02 Jul

By: Nichole Oliver LPC, NCC, DAAETS

Celebrating freedom in the USA on the Fourth of July is a significant and patriotic occasion. It commemorates the adoption of the Declaration of Independence on July 4, 1776, it represents the birth of the United States as an independent nation and the principles upon which it was founded. The Fourth of July can hold different meanings for different groups of people, such as veterans, first responders, firefighters, and civilians. Navigating these varied perspectives can involve showing respect, understanding, and empathy toward one another. The meaning behind this celebration revolves around the core values of freedom, liberty, and the pursuit of happiness for many who have served. It symbolizes the rights and freedoms that American citizens enjoy, such as freedom of speech, religion, and assembly. It also recognizes the sacrifices made by countless individuals throughout history to secure and protect those freedoms. As a result, the Fourth of July is often marked by various activities and traditions such as parades, firework displays, barbecues, picnics, family gatherings, connecting, and gathering in community events. 

Unfortunately, for veterans, first responders and those who have lost loved ones this is a reminder of the cost. Fireworks are a primary part of the celebrations and can potentially trigger panic, fear, anger, rage, and hypervigilance in individuals with PTSD. The amygdala, which is a part of the brain responsible for processing emotions and the fight-or-flight-freeze response, can perceive fireworks as a threat due to the similarities between the sounds of fireworks, gunfire and those associated with war, bombs, tanks firing off, or other traumatic events. This perception can lead to heightened reactivity and physiological changes in various brain systems, outside the individual’s control.  This can lead to an increase in stress hormones, such as adrenaline and cortisol, causing physiological changes like increased heart rate, rapid breathing, muscle tension, and heightened alertness and scanning perimeter. Traumatic experiences can affect the functioning of the prefrontal cortex, which is responsible for executive functions such as decision-making, impulse control, and emotional regulation. In individuals with PTSD, the prefrontal cortex may have difficulty modulating the strong emotional responses triggered by fireworks, leaving individuals unable to calm down, relax, connect, and even sleep for days after festivities.   

Additionally, the hippocampus, another brain region involved in memory formation, may play a role in the fear response to fireworks associated with previous memories. In people with PTSD, the hippocampus may be structurally and functionally altered, affecting the processing of traumatic memories versus the present moment. The person's body is back in the previous trauma and may be dissociative or "spaced out," disengaged or even engaging in high-risk behavior. Some individuals feel anhedonia, numbness, nothing feels or tastes good, lack of interest, and isolation due to overstimulation of basic events for their individual nervous systems are overloaded and cannot meet the current demands outside of their bodies due to internal overwhelm on the nervous system.  Different people may have varying emotional responses based on their unique experiences and coping mechanisms. If you or someone you know is experiencing anger, rage, or other intense reactions to sounds, fireworks, similar stimuli, or even interactions with others it's crucial to seek support from a mental health professional. They can provide personalized strategies to manage these reactions and work towards healing and recovery. The Fourth of July, with its fireworks and celebrations, can evoke complex emotions for veterans and their families, particularly those who have experienced a moral injury, an additional aspect of trauma. Moral injury refers to the psychological distress that arises from actions or events that violate an individual’s deeply held moral beliefs or ethical code. It often occurs in the context of military service, where individuals may be exposed to situations that challenge their values or involve acts that conflict with their sense of right and wrong. 

The Fourth of July, as a celebration of patriotism and national pride, can serve as a reminder of the ideals and values associated with military service. For veterans who have experienced moral injury, this holiday can bring about psychological concepts that cause distress and inner conflict experienced when an individual's actions or witness events that violate their deeply held moral beliefs or ethical values. Examples are taking part in acts against one's moral code: Soldiers may be required to engage in or witness actions during combat that contradict their personal beliefs. For example, being involved in civilian casualties or acts of torture can deeply conflict with an individual's sense of right and wrong. Moreover, feeling survivor's guilt for those comrades that have died or were wounded more visible with physical injuries as many people do not understand the psychological, physiological, and emotional injuries sustained with PTSD are neurophysiological and can be seen in brain imaging and through psychological assessments administered by a mental health professional or psychiatrist and have can have significant implications on one's life, health and wellbeing if not treated. 

