Supporting someone with PTSD or C-PTSD
When a friend or family member has PTSD or C-PTSD, it affects you too.
The symptoms of PTSD can be very difficult to live with, and the changes in your loved one can be can be scary, upsetting and overwhelming.
You may worry that things won’t ever go back to the way they were before. You’re desperate to help them and make them better. At the same time, you may feel angry about what’s happening to your family, and hurt by your loved one’s distance and new emotions. The symptoms of PTSD can even lead to job loss, substance abuse, alcohol misuse, and other problems that affect the whole family. It’s a stressful situation all around – one that can leave you feeling helpless and confused.
‘It’s hard not to take the symptoms of PTSD personally, but it’s important to remember that a person with PTSD may not always have control over their behaviour. Your loved one’s nervous system is “stuck” in a state of constant alert, making them continually feel vulnerable and unsafe, or having to relive the traumatic experience over and over. This can lead to anger, irritability, depression, mistrust, and other PTSD symptoms that your loved one can’t simply choose to turn off.’
The most important thing to know is that you aren’t helpless. Your support can make a HUGE difference in your loved ones recovery. You don’t always need to have ‘answers’ or ways to make things ‘right’ for them – sometimes just having the knowledge that someone is there for them, really listening to them with empathy and understanding, and not making assumptions about how they feel, can make the world of difference. You don’t have all the answers, and that’s ok. You can hold your partner’s hand, offer hugs, and be present. One frustrating aspect of PTSD for sufferers is that it’s very difficult to articulate, or even know what will help – so your loved one may not be able to tell you what they need, or how they’re feeling. At times, a close hug might be what will help them, but the next minute, they may need to be alone. Try to keep communicating with each other about what will help at that moment in time, and don’t make assumptions that the same thing will help in a few days time.
Although this page provides suggestions on how to help someone with PTSD or C-PTSD in terms of emotional support and also tangible, practical ways, please remember it’s not up to you to carry the load alone. Ask your friends and family to support you in this too – the more support your loved one feels from a variety of sources, the more empowered and strong they can feel, which can help in their recovery.
As you go through this time with a loved one with PTSD or C-PTSD, some of the most important things to remember are:
- Educate yourself about the condition. The more you know about the symptoms, effects, and treatment options, the better equipped you’ll be to help your loved one understand what they are going through, and keep things in perspective.
- Take care of your emotional and physical health.As the saying goes, put on your own oxygen mask first. You won’t be any good to your loved one if you are burned out, sick, or exhausted.
- Accept (and expect) mixed feelings. Be prepared for a complicated mix of feelings—some of which you may never want to admit. Just remember, having negative feelings toward your family member doesn’t mean you don’t love them.
- Be a good listener. While you shouldn’t push a person with PTSD to talk, you can let them know you’re available for them. If they do choose to share, try to listen without expectations or judgments. Make it clear that you’re interested and that you care, but don’t worry about giving advice. Instead, do your best to simply take in what they’re saying. Never underestimate how much the act of empathetic listening can help. A person with PTSD may need to talk about the traumatic event over and over again. This is part of the healing process, so avoid the temptation to tell your loved one to stop going over the past and move on. Instead, offer to talk as many times as needed. And remember, it’s okay to dislike what you hear. Some of the things your loved one tells you might be very hard to listen to. But it’s important to respect their feelings and reactions. If you come across as disapproving, horrified, or judgmental, they are unlikely to open up to you again. Find out more about how to talk to a loved one about their PTSD here.
- Do “normal” things with your loved one, ‘things that have nothing to do with PTSD or the traumatic experience. Encourage your loved one to seek out friends, pursue hobbies that bring them pleasure, and participate in rhythmic exercise such as walking, running, swimming, or rock climbing. Take a fitness class together, go dancing, or set a regular lunch date with friends and family.
- Let your loved one take the lead, rather than telling them what to do. Everyone with PTSD is different but most people instinctively know what makes them feel calm and safe. Take cues from your loved one as to how you can best provide support and companionship.
- Manage your own stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one.
- Be patient. Recovery is a process that takes time and often involves setbacks. The important thing is to stay positive and maintain support for your loved one.’
How to help rebuild feelings of trust and safety
Trauma can alter the way a person sees the world, making it seem like a perpetually dangerous and frightening place. It also damages people’s ability to trust others and themselves. If your loved one experiences hypervigilance as part of their PTSD, helping them feel safe can help immensely – but bear in mind, that no matter what steps you put int place, it may work sometimes, and not other times. They’re not ‘choosing’ to ignore your support in that moment, rather the PTSD is making it impossible for their brain to turn off the ‘fight or flight’ mode in that moment.
Anything you can do to rebuild your loved one’s sense of security will contribute to recovery.
This means cultivating a safe environment, acting in a dependable and reassuring way, and stepping in to help when needed. But it also means finding ways to empower the person. Smothering someone with PTSD or doing things for them that they’re capable of doing for themselves is counterproductive. Better to build their confidence and self-trust by giving them more choices and control.
So, in reality, for some people this may look like the following (although bear in mind that everyone is different, and you’re best to come up with a ‘plan’ together if you can):
- Come home at a time you said you would (or calling them as soon as you know you’ll be late)
- Letting them know where you are so their mind doesn’t race, or catastrophise
- Being aware of making sudden, loud noises around the house – you don’t need to walk on eggshells, but slamming a door, or throwing something heavy can send some people into a flashback.
