Dear Blue Collar,
After saying their goodbyes at the company Christmas party, our worker and his wife took their leave. On the way home, they witnessed someone driving erratically on the Henday, swerving and stunting at high speed. Thinking the driver was intoxicated, our worker sped up to record the license plate. The chase ended abruptly when the inebriated driver spun out of control and hit the ditch. Our worker pulled over to lend assistance—only to have four rounds fired in his general direction. The pistol was discharged at point-blank range but somehow our worker managed to escape injury.
Fast forwarding, this particular employee is now off work with PTSD, and we’re wondering if you have any advice in terms of helping him back to work. Thanks, Gary H.
In our experience helping workers and employers manage a return-to-work (RTW) process following a PTSD diagnosis, here’s what we’ve learned:
- “They idle at 95”. This is a common statement used by medical professionals to describe people suffering with PTSD. This means sufferers typically grapple with hypervigilance, intense anxiety and paranoia that can manifest in fast talking, catastrophizing and fragmented thoughts. So you’ll want to avoid putting your worker in stressful situations of any sort for the next while.
- Exposure therapy is the real deal. Gradually exposing ourselves to feared situations shows we can handle it. Modified duties ought to allow for controlled exposure to triggers (e.g. 20 mins of each shift devoted to, say, exposure to a loud environment).
- Employer and peer support makes a massive difference. Establish rules but be flexible and creative with respect to RTW planning, as timelines for recovery will vary by individual. Peer support is also a critical piece, for a ‘buddy system’ helps reduce stigma and facilitates problem solving.
In recent studies of people with PTSD, researchers have found that the amygdala — the region of the brain primarily associated with emotional processes — shows heightened responsivity while the prefrontal cortex shows greatly diminished activity. This makes it that much harder for someone with PTSD to maintain a sense of proportion, as their fight-or-flight mechanism tends to hijack executive-level brain function. In layman’s terms, this means there’ll be a tendency to react first and think second. There may be struggles with memory and attention, making it hard to manage the various stimuli in an environment. Social skills are also often affected. Things that were once easy tend to become more difficult.
For these reasons and more, you may suggest, as part of his disability plan, that he work through The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Emotion Regulation, and Distress Tolerance. DBT has helped many thousands of people recover from a range of mental health problems.