Traumatic
Events
 |
In medical terminology, a trauma is simply a wound or injury
that happens suddenly or violently. Analogously, psychological trauma results
when
“stress”
overwhelms a person and causes lasting psychological
effects.
A traumatic
event, whether a natural disaster such as an earthquake, flood, or fire,
or an accident such as a car or airplane crash, can happen to
anyone.
Fortunately,
most people have a support system that allows for a common sense way of adapting
to the trauma: sharing stories and emotional experiences. In fact, talking
about the event allows a person to “get a handle on it” and so
helps it eventually to slip into place alongside other life
experiences.
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The debilitating
effects of trauma derive from its ability to overwhelm a person emotionally
while driving out any rational understanding of what is happening
psychologically. By consciously creating a narrative structure for the
trauma—in psychotherapy, in personal journaling, in prayer—you
help to dispel the illusion that the traumatic event has control over you,
and you cease to be a helpless victim. |
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Without a way
of adapting, however, a person may find that symptoms develop to the point
that they become unmanageable.
The information
contained in this page will help you understand what is happening to you
and will also help you in deciding if you should seek outside assistance
for your distress. |
Trauma
|
The oppressive psychological weight of trauma can result
from a surprisingly diverse range of experiences, some of which you might
never before have stopped to consider:
• |
Accidents |
• |
Childhood physical, sexual, and emotional
abuse |
• |
Criminal assault |
• |
Combat, as it affects military personnel
and civilians |
• |
Domestic
violence and emotional abuse |
• |
Hostage-taking situations |
• |
Motor vehicle crashes |
• |
Surgical medical procedures involving
loss
(e.g., amputation), death (e.g., abortion), or near
death |
• |
Natural disasters (earthquakes,
tornadoes, hurricanes, tsunamis, floods, fires, blizzards, etc.) |
• |
Political and military torture |
• |
Rape |
• |
Terrorism |
• |
Workplace violence |
A Psychologist
trained in treating trauma can help you if you feel especially overwhelmed.
For a person with no history of previous mental health problems, brief
treatment
(about 12 sessions) may be all that is needed.
In conjunction
with psychotherapy,
medications
may be advised in helping you to sleep and in temporarily relieving severe
anxiety or depression so that psychotherapy can be effective. Following
successful psychotherapy, medications should be unnecessary.
If you are not
ready to see a psychologist, yet feel that you need some additional support,
click on the link for information about
trauma
support groups. |
Common
Responses
To
Traumatic
Events
|
Common symptoms following exposure to traumatic events
include any of the following:
• |
An unusual feeling of being easily
startled (e.g.,
“jumpiness” |
• |
Difficulty falling asleep or staying
asleep; waking up early |
• |
Nightmares
and/or
“flashbacks” |
• |
Difficulty concentrating or paying
attention |
• |
Carelessness in performing ordinary
tasks |
• |
Outbursts of irritability or
anger,
sometimes without apparent reason |
• |
Loss of religious faith and feeling
angry
at God |
• |
Family
or work conflicts that were not usually experienced before the trauma |
• |
Unusual bodily fatigue |
• |
Feelings of emotional numbness (such
as being
“in
a
daze,”or
having an “It doesn’t matter” attitude) |
• |
Recurrent anxiety over personal safety
or the safety of loved ones |
• |
Feeling especially
alone
(e.g., having a “They weren’t there” or “They
can’t understand” attitude) |
• |
An inability to let go of distressing
mental images or
thoughts |
• |
Feelings of
depression,
loss, or sadness |
• |
Feelings of
helplessness,
powerlessness, and lack of
control |
• |
Feelings of guilt for not having
suffered as much as others |
• |
Unrelenting
self-criticism
for things done or not done during the event |
• |
Anxiety
about, and avoidance of, specific reminders of the event |
Developing symptoms
after exposure to a threatening event is expected and normal, and things
can often get better without professional help. Yet often clinical problems
can occur.
Clinical Diagnoses
Related to Trauma
If the
trauma did not involve an experience so intense as to warrant a diagnosis
such as Acute Stress Disorder (see below), and if the symptoms do
not represent ordinary
bereavement,
then an Adjustment
Disorder may be diagnosed. The predominant symptoms
which characterize an Adjustment Disorder can be
depressed
mood,
anxiety,
disturbance of conduct (e.g., fighting, vandalism, reckless driving),
or other maladaptive reactions (e.g., physical complaints, work or
academic inhibition, social withdrawal). By its definition, an Adjustment
Disorder cannot last longer than 6 months, unless the precipitating experience
is ongoing or has ongoing consequences.
