Nurses and PTSD: Interview With Dr. Bill Tollefson

Nurses at Increased Risk for PTSD

Many nurses associate the term Post Traumatic Stress Disorder (PTSD) with combat trauma, but other kinds of trauma can cause PTSD including being physically or sexually abused as a child or adult, witnessing the aftermath of violent attacks, or witnessing the aftermath of catastrophic events such as hurricanes, earthquakes and tsunamis. Among health care workers, nurses, especially those who work in the emergency room, experience the highest rates of work place violence which is another exposure that may lead to PTSD. (Violence Against Nurses and its Impact on Stress and Productivity http://www.ncbi.nlm.nih.gov/pubmed/21667672 )

Despite their increased risk of developing PTSD, most nurses are more adept at recognizing signs and symptoms of this disorder in their patients, family members and friends, than at recognizing it in themselves or co-workers. Even when a nurse recognizes that she is exhibiting symptoms, she may not seek treatment for fear of being stigmatized or viewed as being unable to handle the stress of her job.

In his editorial article, PTSD in Nurses: On-the-job Trauma may be Driving Nurses from the Profession, Thomas Schwartz, RN, states that a nurse’s seeking help when experiencing PTSD should not be viewed as personal weakness, nor should it be seen as dangerous to one’s career. Some nurses become quickly overwhelmed by distress and leave their jobs, while others stay for decades, seemingly emotionally undaunted. Somewhere in the middle of those extremes are nurses who may be burned out but functional. Such nurses are unaware of-- or deny—signs of PTSD and suffer physical effects such as headaches, stomach problems, insomnia, eating disorders, and addictions that may be secondary to undiagnosed and untreated PTSD.

The following scenario titled, Nurse Kathy’s Story, shows how PTSD can be easier to recognize in others, than in oneself. It will be followed by an interview with William Tollefson, PhD., known as Dr. Bill to his clients and colleagues. In his book, Separated From the Light: A Path Back from Psychological Trauma, Dr. Bill, clearly describes the effects that abuse, combat, overwhelming stress events or traumatic life experiences has on humans. He has graciously agreed to share his expertise and will use Nurse Kathy’s experience to explain what traumatic memories, flashbacks and triggers are, and how treatment can help reduce the intensity of flashbacks and achieve closure of the associated emotions.


Nurse Kathy's PTSD Story

Kathy Smith, RN saw her father severely beat and almost strangle her mother to death when she was 5 years old. Because her mother survived the attack and divorced her father Kathy did not believe this incident had any long term effect on her. When she was 22 she married an Iraq war veteran. One night she got up to go to the bathroom and upon returning to bed her husband Sam lunged toward her, grabbed hold of the neckline of her nightgown and snarled, “Don’t move or I’ll kill you.” Then, as quickly as he’d lunged at her, Sam released his hold and fell back to sleep. Although Sam had no memories of the event the next morning, he cautioned her to never sneak up on him again because it triggered flashbacks to his combat experiences. Thus began Kathy’s feeling of walking on eggshells in the household, fearing that doing the wrong thing could trigger a violent response in her husband.

Although he never threatened her again, by the time their son was born, Sam was exhibiting increasing signs of PTSD including frequent nightmares, flashbacks, inability to hold a job, increased startle reflex and emotional numbness. Kathy finally convinced him to get counseling through the VA by making it clear she could no longer go on living the way they had been. Sam’s psychological symptoms improved but he suffered a heart attack and after recovery continued to have unstable angina. By then Kathy’s fulltime job as a community health nurse made her the main bread winner and she had difficulty relaxing at home and was exhausted all the time.

One day while on a homecare visit to a female patient who had a 4 year old child, Kathy’s patient disclosed that her ex-husband had just left the apartment after holding the family hostage for 2 days. The patient also admitted she had been beaten and raped at knifepoint in front of her young daughter.

Recognizing that her patient and the patient’s daughter had been traumatized and endangered, Kathy advised the patient she would have to report the incident to her doctor and to child protective services and that she would also get an order for a psychiatric social worker to provide counseling.

Kathy was badly shaken by the patient’s revelations and realized her own life could have been endangered if the abusive ex-husband had still been holding the family hostage when she’d arrived. After this incident, Kathy began having intrusive flashbacks to the time she’d witnessed her father beating her mother and she felt increasingly fearful in her own home.

