Mental Health Topics
On this page:
A Primer for Employers
Post-Traumatic Stress Disorder, commonly known as PTSD, can be an intimidating condition for employers and co-workers, and is especially challenging for people experiencing it. Talking about trauma makes many people uncomfortable, often leaving these conversations avoided and people feeling isolated and alone. This can result in feelings of discouragement and hopelessness for all involved, but that doesn't have to be the case. Dramatic advances have been made in PTSD treatment over the past two decades.
PTSD is caused by exposure to actual or threatened death, serious injury or sexual violence including fires, natural disasters, accidents, combat, robberies, and physical or sexual violence. PTSD is most common in survivors of rape, military combat veterans, and occupations with a high risk of trauma exposure, including police, firefighters, and emergency medical personnel. PTSD symptoms may occur soon after a traumatic event but can be delayed by months or even years.
Signs of PTSD
PTSD may first come to the attention of employers because of decreased productivity, a drop in performance, and/or more frequent work absences. People with PTSD experience distressing memories and dreams about the trauma event, and extreme distress with things that remind them of the trauma. This, in turn, causes the person to avoid anything that reminds them of the trauma.
People experiencing PTSD often feel badly about themselves and the world, experience decreased interest in activities, withdraw socially, feel detached from others, and have difficulty experiencing positive emotions like happiness. They can exhibit irritably, excess vigilance of their environment, exaggerated response to being startled by touches or noises, trouble concentrating, and poor sleep. As you consider this list, you can imagine how PTSD adversely impacts work performance.
The good news is effective treatments are available. The gold standard for treatment is trauma focused psychotherapies, including, but not limited to the following:
- Prolonged exposure therapy
- Cognitive processing therapy
- Eye movement desensitization and reprocessing therapy
Medications have also been shown to be effective when therapy is not possible or as a compliment to therapy. People should seek help from medical providers who are proficient in treating PTSD. These treatments can take several months to show results.
To reinforce the importance of therapy, I remember a crisp autumn day about a decade ago when I had just completed my prolonged exposure training, one of several cutting-edge therapies for PTSD. The effectiveness of this treatment, and several other closely related therapies was so dramatic, I remember saying to myself, "It's as if I've been given the cure to cancer." That sentiment stayed with me, so much so that I related the story during testimony to the House Armed Services Committee many years later. We have good reason to be encouraged about the available treatments for PTSD.
Supporting Employees with PTSD
Managers and co-workers can support employees with PTSD by demonstrating patience and understanding. PTSD is difficult to live with. The resulting negative behaviors and impaired performance at work are not entirely in the person's control.
Establishing a work climate and culture that supports and encourages help seeking behavior, including seeking treatment for mental health conditions, is essential. More specifically, encouraging employees who may be experiencing PTSD to seek treatment is important. PTSD can resolve spontaneously, but, more often than not, people get better with treatment.
Lastly, people often wonder what to say if they are worried about a co-worker. It can feel awkward, uncomfortable and intimidating. If you approach the conversation in a caring way, the words you choose are not as important as showing an expression of genuine concern. When you do, that's what the person hears. People forgive a misstep or two in the wording when they know you care.
Here are some expressions to try if you are worried about someone you work with:
- I care about you and I'm worried about you.
- I only want what is best for you and to help, if I can.
- I've noticed changes in your work performance and behavior.
- Are you comfortable telling me what's going on and do you want to talk about it?
- How can I help?
Later, after you've listened to a person's situation and if the person agrees to seek help, you might say, "I really think treatment will help. How about I help you connect with care right now?" People want to be understood. The key is to show that you care and, above all else, be a good listener, don't interrupt; let the person share their story and decide on next steps together.
PTSD can be quite challenging, but avoiding its existence serves no one's interests, especially when effective treatments are available. Connecting with care will enhance the person's quality of life, improve work performance and end unnecessary struggles.
Authored by: Colonel Steven Pflanz, M.D., United States Air Force. Former Air Force Director of Psychological Health. Currently serving as Clinical Assistant Professor of Psychiatry, SUNY Upstate Medical Center.
