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Post Traumatic Stress Disorder and the Workplace
What Employers and Coworkers Need to Know

© Amy Menna, Ph.D., LMHC, CAP & Gift From Within

Post Traumatic Stress Disorder (PTSD) affects thousands of individuals across the world. It can be a debilitating illness that inhibits the individual's life. One of the many areas that PTSD affects is the work place. There are many individuals with PTSD who are able to work and are functioning at a level where they are able to hold a job; some successfully, and some just barely. The level of success one has at his or her place of employment depends on many factors including the level of impairment, and support outside and inside the work environment. This article is meant to address some of the pitfalls individuals with PTSD fall into at their place of employment, and how the individual's coworkers can provide support. As many have limited knowledge of PTSD, a brief synopsis will be given here.

Overview of PTSD

Post Traumatic Stress Disorder can develop after a traumatic event has occurred. One of the drawbacks some face is that it may not be recognized because the "traumatic event" may not be readily seen. For instance, if someone comes home from war, we see them as a candidate for PTSD as most of us consider that a traumatic event. However, hidden traumas such as childhood sexual abuse may not be disclosed or recognized therefore PTSD may not be considered.

The components of PTSD are broken down into three main areas; intrusive, arousal, and avoidance symptoms. They exist primarily because of each other feeding off one another to sustain the existence of PTSD. Note that not every trauma survivor experiences all three symptoms. Some may experience one symptom more than another, and others may experience a different cycle. Although this is a pattern, it is not true for everyone. The following diagram depicts the relationship between the symptoms.

The three components combined create a cycle where the individual is constantly trying to "catch up" on life's challenges. The workplace is one of those challenges which may be affected. The following outlines the three symptoms and provides examples of these symptoms.

Intrusive Symptoms - These are things that literally "intrude" on a survivor's life. They can be thoughts, feelings, or body memories. The individual experiencing these may feel as if the trauma is happening all over again. They may also have similar feelings or reactions as they did when the trauma occurred. Examples of intrusive symptoms are;

  • Flashbacks
  • Nightmares
  • Body memories
  • Frightening thoughts
 
      Gina works in the finance office at a small corporation. She has a history of rape and childhood physical abuse that lead to symptoms of PTSD. At work, she has a supervisor that appears very threatening as he walks into her office without knocking and stands over her desk when he is angry about the business not making enough money.
    Her boss's actions cause feelings of when she was overpowered during her assault. Her supervisor has the same physique and she feels threatened, just like during the assault. After he leaves the office, she feels frightened and has memories of the assault, as if it is happening right now.

 

 
  Arousal Symptoms - Arousal symptoms literally "arouse" the body to get into a heightened state of alert. When a survivor is having intrusive thoughts or feelings that the event is happening again, it is natural for the body to respond with anxiety. Examples of arousal symptoms are;
  • Feeling tense
  • Hyper-vigilance
  • Excessive anxiety or worry
  • Anger outbursts
  • Startles easily/jumpiness
  • Over reacts to others emotions and outbursts
  • Reacts to others' traumas (such as EMS, hospital or police department)
 
      Gina feels irritable and jumpy at work. On bad days, she feels anxiety and terror when she hears that her supervisor is in a particularly bad mood or the company is not doing well financially. Now, when someone even knocks on her door she practically jumps out of her seat.

 

 
  Avoidance Symptoms - When you have unwanted thoughts and feelings intruding on your life and your body is in a heightened state of arousal to guard against harm, it is natural to want to escape. This phenomenon is part of what brings on avoidance symptoms. Avoidance symptoms are just that, they are symptoms that allow you to avoid your feelings and what you are experiencing in the moment. Examples of avoidance symptoms are;
  • Avoiding places and people associated with the trauma
  • Loss of memory
  • Loss of interest in once important activities
  • Difficulty falling asleep
  • Feeling distant
  • Self-harming
 
  As a result of all the stress, Gina has had a difficult time falling asleep at night. She dreads going to work in the morning. When there is a meeting that her supervisor runs, she makes an excuse not to go. Lately, she has been calling in sick all together. She wants to reach out to her co-workers but she just doesn't know what to say and doesn't feel as if they would understand.
 
 

Symptoms at work

PTSD affects many facets of a survivor's life. One place is in the workplace. PTSD can manifest itself in various ways in the workplace following the symptoms above. It can be triggered or exacerbated by the work environment. The list is abbreviated as each individual has his or her own reactions, coping skills, as well as work environment. Some examples of problems associated with the workplace for those who have PTSD are:

  • Memory problems
  • Lack of concentration
  • Difficulty retaining information
  • Feelings of fear or anxiety
  • Physical problems
  • Poor interactions with coworkers
  • Unreasonable reactions to situations that trigger memories
  • Absenteeism
  • Interruptions if employee is still in an abusive relationship, harassing phone calls, etc.
  • Trouble staying awake
  • Panic attacks
 
      Gina's performance evaluations started to slip. She was cited for missing work, overlooking simple things, and not getting things done in a timely manner. She was given the opportunity to remedy the situation; however, she had a difficult time concentrating and had a hard time interacting with her supervisor without getting flooded with emotions.
    Many of her co-workers were getting frustrated with her because they felt she wasn't doing her job correctly. They saw her missing meetings and calling in sick to work frequently. The president of the company felt that it was a personality conflict with the supervisor and nothing more. She was seen as someone who needed reprimand more than assistance.