If, however,
the precipitating experience involved actual or threatened death or physical
injury; the symptoms have elements of dissociation,
re-experiencing (i.e., flashbacks), avoidance of reminders
of the experience, and anxiety; and the symptoms persist for several
days and cause a serious impairment in normal daily functioning, a diagnosis
of Acute Stress Disorder
(ASD) may be made. If symptoms persist for longer
than one month, Posttraumatic Stress Disorder
(PTSD) may be
diagnosed.
Children
subject to repeated, on-going abuse may also develop
Dissociative Identity
Disorder, commonly known as
“multiple
personalities.”
All of the above diagnoses, of
course, depend on specific symptoms that must be evaluated by a qualified
clinician. |
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Coping
Strategies
After
Traumatic
Events
|
The best coping strategy, of course, is to talk about the
event with family, friends, clergy, or co-workers. Other
Positive Coping Strategies after
a traumatic event include:
• |
Maintaining a regular routine of
eating, sleeping, and working |
• |
Taking extra time to accomplish ordinary
tasks |
• |
Acquiring the training, tools, materials,
etc. that would have made things easier if you had been able to use them
during the event |
• |
Mentally rehearsing the positive
acts you would perform if there’s a
“next
time” |
• |
Getting quiet recreational exercise
in nature, such as walking or hiking. |
• |
Interpreting physical symptoms (for
example, shoulder pain could be telling you that you’re “trying
to carry too heavy a burden”) |
• |
Asking yourself what
emotions you are actually experiencing. Fear and
anger are not the only emotions in life. |
• |
Getting a therapeutic massage to
release pent-up bodily tension |
• |
Writing about your experiences (in
a journal, diary, or personal letters) |
• |
Being careful not to make the event
into an obsession by reading about it in newspapers or magazines, or following
reports and discussions of it on the radio and TV |
• |
Realizing that different people need
differing amounts of time to recover from trauma |
• |
Learning a relaxation technique such
as
Progressive
Muscle Relaxation or
Autogenics |
• |
Joining a
support
group |
• |
Accepting the emotional work of
forgiving
the person who hurt you |
|
Maladaptive
Coping
Strategies
|
And be careful to watch for the following
Maladaptive Coping
Strategies:
• |
An increased use—or
abuse— of alcohol, coffee, drugs, gambling,
tobacco, etc. |
• |
A compulsion to work more than
usual |
• |
A temptation to make hasty major
life-decisions (e.g., a job change, a divorce) |
• |
A tendency to completely avoid any
feelings or thoughts about the event |
These are
called maladaptive coping
strategies because they serve either
to push out of awareness any memory of the
traumatic event, or
to give you a false sense of
accomplishment. Unfortunately, such strategies
serve no purpose in helping you integrate the trauma into your sense of
self.
|
Remember—an
event is traumatic because it disrupts your previously secure sense of
self. Consider that wild animals live with a sharp awareness of perpetual
danger, yet most people live with a naive—and deceptive—sense of
safety and security to the point of denying their basic
vulnerability
and fragmented
sense of self. So when something disastrous happens, the psychological damage
from the shattering of one’s illusions about life and
identity
may be more problematic than any physical
damage. |
|
Healthy
adaptation to the trauma therefore involves
reorganizing
your attitudes about your
being and
your
purpose
in the world. In fact, this explains why some people who experience a trauma
come away from it as “changed” persons with a new sense of purpose
in
life.[1,2,3]
Of course, not
everyone is so profoundly changed; most people simply get back to life as
usual, feeling perhaps just a bit more practical or realistic about their
lives than they felt before the trauma. |
Treatments
for
PTSD
|
The clinical treatment for PTSD can take a variety of
approaches.[4]
Regardless of the treatment approach, the treatment
should (a) provide a sense of safety, both as a protection from
maladaptive coping strategies and as an acceptance of your thoughts and feelings
as non-threatening; (b) resolve the troubling aspects of the memories
of the traumatic experience; and (c) integrate positive growth into
your lifestyle.
