Post-Traumatic Stress Disorder (PTSD)
A Cornell University and Society for Human Resource Professionals poll taken in January 2011 underscored the fact that there are misperceptions and misunderstandings about the organizational impact of hiring Veterans with Post Traumatic Stress Disorder (PTSD). Among the report’s findings 61 percent of the respondents believed accommodating workers with PTSD or traumatic brain injury required more effort for the employer; 52 percent reported that they didn’t know if accommodations would be costly. While only 6 percent had actually accommodated a worker with one of the top ten disabilities, PTSD. Hannah H. Rudstam, a member of the senior extension faculty at the DBTAC-Northeast ADA Center in the School of Industrial and Labor Relations at Cornell University indicated employers “… were really struggling with understanding ‘What do accommodations in this area look like? What are the possibilities? What do we do?’ They have very, very little experience with these types of accommodations.” (http://www.shrm.org/Publications/hrmagazine/EditorialContent/2011/0711/Pages/0711meinert.aspx)
What is PTSD?
According to the National Institute of Mental Health PTSD is a debilitating condition that can occur after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that can trigger PTSD include violent personal assaults such as rape or mugging, natural or human-caused disasters, accidents, or military combat. Traumatic events most often associated with PTSD include:
- Men: rape, combat exposure, childhood neglect, and childhood physical abuse, and
- Women: rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse
(National Institute of Mental Health, 2008).
Many people with PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event can also trigger symptoms. Feelings of intense guilt are also common. Most people with PTSD try to avoid any reminders or thoughts of the ordeal (National Institute of Mental Health, 2008).
How prevalent is PTSD?
PTSD is common among active military and veterans. In the National Vietnam Veterans Readjustment Study (NVVRS), they found that approximately 30.9% of men and 26.9% of women had PTSD at some point in their life following Vietnam.38 Researchers conducted a study to estimate the prevalence of PTSD in a population based sample of 11,441 Gulf War veterans from 1995 to 1997. The prevalence of PTSD in that sample was 12.1%. The authors estimated the prevalence of PTSD among the total Gulf War veteran population to be 10.1%.39 In 2008, the RAND Corporation published a population-based study that examined the prevalence of PTSD among previously deployed Operation Enduring Freedom and Operation Iraqi Freedom service members. Among the 1,938 participants, the prevalence of current PTSD was 13.8%.40 Based on this sample, the authors suggested that approximately one in five service members who have returned from deployment operations in Afghanistan and Iraq have symptoms of PTSD or depression.
What are symptoms of PTSD?
According to the Anxiety Disorders Association of America, symptoms of PTSD can include:
- Re-experiencing the event, which can take the form of intrusive thoughts and recollections, or recurrent dreams;
- Avoidance behavior in which the sufferer avoids activities, situations, people, and/or conversations which he/she associates with the trauma;
- A general numbness and loss of interest in surroundings; this can also present as detachment;
- Hypersensitivity, including: inability to sleep, anxious feelings, overactive startle response, hyper vigilance, irritability and outbursts of anger.
Symptoms usually begin within three months of a trauma, although there can be a delayed onset and six months can pass between trauma and the appearance of symptoms. In some cases years can pass before symptoms appear. In this case the symptoms are often triggered by the anniversary of the trauma, or with the experience of another traumatic event. Symptoms may vary in frequency and intensity over time (Anxiety Disorders Association of America, n.d.).
What accommodations are suggested to support individuals who are diagnosed with PTSD?
