How PTSD can affect a brain injury survivor?

Written by Michelle Munt, December 2021

Most people have heard of Post-Traumatic Stress Disorder (PTSD) these days but what people don’t seem to realise is how common it is. Often people think it is from a single or series of terrifying events, such as a war zone or abuse, and these events usually do leave people battling with PTSD. However, there are many other situations which can cause PTSD which is why it’s common for brain injury survivors to be contending with it alongside their organic injury.

What is happening in the brain when PTSD is triggered?

The first thing we need to appreciate is that our brains are wired to learn from dangerous or negative situations to keep us safe. Think about a new-born Zebra which has never seen a Lion before. It doesn’t know what the Lion is or that it wants to eat it until it has its first experience of the herd running away in panic from the hungry pride of Lions. If it survives the experience the Zebras brain will record as many details about the incident as possible so that it can look out for warning signs of the danger approaching next time and take action to stay safe. Sensible, right?

In the brain there are a little structure called the Amygdala which acts as your personal alarm system and gives the body its first instructions on how to handle the situation which it’s associating with the previously recorded dangerous or negative experience. It either orders FIGHT or FLIGHT, otherwise known as run away or defend yourself.

Take the young Zebra again. Next time it sees a Lion it’s most likely going to run for its life as it goes into FLIGHT mode. But let’s assume that the baby gets separated from the herd and has nowhere left to run. This is when it’s Mum will start fighting with the Lions even though she is putting herself in grave danger. This is because her Amygdala has switched to FIGHT mode as it is the only way she can save her baby. Again, I think we would all agree that this is a good response to the situation.

The problem with PTSD is this natural alarm system has become too sensitive. It can trigger at a loud noise like a car alarm and make us feel like we need to get out of there. Coupled with this, the prefrontal cortex, which usually acts as our mental brake becomes sluggish. The prefrontal cortex is there to help us make rational decisions and would usually tell us it’s a false alarm when it becomes clear the trigger isn’t dangerous this time. But without its usually rational response at hand the brain continues to leave us feeling panicked and vulnerable.

Many brain injury survivors have PTSD from the event that caused their injury, even if they can’t remember what happened.

I know some people might be confused why a brain injury survivor has PTSD when they can’t remember what happened when they sustained their brain injury. Memory and the brain is a complicated subject, but what you need to know is we don’t just store memories in a file. There are many different elements to the memory; sights, sounds, vibrations, smells etc. So whilst a person may not be able to recall the event the brain still may have kept record of particular details which then only get flagged up when the Amygdala thinks it recognises one of these elements from the event that caused us such a terrible injury.

This happens a lot in people who have been in a car accident for example. My brain injury was caused this way and I remember nothing of that entire day. However, for a long time I was a terrible passenger and would often let out panicked gasps when I thought another driver was about to change lanes. Also I was exceptionally jumpy. Any noise that I wasn’t expecting, such as the sound of a door in another room would make me jump out of my skin. Believe me being forced to live on the edge like this all the time is exhausting!

Advice on how to help yourself.

The mental health charity Mind recommend these 6 techniques for dealing with a flashback but I think you can apply them to any moment of distress:

· Focus on your breathing – Often when we are panicked, stressed or scared our breathing becoming swallow and rapid. Making yourself take a deep breath whilst counting to five and then releasing to the count of five can help you calm down. Repeat this exercise until your heart rate feels more normal and you feel more in control.

· Keep an object with you that remind you of the present – This is more relevant to when you suffer a flashback but it does still help to take your mind away from the thing that triggered the panic attack. It can be something that you also have about you like Jewellery or your keys, or something that makes you feel happy that you have just for these moments.

· Tell yourself that you are safe – As PTSD is about the brain trying to get us to safety. A way to calm it down is to remind it that we have already made it to safety. Write down a couple of sentences that you can use as mantras to repeat when you need to convince your brain that it’s OK.

· Comfort yourself – Get comfy in your favourite room, maybe snuggle in a blanket and bring in your pets. I definitely find my cat sooths me a lot, often so much that I fall asleep.

· Keep a diary – Try to make a note of what happened each time you had a panicked moment. You should be able to identify patterns and triggers. This will help you avoid these triggers more in the future.

· Try grounding techniques – Describing your surroundings aloud to yourself helps the brain focus on the here and now. This helps distract it from what it was concerned about and calm down.

PTSD is a serious condition. If you or someone you love is battling with PTSD please contact a mental health professional. There are mediations that they may offer you but there are also therapies which can help you deal with the effects of PTSD better.

A car accident in December 2014 left Michelle with a diffuse axonal brain injury which went undiagnosed for a year. It was accepted that she had a brain injury, but it wasn't recognised that it was a serious one and therefore had very little support. During this time her dad was diagnosed with Alzhiemers'. Despite living on the opposite side of the country, she supported him through this distressing experience as she found was able to relate to many of the symptoms he was experiencing.

Michelle's injury meant she could not return to her job in recruitment and business development as she didn't know how long her recovery would take. This prompted her to start a blog bout brain injury @jumbledbrain.com so she could reach out to others. Michelle also runs a Facebook group of almost 6,000 members. The community share their experiences and tips with each other offering support wherever they can.