PTSD in the Workplace

Julie Sharrette, PsyDClinical Psychologist

PTSD Clinical Team Lead

Boise VA

September 18, 2015Snake River Conference Twin Falls, Idaho

Disclaimers and Considerations

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The information expressed in this presentation is not:◦A representation of the VA’s opinion◦Promoting or selling a service or product◦Endorsing one specific agency

This presentation will provide information about relevant resources

Posttraumatic Stress Disorder

Brief History of Trauma Reactions

480 BC: King of Sparta: Cowardly reactions1800’s: Railway Hysteria/Railway Spine1860’s (Civil War): Melancholia/Irritable Heart1917 (WWI): Shell Shock1940’s (WWII): Combat/Battle Fatigue1950’s (Korea): Stress Response Syndrome1960’s (Vietnam): Stress ResponseSexual Assault: Rape Trauma

Syndrome/Military Sexual Trauma1980’s (DSM-III): PTSD

Prevalence

The National Comorbidity Survey Replication (NCS-R) Study◦The twelve month prevalence was

1.8% among men and 5.2% among women

◦The lifetime prevalence of PTSD among men was 3.6% and among women was 9.7%

◦Overall, 20 million people at any given time have PTSD

PTSD: Criteria for Diagnosis

A. Exposure to actual or threatened death, serious injury, or sexual violence1. The event is persistently reexperienced in

thoughts and dreams2. The individual experiences persistent

avoidance of reminders of the event and numbing of generally typical emotions

3. Negative changes in thoughts and mood4. Persistent symptoms of increased physical

arousal

(American Psychiatric Association, 2013, p. 271)

What does this really mean?

Common Reactions to Trauma

Physical ReactionsTrouble sleepingUpset stomachHeadachesRapid heart

rate/respirationSweatingCompromised

immune system

Emotional Reactions

NervousnessQuick to

anger/irritableSadness/hopelessGuilt/ShameDifficulty feeling

pleasureStuffing emotions/

numbing out

Common Reactions to Trauma

Behavioral ReactionsTrouble concentration, problems with

memoryJumpy/Easily startledAlways alert/concerned about safetyAvoidance of tasks/places/people that

involve too much stimuli or reminders of the trauma

Aggression*Difficulty fitting in sociallyFor some: use of drugs or alcohol to cope

Mitigating factor to PTSD onset and severity:

Support in multiple areas of the individual’s life

Early Warning SignsSymptom Flare-ups

◦Anniversary dates◦Temperature changes◦Stressors (i.e., financial, relationship,

childcare, etc.)◦Increased stimuli (i.e., noises,

crowds, etc.)◦Chronic pain◦Lack of sleep

Problems in the WorkplaceFrequent Absences or difficulty

meeting deadlinesNeed for multiple breaks due to

GI upset/agitation/anxiety/feeling overwhelmed

Problems with concentration/memory

Prone to distractionDifficulty interacting with

colleagues

Workplace Accommodations

PTSD and ADAA person has a disability if he/she

has a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment

(EEOC Regulations, 2011)An employee does not have to

disclose their diagnosis unless requesting accommodations

Environmental Accommodations

Seating preferenceReduce noise levels/use white noiseReduce traffic areasReduce amount of side activities/break

down assignments into smaller tasksAllow a break in environmental stimuliAllow to take and reference notes, use

calendars, use electronic devicesAllow additional training time/remindersHave tactile articles available

Other ConsiderationsAllow for a consistent work schedule

or flexible start time (accommodation for sleep problems

Driving/parking may effect moodCoping may vary due to anniversary

dates, weather, holidays, etc.Allow time off for counselingPlan for additional coverage around

breaksAllowing a support animal

Other ConsiderationsThe trauma survivor may be triggered by

those who appear similar to those involved in the trauma

Sights, smells, tastes, sounds, touch, etc are all powerful triggers-movies, TV shows, military gear, patriotic clothing, wounds, food smells, fireworks, etc.

“Behavioral Problems” are often an attempt at communication rather than manipulation

Allow employee to walk away when frustrated/agitated

Additional Considerations LISTEN. Don’t force the conversation,

especially if this is something they have never discussed

But avoid assumptionsOffer the support of an employee counseling

or remind them of family support and counseling services

Don’t touch the trauma survivorPosition yourself so that you are facing the

employee with providing feedbackGrounding in reality

Who Can Help?

National Center for PTSD: www.ptsd.va.gov

VA Behavioral Health◦(208)-422-1145 Behavioral Health

Veteran’s Crisis Line◦1-800-273-8255(TALK)◦www.VeteransCrisisLine.net

Questions?

Thank you!

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interventions with soldiers returning from Iraq: Randomization by platoon. Sport, Exercise, and Performance Psychology, 1, 66-83.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC, Author.

Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). EEOC regulations to implement the equal employment provisions of the Americans with disabilities act, as Amended, 29 C.F.R. § 1630 (2011). Considering PTSD for DSM‐5. Depression and anxiety, 28(9), 750-769.

Job Accommodation Network (2013). Accommodation and Compliance Series: Employees with Post Traumatic Stress Disorder (PTSD). Retrieved from http://askjan.org/media/ptsd.html

Massad, P. M., & Hulsey, T. L. (2006). Causal attributions in posttraumatic stress disorder: Implications for clinical research and practice. Psychotherapy: Theory, Research, Practice, Training, 43(2), 201-215.

National Center for PTSD. (2014). Effective treatments for PTSD [data file]. Retrieved from http://www.ptsd.va.gov/about/printmaterials/Effective_Treatment_for_PTSD_Patients.pdf

Nelson, S. D. (2011). The posttraumatic growth path: An emerging model for prevention and treatment of trauma-related behavioral health conditions. Journal of Psychotherapy Integration, 21(1), 1-42.

Owens, G. P., Baker, D. G., Kasckow, J., Ciesla, J. A., & Mohamed, S. (2005). Review of assessment and treatment of PTSD among elderly American armed forces veterans. International journal of geriatric psychiatry, 20(12), 1118-1130.

Schiraldi, G. R. (2009). The post-traumatic stress disorder sourcebook: A guide to healing, recovery, and growth (2nd ed.). McGraw Hill, San Francisco, CA.

Uomoto, J.M., & Williams, R. M. (2009). Post-acute polytrauma rehabilitation and integrated care of returning veterans: Toward a holistic approach. Rehabilitation Psychology, 54(3), 259-269.