When the going gets particularly tough

You and your family member or friend can learn to manage many of the symptoms of PTSD, but some are harder to navigate. These suggestions may not work for everyone, as each situation is unique, but there are known techniques that could help. Reach out for support if you need to.

How to deal with: Flashbacks

A flashback is reliving a memory of a past traumatic event. A flashback may cause your family member or friend to feel and act as though a trauma that they experienced in the past is happening in the present moment. They may feel dissociation or a sense of detachment from their body. They may smell, hear, see, and feel elements of the past trauma.

If your family member or friend is experiencing a flashback:

  • Stay calm,
  • Tell them you think they are having a flashback,
  • Tell them they are safe and in the present moment, not the past,
  • Tell them that the traumatic event is not happening again,
  • Help orient them to who you are, and where they are OR try to ground them by reminding them that you are known to them and they are in a safe place,
  • Avoid sudden movements, and approach them slowly from the front so they can see you coming towards them,
  • Ask them before you touch them,
  • Encourage them to breathe slowly and deeply,
  • Try to keep the environment safe. However, if you feel at risk or that your family member or friend is at risk of harming themselves or someone else, call 911 for help.
  • Realize the person may be disoriented and physically tired following the flashback.

How to deal with: Sleep disruptions

Sleep disruptions include insomnia, as well as more complex features such as reversed sleep cycles, the ability to fall asleep but not stay asleep, and sleeping in a seated position to feel less vulnerable.

If your family member or friend is experiencing sleep disruptions:

  • Help them etablish and maintain a sleep routine – go to bed at the same time every night, avoid television before bed, try calming activities like a bath before bed. Learn more here: https://www.anxietycanada.com/sites/default/files/SleepHygiene.pdf
  • Prior to bedtime, help them try to minimize things that may heighten symptoms, such as social media, news, TV shows or movies, and intense conversations.
  • Accept that sleep disruptions are common for those experiencing PTSD. They often contribute to a lack of motivation and energy, forgetfulness, and feeling distracted.
  • Learn more here: Path to Better Sleep – Veteran Training (va.gov)

With contributions from St. Joseph’s Operational Stress Injury Clinic

How to deal with: Nightmares

If your family member or friend has a nightmare, the general recommendation is not to wake them up. There are a number of reasons for this:

  • It is possible they won’t remember their nightmare in the morning, so they may be less impacted by it than you think,
  • Waking them may actually interrupt their sleep (which may already be compromised),
  • If you wake them, they may resume the nightmare once they fall back asleep,
  • There is a possibility they may not wake up fully, and continue enacting the dream. This could potentially put your safety and theirs at risk.

Some alternative strategies include:

  • Separate beds or sleep in separate rooms,
  • Remove items around the bed that they may use to injure themselves or inadvertently use to hurt someone else,
  • Seek treatment,
  • Discuss the situation with a practitioner for additional strategies and education.

With contributions from St. Joseph’s Operational Stress Injury Clinic

How to deal with: Anger

If you notice your family member or friend’s anger escalating quickly, don’t continue the difficult or challenging conversation.

  • Try to stay calm,
  • Give your family member or friend some space,
  • Try to maintain safety for yourself and others. However, if you feel at risk or that your family member or friend is at risk of harming themselves or someone else, call 911 for help.
  • Learn more here: Anger and Irritability Management Skills – Veteran Training (va.gov)

How to deal with: Intimate partner or family violence

Intimate partner violence (IPV) is more commonly known as spousal abuse or domestic violence. It includes any behaviour that causes physical, psychological, or physical harm to a current or former partner. If you notice your family member or friend’s behaviours become increasingly violent, or if you begin to experience IPV or other forms of family violence, it is important to reach out for support:

How to deal with: Crowds

  • Before going into a crowded setting, discuss with your family member or friend how long you plan to stay,
  • Before leaving home, create a plan with them to meet you back at a specific location if they become too overwhelmed and need to step away,
  • Find out if your family member or friend prefers you to stand or sit in front of them or behind them in a crowd. It is likely that they will prefer you to be where they can see you.
  • Be open to compromise. This may require you to be in crowded settings on your own, or to visit, if possible, when places are less crowded.

How to deal with: Avoidance

Your family member or friend may be avoiding reminders of their trauma – this is called avoidance. This may result in them not wanting to think or talk about their experience, or go out to do things or see people. They may also be keeping themselves busy so that they do not have to remember their experiences or feel their emotions.

  • Try to understand that avoidance is a legitimate symptom of PTSD. Do your best not to take it personally,
  • Allow your family member or friend to have a safe space where they can go to manage their symptoms and decompress, if necessary,
  • Offer opportunities for them to join activities or interact, with the expectation that they may decline. You can still participate in the activity. They may surprise you and join you,
  • Be willing to modify activities so that your family member or friend is more comfortable and has options. For example, participate in an activity but for a shorter period of time or with fewer people,
  • Give advance notice so that they can prepare for the activity and the feelings it may bring on,
  • Accept that connection and intimacy may look different in your relationship right now. Intimacy may be quietly sitting beside your loved one.

How to deal with: Suicidality

There is a relationship between PTSD and suicidal thoughts and behaviours. Your family member or friend may have thoughts or plans of suicide (‘ideation’) or may make attempt(s) to take their life.

However, it is important to note that having PTSD does not necessarily mean that your family member or friend will experience suicidal thoughts or behaviours. Suicide is a complex phenomenon and is rarely the result of one factor alone. Risk of suicide varies depending on someone’s life histories, current situation and emotional characteristics.

Further, having thoughts of suicide does not necessarily mean that your family member or friend is in imminent danger of taking their life. Assess the situation to determine whether they are showing any warning signs of imminent risk. Some examples include:

  • Becoming increasingly self-destructive or reckless in their actions and behaviours,
  • Having precise plans about how, where or when they will take their life, or
  • Seeking access to harmful objects or other means of harming themselves.

If your family member or friend is showing signs of emotional distress, call the Canada Suicide Prevention Service at 1-833-456-4566. For residents of Quebec, call 1-866-277-3553.

If your family member or friend shows signs that they have harmed themselves or are in immediate danger of harming themselves, dial 911.

Find out more about how to help your family member or friend if they are in crisis by checking out this Veterans Affairs Canada resource (PDF, 84 KB).

If there is no imminent danger and you think your family member or friend may be experiencing suicidal thoughts or behaviours, it is important to discuss it with them openly and honestly. A conversation can go a long way. Contrary to popular belief, talking about suicide will not make them think about suicide more. It also will not make them more likely to act on these thoughts. You can start by asking them about when their thoughts or behaviours started, for example. It is also important to use simple and supportive language that empathizes with their experience and shows them that they are not alone.

There is specific language to be aware of when discussing suicidality with your family member or friend. For example, avoid the term ‘commit’ as it implies that suicide is a crime, and do not use the term ‘unsuccessful’ to describe a suicide attempt as suicide is not a matter of success or failure. You can read more about helpful language from the Centre for Suicide Prevention.

It is possible that your family member or friend will not want to talk about these thoughts, feelings and behaviours with you. Do not try to force a conversation. Instead, let them know that you are there for them if and when they are ready to talk. You can also offer them different options to explore on their own accord, such as professional support services. You can find some of these resources listed here: https://veteransmentalhealth.ca/resources/find-support/

References

Flashbacks

Sleep

Nightmares

Anger

Intimate Partner and Family Violence

  • Marshall, A. D., Panuzio, J., & Taft, C. T. (2005). Intimate partner violence among military veterans and active duty servicemen. Clinical psychology review, 25(7), 862-876.

Suicidality