An FAQ About The Physiology of Trauma

 

Q: Why am I so tired? Since the pandemic lockdown started, I haven’t really been exerting myself.  I can’t go to work, so I sit a lot during the day.  But it seems like everything I need to do (e.g. cooking, looking after the kids, even getting up in the morning) takes so much effort.

A: The COVID-19 pandemic is a real threat: physically, economically, and socially.  A lot of people in North America have never experienced this level of threat in their lifetimes.  Your body and mind are cycling through various instinctual coping mechanisms (see below) – during the day, while you sleep.  All the time, really.  It takes time and energy to process this situation and the new reality and changes it brings.  That’s pretty exhausting. 

 

Q: During the first couple of weeks of the pandemic lockdown, I was “freaked out”.  I had trouble concentrating, I felt short of breath.  I even thought I had COVID-19 symptoms.  I wasn’t sleeping well and spontaneously woke up at 4 or 5am.  Since then, things have calmed down a bit.  My situation hasn’t really changed (I’m still stuck at home), but as time goes on, I’m sleeping better and not as panicky as I used to be.  I have good days and bad days and sometimes have to do some deep breathing to get through the day.  Why is this happening?

A: Pandemic means a World Wide Epidemic.  In the last hundred years, there have been several pandemics, including SARS in 2003 and H1N1 or “swine flu” in 2009. 

This COVID-19 coronavirus pandemic is unique in that it is very contagious, and several times more deadly than the seasonal flu, which already kills tens of thousands of susceptible people every year in North America.  Humanity hasn’t experienced a pandemic like this since the 1918 “Spanish” Flu.  That flu was more deadly than COVID-19, and we now have the advantage of modern communications to alert the public to the danger as well as advanced hospital care to support the sickest patients.  But it’s still tricky because this is not a flu virus.  It is a novel or “new” coronavirus for which we currently have no vaccine and no effective treatments. 

This is scary. Even if it’s not life-threatening to every person on the planet, it is definitely life-altering. 

 

The Fight-or-Flight Survival Mechanism

When a mammal is subjected to a life-threatening event, this activates physiological survival mechanisms including the “Fight-or-Flight” reaction.  Depending on the size of the mammal and the nature of the threat, the animal’s body either prepares to “Fight” or prepares to run and escape (“Flight”).  Physiologically, these reactions look similar: the heart starts racing and breathing rate increases to prepare for increased aerobic activity.  There’s a focusing of attention to the threat, and decreased attention to everything else.  This is no time to eat or poop, so the gut stops.   All of these reactions are adaptive and have evolved over millions of years.  Without them, our hominid ancestors could not have survived.  The problem is that this 6 million-year old hardware sometimes has a hard time communicating with the software (brain circuitry) of modern humans.  Sometimes the brain circuits get overloaded and these survival mechanisms all of a sudden are not so adaptive.  This is what happens in a panic attack.  Look at the symptoms of extreme anxiety or panic attack.  Sound familiar?

Difficulty concentrating  (focus on the threat to the exclusion of normal everyday activities)

Hyperventilating (increases oxygen to the body)

Tingling fingers (blood flow to extremities restricted; also the result of hyperventilating)

Heart pounding (increased blood pressure and heart rate to prepare to fight or run)

Difficulty swallowing (gut shuts down)

 

Q: How do I stop this Fight-or-Flight reaction?

A: Sometimes we do it automatically: by deep breathing or relaxing our muscles.  Or relationally, by seeking out help or a comforting person (or pet).  The “mind over matter” technique of talking yourself out of intense anxiety doesn’t often work because when you’re panicky, the rational/thinking part of your brain shuts down and the instinctual parts  (which control the fight-or-flight responses) take over.  We sometimes call this “bottom-up hijacking”. But remember, this is your body’s instinctual way of trying to keep yourself safe.  Don’t get frustrated with it – get curious!

 

The 3-part Brain

Modern reptiles and mammals are just as “evolved” and specialized as humans are.  But there is still a value in using the model/concept of the “3-part brain” in understanding how evolutionary biology can help explain human behaviour, especially as it relates to feelings of safety, as well as panic and anxiety.

