Planned leave for PTSD
June 11, 2019 10:40 PM   Subscribe

I am considering taking planned leave to work on recovery from PTSD. Besides therapy, what do I actually *do* with that time? I’d you have done something similar, what helped you recover?

A couple of months ago I gave first aid to someone who was critically injured. It was a particularly distressing situation and injury and I have been struggling with post-traumatic symptoms since. I went back to work after a few days but have not been my usual self, and have now been formally diagnosed with PTSD. My work performance is slipping and I’m considering taking a planned period of leave to work on getting better.

The thing is...what do I actually *do* with that time? Therapy, yes, but what about the rest of the time? I have an overwhelming feeling that I just need the stress and deadlines to *stop* for a bit, but then what? have no family nearby and most of my friends work full time. I am eligible for insurance coverage which may pay for my medical expenses and lost wages, but I don’t have a lot of additional money to spend.

If you have taken time off for similar reasons, I am curious to know how you spent your time. How did you balance recovery-oriented tasks (therapy homework, exercise?) with things that made you feel like you were actually getting a break? Did you go away somewhere? How did you keep enough structure in your day to not fall into a Netflix hole?

(Possibly relevant: non-US location, don’t need specific advice about insurance, labour laws etc. Am happy with my current therapist - we’re using a mix of EMDR and other modalities. Really just interested in what do with planned time off).
posted by anonymous to Health & Fitness (18 answers total) 3 users marked this as a favorite
At first I really really needed rest, living with PTSD is hard, it's energy sucking and draining. After that I made an effort to try and establish supportive habits, engaging in hobbies, etc. I started regularly going to a spiritual group that I enjoyed and eventually made some of my closest friends that way.
I also went back to work slowly to get back into the routine and process any hiccups with my therapist, if that's possible I recommend that.
posted by AlexiaSky at 11:02 PM on June 11 [1 favorite]

If you like it at all, try to get some contact with nature and exercise every day - forest or park walks are good. Keep meal times. Do something with your hands that results in a physical product - cooking, crafts, diy. (I had burnout rather than PTSD but all these are centering activities.)
posted by I claim sanctuary at 11:36 PM on June 11 [2 favorites]

Have at least a bit of structure for each day, so that you don't feel like you're drifting through unstructured time, but also not to the point where you're stressed by your agenda. As others have suggested, come up with a list of relaxing things you'd enjoy doing (crafts, games, reading or consuming other media, exercise/nature time, relaxation/rest time) and chunk up the days into blocks of doing those things. The schedule can obviously flex if you don't feel like doing the thing you're meant to do at that time, but it should help with the absence of the "I know what I'm supposed to be doing right now" feeling that work often generates by default.
posted by terretu at 11:44 PM on June 11

Could you find a low-stress volunteer opportunity that still involves some contact with other people? PTSD can negatively affect connections with others and the experience of positive emotions. People with PTSD also frequently isolate themselves, which feels comfortable in the short term but in the long term exacerbates symptoms. I definitely think taking some pressure off sounds like it might give you some headspace, but check that you’re not moving too far in the other direction. Volunteering could provide some structure, human connection, and feelings of purpose, pride, and compassion (for yourself and others).
posted by Bebo at 3:05 AM on June 12 [1 favorite]

YMMV here because god knows mindfulness practice is not the cure-all people want it to be, but I personally did find it useful to take an intensive mindfulness-based stress reduction course when I was dealing with PTSD in the aftermath of a difficult event several years ago. If you take a formal course it tends to look like 8 or 12 weeks of weekly group sessions, during which you commit to an hour of personal practice every day, plus one all-day silent retreat. But if that's not something you can afford or commit to, and you want to try a homebrew version, you might try picking up a copy of Jon Kabat-Zinn's Full Catastrophe Living and see if it feels like it might be useful to you. If that is something you want to explore, this might be a time when you have the free time to commit to an hour a day for a specific period of time without too much trouble, and maybe you would find it helpful. (Or not! Some people find meditation actively harmful! If you try it and it sucks for you, or you read about it and are pretty sure it would suck for you, that's okay, you've learned something about yourself and do not need to do it again.)

Other things I found helpful during the worst PTSD times:

- Monthly massages, both for relaxation purposes and for really basic "experiencing human touch in a safe, controlled way" purposes during a time when sometimes touch was weird for me in other contexts

- Picking up a new hobby that required concentration, which was helpful for distracting my mind from spinning in circles. It was knitting for me, and I think having it be an actual physical set of motions also really helped, but YMMV.

