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In the past 20 years, our knowledge of severe stress and its effects on the brain has advanced substantially. We now better understand how severe stress can change how we think, feel and act. It’s very clear that these changes are a normal part of how the brain responds to severe stress. Unfortunately, these changes can cause ongoing issues known as adverse posttraumatic neuropsychiatric sequelae (APNS), such as PTSD, depression, anxiety, and pain and somatic symptoms.

We believe that understanding why these symptoms develop can help normalize how the broader public views them, and that understanding advances in developing interventions to prevent and treat these APNS can help the military community.

APNS Are Normal Brain Responses to Stress

Unfortunately and inaccurately, physical and mental health changes after extreme stress have historically often been considered a voluntary choice, a matter of character or willpower. We now understand that this is entirely false. These changes are due to involuntary biological changes caused by the brain’s “survival mode,” brought on by extreme stress.

These “survival mode” responses can be activated in an instant and, once activated, cause substantial changes in specific areas of the brain. These functional changes have great benefits to assist survival; our bodies evolved these mechanisms over hundreds of millions of years to maximize our odds of surviving life-threatening events. However, the same marked changeability/sensitivity of certain brain areas to severe stress that makes this “survival mode” possible also creates vulnerability for many of us to experience persistent symptoms after severe stress. These changes include:

Memory

Our brain’s “survival mode” has evolved so that we never forget very stressful events so that we might avoid those situations in the future. However, the fact that our brain’s “survival mode” encodes memories so strongly, clearly and vividly also creates vulnerability to persistent memory-related problems after stressful experiences, such as nightmares and flashbacks.

Sleep

In the aftermath of severe stress, our brain’s “survival mode” changes our sleep to become light and fragmented. This aids survival by reducing the chance of being caught off guard. In the short term, the survival benefits of these changes outweigh the costs. However, if these changes persist, then chronic reductions in sleep quality can affect mental and physical health.

Alertness

Hypervigilance after stress is another hallmark brain “survival mode” characteristic. Being hyperalert/hypervigilant puts us in a mental state that is extremely sensitive to our surroundings, most effective at detecting danger and — in an activated physical state — best able to repel danger at a moment’s notice. However, if these changes persist, chronic hypervigilance can contribute to anxiety, social withdrawal/isolation, paranoia and fatigue.

Pain and Other Body Symptoms

Many brain “survival mode” functional changes are very time dependent. For example, immediately after brain “survival mode” activation, pain and other physical symptoms are suppressed, so that all attention can be focused on survival. However, after the immediate stress, the brain’s “survival mode” system is designed to increase sensitivity to pain and other body symptoms, to help us detect injuries and fatigue, so that we know to rest and recover. These changes can result in persistent body aches, pain and fatigue.

APNS Prevention and Treatment After Severe Stress

It is important for those experiencing these symptoms, and for their loved ones, to understand that what’s happening to them can be part of normal body responses to severe stress. The good news is that our understanding of how to prevent and treat APNS has never been greater and is rapidly increasing. Just as we learned how to prevent wound infections during the 19th and 20th centuries, we are now learning how to prevent these “invisible wounds.” Trials testing such preventive interventions are ongoing — for example, Department of Defense-funded trials testing medications administered in the early aftermath of severe traumatic stress to prevent APNS. With continued resourcing and effort, the next few years have tremendous potential to identify methods to reduce the mental and physical health burdens experienced by our warfighters and veterans, reduce military health-care costs and improve the readiness of our joint forces.

Dr. Meredith Bucher is a researcher at the Institute for Trauma Recovery at the University of North Carolina-Chapel Hill, where she is involved with advancing the understanding and treatment of post-traumatic outcomes.

Dr. Emily Lowery-Gionta is the section chief of the Performance Assessment and Chemical Evaluation Laboratory at the Walter Reed Army Institute of Research, where she leads preclinical and clinical research to deliver novel treatments for acute stress reactions and other trauma-related disorders.

Jeff Sabados is a U.S. Navy veteran with more than 10 years of service, including as a Navy SEAL task unit commander.

Dr. Robert Widmeyer was a Vietnam Marine Corps medic and surgeon and is a retired orthopedic surgeon.

Dr. Dennis McGurk is a retired Army colonel with over 25 years of service and over 15 years of research experience focused on serving the health and performance needs of the military community.

Dr. Samuel McLean is a professor of psychiatry and emergency medicine at the University of North Carolina-Chapel Hill and director of the Institute for Trauma Recovery. His research works to gain a better understanding of recovery processes after trauma, including developing effective interventions to improve post-traumatic outcomes.

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