Stress, Traumatic Stress, Posttraumatic Stress and PTSD
WHAT’S THE ISSUE: Is reframing stress for students in order to “get them” to believe that stress is a positive thing the secret to boosting student well-being? It depends. I’m a Youth Mentor and EFT Practitioner specialized in stress, anxiety, and academic performance. And I know that when students are very stressed and overwhelmed – you can’t just give them advice or use logic and reason to help them. It doesn’t work. In this article, you will:
- learn about the healthy range of stress – within which students can self-regulate and act on advice – versus unhealthy levels of stress that require specialist support and co-regulation.
- go beyond an is-all-stress-bad “debate” (this is not a matter of debate) and into a more informed understanding of the spectrum of healthy and unhealthy levels of stress
- why unhealthy levels of stress prevent learners from achieve their academic and well-being potential.
I believe we need to have well-informed conversations about the various degrees stress students may be experiencing. This allows us to be sensitive to the emotional needs of students who are stuck in overwhelming levels of stress. When schools and educators have a good understanding of the biology and the psychology of stress, they can enjoy more success in their efforts to help students become happier and more confident self-directed learners.
BEYOND THE BASIC "NOT ALL STRESS IS BAD" CONVERSATIONS
“Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory…The traumatized person may experience intense emotion but without clear memory of the event, or may remember everything in detail but without emotion…Traumatic symptoms have a tendency to become disconnected from their source and to take on a life of their own.”
Dr Judith Herman (2015) Trauma and Recovery
When we speak of “good stress” and “bad stress” in a binary way, it oversimplifies reality; the truth is, there is a wide spectrum of healthy and unhealthy ranges of stress. Oversimplified descriptions of a student wellbeing issue can lead to oversimplified (and therefore unsuccessful) attempts to address particular problems of student wellbeing.
More and more teachers, parents, and students are becoming aware of the need to speak about stress in a more informed and nuanced way. In his world-renowned book, Trauma-Sensitive Mindfulness, Dr Treleavan talks about how “many meditators who contact me – often teachers themselves – express humiliation around the inability to manage their (stress) symptoms through meditation”. He shares examples of people who are suffering from traumatic stress, posttraumatic stress – and even full-fledged PTSD – who have been advised to “just keep meditating and it shall pass“. Teachers who were advised to just notice, and stay with, the overwhelming stressful feelings and sensations. And that if they just stay with the pain long enough, it would just go away. And (surprise surprise)…it didn’t work. If anything, it made them feel worse. The message was “Well if you aren’t feeling better, it’s because you aren’t trying hard enough”.
Similarly, assuming that all stress can be processed by simply having a teacher, a parent, or a school principal cognitively reframe a stressful crisis as a positive thing for a child also does not work for all cases. That’s because getting stuck in a state of traumatic stress is not just a cognitive problem. Nor is it just an emotional problem. This level of stress exists in the body. And that is why trauma-informed yoga classes, body awareness exercises, and body-based stress management techniques like the Emotional Freedom Techniques can be empowering for teens who are stuck in a state of stress and overwhelm. When we have this level of stress, we need stress management interventions that take the body into account.
Traumatic Stress AND POSTTRAUMATIC STRESS
“For many, being exposed to a single traumatic event won’t produce long-term consequences. We’re impacted, but can metabolize the experience – meaning we can process through the thoughts, memories, and emotions without becoming overwhelmed and stuck. Sometimes, however…some kind of alarm system inside of us doesn’t switch off, and a traumatic experience comes to wreak havoc with our body and mind. This is known as posttraumatic stress – an experience where traumatic symptoms live on past the traumatic event.”