Here are some ways the Fourth of July may impact veterans and their families in relation to moral injury: 

  • Reflection and introspection: The holiday can prompt veterans to reflect on their military experiences and the moral challenges they encountered. They may grapple with the actions they were involved in, witnessing acts that conflicted with their moral compass, or feeling guilty about their own actions.
  • Emotional distress and grief: Fourth of July celebrations can trigger feelings of sadness, grief, or guilt in veterans and their families who have experienced a moral injury. They may mourn the loss of fellow service members, struggle with survivor guilt, or feel a sense of shame and remorse for actions taken during their military service.
  • Sense of disconnection: Veterans and their families who have experienced moral injury may feel disconnected from the celebratory atmosphere of the Fourth of July. They may find it difficult to relate to the narratives of heroism and national pride, as their own experiences have exposed them to the complexities and moral dilemmas of war.
  • Seeking meaning and healing: The Fourth of July can also serve as a catalyst for veterans and their families to seek meaning and healing. It can prompt them to engage in conversations about moral injury, to connect with support networks or mental health professionals, and to pursue personal growth and understanding.
  •  Failing to prevent harm: Soldiers may experience moral injury when they feel they could have done more to prevent harm or protect others but were unable to do so due to circumstances beyond their control. This may lead to feelings of guilt, shame, and a sense of personal failure. 
  •  Betrayal and betrayal trauma: Instances of betrayal within the military unit or organization, such as leadership misconduct, cover-ups, or negligence, can cause moral injury. When trust and loyalty are violated, individuals may experience a profound sense of betrayal and loss of faith in the institution they served.
  •  Moral conflicts and ethical dilemmas: Soldiers may encounter situations where they must make difficult choices with no clear "right" answer. These ethical dilemmas, such as following orders that conflict with personal values or making life-or-death decisions, can result in moral injury.
  • Survivor’s Guilt: Survivor guilt is a psychological condition that can occur when a person feels guilty for surviving a traumatic event while others did not. It is commonly associated with situations such as natural disasters, accidents, combat, or other life-threatening situations. Individuals experiencing survivor's guilt may question why they survived while others did not, and they may feel a sense of responsibility or blame themselves for the outcome. It can lead to feelings of shame, depression, anxiety, or a diminished sense of self-worth.

When individuals with moral injury and/or PTSD hear sounds resembling their traumatic events, it can activate traumatic memories associated with those events. This activation can result in a range of emotional and physiological responses, such as anger, rage, panic, fear, and hypervigilance resulting from the autonomic nervous system. The inner ear plays a crucial role in our perception of sound and balance. Specifically, the malleus, incus, and stapes in the middle ear are involved in transmitting sound vibrations to the inner ear. When it comes to the neurobiology of sounds and how they are stored and retrieved in the brain, several brain regions and systems play crucial roles, particularly in the context of PTSD and physiological triggers. 

  1. Auditory processing: Sounds are initially processed in the auditory cortex, which is responsible for receiving and interpreting auditory information. The auditory cortex analyzes the characteristics of sounds, such as their frequency, intensity, and location.
  2. Amygdala: The amygdala is a key brain structure involved in processing emotions, particularly fear and threat detection. It plays a central role in the alarm system and can rapidly evaluate whether incoming sensory information, including sounds, is potentially threatening. In the context of PTSD, the amygdala can become hyperactive, leading to exaggerated fear responses to trauma-related triggers, including certain sounds.
  3. Hippocampus: The hippocampus is essential for memory formation and consolidation. It helps encode and retrieve contextual memories, including those associated with traumatic experiences. Sounds can become encoded with emotional and contextual information related to traumatic events. When individuals with PTSD hear sounds reminiscent of their trauma, the hippocampus can facilitate the retrieval of traumatic memories, leading to heightened emotional and physiological responses.
  4. HPA Axis: The hypothalamic-pituitary-adrenal (HPA) axis is a complex system involved in the body's stress response. When activated by a perceived threat, such as the recall of traumatic memories triggered by sounds, the HPA axis releases stress hormones, including cortisol, which can result in physiological changes such as increased heart rate, heightened alertness, and intensified emotional states.
  5. Prefrontal Cortex: The prefrontal cortex is responsible for executive functions such as decision-making, impulse control, and emotional regulation. In individuals with PTSD, the prefrontal cortex may exhibit reduced activity, affecting their ability to regulate emotional responses triggered by sounds. This can contribute to heightened physiological reactivity and difficulty in modulating fear and anxiety.

It's important to note that the neurobiology of sounds and PTSD is complex and can vary among individuals. The interplay between these brain regions and systems contributes to the physiological and emotional responses triggered by sounds in individuals with PTSD. Treatment approaches, such as therapy and interventions targeting these brain regions, aim to help regulate and restore balance to these systems, reducing the impact of physiological triggers and improving overall well-being. 

When it comes to trauma triggers and the neurobiology of trauma, the auditory system can indeed play a significant role. Traumatic events, such as war, combat, gunfire, or car accidents, can involve loud and sudden noises that impact the auditory system. These experiences can create a neurobiological association between those sounds and the traumatic event itself.  Fireworks, crowded environments, or any other situations with loud noises and potentially chaotic surroundings can share similarities with the triggering sounds of traumatic events. These similarities can activate the neurobiological pathways associated with the original trauma, leading to heightened emotional and physiological responses.  

