What is post traumatic stress disorder

Post traumatic stress disorder (PTSD) is a mental health condition that develops in some people who have experienced a shocking, scary, terrifying or dangerous event ¹. Post-traumatic stress disorder is a real illness. You can get post traumatic stress disorder after living through or seeing a traumatic event, such as war, a hurricane, sexual assault, physical abuse, or a bad accident. Post traumatic stress disorder (PTSD) makes you feel stressed and afraid after the danger is over. It affects your life and the people around you.

It is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with post traumatic stress disorder (PTSD). People who have post traumatic stress disorder may feel stressed or frightened even when they are not in danger.

Figure 1. Post traumatic stress disorder statistics

Post traumatic stress disorder (PTSD) can cause problems like:

• Flashbacks, or feeling like the event is happening again
• Trouble sleeping or nightmares
• Feeling alone
• Angry outbursts
• Feeling worried, guilty, or sad

Post traumatic stress disorder (PTSD) starts at different times for different people. Signs of post traumatic stress disorder (PTSD) may start soon after a frightening event and then continue. Other people develop new or more severe signs months or even years later. Post traumatic stress disorder (PTSD) can happen to anyone, even children.

Treatment may include talk therapy, medicines, or both. Treatment might take 6 to 12 weeks. For some people, it takes longer.

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. You don’t have to try to handle the burden of PTSD on your own.

What Can I Do If I Think I Have post traumatic stress disorder (PTSD) ?

The only way to know for sure if you have post traumatic stress disorder (PTSD) is to talk to a mental health care provider, such as a psychiatrist or psychologist.

The provider will ask you about your trauma, your symptoms and any other problems you have.

Getting effective treatment after post traumatic stress disorder (PTSD) symptoms develop can be critical to reduce symptoms and improve function.

If stress and other problems caused by a traumatic event affect your life, see your doctor or mental health professional. You can also take these actions as you continue with treatment for post-traumatic stress disorder:

• Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan and routinely communicating with your mental health professional will help move you forward.
• Learn about PTSD. This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively.
• Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or avoid caffeine and nicotine, which can worsen anxiety.
• Don’t self-medicate. Turning to alcohol or drugs to numb your feelings isn’t healthy, even though it may be a tempting way to cope. It can lead to more problems down the road, interfere with effective treatments and prevent real healing.
• Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
• Stay connected. Spend time with supportive and caring people — family, friends, faith leaders or others. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can offer healing and comfort.
• Consider a support group. Ask your mental health professional for help finding a support group, or contact veterans’ organizations or your community’s social services system. Or look for local support groups in an online directory.

When to see a doctor

If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your doctor or a mental health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.

If you have suicidal thoughts

If you or someone you know has suicidal thoughts, get help right away through one or more of these resources:

• Reach out to a close friend or loved one.
• Contact a minister, a spiritual leader or someone in your faith community.
• Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-8255 to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
• Make an appointment with your doctor or a mental health professional.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call your local emergency number immediately.

If you know someone who’s in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person to keep him or her safe. Call your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

When someone you love has PTSD

The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. Post traumatic stress disorder (PTSD) can significantly strain the emotional and mental health of loved ones and friends.

Hearing about the trauma that led to your loved one’s post traumatic stress disorder (PTSD) may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can’t fix your loved one or hurry up the process of healing.

Remember that you can’t change someone. However, you can:

• Learn about PTSD. This can help you understand what your loved one is going through.
• Recognize that avoidance and withdrawal are part of the disorder. If your loved one resists your help, allow space and let your loved one know that you’re available when he or she is ready to accept your help.
• Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
• Be willing to listen. Let your loved one know you’re willing to listen, but you understand if he or she doesn’t want to talk. Try not to force your loved one to talk about the trauma until he or she is ready.
• Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
• Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
• Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your stress.
• Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive.

Post traumatic stress disorder symptoms

Not every traumatized person develops ongoing (chronic) or even short-term (acute) post traumatic stress disorder. Not everyone with post traumatic stress disorder (PTSD) has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause post traumatic stress disorder (PTSD).

Symptoms usually begin early, within 1-3 months of the traumatic incident, but sometimes they begin years after the event. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered post traumatic stress disorder (PTSD). The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose post traumatic stress disorder (PTSD).

