What is Hypervigilance?


Hypervigilance is when the nervous system is inaccurately filtering sensory information and the individual is in an enhanced state of sensory sensitivity.

This appears to be linked to a dysregulated nervous system which can often be caused by traumatic events or post-traumatic stress disorder (PTSD).


Normally, the nervous system releases stress signals in certain situations as a defence mechanism to protect one from perceived dangers. In some cases, the nervous system becomes chronically dysregulated, causing a release of stress signals that are inappropriate to the situation, creating inappropriate and exaggerated responses. Hypervigilance may bring about a state of increased anxiety which can cause exhaustion. Other symptoms include:

  • Abnormally increased arousal;
  • A high responsiveness to stimuli; and
  • A constant scanning of the environment.

In hypervigilance, there is a perpetual scanning of the environment to search for sights, sounds, people, behaviours, smells, or anything else that is reminiscent of activity, threat or trauma. The individual is placed on high alert in order to be certain danger is not near. Hypervigilance can lead to a variety of obsessive behaviour patterns, as well as producing difficulties with social interaction and relationships.

Hypervigilance is differentiated from dysphoric hyperarousal in that the person remains cogent and aware of their surroundings. In dysphoric hyperarousal, a person with PTSD may lose contact with reality and re-experience the traumatic event verbatim. Where there have been multiple traumas, a person may become hypervigilant and suffer severe anxiety attacks intense enough to induce a delusional state where the effects of related traumas overlap. This can result in the thousand-yard stare.

Hypervigilance can be a symptom of PTSD and various types of anxiety disorders. It is distinguished from paranoia. Paranoid diagnoses, such as can occur in schizophrenia, can seem superficially similar, but are characteristically different.


People suffering from hypervigilance may become preoccupied with scanning their environment for possible threats. They might ‘overreact’ to loud and unexpected noises, exhibit an overactive startle response or become agitated in highly crowded or noisy environments. They will often have a difficult time getting to sleep or staying asleep.

Sustained states of hypervigilance, lasting for a decade or more, may lead to higher sensitivity to disturbances in their local environment, and an inability to tolerate large gatherings or groups. After resolution of the situation demanding their attention, people exhibiting hypervigilance may be exhausted and require time to ‘recharge’ before returning to normal activities.

What is Historical Trauma?


Historical trauma (HT), as used by social workers, historians, and psychologists, refers to the cumulative emotional harm of an individual or generation caused by a traumatic experience or event. Historical Trauma Response (HTR) refers to the manifestation of emotions and actions that stem from this perceived trauma.

According to its advocates, HTR is exhibited in a variety of ways, most prominently through substance abuse, which is used as a vehicle for attempting to numb pain. This model seeks to use this to explain other self-destructive behaviour, such as suicidal thoughts and gestures, depression, anxiety, low self-esteem, anger, violence and difficulty recognising and expressing emotions. Many historians and scholars believe the manifestations of violence and abuse in certain communities are directly associated with the unresolved grief that accompanies continued trauma.

Historical trauma, and its manifestations, are seen as an example of Transgenerational trauma (though the existence of transgenerational trauma itself is disputed). For example, a pattern of maternal abandonment of a child might be seen across three generations, or the actions of an abusive parent might be seen in continued abuse across generations. These manifestations can also stem from the trauma of events, such as the witnessing of war, genocide, or death. For these populations that have witnessed these mass level traumas (e.g. war, genocide, colonialism), several generations later these populations tend to have higher rates of disease.

Maria Yellow Horse Brave Heart first developed the concept of historical trauma while working with Lakota communities in the 1980s. Since then, many other researchers have developed the concept and applied it to other populations, such as African Americans and Holocaust survivors.

