By
David R. Henson, Ph. D., C.T.S., B.C.E.T.S.
Trauma! Disaster! Terrorism! Words that shout crisis in individual lives daily from the media reporting the tragedy of individuals and families traumatized by natural and manmade disasters which include domestic violence, child abuse, rape, workplace accidents, terrorism, bombings, fire, homicide, wrecks, crashes, combat, earthquakes and weather-related disasters. Additionally, there are approximately 36 million reported crime victims each year.
The resulting emotional, physical and spiritual responses are very predictable. Most individuals impacted by crisis events feel out of control, helpless, often hopeless and powerless. Frequently the symptoms that occur are minimized, dismissed, or medicated with alcohol, drugs, or “feel good” foods. If the symptoms are not recognized and treated, individuals may describe themselves with statements like: “I’m going crazy”; “I feel like I’m losing it”; “snapping”; “I think I will check out”; or “I don’t know what happened, I just lost half of my day”. Post-traumatic stress is not a new phenomenon. Although it was formally identified as a mental disorder in the early 1980s, there are biblical reports beginning in Genesis. Historically it has been called by several names. In World War I it was known as “shell shock” and in World War II it was called “battle fatigue”. Individuals who have served in Korea, Vietnam and Desert Storm, as well as victims of current man-made disasters and abuse, present typical complaints of acute, chronic and post-traumatic stress disorder (PTSD) no matter what name their symptoms are given.
PTSD symptoms can span many years of forgetting the incident, having intermittent nightmares, struggling with trust and control issues, dissociation, keeping very busy to not-think about the trauma and memories, being divorced or divorcing one partner just to find that the symptoms are still present and belong to him/her, or a myriad of other dysfunctional symptoms. These individuals find little, sometimes temporary, or no relief from their symptoms by being loved and cared for by family and friends. Usually, when the pain and dysfunction around them is sufficient motivation, they will seek professional help in desperation to find relief from their emotional pain, dysfunction and traumatic stress.
In the past, the term “stress” has been used to refer to the adaptive “demands placed on an organism and to the organism’s internal responses to such demands” (Coleman, Butcher & Carson, 1980). To avoid confusion, Coleman and co-workers divide the concept into “stressors”, which are the adaptive demands (usually external) and “stress”, which is the effect (frequently maladaptive and internal). The beginning stage in examining people’s responses to extreme stressors and how to treat these responses, must start by looking at stress as a general concept and people’s responses to “ordinary” stressors; not just people’s normal responses to “abnormal” stressors.
We all encounter stressors in our daily lives. These stressors come in a variety of types: physical; psychological; and social. All types of stressors require us to adapt and when we have difficulty adapting we experience this as stress. Stress can be experienced on a physical level, i.e., when we catch a virus our bodies need to adapt. The virus is the stressor and our bodies’ response to it can be perceived as stress. If we are successful in adapting, we return to the status quo and our bodies have established a new defense, i.e., antibodies to the particular virus. If we are not successful in adapting, our bodies continue to be stressed and move on to new attempts at coping with the stressor.
Stress can be experienced on psychological and sociological levels and the types of stressors and responses can vary considerably. The intensity with which we experience stress varies depending on a variety of factors, which include:
The period of time over which the stressors
occur.
Most people experience
periods of heavy stress. Lazarus (1966) refers to these periods as a crisis and
defines crisis as “a limited period in which an individual or group is exposed
to threats or demands which are at or near the limits of their resources”.
During a crisis, people are often challenged to develop new coping skills to
come through the crisis and readjust. When this does not happen naturally,
crisis intervention is a useful tool to help people develop these new coping
skills and to return them to their normal pattern of functioning. Eye Movement
Desensitization and Reprocessing (EMDR), Traumatic Incident Reduction (TIR),
Neuro-Linquistic Programming (NLP), and Thought Field Therapy (TFT) etc. can be
useful tools in “crisis intervention” and in the treatment of “traumatic stress”
when used shortly after a traumatic or stressful event.
A general working
definition of stress, then, occurs when external demands or internal demands (or
combinations of both) exceed the person’s normal ability to cope and to maintain
one’s ordinary function. This definition also allows for stress experienced as
the result of “ordinary” life stressors, critical incident stress, acute and
chronic stress and post-traumatic stress disorders.
It seems important
that any definition trauma therapists use for traumatic and critical incidents
in clinical practice be “person-focused”. There are a variety of definitions
relating to traumatic stress and critical incidents in use throughout the
psychological community. An in-depth treatment of the subject is seen in
standard texts provided by Donald Meichenbaum (1994), Charles Figley (1985) and
John Wilson (1988). However, the Diagnostic and Statistical Manual of Mental
Disorders (Diagnostic Criteria from DSM-IV, 1994) is used throughout the mental
health field and by insurance companies exclusively, was developed by the
American Psychiatric Association and has been considered the “prime” reference
for any and all mental disorders (of which acute and chronic stress, trauma and
PTSD are included). Post-traumatic Stress Disorder was introduced in the DSM-III
(1980), while previous editions had referred to stress reactions with terms like
“gross stress reaction” and “transient situational disturbance”. However, these
were only two of many labels that have been applied to this behavioral pattern.
It is of much interest to consider the wide array of terms that have been
employed, each with its own implicit etiological theory.
Watch for…Part II, ”History of the Concept of Post-Traumatic Stress Disorder”
The nearness of the stressor, i.e., are
we anticipating a stressor in the near future?
The perception of threat level of the
stressor, including beliefs about our ability to cope.
The stress tolerance of the
individual.
The availability of external resources
and support, i.e., family and friends.
The number of stressors, i.e., multiple
rapes.
~Coming in the next issue~
Dr. David R.Henson
303-987-4660
http://www.trauma-relief.com
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