Promoting Positive Processes after Trauma

Elizabeth M. Altmaier

• Publisher: Academic Press
• Year: 2019
• ISBN:
  9780128119761
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Promoting Positive Processes After Trauma targets one of the most damaging effects of trauma, ongoing impairment across the whole of "living." Viewing clients with trauma histories from the perspectives of their shared experiences is the foundation for the application of six strengths and virtues studied by positive psychology: hope, positive emotions, resilience, forgiveness, spirituality and religiosity, and meaning-making. The lived trauma experience of the contributing author illustrates actual means of change

• Presents foundational information and newest findings from trauma and from positive psychology
• Covers strengths and virtues that can be directly targeted in treatment or used as ancillary treatment goals
• Provides further readings suitable for clients and for clinicians
• Concludes with an integrative exploration of the organization of positive processes and their integration into portfolios.

1

An introduction to trauma

Abstract

The term “trauma” has evolved over the past century, formerly referencing severe physical wounds and now encompassing psychologically damaging events as well as the victim’s subsequent response. The essence of trauma is that of devastating force that overwhelms the victim’s customary beliefs, sources of support, and meaning in life. These impairments of living occur across systems of emotion, cognitions, identity, behavior, and conscious awareness. Newer understandings of trauma have included vicariously acquired trauma, the role of interpersonal betrayal, moral injury as a cause of combat trauma, transgenerational trauma, and traumas unique to refugees and immigrating people groups.

Keywords

Trauma; trauma models; stress reactions

In contemporary society, the words “trauma” and “traumatic” are ubiquitous. As an example, a search on Twitter revealed that the term “traumatic” described the following experiences: taking children to the grocery store, episodes of a television drama, a prom haircut gone wrong, and the relationship dissolution of a well-known celebrity couple. This amplified use has made it exceedingly difficult to comprehend the actual nature of trauma, an event that Herman (1992) described as follows:

Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When that force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning. (p. 33).

Given how many clients come for treatment with a history of trauma, having an accurate understanding of trauma is critical for responding to our clients even if they do not, themselves, cite trauma as the source of their difficulties. In society also, systems and organizations are currently adopting the perspective that working with people having past traumas must incorporate specialized elements. Trauma-informed is the term for this approach (see Ko et al. 2008). Systems that work for children and adults that have been re-envisioned through a trauma-informed lens are in-patient mental health settings, education, community care, critical care, substance abuse treatment, and corrections. A trauma-informed perspective is critical for clinicians as well.

This chapter reviews the history of the concept of trauma; theory and research concerning trauma, including models of how trauma creates impairment among those who experience it; and new contributions to understanding trauma. Included at the end of the chapter are recommended readings for clinicians and for their clients.

What is trauma?

The term “trauma” has been used for centuries, and is derived from a Greek word meaning wound. In its original use, “trauma” referred to physical injuries in and on the body produced by a suddenly occurring outside force; these injuries were severe, with potential to cause death or prolonged disability. Scoring systems for these physical traumas (see Lecky, Woodford, Edwards, Bouamra, & Coats, 2014) therefore focus on indicators that measure the significant damages present in the body, such as problematic changes in blood pressure and respiration rate, and severe anatomical injuries including burns, dislocations, and lacerations.

Another application of “trauma” dates to World War I, where the term was employed for significant psychological damage presumably produced by contiguous physical external forces. Jones, Fear, and Wessely (2007) describe how soldiers’ prolonged exposure to horrific combat conditions resulted in psychological responses such as uncontrollable weeping, becoming mute, and memory loss. At the time, these responses were thought to be caused by the soldiers’ proximity to exploding shells. The term used for these impairments was shell shock, reflecting the belief that the psychological deterioration came from concussive wounds.

A more recent use of “trauma” is for psychological damage from external events that do not necessarily involve physical harm. Sometimes these events are called traumatic stressors to reflect the understanding that these external events are not physical in nature. Examples of these stressors are losing a loved one to a violent death, experience of a mass shooting, and terror events such as 9/11 and the Boston Marathon bombings. This recent perspective is the basis for the current Diagnostic and Statistical Manual (DSM) (American Psychiatric Association, 2013) definition of trauma precursors of post-traumatic stress disorder (PTSD) that include:

witnessing, in person, the event(s) as it occurred to others; learning that the traumatic event(s) occurred to a close family member or close friend; experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

American Psychiatric Association, 2013.

In current psychological research and practice, “trauma” refers to both the causative event and the range of physical and psychological responses following the event that disable the individual. Recall Herman’s definition that trauma overwhelms the individual’s usual control, connection, and meaning. There are many such events in our contemporary world that now are recognized as “traumatic” and meet the criterion of an overpowering experience.

