Strategies for dealing with people with PTSD?

[Wahine]

I work as a PT and I have had several patients with significant PTSD where it seriously impacts their function on a day to day basis. One of my clients went off this morning in the clinic and while I understand that they do not have control of their reactions much of the time, this individual was verbally aggressive/inappropriate with my support staff and I'm afraid that if this behaviour continues, my staff will end up with PTSD. OK, I'm not serious but I do need to do something about this.

Does anybody have any resources they can share about dealing effectively with individuals with PTSD? I'm all ears. Article links would be great, books, whatever.

TIA for any information you can share.

[Crankin]

PM me and I will get back to you when I get home.

[Biciclista]

whether or not they have PTSD the behavior is not acceptable and they need to know that; and you need to set limits. (like you have to leave if you do that again)

[Wahine]

Agreed Biciclista. I'm just thinking that even with setting boundries, there may be strategies that I can employ to help things go more smoothly. I want to help this person with their PT related issues and while I need to address the issue, I want to do it as sensitively as possible while getting the job done. I don't think setting boundries with this individual should be done in the same manner as I would with, let's say my SO or mother or a friend. Or even another patient that didn't constantly feel threatened and easily angered.

[solobiker]

whether or not they have PTSD the behavior is not acceptable and they need to know that; and you need to set limits. (like you have to leave if you do that again)

+1 I work as an OT and have run into issues like you explained. We have had to sit these individuals down and explain to them the expectations/ proper behavior in a public setting.

The setting I work in is different then yours...I work in a short term rehab unit where the people "live" there for a few weeks up to several months. We have had to write up contracts with some of these individuals that they will behave in a respectful manner. We always have them involved in the content of the contract so they have some of the control and input. This also gives them a voice to express concerns to us about situations that may exacerbate their symptoms.


Good luck and I hope you find something that helps.

[Bethany1]

While I don't have experience with PTSD, I do deal with being bipolar and it is very hard to control your reactions. It doesn't excuse the behavior, but be aware that it's hard to stop once a person gets going. While it doesn't look like it, the person is trying. It's hard being in emotional or physical pain 100% of time trying to pretend you are fine and it's easy to blow up on people trying to help.

Sometimes anger is a silent plea for help that the person can't express like normal people can.

Before you work with the person again, pull the person aside privately, sit down and explain the rules and what you expect from this person and make an agreement that both of you can keep and understand. Sometimes the "unwritten" rules aren't clear to those who struggle emotionally. Make it clear that you want to work with this person but you can't if the behavior continues as it's not safe for you and everyone else.

[Wahine]

Solobiker, thank you. I've been thinking of actually writing something up with this patient. It's nice to have confirmation that this is expected practice in settings where you have to deal with behaioural stuff.

Bethany, thank you for sharing. It means a lot to me. The issues you brought up are why I want to do this properly. I realize that this person has trouble coping and I don't want this to be just another incident where they feel attacked or threatened.

[Kiwi Stoker]

They will have triggers to things, so I suggest talking to them about what situations or things that cause or are the stressors, and seeing if there is ways to minimise this.

Also recognise that aggressive behavior just needs to run it's course, so if the person becomes irrational, simply let them have their time to get over it, leave them alone or say "I think we need to have a break".

Also remeber the injury and pain also cause issues. So suggest they take painkillers beforehand and realise that they are working through a grief as well of their loss of health. Reassure them that things will pass (if they will) and injuries do get better.

PTSD is absoltely nothing to do with you, but everything to do with the person with PTSD.

I think most of the suggestions here are very good, but I also think you need to find out about the patient's stressors as well.

[bmccasland]

I have / had mild PTSD and the problem is you can't always control your triggers, or control when you're going to fall apart. We'd like to remain in control, or at least I would. I don't enjoy falling apart, or "over reacting."

Do you know if this person is being treated for the PTSD? Are they on meds, are they taking their meds? Is there a quieter time they could come in for their PT? Maybe the noise and activity is a trigger, so a quieter time might help.

That said, I've seen a Viet Nam vet - 30 years out of the combat zone, and otherwise level headed - freek out because a particular noise occurred behind him and he wasn't able to make the cognative leap that it wasn't an incoming rocket.

