What Are the 5 Stages of PTSD? Post-traumatic stress disorder, or PTSD, is a debilitating disorder that impacts every facet of an individual’s life. PTSD can be divided into different stages of trauma — the five stages of PTSD.
Likewise, it is important to understand each of the individual stages to better develop a path towards healing, depending on one’s current state, and set expectations for each of the PTSD recovery stages.
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What is Post-Traumatic Stress Disorder?
Available PTSD Therapies and Treatments
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Each of the five stages of trauma can present unique hurdles, whether an individual is just experiencing a traumatic event in the emergency phase or moving through the denial phase, intrusive phase, transition phase, or long-term recovery phase.
What Is Post-Traumatic Stress Disorder?
PTSD is an anxiety disorder that can manifest from experiencing or witnessing any number of harrowing, traumatic events. These things can be physically traumatic in nature, such as suffering from an injury, being in a car accident, experiencing a natural disaster, or being the victim of assault or sexual abuse.
However, PTSD can also be caused by other traumas that are more emotional trauma in nature, such as the death of a family member or loved one, or threats made on one’s own life, wellbeing, or the wellbeing of one’s family or loved ones. Any of these kinds of events can have a lasting impression on one’s mind and can change how a person views themselves or perceives the world around them, creating a framework that is dictated by these negative events and disasters.
The effects of these traumas can last a long time and can continue to introduce difficulties in accomplishing routine tasks for years if left unaddressed. However, that doesn’t mean an individual has to tackle all of their trauma at once, and instead can focus on their current stage of trauma.
The Stages of PTSD
Stage 1 – The Emergency Stage
The emergency phase of PTSD is the phase that is occurring in the moment of a traumatic event. The symptoms can manifest quickly in direct response to a currently ongoing traumatic event or directly and immediately after, such as during the event of a car crash, escaping a burning building, or while being engaged in a warzone or with an armed shooter. During this phase, anxiety can be incredibly high, and the brain will switch into “survival mode.” An individual may be reacting based on immediate instinct, which can trigger one’s “fight or flight” responses, as well as take immediate actions to ensure one’s own survival first and foremost.
However, these situations may not result in a person acting in the most rational way. Instead, the anxiety can further develop into panic, depending on the unique situation and the person involved.
Some of the symptoms that may be present at this phase of PTSD are:
Overwhelming fear
Feelings of powerlessness
Shock
Anxiety
Helplessness
Guilt
Depending on the event, this is also the time where medical attention may be necessary. Those who have suffered physical injury as a part of the traumatic event can further experience greater symptoms as well, on top of the mental and emotional toll that such traumatic experiences bring.
This phase can occur very suddenly and can last anywhere from a few minutes to a few hours after an event. During this time, it is important to find support and begin to ground oneself outside of the traumatic event, focusing on your breathing and immediate wellbeing following the situation. It is normal if a person has not yet fully understood or processed what has just happened and instead may focus on removing themselves from the area and securing their immediate safety, working to contact appropriate emergency responses as necessary.
Stage 2 – The Denial Stage
The denial stage, or the “numb” phase, often follows an individual after the emergency has passed and is a major mental and emotional hurdle to get over. During this phase, an individual will try to emotionally and mentally distance themselves from the preceding trauma in an attempt to protect themselves from immediately having to relive the event. However, this can result in the individual simultaneously suffering from the effects of PTSD while also doing their best to minimize or deny its physical and emotional tolls. The symptoms most common during this phase of PTSD are:
Denial
Perpetual sadness/depression
Confusion
Panic
Difficulty sleeping
Nightmares
Feelings of helplessness
Guilt/survivor’s guilt
Feelings of fatigue
Feelings of numbness/emptiness
Pervasive anxiety
Invasive thoughts
Flashbacks
Denial of one’s experiences, thoughts, and emotions can continue to bottle up within the mind, continuing to cause constant duress without having an outlet to admit their emotions or express their trauma. Moving through this phase requires acknowledgment of one’s experiences to both better truly understand the weight of the traumatic experience as well as legitimize and validate one’s emotional responses to a situation. While the brain may be trying to protect itself, the inability to move past denial can cause more harm than good the longer that this phase persists.
