About post-traumatic stress disorder (PTSD)

What is PTSD?

Post-Traumatic Stress Disorder (PTSD) is caused by witnessing or experiencing traumatic events, and/or learning about someone close to you who experienced traumatic events (such as death or threatened death, serious injury, or sexual violence).

The good news: PTSD is treatable.

PTSD includes 4 types of symptoms:

1. Re-experiencing or reliving the trauma, such as:
   • Disturbing memories or nightmares
   • Feeling or acting like the trauma is happening again (flashbacks)
   • Becoming very upset when reminded of the trauma
2. Persistent avoidance such as:
   • Avoiding places, people or conversations that remind you of the trauma
   • Avoiding thoughts, feelings, or memories closely associated with traumatic events
3. Negative thoughts and moods, such as:
   • Feeling detached or isolating from others
   • Negative beliefs (such as “I'm a bad person”, “I can't trust anyone”, “The world is dangerous”)
   • Self-blame for the trauma
   • Persistent negative emotions such as fear, anger, sadness, guilt, or shame
   • Trouble feeling positive emotions like happiness and love
   • Lack of interest or participation in pleasurable/important activities
4. Feeling more on-edge and reactive, such as:
   • Feeling on guard
   • Being irritable or angry
   • Trouble sleeping
   • Startling easily
   • Problems concentrating
   • Being reckless or self-destructive

These symptoms last for a month or more and are bothersome, and/or lead to problems in social or family life, work, and school.

PTSD can also include “dissociation” in which people feel like they are detached from themselves or as if the world around them seems unreal, distant, or distorted.

In Canada, you may hear the term “operational stress injury”, or OSI, which is used to describe any persistent psychological difficulty resulting from operational duties performed by a Canadian Armed Forces or a Royal Canadian Mounted Police member. Operational stress injury describes a broad range of problems that usually result in impairment in functioning, including PTSD and other diagnosed medical conditions such as anxiety and depression, as well as a range of less severe conditions.

PTSD Facts

Things you need to know about PTSD

In Canada, it is estimated that up to 10% of war zone Veterans—including war-service Veterans and peacekeeping forces—will go on to experience a condition known as post-traumatic stress disorder (PTSD), while others may experience at least some of the symptoms associated with this condition.

PTSD is Treatable

No matter how long you have lived with PTSD, there are treatments that can help.

Treatment Helps

Talking to a professional is one of the best things you can do to help with PTSD. There are several evidence-based treatments that have been shown to be effective in reducing PTSD symptoms.

Support Plays a Big Role

Support can go a long way in helping people with PTSD. Studies have shown that support from loved ones improves both treatment and recovery from PTSD.

You’re Not Alone

PTSD affects everyone differently, but it’s extremely common for people to experience significant stress. Don’t be afraid to seek out support to help you deal with any stress you’re experiencing

How does PTSD develop?

After trauma, it's normal to be in shock, have painful memories, and be upset by reminders of traumatic events. Trauma can also change how people think about themselves, others, and the world leading to more extreme ideas like “nowhere is safe,” or “no one can be trusted.”

For most, these reactions will lessen over time. But for some, these reactions continue and can be severe enough to disturb everyday life.

How common is PTSD?

Although most people feel much better within a month or two after a trauma, some people develop PTSD or other problems like depression or substance use problems.

Did you know?

• About 9.2% of Canadians will have PTSD in their lifetime.
• Certain types of trauma, such as sexual assault and combat, can cause even higher rates of PTSD.

Who develops PTSD?

Virtually anyone can develop PTSD. However, there are some factors that make it more likely.

Risk factors before a trauma:

• Being female
• Having experienced a prior trauma
• Having been abused as a child
• Having a pre-existing mental health problem
• Having a family history of mental illness

Risk factors during a trauma:

• Believing you will die
• Feeling detached from yourself or your surroundings
• Feeling completely helpless
• Having a panic attack
• Being seriously injured

Risk factors after a trauma:

• Lack of social support
• Additional life stresses (such as a job loss or divorce)

How long does PTSD last?

PTSD symptoms usually appear soon after a traumatic experience, however, in some cases symptoms do not appear for months or even years after the trauma. For some people who experience symptoms soon after trauma, these symptoms may go away on their own. For others, these symptoms can last for several years, especially if they do not seek help.

PTSD symptoms can worsen during times of stress or when people are reminded of what happened by trauma triggers (such as anniversaries of trauma). How long PTSD lasts also depends on whether effective treatment is received.

Problems related to PTSD

Some other problems are more common for people with PTSD. These include:

• Depression
• Panic attacks
• Alcohol and substance use problems
• Problems in relationships, work, school, or other important activities
• Physical symptoms (e.g., pain, headaches, digestive problems)
• Increased risk of medical problems

Did you know?

• More than half of men with PTSD have alcohol problems.
• Nearly half of women with PTSD also suffer from depression.

Do I have PTSD?

Only a trained mental health professional can determine if you have PTSD. However, there are self-tests, like the one included in the PTSD Coach Canada Application, which can help you decide if your symptoms require a more thorough evaluation from a mental health professional. If you think you have PTSD, talk with your doctor or schedule an evaluation with a mental health professional. Also, remember that some people may develop other problems like depression or substance use disorder after a trauma.