• |
Exposure
Therapy is a form of
cognitive-behavioral
treatment that is really quite a simple concept, and yet it can be very
effective in a short time (10 or 12 sessions) for treating discrete traumatic
events. Through the process of repeatedly talking (and writing)
psychotherapeutically about your traumatic experiences, several things can
happen:
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1. You experience
your thoughts and
feelings in the safety of psychotherapy,
and this helps to reduce the belief that your thoughts and feelings are
dangerous.
2. You become habituated to your thoughts and feelings. That is, much
like a wild animal being tamed, you learn to accept your memories without
perceiving them as a threat.
3. You prevent yourself from falling into the habit of avoiding your
thoughts and feelings as an unhealthy defense against fear.
4. You learn to distinguish troubling thoughts and feelings from ordinary
thoughts and feelings so that everything does not seem threatening.
5. You learn to transform your feelings of helplessness into
competence.
6. You learn to think of yourself less
negatively.
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• |
Psychodynamic
Psychotherapy helps you explore and understand the unconscious aspects
of the trauma and its personal meaning for you. This form of treatment may
be necessary for multiple traumatic events experienced over time (e.g., childhood
abuse in a dysfunctional family).
|
• |
Hypnosis
and Guided Imagery, either alone or in combination with Psychodynamic
Psychotherapy, can help you to transform your perceptions of the trauma through
imagined visual and sensory experiences.
|
• |
Psychological
Debriefing, also called Critical Incident Stress Debriefing (CISD).
The premise of CISD is that a group processing (“debriefing”) of
all persons involved in a critical event within 48 to 72 hours of the event
will prevent the development of full-blown PTSD.
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• |
Eye Movement
Desensitization and Reprocessing (EMDR). The premise of EMDR is that
many traumatic events are not properly “processed” by the memory
network of the brain, and that the eye movements of EMDR help a person
“reprocess” the traumatic memory through “rapid learning”
so that it no longer has negative psychological effects.
|
Advocates of
EMDR often claim that a single 50-minute session of EMDR can be 100% successful
in abolishing distress from a traumatic event. The supposed quickness and
ease with which EMDR works, when held up to all the pain that is in the world,
makes a therapist feel almost guilty for not using EMDR. Well,
almost . . .
. . . because, if you’re not completely cured after one session
you must have another traumatic memory to process. And then another one,
and another one . . . So is EMDR really all that different
from, or more efficient than, other treatments? Does eye movement really
aid brain processing of memory? Maybe. Maybe
not.[5]
Just remember this: after you’ve “reprocessed” your memory
network you may still have a
fragmented
personality, you may still
fear
love, and you may still have a dark part of you that seeks
death
and self-destruction. All of these things can be tangled into your
life’s overall unconscious misery right along
with, on top of, or behind any specific traumatic
memory.
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• |
Pharmacotherapy [6] refers to the
use of medication to help alleviate serious symptoms, such as anxiety and
insomnia, so that psychotherapy can be effective. Following successful
psychotherapy, medications should be unnecessary.
|
• |
Group
Therapy may be used for social support and to help individuals understand
and resolve the social aspects of their symptoms.
|
• |
Marital and Family
Therapy can be of help especially when children or adolescents experience
a trauma.
|
• |
Inpatient
Treatment (that is, hospitalization) for severe cases, may be required
especially if the trauma provokes suicidal thoughts.
|
• |
Psycho-social
Rehabilitation Techniques may be necessary if the trauma has caused a
drastic disintegration of a person’s lifestyle.
|
• |
Creative Arts
Therapies are sometimes used in conjunction with other
treatment. |
Of the
above approaches, Debriefing and EMDR are the most controversial. Each of
these approaches has been popularized in a similar fashion: one person who
discovers the treatment advocates for the use of his or her
“discovery” through a reliance on supportive case reports. Both
approaches currently lack the unambiguous support of randomized, clinical
trials [7]
with control
groups.[8] |
Self-help
for
Trauma
|
If you find that professional treatment for trauma is not
available to you or is too expensive, you might try the following self-help
writing assignments. These suggestions are not meant to replace professional
treatment, but, in some circumstances, anything can be better than
nothing.
The assignments
are meant to be kept private, for your own use, but in writing them you might
be surprised to see things you would not have admitted to yourself in your
own thoughts.
Be careful
not to try to rush the process—allow two or three days for each
assignment.
