This material is taken from the book Invisible Heroes: Survivors of Trauma and How They Heal, by Belleruth Naparstek

(Note: Belleruth Naparstek, in addition to writing Invisible Heroes, has also created a series of CDs (also available on tape) using Guided Imagery to help survivors of post-trauamatic stress heal. You can find out more about her work and order her book and CDs at her website: http://www.healthjourneys.com. She has also created a guided imagery specifically for people with fibromyalgia, as well as ones directed towards healing insomnia depression, pain, cancer, weight loss, fertility, and stress.)

1. What is Post Traumatic Stress and how is it different from Post Traumatic Stress Disorder? Post Traumatic Stress is a syndrome that may occur after a major trauma. When it appears soon after the original trauma it may resolve after several months. If people continue to have post traumatic stress symptoms six months after the initial trauma, their problem is then identified as Post Traumatic Stress Disorder. PTSD can last for many years.

2. What can cause Post Traumatic Stress Disorder? Traffic accidents (or near misses), combat, grievous losses, life-threatening diagnoses, ICU stays, traumatic deliveries, traumatic illnesses, disfiguring accidents, heart attacks, spinal cord and brain injuries, rape, muggings, fires, near-drownings, childhood abuse, domestic violence, living in a war zone, hurricanes and other natural disasters, torture, terrorist attacks, violent assaults, imprisonment, kidnappings, etc.

3. What are some of the initial symptoms of PTS? Restlessness, irritability or outbursts of anger, difficulty concentrating, hyper vigilance, problems with falling asleep or staying asleep, generalized anxiety, inability to relax, shallow breathing, fatigue, and an exaggerated startle response to 1) sudden noises 2) the sight of reminiscent cues or 3) an unexpected touch. Many people also experience headaches, backaches, TMJ, skin complaints such as itching and rashes, irritable bowel syndrome, and weight loss. Many of these same symptoms become ongoing symptoms if the post-traumatic stress continues on into Post Traumatic Stress Disorder.

4. What chronic conditions can develop as a result of long term PTSD? Chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, multiple chemical sensitivities, interstitial cystitis, myofascial pain, low back pain, pelvic pain.

5. What happens to the brain of someone who experiences an intense trauma? “Triggering a potent emergency response within nanoseconds, the brain launches a biochemical cascade.” (Increased adrenalin, etc.) This leads to the “fight or flight” response. If the person goes into “fight” or “flight”, their body is able to discharge the increased hormones. However, if the person feels helpless in the face of the trauma, it can lead to the “freeze response.” During the “freeze response” the results of the potent biochemical cascade are not discharged, but stay in the body to wreak havoc with one’s hormone levels.

6. What happens to a person’s cortisol levels as a result of long term PTSD? “A long-term adult trauma survivor with chronic PTSD will generally display abnormally low cortisol levels. This is connected to a dominant post-traumatic stress symptom of numbing and avoidance…Should [this person] get upset or agitated, however, we would see a temporary extreme spiking in the release of cortisol, than a dip back down the lower flattened levels.”

“The levels of cortisol are consistently low, but when triggered by stress, they spike and then drop, skittering back and forth between abnormally high and abnormally low levels. What would be a relatively small stressor to most people will trigger a dramatic biochemical cascade in someone with PTSD, which coincides with their general hyper-reactivity, followed by a drop to below normal levels along with a return to avoidant numbing. In someone with chronic PTSD , low cortisol levels can persist for decades.”

7. Is this unstable cortisol condition found in other disorders? “No other emotional condition, including depression, panic attacks, or anxiety disorders will produce this quirky profile. It is unique to post-traumatic stress and is leaves a signature biochemical and neurphosiological footprint on the survivor. Possibly no other so-called “mental” condition demonstrates the merging of mind and body as much as this one does.”

8. What is the connection between PTSD and fibromyalgia? “Some dramatic overlaps have been found between post-traumatic stress and certain physical health problems. For instance, one comprehensive Israeli study showed that an extraordinary 57 percent of people diagnosed with fibromyalgia also suffered from significant, persistent post-traumatic stress symptoms, a percentage far greater than the 8 percent we would normally expect to find in the general population. Similarly, an American study of fibromyalgia patients found a 56 percent rate of PTSD, while another showed that 57 percent of fibromyalgia patients reported a history of sexual or physical abuse. It should be noted that the vast majority of fibromyalgia patients are women.”

9. How can someone with PTSD heal from it? The author offers a number of possible avenues to healing, and stresses that they must go beyond a mere cognitive approach. “A traumatized brain is compelled to train its focus away from language and verbal content, toward non-verbal danger cues—body movements, facial expressions, tone of voice and the like, searching for threat-related information. Cognition and behavior are mediated by the more primitive parts of the brain at the expense of abstract thinking…”

“These survivors…are hyper vigilant. Only when sufficiently calmed, can they attend to the meaning of words….This is why interventions that are based on a cognitive, problem solving approach alone cannot impact terror driven behavior….This is why imagery, with its subverbal, calming voice tone, soothing music and nonverbal reassurances of safety… are far more effective with traumatized people.” For healing techniques, she suggests: relaxation, meditation, guided imagery, use of the Emotional Freedom Technique (EFT), and a variety of other imagery based therapies. These and many more techniques are explained in her book.