To be diagnosed with post traumatic stress disorder (PTSD), an adult must have all of the following for at least 1 month:

• At least one Re-experiencing symptom.
• At least one Avoidance symptom.
• At least two Arousal and Reactivity symptoms.
• At least two Cognition and Mood symptoms.

Re-experiencing symptoms or Intrusive memories include:

• Flashbacks—reliving the trauma over and over as if it were happening again, including physical symptoms like a racing heart or sweating
• Recurrent, unwanted distressing memories of the traumatic event
• Upsetting dreams or nightmares about the traumatic event
• Frightening thoughts
• Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Re-experiencing symptoms (intrusive memories) may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include:

• Avoiding and staying away from places, events, activities, people or objects that are reminders of the traumatic experience
• Avoiding thoughts or feelings related to the traumatic event
• Trying to avoid thinking or talking about the traumatic event.

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal and reactivity symptoms include:

• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping
• Having angry outbursts

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Negative changes in thinking and mood include:

• Trouble remembering key features of the traumatic event
• Negative thoughts about yourself, other people or the world
• Distorted feelings like guilt or blame
• Loss of interest in enjoyable activities
• Hopelessness about the future
• Memory problems, including not remembering important aspects of the traumatic event
• Difficulty maintaining close relationships
• Feeling detached from family and friends
• Lack of interest in activities you once enjoyed
• Difficulty experiencing positive emotions
• Feeling emotionally numb

Changes in physical and emotional reactions include:

Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:

• Being easily startled or frightened
• Always being on guard for danger
• Self-destructive behavior, such as drinking too much or driving too fast
• Trouble sleeping
• Trouble concentrating
• Irritability, angry outbursts or aggressive behavior
• Overwhelming guilt or shame

Cognition and mood symptoms can begin or worsen after the traumatic event, but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.

It is natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be post traumatic stress disorder (PTSD). Some people with post traumatic stress disorder (PTSD) don’t show any symptoms for weeks or months. Post traumatic stress disorder (PTSD) is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

Intensity of symptoms

Post traumatic stress disorder (PTSD) symptoms can vary in intensity over time. You may have more post traumatic stress disorder (PTSD) symptoms when you’re stressed in general, or when you come across reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

Do children react differently than adults ?

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children (less than 6 years of age), these symptoms can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to or being unable to talk
• Re-enacting the traumatic event or aspects of the traumatic event during playtime
• Being unusually clingy with a parent or other adult
• Frightening dreams that may or may not include aspects of the traumatic event

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Risk Factors for post traumatic stress disorder (PTSD)

Anyone can develop post traumatic stress disorder (PTSD) at any age. This includes war veterans, children, and people who have been through a physical or sexual assault, abuse, accident, disaster, or many other serious events. According to the National Center for post traumatic stress disorder (PTSD) , about 7 or 8 out of every 100 people will experience post traumatic stress disorder (PTSD) at some point in their lives. Women are more likely to develop post traumatic stress disorder (PTSD) than men, and genes may make some people more likely to develop post traumatic stress disorder (PTSD) than others.

Not everyone with post traumatic stress disorder (PTSD) has been through a dangerous event. Some people develop post traumatic stress disorder (PTSD) after a friend or family member experiences danger or harm. The sudden, unexpected death of a loved one can also lead to post traumatic stress disorder (PTSD).

Why do some people develop post traumatic stress disorder (PTSD) and other people do not ?

It is important to remember that not everyone who lives through a dangerous event develops post traumatic stress disorder (PTSD). In fact, most people will not develop the disorder.

Many factors play a part in whether a person will develop post traumatic stress disorder (PTSD). Some examples are listed below. Risk factors make a person more likely to develop post traumatic stress disorder (PTSD). Other factors, called resilience factors, can help reduce the risk of the disorder.

Some resilience factors that may reduce the risk of post traumatic stress disorder (PTSD) include:

• Seeking out support from other people, such as friends and family
• Finding a support group after a traumatic event
• Learning to feel good about one’s own actions in the face of danger
• Having a positive coping strategy, or a way of getting through the bad event and learning from it
• Being able to act and respond effectively despite feeling fear

Researchers are studying the importance of these and other risk and resilience factors, including genetics and neurobiology. With more research, someday it may be possible to predict who is likely to develop post traumatic stress disorder (PTSD) and to prevent it.

