Coping with trauma symptoms

After a frightening or painful event, it is common to have bad memories, poor sleep and a body that stays on high alert. For most people, these reactions fade over time.¹³ For some, they last for months or years. That is called PTSD (posttraumatic stress disorder).

This page shares practical things you can do on your own, starting today. They can make hard moments easier and help you feel more in control. They work best alongside treatment, not instead of it.^1,8

What self-help can and cannot do

Coping is a skill that gets easier with practice. Small, direct steps can give you back a sense of control.¹

But it helps to be clear about the limits. In 2023, the VA and the Department of Defense reviewed the research on PTSD care. They found there was not enough evidence to say whether apps or other self-help programs work as a treatment for PTSD on their own.¹⁰ The same was true for exercise, yoga and acupuncture.¹⁰

That does not mean they are useless. They have just not been tested enough to count as a PTSD treatment. They can still help day to day.

The strongest evidence is for trauma-focused talk therapies, such as cognitive processing therapy, prolonged exposure and EMDR.⁷ Read about them on our page on trauma-focused therapies.

Grounding: coming back to the present

A flashback is when a memory feels like it is happening again right now. Your heart may pound. You may feel scared, frozen or far away. Grounding means using your body and senses to remind yourself where you are and that you are safe now.¹¹

1. Slow your breath. Breathe in while you count to 5. Breathe out while you count to 5. Fear makes breathing quick and shallow, which can feed panic.¹¹ Our cyclic sigh and box breathing practices can help.
2. Use your senses. Name things you can see, hear, touch, smell and taste. Say them out loud if you can. You can also count all the blue things in the room.¹¹
3. Feel something solid. Press your feet into the floor. Hold a cold drink or splash cool water on your face. Notice how it feels.¹¹
4. Touch a grounding object. Carry a small item, such as a key ring, a smooth stone or a ring, that reminds you that you are safe today.¹¹
5. Read your reminder. Before you need it, write a short note to yourself. For example: "That was then. This is now. I am safe in my kitchen." Keep it in your wallet or phone.¹¹
6. Comfort yourself. Wrap up in a blanket, pet your dog or cat, or play music that calms you.¹¹

The VA suggests a similar idea for intrusive memories: tell yourself it is a memory from the past. Over time, these memories often become less overwhelming.²

Planning for triggers and anniversaries

A trigger (also called a trauma reminder) is anything that brings the trauma back to mind. It might be a smell, a sound, a place, a TV news story or a crowd.^4,11 Sometimes you will not know at first what set you off.

Some ways to cope:

• Keep a simple diary. Write down when you feel upset and what was happening. Over time, you may see patterns.¹¹
• Limit the news. Repeated news about violence, war or disasters can stir up old memories. Take breaks, and notice if you feel more angry, worried or low.⁴
• Do not avoid everything. Pushing away every reminder may bring relief for a while. But over time it can make symptoms stronger.³ Facing some reminders slowly, with support, often helps more.^3,11 A therapist can guide you through this safely.
• Write or talk. If you do not want to talk, writing in a journal is another way to let feelings out.⁴

Anniversaries. The date of a trauma can bring symptoms back, even many years later. Holidays and birthdays can do the same.⁵ Most people feel better within a week or two after the date.⁵

It helps to plan ahead. Decide how you want to spend the day. You might visit a grave, volunteer, or spend time with family. Take care of sleep, food and exercise that week. Download any helpful apps before the date arrives.⁵

Sleep and nightmares

Almost everyone who has PTSD also has trouble sleeping.⁶ Nightmares can replay the event. Some people put off going to bed because the night feels unsafe. Feeling always on guard makes deep sleep hard.⁶

Tips that may help:^2,6

• Go to bed and get up at about the same time each day.
• Use your bed mainly for sleep, not for TV or your phone.
• Cut back on caffeine, tobacco and alcohol, especially later in the day.
• Avoid hard exercise in the hours before bed.
• If you cannot sleep, get up and do something calm, like reading, instead of lying in bed worrying.
• After a nightmare, remind yourself it was a dream. Look around the room, turn on a light, and do something soothing.

These sleep habits are useful, but they are not a full treatment. CBT for insomnia (CBT-I) is a short talk therapy for sleep. The VA calls it the best treatment for insomnia. It helps about 7 in 10 people who finish it, and it can also reduce nightmares.⁶ You can learn it in person, by video, online, or with the free CBT-I Coach app.⁶ Our CBT-I lessons walk you through it.

Sleep medicines are usually meant only for a short time. Some, such as benzodiazepines, can cause serious problems with long-term use and are not recommended for PTSD.⁶ Talk with your doctor or pharmacist before starting or stopping any medicine. See medicines for PTSD and sleep, mood and anxiety.

