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The arousal symptoms of PTSD most commonly overlap with the symptoms of Panic and Anxiety. Imagine your body is like a car engine. With PTSD (and anxiety/panic) your engine is always revved up and ready to go. It’s like you have your foot on the gas pedal and on the brake, this way all you have to do it let off the brake and off you go. The flight, fight, freeze survival system our body has does this on purpose so you do not waste precious time accelerating, which makes sense if you are in a life and death situation, the problem is when your body starts to react like this to regular day to day stress. Imagine what happens to a car engine if you constantly rev the engine while holding down the brakes. It gets worn down and starts to break down. This is what happens to our body when it is under the constant strain of anxiety. Fatigue and exhaustion are all common experiences for those who suffer from PTSD, anxiety, and panic. With PTSD, the body is always revved up and ready to go, aka it is in a state of arousal; that means muscles are tense, breathing and heart rate are fast, and blood pressure is high. People with PTSD often feel on edge, on guard, easily startled, and hyper vigilant. This also primes them to be more easily irritated and angry. It is also very hard to concentrate and sleep. So the primary way to cope with symptoms of arousal is slow the body down through 1) Breathing and 2) Soothing.


When the fight, flight, and freeze survival system is turned on your breathing increases, along with your heart rate, blood pressure, and increased muscle tension. The good news is that all these things are linked together, like dominoes. If you can slow down one system the others will follow. By slowing down your breath you slow down your pounding heart, lower your blood pressure, and start to release the tension in your muscles and calm down. There are many ways to slow down your breathing, from paced breathing, deep breathing, meditative breathing, timed breathing, the options are endless, as are the free breathing apps to chose from. The goal is to find the style that resonates with you.

Belly breathing vs. Chest Breathing

I recommend you start by placing one hand on your chest and one hand on your belly. Then just notice how you breathe. You don’t have to change anything, you just have to observe. Which hand moves more? For some people it might feel like they both move about the same. Ideally, you want your hand on your belly to be moving more. Belly breathing requires deeper, longer breaths. These are more relaxing and better at slowing down your heart rate. If you’ve ever seen an infant sleep you’ll notice their full belly moving up and down, this is how we are naturally born to breathe. Chest breathing takes in shallower breaths. It also allows you to breathe faster and take in more oxygen more quickly if you hyperventilate, which is a common response when panicking. For some people simply placing their hands on their belly and chest for a few minutes is a good reminder to slow down and focus on taking in more belly breaths.

Paced Breathing

Here the goal is to get an even, steady, and smooth breathing pace. Ideally you want your exhale to be longer than your inhale. If you have chronic pain or just feel uncomfortable taking in a deep breath you can focus on just slowing down the breath. For example you can breathe in for a count of 4, pause, and then breath out for a count of 5.

In…two…three…four…pause…Out…two…three…four…five… pause…”

The actual count can change depending on your comfort level. Perhaps you prefer to breathe in for a count of 3 and out for a count of 4, or breathe in for a count of 5 and out for a count of 7. As long as the exhale is longer you are getting a slower, calmer breath.

It is best to practice paced breathing for a few minutes at a time when things are calm, such as right when you wake up, when you take a lunch break, or in the car after you park. Trying something new in the heat of the moment won’t work very well. But if you’ve been practicing your breathing regularly, then you can draw on its calming power in the heat of the moment.


Another great way to cope with symptoms of arousal are to practice soothing strategies. Think of a loving mother and her infant. When the baby cries out in distress the mother soothes her child using touch with soft caresses, sound with a lullaby and kind reassurances, taste with milk, smell as the baby knows her personal scent, and sight by looking into the baby’s eyes. As adults we still have a need for soothing comfort and it is important to soothe all of our senses.

Make a Soothing Kit

The best way to prepare for when your body gets amped up in fight, flight, or freeze mode is to have a soothing kit prepared and ready to go so you do not have to think about what to do. You can just grab something from the kit and try it out, if it doesn’t work grab something else, and so on until you’re back in control of your reactions and can think more clearly. Your actual kit can be anything, a makeup bag, an old wallet, a folder, a folder on your phone, a lunch pail, etc… Here are some recommendations:

  • Touch – small bottle of lotion that you can massage into your hands, an ice pack (one of those 1st aid ones that you can activate when needed), a textured keychain, a reminder to hug a friend or pet your dog, a note to change your sheets and then lie down on the clean sheets, bubbles for a warm bubble bath, etc… The goal here is to do something that soothes your sense of touch.
  • Sound – make a playlist of calming, soothing music, record your grandchildren saying jokes, keep a note card with the lyrics of your favorite song, write a reminder to go listen to nature sounds (the ocean, the trees on a hike), etc…
  • Taste – add a peppermint candy, piece of gum, or Hershey kiss to eat mindfully, noticing the texture, taste, and sensation of chewing or sucking, sample flavors in an ice cream store, make some hot, soothing tea, grab a coffee with a friend, treat yourself to a special dinner. Remember to use taste mindfully to soothe, it is not about eating the whole box of cookies, but mindfully savoring the present moment.
  • Smell – include in your kit a small vial of your favorite essential oil, or a perfume that reminds you of your favorite person, combine smell with touch by adding a small bottle of scented lotion, light a candle, or bake some cookies, go for a walk and literally stop to smell the roses.
  • Sight – add pictures of your favorite things, put a note to remind yourself to visit a museum, art exhibit, or natural lookout point, go bird watching or star gazing, do your nails or create some artwork, you can make a special album on your phone with photos of people or places you enjoy, write on note cards reminders of things you’d like to see that you can take an afternoon to go do.

Remember for both breathing and soothing, (and grounding for symptoms of re-experiencing) the goal is not to relax. If you do relax that is an added bonus, a cherry on top. The goal is to calm down the arousal in the body. To slow your breathing, slow your heart rate, and reduce the tension in your body. You may very well still feel anxious or upset, but you are now in control of your body and not the other way around. These coping skills are intended to help you survive and get through the moment; to help stop things from getting worse. This is a common complaint when clients first start practicing these coping skills, they want them to work right out the gate and to make them feel relaxed. Unfortunately that is not how it goes. All of these coping skills take time and practice (especially the breathing) and they do not always relax you but they allow you to be in control, to think more clearly, and to choose what you want to do next, rather than react automatically to what triggered you.