Post traumatic stress disorder causes

You can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.

Doctors aren’t sure why some people get post traumatic stress disorder (PTSD). As with most mental health problems, post traumatic stress disorder (PTSD) is probably caused by a complex mix of:

• Stressful experiences, including the amount and severity of trauma you’ve gone through in your life
• Inherited mental health risks, such as a family history of anxiety and depression
• Inherited features of your personality — often called your temperament
• The way your brain regulates the chemicals and hormones your body releases in response to stress

Risk factors for post traumatic stress disorder (PTSD)

People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop post traumatic stress disorder (PTSD) after a traumatic event, such as:

• Experiencing intense or long-lasting trauma
• Having experienced other trauma earlier in life, such as childhood abuse
• Having a job that increases your risk of being exposed to traumatic events, such as military personnel and first responders
• Having other mental health problems, such as anxiety or depression
• Having problems with substance misuse, such as excess drinking or drug use
• Lacking a good support system of family and friends
• Having blood relatives with mental health problems, including anxiety or depression
• Living through dangerous events and traumas
• Getting hurt
• Seeing another person hurt, or seeing a dead body
• Childhood trauma
• Feeling horror, helplessness, or extreme fear
• Having little or no social support after the event
• Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
• Having a history of mental illness or substance abuse.

Kinds of traumatic events

The most common events leading to the development of PTSD include:

• Combat exposure
• Childhood physical abuse
• Sexual violence
• Physical assault
• Being threatened with a weapon
• An accident

Many other traumatic events also can lead to post traumatic stress disorder (PTSD), such as fire, natural disaster, mugging, robbery, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.

Prevention of post traumatic stress disorder (PTSD)

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what’s happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Support from others also may help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.

Complications of post traumatic stress disorder (PTSD)

Post-traumatic stress disorder can disrupt your whole life ― your job, your relationships, your health and your enjoyment of everyday activities.

Having PTSD may also increase your risk of other mental health problems, such as:

• Depression and anxiety
• Issues with drugs or alcohol use
• Eating disorders
• Suicidal thoughts and actions.

Post traumatic stress disorder (PTSD) Diagnosis

To diagnose post-traumatic stress disorder, your doctor will likely:

• Perform a physical exam to check for medical problems that may be causing your symptoms
• Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
• Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Diagnosis of post traumatic stress disorder (PTSD) requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

• You directly experienced the traumatic event
• You witnessed, in person, the traumatic event occurring to others
• You learned someone close to you experienced or was threatened by the traumatic event
• You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You may have post traumatic stress disorder (PTSD) if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.

Post Traumatic Stress Disorder Treatment

The main treatments for people with post traumatic stress disorder (PTSD) are medications, psychotherapy (“talk” therapy), or both. Everyone is different, and post traumatic stress disorder (PTSD) affects people differently so a treatment that works for one person may not work for another. It is important for anyone with post traumatic stress disorder (PTSD) to be treated by a mental health provider who is experienced with post traumatic stress disorder (PTSD). Some people with post traumatic stress disorder (PTSD) need to try different treatments to find what works for their symptoms.

If someone with post traumatic stress disorder (PTSD) is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. Other ongoing problems can include panic disorder, depression, substance abuse, and feeling suicidal.

Medications for post traumatic stress disorder (PTSD)

The most studied medications for treating post traumatic stress disorder (PTSD) include antidepressants, which may help control post traumatic stress disorder (PTSD) symptoms such as sadness, worry, anger, and feeling numb inside. Antidepressants and other medications may be prescribed along with psychotherapy. Other medications may be helpful for specific post traumatic stress disorder (PTSD) symptoms. For example, although it is not currently FDA approved, research has shown that Prazosin may be helpful with sleep problems, particularly nightmares, commonly experienced by people with post traumatic stress disorder (PTSD).

Several types of medications can help improve symptoms of PTSD:

• Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
• Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
• Prazosin. If symptoms include insomnia with recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.

Doctors and patients can work together to find the best medication or medication combination, as well as the right dose, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Tell your doctor about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.

Psychotherapy for post traumatic stress disorder (PTSD)

Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk therapy treatment for post traumatic stress disorder (PTSD) usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery.