- Try to be consistent. Nobody is expecting you to be ‘on it’ all the time – you’ll need rest and relaxation too – but try to keep your support ongoing, rather than make a supreme effort when you can see they’re struggling, and backing off when it appears they’re doing ok.
- Get to know their triggers and really think about how your safe, home environment could reflect these. For example, if talk of a certain incident or place triggers them, be aware of what’s on TV, or on newspapers you might leave lying around.
- Express your commitment to the relationship. Let the person know you’re here for the long haul, no matter what their PTSD may bring.
- Create and keep to routines. Structure and predictable schedules can enhance the person’s feelings of security. If things need to change, give them as much warning as possible.
- Be aware of things that can make a person with PTSD feel unsafe, such as new places, crowds, confusion, or being physically constrained or ordered around. So if you’re on public transport that suddenly gets busy, be aware BEFORE they are triggered, and you can begin to reassure them, or do some breathing exercises. PTSD can make you feel very isolated, but to know that someone is ‘on your side’ in the moment, can help so much.
- Speak of the future and make plans. This can help counteract the common feeling among people with PTSD that their future is limited.
- Keep your promises. Help rebuild trust by being trustworthy. Be consistent and follow through on the things you say you’re going to do.
- Tell them you believe they are capable of recovery. Learn about the treatments available for PTSD & C-PTSD. Read our case studies and use that knowledge to help empower them, and emphasise their strengths.
Encouraging and Supporting Treatment
Despite the importance of your love and support, it isn’t always enough on it’s own. Traumatic events can be very difficult to come to terms with, but seeking professional help is often the only way of effectively treating PTSD and C-PTSD
Just over a decade ago, people still thought that PTSD was an incurable condition, but more recent evidence and research proves it is possible for PTSD and C-PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help.
For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy. NICE guidance (updated in 2018) recommends trauma-focused psychological treatments such as EMDR, and trauma-focused cognitive behavioural therapy (CBT).
There are two areas of treatment where your support will be invaluable: encouraging them to start treatment and then supporting them through it.
For someone who doesn’t have PTSD, you’d be forgiven for thinking ‘if I felt as bad as they do, I’d try any treatment’ or asking ‘why are they not willing to try treatment when I’m trying so hard to support them’. The fact of the matter is, treatment is scary. You’re actively asking them to talk, or think in detail about their trauma – and for many people, they’ve spent years ignoring it, or trying to forget about it. Starting treatment is a HUGE step. It’s unknown. And for some people they’re worried that they might try treatment and it doesn’t work for them – and that might terrify them. They might feel they’re not able to be healed. And for some, the guilt, or shame they feel is just too much and they feel unworthy of recovery.
As such, pressurising, or pushing someone into treatment is very unlikely to help. Instead, you want to be encouraging, help counter any fears where you can, and do what you can to practically help them (e.g. help make appointments etc). This is where knowledge about treatments really helps – so have a read of our website, and if you can go into conversations ‘armed’ with details, examples and ideas, not only do they see you’re willing to help, but that you care enough to have spent time alone researching can be hugely comforting.
So how can you encourage someone to take that step, call their GP, or set up the first therapists appointment?
- Emphasise the benefits and results they will see. Help them picture a life free from PTSD or C-PTSD: they’re more independent and in control. They’re free of fear, physical symptoms, and flashbacks. Or it can help reduce the anxiety and avoidance that is keeping them from doing the things they want to do.
- Focus on specific problems. If your loved one shuts down when you talk about PTSD or treatment, focus instead on how treatment can help with specific issues like anger management, anxiety, sleep, flashbacks or concentration and memory problems.
- Acknowledge any concerns they have about treatment. Talking through their worries will allow you to understand how they feel, and you might be able to research, and find out information to help ease their worries.
- Enlist help from people they respect and trust. They may be more open to treatment if the idea is supported by others too. Perhaps it’s their friend, a spiritual leader, a colleague or other family member. Just remember to ask them BEFORE you speak to someone else – going behind their back, even if it’s to help them, could cause major trust and ‘safety’ issues.
So, how can you support someone who’s going through treatment?
- Go with them to appointments, but perhaps wait in the car, or go to a coffee shop nearby, and be there as soon as the session is over.
- Don’t expect too much after a session. Treatment can be emotionally and physically draining – so don’t expect them to talk or have much energy to do things. Be ready with a warm hug if they need it, and have a calm period planned for afterwards.
- Be open to hearing about sessions, but don’t expect to know what happens. Treatment can bring up all sorts of emotions, thoughts and reactions – and the therapist will be supporting them with these. It can feel too much to talk about as session outside the therapy room – so although you might be interested, don’t get upset if they won’t tell you what’s going on – just let them know you’re willing to listen when, or if they’re ready.
- Keep reminding them the benefits of what they’re doing. Treatment can be tough and very hard-work. They may have times when they don’t want to go back, or are not ready for a session. Being able to calmly remind them of the benefits of treatment, and that you’re there to support them can be a real help.
- Be patient. Recovery from PTSD or C-PTSD takes time, even when a person is committed to treatment. Be patient with the pace of recovery. For some people it can be a long process and often involves setbacks. The important thing is to stay positive and keep at it.
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