Understanding the Brain's Response to Stress and Threat

Understanding what causes anxiety or the “flight or fight” response…

What happens to the brain when placed under stress or threat?

The Brain’s Response to Stress and Threat

• The thalamus senses threat, and sends signals to the amygdala and orbitofrontal cortex.
• The amygdala stores/pulls up unconscious memories. Once signaled, it triggers the sympathetic response via the hypothalamus. The hypothalamus fuels and runs both the sympathetic and parasympathetic stress systems.
• The hippocampus then provides conscious memories, placing events in context of space and time.
• The cingulate reasons with the amygdala and asks the frontal cortex areas for help with the process.
• The frontal cortex areas assess the situation, weigh options, plan and reason with the amygdala.

What is the amygdala and what role does it play in this response?

The Amygdala

The amygdala is a primitive part of our brain that keeps us alive. It stores unconscious emotional memories and triggers the body’s responses to stress and threat under stress. It also contacts the hypothalamus and sets the autonomic nervous system in motion.

The amygdala is very much like a “guard dog”. It cannot see or hear subtle differences in signals it receives from the thalamus, and it lacks conscious memories. Its memories are unconscious, primitive, and fragmented—very much like “flashbulb memories” of sound, image, scent and emotion. In its efforts to protect us, it will pull up any memories that might be related to incoming signals. That is the reason why a gunshot and champagne cork popping are all the same to the amygdala and to the mind of a veteran.

**Each time these emotional memory fragments are triggered and re-experienced, the veteran can actually be traumatized by the memories themselves, even if there is no real threat in the present.

What is the autonomic nervous systems? What role does it play in my veteran’s PTSD/anxiety symptoms?

The autonomic nervous system controls our heart rate, breathing, metabolism, energy,

perspiration, etc. It works toward balance, and has two “arms” that rise and fall in turn:

• The sympathetic nervous system, the one that speeds up processes (heart rate,

breathing, metabolism, energy, etc.) and tightens muscles

• The parasympathetic nervous system, the one that slows down these processes and

relaxes muscles

The body’s responses to stress and danger tend to fall into these two categories, sympathetic

and parasympathetic. They are meant to operate in gentle allostasis (use of change to achieve stability), with the sympathetic side rising to fight or flee from temporary threat, and the parasympathetic rising to keep us safe when we are helpless—and to quiet down the sympathetic and return us to homeostasis (a relatively stable state of equilibrium).

A useful tool for keeping these two terms straight might be to think of the sympathetic nervous

system as being “sympathetic” toward our initial need to run from danger, and the parasympathetic as being the opposite and balancing reaction.

What is the hippocampus and how is it affected by stress?

The Hippocampus

The hippocampus is responsible for the ability to store and retrieve memories. People who have experienced some kind of damage to their hippocampus experience difficulties in or the complete inability to store and recall information. Along with other limbic structures, the hippocampus also plays a role in a person's ability to overcome fear responses. Many people with PTSD experience memory-related difficulties. They may have difficulty recalling certain parts of their traumatic event, or alternatively, memories may be vivid and always present. People with PTSD may also have problems overcoming their fear response to thoughts, memories or situations that are reminiscent of their traumatic event. Due to the hippocampus' role in memory and emotional experience, it is thought that some of the problems people with PTSD experience may lie in the hippocampus. Researchers, using MRI’s, have been able to determine that the hippocampus or veterans with PTSD has actually suffered damage. They believe this damage may be under stress.

What are the psychological or mental changes in the veteran as a result of the damage to these areas of the brain?

1. Hostility/Aggression. Our veterans were accustomed to longer periods of time overseas in which they were allowed and encouraged to be hostile in order to stay alive. Because of this, once they return home some veterans may respond differently to challenges or “threats” than civilians.
2. Guilt. Many veterans have what is called “survivor’s guilt” as a result of witnessing their friends and battle comrades get seriously injured or killed. The lingering questions of “Why didn’t it happen to me?” and “What else could I have done to prevent it?” often haunt a veteran’s mind.
3. Depression/Suicide. Veterans suffering from PTSD are seven times more likely to have depression and suicidal thoughts.
4. Paranoia. When in Iraq/Afghanistan, a paranoid soldier stays alive. Everything is considered a potential threat, even a child on a bicycle. That hyper vigilant stage is extremely difficult for a soldier to put “at ease” once she returns home. Also, the damage done to the amygdala under those extreme and prolonged environments of stress can keep the veteran in that “flight or fight” response mode for months to years after returning home.
5. Lack of trust. When overseas, the soldier maintains a limited circle of trust amongst his battle comrades in order to stay alive. Everyone and anything else outside of that circle in those extreme environments are considered untrustworthy and potentially dangerous. Once a soldier returns home, it can be very difficult for him to reestablish that same trust with others, even some family members and spouses.
6. Poor coping skills. As a result of their traumatic experiences, many veterans are overwhelmed and hypersensitive by too much noise, too many people, too many changes, or too much stimuli of any sort. What may be deemed “normal” circumstances to us are not normal to the veteran.  For example, while watching a fireworks display during a local festivity may be exciting for you, the veteran may be terrified and begin to panic at what may sound to him very much like sporadic gunfire.