Many types of psychotherapy can help people with post traumatic stress disorder (PTSD). Some types target the symptoms of post traumatic stress disorder (PTSD) directly. Other therapies focus on social, family, or job-related problems. The doctor or therapist may combine different therapies depending on each person’s needs.

Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy, or CBT.

Cognitive behavioral therapy can include:

• Exposure therapy. This helps you face and control your fear. It gradually exposes you to the trauma you experienced in a safe way. It uses imagining, writing, or visiting the place where the event happened. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma. The therapist uses these tools to help people with PTSD cope with their feelings.
• Cognitive restructuring. This helps you make sense of the bad memories. Sometimes people remember the event differently than how it happened. They may feel guilt or shame about something that is not their fault. The therapist helps people with PTSD look at what happened in a realistic way.
• Eye movement desensitization and reprocessing. Eye movement desensitization and reprocessing. combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.

Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.

There are other types of treatment that can help as well. People with post traumatic stress disorder (PTSD) should talk about all treatment options with a therapist. Treatment should equip individuals with the skills to manage their symptoms and help them participate in activities that they enjoyed before developing post traumatic stress disorder (PTSD).

How Talk Therapies Help People Overcome post traumatic stress disorder (PTSD)

Talk therapies teach people helpful ways to react to the frightening events that trigger their post traumatic stress disorder (PTSD) symptoms. Based on this general goal, different types of therapy may:

• Teach about trauma and its effects
• Use relaxation and anger-control skills
• Provide tips for better sleep, diet, and exercise habits
• Help people identify and deal with guilt, shame, and other feelings about the event
• Focus on changing how people react to their post traumatic stress disorder (PTSD) symptoms. For example, therapy helps people face reminders of the trauma.

How can I help myself ?

It may be very hard to take that first step to help yourself. It is important to realize that although it may take some time, with treatment, you can get better. If you are unsure where to go for help, ask your family doctor. You can also check online for “mental health providers,” “social services,” “hotlines,” or “physicians” for phone numbers and addresses. An emergency room doctor can also provide temporary help and can tell you where and how to get further help.

To help yourself while in treatment:

• Talk with your doctor about treatment options
• Engage in mild physical activity or exercise to help reduce stress
• Set realistic goals for yourself
• Break up large tasks into small ones, set some priorities, and do what you can as you can
• Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms.
• Expect your symptoms to improve gradually, not immediately
• Identify and seek out comforting situations, places, and people

Caring for yourself and others is especially important when large numbers of people are exposed to traumatic events (such as natural disasters, accidents, and violent acts).

Self-help treatment for PTSD

Recovery from post-traumatic stress disorder PTSD is a gradual, ongoing process. Healing doesn’t happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many things you can do to cope with residual symptoms and reduce your anxiety and fear.

PTSD self-help tip 1: Challenge your sense of helplessness

Overcoming your sense of helplessness is key to overcoming PTSD. Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times.

One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that is a common symptom of PTSD.

Positive ways of coping with PTSD:

• Learn about trauma and PTSD
• Join a PTSD support group
• Practice relaxation techniques
• Pursue outdoor activities
• Confide in a person you trust
• Spend time with positive people
• Avoid alcohol and drugs
• Enjoy the peace of nature

PTSD self-help tip 2: Get moving

When you’re suffering from PTSD, exercise can do more than just release endorphins and improve your mood and outlook. By really focusing on your body and how it feels as you move, exercise can actually help your nervous system become “unstuck” and begin to move out of the immobilization stress response. Try:

Rhythmic exercise that engages both your arms and legs, such as walking, running, swimming, or dancing. Instead of focusing on your thoughts, focus on how your body feels. Notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin.

Rock climbing, boxing, weight training, or martial arts. These activities can make it easier to focus on your body movements—after all, if you don’t, you could get hurt.

Spending time in nature. Pursuing outdoor activities like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing helps veterans cope with PTSD symptoms and transition back into civilian life. Anyone with PTSD can benefit from the relaxation, seclusion, and peace that come with being out in nature. Seek out local organizations that offer outdoor recreation or teambuilding opportunities.

