Q: Dear Frank,
I hear from people who do not know what to do when they their PTSD symptoms like flashbacks, and arousal symptoms appear all of a sudden. What do you advise patients when they are in the position of having to handle an all consuming anxiety moment at a child’s ball game, a dinner or even having lunch with a friend or spouse? Is this unusual?
A: Dear reader,
This is common. In most social situations you needn’t explain things if you want to get away. You excuse yourself, go outside “to get some fresh air” or go to a rest room, take some time (and, possibly, a pill) and you return when you can tolerate the company. If you have a companion who understands, that person can help with the appropriate comments so that you do not need to enter a dialogue with a tactless friend or relative who asks too many personal questions.
One of my earliest PTSD patients was a teacher with panic attacks. She could tell when one was coming on. She could abort the attack in 20 minutes with half a milligram of Xanax. But she didn’t want to have to explain her condition to her high school Spanish class. So she devised a plan and she practiced with me. She would pretend to have a nose-bleed when she felt panic approaching. Then she would rush out of class with a napkin to her nose, go to the restroom, take her Xanax, and return, reasonably composed, 20 minutes later. That plan gave her a sense of comfort and calm. She told her principal about her condition and about her plan. He was very supportive. Knowing that he was informed was important to her. I believe I introduced her to a patient of mine who was a school principal in a different district. He had a depressive condition and some trauma in his history. He was kind and encouraging, and that helped my panicky teacher have the courage to approach her own principal.
I’m not suggesting that this particular method will suit others and will work in all circumstances. But I do believe that brief, intense episodes of high anxiety will occur in social situations and they deserve collaborative planning.
Your therapist may be able to help you devise plans and to introduce you to other helpers, but not all therapists are comfortable going “outside the box.”
Talk over options with a trusted friend, a counselor, a colleague. Do your best to devise a contingency plan. Have a “cover story.” In an ideal world, the “cover story” is the truth and the others who witness an anxiety attack or a flashback are informed, mature and sympathetic. But that isn’t always the case. My Spanish teaching patient never had to use her nose-bleed subterfuge. But she had it all worked out and that was a huge relief for her.