Understanding hyper vigilance and other combat PTSD symptoms…

What is hyper vigilance?

Hyper vigilance is one of the hyper arousal symptoms of PTSD and refers to the experience of being constantly tense and "on guard." A person experiencing this symptom of PTSD will be motivated to maintain an increased awareness of their surrounding environment, sometimes even frequently scanning the environment to identify potential sources of threat. Hyper vigilance is also often accompanied by changes in behavior, such as always choosing to sit in a far corner of a room so as to have awareness of all exits. At extreme levels, hyper vigilance may appear similar to paranoia.

Coping with hyper vigilance…

Common compulsive behaviors of hyper vigilance…

• Peeping out the windows, making sure blinds/curtains are closed
• Making sure all doors are locked in house and cars
• Keeping certain items in order at all times
• Patrolling the house at night
• Checking the perimeters outside the house
• Setting curfews and lockdowns for the family
• Scanning exits, entrances, and crowds in public places
• Having to sit facing the exits and entrances in restaurants and buildings
• Holding onto you or the children in crowded, public places

Know and understand the triggers that may spark the hyper vigilant behaviors in your veteran…

Why are many veterans with PTSD compelled to be so vigilant?

On one hand, soldiers are trained that everything has its place and must be in that place. On the other hand, many of these behaviors that are drilled into soldiers became second nature (for many, first nature) and that meant they saved lives. Hyper alertness on the battlefield, or in a terrorist situation, or patrolling streets in Afghanistan and Iraq saves lives.

Because of this, veterans are PTSD hyper vigilant because:

1. Their military training taught them to be hyper vigilant.

2. Their brains were trained to expect danger at any moment.

3. Their hyper vigilance kept them and others alive (usually).

**Your veteran experienced danger and lived through it because of his training. Therefore, his body and soul has been conditioned to stay on constant alert, always ready for trouble. This is fine if you are on a patrol or serving in a combat zone, but it does not help when you are trying to live a “normal” life as a civilian. The problem is that the service never taught your veteran how to turn off his hyper awareness. He may have been discharged and left wound up tight inside - without any teaching or warning that he might have PTSD and exhibit hyper vigilance as part of the PTSD-Identity.

**Your veteran may not be getting the proper amount of sleep at night due to his hyper vigilant behaviors. Check with his doctor to see if any sleep medication or other methods of “winding down” at night may help your veteran get the sleep his needs.

**Be mindful of overstimulated environments which may provoke a negative response from your veteran. While some environments may be unavoidable, be prepared to find an “escape route” if necessary. You may want to introduce your veteran to certain stimuli in small increments rather than risking the panic of overstimulation. Let him get adjusted to different environments in small increments of time. For example, allow him to sit in the back of the auditorium during a child’s dance recital rather than sitting up front. He may be able to deal with the noise and incoming crowd easier that way.

A New Chapter Awaits! Okay, Maybe Just A New Page

"A new chapter awaits!" 

How many times do we hear those words of "encouragement"? How do they make you feel when you hear them? Excited? Anxious? Nervous?

If I were to be quite honest (I always value honesty), I go through a mixture of emotions whenever someone gives me that reassuring hug with these words attached. For me, starting over is much like sitting at the top of the first hill on roller coaster. But not just any roller coaster...one that twists, turns, and plummets, throwing in one surprise after the next.

Many of us as both women and caregivers experience a series of emotions whenever we are having to start fresh. While some of may rise like the mythical phoenix from the ashes of a past life, spreading our wings to fly confidently into the new horizon, the rest of us may be simply crawling out of the remaining rubble, grateful enough to still have clothes on our backs and bread to eat.

And wine. I fall into that category of women who just want that perfect glass (okay, maybe a bottle) of wine to help me turn the next page.