Adler DA, Possemato K, Mavandadi S, et al. Psychiatric status and work performance of veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatric Services. 2011;62:39–46.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Arlington, VA: American Psychiatric Association, 2013.
Belleville G, Marchand A, St-Hilaire MH, Martin M, Silva C. PTSD and depression following armed robbery: patterns of appearance and impact on absenteeism and use of health care services. J Trauma Stress. 2012 Aug;25(4):465-8.
Clarner A, Graessel E, Scholz J, Niedermeier A, Uter W, Drexler H. Work-related posttraumatic stress disorder (PTSD) and other emotional diseases as consequence of traumatic events in public transportation: a systematic review. Int Arch Occup Environ Health. 2015 Jul;88(5):549-64.
Davis LL, Leon AC, Toscano R, Drebing CE, Ward LC, Parker PE, Kashner TM, Drake RE. A randomized controlled trial of supported employment among veterans with posttraumatic stress disorder. Psychiatr Serv. 2012;63(5):464-70.
el-Guebaly N, Currie S, Williams J, Wang J, Beck CA, Maxwell C, Patten SB. Association of mood, anxiety, and substance use disorders with occupational status and disability in a community sample. Psychiatr Serv. 2007 May;58(5):659-67.
Gartlehner G, Forneris CA, Brownley KA, Gaynes BN, Sonis J, Coker-Schwimmer E, Jonas DE, Greenblatt A, Wilkins TM, Woodell CL, Lohr KN. (eds.) Interventions for the Prevention of Posttraumatic Stress Disorder (PTSD) in Adults After Exposure to Psychological Trauma [Internet]. AHRQ Comparative Effectiveness Reviews. Report No.: 13-EHC062-EF. Rockville, MD: Agency for Healthcare Research and Quality (US); 2013.
Greenberg PE, Fournier AA, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). J Clin Psychiatry. 2015 Feb;76(2):155-62.
Joyce S, Modini M, Christensen H, Mykletun A, Bryant R, Mitchell PB, Harvey SB. Workplace interventions for common mental disorders: a systematic meta-review. Psychol Med. 2016 Mar;46(4):683-97.
Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen H-U. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012 Sep;21(3):169-84.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995 Dec;52(12):1048-60.
Lopez A. 2011: Work. 2011;38(1):33-8. doi: 10.3233/WOR-2011-1102. Posttraumatic stress disorder and occupational performance: building resilience and fostering occupational adaptation.
National Center for PTSD. Types of Debriefing Following Disasters. February 23, 2016. Accessed December 1, 2016
Nepon J, Belik SL, Bolton J, et al. The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Depress Anxiety. 2010;27:791–798.
Ramchand R, Rudavsky R, Grant S, Tanielian T, Jaycox L. Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Curr Psychiatry Rep. 2015 May;17(5):37.
Revicki DA, Travers K, Wyrwich KW, Svedsäter H, Locklear J, Mattera MS, Sheehan DV, Montgomery S. Humanistic and economic burden of generalized anxiety disorder in North America and Europe. J Affect Disord. 2012 Oct;140(2):103-12.
Sareen J. Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment. Can J Psychiatry. 2014 Sep;59(9):460-7.
Wilcox HC, Storr CL, Breslau N. Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Arch Gen Psychiatry. 2009;66:305–311.
Wise EA, Beck JG. Work-related trauma, PTSD, and workers compensation legislation: Implications for practice and policy. Psychol Trauma. 2015 Sep;7(5):500-6.
Xue C, Ge Y, Tang B, Liu Y, Kang P, Wang M, Zhang L. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS One. 2015 Mar 20;10(3):e0120270.
Zivin K, Bohnert AS, Mezuk B, Ilgen MA, Welsh D, Ratliff S, Miller EM, Valenstein M, Kilbourne AM. Employment status of patients in the VA health system: implications for mental health services. Psychiatr Serv. 2011 Jan;62(1):35-8.