Career Chat // PTSD management in the workplace // Friday. 2 Sep 10am AEST

Good morning and thanks @NikNik

I’m not sure whether you’re a regular reader of this forum, but I’ve shared in the past that I run a program assisting people with MI to return to work, if and when they’re ready. The aim is to find work that is stimulating enough to provide variety and challenge but not so stressful as to provoke unwanted mental health attacks or pose mental health risks.

Some of the clients I have are sufferers of PTSD and the truth is I’ve had mixed results with PTSD participants. Unless they have a good understanding of how to manage the thoughts and other symptoms; it’s likely any small trigger will send them backwards.

For this reason I always encourage counselling in addition to the program, because PTSD sufferers are some of the least likely consumers to return to work. Yet with a combo of program and counselling we can often establish some useful toolkit that can be used as needed …

Or that’s the theory anyway.

PTSD is a very difficult MI to have, unlike some others which respond well to meds this affliction is often not controllable with meds except in combination with other treatments … it usually runs in conjunction with some other symptom such as OCD making it even more intolerable,

Aside from anti-depressants, I have heard EFT and REM works well to relieve sufferers as a treatment.

I’ve also discovered an excellent app which I’ve referred to clients.

There’s stuff out there it’s a matter of finding what works best for you.

Unfortunately the PTSD client often develops a kind of workplace phobia (a real condition) wherein they are traumatised by the thought of going to work because it may trigger their PTSD.

Others attend work but come and go depending on how they are managing in and out of work …

So where are you in this scenario, if you would care to share your experiences with PTSD and work we would love to hear from you!

Or any experiences with PTSD …

Research time ...

The most frequently studied traumas involved victims of combat, violent crimes, physical and sexual assault, natural disasters, and motor vehicle accidents.

Workplace PTSD is not well researched.

However we do know that clinical symptoms present in a similar way.

So in order to treat PTSD your therapist should be using cognitive-behavioral therapies, including stress inoculation training, prolonged, cognitive processing , imagery rescripting and reprocessing therapy and cognitive restructuring.

Where the goal is to alleviate PTSD and related clinical symptoms by eliminating intrusive traumatic flashbacks, altering maladaptive trauma-related beliefs and schemas (e.g., powerlessness, vulnerability), and enhancing your ability to self-nurture and self-soothe while restoring a sense of competence and self-assurance.

If you’re interested in any of these please ask …

Other treatments include ...

• education about trauma reactions,
• relaxation training,
• imaginal exposure to traumatic memories,
• in vivo exposure to avoided situations,
• and cognitive restructuring of fear-related beliefs.

Plus they found this cognitive behaviour treatment to be significantly more effective than supportive counseling in preventing the onset of PTSD and in reducing intrusive, avoidance, and depressive symptoms.

Researchers note that, in their work with victims of traumatic industrial accidents since the mid-1980s, while many industrial accident patients suffering from PTSD respond positively to exposure therapy (which may consist of some combination of in vivo and prolonged imaginal exposure), a significant percentage of such patients do not respond well to exposure treatment alone.

Weis et al. (2000) hypothesized that for such patients, exposure therapy may need to be supplemented with a cognitive restructuring component to enhance treatment effects.

Smucker, Grunert, and Weis (in press) have further elaborated on the benefits of adding a cognitive restructuring component to the treatment of PTSD, in particular when fear is not the primary PTSD emotion.

Overall what does this study and reserach indicate?

That part of you being able to manage your PTSD at work will include some form of cognitive behaviour therapy to restructure your thoughts and help you deal with your clinical symptoms.

Have you had any experience with the treatments mentioned here?

How do you manage your PTSD at work?

Btw I meant EMDR is used to treat PTSD not REM ... in the first post. Doh, it's Friday.

EMDR is eye movement desensitization and reprocessing... REM is rapid eye movement.

So exactly how employable are people with PTSD?

And what can your workplace do to help?

Does work actually help?

Although it has been found that work enhances PTSD sufferers when conditions are viable...

... a study that examined the role of work environments at approximately 8 months post-accident, in a sample of 69 trauma-exposed, injured adults with and without PTSD, results showed that participants with PTSD reported significantly lower employability than those without PTSD and this translated into significantly poorer return-to-work rates.

This is not suprising and they were able to point to the contributing factors:

• low work support and
• poor organisational structure, were significantly associated with low employability in the sample.
• In other words, poor workplace/environment

Anecdotal reports suggest that negative work environments, and the level of stress they can generate, may aggravate irritability and dysfunctional emotional control in people with symptoms of PTSD (Shalev, Bonne, & Eth, 1996).

Did you know that in Australia, PTSD is the third most prevalent mental disorder with a 12 months prevalence of 3.3%, the highest of the anxiety disorders (AIHW, 1999). For the 33% of those with PTSD who remain clinically symptomatic for 3 years or longer, PTSD provokes significant occupational disability.