If your trauma was less than a month or two ago and you are not in too much distress or having problems functioning in everyday life, then you may want to see if your symptoms get better on their own. Using the tools in the PTSD Coach Canada Application can help you cope when you feel distressed.

If you still don't feel well after one or two months, seek professional help.

I have a PTSD diagnosis. How can the PTSD Coach Canada Application help me?

If you've been diagnosed with PTSD, the tools in the PTSD Coach Canada Application may help you manage your symptoms. However, it is not meant to be a replacement for professional care. If you are currently in treatment for PTSD, you should talk with your provider about using PTSD Coach Canada as part of your work together.

Remember: effective treatment for PTSD is available! You don't have to live with your symptoms forever.

I feel embarrassed about my symptoms

If people with PTSD see it as a sign of weakness or damage, they may feel ashamed or secretive about it. This may be especially true if the person has angry outbursts, flashbacks or other symptoms of PTSD when in public.

Embarrassment and shame can lead trauma survivors to withdraw or keep quiet about their problems. But this can backfire and leave them feeling isolated and unsupported.

Remember: PTSD is a normal response to abnormal circumstances.

I tend to self-isolate

It's common for people with PTSD to isolate themselves. You may feel overwhelmed or unsafe in groups, quick to anger, misunderstood, or just uninterested in being around people. However, isolation can lead to loneliness, depression, and anxiety.

The PTSD Coach Canada Application offers some suggestions and strategies to help you cope with feeling disconnected from people, and start to reconnect with loved ones and friends.

I experience sleep problems: Nightmares

If you have upsetting nightmares that interrupt your sleep, here are some tips:

• Upon waking up, turn the light on, take a few deep breaths, and notice the sights, sounds and smells around you.
• Pay attention to the differences between the nightmare and the current moment, and let those differences calm and reassure you.
• Distract yourself for 5 to 10 minutes after you wake up with a book or some music; try getting up and spending time in a different room.
• When you try falling asleep again, think about pleasant things and avoid thoughts of the nightmare.
• Avoid sleep deprivation. Keep a consistent sleep schedule and exercise regularly to help reduce your nightmare frequency.
• Be cautious about your use of alcohol, caffeine, and nicotine, which can disrupt sleep.

I experience sleep problems: Insomnia

If you lie awake in bed for more than 15-20 minutes without falling asleep, try the following:

• Get up and do something boring, like reading an instruction manual.
• Only return to bed when you become sleepy.
• Keep the lights low and do not use your computer or watch TV.
• Have some water, warm milk, or herbal tea.
• Have a light, low-sugar snack if you are hungry.
• Read something soothing or listen to relaxing music.
• When you return to bed, take slow, deep breaths for about 10 minutes.
• Calm your thoughts with prayer, meditation, or “counting sheep”.
• If it’s hard to share a bed with your partner, consider sleeping separately sometimes.

What do I do if I get triggered?

One approach that may help with being triggered is using the RID method.

Try the RID method:

• Relax
• Identify
• Decide

First, do something to help yourself Relax (such as take some deep breaths, get a drink of water, or remind yourself “I can handle this.”)

Second, identify what the trigger is (such as a car backfiring, being in a crowd). Then identify how the current situation is different from then (such as you are not in a war zone, you have more control now).

Third, decide what to do. For example, if being in a crowd upsets you, recognize that this crowd is not hostile: maybe you’re celebrating. You can decide to stay in the crowd and see that you are safe now.

What is dissociation?

Dissociation is the sense of detachment from physical and emotional experiences, sensations, memories or one's immediate surroundings. Dissociation can range from mild to intense. It often happens without the person's intent, so it can be confusing and upsetting.

Examples:

• Observing yourself/your body from an outside perspective (such as above, across the room).
• Sounds or sights seeming far away or distorted.
• Loss of sense of time.
• Physical or emotional numbing.

What is avoidance?

People with PTSD often find themselves avoiding things that remind them of the trauma they experienced. While it may feel like a relief in the short run to avoid painful reminders, when you end up avoiding things that you need to deal with, isolating yourself, or noticing that your life has gotten a lot smaller, it can mean that avoidance isn’t really working.

You can find tools and strategies for managing triggers and reducing avoidance in the Manage Symptoms section of the PTSD Coach Canada Application.

I don't always trust people

Many people who have been through a trauma feel mistrustful, but it’s not helpful to think “People cannot be trusted" and to mistrust everyone, all the time.

Practice asking yourself questions like:

• Is that true all the time? What percent of the time are people untrustworthy?
• Can I think of a time when someone came through for me?
• Who are 3 people I know who I can trust at least a little?
• What can I trust them with?

I sometimes struggle to control my anger

This can be scary and frustrating for many trauma survivors, especially Veterans and Active Duty Military Personnel who have been in places where being angry or aggressive was seen as beneficial. You can learn to control your behavior when you are upset with the help of this app and/or with in-person therapy. Check out some of the coping tools for anger in the Manage Symptoms section of the PTSD Coach Canada Application.

I often feel on edge

Feeling edgy, vigilant, or constantly alert to danger is a common experience for many people with PTSD. Relaxation exercises and mindfulness practices can help soothe your nervous system. These exercises are available in the Manage Symptoms section of the PTSD Coach Canada Application.

