It’s natural to be afraid after something scary or dangerous happens. When you feel you’re in danger, your body responds with a rush of chemicals that make you more alert. This is called the “flight or fight” response. It helps us survive life-threatening events.

But the brain’s response to frightening events can also lead to chronic problems. This can include trouble sleeping; feeling on edge frequently; being very easily startled, anxious, or jumpy; having flashbacks; or avoiding things that remind you of the event.

Sometimes these symptoms go away after a few weeks. But sometimes they last much longer. If symptoms last more than a month and become severe enough to interfere with relationships or work, it may be a sign of post-traumatic stress disorder, or PTSD.

“There are real neurobiological consequences of trauma that are associated with PTSD,” explains Dr. Farris Tuma, who oversees the NIH traumatic stress research program. NIH-funded researchers are uncovering the biology behind these brain changes and looking for ways to prevent and treat PTSD.

What is Trauma?

“Most people associate post-traumatic stress symptoms with veterans and combat situations,” says Dr. Amit Etkin, an NIH-funded mental health expert at Stanford University. “However, all sorts of trauma happen during one’s life that can lead to post-traumatic stress disorder and post-traumatic stress disorder-like symptoms.”

This includes people who have been through a physical or sexual assault, abuse, an accident, a disaster, or many other serious events.

Anyone can develop PTSD, at any age. According to the National Center for Post-Traumatic Stress Disorder, about 7 or 8 out of every 100 people will experience PTSD at some point in their lives.

“We don’t have a blood test that would tell you or question you can ask somebody to know if they’re in the highest risk group for developing PTSD,” Tuma says. “But we do know that there are some things that increase risk in general and some things that protect against it.”

Biology of Traumatic Stress

Researchers are looking into what puts people at risk for PTSD. One team, led by Dr. Samuel McLean, a trauma expert at the University of North Carolina, is investigating how post-traumatic stress symptoms develop in the brain. They will be following 5,000 trauma survivors for one year.

“We’re enrolling people who visit trauma centers immediately after a trauma because evidence suggests that a lot of the important biological changes that lead to persistent symptoms happen in the early aftermath of the trauma,” McLean says.

They’re gathering information about life history prior to trauma, identifying post-traumatic symptoms, collecting genetic and other types of biological data, and performing brain scans. The study is also using smart watches and smart phone apps to measure the body’s response to trauma. These tools will help researchers uncover how trauma affects people’s daily lives, such as their activity, sleep, and mood.

“Our goal is that there will be a time when trauma survivors come in for care and receive screening and interventions to prevent PTSD, just in the same way that they would be screened with X-rays to set broken bones,” McLean explains.

Coping With Trauma

How you react when something traumatic happens, and shortly afterward, can help or delay your recovery.

“It’s important to have a coping strategy for getting through the bad feelings of a traumatic event,” Tuma says. A good coping strategy, he explains, is finding somebody to talk with about your feelings. A bad coping strategy would be turning to alcohol or drugs.

Having a positive coping strategy and learning something from the situation can help you recover from a traumatic event. So can seeking support from friends, family, or a support group.

Talking with a mental health professional can help someone with post-traumatic stress symptoms learn to cope. It’s important for anyone with PTSD-like symptoms to be treated by a mental health professional who is trained in trauma-focused therapy.

“For those who start therapy and go through it, a large percentage of those will get better and will get some relief,” Tuma says. Some medications can help treat certain symptoms, too.

PTSD affects people differently, so a treatment that works for one person may not work for another. Some people with PTSD need to try different treatments to find what works for their symptoms.

Finding Treatments

“While we currently diagnose this as one disorder in psychiatry, in truth, there’s a lot of variation between people and the kinds of symptoms that they have,” Etkin says.

These differences can make it difficult to find a treatment that works. Etkin’s team is trying to understand why some people’s brains respond to treatment and others do not.

“PTSD is very common. But the variety of ways that it manifests in the brain is vast,” Etkin explains. “We don’t know how many underlying conditions there are, or distinct brain problems there are, that lead to PTSD. So we’re trying to figure that part out.”

His team has identified brain circuits that show when therapy is working. They’ve found a separate brain circuit that can predict who will respond to treatment.

His group is now testing a technique called noninvasive brain stimulation for people who don’t respond to treatment. They hope that stimulating certain brain circuits will make therapy more effective.

Most people recover naturally from trauma. But it can take time. If you’re having symptoms for too long—or that are too intense—talk with your health care provider or a mental health professional. In times of crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or visit the emergency room.

“PTSD is real. This is not a weakness in any way,” Tuma explains. “People shouldn’t struggle alone and in silence.”