Stage 3 – The Intrusive Stage
The intrusive phase is where an individual begins to acknowledge and accept the reality of their trauma. However, that doesn’t mean they are necessarily prepared to address the gravity of the traumatic experience quite yet. This phase is commonly the most dangerous to an individual, as it is common that a person who has PTSD will then take actions to self-medicate, or even longer for the time when they were able to deny their emotions or thoughts. During this phase, individuals may turn to drugs or alcohol in an attempt to placate their minds and thoughts or engage in other self-destructive practices with lesser regard for their own wellbeing. This is most often the time where families, friends, and loved ones will begin to realize the weight that such trauma has had on an individual and indicates the need for a change and help to process one’s PTSD.
An individual may seem to have their thoughts and days invaded by unwanted recollections of traumatic experiences, making it incredibly hard to focus on any one single event, get a good night’s sleep, or address responsibilities such as household care, personal hygiene, or even making it to work on time as they search for some mental and emotional respite from their intrusive memories. One’s own life can begin to feel out of their control and lead to some difficult situations.
The symptoms common throughout this PTSD recovery stage are:
Anxiety
Depression
Invasive thoughts
Insomnia
Nightmares
Susceptibility to triggers
Difficulty managing emotions
Anger
Lashing out
Isolationist tendencies
Development of addiction
Inconsistent adherence to responsibility
Lack of focus
Physical and emotional fatigue
Flashbacks
This phase of PTSD is incredibly difficult to address and is most commonly when an individual will begin engaging in the most self-destructive behavior as a way to mitigate the effects of their internal trauma. However, the outward prevalence of this phase of PTSD recovery ushers in the need for change and is where many people will hit a major crossroads in their recovery path — either to move towards a recovery program and betterment or continue their own intense, internal battle.
Stage 4 – The Transition Stage
The transition stage is where an individual has first made the decision to move into an active recovery mindset, often coinciding with the engagement in a professional recovery program that best fits them. However, that doesn’t mean they will necessarily be readily receptive to the recovery before them at the beginning of a recovery program. Instead, those in this phase of recovery will often jump to one of two different mentalities at the beginning of this transition.
Recovery Mentalities The first mentality that an individual may inhabit is a positive one — one of hope and altruism. For some, the idea and tangibility of change that a recovery program provides can bring forth the idea of hope into one’s life, providing an opportunity for an individual to believe they can move past the debilitating nature of PTSD. It is an optimism that is often accompanied by a desire to reach out to others and better oneself. Individuals with this kind of newfound hope for change can be very open to the idea of trying new therapeutic practices, and while they will still suffer from many symptoms of PTSD, the motivation to change can be a powerful tool going forward.
However, such a mentality is difficult to force yourself to adopt, and it is more common that an individual suffering from PTSD will find themselves seemingly stuck in their own mind with recurring invasive thoughts, anxiety, and depression, making it extraordinarily difficult to find the idea of “change” and “hope” to be tangible at all. It is common that an individual will begin their recovery journey with an air of cynicism or disillusionment about themself, their situation, or their ability to recover at all.
Fortunately, beginning this recovery stage of PTSD with this mindset doesn’t mean there isn’t ample opportunity to change. Professionals are always ready to find new ways to showcase the tangibility and possibility of healing in one’s own life.
