Authors:
Dr. Hernan Gilberto Rincón , Psychiatrist
Dr. Manuela Montoya , Psychiatrist
Dr. Diana Prieto , Deputy Director of Outpatient Services
Liliana is a 45-year-old professional woman with a "normal" life story, including a partner and family, teenage children, periods of financial hardship, and some family conflicts, which she has always faced with dedication and effort. Her health has generally been good, with the occasional minor ailment, but nothing serious or chronic. She was leaving her house on Monday, August 10, 2026, when the earthquake struck. Her husband suffered serious but recoverable injuries, her children were very frightened, and she lost her best friend when the building where she lived collapsed. She feels very sad and distressed, she doesn't sleep well, and she thinks a lot about everything that happened.
Fernando is a 55-year-old man with a technical background, a stable job, a partner, and a family. He has experienced some emotional difficulties in the past, which he attributes to a tough childhood, but with medical and psychological help, he has been able to cope and manage them. He was generally doing well until the earthquake struck. Now he thinks, "What a terrible situation." He knows people who lost everything, and he has coworkers who don't want to return to the office because it's in a building that was damaged or because they've seen all the buildings that have collapsed. The situation has affected him deeply; he feels a lot of anxiety, fear, and helplessness, and he often wonders if life is worth living.
The stories of Liliana and Fernando exemplify the experiences of many people in the regions affected by the earthquake in Colombia. However, some cases may be more severe due to the physical, emotional, or social impact. This health guide explains the psychophysiological mechanisms of the stress response, from normal to pathological, the expected evolution, warning signs, and provides recommendations for managing it.
From threat to defensive response
Mammals, in this case humans, are endowed with a highly sensitive defense system called the nervous system (NS). This system has different pathways to perceive and transmit information or stimuli from the external environment and the body to the mind-brain.
Most of the information the mind receives is unconscious and is categorized as safe or threatening, triggering a corresponding response of calm or alarm and defense—the latter known as the stress response (SR). Since much of the process and response is unconscious, the person may only become aware of it once the SR has already been triggered.
It is important to note that a person's categorization of a perceived stimulus depends on many factors. For example, there are very severe stimuli; in this case, an external situation like an earthquake is an event perceived through many senses: visual, auditory, tactile, proprioceptive, etc., which converge and quickly overcome barriers, reaching consciousness. Therefore, when the stimulus is very strong, the emotional response has both conscious and unconscious components simultaneously.
Another factor is the history of exposure to stressful events throughout life. The effect of these events can be measured by their intensity and severity or by their cumulative impact, with a greater effect in the early stages of life when the brain and mind are developing ( see Health Letter #324 ). For example, from the womb through adolescence versus young adulthood through old age.
In order to categorize, the mind receiving information or stimuli initially employs a rapid defensive response, generally unconscious or with a low level of awareness, and simultaneously compares the present experience with memories of past experiences. At the same time, there is an emotional activation that colors the experience, tinging it with fear as the threat is perceived, increasingly consciously, as imminent.
In this context, all known defensive mechanisms are triggered, such as Confrontation, Avoidance, Numbing, Surrender, or Exhaustion (See Table 1). Although these are part of the immune response to perceived threats and are predetermined in mammals, the mechanisms of activation, inactivation, or conscious perception can be modified throughout life by past experiences or exposures.
From defensive response to exhaustion
Once a person understands that the RE has the characteristics explained, the idea is that they can learn to modulate that response. In that sense, understanding the person-context interaction is fundamental.
On the one hand, a person may have a history of traumatic and difficult life experiences, or, conversely, a life history marked by physically, emotionally, and socially safe environments. Furthermore, the combination of possibilities and how these experiences were coped with at the time is vast for each individual. A person may even have defensively forgotten the experiences and reactions, leaving only temperamental traits behind.
The context, for its part, can have many different traumatic or protective characteristics, because not everyone experiences an earthquake in the same way. The physical situation at the time, especially the level and severity of external stimuli, plays a role. The emotional state, for example, if the person was already affected by other situations, is also important. And the social context is crucial: where the person was—at work, at home, on the street—whether other family members or team members were exposed, what kind of help they were able to give or receive, how isolated and powerless they felt, and so on.