Mass violence

Recognition of mass violence as a trauma experienced by more than the actual victims dates to 1966, when a sniper on the University of Texas campus killed 16 people and injured 31 others over a 90-minute period. The United States Department of Justice (United States Department of Justice, 2001) defined mass violence as follows: “An activity that involves a violent act or an act dangerous to human life… that appears to be intended to intimidate or coerce a civilian population…” (United States Department of Justice, 2001, p. 17580). Often mass violence occurs in settings that would have been considered safe by victims: a school (e.g., the Columbine High School shooting in 1999, the Sandy Hook Elementary School shooting in 2012), a church (e.g., the Emanuel AME Church shooting in 2013), and a community location (e.g., Edmond Oklahoma post office shooting in 1986). The experience of violence in contrast to presumed safety is part of the overwhelming experience of survivors. In a parallel fashion, recent terrorist events have occurred in places associated with tourism or leisure, such as beach promenades or nightclubs.

Sexual assault

Sexual assault, or sexual violence, is a sexual act “committed or attempted by another person without freely given consent of the victim” (Centers for Disease Control, 2014b). Acts including actual sexual contact are covered in this definition. However, sexual violence incorporates other forms of assault, such as verbal coercion, and noncontact activities, such as forced viewing of pornography. Additionally, technology can be used as a means of sexual violence. At the time of the writing of this book, the Defense Department of the United States had begun a criminal investigation into a secret Facebook site used to post sexually explicit pictures of female Marines without their knowledge or consent (see Phillips, 2017 and The Guardian, 2017). The pictures were accompanied by comments regarding the women, including aggressive language and threats of sexual violence.

Peer-to-peer violence among children and adults

Peer-to-peer violence, including bullying, is responsible for many negative outcomes among children (e.g., physical and emotional problems, school avoidance, lowered academic achievement, behavioral problems). Peer violence includes physical attacks such as hitting or pushing, verbal attacks including name calling and teasing, relational aggression such as exclusion from a social group or perpetuation of rumors, and cyberbullying that occurs through technology. The prevalence of these activities (Turner, Finkelhor, Shattuck, Hamby, & Mitchell, 2014) is striking: about half of a sample of school-aged children have experienced at least one type or form of peer victimization in the last year.

However, peer-to-peer violence is not limited to children. In fact, work-place harassment, sometimes called mobbing or workplace bullying, occurs on a regular basis among adults. A definition of workplace bullying from Matthiesen and Einarsen (2007) makes it explicit that bullying is not a one-time event, and is not behavior that is trivial in nature. Rather, the imbalance of power between the persons (i.e., supervisor, worker) and their escalating conflict have negative effects on the victim in work-related indicators, such as absenteeism and sick leave, and on personal well-being indicators, such as depression and anxiety. Branch, Ramsay, and Barker (2012) outline a cyclical model of bullying that includes work environment; organizational response; and characteristics of the target, perpetrator, and bystanders which underlines the serious nature of these events for persons and for the organization.

Intimate partner violence

Intimate partner violence is the term for physical and sexual violence as well as psychological aggression and stalking perpetuated against a victim by a current or former intimate partner. The Centers for Disease Control (Centers for Disease Control & Prevention, 2014a) established not only that these traumas occur frequently, but that they also occur at an early age. In a national survey completed in 2011, approximately 54% of female victims and 47% of male victims were traumatized before age 25. Overall, in the 12 months before the survey was completed, 7% of women experienced sexual violence, 5% of women were stalked, and 5% of women experienced physical violence by a partner. The lifetime prevalence – 1 in 5 women and 1 in 7 men – and the consequences of intimate partner violence (e.g., chronic pain, binge drinking, and sexually transmitted diseases) are so severe that Mercy and Freire (2015) termed it a public health crisis.

Natural disasters and environmental disasters

Natural disasters are unavoidable environmental events that create fear of injury, loss of property, and dislocation of residence. There are many such events in the course of a single year: in 2015, for example, the National Red Cross responded to 176 disasters (Red Cross, 2015) including wildfires, floods, tornadoes, and extreme storms. In contrast, environmental disasters are caused by human and/or machine errors. Examples are oil spills and chemical plant explosions. Both natural disasters and environmental disasters take away people’s access to the basic necessities of food, water, and shelter; create a need for relocation; and cause long-lasting damage to communities. In addition, consequences of disasters often occur over an extended period of time and become sequential traumas, particularly as they promote helplessness among victims.

Bereavement

The loss of a loved one to death is not an event included in the DSM definition of a trauma, but can be a traumatic stressor. Shakespeare-Finch and Armstrong (2010) demonstrated comparable levels of distress among adults who experienced sexual assault, motor vehicle accidents, and bereavement. Distress after bereavement may be influenced by the cause of death, the relationship of the deceased to the person, and the predictability of the death. For example, losing a child, or a loved one, due to suicide, or an ambiguous loss (where the lost one may be physically present but psychologically lost due to dementia or other illness) increases disabling responses to bereavement. In recognition of this potential, the DSM proposes a category for further study, Persistent Complex Bereavement Disorder. The criteria include a lengthy period (12 months for adults, 6 months for children) of intense sorrow and preoccupation, difficulty accepting the death, disruption of normal social activities, and a disturbance in identity.

Motor vehicle accidents

Motor...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Introduction
• 1. An introduction to trauma
• 2. An introduction to positive psychology
• 3. Hope
• 4. Positive emotionality
• 5. Resilience
• 6. Forgiveness
• 7. Meaning in life
• 8. Religiousness and spirituality
• 9. Organization and integration of positive processes
• Glossary of terms
• Index