One final event made Kathy realize she needed to seek psychiatric treatment for herself. She arrived at her homecare office for report and learned that a co-worker had suffered a stroke and the co-worker’s husband (who had a history of violence) had threatened to kill their supervisor because he felt his wife’s stroke had been caused by the heavy work assignments.

Kathy was terrified that even though the office doors were locked, the angry husband might burst into the office at any moment. After getting report she quickly left to visit her first homecare patient who lived in a high crime, inner city neighborhood. Although she’d made home visits in neighborhoods like this many times, things seemed different today because her fear was so acute. She felt nauseous, shaky and had difficulty concentrating as she climbed the dark narrow stairway up to the third floor. She barely got through the visit, and when she got back to the car she knew she couldn’t keep on like this anymore and resolved to make an emergency appointment with a therapist. She was diagnosed with PTSD and depression.

Photo: Dr. Bill Tollefson

Source

Separated From the Light: A Path Back From Psychological Trauma

Dr. Bill's book, Separated From the Light : A Path Back from Psychological Trauma puts forth his theories and principles for stopping the haunting memories from the experience of trauma and abuse.

  • This is a must read for individuals who have experienced traumatic or abusive life events.
  • It offers common-sense theory explaining what a human being does in reaction to trauma and suggests a path to recovery.
  • The book can be purchased by clicking on the highlighted link in this box.


Interview With Dr. Bill Tollefson

Dr. Bill is a well known expert on the effects of abuse, combat, human behavior, stress, and trauma. He has traveled both nationally and internationally educating other professionals on the effects of PTSD and Stress disorders and has developed highly effective and simple life coaching skills to help individuals perform more effectively. Dr. Bill has CD’s and DVD’s for both survivors and professionals that teach his principles and procedure for his widely successful and ground-breaking Rapid Reduction Technique (RRT). He shares his expertise with us in the following interview:

1. Using Nurse Kathy as an example, can you explain how the brain works with traumatic memory? When the brain is faced with an intense overwhelming life event, like Nurse Kathy had when she witnessed the life-threatening abusive attack on her mother, the processing of the event is put on hold and hidden from consciousness for protection. The recorded event is then held in a temporary location where it remains unprocessed for months, or as in Nurse Kathy’s case, years until something triggers it to resurface.

2. Can you explain what a trigger is? Triggers are any event, person, smell, thought, or place that initiates a reaction or sets off another. The trigger brings the memory out of hiding and back into consciousness with all its intensity in an attempt to make emotional closure and integrate it into long-term storage. If the memory isn't processed, i.e. if it’s rejected or repressed, it’s then forced back into temporary storage.

3. Can you explain what a flashback is? It’s the resurfacing of an unprocessed traumatic memory. When Nurse Kathy heard her patient describe how she’d been abused in front of her child it triggered a flashback in Kathy about her own mother’s abuse that had occurred in front of her.

4. Are there any techniques or skills that can help reduce the effects of traumatic flashbacks and memories? Yes. A guided protocol called Rapid Reduction Technique (RRT) was developed to reduce the effects of traumatic flashbacks and memories for women who have experienced abusive and traumatizing life events. RRT, which has been used and studied for 10 years, has been successful in helping survivors reduce the intensity of the flashbacks and achieve closure with the associated emotions. This facilitates storage of the traumatic event into long-term memory.

5. Would Nurse Kathy benefit from RRT? Most likely she would. RRT is a teachable and safe skill which works on one memory at a time and it’s based on revisiting traumatic or abusive life events, not reliving or re-experiencing them. It’s a stress management skill that helps a person to reset and heal the traumatic flashback.

6. Could Nurse Kathy’s husband benefit from RRT? Most probably yes as RRT was redesigned to be used with combat veterans. This version is called V-RRT and helps combat veterans reduce the intensity of their flashbacks by helping them process the images, smells and sounds they experienced in combat. V-RRT is a teachable and safe stress management method which works on one battlefield memory at a time. Both RRT and V-RRT teach survivors to bring a reoccurring flashback up to consciousness safely, work with the associated emotions, re-write the content and assist the brain in processing the memory into storage.

7. Are military nurses and/or nurses who work in civilian trauma units and emergency rooms at increased risk for developing PTSD? Yes, as are those who care for the wounded after catastrophic events such as hurricanes, earthquakes and tsunamis.

