Supporting someone with PTSD

When someone you love has PTSD (posttraumatic stress disorder), the whole family feels it. Your loved one may seem jumpy, distant or quick to anger. They may skip events you used to enjoy together. You may feel worried, hurt or unsure what to do.^1,2

You cannot cure PTSD for someone else, and you do not need to have all the answers.¹ But family and friends can make a real difference. This page covers what helps, what to avoid, how to encourage treatment and how to look after yourself along the way.

How PTSD can affect a family

PTSD symptoms fall into four groups. Each one can touch family life:²

Partners of people with PTSD often report more stress and less happiness in the relationship.² PTSD can also affect sex and intimacy, through symptoms and sometimes through medicine side effects.² Children can be affected when a parent has PTSD.²

Most people with PTSD are never violent. But conflict and partner violence are more likely when one or both partners have PTSD.² Your safety matters, and we cover it below.

To learn more about the symptoms themselves, see signs of PTSD and our PTSD overview.

Understanding triggers

A trigger is a reminder of the trauma that sets off strong reactions. It might be a sound, a smell, a news story, a place, a date or a crowded room. For example, a person who was in a car crash may avoid driving.³

Families can help in a few ways:³

1. Learn the triggers together. At a calm time, ask what tends to set off symptoms. Write them down if that helps.
2. Ask what helps in the moment. Ask ahead of time what they want during a nightmare, flashback or panic attack. Should you talk or stay quiet? Sit close or give space? Is touch welcome or not?
3. Make a plan for hard moments. Agree on what each of you will do if symptoms flare or a crisis happens. Our calm plan can help you write it down.
4. Check in and adjust. Every so often, talk about what is working and what is not. Then change the plan.

You can also learn calming skills together, such as our grounding practice or box breathing. See coping with trauma symptoms for more.

Avoid helping the avoidance

It is natural to want to protect someone from reminders. But some kinds of help can keep PTSD going. For example, one partner may do all the shopping so the other never faces crowds. Over time, this can make avoidance stronger.² If you notice this pattern, talk about it kindly. A therapist can help you find a balance between support and gentle steps forward.

What helps day to day

Learn about PTSD. Understanding why PTSD happens and how it is treated can make the changes in your loved one less confusing.¹

Listen without judging. Let them know you are willing to listen, and that it is fine if they are not ready to talk. Do not rush to fix things. Ask open questions and repeat back what you heard to check you understood.^1,3

Do not push for trauma details. Let your loved one decide what, when and how much to share.^3,6 Do not share their story with others without permission.³

Talk clearly and calmly. Be clear and positive, and avoid blame. Name your own feelings, and help them name theirs, for example by asking if they feel angry, sad or worried. Ask how you can help instead of giving advice they did not ask for.¹

Plan low-pressure time together. Meals, a movie, a walk or a bike ride can help you both. Go at their pace. A small get-together may be easier than a crowded place.^1,3

Encourage other connections. Contact with close friends and family gives your loved one a wider circle of support.¹ Our care circle tool can help you map who can help.

Expect slow change. If your loved one pulls back or turns down help, give them space. Let them know you will be ready when they are.¹

When anger flares

Anger is a common reaction to trauma. It can still harm relationships and feel frightening.¹ Some couples use a time-out plan, agreed on ahead of time:¹

1. Either person can call a time-out at any time, using a signal you choose, such as a word or hand gesture.
2. When a time-out is called, the talk stops right away.
3. Each person says where they will be and when they will come back.
4. During the break, focus on calming down and on solutions, not on going over the anger.
5. When you come back, take turns. Use "I" statements, avoid criticism, and agree on one thing to try.

Encouraging treatment

PTSD can be treated. Talk therapies such as prolonged exposure, cognitive processing therapy and EMDR are among the main treatments. Learn more on our pages about trauma-focused therapies, medicines for PTSD and getting assessed.

Raising the subject of treatment can feel hard. These tips from the VA can help:⁵

• Show support. Say that you want to help, and that you can see things are hard right now.
• Pick a good time. Plan the talk so they are not caught off guard.
• Take it in steps. Share your concern, then come back to it later. One talk does not have to settle everything.
• Avoid pressure and ultimatums. Demands can make a person less likely to get help.
• Respect their choice. Make clear the decision is theirs, and offer specific help, like finding a therapist or driving to the first visit.
• Share how things affect you, in a calm way that is not a threat.

You can also offer to go to appointments, take notes, and help keep track of therapy and medicines, if your loved one wants that.^1,3

During treatment. Some trauma therapies can feel harder before they feel easier. In prolonged exposure, for example, the person may feel more upset at first after practice tasks. This does not mean treatment is failing.⁶ You may be asked to join some practice outings. Give your loved one privacy about what they work on in sessions.⁶ See supporting someone in treatment and how to start a conversation about mental health.

The VA offers a free online course called Help with PTSD. It is built on a method called CRAFT (Community Reinforcement and Family Training). It teaches family members how to encourage treatment, communicate better, care for themselves and make a safety plan. It is made for families of Veterans, but others can use it too.⁷

Family and couples therapy

If talks at home keep breaking down, family therapy can help. A therapist helps everyone talk about how PTSD affects the family, cope with strong feelings and support each other. Each person, including children, gets a chance to speak.^1,4 A doctor, faith community or social services group can help you find a therapist who knows PTSD.⁴

Some therapies treat PTSD with both partners in the room. One is called cognitive-behavioral conjoint therapy (CBCT). It is about 15 sessions. Couples learn about PTSD, practice communication and conflict skills, face avoided situations together and work on unhelpful beliefs.⁹ In a trial of 40 couples, the partner with PTSD improved more with CBCT than with a waitlist, across all symptom groups.⁹ Promising The trial was small, and more research is needed. Ask your loved one's therapist whether a couples approach is right for you.

Caring for yourself

Supporting someone with PTSD can be tiring. You may feel fear, anger, guilt or helplessness at times. That is normal.¹ Family members can also feel distress from hearing about the trauma, or from taking on extra tasks at home.²

Places to find support:

• PTSD Family Coach is a free VA app for iPhone and Android. It has tips for supporting a loved one, stress tools and a way to build your own support network.⁸
• NAMI Family-to-Family is a free 8-session class for family and friends of people with mental health conditions. Family members with lived experience teach it.¹⁰ The NAMI HelpLine is 1-800-950-6264.¹⁰
• VA Caregiver Support Line: 1-855-260-3274, Monday to Friday, 8 a.m. to 8 p.m. Eastern.¹¹ The VA Caregiver Support Program offers coaching, peer mentoring, training and other help for caregivers of Veterans enrolled in VA health care.¹¹
• Dial 2-1-1 to find local help with food, housing, jobs and support groups.⁴

Read more about caregiver burnout, setting boundaries and support groups.

If your loved one is older

PTSD can look different in later life. Retirement can leave more quiet time, when memories surface. Illness, pain and the loss of a spouse or friends become more common with age. They can add to stress, sadness and loneliness.¹² Some older adults talk about body aches instead of feelings, or do not talk about the trauma at all.¹² Treatment still works at older ages.¹²

When PTSD and dementia occur together, suspicion, aggression and nightmares can become stronger. Usual dementia care methods do not always work.¹³ Building trust, keeping a steady routine while staying flexible, and knowing the person's life story can help.¹³ Share what you know about past trauma with care staff, with your loved one's permission when possible.

See PTSD in older adults and veterans, agitation and aggression in dementia and VA benefits for dementia.

Common questions

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.