I often feel sad

Feeling sad, down, heavy or blue most of the time for more than 2 weeks can be a sign of depression. If you are concerned that you may be depressed, talk with your health care provider or reach out to a mental health professional for support. If you are a Canadian Armed Forces (CAF) member, a Military or a Royal Canadian Mounted Police (RCMP) Veteran, you can also call the Canadian Armed Forces Member Assistance Program (CFMAP) and Veterans Affairs Canada (VAC) Assistance Service 24-hour toll-free line at 1-800-268-7708 or 1-800-567-5803 (TDD).

Also, if you are a Canadian Armed Forces (CAF) member, you can contact Canadian Forces Health Services, or visit the “You’re Not Alone” website.  

If you are a serving RCMP member, you can speak with your Divisional Occupational Health Services to gain professional supports as part of your occupational health benefits.

If you are a Veteran, you can also contact Veterans Affairs Canada by at 1-866-522-2122 or 1-833-921-0071 (TDD).

I’m seeking: Psychological Support

If you are a Military or a Royal Canadian Mounted Police (RCMP) Veteran:

• Call Veterans Affairs Canada (VAC) Assistance Service 24-hour toll-free line at 1-800-268-7708 or by TDD 1-800-567-5803. The VAC Assistance Services offers face-to-face psychological support, bereavement support, and referral service to Veterans, former RCMP members, family member (s) or caregivers experiencing mental health or personal difficulties. Identify and understand emotional and relationship problems
• More information can be found on VAC Assistance Service

If you are a Canadian Armed Forces (CAF) member:

• Call the Canadian Armed Forces Member Assistance Program (CFMAP) 24-hour toll-free line at 1-800-268-7708 or by TDD at 1-800-567-5803. The CFMAP offers confidential, voluntary, short-term counselling to assist with resolving any of today’s stresses at home and in the workplace. The CFMAP should not be regarded as treatment for mental illness of addictions.
• More information can be found on the CFMAP website

I’m seeking: Psychological Support for My Child

If you have a child, teen or young adult who needs psychological support or wants someone to talk to, Kids Help Phone is available 24/7 across Canada.

Your child, teen or young adult can call:

• Kids Help Phone: 1-800-668-6868

Or text :

• Crisis Text Line: Free, 24/7 nationwide texting service. Text 686868

Or visit:

• the kids help phone website for additional resources.

If you are a Canadian Armed Forces member, Veterans or their family member, you can also contact the Family Information Line (FIL), which is managed by Military Family Services. The FIL is a confidential, personal, and bilingual service offering information, support, referrals, reassurance, and crisis management to Canadian Armed Forces members, Veterans and their families.

The FIL can be contacted by phone at 1-800-866-4546 or by email FIL-LIF@cfmws.com

I’m seeking: Peer Support

Talk to a peer: You can talk to someone who has been there and is experienced and trained in offering support.

If you are a Canadian Armed Forces (CAF) member, Veteran or family member:

• Visit the peer support (OSISS) website or call 1-800-883-6094.

If you are still serving RCMP member:

• Visit Support Operational Stress Injury Program page on the RCMP's website or email us at RCMP.SOSI-SBSO.GRC@rcmp-grc.gc.ca to be connected with a Divisional Coordinator.

I’m seeking: Domestic Violence Support

To find services in your area, you can consult:

• The Public Health Agency of Canada website

I’m seeking: Military Sexual Trauma Support

If you are affected by, or need to talk to someone about, sexual trauma experienced during service, help is available:

• For immediate support, you can call the Veterans Affairs Canada (VAC) Assistance Service 24-hour toll-free line by phone at 1-800-268-7708 or by TDD at 1-800-567-5803. The VAC Assistance Service offers face-to-face psychological support, bereavement support, and referral service to Veterans, former RCMP members, family member(s), or caregivers experiencing mental health or personal difficulties.
• If you have a medical condition due to sexual trauma related to service, such as Post Traumatic Stress Disorder, Major Depression, and/or physical conditions, you may be eligible for VAC disability benefits and other supports. The medical condition must be linked to sexual trauma related to service with supporting medical information from your treating physician/ psychologist. For information or to apply, see Disability Benefit application.
• Serving and Former CAF (Veterans) also have access to DND’s Sexual Misconduct Support and Resource Centre (SMSRC) for immediate and ongoing support, when needed.
• DND’s Sexual Misconduct Support & Resource Centre provides support to those directly or indirectly affected by sexual misconduct, including:
  • Currently serving members of the Canadian Armed Forces (CAF)
  • Former members of the CAF (Veterans)
  • DND public service employees
  • Former DND public service employees
  • Family members of the above aged 16 and older
  • Cadets aged 16 and older
  • Junior Canadian Rangers aged 16 and older
  • Members of the Defense community and caregivers who support those affected

SMSRC is available by: Telephone (24/7) toll free North America at 1-844-750-1648 (international and other options on their Web site - Sexual Misconduct Support and Resource Centre) and by email at DND.SMSRC-CSRIS.MDN@forces.gc.ca

Other self-directed options to support individuals impacted by sexual trauma:

• Contact the Canadian Association of Sexual Assault Centres
• Use the SMSRC’s resource search tool to find CAF, provincial, and community-based supports in your local area

I’m seeking: Financial assistance

If you have urgent need for quick access to funds, Veterans Affairs Canada (VAC) may be able to help. VAC has funds available to provide financial support to Veterans, their spouses, or their survivors when their well-being is at risk due to an urgent and unexpected situation.

