Ascellus Blog

Time to Face the Music: The PTSD Survival Guide

September 9, 2019

Time to Face the Music: The PTSD Survival Guide

After experiencing a traumatic event, a person often uses avoidance behavior to deal with the pain. The person will avoid people, things or sensations that spark horrific memories. In the case of a worker with posttraumatic stress disorder, this behavior can literally ruin his life.

To recover, the injured worker must be slowly reintroduced to the triggers that are immobilizing him. With appropriate help, the worker can overcome his fears and return to normalcy. 

This next step in the PTSD recovery process is effective only when the following previous actions have been successfully taken:

  • The injured worker has been educated about the brain’s processing of memories during and after a traumatic event
  • He has gone through the debriefing process to sort out his memories and determine which are unrelated to the trauma
  • He has been meeting with others who have been through the same or similar trauma and is spending extensive time with supportive family and loved ones
  • He has engaged in a variety of physiological recovery techniques to calm his stress-arousal response

Once the injured worker is progressing with these steps, he can forge ahead and practice exposure therapy. 

What is exposure therapy

Exposure therapy, or desensitization therapy, includes an array of techniques to help those with PTSD confront their memories, feelings and situations associated with the trauma. Proven to be effective, these techniques are recommended as a first-line treatment for PTSD by several health agencies, including the National Institute for Health and Clinical Excellence. Exposure therapy to treat injured workers with PTSD involves 3 steps:

  1. Create a hierarchy

First, we ask them to come up with a hierarchy of every action they took leading up to and including the trauma and then rank those actions from least to most trauma-inducing. For example, getting dressed for work the day of the traumatic event might be least trauma-inducing while walking into the door of the school where a fatal shooting occurred might be most trauma-inducing.

  1. Visualize each action

Next, we use something called imaginal exposure, where the worker visualizes each action on that list. For example, we ask the person to imagine each activity: getting out of bed, having coffee, putting on clothes. We have him do that repeatedly for every action included. By guiding him through this process in a safe and trusting environment, he is eventually able to at least visualize each activity he undertook without it triggering a flashback to the event.

  1. Exposure to each action

The final step in exposure therapy is to have the worker actually expose himself to each step. This, ‘in vivo therapy,’ is where the injured worker confronts the actual or similar events associated with the trauma. We have him physically expose himself to those places, situations or objects that are safe but which he has perceived as threatening and has, therefore, been avoiding since the event. His unrealistic expectations of harm are then disproven, so the person’s fear response is reduced.

It is crucial that the therapist conducting the exposure therapy has patience with the injured worker, as this can be quite daunting. It is also imperative that the patient follows through with each step because if he doesn’t engage in this process, the worker may find his PTSD symptoms worsen. As time goes on, he may become even more fearful. By processing the frightening experiences, he will lessen his anxiety and increase his quality of life.

The final step in PTSD recovery is assimilating back into the workforce. This, too, must be done gingerly and with care. The return-to-work and -normalcy will be the subject of an upcoming blog post.


While fearful reactions associated with posttraumatic stress disorder can be overwhelming, there are techniques available to eliminate these fears and improve one’s life overall. Practicing exposure therapy is an effective way for those suffering from PTSD to overcome their emotional pain, return to work and enjoy life again.  

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.

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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.