What Happens During a PTSD Episode?

PTSD Episode

Throughout their lifetime, at least half of all people will experience a traumatic event of one kind or another. For some, trauma begins early in life with the devastation of childhood abuse and other maltreatment, including neglect. Beyond this, there are many other types of events that are inherently traumatic, such as military combat, rape, and assault, serious motor vehicle accidents, being stalked, natural disasters, and mass shootings. Mental health experts suggest that living through the COVID-19 pandemic is yet another event that has traumatized many people.

It’s normal for anyone who has endured or witnessed experiences like these to have a strong emotional response that could last for days or weeks. However, some people have a delayed and/or prolonged reaction to the traumatic event which can lead to posttraumatic stress disorder (PTSD).

Prevalence and Symptoms of PTSD

According to the National Center for PTSD, approximately 7-8% of people in the U.S. will develop PTSD during their life—10% of women and 4% of men. To be diagnosed with this condition, a person will have symptoms that include several of these:

  • Recurrent and distressing memories or dreams of the traumatic event
  • Prolonged or noticeable psychological and/or physiological reactions to cues resembling the experience
  • Flashbacks of the event or emotional/psychological dissociation when triggered
  • Avoidance of thoughts, feelings, people, places, or any reminders of what happened
  • Difficulty remembering details of the event
  • Changes in mood, memory, or thinking patterns
  • Hypervigilance, sleep problems, anger outbursts, or self-destructive behavior

While all these symptoms can cause significant impairment, some are more challenging to manage than others. This is largely due to the amygdala, a structure deep in the brain that is best known for our fight or flight response. When in danger, the amygdala assigns an emotional tag to any experience that could be life-threatening, and its function is automatically prioritized over other areas of the brain, including those that govern reasoning and memory.

PTSD Episodes: Flashbacks and Dissociation

The amygdala doesn’t forget anything that it has deemed as dangerous and doesn’t discern whether the threat is real or imagined. This plays a big role in untreated PTSD, especially when these symptoms occur:

  • Flashbacks are a nightmarish and intense reliving of a traumatic event. Whether it is momentary or lasts a few minutes, hours, or even days, someone going through a flashback is unable to distinguish it from reality. Flashbacks are uncontrollable and are very vivid, likely evoking strong sensory memories associated with the trauma that was endured and the environment in which it happened.
  • Dissociation occurs when a person feels separate or disconnected from their body and surroundings as though they are observing things from outside of themselves. This tends to occur automatically as a coping mechanism to manage traumatic memories and the emotions associated with them. Like flashbacks, dissociative episodes can be fleeting or last for a long time.
The amygdala (the brain’s fear center) doesn’t forget anything that it has deemed as dangerous and doesn’t discern whether the threat is real or imagined. This plays a big role in untreated PTSD. Click To Tweet

Flashbacks and dissociation are often unpredictable and are caused by triggers in the environment that are reminders of the traumatic event. Such cues can be sights, sounds, odors, objects, people, places, or any number of things that are somehow associated—even unconsciously—with the fearful experience. The brain responds by activating the amygdala as though real danger is imminent. This in turn causes an increase in heart rate, shallow breathing, perspiration, and panic as the fight or flight system kicks in. For Steven, a mechanic, who witnessed a horrific accident that killed 10 people, his hands would start shaking.

“Grounding” to Offset a PTSD Episode

Although they come on quickly, a person will usually have a little bit of warning prior to the flashback or dissociation. They may feel they are losing their connection to reality or things may start to look blurry. One method for not completely losing touch with reality is through a technique known as “grounding,” which is similar to mindfulness.

Just as it sounds, grounding can help a person stay present so that they recognize their oncoming PTSD symptoms for what they are. This technique involves strategies such as these:

  • Engaging each of the senses by identifying things in the immediate environment they can see, smell, touch, taste, and hear
  • Moving around—whether by walking, running, or jumping—to help disrupt the body’s stress response
  • Breathing deeply and slowly to help calm themselves

Mental Health Treatment for PTSD

It is possible to recover from PTSD, and one of the most effective treatments for this condition is called eye movement desensitization and reprocessing (EMDR), which the mechanic Steven underwent. This type of psychotherapy is done with a licensed mental health practitioner who is trained and certified in it.

After some sessions for EMDR preparation, a process called bilateral stimulation (BLS) is used. This involves having clients move their eyes side-to-side as they follow the therapist’s finger or having the client hold a small device in each hand that alternately vibrates. At the same time, a traumatic memory or associated bodily sensations are recalled simultaneously with the BLS. The distraction of the BLS makes thinking and talking about the experience less terrifying or overwhelming. This method helps the traumatic memories get “unstuck” so they can be more fully processed in the brain. This in turn opens the door to greater coping skills and emotional management related to the trauma.

Sadly, without treatment, many people won’t fully recover from PTSD. Reaching out for help is a sign of strength, not weakness. And though the road to recovery from PTSD and other types of trauma may not be a linear one, the continued progress can lead to a greater sense of well-being and have more fulfillment in life.

