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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
There is no financial support given for this presentation
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!
SourcesAdler, A. B., Bliese, P. D., McGurk, D., Hoge, C. W., & Castro, C. A. (2011). Battlemind debriefing and battlemind training as early
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.