Tips for trainers working with survivors of powerful emotional traumas.
Posttraumatic stress disorder (PTSD) is an anxiety disorder triggered by witnessing or experiencing a traumatic event. Although it is commonly associated with combat veterans, it also frequently affects survivors of violent personal assaults (rape, mugging or domestic violence), childhood abuse, natural disasters, accidents and life-threatening illnesses.
Cohen et al. (2009) note that 8%–12% of all adults, and 13%–31% of military veterans, will suffer from PTSD at some point in their lives. These statistics make it very likely that exercise professionals will encounter clients who have PTSD. Understanding how PTSD influences physical and mental health can be critical to developing a successful exercise program for these clients.
PTSD is fundamentally a dysfunction of the body’s stress-coping system, resulting in serious health effects (see Figure 1). A complex cluster of PTSD symptoms can be divided into three general categories:
Recalling a traumatic event arouses intense emotions like terror or panic.
Traumatic stress blunts or impairs normal emotional functioning. This may lead to drug or alcohol abuse.
Worrisome thoughts cause a person to overreact to even minor stimuli, leading to excessive alertness and startle reactions.
PTSD clients may feel helpless and experience a diminished sense of self-control. Symptoms vary in severity from person to person and can be chronic or intermittent. Without intervention, PTSD can increase the chances of a person developing severe depression, substance abuse and suicidal thoughts.
While PTSD has no known cure to date, evidence is emerging that exercise can be a valuable component of a comprehensive PTSD treatment plan (Tsatsoulis & Fountoulakis 2006). Low- to moderate-intensity exercise can elevate mood, reduce anxiety (Cohen & Shamus 2009) and act as an overall stress-buffer (Tsatsoulis & Fountoulakis 2006). More specifically, exercise—particularly mind-body and low-intensity aerobic exercise—has been shown to have a positive impact on the symptoms of depression and PTSD (Cohen & Shamus 2009).
It is essential to recognize the barriers to exercise for PTSD sufferers. These include
- the presence of other mental health conditions such as depression or substance abuse;
- physical conditions caused by the original traumatic event; for example, debilitating injuries, including traumatic brain injury; and
- cardiovascular disease, diabetes and other chronic illnesses.
The skilled exercise professional should promote the benefits of exercise and help turn these potential “barriers” into a source of motivation for the client to overcome.
Because each client with PTSD has very different needs, it is important to individualize instruction and emphasize communication. One key consideration in designing an exercise program for clients with PTSD is to include low- to mod-erate-intensity body-awareness movement activities (such as Pilates, yoga, Nia®, therapeutic dance, tai chi or qigong), which can reduce symptoms of anxiety and depression and have produced positive results in PTSD sufferers (Netz & Lidor 2003). Diaphragmatic (or pranayama) breathing and muscle relaxation exercises, which have a natural calming effect, should also be a regular part of the program.
When working with PTSD clients, remember that their symptoms can vary from day to day and may be triggered by seemingly innocuous situations, such as loud noises or crowds. Try to learn each client’s triggers and symptom severity, as this information will be critical to success, not only in designing an exercise program, but also in ensuring client compliance in the long term. Be sure to provide a safe environment where clients can relax and focus on their health and well-being during the exercise session.
Fatigue is a common symptom of clients with depression and/or PTSD, particularly those who take antidepressants. Know what medications each client is taking, and adjust the intensity and duration of the activity to avoid overtiring the client. Be aware that a structured exercise program can give some PTSD sufferers a sense of control they lack in other aspects of their lives. There is a risk these clients could develop unhealthy or unsafe approaches to exercise, so make sure exercise does not become an excessive behavior.
Finally, there may be social barriers to exercise for clients whose symptoms include avoidance or withdrawal. For these clients, exercising one-on-one in a private setting may be the best strategy. As they build confidence, they can make the transition into a small-group setting, where positive social interactions will contribute to their mental well-being.
Exercise can play an important role in helping clients with PTSD recover and regain confidence. Exercise also addresses many of the health problems commonly associated with chronic PTSD, including cardiovascular disease and depression. While there may be challenges to beginning an exercise program for those suffering from PTSD, exercise professionals are in a unique position to provide the motivation and tools that will promote favorable change and improve quality of life for these clients.