 

 
 

Accommodations

Accommodating an employee with PTSD can be complex and is unique for each individual. What may be helpful for one individual may not be helpful for the next. First and foremost, it is important for the employer to be educated on PTSD and its symptoms. Knowledge can lead to understanding reactions, which may seem out of the ordinary. It can also provide a framework for adapting the work environment to suit the needs of the individual with PTSD.

Employers and supervisors
Some things that supervisor can do to assist the employee with PTSD are;

  • Listen to the employee's limitations related to job performance. For instance, if a woman has a history of sexual assault that occurred during the night and fears walking alone, she may request to have someone walk her to her car at night. She may even request not to work after dark.
  • Identify what specific tasks may be challenging. At times, PTSD symptoms may manifest themselves in cognitive challenges. An employee may need more time to finish a task or need an office which has less distractions.
  • Identify specifically how you can assist. The best way to find out how you can assist someone is to ask. This may be something that develops over time as the employee may not be aware of limitations until he or she runs into them. An open dialogue about how the employer can assist would be helpful from the beginning. Some survivors of abuse will feel embarrassed to admit they need help, so it is important to keep asking. You want to balance this and insure that you are making yourself available versus being overly persistent and aggressive. If a woman has been put down she may need to be encouraged to add input, acknowledging her input is valued.
  • Evaluate the effectiveness of the environment and the employee. If there are times that the employee is having a hard time or tasks that are not up to standards, speak directly to that employee about how you can assist them. Providing gentle and immediate feedback will allow the employee to determine what is needed to get the task back up to standards. This is not to say that all substandard work is due to PTSD symptoms, but it is helpful to know the origins of the problem.
  • Provide training for coworkers and supervisors. By providing training on PTSD and related symptoms, the other staff members can also be educated on how to help the individual. Sensitivity training may be needed on topics that are related to PTSD.
 
      After some time, Gina realized that her work performance and mental health had been impacted by her work and decided to get help. With the help of her Employee Assistance Program, she found a therapist who assisted her in identifying her triggers at work. She was able to speak to her supervisor at work and discuss what was going on with her and request some accommodations be made for her to be more productive.
    Gina's supervisor did not realize that his behavior was triggering her. Together, they discussed what he could do to better support her. The first thing they decided was for him to start knocking and get permission to enter her office. Next, he agreed to meet with the team and have some pamphlets available on PTSD and how to provide support.

 

 
  Survivors
Some helpful tools for a survivor are:
  • Concentration problems - A large complaint of PTSD survivors is difficulty concentrating because of the heightened state of arousal, stress level, or even fatigue. Reducing distractions such as noise and having a clean workspace will enhance the ability to concentrate. Making lists and creating small, goal oriented tasks will help create a sense of accomplishment. Also, it may be helpful to ask to work at a time that your concentration is at its peak (i.e. earlier in the morning before everyone gets there).
  • Memory challenges - There are often blocks to memory when there is so much happening in the mind of someone with PTSD. Common tricks are making lists, decreasing distractions, and increasing the ability to concentrate on tasks which will assist with the ability to remember things. Other ideas include setting reminders in a phone or computer, using a calendar, taking notes during a meeting, or asking for written instructions to given tasks.
  • Flashbacks - Flashbacks can be some of the most stressful symptoms at work. In a time where the survivor is supposed to be managing the environment, the environment starts to try and manage the survivor. There are many stress management techniques to deal with flashbacks. Finding the one that works is the key. As they relate to work, reaching out to the outside world can help, such as having someone available outside the office to take their phone calls if necessary. If possible, perhaps there is someone within the office that the survivor feels safe going to. Have a safe place within the workplace or outside the building that one can go to in the event of a flashback and have a pre-existing understanding with employers and coworkers that, in the event it's necessary, the survivor may excuse him or herself and take a phone call or go to that safe place. It is important to have a well-established protocol prior to a flashback occurring.
  • Anxiety and startle responses - Finding the triggers to the anxiety or startle responses is a starting point for addressing them. Many survivors have a difficult time when someone walks up behind them. In that instance, asking for a desk to be physically positioned (perhaps with their back against the wall or even having a mirror on it so one can see what is coming up behind them) would be empowering. Keeping oneself in a calm state throughout the day is important and taking care of one's anxiety will be necessary on an ongoing basis. This will take effort on the survivor's part such as listening to soothing music or just taking short breaks several times a day to do some deep breathing. By keeping one's resting state calm, the survivor can decrease the level of anxiety experienced. Again, how to maintain a calm work environment would be something to address with the employer as a preventative technique versus doing damage control in an anxious state.
  • Dealing with co-workers - Dealing with coworkers at times can be stressful in any work environment. Open communication is the key here. This does not mean that the survivor needs to share that they are experiencing PTSD, although it would help with understanding. In some cases, it simply means that there needs to be open communication among coworkers and employers. If there is a negative interaction with another coworker, address it with your employer. In addition, the survivor should allow him or herself to experience the broad range of emotions that this coworker might elicit, knowing that it may "strike a chord." Through processing these thoughts and feelings, the survivor can gain a better understanding of what bothers him or her and how to best address it. Answers may come in the form of working through the issue with the individual or perhaps in the form of a request to work part-time from home.
  • Difficulty handling stress - Stress management is often a difficult task at work for most employees. With PTSD, it becomes even harder. Stress management can come in many forms. The key is to practice coping mechanisms with consistency. Coping at work may mean having a longer workday because the survivor may need more breaks during the day. A flexible schedule may be necessary as counseling may be needed. Sometimes a difficult home environment may also necessitate a flexible work schedule. Predictability is the key to safety and reduces stress. The more predictable the survivor's schedule can be, the less stress. Creating a "game plan" at the beginning of the day to tackle the day's work will help, as will planning for breaks to take care of anxiety from PTSD and additional work-related needs that arise.
 
