Creating Hope Together: Surround PTSD with Support

The effects of post-traumatic stress disorder (PTSD) are significant: someone suffering from the disorder feels stressed and frightened, even when there is no threat or danger. But researcher Dr. Steffany J. Fredman of Pennsylvania State University has zeroed in on how the effects of PTSD also can extend to loved ones. Through her research, she’s identified important ways that friends, family and partners of people suffering from PTSD can help with recovery.

What are the first things you tell people who have someone with PTSD in their lives?

The first and most important thing that I tell everybody—whether it’s patients, couples, or other mental health providers—is that PTSD is one of the most treatable psychological problems out there. Whether someone is suffering from PTSD from a childhood trauma, from an experience in Vietnam 40 years ago, or a more recent traumatic event, it is never too late to get treatment and to recover from PTSD. Left untreated, it is a chronic condition, but there are ways to get better. I am humbled on a daily basis on how people who have had PTSD for decades can, in a matter of months, completely recover.

What are some of the symptoms of PTSD, and how do they affect others in the PTSD sufferer’s life?

Symptoms of PTSD include (a) intrusions in which the person feels like he or she is reliving the event; (b) avoidance of places, people, situations, or feelings that remind the person of the event; (c) negative mood and cognitions (e.g., shame); and (d) arousal and reactivity – being in a chronic state of fight-or-flight. People with PTSD often suffer from depression or anxiety, along with PTSD. Research has also shown that the chronic stress of living with this disorder can put one at risk for physical health problems, such as an elevated risk for cardiovascular disease.

There’s also research that has shown that there’s an association between PTSD and the well-being of the people they have relationships with: partners also can experience psychological distress and a sense of burden related to caring for someone with chronic PTSD. PTSD is also associated with relationship distress, which then reinforces a sense of being under threat and can impede recovery from the disorder. It’s for these many reasons that my colleague Dr. Candice Monson of Ryerson University and I have developed a couple therapy specific to treating PTSD: Cognitive-Behavioral Conjoint Therapy for PTSD. Treating PTSD using a couple-based approach allows you to simultaneously improve symptoms or PTSD and improve intimate relationship functioning. We teach couples to “shrink” the role of the disorder in a relationship by learning to relate to each other in healthier ways (e.g., communicating more effectively, going out and doing things together rather than jointly avoiding things that make the trauma survivor feel anxious or otherwise uncomfortable, learning to make healthier meaning of the traumatic event(s)).

What ways can partners—or anyone who loves someone with PTSD—support a loved one with the disorder?

When someone has PTSD, they tend to avoid situations that trigger the sense of being in danger. They might avoid crowded situations or going to grocery stores or restaurants, or riding in cars, or other situations that make them uncomfortable. As a result, well-intentioned family members may want to prevent distress, and so they can accommodate this avoidance: taking over chores, not mentioning certain events or their own thoughts and feelings, tiptoeing on eggshells, never doing anything that might provoke stress in their loved one. The problem is that doing this deprives the person with PTSD from relearning a sense of safety and takes a toll on the family member’s well-being.

Another challenge is that research has shown that even if the person with PTSD is receiving individual therapy, they may not do as well in their treatment if they don’t feel supported at home. What we try to do is work with a couple to externalize the disorder and make it a third party in the relationship. By making PTSD an unwanted guest by having both members of the couple communicate directly and honestly and approaching rather than avoiding uncomfortable situations, couples can shrink the role of PTSD in their relationship together.

Is there a first step in working towards addressing PTSD as a couple?

For couples in which one or both partners may be ambivalent about treatment or addressing the PTSD, we talk with them about the pros and cons of participating in treatment—and of not participating in treatment. We ask them what are the costs of doing the treatment, which can be hard work for both people, vs. what will happen if they don’t do this treatment. People quickly realize that if they do nothing, they’re almost guaranteed that things will stay the same, plus face the physical health effects of chronic, untreated PTSD. But if a couple is willing to take on this highly treatable condition, even adding on the help of friends and family, we can really give people a sense of hope for a positive outcome.

Have you helped yourself or someone you love recover from a trauma? Share your experience in the comments section below.

Steffany J. Fredman, Ph.D., is an Assistant Professor in the Department of Human Development and Family Studies at the Pennsylvania State University. Dr. Fredman pursued her doctoral training at the University of North Carolina at Chapel Hill, where she was awarded the Martin S. Wallach Award as Outstanding Doctoral Student in Clinical Psychology, and later completed specialized postdoctoral training at the Women’s Health Sciences Division of the National Center for PTSD. Dr. Fredman studies the intersection between individual psychopathology and couple/family functioning, with a focus on posttraumatic stress disorder. She has published numerous scholarly articles and book chapters on this topic and is the co-author of Cognitive-Behavioral Conjoint Therapy for PTSD (Monson & Fredman, 2012).