Dr. Charlie Grantham and Susan Mulholland
Intent
This blog is about how to design workspaces for people with PTSD. However, we really want to place this in a larger context. PTSD is a result of traumatic experiences and our prototype case is taken from an armed combat environment. This group represents approximately 8 million people.
But the larger picture is that trauma comes in many forms: abusive relationships, mass shootings, physical assaults and deadly accidents. Other events can also lead to a PTSD diagnosis like natural disasters, wildfires, terrorist attacks and even a life-threatening event. This larger population is approximately 72 million people. And it varies by gender and age.
| “Trauma in all its many forms creates tremendous stress which shows itself in both physical and psychological forms. Work environments consciously designed to accommodate these symptoms would be a very useful tool in the stress management toolkit”. Dr. Heidi Hanna, author of “Stressaholic” and Fellow at American Institute of Stress. |
We hope that what we present here can be elevated to a larger context effecting bigger segments of the workforce. We note that in the data above the overall prevalence of PTSD is almost 3 times higher among women than men.
Technically, our approach falls into the neuro-diversity paradigm that is used in the workplace design community to account for psychological functioning and value diversity in neurobiological development. In a contemporary setting this usually refers to a person’s placement along a spectrum of autism.
Backstory
We want to extend that thinking to a wider range challenges which effect a person’s work style and differential reaction to environments. We are focused here on just one incidence of a psychological syndrome. It is our belief that the physical design of work environment can ameliorate some of the more common negative symptoms.
Design Challenges
Although there are many symptoms of PTSD, we have decided to focus on a subset we believe is most amenable to changes in the design of the work environment. It should be noted that these could also be extended to other spaces occupied by these folks, such as recreational facilities and the home environment.
In fact, what got us started down this pathway was a challenge presented by a client about how to design home/workspaces to accommodate people along the neuro-diversity spectrum.
To better understand the underlying psychology of trauma and stress we spoke with Dr. Robin Pratt of Enhanced Performance Systems. Dr. Pratt has more than 40 years in the research and development of high performance experimental psychometric cognitive and behavioral assessment techniques. He explained that under high stress conditions signals from the environment are overcome by ‘noise’, people become highly distractible, lose their train of thought and have reduced flexibility.
Based on these hypotheses, we have picked five key psychological characteristics of people with moderate to severe PTSD.
- Hyper-vigilance: Always on alert scanning the environment for real and perceived threats. In severe cases this can turn to paranoia.
- Easily startled: The slightest unusual noise, close presence of someone in their ‘personal space’. Getting snuck up on.
- Difficulty concentrating: Closely related to hyper-vigilance. So much attentional energy is devoted to environmental scanning, little is left for the task at hand.
- Emotional triggers: Usually seen as overreactions to other people’s expression. Triggers the flight/fight/freeze behavior.
- Easily distracted: The ‘look another shiny object’ behavior. Affects all five sensory modalities – sight, sound, smell, touch and taste.
Here are some practical design guidelines to improve the adverse effects of each of these PTSD symptoms. These guidelines should be utilized in a general and that folks who are suffering from severe trauma or have multiple PTSD symptoms will need more of a personalized approach to their workspace environment that focuses on their specific needs. In summary, we can link symptoms and design implications.
| Psychological Symptom | Design Implication |
| Hyper-vigilance | Optional Spaces, Lighting, Acoustics, Workplace artifacts |
| Easily startled | Optional spaces, Movable worksurfaces, Acoustics, |
| Difficulty concentrating | Movable worksurfaces, Lighting, Acoustics, Wall Coverings, Smells |
| Emotional triggers | Acoustics, Smells, Wall Coverings, Workplace artifacts |
| Easily distracted | Optional Spaces, Acoustics, Wall coverings |
Implications Expansion
- To limit distractions and encourage focus, provide employees with optional spaces to do their best work. Include areas that are easily reached from their personal work areas if the work environment has an open plan. An example could be a small conference room that has doors. The views outside should be of landscaping and not parking lots or back alleys. The lighting should be controllable, and the furniture should be modular and movable. The size of the space should be bigger than a typical workstation cubical (6 x 8) where two to four people can work together but no more than what is necessary.
