Hypervigilance

What is hypervigilance?

Part of the reason humans have survived as long as we have is that our brain is wired to look out for danger. While this has served us well, in some cases, our brains become sensitised to the potential of danger or harm in the environment, when we are in fact in a safe place (for example in a supermarket, café, shop or walking along the road).

When this happens, it’s called hypervigilance.

Hypervigilance in itself isn’t a diagnosis. Instead, it’s a symptom that can come as a result of various mental health conditions. Essentially it involves you feeling in a state of high alert (even if you are somewhere safe) and is often linked to previous trauma and/or anxiety. You may feel like you need to be aware of potential dangers, whether physical or emotional. This alertness can affect your physical health and your relationships with others.

In this video, counsellor Pedro Garcia explains what hypervigilance is, why it happens and how counselling can help.

Common conditions linked to hypervigilance include:

• Post-traumatic stress disorder (PTSD): A disorder that some people develop following trauma that can cause flashbacks, nightmares and avoidance.
• Anxiety (and anxiety-related conditions): These conditions lead to increased feelings of fear, worry and panic.
• Schizophrenia: A mental health condition that affects a person's ability to think clearly and can result in hearing voices and paranoia.

Symptoms of hypervigilance

While hypervigilance in itself is a symptom, it also has specific symptoms itself. These can be broken down into physical, behavioural and emotional symptoms.

Physical symptoms

Common physical signs of hypervigilance include a faster heartbeat, quick and shallow breathing pattern, higher blood pressure and dilated pupils. These are similar to anxiety symptoms and when they are constant can lead to exhaustion for the person experiencing them. 

Behavioural symptoms

If you’re in a hypervigilant state, you may find you jump easily at sudden noises. You may also misinterpret what someone is saying to you and take it in the wrong way leading you to react in a hostile way in an attempt to defend yourself. 

Emotional symptoms

Emotionally, you may notice an increased sense of fear and panic, including fear of judgment from others. You may become withdrawn, experience mood swings and develop black-and-white thinking.

Once triggered, hypervigilance may cause enhanced or intense emotional responses – activating a fight or flight response. Emotions are raised to the point of alarm or even panic.

- Counsellor Greg Savva

If you recognise these symptoms, visiting your doctor to learn more is a great first step. They can discuss your symptoms, rule out other causes and help you find the right support.

Common causes of hypervigilance

Hypervigilance is often a skill learnt from being in an environment which has felt (and has possibly been) unsafe. This environment may have been in the family home, at school or, later in life, within the workplace. Looking back at those experiences now, they may be recognised as being traumatic.

Hypervigilance is often caused by trauma in this way and is especially prevalent in those with PTSD. When this is the case, hypervigilance causes people to constantly scan for new threats, especially if triggered by something. 

Sometimes it is caused by another mental health condition where fear and stress are present. For example, those with anxiety may become hypervigilant in new situations. Schizophrenia can also cause hypervigilance, often exacerbating other symptoms like paranoia. Those with obsessive compulsive disorder may also experience hypervigilance as the condition is rooted in anxiety and intrusive thoughts. 

You may be triggered by several things, including a feeling of being trapped, loud/sudden noises, anticipating judgement and feeling emotional distress.

Treatment for hypervigilance

Depending on the cause of your hypervigilance, it’s likely you will be referred to a psychotherapist for further support. To help the symptoms, it’s important to treat the underlying cause. Typically, this will involve therapeutic approaches and possibly medication.

Therapeutic approaches

The type of therapy offered will be decided according to your circumstances and what will be most likely to support you. The options you may discuss include cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR), exposure therapy or somatic therapy.

CBT aims to help you understand the link between thoughts, feelings and behaviour. During sessions, you’ll be encouraged to build awareness around your experiences and consider healthier responses and coping mechanisms. If your hypervigilance is caused by trauma, you may benefit from trauma-focused CBT.

EMDR uses eye movement techniques to help you process traumatic memories and alter the way they are stored in the brain to make them easier to manage.

Exposure therapy looks to help you face experiences and situations that may feel overwhelming in a safe environment so you can learn how to cope. Doing this slowly and with the support of a therapist can ensure you feel safe throughout the process and eventually pull that feeling of safety through into your everyday life.

Somatic therapy explores the way the body can hold trauma, and how physical movements can help to process them. There are various somatic approaches your therapist might use, including somatic experiencing, brainspotting and emotional freedom technique.

Medication

If your condition is severe, you may be offered medication to support you as you undergo therapy. The aim here is to help you function better so you can engage in therapy and feel better able to cope with your symptoms.

If you are ever in any doubt about the treatment you’re receiving, be sure to talk it through with your doctor or therapist. Recovery from mental health conditions is rarely linear, but it’s important to speak up if you think you would benefit from a different approach. 

Self-help tips to manage hypervigilance

In terms of managing hypervigilance outside of therapy sessions, self-help approaches could support you. These are generally focused on reducing the stress and anxiety that can make hypervigilance worse. 

• Carve out time to relax each day. Self-care activities like yoga, journaling, meditation and reading can help to bring down stress levels, so be sure to prioritise this.
• Try being more mindful. Mindfulness exercises, grounding exercises and meditations can help you be more present in the moment which can be especially helpful for those experiencing trauma and anxiety.
• Set boundaries. Try not to burn yourself out or overwhelm yourself with commitments and start building healthy boundaries. Communicate your boundaries with loved ones. Discussing how you’re feeling can help others see your point of view and can clear up miscommunication. 
• Get some gentle exercise, if possible. Moving your body can support both mental and physical well-being, releasing endorphins and reducing stress. 

Frequently asked questions (FAQs) about hypervigilance 

Is hypervigilance a mental illness?

No, hypervigilance isn't a mental illness. Instead, it is a symptom that can come as a result of experiencing trauma and/or different mental health conditions, including PTSD, OCD and schizophrenia. 

Is hypervigilance a trauma response?

Yes, hypervigilance is a response that can happen as a result of experiencing trauma. The symptoms can make you feel like you're still in danger, even when you are safe, causing you to be on high alert for potential threats.

Does hypervigilance go away?

In some cases, hypervigilance will reduce and go away over time, but this will depend on how severe it is and what is causing it. If hypervigilance is impacting your everyday life and it isn't easing, be sure to speak to a professional for further support.

Hypervigilance can feel all-consuming at times but know that you’re not alone and that reaching out for help is the first step to overcoming it. With the support of professionals, you can start reducing hypervigilance and allow yourself to sit back and relax, safe in the knowledge that you’re OK.

Further resources

• PTSD UK
• Combat Stress
• Anxiety UK