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........

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