PTSD and other mental health issues can’t wait. During these uncertain times, your mental well-being is more important than ever and waiting until life gets back to “normal” is likely to make your symptoms worsen over time.

At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, remote clinical evaluations, and video therapy for adults, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.


  1. I can see that my girlfriend is approaching an episode. The past couple of years has been rough. I don’t know what brings it on but her delusional thoughts and anger are increasing lately. I can’t get her to see a doctor. Early last year before the pandemic see was hospitalized because she was completely unhinged. What do I do? How to help her ? How to get her the help she needs ?

    Comment by Joe Curcio — May 21, 2021 @ 3:50 AM

  2. when i was 4 years old my mother left me,my 2 yr old brother and my father to be with another man she eventually married.it was my first day of school….
    I do not remember anything after she left until i was taken to my paternal grand parents with whom I lived until adulthood.my grand mother was a psychiatrist born in 1889!!
    i would like to retrieve some of the memories of my life then.
    I am 78 now …..think its anout time.
    Thank you

    Comment by mic — May 21, 2021 @ 1:50 PM

  3. There is no easy answer here, but I hope that these resources will help you: The Magnesium Miracle by Carolyn Dean as well as Change Your Brain Change Your Life by Daniel Amen

    Comment by Kyle — May 21, 2021 @ 2:35 PM

  4. Your articles are very helpful to me in my practice. Thank you.

    Comment by Mary C Dermody — May 23, 2021 @ 6:54 AM

  5. I HAVE BEEN DIAGNOSED WITH PTSD… from a medical surgery, they put me into a drug induce state of paralyasis… but the hullabaloo of hallucinations, was so awful and real, as I witnessed murders, and horrific scenes of men women and children being dismembered in horrific accidents involving, trains, trucks, boats, cars and exploding bodies from murderous implants .
    EVERYONE, around me had murderous intentions and I was the target… he’s events eventually led to my loss of employment, loss of a 45yr marriage, games being labeled buy friends and family, causing loss of association with loved ones…
    I feel like I’m starting life all over again trying to make sense of the losses…but I aim for new transformation into a new life, with love n peace…into a peaceful realm of living…

    Comment by David — May 24, 2021 @ 7:12 AM

  6. I started having Flash backs 8 during Covid in February of this year. Apparently my therapist did not know enough about EMDR and I started drinking again. I stopped yesterday, saw her today for the last time. She told me she was in the process of getting licensed. I had no idea this was the case. What can I do about it?

    Comment by Christina Gandy — May 24, 2021 @ 1:41 PM

  7. When having a PTSD trigger and you disassociate how do you bring yourself back if you don’t have people around to help or can grasp control of your mind

    Comment by Christian — February 12, 2022 @ 11:44 AM

  8. I have bipolar disorder, and I find your articles quite useful in navigating it. Thank you for reaching out.

    Comment by Irene Johnson — November 14, 2022 @ 6:11 AM

  9. A significant number of nurses who have worked in the OR,ER,and ICU have PTSD from witnessing horrific and unrelenting patient injuries and deaths. They can recall vivid details of these events for years, including mistakes made by other staff members, including MDs and blame that was placed on them by those very MDs and administrators. Many of them quit nursing and also lost their families for this reason.

    Comment by Michelle — November 14, 2022 @ 9:32 PM

  10. My 30 year old grandson, has what I believe to be severe PTSD. He states he was raped. He thinks everyone he sees knows this and is laughing at him and looking down on him. He is currently homeless and sees all attempts to help him as continuing abuse. How can I make a difference in helping him?

    Comment by Jane — November 15, 2022 @ 6:24 AM

  11. I lost my house in a fire 5 years ago and for two weeks while the fire ripped through my city, there were sirens and alarms and all sorts of chaos. I was hardly able to eat during that time and just disassociated to cope with it. Things have gotten much better in the years since then, and I've been feeling that the fire was behind us and although I still think about it daily, it has become less painful. But today at work (i work in special ed at an elementary school) we had a fire drill and while I'd been worried about the kids and helping them, as soon as the alarm went off I just started crying and couldn't get a hold of myself. My reaction totally surprised me and I had no idea that I would react like that. It was so sudden, and I was so scared and couldn't stop trembling and crying. Trauma is such a strange thing! At least now I know that I'll have this kind of reaction, and that my coworkers are very supportive and understanding of my trauma.

    Comment by Kate — January 20, 2023 @ 10:14 AM

  12. PTSD is an extremely complex psychological and physiological condition that requires clinical psychotherapy interventions with a therapist who is highly trained and specialized and clinically experienced in trauma treatments. People with true traumatic stress (media misuses the term) trauma work is completely beyond coaching scope of practice; coaches do not have any clinical training or specialization or board licensing; any coach would be practicing without a license for a serious complex diagnosis.

    Comment by C — May 29, 2023 @ 7:15 AM

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