Here are some strategies to manage triggers associated with sound-related trauma: 

  1. Create a safe environment: Find or create spaces where you feel safe and protected from triggering sounds. This could be a quiet room in your home or a designated area where you can control the noise level.
  2. Use noise-canceling headphones or earplugs: Wearing noise-canceling headphones or earplugs can help reduce the intensity of sounds and provide a sense of control over your auditory environment.
  3. Engage in relaxation techniques: Practice relaxation techniques such as deep breathing, mindfulness meditation, or progressive muscle relaxation to help calm your body's physiological response to triggers.
  4. Seek support: Reach out to a mental health professional experienced in trauma therapy, such as a psychologist or psychiatrist, who can provide guidance and support in managing triggers and developing coping strategies.
  5. Exposure therapy: Under the guidance of a trained therapist, consider exposure therapy, a form of therapy that gradually exposes you to triggering sounds or situations in a safe and controlled manner. This therapy can help desensitize the neurobiological response associated with the triggers.
  6. Develop a coping toolbox: Create a collection of coping strategies that work for you. This could include activities like engaging in hobbies, listening to calming music, journaling, or connecting with a support network of understanding friends or family members.

Remember, managing triggers associated with sound-related trauma is a personalized process. It's essential to acknowledge the diverse range of experiences among veterans and their families. Some individuals may find solace and pride in the Fourth of July celebrations, while others may struggle with conflicting emotions. It's crucial to create a supportive and understanding environment that allows for open dialogue and recognizes the complexities of moral injury. If you or someone you know is a veteran or a family member dealing with a moral injury or related challenges, it is recommended to seek professional help from mental health providers experienced in working with veterans. They can provide guidance, support, and therapeutic interventions to address the emotional impact of moral injury and promote healing. The autonomic nervous system (ANS) is responsible for regulating our body's automatic processes, including our stress response. Traumatic experiences can dysregulate the ANS, leading to heightened sensitivity and reactivity to triggers, including sound-related triggers. Restoring balance and regulation to the ANS can be a gradual and individualized process.

Here are some approaches that may help in resetting and restoring the ANS: 

  1. Deep breathing exercises: Deep, slow breathing activates the body's relaxation response, which can help calm the ANS. Practice diaphragmatic breathing, where you focus on deep inhalations and exhalations, allowing your body to relax and rebalance.
  2. Progressive muscle relaxation: This technique involves systematically tensing and then relaxing different muscle groups to release tension and induce a state of relaxation. It can help reduce overall physiological arousal and restore balance to the ANS.
  3. Mindfulness and meditation: Mindfulness practices and meditation techniques can help regulate the ANS by increasing present-moment awareness and promoting a sense of calm. Engaging in regular mindfulness exercises can assist in resetting the ANS and reducing reactivity to triggers.
  4. Physical exercise, Yoga, Tai Chi: Regular physical activity, such as aerobic exercise or yoga, can help regulate the ANS. Exercise can release endorphins, which are natural mood-enhancing chemicals that promote a sense of well-being. It can also help reduce overall stress and improve the body's ability to respond to stressors.
  5. Sleep hygiene, Nidra Yoga and Body Scan: Adequate and quality sleep is crucial for restoring and rebalancing the ANS. Practice good sleep hygiene by establishing a consistent sleep routine, creating a conducive sleep environment, and engaging in relaxation techniques before bedtime.
  6. Cold Exposure and the Vagus Nerve: Cold exposure, including cold showers or plunges, has been suggested as a potential way to indirectly stimulate the vagus nerve. It is proposed that the shock of cold water on the body may activate the sympathetic nervous system, followed by a rebound activation of the parasympathetic nervous system (including the vagus nerve) once the cold exposure is stopped. This process is thought to help reset the autonomic nervous system, which can have various positive effects on health and well-being. However, scientific research specifically linking cold exposure to vagus nerve stimulation and its long-term effects is limited.
  7. Therapy and trauma-focused interventions: Seeking therapy from a mental health professional experienced in trauma treatment can be invaluable. Modalities like trauma-focused therapy, eye movement desensitization and reprocessing (EMDR), and somatic experiencing can help process and release trauma, leading to a restoration of the ANS.
  8. Medication and medical interventions: In some cases, medication may be prescribed to help manage symptoms associated with ANS dysregulation. Consult with a healthcare provider or psychiatrist who can assess your specific needs and determine if medication could be a beneficial part of your treatment plan.

It's important to approach the restoration of the ANS with patience and self-compassion, as it can be a gradual process. Working with a professional can provide guidance and individualized support throughout your journey toward healing and recovery.

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