Coping with PTSD

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Because PTSD symptoms seldom disappear completely, coping with PTSD symptoms and the problems they cause is usually a continuing challenge for survivors of trauma. Often, it is through receiving treatment for PTSD that many learn to cope more effectively.

Recovery from PTSD is an ongoing daily gradual process. It doesn’t happen through sudden insight or "cure." Healing doesn’t mean forgetting war experiences or having no emotional pain when remembering them. Some level of continuing reactions to memories is normal and reflects a normal body and mind. Healing may mean fewer and less intense reactions. But it also means greater ability to manage trauma-related emotions, and greater confidence in ability to cope.

When a trauma survivor takes direct action to cope with problems, he or she often gains a greater sense of personal power and control. Active coping means recognizing and accepting the impact of traumatic experiences, and then taking concrete action to improve things.

Positive Coping Actions are those which help to reduce anxiety, lessen other distressing reactions, and improve the situation in a way that does not harm the survivor further and which improves things not only today, but tomorrow and later. Positive coping methods can include:

Learning about trauma and PTSD. It is useful to for trauma survivors to learn more about PTSD and how it affects them. By learning just how common PTSD is, and finding that their problems are shared by hundreds of thousands of survivors of trauma, they can better recognize that they’re not alone, not weak, and not "crazy." When a survivor seeks treatment and learns to recognize and understand what is triggering him or her, he or she is in a better position to cope with the symptoms of PTSD. If the survivor wishes, he or she can tackle the source of the problem or tell another person specifically what is happening.

Talking to another person for support. When survivors are able to talk about their problems with others, something helpful often results. Of course, the survivor of trauma must choose his or her support person(s) carefully, and clearly ask for what he needs. However, with support from others the survivor of trauma may feel less alone, feel supported or understood, or receive concrete help with a problem situation. Often, support around issues related to traumatic experiences themselves is best found by talking to professional counselors, who are sometimes more likely to understand trauma and its effects than friends or family. One of the best places to find support is in a specially-designed "support group." Being in a group with other survivors of trauma with PTSD may help him or her reduce sense of isolation, rebuild trust in others, and provide an important opportunity to contribute to the recovery of other survivors of trauma.

Talking to your doctor about trauma and PTSD. Part of taking care of yourself means mobilizing the helping resources around you. Your doctor can take care of your physical health better if he or she knows about your PTSD, and doctors can often refer you for more specialized and expert help.

Practicing relaxation methods. These can include muscular relaxation exercises, breathing exercises, meditation, swimming, stretching, yoga, prayer, listening to quiet music, spending time in nature, and so on. While relaxation techniques can be helpful, they can sometimes increase distress by focusing attention on disturbing physical sensations or reducing contact with the external environment. Be aware that while physical sensations may become more apparent when a person is relaxed, continuing with relaxation in a way that is tolerable (i.e., interspersed with music, walking, or other activities) is, in the long run, helpful in reducing negative reactions to internal thoughts, feelings, or perceptions.

Increasing positive distracting activities. Positive recreational or work activities help distract a person from his or her memories and reactions. Artistic endeavors have also been a way for many trauma survivors to express inner feelings in a positive, creative way. This can be helpful as a means of improving mood, limiting the harm caused by PTSD, and rebuilding a life. It is important to emphasize that distraction alone is unlikely to facilitate recovery; active direct coping with traumatic events and their impact is also important.

Calling a counselor for help. Sometimes PTSD symptoms worsen and ordinary efforts at coping don’t seem to work too well. The survivor of trauma may feel fearful or depressed. At these times, it is important to reach out and telephone a counselor, who can help the survivor of trauma turn things around.

Taking prescribed medications to tackle PTSD. One tool that many survivors of trauma with PTSD have found helpful is medication treatment in partnership with their doctor. By taking medications, some survivors of trauma are able to improve their sleep, anxiety, irritability and anger, or urges to drink or use.

Negative Coping Actions help to perpetuate problems. They may reduce distress immediately, but short-circuit more permanent change. Actions that may be immediately effective but cause later problems can be addictive, like smoking or drug use. These habits can become difficult to change. Negative coping methods can include isolation, use of drugs or alcohol, "workaholism," violent behavior, angry intimidation of others, eating, and different types of self-destructive behavior (e.g., attempting suicide). Before learning more effective and healthy coping, most people with PTSD try to cope with their distress and other reactions in ways that lead to more problems. Consider the following types of coping action:

Use of alcohol or drugs. This may help wash away memories, increase social confidence, or induce sleep. But it causes more problems than it cures, by creating a dependence on alcohol, harming judgment and mental abilities, causing problems in relationships with family and friends, and, sometimes, placing a person at risk for suicide, violence, or accidents.