Please call 1-866-522-2122, or visit any Veterans Affairs Canada (VAC) location to discuss your emergency need. The staff at any VAC office or Transition Centre can assist you.

For more information on financial services and supports available to CAF members, you can visit the website of the DND/CAF Ombudsman.

What is psychotherapy?

Psychotherapy involves meeting with a trained mental health professional who can help you:

• Identify, understand and change emotional, behavioural and relational problems
• Learn about the situations, thoughts, feelings and behaviours that may be contributing to your problems
• Learn more effective ways to manage stress and solve your problems
• Work on improving, resolving, or lessening behaviors such as substance misuse, aggressive or violent behaviors
• Move toward your recovery and improve your overall quality of life

Psychotherapy is available in individual, couple, group, and family formats.

Overall, the goal of psychotherapy is to facilitate a change of attitudes, behaviors, ways of thinking and reacting to allow a person to feel better, find answers to one’s questions, solve problems, make choices and better understand oneself.

Do I need professional help?

It’s normal for people who have experienced trauma to have some challenges adjusting afterwards—this is no cause for shame. Sometimes these challenges are important and last more than a few months.

Whether you need help can only be determined by you and a trained healthcare professional. However, you can take the PTSD self-assessment in the PTSD Coach Canada Application to get a sense of how you are doing.

• If you are having serious thoughts about hurting or killing yourself or someone else, please call 911 or go immediately to the nearest hospital emergency room.
• If you are a Canadian Armed Forces (CAF) member during regular working hours and are having thoughts about hurting or killing yourself or someone else call 911 or attend to your closest Care Delivery Unit (CDU).
• If you are a Canadian Armed Forces (CAF) member, a Military or a Royal Canadian Mounted Police (RCMP) Veteran, you can also call either the Canadian Armed Forces Member Assistance Program (CFMAP) or Veterans Affairs Canada (VAC) Assistance Service 24-hour toll-free line at 1-800-268-7708 or 1-800-567-5803 (TDD).
• You can also call or text the 9-8-8 Suicide Crisis Helpline. Available 24/7/365 anywhere in Canada. Additional information and resources can also be found on the 988.ca website.

Remember, you don’t have to wait for an emergency to speak to someone.

The following problems are common after a trauma and can signal a need for more support:

• Depression—feeling sad, down, or blue most of the time
• Anxiety—nervousness, worry, tension, being very alert to potential danger most of the time
• Overly watchful, or startling easily in response to loud or unexpected noises
• Intrusive thoughts and memories of traumatic experiences that are very upsetting
• Increased use of alcohol, drugs, or prescription medications, or using them to cope with problems
• Easily angered, aggressive/violent behavior
• Reckless or aggressive driving
• Sleep problems such as insomnia, nightmares
• Isolating oneself, withdrawing from friends and family
• Changes in appetite, or gaining/losing a lot of weight without trying
• Having trouble working or meeting daily responsibilities
• Having problems in relationships or trouble taking care of family
• Having thoughts about suicide, or of hurting or killing someone else

If you have any of these concerns, you might benefit from talking with a trauma specialist.

You may also find it helpful to talk with a trauma specialist because you find that :

• Loved ones mean well but they can’t help the way you need them to
• Loved ones are far away and unavailable, or
• The things you want to talk about feel too sensitive or private.

Is psychotherapy confidential?

Therapy is almost always confidential.

Exceptions to this important rule are made if:

• You disclose that you are planning to kill or harm yourself or someone else
• The therapist learns about a child being abused
• You are an Active Duty military member (there may be limits to confidentiality in case of court order, warrant, writ, summons, subpoena or other process issued by a court)

Your provider may write a note in your medical chart that can be viewed by other providers involved in your care.

Please discuss any concerns you have about confidentiality with your therapist or health care provider.

Research supports the use of psychotherapy

Research on different kinds of therapy shows that many types of psychotherapy and medications really do work. Plus, some kinds of therapy only take a few months to complete.

Many Canadian Armed Forces members and Veterans find that they get used to talking to a trauma specialist quickly and come to trust them.

Trauma specialists are psychotherapists who treat individuals who have experienced and survived trauma. They have expertise in the domain of trauma (evaluation and treatment) and in the use of trauma-focused psychotherapies.

Remember: In psychotherapy, you can always see how it goes – you don’t have to commit to anything right away. And if you have a few sessions and don’t think it’s going well, you can talk to the psychotherapist about what you want changed or ask for a different psychotherapist specialist of trauma. Psychotherapists are committed to your recovery and will help you get the support you need.

How do I find a trauma specialist?

To find a psychotherapist specialized in trauma, you can:

• Ask a doctor, a nurse or another health professional to direct you to a trauma specialist.
• Ask friends and family members you trust for recommendations
• If you are a Veteran, you can also visit or call Veterans Affairs Canada for a list of VAC registered service providers in your area.
  • Veterans Affairs also provides specialized treatment services to eligible Veterans through a network of Operational Stress Injury Clinics across Canada.
• If you are a Canadian Armed Forces member, contact a Canadian Forces Health Services Centre.
• Every Canadian Armed Forces medical clinic offers two levels of mental health care: Psychosocial and specialized mental health programs.
  • The Psychosocial Program provides first line services that Canadian Armed Forces members may directly access on their own at any time.
  • Specialized Mental Health Programs provides diagnostic assessment, individual and group treatment for those suffering from a broad range of mental health concerns.

