Post-traumatic stress disorder (PTSD) is by far one of the most disruptive and painful mental health conditions.
Psychological trauma is an absolute beast that wreaks havoc on our health, both physical and mental. Understanding PTSD is fundamental for all aspects of aviation — commercial, civilian and public safety. The bottom line is that everyone in aviation should be armed with the knowledge to recognize and understand what trauma does to our minds, how to mitigate the possibility of the onset of PTSD and what treatment means for those who are already suffering from it.

PTSD is the result of being exposed to a stress trauma that is extreme and beyond a person’s coping capacity. The event is usually sudden and unexpected, traumatic or graphic in nature, and to some degree, violent. Aviation professionals are trained to take control of any situation and remain in control.
Events that cause PTSD frequently feel as though control is lost. It is a very unsettling experience for everyone involved.
For aviation professionals who are exposed to trauma that is beyond their coping capacity, images, smells, tastes, tactile sensations and sounds are captured by the frontal lobes of their brains and lodge themselves there. The frontal lobe acts as a firewall for trauma. It captures the event because it cannot process it like normal information.
When aviation professionals attempt to restore their natural functioning — usually when they go off shift or are at home — the frontal lobe will then try to process this trauma. The frontal lobe attempts to process these stimuli, and aviators experience this as reliving the event, thinking constantly about it, seeing the event as though it’s a movie or by having nightmares.
For the first few days following such an event, it is quite normal to constantly replay it many times over. What I explain to impacted personnel is that this is the brain attempting to process the event. Most of the time, because of good training and a healthy perspective, the brain can move the information from the frontal lobe to long-term memory. This is the direction flow of information in our brains. Trauma that gets processed to long-term memory becomes just that — a bad memory. Trauma that remains stored in the frontal lobe becomes the problem.

Because we want to make sure that every person’s brain can bounce back from adversity, I have set the following standard for our patients. By seven days after the incident, I want the intrusive stimuli to seem like they are fading to long-term memory. It is normal to think about it quite a bit, but at one-week post-incident I want the replay to slow down significantly.
By 14 days after the incident, I want that event lodged into long-term memory. This means you don’t replay it constantly and the nightmares have stopped or at least diminished significantly. You may never forget the event, but you definitely feel the difference between the first few days when the event was in your face, to 14 days later when you have gained space and distance from it. If, after 14 days, you are still experiencing those distressing stimuli, or if you are still having nightmares about the event, I want you to get help. Please do not stuff it, ignore it, walk it off, or drink it off. Get help immediately.

The reason for the two-week window is two-fold. First, when professionals are highly trained and resilient, they tend to process most events quickly and effectively. When they do not, I worry about the possibility of the onset of PTSD. The second reason for the two-week timeframe is because at this point, individuals are experiencing post-traumatic stress syndrome.
Post-traumatic stress syndrome means that something awful happened, but your reactions are normal. Catching and treating trauma when it is post-traumatic stress syndrome is paramount. At this point, everything we are doing is preventative versus reactive. Prevention is the key. It mitigates needless suffering and pain.
Over the course of time, when the frontal lobe cannot download or process those captured images into your long-term memory, the likelihood of the onset of PTSD increases significantly. When this occurs, a damaged hippocampus (through copious release of glucocorticoids) and a “hijacked” amygdala create a perfect storm inside the brain. Individuals with PTSD have sudden, extreme attacks of reliving the events, which are constantly triggered by their environment, putting them in a constant state of fight or flight.
PTSD is overwhelming and debilitating. The result is that aviation professionals with post-traumatic stress disorder will have difficulty performing their jobs.

They will have difficulty in social situations or in public, and they will most likely begin to isolate themselves. Aviation professionals are now incapable of many things they used to take for granted. And they are so ashamed and embarrassed by their condition that they just live on in misery. The hijacked amygdala tells an aviator to fight or run constantly. Living with PTSD is horrible for the individual and for their family members.
Contrary to what many aviation professionals think, PTSD is something we have solutions for. I refer to it as conquering the demons, and together, we fight that good fight until my patients are well. In the early 1990s, Dr. Francine Shapiro stumbled upon the eye movement desensitization and reprocessing (EMDR) technique. As she began to develop and refine the technique, patients began to report significant improvements and even resolution of their PTSD. In my opinion, research on EMDR, on the training and evolution of the technique’s application, has shown the best advancement in the treatment of PTSD by far.

The key to the EMDR process lies in the fact the brain is very resilient. EMDR is designed to process trauma. This technique taps into the brain’s ability to heal itself. The process of replicating rapid eye movements triggers the frontal lobe to process those images and allows the brain to basically move them to long-term memory. The hippocampus generates new neural pathways in the process and heals as it creates these new pathways to process trauma.
The technique is fast and effective. It’s exhausting and usually generates a headache, but when you think about the tremendous amount of work being done by a brain as it heals itself, grows new neural pathways, and unlocks and processes trauma, it’s understandable that a patient is basically wiped out after an EMDR session. In addition to the images being processed, the emotions attached to the event get processed as well. The beauty is that EMDR patients don’t have to talk about their feelings while this is occurring. They certainly can if they want to, but if it makes them uncomfortable, they don’t have to.

Bottom line: trauma and associated reactions get processed very quickly. Patients tell me all the time they wish they had done EMDR sooner, they now have their lives back, and that the treatment has been their pathway out of PTSD hell.
The outcome of the EMDR session is nothing short of amazing. When those synapses open and the brain starts to process the trauma, my patients tend to remember suppressed details. These are usually positive details, such as what they did to assist others. Trauma is inherently negative — we always remember the bad — until we do EMDR. My patients also report that the pervasive, ugly images that have invaded their mind have faded. They describe the experience as gaining distance, fading, and even having a difficult time remembering it, or “seeing it,” in their mind.

The second part of this amazing process is the fact that patients will also notice that the very intense, negative emotions are gone. They describe being at peace with the event or just being “past it.” As they discuss how they are responding so differently to the event after EMDR, they realize their perspective has changed. In other words, they usually realize they did everything they could in the situation, or there was nothing more they could have realistically done. For the first time ever after a trauma, impacted personnel feel relief and they can finally forgive themselves.
The other technique I like to do is progressive desensitization. I refer to EMDR and progressive desensitization as “the one-two punch” to PTSD. Progressive desensitization is the process of returning to the scene where something occurred, or to an activity that caused a trauma.

After doing EMDR, I have taken my aviation patients back into the aircraft, back into the cockpit. I have taken confidence flights with flight crews. After EMDR, we basically go out to the demons and bury them once and for all. This empowers patients to go back to doing their jobs. It takes the mystery out of what it will feel like to go back to that place.
EMDR and progressive desensitization are now the techniques we use to prevent and mitigate PTSD. Implementing these treatments within the first two months of the incident, when we are still in the phase called post-traumatic stress syndrome, is a game changer for aviation professionals. With all the knowledge and understanding of trauma and effective treatment, circumventing the onset of PTSD is something we should all be striving for at this point.