HEALTH Research Institute

Recognizing and experiencing stress, trauma, and post-traumatic stress disorder (PTSD) is nuanced and complicated. Trauma- and stressor-related conditions, such as PTSD, often co-occur with other psychiatric and medical conditions, according to Dr. Anka Vujanovic, HEALTH–RCMI’s Director of the Investigative Development Core. In Vujanovic’s new research initiative, she focuses on developing novel treatment of alcohol use disorder and co-occurring PTSD.

“For example, among people with PTSD, 80 percent or more also have a concurrent mental health condition,” Vujanovic said. “PTSD and trauma- and stressor-related disorders, more generally, rarely present alone. Depression and substance use disorders are common co-occurring conditions—as well as anxiety conditions like panic attacks and chronic worry. Trauma- or stressor-related disorders can evolve, with time, into a much more complicated clinical picture for people, and the last thing most ever want to do is talk about it.”

Experiencing at least one traumatic event in a lifetime occurs to 70 percent of Americans, according to the U.S. Department of Veteran’s Affairs. These events are defined by experiences such as exposure to death or threatened death; actual or threatened serious injury or sexual violence. However, only an estimated 6 to 9 percent of the U.S. population will develop PTSD because of these types of experiences.

In an insightful one-on-one interview, Vujanovic shed light on why some people are more resilient to traumatic events while others are more prone to PTSD.

“What makes some people resilient and puts others at risk: it’s a complex equation,” Vujanovic said. “There are so many factors—biological, psychological, sociocultural; and it’s a unique pathway to recovery or risk for each person.”

Why Some Are More Resilient and Others Face Higher Risk

Vujanovic added that those individuals who have more trouble regulating stress, so that they actively try to avoid talking, thinking, or feeling about the traumatic event(s), face a higher risk. Emotional avoidance in the aftermath of trauma is a significant risk factor, Vujanovic emphasized.

“If people try to avoid talking, thinking, or feeling about a potentially traumatic event—to suppress the trauma memories—especially in the long-term, for example for a month or more, then we are talking about chronic avoidance. In that case, the risk for developing PTSD or related conditions, including substance use disorders, intensifies.” Vujanovic said. “Avoidance is actually fuel for PTSD. What can drive avoidance: biology, psychology, emotion regulation capacity, and stigma.”

For so many individuals of underrepresented communities, processing and discussing these feelings can often evoke feelings of shame, Vujanovic said.

“For some individuals, they feel ashamed to have intense feelings after trauma, so they stay quiet,” Vujanovic. “By staying quiet and wrapped in shame, these people cannot process the trauma memories. They might continue to try to shut down from it, to distract from it even if it’s impairing sleep; even if it’s making them have trouble functioning. They are likely to shut down and not share and stay silent despite the pain that remains. PTSD disorders thrive in silence and shame. That’s the breeding ground for how PTSD develops and what maintains it.”

When You Shut Down the Emotions from Trauma

When the avoidance of processing the trauma is long term, the symptoms can potentially worsen and affect physical health, relationships, and work or school functioning.

“For a subset of people, the symptoms emerge after the trauma or stressful incident and sometimes these symptoms stay the same or get worse over time,” Vujanovic said. “It’s evidence that you should tune into people. It could be job loss, violence, or racism that they’ve experienced or witnessed. They may not want to experience the emotions and may be so upset that they worry about the intensity of the emotions that come up.”

Inevitably, this process of pushing these feelings down and distracting from the initial trauma or stressor creates a perfect storm of psychologically damaging symptoms.

“Some people get good at distracting and pushing the emotions away—not thinking about the trauma—and what happens is that the feelings come up stronger,” Vujanovic said. “That’s what people don’t realize. They’re trying hard to not think about it, but that makes it worse. What happens is that people don’t get to process what happened, so they contain it in their minds and bodies.”

At the extreme, the avoidance of processing the trauma may move into the sphere of alcohol use disorder.

“It can lead not to just substance use issues,” Vujanovic said. “A person might find it hard to push thoughts or feelings away, so they use alcohol or use substances to numb out because they don’t know how to cope in more healthy ways; or they do not know where or how to seek professional help. When people feel emotionally or psychologically overwhelmed, they might not know how to manage that. This can lead to anxiety or depression wherein people are struggling deeply, and it’s affecting their ability to engage with the world and with other people.”

Coping Strategies

So, how do you effectively cope with PTSD and other significant stressors? Vujanovic revealed some of the more effective strategies for loved ones who are struggling with PTSD.

“Providing a nonjudgmental, validating, and stable support to loved ones with PTSD is important,” Vujanovic said. “By definition, trauma and stressor-related disorders stem from uncontrollable and unpredictable life circumstances; and being a source of reliability and predictability becomes especially important for people with PTSD.”

Vujanovic added that stigma and shame go hand-in-hand with PTSD.

“Offering validation, a safe space, and a judgment-free zone are important ingredients for nurturing relationships with people with PTSD,” Vujanovic added.

As traumatic stress, acute stress disorder and PTSD become increasingly pervasive in the U.S., it’s crucial to be able to process it in a compassionate, safe space. While some symptoms get better with time, those individuals experiencing more intense symptoms may need professional help. According to the American Psychological Association, there are four key coping strategies when dealing with traumatic stress.

• Get support from your loved ones. Find your community of friends and family members who can give you support—especially those who will listen to you as you talk about your feelings and experience. It is important to respect boundaries and to understand if people are not ready to discuss their trauma with friends or family; sometimes, being supportive is just being present.

• Face your emotions. While avoidance of thinking about a traumatic event is normal, too much of it can prolong your healing journey and keep you stuck in the trauma. If you're sleeping excessively, isolating yourself or using substances to escape reality, these are warning signs to seek help from loved ones or a mental health professional.

• Make self-care a priority. Be vigilant about eating nutritious meals, getting a good night's sleep, and finding an exercise regime that brings you joy. Seek out time for relaxation, a retreat in nature and meditation.

• Practice self-compassion and be patient. Understand that it's normal to have an acute reaction to a traumatic event. Be patient with yourself and realize that each day your symptoms may improve.

—Alison Medley

If you would like more information about this topic, please contact Alison Medley at 713.320.0933 or email aemedle2@central.uh.edu