Post-Traumatic Stress Disorder (PTSD): Helping People with PTSD at the Fitness Center
WHAT IS PTSD?
Post-traumatic stress disorder (PTSD) is a psychiatric diagnosis. In the DSM-IV-TR diagnostic manual, PTSD is listed as one manifestation of an anxiety disorder. PTSD is triggered by exposure to a severe traumatic event. Most often, PTSD involves exposure to a repeated or sustained event, not usually a single event. People often develop post-traumatic stress disorder when they experience or witness an event that caused intense fear or horror; and the event was one that they felt helpless to control or to avoid in the future.
PTSD can result from war, domestic violence, being a victim of a crime or witnessing a crime, or being in a motor vehicle or plane accident. It can occur at any age or stage of life. Any event that causes intense fear or horror, may trigger the response of intense anxiety.
Many people who are involved in or witness traumatic events have a brief period of difficulty in getting to sleep, relaxing, and returning to a sense of safety. However, with time, they adjust to the new stimuli and learn to cope with the disturbance to their regular lives. In these cases, severe anxiety as a reaction to the stressful event is short-term, and the people return to their usual levels of tension. In other cases, though, the symptoms can get worse or last for months or even years. Sometimes, the heightened anxiety and over-reaction and hyper-vigilance may completely disrupt a person's life. In these cases, a diagnosis of post-traumatic stress disorder is made.
MANIFESTATION OF PTSD
There are levels of the diagnosis of PTSD, from mild to moderate to severe. Each person will be unique in his or her level of functioning and presentation. However, there are some common features to the disorder that are described below.
Some signs that a person may have PTSD are visible to the observer, as well as troubling to the individual with PTSD.
A lack of concentration may be observed, in which a person has to receive instructions or information repeatedly, but will still not be able to retain the information. They lose their belongings and misplace things.
People may show difficulty in getting along with others. They are easily upset by others and say, "people stress me out." People with PTSD often are edgy, and upset others with their abrupt manners and curt statements.
People with PTSD are "watchful" and "check things" over and over. There is a sense of tension and anxiety around the person that makes others want to avoid them. Family members may say they "have to walk on eggshells so as not to upset" the person.
|A veteran is getting his daily dose of exercise with his personal trainer.|
People with PTSD often self-medicate by using prescription, over-the-counter, or illegal drugs, and/or alcohol to dull the pain and anxiety they feel. If the PTSD has been a problem for a certain length of time, the amount of medication used may have increased over time to a staggering amount needed to afford some small measure of temporary relief. It is not unusual for a person to feel that his or her body, soul, and mind are no longer united or "one." This is called dissociative disorder and is often a component of PTSD.
People who have a diagnosis of PTSD may say:
- I was in mortal danger, and could not do a thing about it.
- I am ashamed of the way I reacted or acted, but it can't be changed now.
- I can't get to a safe place. There is no safe place.
- I let others down.
- I want to protect others, but it can't be done.
- I am in a bad place and can't get out. I am at the bottom of a deep well and can't climb out.
COPING WITH PTSD IN THE FITNESS CENTER
Getting professional intervention immediately after the traumatizing event may help the person move through the initial stages and symptoms, and prevent PTSD from becoming a long-term condition.
Burying feelings, troubling thoughts, and memories does not work; although most people try this approach, at least for a while.
The current approach to treating PTSD involves teaching the person with the diagnosis how to use active coping methods. These are:
- Engage in regular physical activity and exercise daily.
- Work on developing a positive mental outlook.
- Develop a personal moral compass for guidance.
- Find social supports.
- Develop cognitive flexibility with relaxation training and psychological counseling.
Accommodation Ideas for the Fitness Center
Some common areas of need are listed below, with suggestions for how a personal trainer (PT) might be able to support the person with PTSD to increase his or her motivation to exercise regularly.
Memory Deficit and Disorganization:
- Provide written instructions.
- Post written instructions near the exercise equipment.
- Use a wall calendar.
- Use a "task list."
- Provide verbal prompts.
- Allow the person with PTSD to record instructions given to him or her.
- Allow additional training time.
Interacting with Others and Dealing with Interpersonal Emotions:
- Encourage the person with PTSD to "walk away" if he or she becomes frustrated.
- Show the person a safe place to unwind and decompress AHEAD OF TIME.
- Provide support when there is a sudden loud noise (such as weights dropping).
- Provide support in setting the person up on each machine, if the fitness center is crowded.
Dealing with Internal Emotion and Anxiety:
- The person with PTSD may have learned to mentally "replay" some of his or her cognitive therapeutic techniques during periods of intense exercise to help with catharsis. This will particularly be the case if the person has a dissociative disorder. Support this psychological "reintegration" work by not interrupting with casual talk during physical workouts.
- Allow the person to have a longer cool-down time than usual, so that the body and mind are cooling down together.
- Provide scheduled breaks during the workout session during which the person can go to the quiet place (mentioned earlier) for some private time, if needed.
- Be on the watch for profuse sweating, watchfulness, shaking, and other signs that the person with PTSD is acutely anxious and upset. Provide access to the nearby place in which he or she can withdraw and get back in control in private. Supportive behaviors for the PT include: staying calm, being near, but not touching the person or asking them questions. (Never say, "Are you alright?") The PT could say, "I am here if you need me." "Let me know if I can get you anything."
- Later, help the person identify what may have set off the panic attack. Sometimes, noises or a specific odor can trigger a panic attack.
- Allow the person to bring his or her support dog to the gym.
RESOURCES AND REFERRALS
National Center for Post-Traumatic Stress Disorder. U.S. Department of Veterans Affairs.
Road to Resilience, American Psychological Association Help Center.