It's important to remember that all ER (endoscopic reflex) is a product of the activity of neurons and other bodily systems, which, as cells, have a finite capacity. This means that if the exposure is too intense or prolonged, exhaustion can occur, altering tolerance and affecting ER from then on, and even, if the stimulus doesn't stop, life can be endangered.
How can I manage my stress response?
A simple way to understand the relationship between the person and the environment is to consider that humans and other mammals need physically and emotionally safe spaces or environments to recover, thrive, and reach their full potential. Typically, in the 2-4 weeks following a severe stressor such as an earthquake, emotional distress and symptoms should decrease. These recommendations can aid in recovery:
Security
The person needs to feel they are in a physically, emotionally, and socially safe place, with access to basic services such as food, water, and privacy.
self-care
That the person can, immediately or gradually depending on the circumstances, resume their previous routines, general and specific self-care for their recovery and rehabilitation. This includes regaining healthy sleep and eating habits.
Regulatory
Gradually seek physical and emotional regulation, utilizing all necessary and available resources according to medical or psychological needs. This includes gradual exercise, contact with nature, relaxing music, professional guidance and support, meditation, yoga, medication, and other activities. Avoid the abuse of alcohol or psychoactive substances.
Connection
It is important to avoid isolation whenever possible, to ensure that the person feels supported, is listened to, and can speak and express themselves without feeling judged or criticized. This includes support from family, friends, coworkers, healthcare professionals, and other support groups.
Identity/empowerment
In some cases, the level of individual, family, or social trauma can affect the perception of identity or role. It is important that the person gradually perceives themselves as part of and connected to the family and social group, that they are valued, and that they have an active role, including in the community and at work, where they can contribute, grow, and help others.
Enjoyment
Part of recovery is being able to enjoy life again, both individually and with a partner, family, and community. In some cases, trauma becomes an opportunity to re-evaluate one's lifestyle, values, and priorities, becoming a turning point and catalyst for change.
When should you seek psychological support?
Psychological care is indicated when emotional distress is constant and hinders the adaptation process after the traumatic event, but the person still retains much of their functionality in daily life.
- Feeling of emotional stagnation: Presence of deep sadness, fear, anger or crying that does not gradually decrease over time.
- Adaptation difficulties: Problems resuming daily routines, work responsibilities, or chores due to demotivation or sustained lack of concentration.
- Intrusive and distressing thoughts: Recurrent and involuntary memories about the event that cause alarm and interrupt the normal flow of the day.
- Avoidance behaviors: Extreme need to avoid places, sounds, people or conversations that remind one of the event, limiting personal peace of mind.
- Interpersonal tension: A noticeable increase in arguments, constant irritability with loved ones, or a tendency to socially isolate oneself.
- Processing difficulties: Feeling the need to talk about the traumatic experience, but being unable to do so with the usual support network because they feel they do not understand the magnitude of the fear.
When should you seek a psychiatric consultation?
A psychiatric evaluation is strictly necessary at any point in the process when symptoms are intense, overwhelming, jeopardize the person's well-being, or are accompanied by serious behavioral disturbances. According to official disaster response guidelines, the criteria for referral to a specialist include:
- Risk to life: Presence of suicide risk.
- Loss of contact with reality: Appearance of psychotic episodes.
- Profound impact on functionality: Marked difficulties in family, work, school or social life.
- Cases of extreme severity: Great suffering due to the intensity of the disorder.
- Lack of response to primary support: Persistent or severe symptoms that have not improved with initial management.
- Established trauma: Presence of an acute or severe post-traumatic stress disorder diagnosed by a health professional.
Considerations on mental health in populations with previous diagnoses
Experiencing an unusual and traumatic event, such as the recent earthquake, disrupts daily life and the overall equilibrium of the population. For individuals with an underlying psychiatric diagnosis or mental limitations, it is to be expected that they will experience concern about the impact this situation may have on their clinical stability. In this context, it is essential to provide clear information, offer support, and foster confidence in the individual's ability to cope.