Brief History of Research

First used by social worker and mental health expert Maria Yellow Horse Brave Heart in the 1980s, scholarship surrounding historical trauma has expanded to fields outside of the Lakota communities Yellow Horse Brave Heart studied. Yellow Horse Brave Heart’s scholarship focused on the ways in which the psychological and emotional traumas of colonisation, relocation, assimilation, and American Indian boarding schools have manifested within generations of the Lakota population. Yellow Horse Brave Heart’s article “Wakiksuyapi: Carrying the Historical Trauma of the Lakota,” published in 2000, compares the effects and manifestations of historical trauma on Holocaust survivors and Native American peoples. Her scholarship concluded that the manifestations of trauma, although produced by different events and actions, are exhibited in similar ways within each afflicted community.

Other significant original research on the mechanisms and transmission of intergenerational trauma has been done by scholars such as Daniel Schechter, whose work builds on the pioneers in this field such as: Judith Kestenberg, Dori Laub, Selma Fraiberg, Alicia Lieberman, Susan Coates, Charles Zeanah, Karlen Lyons-Ruth, Yael Danieli, Rachel Yehuda and others. Although each scholar focuses on a different population – such as Native Americans, African Americans, or Holocaust Survivors – all have concluded that the mechanism and transmission of intergenerational trauma is abundant within communities that experience traumatic events. Daniel Schechter’s work has included the study of experimental interventions that may lead to changes in trauma-associated mental representation and may help in the stopping of intergenerational cycles of violence.

Joy DeGruy’s book, Post Traumatic Slave Syndrome, analyses the manifestation of historical trauma in African-American populations, and its correlation to the lingering effects of slavery. In 2018, Dodging Bullets – Stories from Survivors of Historical Trauma, the first documentary film to chronicle historical trauma in Indian Country, was released. It included interviews with scientist Rachel Yehuda, sociologist Melissa Walls, and Anton Treuer along with first hand testimonies of Dakota, Lakota, Ojibwe and Blackfeet tribal members.

Indigenous Historical Trauma

Maria Yellow Horse Brave Heart first coined the term Indigenous Historical Trauma (IHT) in the 1990s, to characterise the psycho-social legacy of European colonisation in North American Indigenous communities. The broader concept of Historical Trauma was developed from this, and gained footing in the clinical and health science literatures in the first two decades of the 21st century. In 2019, a team of psychologists at the University of Michigan published a systematic review of the literature so far on the relationship between IHT and adverse health outcomes for Indigenous peoples in the United States and Canada.

An example of IHT is the ”Indian boarding schools” created in the 19th century to acculturate Native Americans to European culture. According to one of their advocates Richard Henry Pratt, the intention of these schools was to literally “kill the indian” in the student, “and save the man”. These schools attempted to strip children of their cultural identity by practices such as cutting off their long hair, or forbidding them to speak their native language. After the school year was over, some indigenous children were hired to work for “non-Indian families” and many did not return home to their families.

The fear and loneliness caused by such schools can be readily imagined. But scientific research has consistently found that the stress caused by Indian boarding schools resulted in depression, sexual abuse, and suicidality. Descendants of boarding school survivors may carry this historical trauma for generations, and in the present day, Native American students still face challenges related to their lack of awareness of “psychological injury or harm from ancestral experiences with colonial violence and oppression”. Indeed, people who are unaware of the traumatic experiences their ancestors endured may find themselves involved in continued patterns of substance abuse, violence, physical abuse, verbal abuse, and suicide attempts.

Therefore, the term IHT can be useful to explain emotions and other psychological phenomena experienced by Native Americans today. Identifying IHT helps with recognising the “psychological distress and health disparities” linked to current Indigenous communities.


HT, or HTR, can manifest itself in a variety of psychological ways. However, it is most commonly seen through high rates of substance abuse, alcoholism, depression, anxiety, suicide, domestic violence, and abuse within afflicted communities. The effects and manifestations of trauma are extremely important in understanding the present-day conditions of afflicted populations.

