IF SOMEONE IN YOUR LIFE is struggling with post-traumatic stress disorder, you may wonder what to say or how to help. With PTSD, a disturbing event in the recent or distant past can cause intrusive memories, flashbacks and nightmares, unexpected outbursts, paralyzing fear and social avoidance. PTSD disrupts people's lives and relationships as it affects their ability to function.
Although it shares similarities with anxiety disorders, PTSD is a standalone diagnosis. "The unique thing about PTSD is the person went through a traumatic event," says Jeremy Tyler, an assistant professor of clinical psychiatry at the Center for the Treatment and Study of Anxiety at University of Pennsylvania. "It's a disorder that has to do with how they respond to the trauma over time."
After someone goes through a horrific event, it's quite common to have intense emotional symptoms for the next few months, Tyler says. "We consider that to be pretty normal," he says. "PTSD is when those symptoms don't resolve."
Below, experts suggest supportive ways to respond if you learn a family member or friend is dealing with PTSD.
What It Looks Like
PTSD affects about 3.5% of U.S. adults and an estimated one in 11 people will be diagnosed with the disorder at some point, according to the American Psychiatric Association. It can occur in people of any ethnicity, nationality, culture or age. Women are at higher risk than men, with double the likelihood of having the disorder.
Hallmarks of PTSD
A person with PTSD can experience the following symptoms soon after or long past the traumatic exposure or event:
Intrusive memories of the event. That's different than deliberately thinking about what happened, Tyler explains. Instead, disturbing thoughts come unbidden, perhaps while at work or in class. With intrusive thoughts, he says, it's a matter of: I don't want to be thinking about this, and it's invading my cognitive space.
Avoidance. This includes avoidance of the memory itself – pushing it away. It's also avoiding places, people and situations that might remind the person of what happened. Avoidance may not seem specific to the event itself. A woman who was sexually assaulted might forgo using the subway, for example, or go out of her way to prevent being alone in elevators with men.
Behavior changes. A person may show uncharacteristic signs of temper or irritability. He or she may become easily startled or develop problems with sleep or concentration.
Negative feelings and thoughts. With PTSD, negative thoughts can turn inward, for instance, blaming oneself for what happened. Persistent guilt, shame, horror and anger can occur. Distrust of others, and feelings of estrangement, disinterest or detachment may affect the person's relationships.
When someone shares that they're having these issues, or lets you know they've been diagnosed with PTSD, their reaching out provides an opening for a conversation and for you to offer support.
"First, it's letting the person know we're grateful for them being safe enough to tell us that," says Janina Scarlet, a clinical psychologist and lead trauma specialist at the Center for Stress and Anxiety Management in San Diego and founder of superhero-therapy.com. "Saying something along the lines of: I'm so glad that you told me."
How to Respond
There are many positive ways to respond if friends or family members tell you they have PTSD:
Ask. What are some ways I can be there for you? What are some times that your symptoms might flare up? How would you like me to support you in those moments? Scarlet suggests using open-ended questions like these.
Be sensitive. You might not realize how reactions can change for the person with PTSD. "For example, some people, after experiencing sexual assault, might not really like being touched," Scarlet says. "Whereas in the past that might have been OK with them – receiving a hug from a family member or friend." Now, however, that person might be enduring hugs but feeling uncomfortable. Asking for permission ("Would it be OK if I gave you a hug right now?") lets the person choose.
Foster feelings of control. "Just allowing the person to have a sense of control can be really helpful," Scarlet says. "Because (for a lot) of trauma survivors, after the traumatic experience they might feel as if they have no control over what happens to them. So, asking permission and checking in with the person – seeing how they're doing and if there's something they need – can go a long way.
"Have patience. If a friend with PTSD cancels on you or seems uncomfortable with typical activities you've done in the past, like going to the mall, don't take it personally. Instead, ask if they're doing OK and consider different arrangements, such as spending time together in smaller groups or simply one on one, Scarlet suggests.
Offer to listen and help. Situations related to PTSD can really impair someone's life, Tyler says. They may stop going to work, going to social gatherings or taking public transportation. It's great to offer encouragement and support, he says, as in: "Hey, I'll go with you if you're afraid to go to that crowded store, so that we can see it's going to be OK.