Recommendations for maintaining well-being:
- Maintaining routines: Many people with mental health conditions are vulnerable to sudden changes in their environments and routines. Therefore, in the face of the disorganization that follows an earthquake, it is recommended to structure daily life by strictly adhering to sleep, meal, and rest schedules.
- Continuity of treatment: medication and psychotherapy are the main protective factors. Maintaining adherence to medical and psychological recommendations is vital in this clinical setting.
- Use of general support channels: Mental health services structured for the general population are equally beneficial for those with a pre-existing mental disorder, since disaster-related stress affects all population groups without distinction. Participation in community or institutional support programs is highly recommended.
Identification and management of increased clinical discomfort
It must be acknowledged that, on many occasions, the individual has reached a level of clinical stability or balance that proves fragile at the time of the disaster, making it foreseeable that the added stress will disrupt this equilibrium. The exacerbation of pre-existing symptoms should not be interpreted as a definitive therapeutic setback, but rather as an expected response to the emergency. In certain cases, additional support may be required through individual, family, or group psychotherapy, medication adjustments, or, if necessary, hospitalization to restore stability.
Table 1. Responses to stress and trauma: the 5 E model (Confrontation – Avoidance – Numbness – Surrender – Exhaustion)
| The 5 Es Mechanism (5 F Mechanism) | Function / meaning | Predominant autonomic nervous system state | Autonomic and physiological symptoms | Clinical/behavioral manifestations |
| Confrontation (Fight) | Mobilize resources to confront, block, or neutralize a threat. This includes moving, running, speaking, shouting, etc. | Sympathetic predominance: adrenergic mobilization (adrenaline). | • Increased heart rate and blood pressure. • Rapid breathing; possible hyperventilation. • Increased muscle tone, especially jaw, shoulders and limbs. • Pupil dilation, sweating, and increased glucose availability. | • Irritability, anger, or an urgent need to act. • Defensive posture, raised voice, tense fists or jaw. • Focused attention on the source of the threat. |
| Evasion, Escape, Avoidance (Flight) | Increase the distance from the threat, escape, or seek safe spaces. | Sympathetic predominance: motor preparation for escape. | • Tachycardia and increased cardiac output. • Rapid and shallow breathing. • Tremors, motor restlessness, and sweating. • Dry mouth and temporary reduction of digestive activity. | • Impulse to leave, get away or avoid. • Visual exploration of the environment and hypervigilance. • Restlessness, urgency, or difficulty in remaining in place. |
| To become numb, stiff, or frozen (Freeze) | Temporarily stopping action to "reduce the possibility of being detected" and assess the threat before responding. This includes freezing, becoming paralyzed, or feeling like your body is unresponsive. | Variable autonomic coactivation: sympathetic activation with parasympathetic modulation; relative cardiac deceleration may occur. | • Marked reduction in body movement. • Shallow or more shallow breathing. • Possible slowing of heart rate. • Increased muscle tone and intense sensory orientation towards the threat. | • Feeling of being “paralyzed” or unable to initiate an action for a few moments. • Intensely focused attention on the danger. • As a more extreme response, it can present dissociation, even tonic immobility/collapse/syncope. |
| Delivery (Fawn, Appeasement) | Reducing risk in interpersonal relationships through submissive behavior, cooperation, or excessive adaptation to the demands of the other. | There is no single established autonomic profile. Sympathetic activation can coexist with efforts at social regulation. | • Nonspecific signs of anxiety: tachycardia, tension, sweating. • Gastrointestinal discomfort or a “knot” in the stomach. • Fatigue following emotionally demanding interactions. | • To accommodate, give in, apologize, or anticipate the needs of others in order to reduce conflict. • Conciliatory expression despite fear or internal discomfort. • Difficulty setting boundaries under interpersonal threat. |
| Exhaustion (Fatigue, burnout, exhaustion) | Cumulative wear and tear from persistent exposure to demands that exceed the body's resilience. It is not part of the acute defense mechanism, but rather exhaustion because the resilience mechanism does not shut down. It is frequently used in occupational health and caregiver burnout syndrome. | Autonomic dysregulation or reduced flexibility; activation can fluctuate between hyperactivation and low activation levels. There is a loss of autonomic recovery capacity, resulting in dysfunction. | • Persistent fatigue and non-restorative sleep. • Sleep and daytime energy disturbances. • Muscle tension, headache, and gastrointestinal symptoms. • Possible lower heart rate variability and slower physiological recovery. • Changes in the neuro-endocrine axis are heterogeneous and depend on duration, intensity, and context. | • Physical and emotional exhaustion. • Reduced attention, concentration, working memory, and efficiency. • Intolerance, irritability, insecurity, demotivation and a feeling of being overwhelmed. • In occupational burnout: exhaustion, distancing/fear or rejection of work and reduced professional effectiveness. |
Note: The first four E's describe defensive strategies that may appear in response to an acute threat. The fifth, Exhaustion, represents a pattern of wear and tear associated with persistent stress, not an acute defensive response. Autonomic profiles are physiological tendencies and can vary between individuals and situations.
