Anxiety and Trauma

A hallmark feature of trauma is anxiety. In fact, post-traumatic stress disorder (PTSD) is categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an anxiety disorder. There are six different anxiety disorders, and PTSD is one of these (the others are phobias, social anxiety, generalized anxiety, panic disorder, and obsessive-compulsive disorder).

It isn’t difficult to understand why anxiety is so common in the aftermath of traumatic events. After all, these are events that often shatter a person’s sense of safety and security in the world, leaving them emotionally overwhelmed and feeling especially vulnerable. This anxiety can show up as hypervigilance and avoidance in response to intrusive memories.

Intrusion and Anxiety

Individuals with PTSD often experience intrusive and distressing memories or flashbacks of the trauma, leading to intense fear and helplessness. The emotional re-experiencing of the trauma can lead to a perpetual state of anxiety as the individual braces for the next bout of intrusion while struggling to process and make sense of the overwhelming emotions causing the intrusive memories.

Hypervigilance and Anxiety

Anxiety in PTSD is closely linked to hypervigilance. Hypervigilance refers to a heightened state of alertness and reactivity, where the individual is constantly on edge, anticipating danger. This can be exhausting and lead to difficulty sleeping, irritability, and a constant feeling of being “on guard.”

Avoidance and Anxiety

Chronic distressing memories and hypervigilance can lead to behaviors that aim to avoid anything that might feel overwhelming or activating. Avoidance can take various forms, such as avoiding places, people, or activities that trigger memories of the trauma. While avoidance provides temporary relief because it may eliminate certain triggers, it ultimately perpetuates anxiety by preventing the individual from confronting and processing their emotions.

Anxiety as Adaptation

Even though it causes incredible distress, it is crucial to understand that this anxious response is a biological adaptation—an instance of your brain trying to protect you. The brain is constantly taking in data from the world outside and from inside the body, regulating blood flow and electrical activity accordingly.

When an overwhelming event happens, your brain goes through a set of automatic responses to make sure that you stay alive. These mechanisms are evolutionary and biological. They are our parachutes. They are rooted in our will to survive, to cope, and to adapt to a world over which we do not always have control.

These mechanisms also are sometimes hard to regain control over and can create lasting and crippling symptoms. But all of them are designed to save us in the moment of overwhelm. When we understand that, we can see how attaching shame to the trauma response is unwarranted and unhelpful.

Anxiety: What Can I Do About It?

Though we do not have control over the automatic responses in our brains and bodies, we can absolutely intervene in those responses once we recognize them. There are two different methods for interrupting an overactive stress response. They fall into two buckets—top-down regulation and bottom-up regulation.

Top-Down Regulation

The anxiety response arises when there is overwhelm in the brain. The brain sends a message to the brain stem that there is a threat, and the brain stem responds by sending stress hormones through the central nervous system to prepare you for danger. One way to short-circuit that is by essentially forcing blood flow and electrical activity away from the amygdala and back towards the parts of our brain responsible for rational thought and executive function.

What you are doing here is essentially passing the ball back up from your amygdala to your prefrontal cortex. You’re forcing executive function back on. In turn, this slows the production of stress hormones, which allows your body to relax.

There are many ways to do this. Here are two very simple examples:

1. Name all of the blue (then green, then yellow) things that you see in the room.
2. Play a puzzle game (like Tetris) on your phone.

Both things require that you distract yourself from the alarm and focus on things that are happening right this very moment. They are also activities that require your prefrontal cortex, working memory, and executive function.

Bottom-Up Regulation

The system can also be short-circuited in the other direction by sending a message from the body back up to the brain that everything is OK. The key to this is the vagus nerve. The vagus nerve is the longest nerve in your whole body, and it runs from your brain stem through your whole body and touches most of your internal organs.

The vagus nerve is critical in the process of sending stress hormones through your body. Because of this, it is also critical in regulating your heart rate, blood pressure, and digestive system. The fascinating thing is that you can interact with it and regulate what it is doing. Here are three super simple ways:

1. Deep, slow breathing: When you take a deep breath into your belly, you push against a spot where the vagus nerve has many nerve endings. This essentially sends the message back up to the brain stem that things are actually fine, and you can calm down because you wouldn’t be taking deep, slow belly breaths if you were under attack. It also stimulates the parasympathetic system, which is what makes it possible for us to relax.
2. Cold exposure: This lowers the sympathetic response—that’s the fight-or-flight reaction—and at the same time stimulates your vagus nerve and parasympathetic (rest) response. Splash your face with cold water, wash your hands with cold water, or take a cold shower.
3. Singing: The vagus nerve has lots of nerve endings at the back of your throat. Singing activates these muscles, which then, in turn, activates the vagus nerve.

The more you practice regulation, the better you get at intervening and bringing your stress response back down. Over time, you show your body that the world is safe, that it’s OK to relax, and that you don’t have to be hypervigilant 24/7. The best thing about these regulating techniques is that you can begin to practice them right now, and they can accompany you for your entire healing journey.