Dr David Treleaven (2018) Trauma-Sensitive Mindfulness
For many students around the world, online learning due to COVID has been a traumatic stress experience. Some forms of traumatic stress are indeed caused by a single event that can cause our Autonomic Nervous System (ANS) to move into a dysregulated state of:
- hyperarousal (e.g. unproductive anxiety, panic attacks, anger outbursts, restlessness)
- hypoarousal (e.g. low energy, low motivation, numb to feelings, foggy brain, moving slowly)
Or both, which means they are oscillating between hyperarousal (e.g. panicking) and hyperarousal (e.g. “I can’t be bothered”). However, we now know that ongoing stress can also contribute to the dysregulation of the Autonomic Nervous System. The key word here is “autonomic”, meaning automatic. Overwhelming levels of stress cannot be consciously controlled. The automatic biology of stress influences our thoughts, feelings, and behaviors, when we are in a state of too much (di)stress. When we are stuck in such high levels of stress, we need the support of professionals who have the knowledge and skills to help us co-regulate and renegotiate our way back into the healthy range of stress. For students to be able to emotionally self-regulate, they need to be within the healthy range of adaptive stress arousal. Yet a lot of High School students around the world are currently stuck in the hyperaroused / hypoaroused, unhealthy levels of school-related stress, as they fall behind with their assignments and are told by schools that they need to drop one or more classes because they are guaranteed to fail that subject’s exams, if not.
Traumatic stress occurs when we are trapped in a shocking situation where our Autonomic Nervous System becomes overwhelmed by a real or perceived existential threat. For example, while the fear of failing an exam may not present a real threat to one’s existence (there’s no saber-toothed tiger that’s about to attack), it can still be perceived as a real existential threat. This can trigger a lot of anxiety, overwhelm, or panic in teenagers and Uni/college students, both while studying for, and while sitting an exam. Posttraumatic stress occurs after a traumatic event, whereby the symptoms of hyperarousal and hypoarousal continue in a person’s daily life after the real or perceived danger is over. Let me give you an example. When someone had an existential crisis from a traumatic stress experience with COVID, followed by post-COVID health complications, they may find themselves stuck in a posttraumatic stress state of hypoarousal that exacerbates their long-COVID symptoms.
A lot of the teens and adults I work with are being held back from achieving their academic potential due to too much exam stress. They might even have had a panic attack in a test or exam, where they froze from stress and forgot everything they learned. Until recently, Cognitive Behavioral Therapy (CBT) was seen as the best approach for helping kids overcome exam-related stress. Another approach that’s been used to help these students is informal, or formal, Exposure Therapy. Cognitive reframing and repeated exposure can eventually lead to a positive result and help kids overcome unhelpful levels of exam stress or exam anxiety. However, these can be quite drawn-out and painful approaches to solving the problem of exam-related hyperarousal. We now have scientific, evidence-based stress management tools that are a gentler and quicker approach to address exam-related student anxiety, such as the Emotional Freedom Techniques (EFT). That is why I love to use these stress management techniques when I’m mentoring students who have unhealthy levels of exam stress and exam anxiety.
One common mistake we make is to assume that we can reason our way back into emotional self-regulation, just by reframing how you think about the overwhelming stress that our body is experiencing…for ALL degrees of stress. Independent self-care practices like going for walks, exercising, and doing self-soothing meditations can help us stay within the healthy range of stress. However, when it comes to overwhelming levels of stress, like when our Autonomic Nervous System is stuck in a state of hypoarousal and / or hyperarousal due to postraumatic stress, one-to-one support from someone who can help us get back into the healthy range of stress through co-regulation is essential. We are social creatures. And while we can certainly sometimes let our ego get the best of us, and think illogical things like “I don’t need anyone – I can figure this out on my own”, the truth is that we need other humans to survive and thrive.
Another common mistake we can make when we are stuck in a state of hypoarousal or hyperarousal is to let limiting beliefs like “I have to go it alone” or “It’s weak to ask for help” to stop us from getting help. Basic self-care routines like going for a daily walk, doing regular exercise, and joining a yoga class help to calm our Autonomic Nervous System down. But if a student’s anxiety goes up to a 10/10 every time they try to face the assignments they haven’t yet handed in that are piling up, after coming back from a relaxing walk or yoga class…then you know that basic self-care acts like going for a walk will not solve the problem of what’s triggering a school-related hyperaroused stress response.
Procrastination is an avoidance behavior. When the event that is repeatedly triggering an avoidance behavior in a student is one of their assignments or upcoming exams, this is a sign that the student is either being held back by traumatic stress or posttraumatic stress. If a student struggles to get started on schoolwork, even after taking part in a relaxing yoga or meditation class, and they continue to avoid their work, you know that they need targeted support for the particular school-related stress that’s triggering the fear-based flight response. How can a student learn when they feel overwhelmed and triggered by the thought of starting an academic assignment? What can a parent do when their child has started shutting down their attempts to help them and give them advice? Kids who are experiencing this level of stress need more than just conversational interventions to help them get unstuck.