How much does psychotherapy cost?

Get informed as to the different options available to you.

Try not to worry about how much therapy will cost, until you have details. Think of therapy as an investment in your health and well-being. It helps you live a happier fuller life.

If you are a Veteran, you can contact Veterans Affairs Canada and ask for the treatment benefits available to you.

If you are a Canadian Armed Forces member, services at Canadian Forces Health Services Centres are provided at no cost to the member.

I want psychotherapy but I work all day

If you need flexible appointments so you don’t miss work, look for a mental health practitioner who can work with your schedule. Also, most employers will understand and help you take care of your health, whether it’s physical or emotional.

Often, people can work out a flexible schedule with their boss to free up time for appointments during the day.

Transportation to appointments

Some people have problems getting to and from appointments. If this is an issue for you, consider these options:

• Public transportation
• Ask for a ride from a friend, family member, or neighbor
• Borrow a vehicle from a friend, family member, or neighbor
• For Veterans and other Veterans Affairs Canada (VAC) clients, VAC may reimburse certain health-related travel costs when Veterans must travel to attend an authorized medical appointment. You can contact Veterans Affairs Canada and ask for the treatment benefits available to you.
• The VAC Network of Operational Stress Injury (OSI) Clinics offers tele-mental health services for those living in remote areas.
• For Canadian Armed Forces personnel, health-related travel costs outside your area of responsibility (AOR) will be covered by the Canadian Armed Forces Health Services Centre making the referral.

I’m embarrassed to go to psychotherapy

Some people feel ashamed to need help or ask for help. But think about this:

• We are not alone in this world. People are here to help you now, just as you’ve helped others in the past.
• Did you know that people who accept help after a stressful time do better than those who don’t get support?
• You may think that asking for help means that you’re not normal, but it’s normal, and common, to have difficulties after a trauma, including sleep problems, increased anger, depression, anxiety, and substance use problems.
• Seeking psychotherapy doesn’t mean you are non-functional. In fact, most people experiencing PTSD can continue their usual routines while recovering.
• If you feel guilty about taking the time and money for psychotherapy, remember: you will be better able to be there for your family and your work once you are feeling better.
• If you don’t feel better and it’s been months, or years, since your trauma, talking to a trauma specialist may help so that problems don’t become chronic or more severe.
• Psychotherapy is not for weak or broken people. It takes courage to ask for help. You are actively taking charge of your life and improving your ability to help yourself.

PTSD treatments that work

The good news is that there are several effective treatments for PTSD.

Cognitive Behavioral Therapy (CBT) focuses on changing patterns of thoughts, feelings, and behaviors that lead to difficulties in functioning.

Three strongly recommended manualized trauma-focused psychotherapies are listed below. The first 2 psychotherapies listed are based on CBT as well as the later mentioned Ehlers’ Cognitive Therapy for PTSD.

• Prolonged Exposure (PE) Therapy: Teaches the person to gradually approach trauma-related memories, feelings and situations and learn that trauma-related memories and cues are not dangerous and do not need to be avoided.
• Cognitive Processing Therapy (CPT): Focuses on thoughts developed as a result of the trauma and helps the person learn how to modify and challenge unhelpful thoughts related to the trauma.
• Eye Movement Desensitization and Reprocessing (EMDR): Encourages the person to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories.

Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE) remain the most effective treatments; they are recommended over medications.

Ehlers’ Cognitive Therapy for PTSD, Present-Centered Therapy, Written Exposure Therapy (WET), and Mindfulness-Based Stress Reduction are also suggested as effective treatments.

• Ehlers’ Cognitive Therapy for PTSD: Helps diminish the sense of threat felt by the person by helping change the person’s negative appraisals of the trauma and of its consequences.
• Present-Centered Therapy (PCT): Focuses on increasing adaptive responses to current life stressors and difficulties that are directly or indirectly related to trauma and of its consequences.
• Written Exposure Therapy (WET) helps individuals to develop new ways to think about the trauma memory and its meaning and better tolerate negative feelings while they are focusing on writing about the trauma memory.
• Mindfulness-Based Stress Reduction (MBSR): Helps, through meditation and yoga, to bring people into the present moment so they can experience their thoughts and feelings non-judgmentally and avoid worrying about the past or future. It is part of the Complementary, Integrative, and Alternative Approaches.

Medications (if psychotherapy is not an option for you):

• Paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) are the medications with the strongest evidence for the treatment of PTSD

The best treatment is psychotherapy, but medications may be helpful if psychotherapy isn’t available or affordable for you.

Your provider should work with you to personalize your treatment based on your:

• Needs
• Preferences
• Treatment goals
• Previous treatment experiences

For more information about treatment, contact Veterans Affairs Canada or call: 1-866-522-2122. For Canadian Armed Forces members, the main providers or mental health services are located within the Canadian Armed Forces medical and dental centres.

Who can help me?

There are many experts who can help you if you seek care.

You can find a professional that can help through the following:

• A referral from a physician or a nurse
• The public healthcare system
• People you know
• CAF’s Chain of Command (CoC)
• Operational Stress Injury (OSI) Clinics
• Veterans Affairs Canada

You can learn more about the roles and duties of primary care providers, social workers, psychologists, psychiatrists and pastoral counselors/chaplains. Information is provided below to describe how each professional is different from one another.

