Research has shown that social support can have an important influence on response to trauma-focused psychotherapy for those with PTSD. A recent meta-analysis of various predictors of outcome in trauma-focused psychotherapy for those with PTSD found that greater social support predicted better treatment response (Keyan et al., 2024). For those who know someone with PTSD, knowing what to say to support them is crucial. They may have the best of intentions; however, some statements can unintentionally minimize or invalidate the person’s emotions and experiences.
To have an idea of what to say to support someone with PTSD, it’s important first to learn about what traumatic events are, what PTSD symptoms are, and their impact on functioning. Understanding the symptoms and their effects can reduce judgments and assumptions, which underlie most examples of the worst things to say to someone with PTSD.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013) defines a traumatic event as exposure* to actual or threatened:
-death,
-serious injury, or
-sexual violence
*Exposure can be that you experienced it, you saw it in person, you learned that it happened to a close friend or family member, or you were repeatedly exposed to traumatic details through your job (such as a first responder).
What is PTSD?
PTSD consists of symptoms that are associated with the traumatic event(s). The symptoms are grouped into 4 symptom clusters:
Intrusions: intrusive memories, nightmares, flashbacks, intense psychological and/or physiological reactions to trauma-related reminders
Avoidance: persistent avoidance or persistent efforts to avoid memories, thoughts, feelings, people, places, things, etc. related to the traumatic event(s)
Negative alterations in mood and cognition: negative views of self, others, or world, blame, persistent negative emotion (fear, horror, anger, guilt, or shame), feel detached from others, difficulty experiencing positive emotions (happiness, satisfaction, or love)
Alterations in arousal and reactivity: irritable behavior, hypervigilance (on guard too much), jumpy or easily startled, difficulty concentrating, trouble falling and/or staying asleep).
To find out more information on PTSD, you can read my blog post What is PTSD: What You Need to Know here.
Below we cover the worst things to say to someone with PTSD followed by examples of what to say.
What NOT to say to someone with PTSD
The worst things to say to someone with PTSD are statements that don’t support the person or what they’ve experienced. The statements below typically make a judgement or assumption. Those statements and behaviors can be dismissive instead of supportive.
Here are some examples:
- It could have been worse.
- It’s not that bad.
- Others/I experienced worse and have been fine.
- What’s wrong with you?
- Life isn’t fair.
- Everything happens for a reason.
- Everything will be okay.
- Focus on the positive.
- Just relax.
- Don’t worry.
- Just be grateful.
- You should feel lucky/fortunate that you have X.
- Why aren’t you over that already?
- That happened so long ago.
- Get over it and move on.
- Stop dwelling on the past.
- You’re overreacting.
- You’re being too sensitive.
- It’s all in your head.
- I know how you feel. / This reminds me of the time I…
- Here’s what you should do…
- If you had/hadn’t done X, then maybe the event wouldn’t have happened.
- Why are you so X (e.g., angry/uptight/paranoid) all the time?
What to say to someone with PTSD
Be supportive and understanding. Listen without judgments or assumptions, show that you’re interested and you care about them. Acknowledge their emotions and where they are coming from. Be patient. Follow their lead on how you can support them.
Examples of helpful statements:
- I’m here for you if you want to talk or need support.
- I’m here to talk or support you when you’re ready.
- I’m sorry those horrific events happened to you. I’m here if you want to talk.
- I see how upset this makes you feel.
- It sounds like this event really hurt you.
- You’re safe with me.
- I’m committed to our relationship and I’m here to support you.
- I’m confident that your symptoms/challenges can get better. I’m confident that you can recover from PTSD. I’ll be here to support you in the recovery process.
- You’re going through a really tough situation.
- It doesn’t matter how long ago it happened. It’s still affecting you and I’m here to support you in what you need.
Social support is an important piece in recovery after a traumatic event. Understanding the nature of traumatic events and the impact of PTSD symptoms is essential to foster empathy and avoid harmful statements that may unintentionally invalidate a survivor’s experience. Instead, offering compassionate, nonjudgmental support and following their lead in conversations can make a significant difference. By being aware of our words and actions, we can create a safe and supportive environment that encourages recovery for those with PTSD.
In my private practice in Northeast Ohio, I’m here to help those with PTSD navigate their emotions with care and understanding as they do evidence-based trauma-focused psychotherapy. I guide clients with a gentle and direct approach that addresses their needs. I specialize in providing two gold-standard psychological treatments for PTSD, Cognitive Processing Therapy and Prolonged Exposure Therapy, in person and via telehealth for those in Ohio.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). doi: 10.1176/appi.books.9780890425596
Keyan, D., Garland, N., Choi-Christou, J., Tran, J., O’Donnell, M., & Bryant, R. A. (2024). A systematic review and meta-analysis of predictors of response to trauma-focused psychotherapy for posttraumatic stress disorder. Psychological Bulletin, 150, 767–797. https://doi.org/10.1037/bul0000438