Transition Towards Acceptance and Change This stage also comes with an air of acceptance about one’s situation — whether that be an acknowledgment that the trauma has happened or that an individual has begun to understand the weight of their situation. This phase begins to instill daily coping mechanisms for an individual to begin transitioning back to a daily routine, introducing the idea of a healthy “normalcy” back into their life. However, it is important to accept that this new “normalcy” isn’t the same as a return to one’s previous lifestyle, but rather a newfound comfort and routine that can help begin to address many of their PTSD symptoms. One’s symptoms from the previous phases of PTSD may still be prevalent, and while coping with them on a daily basis can still be extraordinarily difficult, one’s dedication to the transition phase of recovery is a hallmark to their desire to address these symptoms with intention. This includes working to begin developing effective coping strategies, support groups, and supportive relationships while also directly tackling symptoms and de
Stage 5 – Long-Term Recovery
Long-term recovery, or prolonged recovery, is the stage of PTSD recovery that doesn’t necessarily have an end date. Rather, it is defined by the ability to self-employ many of one’s own daily coping strategies regularly. This is the hallmark of an individual who has dedicated themselves to change and has expressed the agency to continue to employ these tactics successfully both inside and outside of the recovery sphere. However, this doesn’t mean there isn’t still progress to be made or actions to be taken regarding one’s continued PTSD recovery.
Coping strategies may need to be adjusted as an individual is exposed to new stressors or moves to new areas of their lives, such as developing relationships or going through professional advancements. Constantly exploring new coping strategies and grounding techniques is paramount throughout this stage of recovery, and the ability to identify new techniques and work to employ them at one’s own behest is a powerful tool.
It is also important to know that this stage of recovery is intentionally not defined by the absence of PTSD symptoms but rather by one’s ability to manage them on a regular basis. Symptoms of PTSD may still be prevalent, even daily, and an individual may continue to struggle with anxiety, depression, nightmares, flashbacks, and many other PTSD symptoms. However, the ability to manage these symptoms and find a place of consistency is crucial for one’s long-term recovery.
Those in the long-term recovery phase of their PTSD recovery will work towards being able to:
Regularly attend work
Maintain personal hygiene
Tend to one’s self-care
Set personalized goals
Manage PTSD symptoms
Engage in meaningful interpersonal situations
These things are all major, overarching goals of the recovery process, but achieving them is not accomplished by returning to a state of life before experiencing trauma. Rather, it is done by reconstructing a new idea of normalcy, routine, agency, and happiness — all defined by one’s ability to look towards the future and see the potential of change and hope for oneself. The long-term phase of recovery may still be filled with hardships, but it is also defined by one’s own strength and ability to change.
Available PTSD Therapies and Treatments
Overcoming trauma and PTSD is a difficult and complicated task, but it is possible to build back a “normal” way of life, regardless of how helpless one may feel at any given moment.
Beginning with psychotherapy in either an individual or group setting, a person can begin to better understand their own symptoms by way of education and acknowledgment. This practice is intended to help each individual accept that they have experienced a traumatic event in their lives. This acceptance enables them to take the next step forward, all while personalizing their own coping strategies for daily use. Group therapy can be exceptionally helpful during the beginning of one’s PTSD recovery, as a person can share space with those who can objectively understand the nature of PTSD, working to create a tribe of kinship rather than leaving prevailing feelings of isolation to develop.
Medication-assisted therapies may also be pertinent, depending on the individual and the PTSD symptoms they may suffer from. Being able to alleviate some of the symptoms of anxiety, depression, or helping an individual get enough sleep each night are all crucial for being able to develop other coping strategies. While medication is not a replacement for other therapeutic practices, it can enable an individual to focus more of their energy on developing new coping strategies, strengthening relationships, or working on their self-care routines instead of constantly feeling the mental and emotional exhaustion that comes with constantly battling symptoms of PTSD. EMDR, or Eye-Movement Desensitization and Reprocessing, can also help alleviate some of these stresses and may be used to help an individual cope with their daily anxieties.
Finding ways to validate one’s emotions is also paramount for healthy, prolonged recovery. Having a time of remembrance regarding certain traumas can help an individual legitimize their feelings to themselves, all while providing a safe space to mourn. This can especially help those who were victims of shooting events, natural disasters, or were involved in warzones.
Expressing one’s emotions is also of great importance and is the key part of movement out of the denial stage of PTSD recovery. Art therapy, music therapy, and physical-based therapies such as sport, dance, or outdoor recreational activities can all provide unique ways for an individual to express themselves in ways that don’t necessarily rely on words or demand that you find a way to simplify complex emotions for conversation.