Social isolation. By reducing contact with the outside world, a trauma survivor may avoid many situations that cause him or her to feel afraid, irritable, or angry. However, isolation will also cause major problems. It will result in loss of social support, friendship, and intimacy. It may breed further depression and fear. Lessened participation in positive activities leads to less opportunity for positive emotions and achievements.

Anger. Like isolation, anger gets rid of many upsetting situations by keeping people away. But it also keeps away positive connections and help, and gradually drives away the important people in a person’s life. It may lead to job problems, marital or relationship problems, and loss of friendships.

Continuous Avoidance. Avoidance of thinking about the assault or seeking counseling keeps away distress but prevents progress on coping with trauma and its consequences. Avoidance can prevent people from seeking help with their problems.

Lifestyle Changes – Taking Control

Survivors of trauma with PTSD need to take active steps to deal with their PTSD symptoms. Often, these steps involve making a series of thoughtful changes in lifestyle, to reduce symptoms and improve quality of life. Common lifestyle changes include:

Calling about treatment and joining a PTSD support group. Often, it’s hard to take the first step and join a PTSD treatment group. Survivors say to themselves "What will happen there? Nobody can help me but myself anyway." And if you’re struggling with PTSD, it is often hard to meet new people and trust them enough to open up about yourself. But after going along, it often is a great relief to feel that you’ve taken positive action. Then when you’ve gone to a few meetings, it can feel great to begin a friendship with another survivor of trauma.

Increasing contact with other survivors of trauma. Often the best source of understanding, and comraderie and support is other survivors of trauma. By joining a survivors of trauma (i.e., veteran's organization for vets) organization or otherwise increasing contact with other survivors, it is possible to reverse the process of more and more isolation and distrust of others, and slow or stop the vicious cycle of symptom worsening, less contact with others, less satisfaction in life, symptoms continuing to worsen, and so on.

Reinvesting in personal relationships with family and friends. Most survivors of trauma with PTSD still have some kind of relationship with someone: a son or daughter, a wife or partner, an old friend or work acquaintance. Often, by taking action to have more contact with those persons, and working at improving those relationships, they can re-connect to others and get more good things happening in their lives again.

Changing neighborhoods. PTSD is a disorder in which trauma survivors feel that the world is a very dangerous place and that the likelihood of being harmed is high. This means that living in a high-crime area is not a good idea; it will only make those feelings worse and confirm their beliefs. By moving, if possible, to a more safe and quiet neighborhood, there will be fewer things to set off traumatic memories and more chance to move to a reconsideration of personal beliefs about danger.

Stopping drinking alcohol or using drugs/Joining an alcohol or drug treatment program. Many, many survivors of trauma have turned to alcohol or drugs to help cope with PTSD. However, alcohol and other drugs, while possibly having some positive effects in the short-term, always makes things worse in the medium- or long-term. Therefore, it is important for many survivors of trauma with PTSD to stop using alcohol or drugs, and stay stopped. This lifestyle change is required if they are benefit from treatment and stay on the path to recovery. Most people are more effective in stopping drinking or using drugs if they team up with others in recovery and get involved in a treatment program.

Starting an exercise program. It’s important to see a doctor before starting to exercise, but after getting the OK, exercise in moderation has a number of possible benefits for those with PTSD. Walking, jogging, swimming, weight lifting, and other forms of exercise may reduce physical tension. They may help distract the person from painful memories or worries, and thus give them a break from difficult emotions. Perhaps most important, they can improve self-esteem and create feelings of personal control.

Starting to volunteer in the community. It’s important to feel like you’ve got something to offer to others, that you’re making a contribution. When you’re not working, it can be hard to get this feeling. One way that many survivors of trauma have reconnected with their communities and regained a feeling of contribution is to volunteer – to help with youth programs, medical services, literacy programs, community sporting activities, and so on.

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By Joe Ruzek, Ph.D.

This article has been reproduced by permission of the National Center for PTSD.

Please also check out the National Center for PTSD website!

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