8. You are a certified life coach and offer phone consultations to coach and teach individuals to take back their freedom from past events of trauma and abuse and move forward. How can readers learn more about your coaching sessions, coaching tools, book, CD’s and DVD’s?They can visit my website, William Tollefson, Ph.D. Life Coach, Author and Speaker at: http://www.drbilltollefson.com/, email me at TollefsonEnterprises@gmail.com or call me at 239-349-2209.

Summary

Nurse Kathy’s story illustrates how our work experiences, especially when combined with a stressful home situation and previous exposure to trauma, can trigger PTSD symptoms in ourselves, yet we may be so busy focusing on our patients and our families that we fail to recognize our own emotional vulnerability and symptoms until they've reach the point of near incapacitation. All nurses need to be aware that their jobs may put them at risk for developing PTSD and should seek treatment if they suspect they may have PTSD.

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Comments 40 comments

cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

social workers, too, can get vicarious trauma and PTSD, just from listening to stories of how others were traumatized.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Cathylynn99,

Thanks for leaving such an insightful comment. I totally agree and am glad you brought that point up.


BobbiRant profile image

BobbiRant 5 years ago from New York

I escaped PTSD pretty much from my first marriage, but I did suffer other ill effects from the trauma. Good hub.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi BobbiRant,

Thanks for leaving a comment. In reading your hubs I know you went through a lot of trauma when you were married to your first husband, who had PTSD.

I'm glad, however, that you didn't develop PTSD from his abuse.

Of course you still suffered greatly during those years and it's a testament to your resilience, strength, determination and hard work that you not only endured, but went on to create a good life.

I appreciate your feedback and support.


Dr Bill Tollefson profile image

Dr Bill Tollefson 5 years ago from Southwest Florida

Happyboomernurse - Awesome Hub!!!! What an important subject that describes the unseen plight of nurses with PTSD. It is important that the general public is made aware of how much a nurse goes through, what they see and how they are affected.

A lot of people are unaware that there are two types of trauma, primary and secondary. Primary is when the trauma happens to one directly and secondary is when one witnesses a trauma (visually, verbally or emotionally). There is no difference between the resulting PTSD symptoms.

Nurses are on the front line of patient care and are subjected to secondary trauma all the time. They do not get the respect they deserve. Thanks for writing this article to let others become more aware and to hopefully get nurses more recognition for what they do.

Great HUB!!


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Dr. Bill,

Thanks so much for your gracious assistance and support in writing this article. I am so pleased you liked it! Am also glad that you're on Hub Pages bringing recognition to this issue, not just for nurses (who are so dear to my heart because I am one) but also for those in other occupations who are exposed to secondary trauma as part of their jobs such as police, EMT, social workers, physicians, military etc.

You bring hope and relief to those who are suffering from PTSD and also to their family members, friends and co-workers and can help them move forward with their lives.

Thanks again for your help in writing this article. It's been such an honor and pleasure working with you.


Dr Bill Tollefson profile image

Dr Bill Tollefson 5 years ago from Southwest Florida

Hey Happyboomernurse

It was really my pleasure to work with you. We make a good team to help enlighten others. Peace!!!!


Chatkath profile image

Chatkath 5 years ago from California

Such great information HBN - thank you for sharing this with us. Great article! Rated up and useful!


Hyphenbird profile image

Hyphenbird 5 years ago from America-Broken But Still Beautiful

This article is so needed in the field of nursing. These days nurses see even more trauma and the young children ans elderly victims tear out the heart. A friend is a nurse and she suffers terribly after working with a patient who needlessly died or was damaged for life. I am going to email her the Hub link to this. Thank you HBN for your compassion and love.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Chatkath,

Thanks for taking to read this hub and for the rate up. I really appreciate your ongoing support, and this topic is particularly dear to my heart as I know so many who suffer from PTSD.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Hyphenbird,

So glad you're passing this hub onto your nurse friend. I'm sure she appreciates the fact that she can talk to you and know she'll receive a compassionate, understanding response. Also, thanks so much for your ongoing support. This topic really hit home with me as my spouse is a Vietnam Vet dx with PTSD and I suffered from it also. Nurse Kathy's scenario was partially based on my own experiences.


Denise Handlon profile image

Denise Handlon 5 years ago from North Carolina

Excellent hub, Gail. I'm so glad you shared this and in the unique and special way you did. I can so relate to the subject matter. Voted up and awesome,useful, interesting. :) Well done!


