Ascellus Blog

Learning to Play Well with Others: The PTSD Survival Guide

July 24, 2018

Post-Traumatic Stress Disorder leaves a person feeling unsafe and out of control. He has faced an unexpected event and his choices have been taken away. Regaining the sense of security and self-empowerment is a vital step in helping these injured workers recover.

Trauma and the Freeze Response
We often hear that our bodies are poised to adopt a ‘fight’ or ‘flight’ response to danger; we choose to protect ourselves either by taking action against the threating person or situation, or get the heck away from it.

Less discussed is the ‘freeze’ response. The term, playing possum is a form of the freeze reaction. When neither fight or flight is an option, our bodies may become immobile.

Whatever action someone takes when faced with a treat — fight, flight or freeze — depends on a slew of factors. But each of us is different and we have different responses. Interviews with airline passengers who believed the plane was going to crash show all three types of reactions. Those who ‘freeze’ may literally faint and recall nothing of the event.

This freeze reaction is actually deeply rooted in human behavior. It is a primal stress arousal response which reduces bodily demands, such as metabolic, oxygen and food, in an attempt to enhance survival. It is regulated by a part of the nervous system called the vagus nerve.

Over time, humans and the vagus nerve evolved and enabled people to optimize metabolic resources by engaging with other humans. When we are social and engaged, we reduce metabolic demands, to facilitate health, growth and restoration.

However, some people who experience a traumatic event go into a state of immobilization. They are fearful and cannot get out of this state by themselves. They need help to reenlist the social engagement system, which settles down the physiological symptoms, such as anxiety, panic, or despair, and helps them heal.

Social interaction is one of the most important steps in helping an injured worker with PTSD. The people in the best position to do that are those who have a clear understanding of what the person has experienced, as well as people who are supportive — family members, especially. This feeling of being socially supported helps them regain a sense of safety and control in their lives.

We do critical debriefing in groups, for this very reason. Each group is comprised of others who have been through the same or a similar trauma. We also encourage these workers to spend as much time as possible with their families doing things they normally would.

Another social support is in the form of peer counseling. This is especially important with first responders as the camaraderie of these professions is one of the protective factors against development of PTSD, by sharing similar experiences with a peer police officer, firefighter or EMT brings a level of mutual trust that does not exist easily with a counselor outside of that group.

Once the injured worker feels safe, his whole outlook and appearance change. His voice and facial expression may change. This is the start of getting the social engagement system re-stimulated.

In addition to interacting with others who understand and family members, injured workers with PTSD can use a variety of techniques to settle the vagus nerve. In an upcoming post, I’ll focus on some of these methods.

Integrated Medical Case Solutions (Ascellus) is a national network of Health Providers in Psychology that delivers cognitive behavioral therapy (CBT) for chronic pain, trauma and insomnia across the country for the workers’ compensation industry.

For additional information, contact us at, or Please join our LinkedIn group, COPE with Pain at .

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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.