Primary Care Provider

A primary care provider is usually a medical doctor (MD) or a specialized nurse practitioner (SNP). They can treat common medical problems, and may also be trained to recognize and help with common psychological problems, such as depression and anxiety.

A primary care provider can help you with:

• Medical attention
• A prescription to help with depression or sleep problems
• A referral to a psychologist, social worker, or psychiatrist

Social Worker

Social workers work with individuals, couples, families, and groups.

A social worker can help you with:

• Practical challenges like finding employment, housing, and government benefits
• Mental health problems like depression, anxiety, PTSD, and substance use disorders
• Family and relationship difficulties

Social workers cannot prescribe medications.

Psychologist

Psychologists have a Doctoral Degree in psychology (Ph.D. or Psy.D). Psychologists can provide assessment of mental health disorders/conditions and deliver therapy treatment.

A psychologist can help you with:

• Various mental health problems such as depression, anxiety, post-traumatic stress disorder, and substance use disorders
  • Chronic pain
  • Sleep problems
  • Family and relationship difficulties

In Canada, psychologists cannot prescribe medications. 

Psychiatrist

A psychiatrist is a medical doctor (MD) with specialized training in psychiatry. Psychiatrists mostly treat patients with medications that can ease symptoms of depression, anxiety, or PTSD, or help with sleep or other problems associated with mental health issues.

A psychiatrist can help you with:

• Medications for mental health problems like depression, anxiety, PTSD and severe mental illnesses
• In some cases, psychotherapy

Pastoral Counselor or Chaplain

A pastoral counselor or chaplain is a member of the clergy who:

• Provides spiritual support and guidance
• Conducts religious services in the field
• Offers support in emergency situations

Chaplains help people regardless of their faith and religious beliefs, and offer spiritual counseling and support. Although chaplains are not usually trained to provide mental health counseling, some pastoral counselors may also be licensed as mental health providers. Chaplains or pastoral counselors may also refer you to a specialist like a psychologist, psychiatrist, or social worker.

If you are looking for spiritual guidance, a pastoral counselor or chaplain is a good place to start.

Community-based Mental Health Organizations

Community-based mental health care encompasses a wide variety of programs and services designed to meet local needs. These programs are delivered primarily by community agencies and sometimes through hospitals or health clinics.

Canadian Mental Health Association (CMHA)

Canadian Mental Health Association (CMHA) is the most established, most extensive community mental health organization in Canada. CMHA provides programs and resources that help to prevent mental health problems and illnesses, support recovery and resilience, and enable all Canadians to flourish and thrive. We also advocate with governments to transform the mental health system, so all people can receive the kind of care they want, need and deserve.

BounceBack® is one of the programs offered by CMHA. It is a free skill-building program designed to help adults and youth 15+ manage low mood, mild to moderate depression, anxiety, stress or worry. Working with workbooks and a trained coach to guide you and encourage you to reflect, BounceBack® can help you build skills to improve your mental health.

To find a CMHA branch in your community, visit the Canadian Mental Health Association’s website.

211

211 is a free and confidential service that easily connects people to the critical social and community supports they need. Learn more on the 211.ca website.

What is couples therapy?

If you and your partner are having trouble getting along or feeling close, couples therapy may be helpful.

In this type of therapy, a therapist can help the two of you:

• understand where your difficulties are coming from
• learn ways to cope with relationship stress
• develop skills to communicate and solve problems better
• build trust and feel emotionally closer

A health care provider, chaplain, or social services organization can help you find a couple therapist.

What is family therapy?

If your family is having trouble communicating or getting along, consider family therapy.

In this type of therapy, a therapist helps you and your family:

• communicate better
• develop and maintain good relationships
• cope with upsetting emotions, and
• understand and cope with PTSD

A health care provider, chaplain, or social services organization can help you find a family therapist.

Reconnecting with your partner

Relationships may feel strained if one partner is struggling with PTSD. Here are some tips to help you become closer again.

• Feeling emotionally numb can make it hard to express love and care. You can start with appreciating concrete things your partner does (such as "thank you for doing the dishes," or "I appreciate you changing the oil in the car.")
• Talk to your partner about how PTSD has affected you and what you need. They can support you better if they know what’s going on.
• Ask questions and listen to your loved one’s feelings and needs. Do your best to stay open and put yourself in their shoes when they speak.
• If you tend to withdraw under stress, make an effort to move toward your loved one instead with small favors, little touches, or a few kind words.
• Avoid saying hurtful things or becoming physically violent. Instead, take a Time Out to calm yourself. You can find this tool in the Manage Symptoms section of this app.
• With the stress of PTSD, sexual intimacy may be off the table for a while. If so, try to focus on other ways of being close, like spending fun time together, holding hands, hugging, and kissing.
• Understand that PTSD may lead you to feel more distant or irritable. Try to keep your expectations and self-criticism in check—you’re only human, and healing takes time!
• Seek help from a couple therapist if needed.

