Post-traumatic stress disorder (PTSD) may occur in people who have experienced or witnessed a traumatic event, series of events or set of circumstances. This might be a natural disaster, car accident, physical assault, rape, serious injury or childhood abuse, among others. Not everyone who has these experiences develops PTSD, but for those who do, episodes can be disturbing and very hard to cope with. Read on to learn more about PTSD episodes.

What Is a PTSD Episode?

People with PTSD have episodes with intense, disturbing thoughts and feelings related to their experiences that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares (an “episode”) or feel sadness, fear or anger, or they may feel detached or estranged (“dissociated”) from other people.

Of the four main groups of symptoms those with PTSD may experience, episodes (or “attacks”) typically involve intrusive memories and flashbacks, including [1]:

• Unwanted, distressing memories of a traumatic event that return repeatedly
• Reliving a traumatic event as if it were happening again; also called a flashback
• Disturbing dreams or nightmares about a traumatic event
• Severe emotional distress or physical reactions to triggers that remind you of the event

PTSD and the Brain

Symptoms of PTSD are believed to be due to stress-induced changes in brain structure and function. Stress results in acute and chronic changes in neurochemical systems and specific brain regions. These result in long-term changes in brain circuits involved in the stress response. Brain regions that play an important role in PTSD include the hippocampus, amygdala and prefrontal cortex [2].

Cortisol and norepinephrine are two neurochemical systems critical to the stress response. Cortisol is known as the “stress hormone” although it has many other functions. But one of its main roles is to regulate the body’s stress response. During stressful times, your body can release cortisol after releasing its “fight, flight or freeze” hormones, such as adrenaline, so you continue to stay on high alert. But with trauma keeping your body on high alert, too much cortisol may be released for too long, which can disrupt almost all the body’s processes.

What Does a PTSD Episode Feel Like?

Episodes can feel very different for each person. Here is one example:

“I don’t feel fully present at any moment. Even when things feel stable and calm on the outside, on the inside you are somewhere else. Everything is a trigger taking you back to uncomfortable experiences that you can’t push down or away. Suddenly you are brought back to the present and feel physically unwell. Tears won’t stop. Your heart is pounding and you are left with an unsettled feeling the rest of the day due to the relived trauma you faced and will probably face several times again before the day ends.”

And another example:

“I occasionally experience what might be more in line with the traditional idea of flashbacks, where something will trigger an image of a memory. Then I’ll get flooded with pain, sadness, fear. But in those cases, I don’t feel any sense of desperation for help or any sense of urgency. I usually just sort of shut down and zone out until it’s over and I can shake it.”

What To Do to Help Someone During a PTSD Episode

Helping someone suffering from PTSD can be complex and requires a great deal of care. Ask the person if they want help to manage their episode. If they do, ask them what they need from you. Maintain a calm, warm tone.  Don’t push the person to talk. Consider the following guidelines [3]:

• Create a safe space: Remove any possible triggers such as loud noises or bright lights. Try to find a quiet place where the person can sit or or preferably lie down
• Remind the person they are safe: Let them know you are with them through the episode
• Remain calm and reassuring: Use a gentle voice and positive words to help the person feel calmer and more in control. Avoid sudden movements. Speak in simple sentences.
• Encourage the person to ground by breathing slowly and evenly: This helps them to manage their hyperventilation and anxiety which can worsen the episode and make them feel like they are losing control.
• Support the person to stay in the present moment: Ask the person to describe what they feel, see and hear right now. This helps them ground and manage feelings of detachment or dissociation from their bodies.
• Ask if you can help them get to somewhere that feels calmer: If the current environment is triggering, offer to take them to another room, back home etc.
• Don’t pressure them into talking. For some, it can even make them feel worse. Instead, listen carefully so they feel heard.
• Let the person take the lead, rather than telling them what to do. Take cues from your loved one as to how you can best provide supportand companionship.
• Offer emotional support: Let the person know you are there for them and that they are not alone. Listen without judgment and share encouraging thoughts that validate their experience. Offer reassurance that this will pass.
• Deal with volatility and anger: PTSD can lead to difficulties managing emotions and impulses. This may manifest as extreme irritability, moodiness, or explosions of rage since people suffering from PTSD live in a constant state of physical and emotional stress.
• Encourage the person to seek professional help: To prevent further episodes, a trauma-informed counselor or therapist is essential. Support them to find one.

What To Do If You Are Experiencing a PTSD Episode

Developing an active coping approach can help greatly in dealing with episodes such as nightmares and flashbacks. It means accepting the impact of trauma on your life and taking direct action to improve things. Recovery is an ongoing response to the trauma. This is normal. It takes time to heal. Here are some tips:

• Talk with others for support: It can be very helpful to talk about your problems with others. It’s important to not isolate yourself.  Be clear with them what your needs are.
• Practice relaxation: This might include muscle relaxation and breathing exercises, mindfulness meditation, stretching, yoga, swimming, listening to quiet music, taking a walk in nature. For some, relaxation exercises can increase distress at first so just do small amounts until comfortable.
• Distract yourself with positive activities: Pleasant recreational or work activities can help distract you from your memories and reactions and improve mood and develop strength to rebuild your life.
• Talk to your doctor or counselor about trauma and PTSD: If your efforts at coping aren’t working, you may become fearful or depressed. Reach out for help to learn more about PTSD and ways to manage your feelings.

When to Seek Help

If your symptoms of nightmares and flashbacks are uncomfortably disturbing, do not go away within a month and interfere with aspects of daily life such as relationships or work , then you should seek help from a counselor or therapist who has experience working with PTSD. The main treatments are psychotherapy, medications or a combination of these. It is possible for most people to heal from PTSD and reduce or eliminate your episodes.

Help Available in Utah

Treatment is available in Utah. Are you or a loved one looking for a compassionate space to heal from trauma or PTSD, other mental health issues or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.

Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.