Sunnie Day 5 years ago

Dear Gailm

This was by far one of the best hubs I have read in awhile..As a school nurse I have seen children with PTSD..in little ones whose fathers are over in the war zones or even overseas..As a nurse it does effect us..day after day dealing with the emotions and not being able to make it better as we are only with them a short time..I know this is not near as traumatic as working in the ER or with victims but it does come in so many different pacages..Thank you for sharing such an infromative hub.

Sunnie


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Denise,

Thanks so much for the vote up and kind words. I so appreciate your support.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Sunnie Day,

How sad to think of the little children suffering from this. I agree that as nurses the things we are exposed to can be emotionally draining even if it's not related to severe trauma and even if we're not suffering from PTSD. We often wish there was more we could do to help our patients and have to learn how not to bring the psychic pain home with us. Sometimes that's extremely hard.

Thanks for all your support. It's greatly appreciated.


mothercristina profile image

mothercristina 5 years ago

Thanks for sharing this information. I have many close people in my life who are extremely caring nurses, but never think of looking out for themselves. Good to know the signs to help be a safe guard for them. Very informative.


b. Malin profile image

b. Malin 5 years ago

I imagine that Nurses see so much and do so much to Aid and be there in some of the Darkest Hours...and so it's got to catch up. What a Wonderful, Informative and so timely a Hub Read, Gail. Thanks for Sharing.


Dr Bill Tollefson profile image

Dr Bill Tollefson 5 years ago from Southwest Florida

Thanks to all for such great comments. Nurses are an extremely important part of the healing art of medicine and they need to be taken care of and supported.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Thanks Dr. Bill, Mothercristina and b. Malin,

It feels so good to have nurses being supported and appreciated for the difficult work they do and I've been so touched by the compassionate response to this hub, and very honored to work with Dr. Bill on it.

I appreciate the kind, thoughtful comments.


Danette Watt profile image

Danette Watt 5 years ago from Illinois

Very informative hub on PTSD. I've had some experience with it myself and could relate to the building up to seeking help that Nurse Kathy experienced. Voted up and useful


kimh039 profile image

kimh039 5 years ago

OUTSTANDING! Very well done on many levels, HBN. Sadly, or even more sad, is that PTSD untreated often leads to substance abuse problems as an attempt to medicate the symptoms and "forget" the memories. I often see nurses who are working with the nursing board to re-instate their license. By the time I see them they are ambivalent about whether or not they want their license back. Thanks for the exceptionally well presented information. We should get continuing ed credits for reading this one!


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Danette,

Thanks for the vote up and positive review. I greatly appreciate your support and always look forward to your feedback.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Kim,

As you so frequently do, you've brought up an important point that enhances the body of my hub. Without treatment for the PTSD, substance abuse can become a big issue, leading to eventual job loss.

Thank you so much for the work you do with nurses who are suffering from PTSD and also those who are or have been substance abusers in an effort to self-medicate.

I highly value your professional point of view and critique of this article and am glad you took the time to make such an insightful comment.

Much of the credit for this article goes, of course, to Dr. Bill who was so wonderful and generous with his time and expertise. It was a pleasure working with him on it.


wysley profile image

wysley 5 years ago

Terrific article!!! The information was extremely enlightening, comprehensive and moving! PTSD can indeed be a very difficult thing to deal with. Having a life coach who specializes in helping people heal from PTSD, such as Dr. Bill can help transform a person's life from the insidious effects PTSD may be having. Thank you for the review.


Dr Bill Tollefson profile image

Dr Bill Tollefson 5 years ago from Southwest Florida

Wysley - Thanks for the nice words. There is a safe way out of the effects of PTSD.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Wesley,

I agree that having a life coach like Dr. Bill, who specializes in helping people heal from PTSD, can help transform a person's life from the insidious effects of PTSD. I was so thrilled to be able to have Dr. Bill's expertise while writing this article.

Thanks for taking time to leave an insightful comment. It's very much appreciated.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Dr. Bill,

Am glad you saw Wesley's comment and I thank you again for your help in writing this article and for all the work you do with clients who are suffering from PTSD.


Dr Bill Tollefson profile image

Dr Bill Tollefson 5 years ago from Southwest Florida

Happyboomernurse

Thanks, my work is my passion and I am attempting to help one survivor at a time. I am glad I have been involved with you to get out the word that there is away to decrease a PTSD symptom that is safe.


prairieprincess profile image

prairieprincess 5 years ago from Canada

HBNurse, this is just such excellent material. I studied this condition myself after going through an abusive relationship and growing up with abuse in my home, too. For me, counselling was very helpful and I eventually was able to move past it.