_images/Triune_Brain.jpg

The Survival Brain - refers to those brain structures related to territoriality, ritual behavior and other "reptile" behaviors. Includes brainstem and midbrain structures involved in reflexive breathing, heart rate, and sex drive.

The Emotional Brain – refers to brain structures (also called “limbic system”) involved in social and nurturing behaviours (including bonding and attachment) that evolved in mammals.

The Thinking Brain – refers to brain structures (like the neo-cortex) that grew in complexity in some mammals including primates (i.e. humans!) These involve cognition (thoughts and “reasoning”), planning, modeling, and simulation.

The Frontal Lobes and “Flipping Your Lid"

A special part of the “thinking brain” or neo-cortex, lies in the front of your brain, just behind your forehead and eyes.  This is the part that develops more as one grows from infancy to adulthood.  It puts the brakes on impulsivity and helps us “observe” and modulate our own feelings and behaviour.  But when we are in a fight-or-flight situation, this part of the brain goes “off-line”.  Dr. Dan Siegel has a terrific way of explaining this:

https://youtu.be/gm9CIJ74Oxw 

 

Q: I really try to do all the things people suggest to manage anxiety.  I try deep breathing and not watching too much news.  But I can’t even focus or sit still.  Many of my friends and family have adjusted (more or less) to the physical distancing/stay-at-home rules.  But I still feel like I’m in danger almost every second of the day.  What’s wrong with me?

A: There’s nothing “wrong” with you.  Your body and your brain may be taking longer to adjust to your new reality and environment.  The kind of stress management advice given through media outlets or social media is helpful to most people.  But a certain percentage of the population will go on to have more chronic symptoms of anxiety or even PTSD, which significantly interfere with their ability to manage day-to-day.  The main risk factors appear to be:

  • Survivors of previous disasters, life-threatening illness, or accidents
  • Survivors of physical or sexual abuse; also early childhood neglect
  • People who experienced a lot of adverse childhood experiences

This doesn’t mean that everyone with these types of traumatic history will have an extremely tough time with the COVID-crisis.  Some even became more “resilient” due to these experiences.  But they are probably in the minority.  It’s not a question of how hard you try – it’s often a matter of how your brain and body are “wired”. 

It has been over a month since most of North American went into “lock-down”.  If you:

  • Feel the same (or worse than) when it started, in terms of difficulty concentrating, “flight-or-flight” reactions, nightmares or flashbacks
  • Feel that life is not worth living or you’d be better off dead
  • Feel that your previously existing medical problems (esp. high blood pressure, diabetes, or lung disease) are worsening from the stress

Make a video or phone appointment with your family doctor (while the COVID-19 physical distancing restrictions are in effect). There are effective therapies for trauma.  The brain has been found to be very adaptive and can be “re-wired” in a healthier way, through neuroplasticity.

If you want to find out more about trauma, here are some well-regarded books (and one particular website):  

 

Books

Waking the Tiger by Peter Levine

The Body Keeps the Score by Bessel van der Kolk

Complex PTSD: from Surviving to Thriving by Pete Walker

Adverse Childhood Experiences:  https://acestoohigh.com/

 

For more practice “tuning in” to your own body and mind, try these:

Physical Movement, Breathing, Meditation Practices

Yoga

Tai Chi

Qi gong

Self-compassion practices:

http://centerformsc.org/practice-msc/guided-meditations-and-exercises/

https://chrisgermer.com/meditations/

https://self-compassion.org/category/exercises/#guided-meditations

 

If none of the above help, or seem to make things worse, please contact a qualified trauma therapist.  See below to find one in your area.  Many will be able to do remote (e.g. video or phone) consultations:

Therapies

EMDR:  https://emdrcanada.org/find-a-therapist/ 

Sensorimotor Psychotherapy:  https://www.sensorimotorpsychotherapy.org/home/directory-int/prCanada.html 

Somatic Experiencing:  https://directory.traumahealing.org/?cs=canada 

Comprehensive Resource Model:  https://comprehensiveresourcemodel.com/find-a-crm-therapist/?cn-cat=56 

Internal Family Systems Therapy: https://ifs-institute.com/practitioners?country=CA&us_state=All&city=&field_acceptphone_value=All&keyword=&field_contact_information_note=