The Effects of Trauma Do Not Have to Last a Lifetime
Most people will experience a trauma at some point in their lives,
and as a result, some will experience debilitating symptoms that
interfere with daily life. The good news is that psychological
interventions are effective in preventing many long-term effects.
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can
develop after exposure to a terrifying event or ordeal in which grave
physical harm occurred or was threatened. Traumatic events that may
trigger PTSD include violent personal assaults, natural or human-caused
disasters, such as terrorist attacks, motor vehicle accidents, rape,
physical and sexual abuse, and other crimes, or military combat.
Those suffering from PTSD can have trouble functioning in their jobs
or personal relationships. Children can be traumatized and have
difficulty in school, become isolated from others and develop phobias.
Many people with PTSD repeatedly re-experience the ordeal in the form of
flashback episodes, memories, nightmares, or frightening thoughts,
especially when they are exposed to events or objects that remind them
of the trauma. PTSD is diagnosed when symptoms last more than one month.
Psychologist Roxane Silver has studied the effects of the 9/11/01
terrorist attacks on New York City and Washington, D.C. Her research
focused on the immediate and long-term responses to the attacks and
found that the severity of exposure to the event, rather than the degree
of loss, predicted the level of distress among people. For example,
people who reported seeing the planes smash into the trade center
buildings experienced more PTSD symptoms than average, but people who
experienced financial losses because of the attacks did not. Other
studies have shown that simply watching traumatic events on TV can be
traumatic to some, especially those individuals who had pre-existing
mental or physical health difficulties or had a greater exposure to the
The good news is, research has shown that psychological interventions
can help prevent these long-term, chronic psychological consequences.
In general, cognitive-behavioral therapies (CBT) (which strive to
help traumatized individuals understand and manage the anxiety and fear
they are experiencing) have proven very effective in producing
significant reductions in PTSD symptoms (generally 60-80%) in several
civilian populations, especially rape survivors. Even combat veterans
who have experienced PTSD after chronic, repeated exposure to horrific
events experience moderate benefits from CBT (though, not surprisingly,
this kind of repeated trauma is harder to treat).
Research also suggests that brief, specialized interventions may
effectively prevent PTSD in some subgroups of trauma patients.
Psychologist E. B. Foa and colleagues have developed brief
cognitive-behavioral treatments (lasting four to five sessions) that
include, (1) education, (2) various forms of relaxation therapy, (3) in
vivo exposure (repeated confrontations with the actual traumatic
stressor and with situations that evoke trauma-related fears), and (4)
cognitive restructuring (techniques for replacing catastrophic,
self-defeating thought patterns with more adaptive, self-reassuring
statements). If used within a few weeks of exposure to traumas, this
brief form of therapy often prevents PTSD in survivors of both sexual
and nonsexual assaults. R. A. Bryant’s research found that
cognitive-behavioral treatment is also effective in preventing the
occurrence of PTSD in survivors of motor vehicle and industrial
accidents. In addition to targeted, brief interventions, some trauma
survivors may benefit from ongoing counseling or treatment, according to
Bryant, and candidates for such treatment include survivors with a
history of previous traumatization (e.g., survivors of the current
trauma who have a history of childhood physical or sexual abuse) or
those who have preexisting mental health problems.
Trauma disorders are a common and costly problem in the United
States. An estimated 5.2 million American adults ages 18 to 54, or
approximately 3.6 percent of people in this age group in a given year,
have PTSD. In 1990, anxiety disorders cost the U.S. an estimated $46.6
billion. Untreated PTSD from any trauma is unlikely to disappear and can
contribute to chronic pain, depression, drug and alcohol abuse and sleep
problems that impede a person’s ability to work and interact with
According to psychologist R.C. Kessler’s findings from The National
Cormorbidity Survey Report (NCS) that examined over 8,000 individuals
between the ages of 15 to 54, almost 8 % of adult Americans will
experience PTSD at some point in their lives, with women (10.4%) twice
as likely to be victims as men (5%).
The challenge for the mental health community is to learn how best to
help people who are suffering from ill effects of traumatic events.
Within the past decade, a number of programs have been created to bring
appropriately trained mental health services to trauma victims. Examples
The American Psychological Association developed its Disaster Response
Network (DRN) in response to the need for mental health professionals to
be onsite with emergency workers to assist with the psychological care
of trauma victims. Over 1,500 psychologist volunteers provide free,
onsite mental health services to disaster survivors and the relief
workers who assist them. The APA has worked with the American Red Cross,
the Federal Emergency Management Agency (FEMA), state emergency
management teams and other relief groups on every major disaster our
country has experienced and many smaller disasters since 1992.