[NbyNW]

+1 re talking to your patients about their triggers. If they are receiving treatment, then a part of that should involve learning to recognize triggers, making decisions about whether those triggers can be avoided and if not, whether the patient can work cognitively to change his/her response to those triggers.

The PTSD may or may not be related to the injury for which you are treating them. It might be worthwhile to see if there is any research about the relationship between the physical aspects of living with/rehabbing an injury and the mental/emotional aspects of it, w/ or w/o PTSD. If any such research exists it might help shed light on how you discuss progress and setbacks with your patients, which I'm sure is something you find yourself doing from time to time anyway.

[Wahine]

Thank you to everyone for your input.

I have discussed trigger with him to some degree but perhaps I could explore this further. As for aggressive behaviour running its course, you are exactly right.

The only reason this patient is still seeing me is because I let them have a chance at the beginning of every appointment to "vent" in the privacy of my treatment room. Sometimes this takes 10 min, sometimes 30 min. For this reason I always have them booked before my lunch so that I never have to rush the appointment. This also happens to be a typically quiet time in the clinic and a time of the day when the patient is usually doing better physically. I've found that the only way to have any PT happen is to let this aggression run its course and then we get to treatment. So many days I end up running into my lunch hour to treat.

This individual has walked out on at least 4 other PTs in the area. I'm the only one that he has stuck with for any length of time. So in a sense I feel like I'm doing a good job handling him. He's getting treatment consistently. I must be doing something right to have him still coming in. But there are days when I wonder why I'm trying so hard to accomodate him when he does things like he did today. And really, today wasn't that bad, he wasn't truly aggressive, not to the extent where anyone was concerned for their safety. But he was very mean to my receptionist and said several hurtful things to her.

He is receiving psych treatment and he is on medication. But he is very ill and there are days when I feel like I'm in over my head.

NbyNW, I would love to see some research on those types of issues. That's part of what I was hoping for, some references to articles that would apply to my profession directly.

Alright. Now that I'm done venting... maybe we can get on with talking about bikes. :D

[smilingcat]

I've only experienced someone with PTSD from a distant. It was back in college, mid 70s. He was a floor counselor at a dorm. He was a Viet Nam Vet as a medic.

On one rare occasion when the guys were playing poker with him, he drifted off without a warning and into his own world, back into the combat zone. The guys who were playing poker said it was really eerie seeing him drift off without warning then snapping out of the "trance". The trigger was noise of rain drops hitting the window during a heavy thunderstorm. He said the sound reminded him of...

Then I also think of people with phobias and I see similarities. Both PTSD and phobia seems to be "out of control" of the individual. You can reason through it, but when the trigger hits, its there. Knew a really smart engineer with one of the worst flying phobias ever. Only way we could get him to fly was he needed an escort or two and some understanding from the flight crew...

I will also admit that I have bit of phobia of being alone where there are no one around. It's okay if I have one of our dogs with me or if there is a stranger nearby. It's just uncomfortable when I'm all alone whether this is in my own house when my animals were still at the other house, or when I'm in the garden or when I'm out in the wild. I have this irrational fear. but I manage. So in this regard, I have a vague understanding of not being able to control it.

Is there a way to find out what triggers his PTSD reaction? Like Beth was saying about a 30 year vet with the incoming rocket kind of thing.

From my little experience, it seems that one way to deal with the "events" are to redirect him away from the trigger.

I hope his anger doesn't escalate into physical violence.

And remember too that there are times when it's just beyond our means to help. It's over our head.

Be safe,

[mmouwse]

Good Morning,
PTSD can be physically induced as well as emtionally/mentally. In either case, the patient is truely incapable of controlling the reaction as they no longer have normal physiological brain function.
Please treat these patients with extreme care, compassion, understanding and acceptance. Writing them up, threatening them with removal, or expecting them to behave differently is not realistic to their condition and will actually harm them, making their PTSD worse.
Please contact PTSD and Brain Injury Expert Professionals to learn how to deal with these patients without causing harm to them or yourselves. With training, staff can learn appropriate, effective skills to cope with the patients behavior and staffs reactions/feelings.
It is incumbant upon you, as the caregiver, to understand the patient and meet their needs. It is not the patient's responsibility nor within their capacity to teach you, explain to you, understand themselves, or immediately alter or contain their behavior.
As difficult as it may be for you to understand this or accept this, they truly cannot control their behavior much. Kindness and understanding in dealing with them will be most effective in calming them.
If you google "brain injury" or "PTSD" you will find informative resources.