I think PTSD is a big factor for a lot of people, especially kids from abusive homes. Many kids who can't learn may be suffering from this condition. It makes sense that nurses would be subject to it, too, because of the situations they find themselves in.

As always, a wonderful informative hub from you. Thanks for writing it! Take care.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Prairieprincess,

Thanks so much for sharing your personal experience. You are right in saying that PTSD can also effect survivors of domestic and child abuse. I am glad you got the help you needed to move past your traumatic experiences.

I appreciate your ongoing support and the insightful comments that you leave.


Minnetonka Twin profile image

Minnetonka Twin 5 years ago from Minnesota

Hi Happyboomernurse-As you may remember, I have my Master's degee in counseling and psychological services but more than that I had a tough childhood. I was diagnosed with PTSD for a couple of reasons: Born with a heart defect and eventually had open heart surgery as a young girl and always being treated with kid gloves because of it, difficult childhood with alcoholic parents. I think the numbers on PTSD are much bigger than are reported as many aren't aware of what they are experiencing and many never get help. Great article with great information and case study. Hit many buttons :-)


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Minnetonka Twin,

Your life and chosen career have given you special insight into the diagnosis of PTSD and I so appreciate you sharing your knowledge and personal experience and agree that there are probably many who are suffering from PTSD symptoms but aren't receiving treatment.

I'm glad you liked this article and much of the credit for writing it goes to Dr. Bill as I couldn't have done it without his help.

Thanks for your ongoing support. It really means a lot to me.


RNMSN profile image

RNMSN 5 years ago from Tucson, Az

excellent Hub Gail as always and very pertinent issue for us all!


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi my dear friend Barbara,

I've missed your wonderful presence on Hub Pages but have read some of your articles on other sites, just haven't been able to leave comments.

Glad you found this hub useful. Coming from a nurse whose articles I admire so much, your feedback is special to me cause I know you set high standards for yourself and others.

Thanks for the support you've given me since the start of my Hubber journey. It's greatly appreciated.


marcoujor profile image

marcoujor 5 years ago from Jeffersonville PA

Happyboomernurse,

I saw so many hubs of yours that I wanted to check out, but this had to be first on my list. This is a subject I am all too familiar with. As such, I feel quite an "expert" in telling you and Dr Bill that you do make an awesome team in sharing this "sanity" saving information.

I was grateful for my dear husband's encouragement (rather strong) to get me to agree to see treatment in 1999. It was so resisted by me (saver of all but herself) but in looking back, so necessary to move on and thrive.

Thanks for this wonderful piece- voted UP & UABI, mar.


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Welcome Marcoujor,

Thank YOU, for your kind words and I was hoping you would find this hub and give me feedback. When I read your survival hub I got chills as workplace violence directed at nurses is a risk all nurses are exposed to and I was so sorry that you had been through such a trauma. However, I was absolutely in awe of how you have moved on to a place of compassion, empathy, sensitivity and are now thriving and helping others to move forward.

I'm so glad that you listened to your husband's urgings and got the help you needed. Yes, as a group nurses, myself included, have a hard time acknowledging we need help. We easily see when our patients, friends and loved ones show signs of PTSD but too often fail to see it in ourselves.

As regards to Dr. Bill, I felt so blessed to work on this article with him as he has so much expertise and experience in this field and was wonderful to work with.

May God bless you as you continue on your healing journey.


Peggy W profile image

Peggy W 5 years ago from Houston, Texas

What an important topic for all the nurses and others who are daily exposed to things that can trigger PTSD. You have covered it pretty thoroughaly especially with the additional comments. Nice to know that there is treatment for this. I'll bet that the statistics are much higher than reported! Useful and up!


Happyboomernurse profile image

Happyboomernurse 5 years ago from South Carolina Author

Hi Peggy,

Thanks for the positive feedback. This is an important topic and there is effective treatment for it which is why I felt so honored to collaborate on this article with Dr. Bill.


thecnatraining profile image

thecnatraining 4 years ago from Vancouver

This is a great hub, i really enjoy interviews in general because they give us an in depth look into the persons brain otherwise we would not see. thank you!


Happyboomernurse profile image

Happyboomernurse 4 years ago from South Carolina Author

Welcome thecnatraining,

So glad you enjoyed the hub and I thank you for leaving an insightful comment. It's greatly appreciated.

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