Posttraumatic Stress Disorder Recovery: Coping with Hypervigilance

Medically reviewed by Dr. April Brewer, DBH, LPC
Updated July 16, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that could be triggering to the reader. Please see our Get Help Now page for more immediate resources.

Although post-traumatic stress disorder (PTSD) can be commonly associated with war veterans, assault, and other intense experiences, trauma can affect anyone, regardless of their background or identity. The symptoms of PTSD tend to be varied and complex, but one of the most common signs can be hypervigilance, which can be defined as a near-constant state of high alert. When you’re constantly scanning your environment for possible dangers, it can take a toll on your mental and physical health. A few ways to cope can include noticing and writing down your thoughts, exercising regularly, practicing positive self-talk, and building a support system. Working with a therapist, whether online or in person, can also be immensely helpful.

Feeling tense, on guard, or uneasy?

What are the symptoms of hypervigilance?

Generally, people who exhibit hypervigilance report feeling on guard, hyper-aware, and always on the lookout for danger. That said, hypervigilant behaviors can look slightly different for every person, and may include the following:

  • Overreacting to loud or unexpected sounds or smells
  • Constantly scanning the environment, which may look like “darting eyes”
  • Appearing jumpy and jittery
  • Constant concern about others’ actions 
  • Obsessive avoidance of perceived threats, which may include certain places or people
  • Physical symptoms, including dilated pupils, increased heart rate, elevated blood pressure, and poor sleep

These behaviors and symptoms can vary widely in their severity. In general, people with hypervigilance may recognize their symptoms, but they may not always acknowledge the intensity of their reactions and behaviors. They may defend their actions and argue they’re necessary to ensure their safety.

While hypervigilance can be a primary symptom of PTSD, these behaviors may also occur in people with other anxiety disorders, including panic disorder and social phobia. Many researchers believe that anxiety can naturally boost hypervigilance, which may increase a person’s level of threat detection. This can result in a distressing feedback loop of anxiety, threat detection, and over-alertness. 

Hypervigilance vs. paranoia

The terms “paranoia” and “hypervigilance” are sometimes used interchangeably, but there can be some important distinctions between the two terms.

Whereas people with hypervigilance are usually aware of their symptoms, a person with paranoia tends to express beliefs that are not based in reality, and their symptoms can sometimes be associated with schizophrenia. Left untreated, paranoia may escalate to delusions, coupled with a deep suspicion of others’ intentions and motivations. 

While these behaviors may differ in terms of a person’s awareness of their symptoms, both paranoia and hypervigilance can be characterized by feelings of fear and distrust.

What are the other symptoms of PTSD?

Hypervigilance can be one of the most common symptoms of PTSD, but not everyone with this diagnosis may experience this symptom. Other common signs of PTSD are typically divided into four categories, according to the APA:

  • Intrusion, which can include intrusive thoughts, upsetting dreams, and flashbacks to traumatic events
  • Avoidance of people, places, activities, objects, and situations that trigger traumatic memories
  • Changes in cognition and mood, potentially including an inability to remember important aspects of the trauma and distorted thoughts about the causes or consequences of the event
  • Changes in arousal and reactivity, which can include hypervigilance, angry outbursts, and reckless behavior
If you believe your symptoms align with PTSD, it can be best to consult a licensed medical or mental health professional to ensure a proper diagnosis. Depending on the person and the nature of the trauma, PTSD symptoms may appear within days or develop months later, and they can persist for years at a time.

Strategies to cope with hypervigilance

If you’re experiencing hypervigilance, it can be likely that you’re also living with other PTSD symptoms. To support a full recovery, it’s often important to treat all symptoms of PTSD. A licensed mental health professional can provide you with the knowledge and tools you deserve to begin the journey.

The following coping strategies for hypervigilance are generally recommended by medical doctors as well as mental health professionals. Feel free to adapt these ideas to meet your specific needs, and always consult with your medical team for a personalized treatment plan.

Getty/Vadym Pastukh

1. Notice and write down your thoughts

In the moment, it can be difficult to stop yourself from entering the spiral of hypervigilant thought patterns, but whenever possible, make an effort to “catch yourself” before these thoughts escalate. 

To recognize and prevent the spiral, it may help to write down recurring thought patterns as they arise, or to confide in a trusted loved one about your thoughts and feelings. By recording your thoughts in a visual form – in a notepad, an online document, or even your phone notes – you can develop a better sense of when and why those thoughts occur.  