      With the help of her supervisor, Gina was able to renew her sense of safety at work and create a better space where she felt more in control. She took some time to go through her desk to de-clutter it so that she could better concentrate and not get distracted. In addition, she took out a stress ball and put it on her desk along with a picture of a meadow that she found very peaceful. She took some time daily to look at the meadow and just do some deep breathing.
 
  Coworkers
  • Educate self on PTSD - Having an overview of the symptoms of PTSD is a starting point to supporting someone struggling with it. Providing assistance to the survivor varies by individual.
  • Ask how you can assist - It would be helpful to ask the individual what he or she needs. Practical assistance such as walking them to their car at night or being a safe person to talk to can prove to be invaluable to a survivor.
  • Listen to what the survivor has to say - So often, assumptions are made when people are speaking. We feel as if we are helping by "filling in the blanks" when people are talking when what we are really doing is interrupting them. Listening to an individual can sometimes be all that is needed at the time. Listening without interruption, without an agenda, and without the need to steer the conversation can prove to be very supportive to individuals. If the employee has difficulty verbalizing, permit him or her to communicate needs in writing.
  • Be open to communication about accommodations - Being open to a dialogue about the specific accommodations necessary will enhance everyone's understanding of what is expected. It will also give the coworker the opportunity to clarify what specifically will be helpful.
 
      Gina found it helpful to address her co-workers one on one instead of in a large group. Some she addressed only in general terms of what she felt would be helpful in them being able to work better together. Others, she felt comfortable enough to disclose more to and discuss her PTSD more freely. These were individuals who could offer her even more support.
    Gina found that, by being specific about what her needs were and keeping lines of communication open, she had a better relationship with her co-workers. People understood what was expected of them and what the boundaries were. In some instances, they understood better where she was coming from, whereas they were going on misinformation prior to her explaining her PTSD.
    Gina still has trouble with some of her symptoms but her place of employment is no longer a hostile environment for her. Through understanding some simple dynamics of PTSD, she was able to take empower herself by resolving some of the issues that trigger her. Her supervisor assisted her in creating a safer, less psychologically hostile work environment where everyone benefits. She was able to go to work without having to feel re-traumatized and was able to be more peaceful and more productive. The other employees were also more productive because they didn't have to try to figure out what Gina needed.

 

 
  PTSD influences many aspects of a survivor's life. The place of employment is no exception. Although at times the experiencing of symptoms is unavoidable, there are actions and safeguards that can be taken to avoid exacerbating them. Accommodations can be made to protect the individual and provide a safer work environment where the individual feels more comfortable and has the ability to engage in self-care while at work.

From the supervisors to the front line staff, we all need to care for those affected with PTSD. As with physical handicaps, through gaining an understanding and providing accommodations, we can cast a wide net of support for those suffering. We owe it to our veterans returning home, as well as to every trauma survivor, to create a supportive work environment. It starts with education and continues through making the necessary modifications to create a successful experience. It benefits the individual as well as the company when people come together for the betterment of one person. A place of employment is where individuals work together toward a common goal. Supporting the individual with PTSD should be a common goal for everyone. A weak link in a chain can be reinforced to become a valuable asset in strengthening the whole. At times it may be a challenging task, but there is great work to be done.

Amy Menna has a Ph.D. in Counselor Education and Supervision, is a Licensed Mental Health Counselor, and Certified Addictions Professional. She is in private practice and lives in Tampa, Florida. She is available by email at amymenna@aol.com

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Article Index:

Addiction | Adoption | Auto Accidents | Chaplains, Police, EMT | Childhood & Adult Sexual Victimization | Compassion Fatigue
Culture, Race, and Ethnicity | Domestic Violence and Sexual Assault | Grief | Journalists, Survivors, and the Media
Male Sexual Abuse & Domestic Violence | Partners & Families | PTSD Treatment & Recovery | PTSD and Health
PTSD and Workplace Issues | Recovery & Self Help | Resiliency | School Disasters
Spirituality & Trauma | Survivor Guilt | Trauma Responses in the Aftermath of Disasters | Veterans & Their Families


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