Whatever type of survivor you may be, there is still that "next chapter" or the next page that lies ahead of you....just waiting to be discovered, navigated, and conquered. What will you choose to do with it? You've gotten this far, therefore you owe it to yourself to make this next ride better than the last. In order to do that, there a few things that you should know (but you're so awesome you're probably one step ahead of me).

1. Family and friends all mean well, they really do. But they aren't YOU. Take all advice with a grain of salt. Some of it may be great...some of it not so great. Respond to all advice given with a simple "Thank you for caring. I'll think about that", and it's a win-win situation. Only YOU can decide what the next step will be, and what can make you truly happy. Let your friends and family know that you are appreciative of their advice, but remember that you don't necessarily have to take it.

2. Trust your gut. It knows you best. Two years ago, I started taking classes for an online degree that I thought would promise me an exciting new career. And with my full-time job, the online option seemed too good to be true. I happily bought all my required textbooks, and set up my online accounts. Something kept nagging at me, like a little whisper that questioned my actions. "Is this really for you, Mandy? Are you really disciplined enough to take online classes?" Sure! I told myself. Boy, was I in big denial. Two courses into my fabulous new degree, I sheepishly had to admit to my husband that it wasn't working for me. I didn't want to be a quitter, so I trucked through another two courses the next semester. I wasn't enjoying myself. Something was wrong. Then it hit me. I yearned to be in an actual classroom, talking to real people, engaging in discussion and feedback from my classmates and the professor. Lesson learned. My gut had tried to tell me all along that I was going against my true nature. Trust it!

3. Make mistakes. Lots of them. Get lots of "no's" from people too. Really, it's okay...and encouraged. Learning from our mistakes makes us stronger, and hearing the "no's" when we thought we'd hear "yes" also enables us to understand that it's not always personal. It helps us to grow a thicker skin and work on our skills that we thought were perfect. Learn to take constructive criticism with open arms rather than an "Oh, no she didn't!" attitude.

4. Make time for yourself. Feed into at least one of your passions consistently. This is one of the most difficult things for caregivers to do. With crazy schedules, a serious lack of that mythical concept known as "free time", and a depletion of energy we often wonder how we even made it through the day with the kids, husband, and pets still alive and functioning (at least somewhat). Carving that little bit of time out for yourself each week is crucial to maintaining the spirit and energy you need to take care of others. Are you a Pinterest queen? Then pick one small project you can accomplish within two weeks time, working on it for 10-15 minutes on it each day. But make sure to see it as something you'll enjoy doing, not a task.

5. Be imperfect. You know those women who always seem to have it together? You see them dropping off their children at school, the ones with the really cute handbags and perfect hair. They drive a super shiny, just off the factory line vehicle that is mostly likely cleaner than your kitchen table on the inside. Whenever you see them you just want to rock their little supposedly perfect world with the key to your scrappy mini van against the side of their Audi. (Did I say that out loud?)  Well, I don't even know where the last purse I used is located. And my hair...well, let's not even go there. But you know, I have learned to laugh at my not so perfect self. In fact, I am sitting at my desk right now typing with the lingering odor of spit up that my sweet little girl left on my new blouse (on sale at Old Navy). And it's okay. I may have even used a tampon to soak up a small pond of spilled coffee inside my care earlier this morning as well.  Celebrate your quirks and wave your freak flag. Just do your THANG, girl! Because it's the REAL you that will get you where you need to go.

Starting over isn't easy, but it's not the end of the world. And if it is, then at least you can count on me to share that last glass (okay, bottle) of wine with you :)

Stress Eating: The Good, The Bad, and the "Oh, No You Didn't!"

Stress Eating: The Good, The Bad, and the “Oh, No You Didn’t!”

We’ve all been there before. Staring at the bottom of an empty ice cream carton, dumping a plate of tiny bones leftover from a whole Rotisserie chicken into the trashcan, licking the batter out of a mixing bowl after we’ve already baked the brownies…and eaten the entire pan. We know in our heads that it’s wrong, but in the moment it feels so very right.

Stress eating, otherwise known as emotional eating. We all succumb to it from time to time. Just every once in a while. Maybe every few days or so. Well, perhaps almost every day. Okay, I need my fix and I need it now.

Stop. Collaborate. And Listen. 

What are we doing to ourselves? How did we let it go this far? How can we get out of this seemingly never-ending cycle of stuffing our faces? How do we learn to curb the appetite that is never quite satisfied?

Stress eating (or emotional eating) is actually very common amongst caregivers. It’s not rocket science. We are tired, exhausted, and emotionally and physically drained. Our hearts and minds are not healthy because we haven’t taken the time to really take care of ourselves…in a looong time. We rely on those goodies, those tangy, salty and sweet morsels to provide that false sense of security. We “treat ourselves” with all the wrong kinds of food…or by eating too much food, with the hopes that it will squash the anxiety, the anger, the sadness…and all the other negative thoughts that bring us down.

