main inhibitory neurotransmitter and helps inhibit amygdala and nervous system activity.

• Glutamate: The brain’s main excitatory neurotransmitter.

It is generally accepted that PTSD is caused by a dysregulation in several stress-mediating systems as a result of exposure to trauma, but exactly how and why this dysregulation occurs remains unclear. What we do know is that these structural and functional differences cause observable effects, including:

• Exaggerated stress response

• Inability to extinguish fears associated with the traumatic event

• Impaired ability to discriminate between safe and unsafe stimuli

• Inability to suppress unwanted thoughts and memories

• Difficulty regulating emotions and coming down from high emotional states (such as anxiety and anger)

• Periods of dissociation (out-of-body experiences, not knowing where you are or how you got there, etc.)

• Difficulty with concentration, attention, learning, and memory

• Increased physical ailments

Understanding how things become dysregulated with PTSD is problematic because there are so many systems involved, and the neurological, biochemical, and genetic influences have not yet been fully unravelled. Contradictory research findings further compound the problem, making it nearly impossible to draw clear conclusions.

PRACTICAL EXERCISE — CONSIDER THE EFFECTS OF PTSD

Understanding the functional and structural brain changes in PTSD can relieve some of the guilt and shame that can be experienced by those with PTSD. When someone believes their situation is their fault or that they are just not strong enough to fight it, it may help to know there is an organic, physiological explanation. The more we understand these biological factors, the more we can learn effective ways to influence them in positive ways. In your journal, describe how you feel about the measurable physiological changes that are affecting you.

REFLECTIVE QUESTIONS

• On a scale of 1 to 5, how possible do you believe it is to positively influence your nervous system?

• How might you experience life differently if your most distressing effects were no longer present? Imagine your life without PTSD and what that would look like. How would your life be if you woke up tomorrow and PTSD had magically disappeared overnight? Create a clear vision of this possibility in your mind.

• PTSD has already robbed you of a lot of precious time and energy. Consider what else you might lose if your nervous system stays in survival mode. Make a list.

RISK FACTORS

Imagine a police officer arrives on a crime scene moments after a serial killer has removed the kidneys of a man he has just murdered. By the time the officer arrives, the killer has already been arrested by the first officers on the scene, and his bloody hands are in handcuffs. As the officer examines the area, he discovers another room where he finds several more dead bodies.

Now imagine a second scenario where a medical student is in the operating room observing a potentially life-saving kidney transplant. As it sometimes happens, things go wrong and the patient dies. Let’s further suppose the medical student then goes to the morgue and passes several corpses before finding the pathologist.

The police officer and medical student are essentially being exposed to very similar scenes. Considering the two scenarios, who would you predict would be at highest risk for developing PTSD?

You may have guessed the police officer, which would be a good guess. However, the risk and vulnerability factors associated with PTSD are multifaceted and unique to each individual, making it very difficult to predict who will develop PTSD. It may be the officer or the student, or it could be the surgeon, a nurse who was in the operating room, or a family member of one of the murder victims. The truth is, no one knows exactly why one person will develop PTSD after a traumatic event while another will not. To complicate matters, trauma responses not only vary from person to person, but also vary within the same person over time. In other words, even if you’ve moved through trauma in a certain way in the past, it doesn’t mean you will move through it in the same way if exposed to a similar trauma in the future. Many first responders have told me things like, “I’ve seen worse things before, I don’t understand why I can’t get over this one,” or “I’ve handled similar situations so many times. Why is this one still haunting me?”

There are so many factors and variables at play in any given situation affecting a person’s reaction to a traumatic event. Why some people develop PTSD while others do not, or why one person develops PTSD in response to an event that they’ve dealt with before, is not an easy question to answer, and in fact, it cannot be fully answered with the information that is currently available. While it is impossible to predict who will develop PTSD, or when, there are certain factors that increase a person’s risk. Some of these factors revolve around the nature of the traumatic event itself, while others have to do with the person’s past experiences, conditioning, and genetics. Keeping in mind that we are all different as individuals and each person’s experience has unique aspects, here are some of the risk factors, in no particular order:

• Previous exposure to stress, trauma, and adverse experiences early in life

• Co-occurring physical or psychiatric conditions (two conditions occurring at the same time)