When a teenager or Uni/college student is feeling overwhelmed by the academics, they need a personalized, body-based approach that helps them shift from the maladaptive Autonomic Nervous System levels of stress, into a process of renegotiation. They need one-to-one stress management support that works. When they are back within the healthy range of somatic stress, they can start to emotionally self-regulate, focus more, and learn better again.
PTSD AND COMPLEX PTSD
“Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning. It was once believed that such events were uncommon. In 1980, when post-traumatic stress disorder was first included in the diagnostic manual, the American Psychiatric Association described traumatic events as ‘outside the range of human experience’. Sadly, this definition has proved to be inaccurate.”
Dr Judith Herman (2015) Trauma and Recovery
An important distinction needs to be made between Posttraumatic stress, and Post-Traumatic Stress Disorder. If you have never seen what PTSD “looks like” in that initial shock stage, you’ll find lots of history of war documentaries by typing things like “PTSD in WWI” and “PTSD in WWII” into YouTube. You’ll also notice that changes in historical context have led to shifts in how intense the involuntary PTSD “tics” present themselves in war veterans. The involuntary movements that occur when someone is reliving the old trauma as if it was still happening have become more and more subtle as time goes on, partly due to increased social pressure of what involuntary movements are seen as socially acceptable. If you compare the “tics” that WWI Veterans who suffered from PTSD had, to the WWII Veterans, you will see how historical context influences how some PTSD symptoms present themselves.
Beyond these kinds of external tell-tale signs of PTSD, other gender-neutral symptoms include tormenting nightmares, restless behaviors, traumatic memory flashbacks, being jumpy or easily startled, and a constant state of vigilance or irritability. Reminders of the traumatic event(s) may make someone with untreated PTSD feel panicky, or trigger the unprocessed traumatic memor(ies), causing them to feel like they are reliving the event in the here-and-now. Generally speaking, men with untreated PTSD tend to display more rageful outbursts and aggressive behavior towards others than women with untreated PTSD due to gender-specific socialization. Meanwhile, we also know that very young children are more likely to reenact parts of a trauma through play, or they might draw parts of it.
In recent years, a distinction has also been made between PTSD (extreme stress due to adult trauma, or due to single-event trauma), and Complex PTSD (extreme stress that dates back to long-term and extremely serious trauma, like survivors of childhood sexual abuse or incest survivors). While it is a difficult book to read (before you decide to read this book, make sure you are in a place in your life where you can handle it), Dr Judith Herman’s seminal book in the world of PTSD and Complex PTSD, Trauma and Recovery: The Aftermath of Violence – From Domestic Violence to Political Terror, makes it crystal clear that even within a PTSD diagnosis, the severity of this extreme form of psychological and biological stress varies.
One of the things you learn from reading Dr Herman book is that many of Sigmund Freud’s “hysterical” young adult female patients (“hysterical” being the term used in the 19th century to describe what we now call PTSD and Complex PTSD), were children of the bourgeois families of Vienna. This was where Freud established his practice. Early in his career, Freud concluded that these young ladies must have been the victims of “perverted acts against children” during their childhood years, if what he learned from the eighteen case studies entitled The Aetiology of Hysteria was indeed true. But Freud’s inability to come to terms with how widespread severe child abuse was among the Viennese elite (combined perhaps with his motivation to safeguard his business interests) led to him retracting his initial discoveries of the root cause of his patients’ (di)stress. He proceeded to gaslight the young ladies who were brought to him by their parents for mental health treatment; he made victims believe that the traumatic flashbacks they were having of horrific childhood abuse were just “in their head.”
This historical example speaks to the importance of avoiding being dismissive when children and young adults say they feel really stressed and overwhelmed. Schools can (inadvertently) cause harm by making blanket statements like “Stress is good for you! It’s all about how you think of stress. It’s all in your head”. Let’s please engage in a more nuanced, educated, and informed dialogue about the different degrees of biological and psychological stress, so that we can better serve the health and wellbeing needs of all students in schools around the world.
I believe educators need to be aware of the danger of overgeneralizing and oversimplifying the various wellbeing issues related to student stress so that students in crisis can get the specialist support they need for their level of dysregulating (di)stress.