Within Native American communities, high rates of alcoholism and suicide have direct correlation to the violence, mistreatment, and abuses experienced at boarding schools, and the loss of cultural heritage and identity these institutions facilitated. Although many present-day children never experienced these schools first-hand, the “injuries inflicted at Indian boarding schools are continuous and ongoing,” affecting generations of Native peoples and communities.

Countries like Australia and Canada have issued formal apologies for their involvement in the creation and implementation of boarding schools that facilitated and perpetuated historical trauma. Australia’s Bringing Them Home report and Canada’s Truth and Reconciliation Commission (Canada) both detailed the “experiences, impacts, and consequences” of government-sponsored boarding schools on Indigenous communities and children. Both reports also detail the problems facing Indigenous populations today, such as economic and health disparities, and their connection to the historical trauma of colonisation, removal, and forced assimilation.

Author and teacher Thomas Hübl, documenting his experiences working with Germans and Israelis to engage in dialogue around their shared historical and intergenerational trauma, writes:

Whether we refer to a person as victim or victimiser, oppressor or oppressed, it appears that no one, given time, remains untouched by collective suffering. Historical traumas impart their consequences indiscriminately upon child and family, institution and society, custom and culture, value and belief. Collective traumas distort social narratives, rupture national identities, and hinder the development of institutions, communities, and cultures, just as personally experienced trauma has the power to disrupt the psychological development of a growing child.


Treatment of HT must repair the afflicted person or communities’ connection with their culture, values, beliefs, and self-image. It takes the forms of individual counselling or therapy, spiritual help, and group or entire community gatherings, which are all important aspects in the foundations of the healing process. Treatment should be aimed at a renewal of destroyed culture, spiritual beliefs, customs, and family connections, and a focus on reaffirming one’s self-image and place within a community. Cultural revitalisation initiatives for treating historical trauma among Native groups in North America include “culture camps,” where individuals live or camp out on their tribe’s traditional lands in order to learn cultural practices that have been lost to them as a result of colonial practices.

Due to the collective and identity-based nature of HT, treatment approaches should be more than solutions to one individual’s problems. Healing must also entail revitalisation of practices and ways of being that are necessary not just for individuals but for the communities they exist within. Relieving personal distress and promoting individual coping are important treatment goals, but successful treatment of HT also depends upon community-wide efforts to ending intergenerational transmission of collective trauma.

Particular attention should be given to the needs and empowerment of peoples who are vulnerable, oppressed, and living in poverty. Social workers and activists should promote social justice and social change with and on behalf of clients, individuals, families, groups, and communities. In order for advocacy to be accurate and helpful to the afflicted populations, social workers should understand the cultural diversity, history, culture, and contemporary realities of clients.

Major Depressive Disorder & Childhood Trauma

Research Paper Title

Major depressive disorder with childhood trauma: Clinical characteristics, biological mechanism, and therapeutic implications.


Major depressive disorder (MDD) is a main type of mood disorder, characterised by significant and lasting depressed mood.

Until now, the pathogenesis of MDD is not clear, but it is certain that biological, psychological, and social factors are involved.

Childhood trauma is considered to be an important factor in the development of this disease.

Previous studies have found that nearly half of the patients with MDD have experienced childhood trauma, and different types of childhood trauma, gender, and age show different effects on this disease.

In addition, the clinical characteristics of MDD patients with childhood trauma are also different, which often have more severe depressive symptoms, higher risk of suicide, and more severe cognitive impairment.

The response to antidepressants is also worse.

In terms of biological mechanisms and marker characteristics, the serotonin transporter gene and the FKBP prolyl isomerase 5 have been shown to play an important role in MDD and childhood trauma.

Moreover, some brain imaging and biomarkers showed specific features, such as changes in gray matter in the dorsal lateral prefrontal cortex, and abnormal changes in hypothalamic-pituitary-adrenal axis function.