Regardless of mental health status, we all tend to experience some negative or distressing thoughts on occasion. Writing them down can help you question whether those thoughts are rational and redirect your thoughts and energy toward more enriching, life-giving activities. 

2. Get active

For many people, physical activity has a positive impact on their mental health, regardless of their specific diagnosis. Among people with PTSD, research suggests that aerobic exercise can reduce the feeling ofhyper arousal often associated with hypervigilance and other PTSD symptoms. In terms of exercise, any movement can count. You can dance, do yoga, run around the park with your dog, or walk with a friend.

3. Practice positive self-talk

At first, positive self-talk may feel awkward or uncomfortable, but it can have significant benefits for your mental health, whether you’re struggling with hypervigilance, paranoia, or another challenge. 

Your inner critic may have a powerful microphone, but if you imagine talking to yourself like you would with a friend, positive self-talk often becomes easier and more natural over time.

To improve your self-talk, consider trying some of the following tips:

  • Challenge yourself and ask whether your thoughts are true (often, they’re not – especially in the context of hypervigilance!). Try to find another explanation or way to look at the current situation.
  • Stop the thought or negative self-talk with the “thought-stopping” technique. Try to imagine yourself literally stopping, squashing, or “zapping” a negative thought away.
  • Focus on your strengths. If you notice you’ve said two unkind things to yourself, try to replace those comments with two kind expressions that highlight your unique strengths and abilities.

4. Build your support system

Hypervigilance and other PTSD symptoms can often create isolation fromloved ones and acquaintances. Yet, during this challenging time, people often benefit from all the social support, love, and compassion they can get.

Some people find that in-person or online support groups can provide a sense of community and solidarity with people whose symptoms mirror their own. Other people may confide in close friends, family members, and other loved ones. 

In any case, it’s usually helpful to lean on a variety of people. When you build a healthy, sustainable support system, you don’t usually have to ask one person for more support than they’re able or willing to provide. 

Feeling tense, on guard, or uneasy?

5. Connect with a therapist

A licensed therapist can become a foundational part of your support system. They’re typically trained to provide a mix of compassion and research-backed insights, and they can help you manage the effects of hypervigilance and other PTSD symptoms. 

Benefits of online therapy

Today, a growing number of people use online therapy to invest in their mental health while balancing active lifestyles. If you’re struggling to find the time or finances to begin therapy, an online platform like BetterHelp may offer a solution. BetterHelp features thousands of therapists licensed by their state boards, and each one generally has at least three years of professional experience. Many specialize in helping people with PTSD and other anxiety disorders, and they can offer the tools and reassurance you deserve to overcome your symptoms.

Effectiveness of online therapy

Research suggests that online therapy can be just as effective as face-to-face options. A 2019 review of 10 studies found that internet-based cognitive behavioral therapy (iCBT) can be a valuable intervention for adults with PTSD. While more research may be needed, the researchers cite several other studies that describe iCBT as a flexible, affordable, and clinically effective treatment for PTSD and other mental health conditions.

Counselor reviews

“Erin is the best counselor I’ve ever had the pleasure of working with. She works with me on things I’ve turned over and over in my head and reframes them so that they seem much less daunting. She understands PTSD and trauma better than anyone I’ve spoken to and is really helping me unpack some of it. Thank you, Erin!”

“Joseph takes a caring, individualized approach for what I need to cover for my mental health, whether it’s talking about past traumas or an ongoing crisis. He is attentive and recalls details that I wouldn’t have expected him to, which really helps me know that there’s a genuine rapport. I am a military and police veteran with divorce and relationship issues, post traumatic stress, and major depression. Sometimes I feel like I just want to update Joseph on what’s going on in life when I don’t really have a general direction in the conversation that I want to go in, and he shows interest even when I’m just venting. I would absolutely recommend him to a friend or coworker.”


Hypervigilance can be one of the trademark symptoms of PTSD, and it’s often an intense and distressing experience. However, with the help of your support system and therapist, you can restore your sense of calm and clarity in the present moment. It can also be helpful to notice and write down your thoughts, practice healthy self-talk, and add physical activity to your daily routine.
Heal from trauma with compassionate support
The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
Get the support you need from one of our therapistsGet started