Loud snoring or gasping in sleep can be a sign of sleep apnea, which is common with PTSD.⁶ Tell your doctor. Read more about sleep apnea.

Keeping a steady daily routine

A daily routine gives your days a shape you can count on.⁴

• Get up, eat and go to bed at regular times.^2,4
• Move your body every day, even a short walk. Exercise can ease tension and stress.²
• Plan at least one pleasant or meaningful activity each day, such as a hobby, art, gardening or time with a friend.^2,4
• Try a relaxation practice, such as slow breathing, gentle stretching, prayer, music or time in nature.² See muscle relaxation and tai chi.

Alcohol, drugs and other "quick fixes"

Many people use alcohol or drugs to sleep, relax or quiet bad memories. It makes sense. But it tends to backfire.

• More than 4 in 10 adults with PTSD (45%) also have problems with alcohol or drugs.⁷
• Alcohol may help you fall asleep, but it makes sleep less restful.⁷
• Drugs can make you more irritable and more likely to avoid feelings, which can worsen PTSD.⁷
• Using substances to cope with PTSD or poor sleep is linked to a higher risk of suicidal thoughts.⁶

Other quick fixes can also backfire: pulling away from people, angry outbursts, working nonstop to stay busy, and risky behavior such as fast driving or gambling.³

If you want to cut back, talk with your doctor. PTSD and alcohol or drug problems can be treated at the same time, and some medicines can lower the urge to drink.^7,2 Groups such as Alcoholics Anonymous and SMART Recovery can help too.⁷ The free SAMHSA National Helpline, 1-800-662-4357, can refer you to treatment any time, day or night, in English or Spanish.¹⁴ See also alcohol in later life.

Staying connected

Trauma can make you want to pull away. But being alone can make sadness, anger and fear grow.³ The VA encourages reaching out to people you trust, even when you do not feel like it.³

• Choose your people. Pick one or two people who listen well. Tell them clearly what you need, such as a walk together or just company.²
• You do not have to tell the whole story. You can get support without describing what happened.¹¹
• Try peer support. Talking with others who have been through trauma can help you feel less alone.^11,1 See support groups and peer support.
• For veterans: Vet Centers, the VA and veterans groups offer places to connect with people who understand.⁴

If anger leads you to lash out at someone you love, take a break and walk away. Later, talk with them about how you are feeling and coping.²

Family members can read supporting someone with PTSD.

The PTSD Coach app and other free tools

PTSD Coach is a free app from the VA's National Center for PTSD and the Department of Defense. It works on iPhone and Android. Anyone can use it, not just veterans. Family members can use it too.⁸

It offers:⁸

• Clear facts about PTSD and treatments that work
• A short checklist to track your symptoms over time
• Tools to handle stress in the moment
• Quick links to support and crisis help

There is also PTSD Coach Online, a computer version with 17 video-guided tools. Its tools cover problems such as sleep, trauma reminders and anger.⁸ The VA also offers free Mindfulness Coach and Coping Coach apps.¹

Does it work? In a 2022 study in Sweden, 179 adults with PTSD symptoms got either PTSD Coach or a three-month waiting list.⁹ After three months:

Source for the table: Hensler and colleagues, 2022.⁹

The benefit was real but modest. About half of app users had at least one complaint, mostly that the app was disappointing or confusing. About 1 in 8 felt more stress or had upsetting memories, though the app group did not get worse more often than the waiting group.⁹

About privacy. Your data in the app are only as safe as your phone. Use a passcode or other lock. The app is not meant to replace a professional exam or care.⁸

Later life: when old memories come back

Trauma symptoms can show up or get stronger in later life, even decades after a war or other event. Retirement, more free time, health problems and the loss of loved ones can all play a part.¹² Some older adults feel distress mostly as body symptoms, or do not talk about it.¹²

The coping skills on this page work at any age. Staying socially active and volunteering can help with both healthy aging and recovery.¹² Treatment also works for older adults. If travel is hard, ask about video visits.¹²

Older adults often take several medicines. Be sure each doctor knows all your health problems and your full medicine list.¹² Read more on PTSD in older adults and veterans.

When to get help

Reach out to a doctor or mental health professional if:^2,4

• Your symptoms are not easing, or are getting worse, after several weeks
• Coping skills do not seem to be enough
• You feel afraid, hopeless or depressed most of the time
• You are drinking or using drugs more
• Problems are hurting your relationships or work

Your family doctor can refer you to someone who treats PTSD.² See getting assessed for PTSD and how to find a therapist.

A safety plan can help you prepare for hard moments. Recovery from trauma is possible, and help works at any age.¹²

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.