10 Ways to Help Someone Cope with Trauma-Related Nightmares
First, a word about Trauma…
Trauma is defined as an emotional response to a terrible event like an accident, rape, or natural disaster according to the American Psychiatric Association (APA).
There is no doubt about it, trauma impacts each of us differently. In her seminal research with birth trauma survivors, Dr. Cheryl Beck has affirmed that trauma is in the eye of the beholder. This statement holds so much validation for survivors of trauma because the reality is we each have a subjective understanding of what constitutes a traumatic event. So, if you want to help someone cope with the symptoms of a trauma event, such as a flash back or nightmare, it’s crucial for you to be supportive, nonjudgmental and well informed about trauma.
Most people understand that there are common human responses to a traumatic or stressful incident. Shock, disbelief, denial, fear, anxiety, grief, and sadness are a few examples of reactions that are generally reported after a traumatic experience. Other reactions such as nightmares, depression, self-blame, guilt, negative thinking, and suicidal ideations may be less understood by others and for some people are underreported because fear of stigma.
There are many reasons for difference of experience. A person’s history of trauma exposure, family and childhood experiences, mental health and substance use history and internal and external coping mechanisms are all factors that play a role in whether someone is at risk of developing post-traumatic stress disorder.
What is Post Traumatic Stress Disorder?
When you read the letters PTSD, what thoughts or images come to mind? Do you think post-traumatic stress only affects certain groups of people such as war veterans or rape victims?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines post-traumatic stress disorder (PTSD) as a psychiatric condition that may develop after exposure to a traumatic or stressful event. There are a lot of misconceptions about post-traumatic stress disorder, most commonly why and how someone develops the condition. To better understand the disorder, lets first examine how prevalent PTSD is according to the research.
How Prevalent is it?
There are currently about 8 million people in the United States with PTSD. It is estimated that for every 100 people, as many as eight of them will be diagnosed with the disorder at some point in their lifetime.
Gender disparities between men and women’s likelihood of developing PTSD also exists. This is because women are more likely than men to experience a traumatic event that could lead to developing the disorder. Women are more likely to be a victim of a crime such as domestic violence or sexual assault in childhood or as adults compared to men. For example, globally, an estimated 736 million women—almost one in three—have been subjected to physical and/or sexual intimate partner violence, non-partner sexual violence, or both at least once in their life (30 per cent of women aged 15 and older) according to UN Women. Women may also experience trauma during childbearing. A research study examining the prevalence of PTSD in 933 pregnant women following childbirth found that about one third developed PTSD after a traumatic birth. Thus, as a society, PTSD affects more people than we realize.
What are the Symptoms of Post-Traumatic Stress Disorder?
For many people living with post trauma stress disorder, the symptoms of the condition can feel isolating and debilitating. These indicators can also vary depending on someone’s childhood experiences, gender, and exposure to traumatic events throughout their lifetime. According to the American Psychiatric Association (APA), the symptoms of PTSD can fall into 4 categories and with varying symptom severity (see chart below):
It's important to note that not everyone with PTSD will experience all of these symptoms in response to a trauma. Likewise, not all of these characteristics are, by themselves, evidence that someone has PTSD. Its paramount to think holistically about a person’s lived experience to understand the severity of their reactions.
A Focus on Nightmares and the 10 Ways to Help Someone Cope
You may be wondering are nightmares a common symptom of PTSD? Nearly 80% of people diagnosed with post-traumatic stress disorder report having nightmares. According to the Sleep Foundation, people with PTSD often have frequent, intense nightmares in which they relive traumatic events contributing to worsening symptoms and insomnia. Nightmares are considered the hallmark symptom of PTSD. They fall into the reexperiencing cluster of the disorder along with flashbacks and intrusive recollections of the trauma.
Often the effects of PTSD on an individual’s mental and physical health are misunderstood by family members and friends. There are some ways that you can provide support to someone who is experiencing difficulties with sleep due to nightmares or flashbacks related to a traumatic event.
If you are supporting someone with PTSD who is experiencing a frightening trauma-related nightmare, here are a few tips and coping techniques:
Help the person stay in the present moment using grounding techniques focused on their five senses (e.g., sight, sound, taste, touch, and smell). A popular grounding exercise I’ve used in therapy sessions is called 5-4-3-2-1. Learn more about this therapeutic exercise here.
Try to calm the person down by reminding them that they are safe, they just had a bad dream and that they are not in harms way, despite feeling like they may be.
