What Kind of Strategies Can You Use to Help Patients Who are Hypervigilant?

[Dr. Kristen Maisano] Hypervigilance is something we see everyday— everyday in the service-member population. Even if somebody doesn't have a diagnosis, what the military does— we do an excellent job of teaching somebody to be hyper-vigilant. And they need those skills to survive in Afghanistan, in Iraq, in other deployed situations. So it's not a switch that we turn on—that's months and years of training to be able to scan rooms for threats, to be able to find a point of domination in the room. And we can't flick that switch back off as soon as they get off the plane from that deployment. So what we do is we find where that person is now. What safety behaviors are they using? So are they always sitting with their back to the wall? Are they scanning their environment? Are they only going to a certain Starbucks or a certain restaurant that's comfortable where they know that the person will seat them where they're comfortable? And then we slowly work toward where they want to be. "I want to be able to go to Happy Hour and sit anywhere and enjoy my meal with my partner or my friend." And we develop strategies in between that will help us reach those goals. And we stay at each level until it becomes very comfortable. So an example of riding a train or riding the Amtrak for someone with hypervigilance. So first time on the Amtrak, we might panic, we might need to get off early. We meet them where they are. We develop strategies. "What can we do to calm you down while you are on the Amtrak? What things can you say to yourself while you're in that situation? Can you distract yourself with a game on your phone— and then you're not thinking about the things going on around you? Can you think positively about—you know what, I made it safely through Iraq and Afghanistan. I have the skills I need to ride this Amtrak successfully today. And if I get nervous, I can call X, Y, or Z, and I can calm down that way. And then we use those strategies as we build up the intensity of the activity until they reach their goal of being able to ride the Metro or Amtrak in prime time.