• Neurobiological changes (i.e., a smaller hippocampus, larger amygdala, low cortisol at time of trauma, persistently high norepinephrine)

• Genetic predisposition (family history of PTSD)

• Warfare

• History of sexual assault

• Bullying, workplace, or social harassment

• Previous mental, emotional, or physical abuse

• Gender: women are more likely to develop PTSD than men

• Isolation and lack of social, family, and work supports

• Type of trauma

• Severity of the trauma: the more extreme, prolonged, or personal, the more increased the risk for PTSD. For example, a traumatic experience such as rape increases risk of PTSD in comparison to a natural disaster.

• Proximity to the trauma: how close you were physically as well as emotionally. For example, if you are exposed to the death of child that resembles your own child, it will be closer to you emotionally.

• Duration of trauma: how long did the traumatic experience last? Was it repetitive?

• Perceived level of threat:

• Was the traumatic event perceived as intentional or unintentional, expected or unexpected, uncontrollable or inescapable? For example, imagine you are on the reality show Fear Factor, and you are willingly eating maggots in an effort to win the game versus being forced to eat maggots by your older brother who enjoys tormenting you. In both scenarios you are eating maggots, but in the first scenario you have control, it is expected and escapable, and there is no real or perceived threat of harm.

PRACTICAL EXERCISE — UNDERSTAND YOUR PTSD RISK FACTORS

Using the list above, identify all of the risk factors you believe may have put you at risk for developing PTSD. Write them in your workbook or journal.

REFLECTIVE QUESTIONS

• Of the factors you identified, which do you believe put you at highest risk for PTSD?

• Are there other factors not listed that you believe may have put you at higher risk?

• In examining your personal risk factors for PTSD, is there anything that surprised you? Why or why not?

POSITIVE PREDICTORS

Just as there are several known risk factors for developing PTSD, there are also several factors that are associated with a positive prognosis. It is shown that people who receive support and practice healthy lifestyle habits are more likely to achieve higher levels of functioning and a better quality of life. Although things can feel hopeless at times, there are several things within your control (or at least partially within your control) that can positively affect your prognosis, including:

• Early treatment: Several studies found that the sooner treatment is received, the better the outcome

• Subjective interpretation of the trauma

• Availability of support immediately after the trauma

• Social support network and sense of community/belonging

• Abstaining from alcohol

• Avoiding re-traumatization

• Mental, physical, and emotional fitness/wellness prior to traumatic event

• Healthy habits (good sleep, regular exercise, proper nutrition, etc.)

• The belief that you can, and will, recover

PRACTICAL EXERCISE — GET MORE SUPPORT

In order to contribute to your own recovery, it is important to identify the factors that are within your control and to get support to tackle them. Joining a support group can be hugely beneficial. These benefits include things like being able to talk openly to people who understand what you’re going through, feeling normal and less alone, and getting advice and feedback on how to cope. Try to find a local support group in your community and go to a meeting this week. For example, in Canada, Wings of Change is a peer support group that is education and solution-based for those who experienced work-related trauma. If your trauma is not work-related or if you live in a different part of the world, a good starting place would be to contact your local hospital, doctor’s office, counselling centre, or do some online research to find out what’s available in your area. Avoid support groups that focus on the details of trauma and instead find one that is focused on healing and recovery.

REFLECTIVE QUESTIONS

• What, if anything, have you been doing to keep yourself as healthy as possible?

• What things could you start doing to increase your predictors for a more positive prognosis?

• Do you plan to join a support group? Why or why not?

CONCLUSION

When acute stress caused by trauma has negatively impacted you physically and psychologically, you can feel as though all hope is lost. That you will never again be able to enjoy a healthy, happy, and peaceful life, but research has consistently shown evidence of the neuroplasticity of the human brain. While influenced by early childhood experiences and environments, our neurology is not set in stone. In fact, our brain circuitry can be rewired and reprogrammed to a large degree. Human beings are dynamic, and we are capable of change from the inside out. By further understanding PTSD at a neurobiological level, there is real promise of unlocking the mysteries that will lead to reliable assessment, detection, and effective treatment of PTSD.