Offer them something warm or cool to drink such as hot tea or ice-cold water. This can help them focus on the temperature of the drink and promote mindfulness and self-soothing.
It can be effective to ask them to change their physical environment after a nightmare. For example, if they are sleeping in their bedroom, have them go into another room in their home such as the living room or dining room. Changing environments can help them reorient to the present moment.
Sharing healthy sleep hygiene tips can also give them concrete ideas on how to obtain more restful sleep or to return to sleep after a bad dream. Some helpful sleep tips include avoiding alcohol and caffeinated beverages just before bedtime, turning off stimulating content on television such a scary movie or the 6 o’clock news, and preventing the use of the bedroom for things other than sleeping and sex. Other sleep hygiene strategies can be found here.
Practicing mindful breathing techniques can promote calming and centering, especially after a disorienting experience like a nightmare. Taking 3 mindful breaths and Square Breathing are just a few popular techniques that are easy to teach and remember.
Because nightmares are so common among PTSD sufferers, it can be useful to keep a journal. Utilize the journal to capture thoughts and feelings after a bad dream or nightmare. It can also be used to develop an action plan for how to cope after experiencing a nightmare. Having a coping plan in place can promote a sense of self-control, confidence in one’s ability to cope with a challenging aspect of the condition and learn what works well and what doesn’t.
Using a mobile app such as PTSD Coach can assist someone in learning new and creative coping skills that they may not have tried before. Reference the coping and resources section of this post for links to more information.
Help them identify a grounding partner. This person is a source of support for the individual who is experiencing a nightmare. The grounding partner guides them through grounding techniques, reminds them that they had a nightmare and reassures them that they are safe and are not experiencing the traumatic event again. This supportive other can be a family member, a peer, a close friend. They can be a professional such as a therapist, case manager or life coach. It can even be an emotional support animal. Remember to also identify how they will access their support partner when they need them. Will it be in person, via virtual platform, or over the phone?
Lastly, offer to help them find a mental health professional who can offer therapeutic and evidence-based treatments proven to reduce PTSD symptoms. It’s recommended that the professional have expertise and experience working with trauma survivors and administering treatment interventions for PTSD. Researching therapist through a professional directory such as Psychology today’s therapist finder tool is a great place to start.
Coping Tools and Resources
Did you know that the month of June is recognized as Post-Traumatic Stress Disorder Awareness Month? This time of year is dedicated to raising awareness in local communities and at the state and federal levels about trauma and PTSD. Help someone by becoming an ambassador for change. Through awareness and speaking up about mental health we all can end the stigma associated with mental illness in our society.
If you or someone you care about is experiencing signs and symptoms of post-traumatic stress, remember you are not alone and there is help available.
If you aren’t sure where to turn, I recommend talking to a mental health professional as a starting point.
Additionally, coping tools and self-help resources are readily available in many formats. For example, websites, apps, books, and articles focused on living with PTSD can be valuable for anyone wanting to learn new coping strategies or how to support someone affected by the disorder.
Here are a few additional self-help resources I recommend exploring:
Websites: National Center for PTSD; International Society for Traumatic Stress Studies: Survivors Talk About Trauma; and Postpartum Support International
Apps: PTSD Coach, Mindfulness Coach; PTSD Family Coach; Virtual Hope box;
Books: The Body Keeps the Score by Bessel van der Kolk; The PTSD Workbook by Mary Beth Williams; and What Happened to You?: Conversations on Trauma, Resilience and Healing by Bruce D. Perry
Hotlines: If you in crisis dial 9-8-8 to speak immediately with a mental health professional. National Domestic Violence Hotline: (800) 799-7233; National Sexual Assault hotline: (800) 656-HOPE (4673)
Guest Blog Written by Shakima “Kima” Tozay, MSW, LICSW, PMH-C
Shakima is a Licensed Clinical Social Worker with over 15 years of experience serving our great men and women of the Armed Forces as a Military Social Worker. Shakima is an enthusiastic leader, therapist, and advocate. She is a Medical Social Worker in her current role for the Department of Veteran Affairs. Her first post MSW job was as a trauma therapist serving Women Veterans affected by Military Sexual Trauma and Addiction at the Seattle VA Hospital; a role she credits for profoundly shaping her therapeutic orientation. Shakima’s clinical expertise includes trauma, grief and loss, domestic violence, perinatal mental health, reproductive health, disaster mental health and suicide prevention. She also writes and presents on diverse topics in the fields of mental health and organizational leadership.