[mmouwse]

wow. I am in awe of all of you who have replied to Wahine's post, sharing your experience, knowledge and compassion to help her and her patient. Many of you demonstrated sincere compassion and understanding for both the patient and Wahine. I am heartened that you had the courage and compassion, Wahine, to reach out for help for you and your patient. Your patient is blessed to have you in their life. You are rare. It only takes 1 caring compassionate person to make a difference in someone's life... to help someone heal and recover; to save someone's life. Thank you for being that person.

[Wahine]

wow. I am in awe of all of you who have replied to Wahine's post, sharing your experience, knowledge and compassion to help her and her patient. Many of you demonstrated sincere compassion and understanding for both the patient and Wahine. I am heartened that you had the courage and compassion, Wahine, to reach out for help for you and your patient. Your patient is blessed to have you in their life. You are rare. It only takes 1 caring compassionate person to make a difference in someone's life... to help someone heal and recover; to save someone's life. Thank you for being that person.

Wow. Thank you. You just made my morning. :)

[Biciclista]

Wahine, you are awesome! You show a lot of courage. Good luck.

[Miranda]

He is receiving psych treatment and he is on medication. But he is very ill and there are days when I feel like I'm in over my head.



You might consider if the patient would sign a release of patient confidentiality consent for you to contact his therapist and see what suggestions he/she might have (and/or start with asking the medical doctor's advice- since your PT order stems from them).

This link below should go to a website that briefly notes some information about EMDR (sure there are more indepth articles, this was just the 1st web site that popped up in google for me).

http://www.safeharborhouse.com/articles.php?id=PTSD-Treatment

I've personally undergone this techinique before and it was helpful. But I did have some side effects as my session was "incomplete" the therapists called it. Which she explained everything to me before. To that I was grateful or I would have thought I'd completely lost my mind when they happened.

Just sharing that experience in that if possible to establish a relation with his other care providers it might give you a heads up on how to problem solve even better.

As others have stated, agreed about your caring attitude and going the extra mile. Your patient is blessed to have you.

Good Luck:).

[Wahine]

Thank you Biciclista.

There's a fascinating story about how this fella came into my life but it's a very long story. Definitely interesting, but perhaps too long for TE. The Cole's version is I never used to be able to tolerate people who demonstrated self destructive behavior or people couldn't take action when action was needed. When dealing with these patients, I would get very frustrated to the point of it being unhealthy for me. Over the last 6 years, I have worked very hard to understand that some people are just not wired like I am. That their drive is different and that I needed to be more compassionate with those individuals for my own good. I did better but it was still a struggle for me to understand.

The day before this fella came into my life I was involved in a group role playing/problem solving session that went down a very strange path. A path that I thought had nothing to do with my current life circumstances. It ended up dealing with PTSD. The very next day, this man comes into my clinic for an evaluation. He ranted for 30 min at the get go and I sat and listened. I didn't get frustrated, I just let him go. Eventually, we got through it and got on to the business of PT. I was able to help him.

I came out of that appointment knowing that there was a very important life lesson for me in my relationship with this person. So, I've tried to keep that my focus through all of this.

I really appreciate everyone's input and kind words. It is very helpful because I do still struggle with it. Even though I know that when it's all over I will have learned something from it all that will result in a happier and healthier me. :D So really, it is all about me. ;)

[Wahine]

You might consider if the patient would sign a release of patient confidentiality consent for you to contact his therapist and see what suggestions he/she might have (and/or start with asking the medical doctor's advice- since your PT order stems from them).

As others have stated, agreed about your caring attitude and going the extra mile. Your patient is blessed to have you.

Good Luck:).

Thank you for your input. I've done these techniques myself and did find them very useful.

[indysteel]

Thank you for your input. I've done these techniques myself and did find them very useful.

Me too. My therapist asked me to volunteer for it so that she could get enough hours to be certified in EMDR. While I don't technically have PSTD, I do have some things from my childhood that were traumatic, and EMDR really helped me process through them in a way that talk therapy had not. If your patient hasn't considered it, perhaps that's something you could discuss with him.

As others have stated, your compassion toward this man and desire to help and understand him is admirable.