The big question is…what fuels this desire to eat? Are you, in fact, an emotional eater? Take a quick look at the questions below, and place a mental check mark beside those that you feel most apply to your situation.

• Do you eat more when you’re feeling stressed?
• Do you eat when you’re not hungry or when you’re full?
• Do you eat to feel better (to calm and soothe yourself when you’re sad, mad, bored, anxious, etc.)?
• Do you reward yourself with food?
• Do you regularly eat until you’ve stuffed yourself?
• Does food make you feel safe? Do you feel like food is a friend?
• Do you feel powerless or out of control around food?

Who doesn’t like to eat? I mean, personally, I LOVE to eat. Food is an integral part of my family’s life…we just migrate towards food. We can’t help it. It’s part of who we are, and I love it; however, I know just how easily I can let it get out of hand when I’m stressed or feeling overwhelmed. That jar of peanut butter starts calling my name, along with the bag of chocolate chips. They whisper sweet nothings into my ear. How on earth can you ignore something that good? Knowing the differences between emotional hunger and physical hunger can help you say “nay” to that seductive calling. Now, let’s take a look at some of those differences.

Emotional hunger vs. Physical hunger
Emotional hunger comes on suddenly.	Physical hunger comes on gradually.
Emotional hunger feels like it needs to be satisfied instantly.	Physical hunger can wait.
Emotional hunger craves specific comfort foods.	Physical hunger is open to options–lots of things sound good.
Emotional hunger isn't satisfied with a full stomach.	Physical hunger stops when you're full.
Emotional eating triggers feelings of guilt, powerlessness, and shame.	Eating to satisfy physical hunger doesn't make you feel bad about yourself.

Does any of that sound familiar? I’ll be the first to admit that it called me out pretty bad. Of course, I pouted for a minute or two; then, I realized that maybe…just maybe…I needed to make some changes.  Sigh. Don’t you hate it when you’re not right?

Now that you have a better idea of what may be fueling your desire to eat that third bowl of cheese dip with your family-sized bag of Fritos (it’s a great combination), what are you going to do about curbing those cravings? More than likely you’re already feeling a little yucky on the inside and out. You need to be able to love you for who you are…but yours emotions are winning the battle. Set a goal today to get back on the right track, both emotionally and physically, by following these four useful tips. And yes, I actually tried each one myself. 

Four Tips to Stop Emotional Eating

Tip 1: Identify your triggers. What’s going on in your head or in your heart? Did someone say something upsetting to you? Are your children driving you nuts? Do you feel inadequate or overwhelmed?

Tip 2: Find other ways to feed your feelings. Whip out that book you’ve been meaning to read. Write down what you’re feeling in a journal. Plant an herb garden.

Tip 3: Pause when cravings hit. When you feel that bag of Doritos calling your name, stop in front of the pantry and think about how it’s going to affect your overall health. Is it worth it?

Tip 4: Support yourself with healthy lifestyle habits. Find a walking partner. Get out of the house with the kids and the spouse for a fun family day. Throw a ball for your dog. Start exchanging that craving with a physical activity.

Bottom line is….we all have our little vices and weaknesses. And that’s okay. We should have those guilty pleasures, those little perks to get us through our most stressful days. For me, I noticed that after giving birth to my daughter, my pregnancy cravings were still in full swing. Thinking I deserved to treat myself for dealing with the stress, the sleepless nights, and trying to be a good wife to my veteran husband, I gave in to those cravings. Low and behold, the reality check finally slapped me in the face when I realized that I was allowing my stress, my fears of being a new mom, and the guilt of going back to work affect my eating habits. And it was showing in our family pics. Talk about feeling awkward.

You deserve to feel great! So kick those negative thoughts and feelings to the curb…and that carton of chocolate chip cookie dough. Okay, maybe not the whole carton but at least get rid of the “big spoon”. You know which one talking about ;0

The Humble Homefront

Her tired hands are soaked in soapy water, going through the motions of washing a pile of dishes that never seems to end. She can barely keep her eyes open, but she knows there will be several more hours ahead until she can attempt to fall asleep. More than likely, she will get very little sleep. Just like the night before…and the night before that. The kids still need to eat dinner, finish their homework, and get their baths done until negotiations for bedtime will come. She has to make sure that her youngest child has her own time to wind down and follows a specific routine or she will get very upset, having been diagnosed with Autism at the age of four.