PTSD self-help tip 3: Reach out to others for support

PTSD can make you feel disconnected from others. You may be tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. You don’t have to talk about the trauma if you don’t want to, but the caring support and companionship of others is vital to your recovery. Reach out to someone you can connect with for an uninterrupted period of time, someone who will listen when you want to talk without judging, criticizing, or continually being distracted. That person may be your significant other, a family member, a friend, or professional therapist. Or you could try:

Volunteering your time or reaching out to a friend in need. This is not only a great way to connect to others, but can also help you reclaim your sense of control.

Joining a PTSD support group. This can help you feel less isolated and alone and also provide invaluable information on how to cope with symptoms and work towards recovery.

If connecting with others is difficult

No matter how close you are to someone, or how helpful they try to be, the symptoms of PTSD that leave your nervous system feeling “stuck” can also make it difficult to connect to others. If you still don’t feel any better after talking to others, there are ways to help the process along.

• Exercise or move. Before chatting with a friend, either exercise or move around. Jump up and down, swing your arms and legs, or just flail around. Your head will feel clearer and you’ll find it easier to connect.
• Vocal toning. As strange as it sounds, vocal toning is a great way to open up your nervous system to social engagement—even if you can’t sing or consider yourself tone-deaf. Sit up straight and with your lips together and teeth slightly apart, simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face. Practice for a few minutes and notice if the vibration spreads to your heart and stomach.

The symptoms of PTSD can be hard on your body so it’s important to take care of yourself and develop some healthy lifestyle habits.

• Take time to relax. Relaxation techniques such as meditation, deep breathing, massage, or yoga can activate the body’s relaxation response and ease symptoms of PTSD.
• Avoid alcohol and drugs. When you’re struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But substance use worsens many symptoms of PTSD, interferes with treatment, and can add to problems in your relationships.
• Eat a healthy diet. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day. Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed food, fried food, refined starches, and sugars, which can exacerbate mood swings and cause fluctuations in your energy.
• Get enough sleep. Sleep deprivation can trigger anger, irritability, and moodiness. Aim for somewhere between 7 to 9 hours of sleep each night. Develop a relaxing bedtime ritual (listen to calming music, watch a funny show, or read something light) and make your bedroom as quiet, dark, and soothing as possible.

Cognitive Behavioural Therapy (CBT)

The Royal College of Psychiatrists defines cognitive behavioral therapy as a way of talking about:

• How you think about yourself, the world and other people
• How what you do affects your thoughts and feelings.

They say that CBT can help you to change how you think (the cognitive part) and what you do (the behavioral part). These changes can help you to feel better. Unlike some of the other talking treatments, it focuses on the “here and now” difficulties. Instead of focusing on the causes of your distress or symptoms in the past, it looks for ways to improve your state of mind now.

If you are not sure you want to commit to a long course of sessions with a clinical psychologist, there are various resources on the Internet which will provide an introduction to CBT or even a course of computer-aided CBT sessions:

• Developed by the Australian National University, MoodGYM (https://moodgym.com.au/) is a fun, free interactive web program that teaches the principles of CBT using flashed diagrams and online exercises. MoodGYM (https://moodgym.com.au/) demonstrates the relationship between thoughts and emotions, and works through dealing with stress and relationship break-ups, as well as teaching relaxation and meditation techniques. It consists of five modules (why you feel the way you do, changing the way you think, changing ‘warped’ thoughts, knowing what makes you upset, assertiveness and interpersonal skills training), an interactive game, anxiety and depression assessments, downloadable relaxation audio, a workbook and feedback assessment. Scientific trials have shown that using two or more modules is linked to significant reductions in depression and anxiety symptoms. These benefits last after 12 months. MoodGYM has won several IT and health awards, and has over 1,000,000 users worldwide. MoodGYM (https://moodgym.com.au/)

• Living Life to the Full (https://llttf.com/) is a free online life skills course for people feeling distressed. It aims to provide easy access to CBT skills in a way that cuts through jargon. It helps you understand why you feel as you do, and to learn new ways of improving how you feel, by making changes in your thinking, activities, sleep and relationships. The course is based on the idea of helping you to help yourself. It is supported by a series of CBT self-help workbooks that can be used between the e-learning sessions. These encourage you to put what you are learning into practice, and to stop, think and reflect on what you are learning. Living Life to the Full (https://llttf.com/)