SUPPORTING A STUDENT'S HEALTH AND WELLBEING: HOW I CAN AND CANNOT HELP
“Social Emotional Learning is the process through which all young people and adults aquire and apply knowledge, skills, and attitudes to develop healthy identities, manage emotions, and achieve personal and collective goals, feel and show empathy for others, establish and maintain supportive relationships, and make responsible and caring decisions”
From the CASEL official website
Treating a child or adult who is suffering from any form of PTSD goes beyond my level of expertise. As a Youth Mentor and EFT Practitioner specialized in stress, anxiety, and academic performance, I can help students ages 14+ who are experiencing overwhelming levels of stress in the traumatic stress and posttraumatic stress range of distress. I can help students who are being held back from achieving their academic and wellbeing potential by too much stress. I cannot treat illnesses. I can teach a scientifically proven, evidence-based stress management technique called EFT (Emotional Freedom Technique) that helps students who are in the mid-range levels of dysregulation to return to the healthy stress range. EFT tapping is one of many body awareness and emotional awareness tools in my professional toolbox.
I cannot diagnose or treat mental illnesses. I’ve suffered from PTSD myself [If you’d like to learn more about my story you can watch this video on my EFT Practitioner page]. So I have lived experience of what an extreme and painful state of stress involves, and how successful recovery requires the professional skills of a specialist Trauma Therapist. However, I cannot diagnose or treat mental illnesses and stress-related disorders.
Most of the parents who come to me have already taken their child to a Psychologist, and they have found that their child is not suffering from PTSD, Anxiety Disorder, or from some other form of stress-related mental illness. These parents have been told that their child has too much stress or anxiety, but that they are not mentally ill. Their child may still suffer from stress-induced problems like stomach pains and migraines, or stress-related skin problems like persistent acne or dermatographia. They may have had one or two panic attacks in tests or exams that caused them to forgot everything they studied. The student may also have low energy and be stuck in a state of hyperarousal that is exacerbated by bad sleeping habits, excessive gaming/time on social media habits, or low attention span problems.
While the child does not have, for example, an Anxiety Disorder, a Panic Disorder, Depression, Anorexia, Agorophobia, they may still have unproductive levels of anxiety, panic, or overwhelm due to school-related stress. Their parents want to do something to support their child’s academics and wellbeing before things get any worse that could develop into a mental illness. They want to be proactive. It is with these forward-thinking parents and willing students that I work to systematically help a student rebuild their confidence and self-esteem.
Finally, some of the kids I mentor do not have an actual addiction to gaming or social media. But the amount of time they spend on social media or online entertainment platforms is affecting the progress of their conversational skills (in some cases) or their grades (in others). In some cases, the child has been diagnosed with ADD or borderline ADD. Many of these parents have tried hiring Study Skills tutors to teach their child how to study and organize themselves prior to coming to me. But they have realized that these study techniques cannot work if their child continues to feel overwhelmed by academic stress.
Stress management techniques that help a child with ADD move back into healthy levels of stress can help a student focus more and organize their time better, as they prepare for an important test or exam. While I do include some time management skills training and study skills within my mentoring programs (if needed), most of the work I do is focused on reducing student stress levels. Because when a student’s stress shifts into the healthy range, they have more energy. They can focus more. They feel empowered to organize themselves and to think of solutions to their problems. And they eventually reach a point where they can reframe their experience of (di)stress and overwhelm as a learning experience, for themselves.
DISCLAIMER: This article does not constitute a replacement to seeing a Psychologist or Psychiatrist who has the skills and knowledge to diagnose stress-related mental illnesses and disorders. If you suspect that you or your child may be suffering from Post-Traumatic Stress Disorder or another stress-related mental illness or disorder, it is vital that you see someone who can has the skills and knowledge to diagnose and treat illnesses as a matter of urgency. I hope that this article helps us move beyond the over-simplified "debate" of whether "all stress is bad". There is a spectrum of stress severity. I wrote this article to help shed some light on this reality, so that we can develop a more informed and nuanced approach to talking about student stress in school communities.
About the author
Eleni Vardaki works with individuals and small groups online to support parent, teacher, and student well-being. Her mission is to help bridge the gap between mainstream education and the wellbeing skills we need to thrive in the 21st century. She believes in doable, sustainable interventions for student wellbeing in school and family cultures that value student and community wellbeing.
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