Guo, W., Liu, J. & Li, L. (2020) Major depressive disorder with childhood trauma: Clinical characteristics, biological mechanism, and therapeutic implications. Journal of South Central University. 45(4), pp.462-468. doi: 10.11817/j.issn.1672-7347.2020.190699.

Psychological Trauma: Metaphor and Psychiatrists Beliefs

Research Paper Title

A frog in boiling water? A qualitative analysis of psychiatrists’ use of metaphor in relation to psychological trauma.


Tensions about the definition, diagnostics, and role of psychological trauma in psychiatry are long-standing. This study sought to explore what metaphor patterns in qualitative interviews may reveal about the beliefs of psychiatrists in relation to trauma.


A qualitative inquiry using systematic metaphor analysis of 13 in-depth interviews with Australian psychiatrists.


Three themes were identified: a power struggle between people, trauma, and psychiatry; trauma is not a medical condition; and serving the profession to protect society.


Metaphors present trauma as a powerful force that people can manage in different ways. Psychiatrists may view trauma as a social rather than medical issue. Psychiatrists experience role pressure associated with trauma including incongruence with risk management expectations of their roles.


Isobel, S., McCloughen, A. & Foster, K. (2020) A frog in boiling water? A qualitative analysis of psychiatrists’ use of metaphor in relation to psychological trauma. Australasian Psychiatry. doi: 10.1177/1039856220946596. Online ahead of print.

Is ERRT-M Useful and Credible?

Research Paper Title

A Pilot Randomized Controlled Trial of Cognitive Behavioral Treatment for Trauma-Related Nightmares in Active Duty Military Personnel.


The aim of this study was to obtain preliminary data on the efficacy, credibility, and acceptability of Exposure, relaxation, and rescripting therapy for military service members and veterans (ERRT-M) in active duty military personnel with trauma-related nightmares.


Forty participants were randomised to either 5 sessions of ERRT-M or 5 weeks of minimal contact control (MCC) followed by ERRT-M. Assessments were completed at baseline, post-treatment/post-control, and 1-month follow-up.


Differences between ERRT-M and control were generally medium in size for nightmare frequency (Cohen d = -0.53), nights with nightmares (d = -0.38), nightmare severity (d = -0.60), fear of sleep (d = -0.44), and symptoms of insomnia (d = -0.52), and depression (d = -0.51).

In the 38 participants who received ERRT-M, there were statistically significant, medium-sized decreases in nightmare frequency (d = -0.52), nights with nightmares (d = -0.50), nightmare severity (d = -0.55), fear of sleep (d = -0.48), and symptoms of insomnia (d = -0.59), post-traumatic stress disorder (PTSD) (d = -0.58) and depression (d = -0.59) from baseline to 1-month follow-up.

Participants generally endorsed medium to high ratings of treatment credibility and expectancy.

The treatment dropout rate (17.5%) was comparable to rates observed for similar treatments in civilians.


ERRT-M produced medium effect-size reductions in nightmares and several secondary outcomes including PTSD, depression, and insomnia.

Participants considered ERRT-M to be credible.

An adequately powered randomised clinical trial is needed to confirm findings and to compare ERRT-M to an active treatment control.


Pruiksma, K.E., Taylor, D.J., Mintz, J., Nicholson, K.L., Rodgers, M., Young-McCaughan, S., Hall-Clark, B.N., Fina, B.A., Dondanville, K.A., Cobos, B., Wardle-Pinkston, S., Litz, B.T., Roache, J.D., Perterson, A.L. & STRONG STAR Consortium. (2020) A Pilot Randomized Controlled Trial of Cognitive Behavioral Treatment for Trauma-Related Nightmares in Active Duty Military Personnel. Journal of Clinical Sleep Medicine. 16(1), pp.29-40. doi: 10.5664/jcsm.8116. Epub 2019 Nov 26.

Book: The PTSD Workbook

Book Title:

The PTSD Workbook, 3rd Edition: Simple, Effective Techniques for Overcoming Traumatic Stress Symptoms.