Tips to Help With Trauma Recovery

• Talk with others about how you feel. Don’t isolate yourself.
• Calm yourself. Try meditation or deep breathing exercises. Do physical activity, like walking or yoga.
• Take care of yourself. Get plenty of sleep. Eat a healthy diet. Drink enough water.
• Avoid using alcohol, drugs, and tobacco.
• Get back to your daily routine. Do the things you would normally do, even if you don’t feel like it.
• Get involved in your community. Volunteering is a great way to create a sense of meaning.
• Get help if symptoms persist. Talk with a mental health professional.
• If you’re trying to help a friend, listen and find out where they are in the coping process. Try to accept their feelings and help in any way you can.

A traumatic event is a shocking, scary, or dangerous experience that can affect someone emotionally and physically. Experiences like natural disasters (such as hurricanes, earthquakes, and floods), acts of violence (such as assault, abuse, terrorist attacks, and mass shootings), as well as car crashes and other accidents can all be traumatic. Researchers are investigating the factors that help people cope or that increase their risk for other physical or mental health problems following a traumatic event.

Physical trauma is a serious injury to the body. Two main types of physical trauma are:

• Blunt force trauma—when an object or force strikes the body, often causing concussions, deep cuts, or broken bones.
• Penetrating trauma—when an object pierces the skin or body, usually creating an open wound.

Surgery can also cause physical trauma, sometimes called a controlled injury.

Psychological trauma is an emotional or psychological injury. It usually results from an extremely stressful or life-threatening situation.

Responses to trauma can be immediate or delayed, brief or prolonged. Most people have intense responses immediately following, and often for several weeks or months after a traumatic event. These responses can include:

• Feeling anxious, sad, or angry
• Trouble concentrating and sleeping
• Continually thinking about what happened

For most people, these are normal and expected responses and generally lessen with time.

In some cases, these responses continue for a longer period of time and interfere with everyday life. If they are interfering with daily life or are not getting better over time, it is important to seek professional help. Some signs that an individual may need help include:

• Worrying a lot or feeling very anxious, sad, or fearful
• Crying often
• Having trouble thinking clearly
• Having frightening thoughts or flashbacks, reliving the experience
• Feeling angry, resentful, or irritable
• Having nightmares or difficulty sleeping
• Avoiding places or people that bring back disturbing memories and responses.
• Becoming isolated from family and friends

Children and teens can have different reactions to trauma than those of adults. Symptoms sometimes seen in very young children (less than six years old) can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Physical responses to trauma may also mean that an individual needs help. Physical symptoms may include:

• Headaches
• Stomach pain and digestive issues
• Feeling tired
• Racing heart and sweating
• Being very jumpy and easily startled

Individuals who have a mental health condition or who have had traumatic experiences in the past, who face ongoing stress, or who lack support from friends and family may be more likely to develop more severe symptoms and need additional help. Some people turn to alcohol or other drugs to cope with their symptoms. Although substance use may seem to relieve symptoms temporarily, it can also lead to new problems and get in the way of recovery.

Healthy ways of coping in this time period include:

• Avoiding alcohol and other drugs;
• Spending time with loved ones and trusted friends who are supportive; and
• Trying to maintain normal routines for meals, exercise, and sleep.

In general, staying active is a good way to cope with stressful feelings.

Recovery after a traumatic event is a process that takes time. If you take direct action to cope with your stress reactions it may create a sense of power. Learn how you can use active coping after trauma and for PTSD symptoms.

Active Coping

• Active coping means accepting the impact of trauma on your life and taking direct action to improve things.
• Active coping occurs even when there is no crisis. Active coping is a way of responding to everyday life. It is a habit that must be made stronger.

Know That Recovery Is a Process

Following exposure to a trauma most people experience stress reactions. Understand that recovering from the trauma is a process and takes time. Knowing this will help you feel more in control.

• Having an ongoing response to the trauma is normal.
• Recovery is an ongoing, daily process. It happens little by little. It is not a matter of being cured all of a sudden.
• Healing doesn't mean forgetting traumatic events. It doesn't mean you will have no pain or bad feelings when thinking about them.
• Healing may mean fewer symptoms and symptoms that bother you less.
• Healing means more confidence that you will be able to cope with your memories and symptoms. You will be better able to manage your feelings.

Positive Coping Actions

Certain actions can help to reduce your distressing symptoms and make things better. Plus, these actions can result in changes that last into the future. Here are some positive coping methods:

Learn about trauma and PTSD

It is useful for trauma survivors to learn more about common reactions to trauma and about PTSD. Find out what is normal. Find out what the signs are that you may need assistance from others. When you learn that the symptoms of PTSD are common, you realize that you are not alone, weak, or crazy. It helps to know your problems are shared by hundreds of thousands of others. When you seek treatment and begin to understand your response to trauma, you will be better able to cope with the symptoms of PTSD.