• FearFighter (http://www.fearfighter.com/) delivers CBT over the internet, useful for those who may be concerned about the stigma associated with seeing a therapist. Taking only three months to complete, with minimal telephone support, FearFighter helps you improve even if you have virtually no computer skills. You are encouraged to use FearFighter as often as you wish but for at least once a week. It helps you identify specific problems, work on realistic treatment goals, and monitor achievement of those goals by repeated self-exposure. You get scheduled brief helpline support to a total of one hour over 10 weeks. FearFighter helps you to work out exactly what brings on your fear, so you can learn how to face it until it subsides. This is called exposure therapy. It consists of nine steps that need to be worked through one by one to obtain the greatest benefits. Like a therapist, FearFighter asks you to return every week to report on how you’ve been doing. You can ask it to print out questionnaires and graphs of your progress. It guides you through CBT as much as a therapist does.
  • Step 1: Welcome to FearFighter – Introduces the system, asks you to rate your problem on the Fear Questionnaire (FQ) and Work & Social Adjustment Scale (WSA), and asks about suicidal feelings and alcohol misuse.
  • Step 2: How to Beat Fear – Explains the principles of CBT, with case examples. You are asked to keep a daily record of your triggers.
  • Step 3: Problem Sorting – Helps you identify your triggers, shows you scenarios relevant to your problem, and helps you personalise your triggers and rate them on a 0-8 scale.
  • Step 4: How to Get a Helper – Explains the value of recruiting a CBT co-therapist and gives hints on how to find one.
  • Step 5: Setting Goals – Guides you through the process of setting good goals and tests them. You record and rate these on the system and can print personalised homework diaries.
  • Step 6: Managing anxiety – Offers a menu of coping strategies for use during CBT homework.
  • Step 7: Rehearsing Goals – Guides you on how to practise personal coping strategies during both imagined and live CBT homework.
  • Step 8: Carrying On – Reviews progress with the help of graphs, allows new goals to be devised, and offers feedback and advice.
  • Step 9: Troubleshooting – Offers a menu of tips on overcoming common sticking points in treatment.

You may have found that when you avoid things that make you panic or feel uncomfortable, the situation tends to get worse and worse. FearFighter can teach you how to face your fear until you adapt and no longer want to run away from it. It helps you learn to face the things that make you panic, such that, with time, you’ll find that, one by one, they’ll get easier.

Self-exposure therapy guided by computer is as effective as clinician-guided therapy and both are superior to relaxation to improve phobia/panic. FearFighter has been tested in four clinical trials and is as effective as the best CBT therapists.

Approved by the National Institute of Clinical Excellence (NICE), free access can only be prescribed by your doctor in England and Wales. FearFighter (http://www.fearfighter.com/)

Helping Someone with PTSD

Helping a Loved One While Taking Care of Yourself

When someone you care about suffers from post-traumatic stress disorder (PTSD), it can leave you feeling overwhelmed. The changes in your loved one can be worrying or even frightening. You may feel angry about what’s happening to your family and relationship, or hurt by your loved one’s distance and moodiness. But it’s important to know is that you’re not helpless. Your support can make all the difference in your partner, friend, or family member’s recovery. With your help, your loved one can overcome PTSD and move on with his or her life.

PTSD can take a heavy toll on relationships. It can be hard to understand your loved one’s behavior—why they are less affectionate and more volatile. You may feel like you’re walking on eggshells or living with a stranger. You may have to take on a bigger share of household tasks, deal with the frustration of a loved one who won’t open up, or even deal with anger or disturbing behavior. The symptoms of PTSD can also lead to job loss, substance abuse, and other problems that affect the whole family.

It’s hard not to take the symptoms of PTSD personally, but it’s important to remember that a person with PTSD may not always have control over their behavior. Your loved one’s nervous system is “stuck” in a state of constant alert, making them continually feel vulnerable and unsafe. This can lead to anger, irritability, depression, mistrust, and other PTSD symptoms that your loved one can’t simply choose to turn off. With the right support from friends and family, though, your loved one’s nervous system can become “unstuck” and he or she can finally move on from the traumatic event.

Provide social support

It’s common for people with PTSD to withdraw from friends and family. While it’s important to respect your loved one’s boundaries, your comfort and support can help the person with PTSD overcome feelings of helplessness, grief, and despair. In fact, trauma experts believe that face-to-face support from others is the most important factor in PTSD recovery.

