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Rates of post-traumatic stress disorder (PTSD) in men are about half those in women—but men are at higher risk of experiencing traumatic events. What explains the discrepancy? That question is worth exploring because it has direct implications for the treatment of PTSD in men.
For more insights, we reached out to someone who has extensive experience treating PTSD in men. Annalee Moody, LMHC, CFRC, is a certified first responder counselor in FHE Health’s specialized treatment program for first responders and veterans (“Shatterproof”). Moody is also a licensed mental health counselor with a master’s degree in clinical mental health counseling and a focus in neuroscience-based therapies. As a veteran of the U.S. Army Reserves and former first responder, Moody has personal familiarity with the kinds of trauma that disproportionately affect men. She is also trained in the highly effective trauma therapy knowng as “EMDR” (or “Eye Movement Desensitization Reprocessing”) and has advanced training in EMDR for treating cumulative and ongoing traumatic stress in veterans and responders.
Challenges Unique to Men with PTSD
We began our discussion with Moody by asking her to describe some of the challenges unique to men with PTSD. She was quick to point out the “social stigma” men face “with any mental health issues, especially PTSD.”
“Men have internalized that social stigma,” Moody said, “and that manifests as a harshly negative judgment with unfair and unreasonable expectations of themselves.”
This tendency toward self-judgment is amplified within the first responder population because of the nature of their work and the occupational expectations thrust upon them, Moody added.
Specialized Supports for PTSD in Men
Effective treatment of PTSD in men must address these obstacles to recovery that men uniquely face, starting with “brain-based education.”
“Men have this harsh judgment of themselves combined with very little education,” Moody said. “They don’t even know what PTSD is or how it works but they’re judging themselves. Brain education works by helping them understand they have a human brain problem and that the brain is adaptive over time to the environments we put them in.”
As illustration of this last point, Moody used an analogy that she often employs with first responders who have PTSD. “Say you have a dozen eggs and you put them in a pot of boiling water. We expect all those eggs to get cooked. Similarly, if you regularly expose your brain to trauma and high stress, it is only a matter of time before your brain will begin to experience the negative effects.”
In other words, “experiencing symptoms after exposure to traumatic stress isn’t something wrong with you or a personal weakness,” Moody said. When men see there is “not something inherently wrong with them,” this new awareness “helps to mitigate the very toxic guilt and shame” that too often impede recovery and are “why suicide rates are so high.”
Treatments That Work Better for Men with PTSD
What treatments tend to work better for men with PTSD? Moody recommended EMDR. Why? Because unlike more traditional psychotherapy, EMDR does not require a lot of talking or unloading of problems:
This application is good for men with PTSD, especially first responders, since they typically won’t burden other people with their issues and have limited emotional awareness. EMDR has over 30 years of research to support its use. It aims to operate on three levels, all of which are associated with the trauma: decreasing the disturbance level, reducing the somatic responses, and replacing the negative belief about oneself attached to that experience. EMDR works on all these levels without requiring that the patient talk very much at all about the incident(s) or their feelings. Once we’ve done some EMDR and the disturbance [from the traumatic memory] isn’t so high or is gone, then the patient is actually able to talk about it should they have that desire. Memory reconsolidation is a way to quickly mitigate the effects of traumatic exposures.
Common Misconceptions About PTSD in Men
The statistics regarding PTSD in men are “skewed,” Moody said, primarily because the condition “is not being diagnosed.” That can fuel misconceptions. In first responder settings, PTSD is not getting diagnosed because there is “no preventative mental health care for first responders,” Moody said, even though “we’re putting them in known PTSD-inducing environments.” Instead, most first responders must wait to receive care “until the train is totally derailed” and they’re in a full-blown health crisis.
That is one reason why Moody believes the prevalence of PTSD in first responders, a predominantly male occupation, is much higher than commonly cited statistics suggest. These usually say 40-50 percent of first responders have PTSD, “but how can you pull accurate numbers about a diagnosis when most first responders are not seeking treatment?” Moody asked. She believes as many as 80 percent of first responders have symptoms of PTSD that they don’t recognize.
What LMHCs Need to Treat PTSD in Men
We asked Moody to share some tips about what licensed mental health counselors need to treat PTSD in men. She emphasized “they need to get culturally trained to work with that specific population, because otherwise they won’t trust you. Trust is the most important factor in therapy.”
In addition to cultural training, Moody reinforced the importance of brain-based education skills and training in trauma therapies, especially EMDR: “You need to be able to educate patients about their brain and how they function; and knowing a treatment modality like EMDR is completely necessary.”
Advice to Those Who Are Hesitant to Seek Help
As for advice to men who may be hesitant to seek help for PTSD? Moody had these suggestions:
- Seek out other men who have gotten treatment and are in recovery for PTSD, because that will you “give you a real-life example of people who have gotten better and help reduce shame.”
- Educate yourself about PTSD, by reaching out to organizations like NAMI (National Alliance on Mental Health), SAMHSA (Substance Abuse and Mental Health Administration), or a local therapist. You can also find certified first responder counselors through the published online directory www.firstrespondercounselor.com.
- “Try things to see what works and understand that recovery is possible; part of the problem may be you think you can’t get better.”
Advice for Family Members Affected by PTSD
PTSD can be hard on close family members, too. Moody shared these words of advice and support:
- “Read, read, read. Get educated about the brain and PTSD, because there are so many misconceptions.”
- Get involved in your loved one’s therapy and ask them if therapy is helping, and if so, what is helping. Don’t ask them to share what they talk about during therapy; rather aim to be curious and supportive about their therapy experience.
- Be vocal in affirming your loved one’s progress in recovery when you see it and encourage them to keep going. You can often see improvements before the individual with PTSD recognizes them.
- Help reduce their guilt and shame by thanking them for taking care of themselves by seeking help. Ensure you are expressing your love and how valuable they are in your life.
- If you’re living with someone who has PTSD, you should consider seeing a therapist whom you can confide in for support or trying a support group.
Today we know more than ever about PTSD, what it is, and how to treat it. We therefore have more reasons than ever to speak in terms of “recovery” from post-traumatic stress. What quickly becomes evident from speaking with Moody is that more men need to hear this same message, only louder and clearer.