• |
Write at least one paragraph defining
the concept of “victim.” Read it and re-read it over the course
of the next couple days. |
• |
Write at least one page on what it
means to you that you have experienced a trauma. Please consider the effects
that the trauma has had on your beliefs about yourself, your beliefs about
others, and your beliefs about the world. Also consider the following topics
while writing your answer: Safety, Trust, Power, Competence, Esteem, and
Intimacy. Read it and re-read it over the course of the next couple
days. |
• |
Write a detailed account of your
last experience of trauma. Include as many sensory details as possible, as
well as your thoughts and feelings about the experience. Be sure to track
the development of your anxiety from your description of its first beginnings
to its peak and on through its dissipation. If you are unable to complete
the account in one sitting, draw a line where you stop. When you are ready
to continue, read what you have already written before writing more. If there
are parts that you do not remember, draw a line and continue on at the part
that you remember next. At least once a day, over the course of the next
couple days, read whatever you have written, whether it be complete or in
progress. |
• |
For this assignment, write three
paragraphs.
First, write a paragraph about how you want your life to
change once you have overcome your trauma. Read it and re-read it over the
course of the next couple days.
Second, write a paragraph describing what you will lose
(that’s right—lose) by being able to live comfortably without troubling
memories or anxiety. Read it and re-read it over the course of the next couple
days.
Third, write a paragraph summarizing the five most
important reasons for your being able to overcome the trauma. Read it and
re-read it over the course of the next couple days. |
• |
Finally, write a statement of what
it means to you that you have taken on this self-help work for a trauma.
You should, of course, review what you have written in all the writing
assignments; you should also consider any anxieties you might still have
as well as any insights you may have achieved. (Remember: sometimes knowing
where you have been can give you a clue as to where you are headed.) |
|
A
Final
Note
About
Terrorism
and
Trauma
|
Imagine sitting in an airplane, happily sipping a glass
of wine, talking to your seatmate and feeling quite wonderful about your
recent business success. Suddenly there’s a loud noise, the plane pitches
nose down, food and baggage fly all over the cabin, everyone is screaming,
and you lose consciousness. You wake up covered in blood, surrounded with
smoke and fire, and next to you is the mangled body of your
seatmate.
Now, although
in your daily life you might delight in entertainment that depicts graphic
violence and death, when an experience like this suddenly throws itself into
your lap—along with your neighbor’s severed arm—it’s
no longer fun and games. It’s traumatic, and you’re likely to develop
symptoms of posttraumatic stress disorder.
Yet now imagine
something even more horrifying. With no sudden warning, people around you
start falling ill. Soon, many of the sick begin to die. The government is
baffled and helpless. Panic drifts through the air. What do you do? What
can you do?
Well, in the
case of biological
terrorism,
you’re confronted not just with actual death but also with the continuing
threat of mysterious death on a large, public scale. Such a threat will trigger
the deepest, ugliest, and most
fearful
aspects of your psyche.
And, in the same
way, scattered bombings in subways, trains, busses, markets, and hotels pierce
deeply into the same fears.
No government
is prepared for the mental health consequences of this sort of threat. And
no government ever will be.
And that’s
because the only treatment for such a trauma is
spiritual.
Religious mystics have said for ages that you only begin to live when you
learn to die to yourself in every moment. So when
your life is motivated by pure faith, hope, and love, when you are
prepared to die in any moment, and when death is no longer a fearful, ugly
mystery, trauma has no place to sink its claws in you.
“Wait a
minute,” you say, “the motto of this country is In God We
Trust. America is a spiritual
country.”
Well, we
can wonder about that. How can the pursuit of “happiness”—with
its narcissistic hunger for aggressive political hostility and sniping, angry
and hateful protest, violent video games, competitive sports, erotic
entertainment, obesity, drugs, gambling, social rudeness, exploitation of
the underprivileged, and abuse of the environment—be spiritual? Remember
that terrorists are angry with this country because of the happiness that
we pursue at the expense of charitable concern for our less fortunate
neighbors.[9]
So the trauma
of all terrorism is aimed at our deepest
vulnerability: the narcissistic
emptiness in our own hearts. |
No
advertising—no sponsor—just the simple truth . . .
|
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Additional
Resources
References:
1. Linley, P. A., Joseph,
S. (2004). Positive change following trauma and adversity: A review. Journal
of Traumatic Stress, 17, 11–21.