Talk to others for support

When survivors talk about their problems with others, something helpful often results. It is important not to isolate yourself. Instead make efforts to be with others. Of course, you must choose your support people with care. You must also ask them clearly for what you need. With support from others, you may feel less alone and more understood. You may also get concrete help with a problem you have.

Practice relaxation methods

Try some different ways to relax, including:

• Muscle relaxation exercises
• Breathing exercises
• Meditation
• Swimming, stretching, yoga
• Prayer
• Listening to quiet music
• Spending time in nature

While relaxation techniques can be helpful, in a few people they can sometimes increase distress at first. This can happen when you focus attention on disturbing physical sensations and you reduce contact with the outside world. Most often, continuing with relaxation in small amounts that you can handle will help reduce negative reactions. You may want to try mixing relaxation in with music, walking, or other activities.

Distract yourself with positive activities

Pleasant recreational or work activities help distract a person from his or her memories and reactions. For example, art has been a way for many trauma survivors to express their feelings in a positive, creative way. Pleasant activities can improve your mood, limit the harm caused by PTSD, and help you rebuild your life.

Talking to your doctor or a counselor about trauma and PTSD

Part of taking care of yourself means using the helping resources around you. If efforts at coping don't seem to work, you may become fearful or depressed. If your PTSD symptoms don't begin to go away or get worse over time, it is important to reach out and call a counselor who can help turn things around. Your family doctor can also refer you to a specialist who can treat PTSD. Talk to your doctor about your trauma and your PTSD symptoms. That way, he or she can take care of your health better.

Many with PTSD have found treatment with medicines to be helpful for some symptoms. By taking medicines, some survivors of trauma are able to improve their sleep, anxiety, irritability, and anger. It can also reduce urges to drink or use drugs.

Coping with the Symptoms of PTSD

Here are some direct ways to cope with these specific PTSD symptoms:

Unwanted distressing memories, images, or thoughts

• Remind yourself that they are just that, memories.
• Remind yourself that it's natural to have some memories of the trauma(s).
• Talk about them to someone you trust.
• Remember that, although reminders of trauma can feel overwhelming, they often lessen with time.

Sudden feelings of anxiety or panic

Traumatic stress reactions often include feeling your heart pounding and feeling lightheaded or spacey. This is usually caused by rapid breathing. If this happens, remember that:

• These reactions are not dangerous. If you had them while exercising, they most likely would not worry you.
• These feelings often come with scary thoughts that are not true. For example, you may think, "I'm going to die," "I'm having a heart attack," or "I will lose control." It is the scary thoughts that make these reactions so upsetting.
• Slowing down your breathing may help.
• The sensations will pass soon and then you can go on with what you were doing.

Each time you respond in these positive ways to your anxiety or panic, you will be working toward making it happen less often. Practice will make it easier to cope.

Feeling like the trauma is happening again (flashbacks)

• Keep your eyes open. Look around you and notice where you are.
• Talk to yourself. Remind yourself where you are, what year you're in, and that you are safe. The trauma happened in the past, and you are in the present.
• Get up and move around. Have a drink of water and wash your hands.
• Call someone you trust and tell them what is happening.
• Remind yourself that this is a common response after trauma.
• Tell your counselor or doctor about the flashback(s).

Dreams and nightmares related to the trauma

• If you wake up from a nightmare in a panic, remind yourself that you are reacting to a dream. Having the dream is why you are in a panic, not because there is real danger now.
• You may want to get up out of bed, regroup, and orient yourself to the here and now.
• Engage in a pleasant, calming activity. For example, listen to some soothing music.
• Talk to someone if possible.
• Talk to your doctor about your nightmares. Certain medicines can be helpful.

Difficulty falling or staying asleep

• Keep to a regular bedtime schedule.
• Avoid heavy exercise for the few hours just before going to bed.
• Avoid using your sleeping area for anything other than sleeping or sex.
• Avoid alcohol, tobacco, and caffeine. These harm your ability to sleep.
• Do not lie in bed thinking or worrying. Get up and enjoy something soothing or pleasant. Read a calming book, drink a glass of warm milk or herbal tea, or do a quiet hobby.

Irritability, anger, and rage

• Take a time out to cool off or think things over. Walk away from the situation.
• Get in the habit of exercise daily. Exercise reduces body tension and relieves stress.
• Remember that staying angry doesn't work. It actually increases your stress and can cause health problems.
• Talk to your counselor or doctor about your anger. Take classes in how to manage anger.
• If you blow up at family members or friends, find time as soon as you can to talk to them about it. Let them know how you feel and what you are doing to cope with your reactions.

Difficulty concentrating or staying focused

• Slow down. Give yourself time to focus on what it is you need to learn or do.
• Write things down. Making "to do" lists may be helpful.
• Break tasks down into small do-able chunks.
• Plan a realistic number of events or tasks for each day.
• You may be depressed. Many people who are depressed have trouble concentrating. Again, this is something you can discuss with your counselor, doctor, or someone close to you.