Tips for improved communication

Conflict will always exist in relationships. If you are irritable or have a “short fuse” it can make it even more challenging. Here are some tips for improved communication:

• Think before you speak. Keeping a cool head goes a long way toward resolving problems.
• When speaking, consider using statements starting with "I," such as "I think" or "I feel." Using "you" statements can sound accusing.
• Take "small bites." Focus on one issue at a time.
• Be positive - Clearly request what you want or need. Blame and negativity won't help resolve things.
• Put your feelings into words. Your loved one may not know you are sad or frustrated unless you say so.
• During a confrontation, allow the other person equal time to speak his/her mind.
• When the other person is talking, listen to what he/she has to say without interrupting. Ask questions and repeat back what they said to be sure you understand.
• Don't give advice unless you are asked.
• Don’t hit “below the belt” with comments about sensitive topics. Stick to the issues at hand.
• Never argue in bed. Discuss in a neutral room, and express your love often.
• Work as a team to solve problems. You can get a lot more done this way than you can as rivals.
• Avoid saying "I told you so." Remember that a problem solved is a win for you both.
• If things are getting too heated, take a time out, but agree to continue the discussion when things cool off.

Talking to kids about PTSD

Are you and your child having a hard time connecting?

Think about ways to express your appreciation for your child - by saying something nice to them, using gestures (e.g., giving them a hug), or some other signal that shows how much you care.

Have you and your child been distant from each other?

Re-introduce yourself to your child by doing things together that you both enjoy. Gradually try to increase how much time you spend together. This could include eating a meal together or going on a walk.

Feeling like a bad parent?

Know that you’re not alone. It’s incredibly difficult to parent with PTSD, and you can only do your best. Children are resilient, and children know when they’re loved. Love your children, accept that you will make mistakes, forgive yourself, and move on. Just try to do the best that you can do.

Do you have a toddler (2-4 year old)?

• Ask your child what you can do to help them. Take several minutes to hear anything they have to say, and find one thing each day to help them with, however small.
• Set some short and clear rules with your child about things like personal space, using outside voices inside, or other potential triggers. Find 1 or 2 words to remind them gently, but frequently, about the rules for interacting with family.

Do you have a young child (2-12 years old)?

• Keep your rules short and to the point. Follow through on your promises and your rules. Set expectations that you’re sure your child can meet.
• Celebrate your child’s successes.
• Trust your instincts about how to be the best parent you can be.
• Establish and keep a routine if you don’t already have one. Children thrive on consistency.

Do you have a young child (5-12 year old)?

Help your child manage their emotions such as anger. For instance, give them tools to manage their anger: count to 10, find a creative way to vent their anger, do some deep breathing, find an ally that they can talk to (e.g., aunt/uncle, or teacher).

Do you have a teenager?

• Don’t be afraid to talk with your teenager about PTSD. Ask for, and listen to, their opinions. Encourage them to express their feelings – in words, or music, or some other outlet.
• Teenagers may need their own space to deal with their loved one’s PTSD. Respect your teenager’s privacy as much as you safely can. Don’t step in to solve their problems or make decisions for them.
• Pick your moments with your teenager, and when they do want to talk, just listen. Show affection for your teenager, even when it annoys them!

Do you have a partner who helps with your child?

• Include your spouse or partner as often as you can when making decisions about how to discipline your child.
• Try to make sure your children are getting a consistent message when they talk to you and when they talk to your partner. Even if you have very different parenting strategies, try to find common ground where you can.

Support your loved one’s parenting

Compliment your partner when you notice them doing something well.

Feeling like things are out of control?

Tell your family that you’re going to start having regular Family Meetings. Schedule a family meeting when you know everyone in your family can be together – meals are good times for these.

Family Meetings

Make an agenda together. Work together as a family to see if you can come up with some solutions for each item on the agenda.

Does your child have a hard time discussing feelings?

• Take the time to give your child your full and undivided attention. Listen with respect and interest, and avoid commenting or judging – let your child do the talking.
• Help your child give a label or name to any feelings you hear them talking about – like happy, sad, afraid, excited, interested.
• You don’t always have to talk. Sometimes it’s enough just to be together for a while.

Try a conversation starter, ask what they think.

With children who can understand, try something like: “I have been dealing with some difficult stuff lately and I would like to talk with you for a few minutes. How do you feel about how things have been going?”

Try a conversation starter, share how you’re feeling.

If you are open to discussing how you are feeling, try saying something like “I’ve been a bit cranky lately. It may be hard for you to understand, but I want to tell you a little bit about what is going on with me, is that okay with you?”

***It is important to make sure you are sharing only appropriate information. Some information may not be suitable for younger children, and in-depth information about trauma events is not the intention. Focus on expressing your emotions when sharing.

Try a conversation starter, open up.

With older children, model how to share feelings: “I’d like to tell you how I have been feeling lately”

Focus on strengths.

Pay attention to your child’s strengths – let them know you see them in a positive light. Point out things they do well.

Give kids time to speak.

Ask your child about their worries and concerns, and then give them a long moment to respond, to show that you really want them to have a voice.

Is your child missing quality time with you?

Find at least one activity you can share with your child for a few minutes each day. Quality time will be good for both of you.

Impact of PTSD on children

Adjusting to living with a parent with PTSD can be challenging for children and teens. While many children adjust well, others may respond in problematic ways, including:

• Acting like their parent, perhaps as a way of trying to establish a closer connection with them. These children might show some of the same symptoms as the parent with PTSD, such as being irritable or complaining of sleep problems.
• Taking on adult roles and responsibilities to “fill in” for the parent with PTSD. This child may act too grown-up for his or her age. This can be overwhelming for the children, and can keep them from living like the kids they are.
• Acting younger than they are (such as bed wetting, temper tantrums).
• Thinking that they are the problem, or that they are responsible for the behavior of the parent with PTSD (such as “he wouldn’t get so mad if I could be quieter.”).
• Experiencing symptoms of depression or anxiety.
• Showing problems at school or in relationships with friends.