- A support group. I didn't talk all that much, but it was really helpful just to be around other people who had experienced their own variants of what I'd been through, and to hear how much of my own experience was echoed in theirs.
posted by Stacey at 5:02 AM on June 12 [1 favorite]

Therapy and your therapist's recommendations come first, of course, but I'd try to get ahead of chores to make the transition back to work easier. For instance, cook healthy meals and freeze in single size servings, do any spring cleaning you've been putting off, and get ahead of those occasional errands like changing the oil in the car, getting your teeth cleaned, and buying any birthday gifts you'll need to send out in the next few months. Having this stuff done can let the rest of your life run on autopilot when you do go back to work.

Also, cook a dinner for your busy friends on some week night. It'll strengthen the bonds of friendship and make it easier for you to ask for their help when you need it.
posted by sdrawkcaSSAb at 5:54 AM on June 12 [1 favorite]

I have **just** been reading a book "Why We Sleep: The New Science of Sleep and Dreams" by Matthew Walker. His claim, after having studied sleep over last twenty years or so, was that sleep, especially REM sleep, alleviates painful memories by suppressing noradrenaline. Drugs like prazosin which reduces blood pressure and also suppresses noradrenaline, and is shown to reduce PTSD symptoms.

I can be just quoting this all wrong, so I highly recommend you read the book and sleep a lot in your time off work :)
posted by moiraine at 6:05 AM on June 12 [1 favorite]

When I was recovering from a domestic violence situation, I went to a therapist, and one thing she pushed me to do was go walking outside every day. I did that, after breakfast, wearing headphones and listening to upbeat music. She also encouraged me to get a hobby, and I chose writing, as it is free.

The other things I like doing are gardening, taking care of plants is soothing to me, and bird watching, trying to identify bird calls and observing them and their habits. I buy cheap seed packets and grow things from seed, or root things like mint that I buy for cooking, just stick 'em in a glass of water and they develop roots within a week or so.

What I really wanted to do was stay inside and not go out of the house, but she was very helpful, in addition to providing validation and helping me figure out other issues.

I also have other hobbies, crafts that I can pick up or put down, such as beading, using cheap wire from the hardware store and beads that I find on sale here and there, and painting, using cheap acrylic paints (I am not very good, but I like doing it once in a while).

I listen to my body, and when I am tired, will go sit on the couch and rest for 20 minutes (or more), sometimes I will indulge in watching Netflix for an afternoon, but usually just sitting quietly, with a cat next to me, for 20 minutes helps clear my head.

I also enjoy cooking, and have found ways to make delicious meals on a budget, and will often make extra (like pork dumplings, ground pork is cheap here, or gnocchi, potatoes are also cheap), and freeze the extra to make quick meals for when I am too tired or busy to cook. Lately I have been trying to incorporate more green vegetables into my diet, and exploring new and different ways to make them tasty (confit fennel with lemon is divine, and you can use the leftover oil in salad dressings, etc.).

I have a cheap pair of bluetooth headphones, and will sometimes listen to a podcast or relaxing YT video while I'm puttering around.
posted by Marie Mon Dieu at 6:37 AM on June 12

Just a note about prazosin, since moiraine brought it up: a large trial was recently published showing that prazosin did NOT reduce PTSD symptoms (Raskind, M. A. et al. (2018). Trial of prazosin for post-traumatic stress disorder in military veterans. New England Journal of Medicine, 378(6), 507-517.

Working on improving your sleep may be helpful (I definitely think sleep deficits are harmful), but be kind to yourself if sleep is challenging -- sleep problems are a VERY frequent issue in PTSD (they are one possible diagnostic criterion) and seem to be more resistant to treatment than some other symptoms. You also do not want to over-do sleep in the sense that you are laying in bed for hours of the day, or getting into a very erratic sleep schedule with lots of naps during waking hours.
posted by Bebo at 6:56 AM on June 12 [1 favorite]

Look for ways to be kind to yourself. Go for walks in lovely peaceful places. If you like to make art, do that, even if it doesn't feel like anything special to you. Visit art museums or galleries or sculpture parksLet yourself be lazy. Take time to take care of yourself in ways that feel good. Do you like to cook? Make yourself some delicious meals that you might not have time for when you're working.
posted by spindrifter at 8:29 AM on June 12