Trouble feeling or expressing positive emotions

• Remember that this is a common reaction to trauma. You are not doing this on purpose. You should not feel guilty for something you do not want to happen and cannot control.
• Make sure to keep taking part in activities that you enjoy or used to enjoy. Even if you don't think you will enjoy something, once you get into it, you may well start having feelings of pleasure.
• Take steps to let your loved ones know that you care. You can express your caring in little ways: write a card, leave a small gift, or phone someone and say hello.

A Final Word

Try using all these ways of coping to find which ones are helpful to you. Then practice them. Like other skills, they work better with practice. Be aware that there are also behaviors that DON'T help. 

When you have PTSD, you may try to deal with symptoms in ways that cause more harm than good. This is called negative coping. Learn how quick fixes may make your PTSD symptoms worse in the long run or create new problems.

What Are Examples of Negative Coping to Avoid?

Substance abuse

Taking a lot of drugs or alcohol to feel better is called substance abuse. You may try and use drugs or alcohol to escape your problems, help you sleep, or make your symptoms go away.

Substance abuse can cause serious problems. Drinking or using drugs can put your relationships, your job, and your health at risk. You may become more likely to be mean or violent. When under the influence of alcohol or drugs, people often make bad decisions.

Avoiding others

Certain social situations may cause you stress, make you angry, or remind you of bad memories. Because of this, you may try to avoid doing things with other people. You may even avoid your friends and family.

Avoiding others can make you feel isolated. Isolation is when you tend to be alone a lot, rather than spending time around other people. Yet social support is critical to healthy coping.

When you distance yourself from others, your problems may seem to build up. You may have more negative thoughts and feelings like sadness and fear. You may feel like you're facing life all alone.

Reach out to those in your support circle, even if you don't feel like it. You're not alone.

Staying always on guard

After going through a trauma, it may seem reasonable to try to stay extra alert. You may be on the lookout for danger at all times. However, this way of coping doesn't work. You end up feeling stressed, fearful, and worn out.

Avoiding reminders of the trauma

Trying to avoid bad memories or trying to shut out feelings may seem reasonable. However, they don't work because trauma controls your life if you run from it. If you avoid thinking about the trauma or if you avoid seeking help, you may keep distress at bay for a time, but at a cost. This behavior also prevents you from making progress in how you cope with trauma and its consequences.

Anger and violent behavior

You may feel a lot of anger at times. Your anger may cause you to lose your temper and do reckless things. You may distance yourself from people who want to help.

This is understandable. It's natural to feel angry after going through something traumatic. But anger and violent behavior can cause problems in your life and make it harder for you to recover.

Dangerous behavior

You also may cope by doing things that are risky or dangerous. For example, you may drive too fast or be quick to start a fight when someone upsets you. You may end up hurting yourself or someone else.

Certain ways of dealing with stress can be dangerous. If you start smoking or smoke more, you put your health in danger. Eating to relieve stress also can be dangerous if you gain too much weight.

Working too much

Work is a good thing. You learn new things, interact with others, and gain confidence. But working too much can be a form of avoidance. You may be working to avoid memories or to help yourself forget about the trauma. This is negative because:

• You may not seek help for your PTSD.
• You're not spending time with your family and friends. Being with them and getting their support may help you recover and deal better with PTSD.
• You may work so much that you get little sleep and don't eat right. This can hurt your health, so you're more likely to get sick.

During the COVID-19 outbreak, you might have concerns about safety, feeling unable to cope, helplessness, guilt and anger. While it is understandable to feel this way, focusing on such negative feelings can make coping even more difficult. You may find it useful to become more aware of unhelpful thoughts and consider focusing on more helpful thoughts.

Use this table to identify thoughts you might be having now, and helpful thoughts you can try instead. Then, it's important to practice using more helpful thoughts as often as you can.

Topic: Safety

Topic: Helplessness and Control

Topic: Coping

Topic: Guilt

Topic: Blame and Anger

Mental health conditions can be treated. If you or someone you know needs help, talk with your health care provider.

If You Know Someone in Crisis

Some symptoms require immediate emergency care. If you or someone you know is thinking about harming themselves or others or attempting suicide, seek help right away:

• Call 911 for emergency services or go to the nearest emergency room.
• Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741).
• Contact social media outlets directly if you are concerned about a person’s social media updates or dial 911 in an emergency. For more information about how to contact social media outlets, visit the Lifeline’s Support on Social Media webpage.

Take any comments about suicide or wishing to die seriously—even those said by children and adolescents. Even if you do not believe your family member or friend will attempt suicide, the person is in distress and can benefit from your help in finding treatment. You can learn more about suicide prevention on NIMH’s Suicide Prevention webpage.