The Job Accommodation Network (JAN) has listed several accommodations for PTSD. These include activities or actions around various topics such as:
- Provide written instructions
- Post written instructions for use of equipment
- Use a wall calendar
- Use a daily or weekly task list
- Provide verbal prompts and reminders
- Use electronic organizers or hand held devices
- Allow the employee to tape record meetings
- Provide written minutes of each meeting
- Allow additional training time
Lack of concentration
- Reduce distractions in the work environment
- Provide space enclosures or a private space
- Allow for the use of white noise or environmental sound machines
- Allow the employee to play soothing music using a cassette player and a headset
- Increase natural lighting or increase full spectrum lighting
- Divide large assignments into smaller goal oriented tasks or steps
- Plan for uninterrupted work time
Time management/performing or completing tasks
- Make daily TO-DO lists and check items off as they are completed
- Divide large assignments into smaller tasks and steps
- Schedule weekly meetings with supervisor, manager, or mentor to determine if goals are being met
- Remind employee of important deadlines via memos or e-mail
- Use calendars to mark meetings and deadlines
- Use electronic organizers
- Hire a professional organizer or organizational coach
- Assign a mentor to assist employee
Coping with stress
- Allow longer or more frequent work breaks
- Provide backup coverage for when the employee needs to take breaks
- Provide additional time to learn new responsibilities
- Restructure job to include only essential functions
- Allow for time off for counseling
- Assign a supervisor, manager, or mentor to answer employee’s questions
Working effectively with a supervisor
- Giving assignments, instructions, or training in writing or via e-mail
- Provide detailed day-to-day guidance and feedback
- Provide positive reinforcement
- Provide clear expectations and the consequences of not meeting expectations
- Develop strategies to deal with problems
Interacting with co-workers
- Encourage the employee to walk away from frustrating situations and confrontations
- Allow employee to work from home part-time
- Provide partitions or closed doors to allow for privacy
- Provide disability awareness training to coworkers and supervisors
Dealing with emotions
- Refer to employee assistance programs (EAP)
- Use stress management techniques to deal with frustration
- Allow the use of a support animal
- Allow telephone calls during work hours to doctors and others for needed support
- Allow frequent breaks
- Allow the employee to work one consistent schedule
- Allow for a flexible start time
- Combine regularly scheduled short breaks into one longer break
- Provide a place for the employee to sleep during break
Muscle tension or fatigue
- Build in “stretch breaks” during the workday
- Allow private space to meditate or do yoga
- Allow time off for physical therapy or massage therapy
- Encourage use of the company’s wellness program
- Allow for a flexible start time or end time, or work from home
- Provide straight shift or permanent schedule
- Modify attendance policy; for example: count one occurrence for all PTSD-related absences, or allow the employee to make up the time missed.
- Allow the employee to take a break and go to a place where s/he feels comfortable to use relaxation techniques or contact a support person
- Identify and remove environmental triggers such as particular smells or noises
- Allow the presence of a support animal
- Allow flexible bathroom breaks
- Move employee to location where he/she can access the bathroom discreetly
- Provide space for storing extra clothing or personal hygiene products
- Provide alternative lighting
- Take breaks from computer work or from reading print material
- Practice stress-relieving techniques
- Eliminate non-essential travel
- Provide a driver
- Allow extra time for travel
- Allow the employee to bring a support person
For more information about PTSD and accommodations, please visit
The Vet Centers Program was established by Congress, as part of the VA. The goal of the Vet Centers Program is to provide a broad range of counseling, outreach, and referral services to veterans, in order to help them make a satisfying post-service readjustment to civilian life. Since 2003, the VA has authorized Vet Centers to also furnish bereavement counseling services to surviving parents, spouses, children, and siblings of service members who die of any cause while on active duty, to include federally activated Reserve and National Guard personnel.
America’s Heroes at Work:
America’s Heroes at Work, a DOL project, addresses the employment challenges of returning service members and veterans living with TBI and/or PTSD. Designed for employers and the workforce development system, this website provides information and tools to help returning service members and veterans living with TBI and/or PTSD succeed in the workplace.
National Center for PTSD:
PTSD 101, a VA National Center for PTSD, is a web-based curriculum that offers courses related to PTSD and trauma. The goal is to develop or enhance practitioner knowledge of trauma and its treatment. Continuing education (CE) credits are available for most courses. http://www.ptsd.va.gov/professional/ptsd101/ptsd-101.asp
Where to Get Help for PTSD:
The VA National Center for PTSD provides a comprehensive list of resources that are available to veterans and the public on the issue of PTSD.
Swords to Plowshares:
Swords to Plowshares is a community-based veteran service organization that provides wrap-around services to more than 2,000 veterans in the San Francisco Bay Area each year, to assist veterans in breaking through the cultural, educational, psychological, and economic barriers they often face in their transition to the civilian world. Swords to Plowshares is a national model for veteran services and advocacy with more than 35 years experience, and a respected and comprehensive model of care for veterans in the country.
http://www.swords-to-plowshares.org/A Cornell University and Society for Human Resource Professionals poll taken in January 2011 underscored the fact that there are misperceptions and misunderstandings about the organizational impact of hiring Veterans with Post Traumatic Stress Disorder (PTSD). Among the report’s findings 61 percent of the respondents believed accommodating workers with PTSD or traumatic brain injury required more effort for the employer; 52 percent reported that they didn’t know if accommodations would be costly. While only 6 percent had actually accommodated a worker with one of the top ten disabilities, PTSD. Hannah H. Rudstam, a member of the senior extension faculty at the DBTAC-Northeast ADA Center in the School of Industrial and Labor Relations at Cornell University indicated employers “… were really struggling with understanding ‘What do accommodations in this area look like? What are the possibilities? What do we do?’ They have very, very little experience with these types of accommodations.” http://www.shrm.org/Publications/hrmagazine/EditorialContent/2011/0711/Pages/0711meinert.aspx