Children’s responses to PTSD symptoms

A parent’s reactions to a past trauma can affect children in different ways:

If a parent has upsetting nightmares or overwhelming memories/ flashbacks, children may:

• Feel confused about what is happening and why
• Feel scared if they see or hear the parent in a very upset or frightened state
• Worry about their parent's well-being
• Worry that their parent cannot properly care for them

If a parent avoids going out or isolates him/herself, children may:

• Take it personally and worry that their parent does not care about them, about spending time with them, or about being involved in their lives (such as school sports games, family outings)
• Feel neglected
• Have hurt feelings, or feel frustrated

If a parent is withdrawn, numb, or uninterested, children may:

• Think that the parent is not interested in them or doesn’t love them, even if the parent’s words say otherwise
• Feel worried that their parent will leave them or the family.

If a parent is irritable, angry, or easily frustrated, children may:

• Question their parent's love
• Walk on eggshells around their parent, or feel tense and anxious
• Lose respect for their parent

If a parent is vigilant, sensitive to danger, or startles easily, children may:

• Develop levels of vigilance similar to their parent and feel very stressed
• Feel more on edge and wary of danger

Can children get PTSD from their parents?

While it is not common, it is possible for children of people with PTSD to show signs of PTSD, too. This is called “secondary traumatic stress.”

Here’s how it can happen:

• When a family teaches a child never to talk about disturbing events, thoughts, or feelings, the child's anxiety may get worse. He may worry about causing the parent's symptoms, make up his own story about what happened.
• Sometimes parents share too many details about the events. Children may start to have their own stress and PTSD symptoms in response.
• A child may begin to share in her parent's symptoms as a way to connect with the parent.
• Children may also re-enact or re-do some aspects of the trauma their parent experienced. It is difficult at times for children to separate the past trauma from the present moment.

Helping children cope

When PTSD impacts the family:

• Explain the reasons for the difficulties. Knowing what is happening, and why, helps children feel safer.
• However, be careful not to share too many details of the event(s) with the child. How much you say depends on your child's age, cognitive and maturity level.
• Help them see that PTSD symptoms and trauma reactions are not their fault.
• Talk about related events and experiences together. Listen to their concerns and accept their feelings.
• Recognize that change is stressful for children just as it is for adults, and be patient.
• Remember that they may have mixed feelings about you and your PTSD. They may feel loving, concerned, and protective, and also resentful, anxious, or angry at times.
• Help them learn tools to better manage stress. Examples include:
  • Running or exercising to blow off steam
  • Drawing or writing for self-expression
  • Taking deep breaths to relax
• Give them a journal to keep track of these events and their feelings and experiences.
• Involve them in decisions that affect them whenever possible.

Parenting tips

Here are some tips for parenting children who are adjusting to living with someone suffering from PTSD.

Educate Yourselves

• Both parents should learn about how PTSD can impact children, and about children’s common responses to having a parent with PTSD.
• Be aware that children may need extra care, attention, and closeness during this time.

Provide Support

• Make time to do activities and talk together. Both parents should listen to their children’s feelings and concerns, and take them seriously.
• Provide reassurance and support for their questions and worries.
• Give kids information at a level they can understand about PTSD and about the experiences and changes of their parent suffering from PTSD to ease the confusion and fear of the unknown.
• Encourage and organize activities (moving around to blow off steam, drawing and writing to express themselves, etc.) that help kids to express themselves and manage stress.

Be Loving and Have Clear Limits

• Be loving, patient and attentive, while also holding clear, consistent limits.
• Understand kids may act out and misbehave at times, and give them the space for this. Acting out is a normal response to stress, as long as it doesn’t become frequent or cause bigger problems.
• Praise their positive behavior and healthy ways of coping. Always keep your focus on what you appreciate about them.
• If you are the parent suffering from PTSD, focus on quality and fun time with kids and delay getting involved in disciplining, especially if you have been moody or irritable lately.

Keep Things Ordinary

• Maintain basic family routines like dinnertime and bedtime rituals.
• Make sure children keep attending school and other regular activities.

Include Them

• Involve kids in family activities. Keep weekends fun with kid-friendly activities.
• Stay as involved as possible in your kids’ school and social activities.
• Ask about their interests and listen without judging or teasing.

Are my kids ok? When to seek outside help

If your child or teenager seems to have trouble adjusting to your PTSD, don't hesitate to contact your doctor or a mental health professional for support. Here are some things to watch out for:

• Trouble concentrating or engaging in school assignments and activities
• Intense emotional responses, such as continued crying, intense sadness or moodiness
• Depression, or actively withdrawn and uncommunicative
• Expressing violent or depressed feelings in "dark" drawings or writings
• Significant weight loss or gain, or lack of attention to hygiene
• Big changes in social activities or friendships
• Drug or alcohol use

Please seek help immediately if your child intentionally hurts or cuts themselves, seems at risk of hurting others, or expresses suicidal thoughts.

Should my child have individual psychotherapy?

Children may benefit from individual psychotherapy or family therapy.

Family therapy helps family members learn how to cope, communicate, and get along when they are under stress.

Individual psychotherapy offers a private place for kids to talk about and learn to cope with their experiences.