2. Waysman, M., Schwarzwald,
J., & Solomon, Z. (2001). Hardiness: An examination of its relationship
with positive and negative long term changes following trauma. Journal
of Traumatic Stress, 14, 531–547.
3. Tedeschi, R.
G., Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring
the positive legacy of trauma. Journal of Traumatic Stress, 9,
455–471.
4. Foa, E. B., Keane,
T. M., & Friedman, M. J. (Eds.). (2000). Effective Treatments for
PTSD: Practice Guidelines from the International Society for Traumatic Stress
Studies. New York:
Guilford Publications.
5. McNally, R. J.
(1999). Research on Eye Movement Desensitization and Reprocessing (EMDR)
as a treatment for PTSD.
PTSD
Research Quarterly, 10, 1.
6. Friedman, M.
J. (2000). A guide to the literature on pharmacotherapy for PTSD.
PTSD
Research Quarterly, 11, 1.
7. Avery, A., King,
S., Bretherton, R., & Ørner, R. (1999). Deconstructing psychological
debriefing and the emergence of calls for evidence-based practice.
Traumatic
Stress Points, 13, 2.
8. Schnurr, P. P.
(1999). Control groups in psychotherapy research.
PTSD
Research Quarterly, 10, 1.
9. Of course, those
who commit acts of terrorism also defile spirituality. This just goes to
show that there are no gray areas in regard to a genuine spiritual life:
either your life is grounded in true love, or it isn’t. Period. Those
who advocate terror and violence cut themselves off from any hope of healing
the anger that fuels their bitterness.
Anxiety Disorders:
Anxiety Disorders from THE MERCK MANUAL, Sec. 15,
Ch. 187.
Community
Services:
Knowledge
Exchange Network (KEN) from the Center for Mental Health
Services.
Crisis Counseling:
Crisis Counseling - Non-Profit
Information, Guidance and Referral Assistance
Crisis Counseling from the Center for Mental Health
Services.
Emergency
Services:
Emergency Services from the Center for Mental Health
Services.
Ricin:
Ricin
Poisoning Fact Sheet —a consumer-oriented article from the
Wisconsin Department of Health and Family Services.
Ricin —a
medically-oriented article from eMedicine.
Smallpox:
Smallpox from THE MERCK MANUAL, Sec. 13, Ch. 162,
Viral Diseases.
Trauma & Child/Sexual Abuse
Survivors:
Adult Survivors
of Child Abuse (ACSA) is an innovative psychologically based support
group recovery program that offers workshops, peer-guided and professional-guided
support groups, and a guidebook.
The National Organization
on Male Sexual Victimization (NOMSV) “is dedicated to the
prevention, treatment, and elimination of male sexual victimization.”
Trauma &
Children:
Helping Children After a Disaster from the American
Academy of Child and Adolescent Psychiatry.
Trauma & Law
Enforcement:
Law
Enforcement Traumatic Stress: Clinical Syndromes and Intervention
Strategies from The American Academy of Experts in Traumatic
Stress.
Trauma/PTSD –
General:
The International Society
for Traumatic Stress Studies (ISTSS) provides a forum for the sharing
of research, clinical strategies, public policy concerns, and theoretical
formulations on trauma in the United States and around the world through
its education and training programs and its various publications.
Mental Health
Net: Self-help Trauma, PTSD, and Stress Resources is a comprehensive
listing of trauma, PTSD, and stress information and self-help resources
online.
The National Center for
PTSD provides information about PTSD research and a PILOTS data
base linked to the world’s largest collection of traumatic stress
literature.
Suicide
and Posttraumatic Stress Disorder (PTSD) provides information about
suicidal thinking and PTSD.
Trauma Information
Pages provides a comprehensive listing of trauma support info,
disaster info, and related mental health issues on the Internet.
Related pages within A Guide to Psychology
and its Practice:
Anger
Autogenics
Training
Death—and the Seduction
of Despair
Forgiveness
Hypnosis and
“Negative” Hypnosis
Identity
Personality
Progressive Muscle
Relaxation
Questions and Answers
about Psychotherapy
Spiritual
Healing
Stress
Systematic
Desensitization
Terrorism and
Psychology
Trauma Support
Groups
The Unconscious
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