…however, even severe trauma does not necessarily result in PTSD
Most people (75-85%) who experience trauma do not develop PTSD. Thanks to the resilient nature of our minds we have the potential for a natural recovery. Many people return to full health, physically and emotionally, without a need for professional help. In fact, treatment for PTSD must never start immediately after a traumatic event, as it can do more harm than good if initiated too early. Among those, who do need treatment, most have developed chronic depression and/or anxiety, rather than PTSD.
What makes the difference?
What determines an individual’s likelihood of developing it? Social & economic circumstances? Appropriate attention, social support? Opportunities to talk? Interestingly, it seems that our main vulnerability lies in how we think about what happened to us, and how much.
Increased exposure to trauma in a country has been found to be associated with a decrease in PTSD in its citizens. Another study showed that how the trauma was perceived was the main determinant of the development of the disorder. The severity of physical injuries, other life stressors, amount of social support and self-blame did not predict PTSD. Rumination about why it happened and what it meant for their lives or their person was the main factor in the maintenance of symptoms.
I see it every week in my clinic: we humans experience setbacks in life, develop stories around their impact or their meaning about our person. We fail to maintain a broader, wider outlook. People present with chronic depression, generalized anxiety, a profound sense of being ‘stuck’. Some have developed specific co-morbidity, like social anxiety disorder, or obsessive-compulsive disorder.
What do we do about it?
Specific disorders can benefit from targeted, evidence-based treatments: when PTSD is diagnosed, we have a few options (more on PTSD interventions forthcoming). Depression and anxiety (with or without PTSD ) require specific (cognitive-behavioral) therapy. More chronic, perhaps even sub-clinical symptoms resulting from objective and subjective trauma, may require a longer-term skill-building approach around managing rumination and worry, enriching life and building resilience (more on this topic soon).
The good news is that we can do a lot to help people, who have not recovered from the impact of trauma in their lives, as long as our approach is guided by evidence.
Dückers, Alisic & Brewin (2016): A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder. British Journal of Psychiatry, 209 (4), 300-305
Meiser-Stedman, et al., (2019): A core role for cognitive processes in the acute onset and maintenance of post-traumatic stress in children and adolescents. Journal of Child Psychology & Psychiatry [Epub ahead of print]
Ehlers & Clark (2005): Cognitive Therapy for Post-Traumatic Stress Disorder: Development and Evaluation Behaviour Research and Therapy, 43, 413-431.