"Be nonjudgmental. People with PTSD sometimes feel shame or guilt about a traumatic experience or feel they did something to deserve it, Tyler notes. So, they may be hesitant to share what happened. "I'm willing to listen, and I'm not here to judge you," can be reassuring for them to hear.
If you're a parent whose child has undergone trauma, such as bullying or the loss of a beloved pet, you might see signs including anger and tantrums. "The most important thing a parent can do is really be present and attentive to the child," Scarlet says. "Trying to give their child attention and support, even when they're acting out."
In some cases, Scarlet says, children can process painful experiences through games or toys or by parents creating scenarios where kids can work out a positive response. "If a parent is struggling with managing their child, there are child psychologists who can be very helpful," she adds.
When someone confides that they have PTSD, respect their emotional experience. It's not helpful to downplay the traumatic event, even if you have the best intentions. It's important to validate – not negate – what they're feeling.
What Not to Say
Clinicians describe counterproductive responses that PTSD patients may hear:
"It's been a while – you should be doing better by now. Why are you still feeling this way?" Asking a lot of "why" questions can make the survivor feel they're being challenged instead of supported."Look on the positive side: You survived this situation." There's nothing positive about having ongoing fears and intrusive thoughts."It could have been worse." Comparing someone else's traumatic event with that of the person sitting in front of you seems to minimize the importance of what he or she experienced.Direct, unasked-for advice. "That can come from even a really good place, where you're not trying to make the person feel bad but trying to 'fix it,'" Tyler says. Instead, he suggests taking more of an "I've got your back" approach.
What's unhelpful in general? "Basically, in any way, shape or form, devaluing their experience and making them feel as if they have no right to feel the way they do," Scarlet says. "Also, forcing them to do certain activities they might not be ready to do."
Insisting that someone with PTSD immediately start counseling before they're prepared to take that step is an example of pushing too hard. Another is urging someone to go to an overwhelming social event, which might actually retrigger that person, Scarlet says, and could make their symptoms worse.
When a person you care about seems troubled, you can suggest resources like counseling in a matter-of-fact, empathetic way.
For example, Tyler says, when you suspect someone's been through a terrible event, certain behaviors might suggest they need help. "(If) it's been a while and you notice they might seem depressed, they're avoiding more, they aren't coming out as often, they're not calling as much, they're sort of turning inward – (you could) say, 'Hey, you know, have you ever thought about going and talking to someone about it? I'd be happy to help you find someone.'"
A therapist who specializes in trauma can make a PTSD diagnosis and discuss possible treatments. Prolonged exposure therapy, which is based on cognitive behavioral therapy, is one option. Requiring a minimum of 10 to 15 sessions, it helps a patient process traumatic events and reduces the psychological impact. "People are getting their lives back, and it doesn't require any medication," Tyler says.
You can locate resources for information and referrals for loved ones – or yourself. Checking online is an early step toward learning more, Tyler says. Be aware of your sources and make sure they're legitimate, he adds. These are some places to start:
Anxiety and Depression Association of America.
Association for Behavioral and Cognitive Therapies.
Center for the Treatment and Study of Anxiety.
National Alliance on Mental Illness (NAMI).
National Center for PTSD (Department of Veterans Affairs).
National Institute on Mental Health.
There's plenty of hope after PTSD, Scarlet emphasizes. Superhero therapy, her focus, incorporates elements from popular culture, such as Harry Potter or Star Wars characters, to help people understand that many heroes in movies and literature have been through something traumatic.
"Sometimes, our traumatic experiences are actually the very beginning of our heroic journey," Scarlet says. "Our traumatic experiences don't define who we are. We get to decide the rest of our journey after experiencing trauma."
The pain of PTSD doesn't last forever. In her practice, Scarlet says most people go through what's called post-traumatic growth. "They find meaning in their trauma," she says. "Over time, as the individual connects with their own core values, they might not only be able to manage their own symptoms, but help other people too." Janina Scarlet, PhD; Jeremy Tyler, PsyD
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