Plastered across the refrigerator space, there is hardly any room for colorful drawings or family photos because of all the different schedules that have now become the blueprints for their new life. Appointments with the TBI doctor, the husband’s therapist, the children’s therapist, the VA clinic, and the Autism support group are all color coded so that the children know what to expect this week.  The woman looks at the refrigerator with her tired eyes, and feels a tug in her chest knowing that soon she will have to tell her son that he can no longer go to his guitar lessons because she can no longer afford to pay for them.

Suddenly, she hears the familiar sound of a truck door slamming shut, and anxiety increases the tightness in her chest. Her heart rate quickens, and her fatigued muscles are now tense with expectation. What kind of mood will he be in today? Now, she can hear the back door to the mud room slamming shut and a curse of impatience from her husband as he trips across her daughter’s tennis shoes, left haphazardly thrown in the doorway when she came home from school. 

The children all run eagerly into the kitchen, excited to tell their father what they did at school that day, who said what, and asking when he can play outside with them. Rather than greeting his children with a big smile and open arms, he rubs his face in agitation and pushes them aside. The children are hurt, but know that their Daddy must need his quiet time. It’s best just to leave him alone, but they can’t help but wonder when their Daddy will be better again. All they know is that their father went away for a while, and came back a different Daddy…a Daddy that doesn’t want to play with them anymore and yells at them when they get too noisy. The old Daddy loved to go out on family trips and have fun, but now he takes lots of naps and says everything is too loud or too bright. 

The woman at the kitchen sink fights back her tears, thinking of how her husband used to kiss her when he came home every day, and how he would stay up talking with her at night about the children, laughing over funny memories. Now, the man that returned is more like an empty shell of a person…an angry roommate rather than a husband or father.  She wants to help him so badly, but doesn’t know what to do. Her family and friends all mean well, but they just don’t understand what she is going through…and she feels guilty about asking for help. She knows that something needs to change, but doesn’t know how to make it happen.

This is an example of the daily life of some military caregivers. Across the United States, we currently have 275,000-1,000,000 military caregivers. But what is a military caregiver? According to a recent  RAND survey, a military caregiver is a family member, friend, or other acquaintance who provides a broad range of care and assistance for, or manages the care of, a current or former military service member with a disabling injury (physical or mental) that was incurred during military service. The culture of military caregiving is unique because these caregivers are dealing with multiple and severe injuries or illnesses, a very complex system of care (VA/Tricare), and invisible wounds such as Post Traumatic Stress and Traumatic Brain Injury. What also sets them apart from other caregivers is that many of them provide around the clock care or feel as if they are “on call” 24/7, and will continue to provide a lifetime of care to their loved one.

Out of our service members deployed during Operation Iraqi Freedom and Operation Enduring Freedom, at least 725,500 returned home with a Traumatic Brain Injury, PTSD, or depression. The families and spouses of these service members are stepping up to the plate and filling the dutiful role as caregiver before ever knowing what they are truly facing. The role of caregiving often affects every aspect of a military caregiver’s life. According to RAND, the roles and responsibilities of caregivers often take more time than holding a typical full or part-time job. In a survey of veteran caregivers by the National Alliance for Caregiving, approximately one-fifth provided more than 80 hours a week of care, and more than two-thirds (69%) provided more than 20 hours of care per week, leading some caregivers to experience a decline in their own health and well-being. As a result, some military caregivers have extensive needs, independent of the needs of their loved ones.

Military caregivers in particular suffer from mental health issues at rates greater than the non-caregiving population, with one study showing about two-thirds suffering from type of emotional stress. Unfortunately, resources for this group of caregivers are often challenging and limited. Military caregivers cope with the ongoing challenge of caregiving itself while sorting through a maze of policy structures, program opportunities, and well-wishers to meet both their own needs and the needs of their veteran. These efforts are not always successful. A large gap between caregiver needs and community resources have yet to be met. The RCI’s Operation Family Caregiver program seeks to help accommodate the needs of these caregivers and provide the training and tools necessary to help relieve their burden and stress.

Operation Family Caregiver provides free and confidential support via in-home sessions, Skype and telephone for military caregivers who want to be proactive in learning how to effectively identify and solve the problems they are having as a result of their loved one’s injuries. A program coach works one-on-one with the caregiver in a research-based, customized training approach that empowers the caregiver, allowing them to feel more confident and less stressed about taking care of the needs of their loved one.

Reaching out for help is a sign of strength! Call today to schedule a free assessment: (229) 931-2034.