Author(s): Mary Beth Williams and Soili Poijula.

Year: 2016.

Edition: Third (3rd).

Publisher: New Harbinger.

Type(s): Paperback and Kindle.


Post-traumatic stress disorder (PTSD) is an extremely debilitating condition that can occur after exposure to a terrifying event.

But whether you are a veteran of war, a victim of domestic violence or sexual violence, or have been involved in a natural disaster, crime, car accident, or accident in the workplace, your symptoms may be getting in the way of you living your life.

PTSD can often cause you to relive your traumatic experience in the form of flashbacks, memories, nightmares, and frightening thoughts. This is especially true when you are exposed to events or objects that remind you of your trauma.

Left untreated, PTSD can lead to emotional numbness, insomnia, addiction, anxiety, depression, and even suicide. So, how can you start to heal and get your life back?

In The PTSD Workbook, Third Edition, psychologists and trauma experts Mary Beth Williams and Soili Poijula outline techniques and interventions used by PTSD experts from around the world to conquer distressing trauma-related symptoms.

In this fully revised and updated workbook, you will learn how to move past the trauma you have experienced and manage symptoms such as insomnia, anxiety, and flashbacks.

Based in cognitive behavioural therapy (CBT), this book is extremely accessible and easy-to-use, offering evidence-based therapy at a low cost.

This new edition features chapters focusing on veterans with PTSD, the link between cortisol and adrenaline and its role in PTSD and overall mental health, and the mind-body component of PTSD.

Clinicians will also find important updates reflecting the new DSM-V definition of PTSD.

This book is designed to give you the emotional resilience you need to get your life back together after a traumatic event.

Book: The PTSD Behavioural Activation Workbook

Book Title:

The PTSD Behavioral Activation Workbook: Activities to Help You Rebuild Your Life from Post-Traumatic Stress Disorder (A New Harbinger Self-Help Workbook).

Author(s): Matthew Jakupcak (PhD), Amy W Wagner (PhD), Christopher R. Martell (PhD), and Matthew T Tull (PhD).

Year: 2020.

Edition: First (1st).

Publisher: New Harbinger Publications; Workbook Edition.

Type(s): Paperback and Kindle.


If you suffer from post-traumatic stress disorder (PTSD), reliving the past through trauma-focused treatments may be too painful a place to start. Behavioural activation – the powerful treatment method outlined in this workbook – provides an essential foundation for recovery by shifting the focus of your trauma to the things in life that give you true fulfilment, joy, and value. This way, you can envision the kind of future you want to have, and move forward in your treatment to pursue that future.

With this breakthrough workbook, you will learn to replace unproductive coping strategies – such as avoidance – with activities that you find pleasant and meaningful. You’ll find an overview of behavioural activation: what it is, why it works, and how you can implement it into your life to begin healing the wounds of your past and paving the way for a bright future full of possibility.

If you have experienced trauma, you need real tools to help you manage your pain and jumpstart your recovery. With this compassionate and evidence-based workbook, you will find actionable solutions to help you begin healing and take that next needed step toward wellness, wholeness, and peace.

Psychotraumatology: What Have We Learned?

Research Paper Title

A decennial review of psychotraumatology: what did we learn and where are we going?


On 06 December 2019 the reviewers started the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma.

This editorial is part of a special issue/collection celebrating the 10 years anniversary of the journal where the reviewers will acknowledge some of their most impactful articles of the past decade.

In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline.

These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience.

The reviewers address innovations in psychological, medication (enhanced) and technology-assisted treatments, mediators and moderators like social support and finally how new research methods help them to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions

  1. Where did we stand in 2010?
  2. What did we learn in the past 10 years?
  3. What are our knowledge gaps?

The reviewers conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.