How to support your loved one

Knowing how to best demonstrate your love and support for someone with PTSD isn’t always easy. You can’t force your loved one to get better, but you can play a major role in the healing process by simply spending time together.

Don’t pressure your loved one into talking. It can be very difficult for people with PTSD to talk about their traumatic experiences. For some, it can even make things worse. Instead, let them know you’re willing to listen when they want to talk, or just hang out when they don’t. Comfort for someone with PTSD comes from feeling engaged and accepted by you, not necessarily from talking.

Do “normal” things with your loved one, things that have nothing to do with PTSD or the traumatic experience. Encourage your loved one to participate in rhythmic exercise, seek out friends, and pursue hobbies that bring pleasure. Take a fitness class together, go dancing, or set a regular lunch date with friends and family.

Let your loved one take the lead, rather than telling him or her what to do. Everyone with PTSD is different but most people instinctively know what makes them feel calm and safe. Take cues from your loved one as to how you can best provide support and companionship.

Manage your own stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one.

Be patient. Recovery is a process that takes time and often involves setbacks. The important thing is to stay positive and maintain support for your loved one.

Educate yourself about PTSD. The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your loved one, understand what he or she is going through, and keep things in perspective.

Accept (and expect) mixed feelings. As you go through the emotional wringer, be prepared for a complicated mix of feelings—some of which you’ll never want to admit. Just remember, having negative feelings toward your family member doesn’t mean you don’t love them.

Be a good listener

While you shouldn’t push a person with PTSD to talk, if they do choose to share, try to listen without expectations or judgments. Make it clear that you’re interested and that you care, but don’t worry about giving advice. It’s the act of listening attentively that is helpful to your loved one, not what you say. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop rehashing the past and move on.

Some of the things your loved one tells you might be very hard to listen to, but it’s important to respect their feelings and reactions. If you come across as disapproving or judgmental, they are unlikely to open up to you again.

Communication pitfalls to avoid

DON’T…

• Give easy answers or blithely tell your loved one everything is going to be okay
• Stop your loved one from talking about their feelings or fears
• Offer unsolicited advice or tell your loved one what they “should” do
• Blame all of your relationship or family problems on your loved one’s PTSD
• Invalidate, minimize, or deny your loved one’s traumatic experience
• Give ultimatums or make threats or demands
• Make your loved one feel weak because they aren’t coping as well as others
• Tell your loved one they were lucky it wasn’t worse
• Take over with your own personal experiences or feelings

Rebuild trust and safety

Trauma alters the way a person sees the world, making it seem like a perpetually dangerous and frightening place. It also damages people’s ability to trust others and themselves. Anything you can do to rebuild your loved one’s sense of security will contribute to recovery.

Express your commitment to the relationship. Let the person know you’re here for the long haul so he or she feels loved and supported.

Create routines. Structure and predictable schedules can restore a sense of stability and security to people with PTSD, both adults and children. Creating routines could mean getting your loved one to help with groceries or housework, for example, maintaining regular times for meals, or simply “being there” for the person.

Minimize stress at home. Try to make sure your loved one has space and time for rest and relaxation.

Speak of the future and make plans. This can help counteract the common feeling among people with PTSD that their future is limited.

Keep your promises. Help rebuild trust by being trustworthy. Be consistent and follow through on the things you say you’re going to do.

Emphasize your loved one’s strengths. Tell your loved one you believe he or she is capable of recovery and point out all your loved one’s positive qualities and successes.

Encourage your loved one to join a support group. Getting involved with others who have gone through similar traumatic experiences can help some people with PTSD feel less damaged and alone.

Anticipate and manage triggers

A trigger is anything—a person, place, thing, or situation—that reminds your loved one of the trauma and sets off a PTSD symptom, such as a flashback.

Sometimes, triggers are obvious. For example, a military veteran might be triggered by seeing his combat buddies or by the loud noises that sound like gunfire. Others may take some time to identify and understand, such as hearing a song that was playing when the traumatic event happened, for example, so now that song or even others in the same musical genre are triggers. Similarly, triggers don’t have to be external. Internal feelings and sensations can also trigger PTSD symptoms.

