When the Sirens Haven’t Stopped: Understanding Trauma While Danger Is Still Real

By Dr. Ivan Gulas, Board-Certified Clinical Psychologist and Author of ‘Changing the Odds: A New Understanding of PTSD and the Path to Recovery’

When the siren sounds, people do not pause to analyze the situation. Parents grab their children, soldiers move toward protective cover, and civilians instinctively calculate the fastest path to safety. In those moments the brain’s alarm system activates almost instantly, triggering the fight-or-flight response designed to protect human life.

For millions of people living in Israel today—and for many others in Ukraine and regions of the world where violence remains a real possibility—these moments are not rare interruptions but recurring features of everyday life. Entire societies must continue working, raising families, and planning for the future while knowing that danger can appear suddenly and without warning.

Most discussions of trauma assume something different: that the traumatic event has already ended. Traditional models of post-traumatic stress disorder (PTSD) focus on individuals whose nervous systems continue reacting as if the threat were still present long after the danger has passed.  But when the sirens have not entirely stopped, the psychological challenge becomes far more complicated.

Traditional PTSD models describe what happens when the nervous system remains stuck in survival mode even after the environment becomes safe again. Individuals may experience intrusive memories, exaggerated startle responses, sleep disturbance, chronic hypervigilance, and persistent anxiety. These symptoms reflect changes in several brain systems responsible for detecting and responding to danger.  The amygdala, the brain’s rapid threat-detection center, becomes highly sensitive to possible danger signals. The hippocampus, which helps distinguish past events from present reality, may struggle to clearly place the traumatic experience in the past. At the same time, the prefrontal cortex, responsible for rational evaluation and emotional regulation, becomes less effective at calming the alarm signals generated by the amygdala. Speed plays a critical role in this process.

The amygdala’s fight-or-flight response activates extremely rapidly—often within milliseconds—while the prefrontal cortex evaluates situations more slowly. In dangerous environments this rapid response is essential for survival because it allows individuals to react before conscious reasoning has time to unfold.  However, this same speed difference helps explain why trauma symptoms can persist even when danger has passed. The amygdala may trigger alarm responses before the brain’s reasoning systems have time to intervene.

In my recently published book ‘Changing the Odds: A New Understanding of PTSD and the Path to Recovery,’ I describe a framework for understanding trauma that centers on how the brain estimates the likelihood of danger. A central element of this theory is that the brain constantly performs a quiet calculation about risk, distinguishing between what is possible and what is probable. Many harmful events are possible in life—car accidents, sudden illness, or acts of violence—but they are relatively unlikely. Because the brain recognizes that these events are possible but not probable, we are able to move through everyday life without constant fear while still avoiding clearly dangerous situations.

Trauma can disrupt this calculation. In the framework I propose, overwhelming danger recalibrates the brain’s estimate of probability so that events that were once merely possible begin to feel probable. When this occurs, the nervous system behaves as though catastrophe might occur at any moment. Trauma, in effect, causes the brain to treat what is merely possible as though it were probable, keeping the body in a continuously heightened state of alert. This persistent activation of the brain’s alarm system helps explain many of the ongoing symptoms associated with trauma. Over time, maintaining this constant state of readiness can exhaust the brain’s regulatory systems, contributing to sleep disturbance, irritability, difficulty concentrating, and the sense of being perpetually on edge that many trauma survivors describe.

Traditional PTSD treatment attempts to reverse this process by helping the brain gradually recalibrate its estimate of danger through repeated experiences demonstrating that the environment has become safe again. But when individuals continue living in environments where danger remains possible—as in Israel, Ukraine, and other conflict zones—this recalibration becomes far more complicated. Heightened vigilance may not represent a malfunction of the nervous system. It may reflect a realistic response to environments where danger still occasionally occurs.

The probability-recalibration framework described in ‘Changing the Odds’ therefore leads to somewhat different treatment implications. If trauma alters the brain’s estimate of danger, treatment—especially when danger persists—cannot focus simply on eliminating vigilance. Instead, the goal becomes helping the brain’s alarm system remain responsive to real threats without becoming locked in a constant state of emergency. Several practical principles follow from this understanding

Vigilance should be bounded rather than constant. Responding quickly to sirens or security alerts is appropriate, but the nervous system must also be allowed periods of recovery when no immediate threat exists.

Maintaining daily routines is equally important. Work, school, family meals, exercise, and social interaction help anchor the brain in normal rhythms even during uncertain times.

Sleep must be protected whenever possible. Sleep restores emotional balance and regulates the brain’s stress systems.

Limiting continuous exposure to threat-focused media can also help prevent the brain’s probability system from overestimating danger.

Finally, social connection remains one of the strongest stabilizing forces during prolonged stress. Conversations with friends, family members, and communities help counterbalance the isolating effects of chronic vigilance.

These recommendations do not remove the reality of danger. Rather, they help prevent the brain’s alarm system from remaining permanently locked in emergency mode. Periods of prolonged threat place enormous strain on individuals and societies. Yet human beings have repeatedly demonstrated a remarkable capacity to adapt and endure.

In some cases psychologists have observed what is known as post-traumatic growth, in which individuals report greater appreciation of life, stronger relationships, and increased personal resilience after adapting to adversity. Over time, as experiences of safety accumulate, the nervous system can gradually relearn what it once knew: that while danger is always possible, it is not the most probable outcome of daily life.

Readers interested in a deeper exploration of this framework can find a fuller discussion in ‘Changing the Odds: A New Understanding of PTSD and the Path to Recovery,’ available on Amazon, Kindle, Barnes & Noble, and at ChangingTheOdds-PTSD.com.

© The Times of Israel (Blogs)