Traumatic events are unfortunately common and never easy to discuss. With the sensitivities surrounding these events, many people often try to avoid talking about or dealing with the effects a trauma may have had on their health. Recent events have thrust the topic of traumatic events to the forefront of the debate, prompting people to confront the issue directly.

The best methods to discuss a trauma are not always clear, says David J. Puder, MD, medical director of the MEND partial and intensive outpatient program at the Loma Linda University Behavioral Medicine Center (BMC). Today, on World Mental Health Day, Puder offers guidance to support a loved one who has survived a traumatic event. Here are some edited excerpts from an interview:

Question: When dealing with somebody who is a survivor of a traumatic event, or may be suffering from post-traumatic stress disorder (PTSD), is there anything we should avoid saying?

David J. Puder: Only about one-fourth of people who go through trauma end up having PTSD — the worst the trauma, the more likely they are to have PTSD. People can experience nightmares, flashbacks, numbness and thoughts of the trauma that invade someone's life. PTSD is a living memorial of the traumatic events.

Usually the first time someone brings their trauma up, they will re-feel some of the anger and numbness that comes with experiencing trauma. You, as the person listening, are often not ready to hear the story.

I've had numerous patients who tell me how distressing it was to tell their parents — and for their parents to get agitated and not know what to do about it. You would not want to get angry at the person who's been through the trauma, and you would not want to tell them that they did something wrong.

Parents often do this because they want some level of control, and they don't want something so horrible to happen again. Despite wanting to be helpful, this communicates to the victim that they were responsible for their trauma, and it's very shaming.

If a loved one or a family member opens up about experiencing something traumatic, is it beneficial to ask questions, or should the listener remain silent?

Express your concern for the person. Tell them that you appreciate them sharing these details with you and that you’re glad that they’ve shared what has been causing them to struggle. Let them know that you hear them and that you’re hurting with them.

If you're confused on why a person is stuck in their grief, ask them to help you understand. By listening to the person’s needs you can achieve a new level of understanding.

Quips like “Look on the bright side” or “There's always a silver lining” may feel helpful, but can they be damaging?

Just showing empathy and sitting with them in silence would be more beneficial than making these statements. Some people have hypomanic defenses — meaning that they have emotions they don't want to feel, so they try to look on the bright side.

It's a defense against the experience, but we want to stay in the emotion of actual experience, even if it's extremely difficult.

Instead of these statements, it would be better to acknowledge their feelings and let them know you wish you could have protected them. I think it's good to consider how you would want someone to be present with you in the midst of your hardship and then consider how you will be present with people when they tell you their stories.

What would you advise if someone who knows a loved one is suffering feels as though that loved one is trying to disconnect?

Disconnection is normal at times, and it can be beneficial. In relationships, people sometimes need a break or some distance.

If nothing else, it can be beneficial for the other person to know that you are there. If you feel a level of disconnection, reach out and remind them you’re there. That open invitation is helpful for the person to know that you care and that you want to continue to hear their story even though it's hard to hear the stories. It's hard to walk through pain and suffering with someone.

What can you do if a loved one is lashing out when you're trying to be there or while they're sharing a difficult experience?

If they're physically lashing out, you need to protect yourself first and foremost. However, if they're getting angry at you, it may be their way of releasing frustration at the safest person.

As a therapist, I usually embrace when someone is angry at me because it's part of the process, and it’s actually helpful in getting out of the trauma. It can be best to not get defensive, and to let them know that you understand why they might feel anger from the situation.

Often people who suffer from PTSD vacillate between anger and association. The anger can be difficult to deal with, especially for spouses. Getting back to a place where they feel safe and comfortable will allow them to better work toward overcoming PTSD. There are great options for therapy that can help people in the midst of the trauma.

How much time as a loved one do you need to give your friend or your family member to grieve?  

Sometimes, it can take years. Instead of asking when the grieving will end, think how you can more accurately understand the depths of this person's pain in the midst of their situation.

A couple of therapy sessions can make a huge difference in the healing process as well. Repetitive traumas take longer to heal and work through, and survivors may continue to have some issues, but by and large, good long-term therapy can make a huge difference.

Treatment programs can also make a huge impact. A day treatment program, like a partial hospitalization, can provide a group setting for survivors to share their stories. Being with a group of people who have gone through similar things can mean not feeling alone in the midst of their trauma, and help the person realize other people are struggling as well.

Are there signs to recognize that someone might have PTSD, or have developed anxiety or depression from a traumatic event?

The signs of PTSD vary based on multiple factors. How it presents in the body is determined by the biology with which each person was born.

If you see a loved one who is chronically fatigued or depressed, hopeless, irritable, uninterested in doing the things they used to enjoy, you should consider asking them if they’re experienced something they might need help understanding. It presents in some people through panic attacks triggered by something related to the traumatic event. Some people may have increased anxiety, or be hyper-sensitive to noises or other stimuli.

It can be difficult to know if these symptoms are from an issue impacting mental health, or if they are the result of an unrelated medical issue. It’s always good to see a primary care physician to get worked up to make sure there aren’t any medical issues causing the problems. During that time, seeing a therapist as well can allow a person to explore their psychological health.

It’s not only beneficial for someone who has experienced a traumatic event, but also for those with whom they are sharing their experience. Sometimes a person who is in the midst of walking with someone who's going through trauma needs help navigating how they're coping as well.

Consider treatment not only for your loved one but for yourself. See a therapist even if it's just a couple of sessions to process through what's going on. Everyone has a situation that is idiosyncratic and unique, and talking with a therapist can make a big difference.


Listen to the clip below to hear to the full interview with David J. Puder, MD.