- Worksurfaces and desks should be easily movable or mobile depending on the traffic flow or door location where it can be moved within the area allocated for that particular employee. This allows them to create their own space and meets their comfort level. Chairs should be ergonomically designed. Not all furnishings will pose a problem, but those that can should be removed or relocated to another part of the facility.
- Harmful artifacts should be removed from the work area. Suicidal ideation is a severe reaction to PTSD. However, self- harm is seen as the next workplace safety crisis. Design guidelines should include the use of anti-ligature furnishings similar to those found in residential behavioral health treatment facilities.
- Control of light both natural and artificial needs to also be in the hands of the employee. If the lighting in the workplace is typical florescent or LED ceiling grid lighting that covers the entire space, the best way to address this is to have closed areas where the lighting can be dimmed or limited. Light that is too harsh or bright can be particularly harmful to anyone who is light sensitive or suffers from migraine headaches. Natural light from a window or a skylight also needs to have some shades or blinds not just to control glare or temperature, but because of the harshness of the light coming into the space can be too much.
- Acoustics are especially important. Working in loud environments for any length of time has negative effects on everyone. Controlling noise in an open work environment can be challenging especially if the ceiling is exposed or if there isn’t enough carpeting or other sound absorbing finishes around to lower the sound decibels. Acoustic wall boards and dividers are an easy way to address this issue. White noise or sound masking equipment may not work because of the sensitivity of those who are in the space. They make “hear” the noise masking or have other sensations that are not related to the actual noise like ringing in their ears.
- Artwork. Be careful of the colors and the images that are on the walls where an employee who has PTSD symptoms. Images especially have been shown to be triggers for folks who have neurological spectrum disorders. This is also true if someone has been diagnosed with schizophrenia, depression or is bi-polar. Harsh colors that are used for accent walls such as brilliant orange, yellow or red can be triggers. Images that are blurred or abstract can trigger memories or emotions that are painful. Look for artwork that clearly represents a nonthreatening subject or scene. Stay away from black and white images and graphic modern designs that are considered street art or graffiti. These images although popular in current design trends can be unsettling to a large group of people regardless of their mental state.
- Common office smells from burnt popcorn, old coffee to toner ink have been known to be triggers for some PTSD folks. Keeping break rooms and print rooms confined or away from work areas may not be the best use of space, but it does a few things: 1) it gets people moving and 2) keeps these odors from offending anyone who is in the office. Do not use deodorizers or other scented accessories. There is no telling who might be affected by the scent or to what degree the person affected suffers.
Action Suggestions
Although PTSD is covered under the Americans with Disabilities Act (ADA) ,it can be hard to make a specific determination as to which employees would require an accommodation. We suggest an open-ended approach by letting employees know certain accommodations can be made if they do have this disability condition. Their voluntary disclosure should help avoid any legal action for discrimination. We strongly encourage you to have a Senior Human Resources person as a member of your workplace design team.
Perhaps the most important action you can take is to practice what we call ‘responsible design’. By that we mean that workplace designers take up the responsibility of conscious consideration of the psychological range of mental health symptoms which residents of the work area may or may not exhibit. The psychological comfort of employees/workers is just as important regardless of the costs.
We would like to close with an open acknowledgement of the ‘elephant in the room’. As we intimated in our introduction this is an issue larger than one symptom (PTSD) and it is large even than the newly discovered ‘neuro-diversity’ design approach. It is the larger context of overall mental health that is important. The built environment does affect our lives and people with various mental health disorders seem to be especially sensitive to these factors. Wellbeing is more than physical comfort – set your design intent to make your work to encompass the whole idea of wellness that includes mental health.
Resources
https://www.webmd.com/mental-health/what-are-ptsd-triggers#2
https://qz.com/work/1741745/how-to-design-an-office-that-champions-neurodiversity/
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