Practical exercises to regulate stress and anxiety:
Start with a central idea: do not try to "eliminate" stress, but help the nervous system to gradually regain its regulatory capacity , always after verifying physical and emotional safety.
Taking into account the five responses to the threat:
Confrontation → Evasion → Numbness → Surrender → Exhaustion.
Several techniques are proposed for implementation.
Regulatory sequence for orientation and safety
Objective: shifting attention from the threat to the present context.
This is especially important after a traumatic event, given that the physical, emotional and social security They are part of the first recovery requirement.
1–2 minutes
Standing or sitting, with feet on the ground.
Exercise: “I am here, now”
– Look around slowly.
– Identify 3 visual elements.
– Perceive 2 sounds.
– Feel the contact of your feet with the ground.
– Observe where the body is supported.
Wonder"Am I physically safe right now?"
It is not necessary to close your eyes or immediately delve into internal sensations
Regulatory breathing
Prolonged exhalation: Breathe comfortably, without forcing it. The key is not to "breathe deeply", but: “Breathe gently and let the exhalation be a little longer.” Avoid maximal inspiration or hyperventilation.3–5 minutes (Repeat 8–12 cycles)
– Breathe in gently through your nose: 4 seconds
– Exhale slowly: 6 seconds.
Sign of good tolerance
– less tense jaw
– shoulders drooping
– spontaneously slower breathing
– feeling of greater body space
Conscious movement to release activation
Shake off tension: useful when restlessness, muscle tension or urgency to act predominate, manifestations described in the confrontation and avoidance responses.
Phrase: “I don’t need to fight the sensation. I allow my body to complete the movement and then I rest.”
1–2 minutes
Standing:
– Bend your knees slightly.
– Gently shake hands and arms.
– Add shoulders.
– Then legs.
– Finally, the whole body for 20–30 seconds.
– Stop.
– Feel your body still for 20 seconds.
Intensity is not the goal.
Conscious release movement
Push and release: The intention is to provide a motor outlet controlled and safe, do not increase activation.
2 minutes
– Standing in front of a wall.
– Place both hands against it.
– Breathe in gently.
– Push against the wall for 4–5 seconds.
– Exhale and release gradually.
– Relax arms and shoulders.
Repeat 5 times.
For people who are “blocked” or frozen
Numbness /Freeze is the marked reduction of movement, shallower breathing, and a feeling of being paralyzed or unable to initiate action.
Micro-movement: “You don’t have to move much. You just need to regain a little movement.” (Seated)
– Slowly move your toes.
– Gently press your feet against the ground.
– Let go.
– Move your fingers
– Slowly rotate your wrists.
– Slightly raise your shoulders.
– Let go.
– Slowly turn your head to one side and return.
Repeat 5-6 times.
Parasympathetic shutdown / recovery
“For now, I don’t need to solve everything. My task is to regain stability, one moment at a time.”
Lying on their backs, hands on their bodies: One hand on the chest and the other on the abdomen, only if the physical contact is comfortable.
2 minutes
Observe, without changing anything, for 30 seconds:
- Temperature
– Respiratory movement
– Body weight
– Support points
15-minute daily routine
Upon awakening: activate without overstimulating
– 2 min orientation
– 3 min joint mobility
– 3 min mindful walk
– 3 min natural breathing with slightly prolonged exhalation
– 2 min gentle stretching
– 2 min intention of the day