Under the auspices of The National Association of State Mental Health
Program Directors (NASMHPD) 15 state departments of mental health have
initiated formal efforts to better address the needs of persons exposed
to trauma with state-wide trauma initiatives and resources. Now “tool
kits” have been developed to better help trauma victims.
The University of South Dakota developed the Disaster Mental Health
Institute (DMHI) in 1993. Psychologist Gerad Jacobs, Ph.D., helped
create the Institute in response to his involvement in helping airline
crash victims in the 1989 Sioux City airline crash. The DMHI is designed
to bring together practice and research in disaster mental health and
help prepare psychologists to deliver mental health services during
emergencies and their aftermath. Furthermore, educational opportunities
exist for students to learn how to serve their communities in times of
disaster. This undergraduate program includes working with the American
Red Cross Disaster Service.
Pacific Graduate College and Stanford University recently created the
National Center on Disaster Psychology and Terrorism, which trains
doctoral students to help victims of catastrophic events.
Blanchard, E.B., Hickling, E.J., Barton, K.A., Taylor, A.E., Loos, W.R.,
& Jones-Alexander, J. (1996). One-year prospective follow-up of motor
vehicle accident victims. Behaviour Research and Therapy, Vol. 34, No.
10, pp. 775-786.
Bryant, R.A., Sackville, T., Dang, S.T., Moulds, M.L., & Guthrie, R.
(1999). Treating Acute Stress Disorder: An evaluation of cognitive
behavior therapy and supportive counseling techniques. American Journal
of Psychiatry, Vol. 156, No. 11, pp. 1780-1786.
Bryant, R.A., Harvey, A.G., Dang, S.T., Sackville, T., & Basten, C.
(1998). Treatment of Acute Stress Disorder: A comparison of
cognitive-behavioral therapy and supportive counseling. Journal of
Consulting and Clinical Psychology, Vol. 66, No. 5, pp. 862-866.
Frueh, B. C., Cusack, K.J., Hiers, T. G., Monogan, S., Cousins, V. C., &
Cavenaugh, S. D. (2001). The South Carolina Trauma Initiative.
Psychiatric Services, Vol. 52, pp. 129-146.
Foa, E.B., Hearst-Ikeda, D.E., & Perry, K. J. (1995). Evaluation of a
brief cognitive-behavioral program for the prevention of chronic PTSD in
recent assault victims. Journal of Consulting and Clinical Psychology,
Vol. 63, No. 6, pp. 948-955.
Foa, E. B., Dancu, C.V., Hembreee, E. A., Jaycox, L. H., Meadows, E. A.,
& Street, G. P. (1999). A Comparison of Exposure Therapy, Stress
Inoculation Training and their Combination for Reducing Posttraumatic
Stress Disorder in Female Assault Victims. Journal of Consulting and
Clinical Psychology, Vol. 67, pp. 194-200.
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M.,
et al. (1994). Lifetime and 12-month prevalence of DSM-III-R Psychiatric
Disorders in the United States. Archives of General Psychiatry, Vol. 51,
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B.,
(1995). Post-traumatic Stress Disorder in the National Comorbidity
Survey. Archives of General Psychiatry, Vol. 52, pp. 1048-1060.
King, L.A., King, D.W., Fairbank, J.A., Keane, T.M., and Adams, G.A.
(1998). Resilience-Recovery Factors in Post-Traumatic Stress Disorder
Among Female and Male Vietnam Veterans: Hardiness, Postwar Social
Support and Additional Stress Life Events. Journal of Personality and
Social Psychology, Vol. 74, pp. 420-434.
Narrow WE, Rae DS, Regier DA. NIMH epidemiology note: prevalence of
anxiety disorders. One-year prevalence best estimates calculated from
ECA and NCS data. Population estimates based on U.S. Census estimated
residential population age 18 to 54 on July 1, 1998. Unpublished.
Silver, R.C., Holman, A., McIntosh, D.N., Poulin, M., and Gilrivas, V.
(2002). Nationwide Longitudinal Study of Psychological Responses to
September 11. Journal of the American Medical Association, Vol. 228, pp.
Zoellner, L.A., Fitzgibbons, L. A., & Foa, E. B., (2001).
Cognitive-Behavioral Approaches to PTSD. In J. P. Wilson, M. J.
Friedman, & J. D. Lindy (Eds.), Treating Psychological Trauma and PTSD
(pp. 159-182). New York: Guilford
American Psychological Association’s disaster information
A National Center for PTSD Fact Sheet, by Eve B. Carlson, Ph.D. and
Josef Ruzek, Ph.D.:
National Institute of Mental Health Web site on PTSD:
Jon D. Elhai, Ph.D., Assistant Professor, Disaster Mental Health
Institute, The University of South Dakota:
© 2005 American Psychological Association