Common external PTSD triggers

• Sights, sounds, or smells associated with the trauma
• People, locations, or things that recall the trauma
• Significant dates or times, such as anniversaries or a specific time of day
• Nature (certain types of weather, seasons, etc.)
• Conversations or media coverage about trauma or negative news events
• Situations that feel confining (stuck in traffic, at the doctor’s office, in a crowd)
• Relationship, family, school, work, or money pressures or arguments
• Funerals, hospitals, or medical treatment

Common internal PTSD triggers

• Physical discomfort, such as hunger, thirst, fatigue, sickness, and sexual frustration
• Any bodily sensation that recalls the trauma, including pain, old wounds and scars, or a similar injury
• Strong emotions, especially feeling helpless, out of control, or trapped
• Feelings toward family members, including mixed feelings of love, vulnerability, and resentment

Talking to your loved one about triggers

Ask your loved one about things he or she did in the past in response to a trigger that seemed to help (as well as those that didn’t). Then you can come up with a joint game plan for how you will respond in future.

Ask what your loved one would like you to do during a nightmare, flashback, or panic attack. Having a plan in place will make the situation less scary for both of you. You’ll also be in a much better position to help your loved one calm down.

How to help in the middle of a flashback or panic attack

During a flashback, people often feel a sense of disassociation, as if they’re detached from their own body. Anything you can do to “ground” them will help.

• Tell them they’re having a flashback and that even though it feels real, it’s not actually happening again
• Help remind them of their surroundings (for example, ask them to look around the room and describe out loud what they see)
• Encourage them to take deep, slow breaths (hyperventilating will increase feelings of panic)
• Avoid sudden movements or anything that might startle them
• Ask before you touch them. Touching or putting your arms around the person might make him or her feel trapped, which can lead to greater agitation and even violence

Deal with volatility and anger

PTSD can lead to difficulties managing emotions and impulses. In your loved one, this may manifest as extreme irritability, moodiness, or explosions of rage.
Understanding anger in PTSD

People suffering from PTSD live in a constant state of physical and emotional stress. Since they usually have trouble sleeping, it means they’re constantly exhausted, on edge, and physically strung out—increasing the likelihood that they’ll overreact to day-to-day stressors.

For many people with PTSD, anger can also be a cover for other feelings such as grief, helplessness, or guilt. Anger makes them feel powerful, instead of weak and vulnerable. For others, they try to suppress their anger until it erupts when you least expect it.

Watch for signs that your loved one is angry such as clenching jaw or fists, talking louder, or getting agitated. Take steps to defuse the situation as soon as you see the initial warning signs.

Try to remain calm. During an emotional outburst, do your best to stay calm. This will communicate to your loved one that you are “safe” and prevent the situation from escalating.

Give the person space. Avoid crowding or grabbing the person. This can make a traumatized person feel threatened.

Ask how you can help. For example: “What can I do to help you right now?” You can also suggest a time out or change of scenery.

Put safety first. If the person gets more upset despite your attempts to calm him or her down, leave the house or lock yourself in a room. Call 911 if you fear that your loved one may hurt himself or others.

Take care of yourself

Letting your family member’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. In order to have the strength to be there for your loved one over the long haul, you have to nurture and care for yourself.

Take care of your physical needs: get enough sleep, exercise regularly, eat properly, and look after any medical issues.

Cultivate your own support system. Lean on other family members, trusted friends, your own therapist or support group, or your faith community. Talking about your feelings and what you’re going through can be very cathartic.

Make time for your own life. Don’t give up friends, hobbies, or activities that make you happy. It’s important to have things in your life that you look forward to.

Spread the responsibility. Ask other family members and friends for assistance so you can take a break. You may also want to seek out respite services in your community.

Set boundaries. Be realistic about what you’re capable of giving. Know your limits, communicate them to your family member and others involved, and stick to them.

Trauma can be “contagious”

Caring for someone with PTSD can lead to the potential for secondary traumatization. You can develop your own symptoms from listening to trauma stories or being exposed to disturbing symptoms like flashbacks. The more depleted and overwhelmed you feel, the greater the risk that you may become traumatized.

1. Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml[↩]
2. Post-Traumatic Stress Disorder Among Children. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/prevalence/post-traumatic-stress-disorder-among-children.shtml[↩]