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Hypervigilance when having PTSD: characteristics and therapy

26 May 2022

The human body has powerful self-protective properties.

In particular, hypervigilance is also the body`s way of protecting you from threatening situations.

Chronic excessive vigilance can be a common symptom of post-traumatic stress disorder (PTSD). You can read more about PTSD in a separate article.

Hypervigilance symptoms when having PTSD

One of the many symptoms of PTSD is excessive vigilance (hypervigilance).

Hypervigilance displays a sense of threat in safe situations, places with people. Even familiar surroundings and people can be a problem, as hypervigilance can make people acutely evaluate details they have not paid attention to before: body language, a person`s voice and tone, their mood, facial expressions.

Hypervigilance can be characterized by four general features.

  • Threat overestimation: people who are exceedingly vigilant will look for threats that are either improbable or exaggerated.
  • Intrusive avoidance of perceived threats: a person avoids places where they think threatening situations may arise in advance (e.g. public gatherings). In extreme cases, a person may develop agoraphobia, a type of intrusive fear that encompasses a set of different types of phobias: fear of crowds, fear of being unaccompanied in the open space, public places and transport.
  • Increased fear reflex: it is an abnormal reaction in which a person flinches at any sudden noise, movement or surprise, even at night. Being in a new environment can further exacerbate the reaction.
  • Adrenaline-induced physiological symptoms: people with hypervigilance associated with PTSD often have a persistent adrenaline reaction, which is marked by dilated pupils, increased heart rate and elevated blood pressure.

There are some other common hypervigilance symptoms:

  • Lack of objectivity.
  • Excessive analysis of what people see or think about us.
  • Unawareness of what is obvious to others.
  • Anxious, restless appearance, a person cannot sit still.
  • Unwillingness to try new things or meet new people.
  • Sometimes people with hypervigilance can`t talk because they are distracted by some details/sounds and can`t concentrate.
  • Constant worrying about others.
  • Effects on sleep: someone may be very afraid to fall asleep, and when falling asleep, the slightest noise can wake the person up completely, and the adrenaline burst can make it very difficult to fall asleep again.
  • Catastrophizing: panic associated with hypervigilance focuses a person only on the negative aspect and they unconsciously create a situation that will consciously lead to failure.

Many people with excessive vigilance do not consider their reactions to be unreasonable. They may feel that their actions are necessary for safety after the trauma. However, if hypervigilance interferes with activities of daily life, it should be treated as part of post-traumatic stress disorder.

Therapy features

The treatment of hypervigilance can vary depending on the underlying cause as well as the severity of the behavior.

The first step in therapy is to separate the person from an environment where there is a real threat (e.g. in cases of domestic violence) or where the potential threat may be real (e.g. working for the police).

Treatment may include psychotherapy or medication therapy:

  • Cognitive behavioral therapy: it is a talk therapy that can help you change the way you think about PTSD: to feel better and behave differently. Usually this kind of therapy when having PTSD is conducted face-to-face, sometimes it can take place in groups.
  • Exposure therapy: the aim of exposure therapy is to expose you to the influences of triggers that stimulate stress. It will help you recognize them in your life and find ways to react more gently.
  • Eye movement desensitization and processing technique: it is a technique that uses eye movements to help the brain process traumatic memories and gradually reduce PTSD. You will be asked to mention the traumatic event and what it makes you think and feel. While doing that, you should make eye movements or receive some “bilateral stimulation”, like tapping your hands. It reduces the intensity of the emotions the person is feeling about the traumatic memory, helping to remove the trauma.
  • Treatment: Antidepressants and anti-anxiety (anxiolytic) medicines may be used in the treatment of PTSD and their anxiety disorders. However, their prescription should be determined solely by the doctor, as well as the duration and regimen of use.

Hypervigilance as a symptom of PTSD cannot be treated separately. Therapy of hypervigilance depends on proper treatment of the underlying disorder, and in some cases hospitalization may be necessary in order to control symptoms.

Practical advice

Hypervigilance can be quite addictive in the lives of people suffering from post-traumatic stress disorder. Some of these tips may help you feel a little calmer.

  • Transparent shower curtain. For some people, an ordinary shower curtain, when combined with staying in a small enclosed space in the shower cubicle, can hide the “unknown”. If you feel something similar, try changing a shower curtain to a transparent one.
  • Lighting. Darkness is capable of inducing fear even in people without PTSD. If you feel uncomfortable because of the darkness, think about installing a motion sensor by the entrance door; install a night light in your bedroom and a hallway nearby.
  • Alarm. If hypervigilance prevents you from sleeping because of fear of other people entering the flat, an alarm system with a special mode for the nighttime can help you.
  • Move your furniture according to your needs. For example, place the sofa in a position where you can see the door or windows while you watch TV.
  • Listen to music. For some people, listening to music means they can`t hear what`s going on around them. For others, playing soft music on headphones during movement can be distracting to hear any sudden noises.

Remember, sometimes even small things can increase your sense of safety.



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