I just took about 10 days off for a little reboot, and I lightly scheduled my days into some kind of outdoor physical component (a couple of times I went to interesting places to walk around, but I also had some garden and yardwork that needed to be done), some kind of offline component (I generally took the 1pm-5pm range offline, either stuck into a household project and listening to an audiobook, or curled up reading an actual book, which I haven't done in aaaages), a journaling and/or meditation component, a block for errands most conveniently done on weekdays (passport renewal, car maintenance, haircut, etc). I did set aside two days to mostly do nothing but eat snacks and read a book, calling it a bookcation.
posted by Lyn Never at 8:31 AM on June 12

Possibly off-topic, so apologies if it's not useful, but you may find information in my earlier comment interesting in regard to lesser-known treatment options.
posted by Violet Blue at 10:54 AM on June 12

I slowed waaaaaay down on all life activities, got a lot of sleep (which helped a lot), read easy novels, and did the exercises in this book : Mind-Body Workbook for PTSD, which actually helped me considerably.

Other stuff that helped:
—Bessel van der Kolk’s PTSD book The Body Keeps The Score gave me useful intellectual understanding
—breathing exercises which have been shown to help the nervous system and help with PTSD, which I learned about from Bessel van der Kolk, and did using this device
yoga nidra
—and seconding the walking (and getting into nature), provided that feels okay for you

I felt a lot better after a month of slowing down and using the workbook I linked in the first paragraph. I hope you find something that is similarly healing for you <3
posted by sockkitude at 11:07 AM on June 12

Or, to put it another way, I embraced a state of “doing nothing” which was mostly only punctuated by PTSD homework (and life responsibilities I could not take a break on). I really did very, very little. It was a lot like a Netflix hole but without much Netflix. That’s what felt right to me at that time.
posted by sockkitude at 11:11 AM on June 12

I don't know that mine was a serious- EMDR helped it immensely- but mindfulness practices were really great, and by mindfulness, I mean watching the ground squirrels bicker for hours at the side of our local body of water. I just can't do the sitting still thinking of nothing, but apparently petty and spiteful ground squirrels are just the ticket.

The hard part for me was putting away all distractions and it would take at least 20 minutes for it to "work". For the first 20 minutes, I was thinking "well this is dumb." and "what a waste of time." and "I should probably be getting something done." and "well, I guess it's not going to work today."
posted by small_ruminant at 12:22 PM on June 12 [1 favorite]

Excercise. Planned daily excercise in whatever form works for you and your body. Maybe it's X number of 'hikes' (urban park walks count!). Maybe it's a trial membership at a gym for those days. Maybe it's yoga. Maybe it's crossfit. Maybe it's a mall-walk every morning? Maybe it's something new and interesting to you (horseback riding? climbing gym? a couch to 5km program?). Doesn't have to be intense. But daily exercise has benefits to your well-being, usually improves your sleep, often improves mood, and provides some structure to your day. Exercise can also be basically cost free (walking is free, trial memberships can be very cheap/free). This time is for you to take care of you, and taking care of the 'hardware' counts as much as re-programming the 'software' (brain) piece.
posted by Northbysomewhatcrazy at 12:47 PM on June 12

I like most everything mentioned above. Maybe useful: talk with your therapist *before* your break and set up a plan that complements whatever the clinical approach is.
posted by j_curiouser at 12:59 PM on June 12

The theory on prazosin and other alpha- and beta-blockers is that by dropping blood pressure, they decrease the fight or flight response, which can make a big difference for some people. I personally found that beta-blockers made me have to pee all the time, and alpha blockers interfered severely with my sleep medication.

I am also going through a bad episode of PTSD. What's helping me is:

Creative projects. Even on days where I sit on the couch with the tv, I have a bunch of art supplies in reach and I can at least mess with them, kind of the Lynda Barry school of thought - if you're going to watch tv, why not draw at the same time?

Yoga or some other physical activity. It can be hard, but whatever moving around you can do will help.

Eat properly. Fruits, vegetables, actual meals, you know the drill. If you can't handle cooking right now, that's okay, but even if it's just cutting up some raw stuff to go with whatever else you're eating it's a good step.

Stick to a regular schedule as much as you can. I find it very tempting to stay up very very late and go to sleep when it gets light out because I feel safer sleeping in the light, but don't do this if you can help it. YMMV but I honestly find it helps me to get up early, it makes me feel like I have more of the day to do things.

Stay in touch with your support network, and for as much as you can, see people in person and have physical contact.

Feel free to memail me if you want to talk about this more.
posted by bile and syntax at 3:32 PM on June 12 [1 favorite]

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