Overall a combination of 3 variables was seen to create this poor return to work rate;

1. PTSD symptom severity,
2. physical functioning, and
3. workplace organisational structure, accounted for 60% of variation in employability.

The study revealed that interventions in the workplace should aim to minimise and accommodate PTSD symptomatology and physical dysfunction.

But how?

• By clarifying expectations about job tasks, that is identifying the PTSD and acknowledging what can and can’t be done within the role
• promoting moderate managerial control in the workplace, or allowing the person to be engaged without micromanagement.
• These factors should be considered for inclusion as standard disability management practices for this population. This way, the person with PTSD feels they are understood and protected.

The findings from this study suggest that increased employability and successful return to work may also be achieved by improving the organisational structure within an individual’s workplace.

Employers, managers and rehabilitation providers are best placed to implement these workplace-based interventions and to promote the integration of workplace organisational structure assessment into wider disability management practices.

Has your workplace made accommodations for your PTSD?

Would they do something if they knew how?

I mentioned before that there’s technology to help people with PTSD, an example is a government app called PTSD Coach.

Here’s what they say about it …

The PTSD Coach Australia app can help you learn about and manage symptoms that commonly occur after trauma.

Features include:

• Reliable information on PTSD and treatments that work.
• Tools for screening and tracking your symptoms.
• A scheduler that allows you to manage all your self-care, health appointments and activities.
• Convenient, easy-to-use skills to help you handle stress symptoms.
• Direct links to support and help.
• Designed specifically for ex and current serving ADF personnel.
• Always with you when you need it

Check it out here http://at-ease.dva.gov.au/veterans/resources/mobile-apps/ptsd-coach/

I used it for myself to gauge its effectiveness (I don’t have PTSD but have clients who do) and I felt it would have positive effects so I referred it to clients; they commented that it’s a bit cumbersome but gives you ideas about how to refocus your thoughts.

Overall postive. And not just for Vets with PTSD.

Obviously alone it won’t solve all your issues but in conjunction with CB, counselling, medication and positive work environment … could be a neat addition to your toolkit.

Resilience … the workplace … and PTSD.

How can these three correlate?

Resiliency is a multidimensional construct that is defined by

• How well you perform
• the adequacy of your responses to normal and severe stressors, including traumatic ones,
• and how cognitive processes and the ability to handle emotions influences your capacity to use your own personal and social resources.

Viewed from the perspective of PTSD, resilience is the ability to create an efficient adaptation regardless of significant traumatic threats to personal and physical integrity

Children that have had exposure to chronic stress such as war trauma, refugee status, civil violence, extreme poverty, and economic or social deprivation exhibited diverse forms of resiliency (Wilson & Drozdek, 2004).

In examining “at-risk” populations that exhibit resiliency (e.g., raped adolescent girls in situations of ethnic cleansing, displaced refugees and asylum seekers, torture victims, etc.), various protective factors have been identified (Solomon, Neria, Ohry, Waysman, & Ginzburg, 1994; Wilson & Drozdek, 2004).

The groups that develop resilience have been given opportunity to develop optimal coping and adaptation behaviours. These are to be found in light of the trauma, they’re found on the same continuum … that is you have experienced trauma and you incorporate it (via whatever coping means you have or are able to adapt) and you develop resiliency.

At the other end of the scale, minimal coping defines acute and long-term negative adaptation and represents significant risk factors for the development of PTSD and psychopathology.

How can you develop resiliency or encourage others to do the same ?

According to the research:

• Posttraumatic resilience can be learned.
• Posttraumatic resilience characterizes psychobiologically healthy survivors.
• Posttraumatic resilience can be implemented through training programs to reduce the effects of traumatic exposure.

Have you ever considered your PTSD could be turned into resiliency? Is this absurd? Does it make sense?

Hi @Former-Member ... great to hear from you.

Hope you're going ok today.

Yes 'truth is having comorbid PTSD is demotivating ... but not hopeless.

Ive included a lot of research today and there's a lot more out there (even stuff that I was unaware of).

My posts don't mean to be demotivating but acknowledging reality is sometimes .. yes a bit blech.

However I always like to cover all aspects and end on a (if possible) positive note ...

and I've included information on the best treatments, the government app PTSD coach, research to show that workplaces can make a huge impact and also the development of resiliency which has been shown to increase adaptability.

Again, hope you're ok.

Today I’ve looked at PTSD and the reality that it’s hard … but not hopeless. Since the 1980’s when PTSD was first treated as a serious health condition, we’ve come a long way.

Much of the latest research is promising and certainly the best bet with PTSD is cognitive behaviour therapy rather than counselling to help with the clinical symptoms … please investigate this if you are not already.

Do leave comments and continue to post the forum is open until 4pm!

I wish you all a relaxing weekend and for those who still have one, care to celebrate ... a happy father’s day.