An Expert Review of Why Some People Develop PTSD and Others Exposed to Trauma Do Not
Why will one person be traumatized by a frightening, potentially life-threatening event when another person won't?
Statistically, the research indicates that when a group pf people experience a traumatic event, up to 20% three months later will still be traumatized. Thus, 80% of people will be functioning fairly normally thereafter (1).
Even though people are functioning relatively ‘normally’ they will still remember the event and it will bother them periodically. But, they will not have the classic symptoms of PTSD including flashbacks, nightmares, panic anxiety episodes or avoiding people, places or objects associated with the traumatic episode.
Repeatedly Talking About Trauma Without Skills Can Make Things Worse
Repeatedly Talking Out the Trauma
Telling the story of the trauma from different angles, asking questions about how it might have happened, and putting together lots and lots of detail helps some people.
After telling the trauma story repeatedly, some people become confident they now understand what had happened, and in what order. Their conscious mind retrieves the experience repeatedly after which they can stop focusing on it all the time.
Some lingering triggers may be present for a time but will fade over time as well. But what often gets rid of the trauma or the main part of the experience was the telling and retelling the specifics of the trauma after it had happened and with a focus on detail and timing.
From a theoretical perspective, storytelling processes the raw experience (with all its emotion) into a narrative. Instead of "oh no I am going to die", it becomes, "this happened first, then this happened, and then this". When you talk about the experience in your own words this places a barrier around the experience. Thus, it is processed out of the immediate memory channel of the brain (hippocampus) and into long-term memory (storage into the areas of the brain consistent with the content). “It is in the past and can no longer hurt me now.”
What Prevents Natural Neutralization of the Trauma.
What happens when the traumatic experience is shameful to the person? This may be due to the kind of trauma itself such as a sexual assault, or due to attitudes or beliefs the person had prior to the trauma. Some people are known to be more vulnerable to developing PTSD. This might include those with prior trauma in childhood or before the most recent traumatic exposure.
Poverty, limited social or family support, pre-existing behavioral health problems, those with eating disorders or a history of substance abuse are particularly vulnerable although not necessarily. Also, anything that prevents an instinctive and outpouring of a narrative that might usually come naturally. This may be because the experience was so horrific that the person can’t seem to retell what occurred at all. This may be due to the images or thoughts being too strong when they retell the trauma. In my clinical experience, this sometimes occurs with the trauma survivor having been sexually assaulted.
Critical Incident Debriefing Doesn’t Work
At one time it was thought that Critical Incident Debriefing was helpful in reducing PTSD. Subsequent research has discovered that this is not the case. The experiences of 9/11 survivors were instructive in this regard.
Research for preventing post-traumatic stress disorder (2) found that there was no evidence the one off debriefing after a traumatic event helped. Post trauma debriefing did not lessen symptoms or prevent PTSD from emerging.
Rather, as mentioned above, talking over what happened especially with people who were there is helpful. It is kind of like telling the story that puts it in perspective and allows the processing from some people.
Can Treatment Make PTSD Worse?
Yes. Critical incident Debriefing can actually make things worse for some people.
"If a trauma victim is debriefed in a state of high emotion, the process can increase the arousal to the point of overload, trapping the sensory impressions in the amygdala."
-Dr. Noreen Tehrani, Health Psychologist
Many clinicians including this one prefers to teach the client to become calmer first. Giving the person skills to manage their emotions and calm their body can be empowering and an important element of trauma treatment.
We know from scientific studies that phobia and PTSD victims tend to very good hypnotic subjects. Their narrow focus upon which they are frightened is often central to a capacity to be hypnotized.
Phobias can be quite similar to aspects of PTSD. When we are scared or experiencing a major threat, the mind is in an emotional learning phase. This creates the link or subsequent trigger between the feared object or place. Terror kicks the mind into emotional learning mode and the brain makes permanent the link between the object and feeling petrified. This gives birth to a phobia.
So, there are various methods to treat PTSD today and some are more effective than others for a particular individual. It is important to match the person to the interventions. But most importantly, the therapy does not have to be difficult to accomplish.
To learn more reach out for a free 20 minute consultation.