Olff, M., Amstadter, A., Armour, C., Birkeland, M.S., Bui, E., Cloitre, M., Ehlers, A., Ford, J.D., Greene, T., Hansen, M., Lanius, R., Roberts, N., Rosner, R. & Thoresen, S. (2019) A decennial review of psychotraumatology: what did we learn and where are we going? European Journal of Psychotraumatology. 10(1):1672948. doi: 10.1080/20008198.2019.1672948. eCollection 2019.

Polycythemia, Mental Health & the Great East Japan Earthquake

Research Paper Title

Relationship between the prevalence of polycythemia and factors observed in the mental health and lifestyle survey after the Great East Japan Earthquake.


The researchers have been examining the Comprehensive Health Check of the Fukushima Health Management Survey of residents of 13 municipalities who were forced by the government to evacuate due to the 2011 Great East Japan Earthquake (GEJE).

Their findings showed that evacuation is a risk factor for polycythemia and suggested that experiencing an unprecedented disaster and exposure to chronic stress due to evacuation might be a cause of polycythemia.


The researchers analysed the relationship between the prevalence of polycythemia and the following factors observed in the Mental Health and Lifestyle Survey in an observational study with a cross-sectional design:

  • Traumatic symptoms;
  • Depression status;
  • Socioeconomic factors such as residential environment; and
  • Working situation after the GEJE.

Target population of the survey included men and women who were at least 15 years of age and who lived in the evacuation zones specified by the government.

Participants analysed consisted of 29,474 persons (12,379 men and 16,888 women) who had participated in both the 2011 Comprehensive Health Check and Mental Health and Lifestyle Survey from June 2011 through March 2012.


The prevalence of polycythemia was not associated with mental states associated with traumatic symptoms (Post-Traumatic Stress Disorder Checklist Scale ≥ 44) and depression status (Kessler 6-item Scale ≥ 13).

Furthermore, multivariate analysis showed that there was a tendency for males to develop polycythemia, with characteristics such as:

  • Being aged 65 years and older;
  • Highly educated;
  • Obese (body mass index ≥ 25);
  • Hypertensive;
  • Diabetic;
  • Having liver dysfunction; and
  • A smoker being significantly related to the prevalence of polycythemia.


The researchers state their findings conclusively demonstrated that polycythemia was not significantly related to psychological factors, but was significantly related to the onset of lifestyle-related disease after the GEJE.


Sakai, A., Nakano, H., Ohira, T., Maeda, M., Okazaki, K., Takahashi, A., Kawasaki, Y., Satoh, H., Ohtsuru, A., Shimabukuro, M., Kazama, J., Hashimoto, S., Hosoya, M., Yasumura, S., Yabe, H., Ohto, H., Kamiya, K. & Fukushima Health Management Survey Group. (2020) Relationship between the prevalence of polycythemia and factors observed in the mental health and lifestyle survey after the Great East Japan Earthquake. Medicine (Baltimore). 99(1):e18486. doi: 10.1097/MD.0000000000018486.

Childhood Trauma: Time, Trust, and Opportunities

Research Paper Title

Repairing the effects of childhood trauma: The long and winding road.


  • What is known on this subject:
    • Domestic and family violence contributes to mental distress and the development of mental illness and can reverberate throughout a person’s life.
  • What this paper adds to existing knowledge.
    • Therapeutic work with people who experience domestic and family violence needs to take considerable time to allow the process to unfold.
    • Understanding the triggers that cause past traumas to be re-experienced helps people to recognise and change their conditioned emotional responses.
  • What are the implications for practice?
    • Time needs to be invested to develop a secure and trusting relationship to enable a person to work through childhood experiences that have the potential to overwhelm.
    • It is important for adults who have experienced childhood trauma to have an opportunity to process the abuse to help minimise its intrusion in their lives.


Palmer, C., Williams, Y. & Harrington, A. (2019) Repairing the effects of childhood trauma: The long and winding road. Journal of Psychiatric and Mental Health Nursing. doi: 10.1111/jpm.12581. [Epub ahead of print].