After a traumatic event, a person may experience psychological trauma (or simply “trauma”)—in more specific terms, post-traumatic stress. Post-traumatic stress is clinically significant dysfunction or distress—that is, stress that is significantly affecting daily life in a way that is capable of being assessed or observed by a mental health professional.
According to the diagnostic criteria most commonly used in the mental health field, the individual with post-traumatic stress will often experience negative thoughts and mood (e.g., anxiety, depression, anger, shame, amnesia about the event, etc.), intrusive thoughts (distressing memories, which might include dissociative flashbacks), hyperarousal (e.g., hyper-awareness and anxiety about possible dangers, increased anger / irritability, sleep problems, concentration problems, etc.), and avoidance of internal (thoughts) or external (places, scents, sounds, representations in media, etc.) reminders of the traumatic event.
These signs/symptoms are referred to as acute stress disorder if they last less than a month, or post-traumatic stress disorder (PTSD) if the signs/symptoms persist longer than a month.
Due to the challenging nature of defining and studying PTSD, the data on recovery rates is conflicting and therefore unclear; nevertheless, we know that in some individuals PTSD can become a chronic (long-lasting) problem that may be difficult to treat. Unfortunately, the common belief that this is always the case may lead individuals to feel hopeless, which may decrease their likelihood of recovery. Regardless of whether you are experiencing or are diagnosed with acute stress disorder or PTSD, the effects of trauma may be affecting your quality of life and preventing you from reaching your goals.
While trauma may affect us on a physiological (or biological) level—such as by changing our levels of hormones, neurotransmitters, and possibly “rewiring” our neural pathways over time—the way we think about trauma can make these effects more pronounced or less likely to reverse. For example, if we hold beliefs (consciously or unconsciously) like “I am forever scarred and damaged,” or “I am tainted or impure,” or “I will never be like I was” (with the belief that this is wholly a bad thing), then our post-traumatic stress will be more likely to become chronic and get in the way of our ability to live the sort of life we want.
The parable of the two arrows in Buddhism does a good job of explaining this:
“The Blessed One said, ‘When touched with a feeling of pain, the uninstructed run-of-the-mill person sorrows, grieves, & laments, beats his breast, becomes distraught. So he feels two pains, physical & mental. Just as if they were to shoot a man with an arrow and, right afterward, were to shoot him with another one, so that he would feel the pains of two arrows; in the same way, when touched with a feeling of pain, the uninstructed run-of-the-mill person sorrows, grieves, & laments, beats his breast, becomes distraught. So he feels two pains, physical & mental’” (Sallatha Sutta: The Arrow, 2013).
In this parable, the experience of being harmed is likened to being struck by an arrow; unfortunately, when we encounter harm (or the perception of harm), we often exacerbate our suffering by inflicting a second arrow upon ourselves by making the harm into something much greater than it actually is. For instance, we might catastrophize the harm we feel — that is, we may blow something up into a catastrophe when it doesn’t have to be. This tendency emerges when we convince ourselves that we are irreparably traumatized by what happened to us, when, in fact, we have the potential to be incredibly resilient. This is not to discount the reality of psychological issues like post-traumatic stress disorder, but rather to point out the power of the “second arrow” of our perception or interpretation. When we believe something to be horribly traumatic it tends to become a self-fulfilling prophecy. Underestimating our ability to not be greatly harmed by traumatic experiences, or to recover from traumatic experiences, limits our potential to inoculate ourselves against trauma, to heal from it, and even to experience post-traumatic growth, or, in biological terms, hormesis.
A similar sentiment is expressed in the philosophy of Stoicism. One of the early Stoic philosophers, Epictetus, stated:
“It isn’t the things themselves that disturb people, but the judgements that they form about them” (The Enchiridion, 5, in Epictetus, ca. 108 C.E./2014 C.E.).
Also, consider the following quote from the Roman emperor and Stoic philosopher Marcus Aurelius: “Take away thy opinion, and then there is taken away the complaint, ‘I have been harmed.’ Take away the complaint, ‘I have been harmed,’ and the harm is taken away” (Meditations, 4.8, in Aurelius, ca. 180 C.E./1900 C.E.).
These quotes illustrate the significant role that our thinking plays in how we respond to trauma. In essence, the way we think largely determines whether we persist in a state of distress, or adapt and grow. Thinking that reinforces or perpetuates trauma can be addressed through trauma-focused cognitive behavioral therapy (TF-CBT)—an evidence-based approach to treating PTSD. With TF-CBT we learn to stop uncritically believing our automatic thoughts; instead, we learn to internally debate, so that we can challenge or dispute unhelpful or irrational ways of thinking. We may also consider reframing our situation to highlight opportunities or the potential for growth within unfortunate or dis-preferred circumstances.
Cognitive processing therapy (CPT), another evidence-based approach to trauma, similarly addresses problematic thinking that reinforces post-traumatic stress. CPT challenges biases and thinking errors, such as the just world hypothesis (the view that the world is just and people get what they deserve), which can lead individuals to blame themselves or others when unfortunate things happen—thereby hindering their ability to process, understand, and heal from traumatic experiences. This is often done by asking the individual to express or write an impact statement that includes why they think the event occurred, and what beliefs developed because of the event. Doing this often reveals irrational or unhelpful beliefs. By challenging irrational or self-defeating beliefs and promoting self-compassion, CPT aims to foster acceptance and other rational/helpful ways of thinking that will promote healing from traumatic experiences.
Another part of the cognitive approach to dealing with trauma is to practice reframing. Reframing involves looking for ways to change the way we are viewing the experience of trauma; we might look for opportunities for growth or insight. This doesn’t mean being “Pollyannaish” or superficially positive, but trying to identify the possible potential that exists even in the worst circumstances. For example, going through a traumatic event might, after time, allow us to develop a more realistic view of the world or develop greater compassion for those who are suffering.
Another type of therapy that works well for PTSD is exposure therapy. Exposure therapy involves a gradual exposure, in the therapy session, to memories and thoughts about the traumatic experience. During the process of discussing intrusive thoughts or memories the client is gradually learning ways to regulate emotion, reduce stress, and to overall make these thoughts and memories less “triggering”—that is, less likely to cause a spiral into anxiety, panic, shame, or depression.
To move past trauma, it’s crucial to shift our perspective from victimhood to growth. Journaling can aid in this process by allowing us to explore our thoughts and change the narrative surrounding the traumatic event. Rather than focusing solely on the harm or perception of harm, we can focus on our potential for developing resilience, insight, empathy, and strength. When we process our trauma and shift to focusing on growth, we can truly incorporate the lessons of living through difficult events into our lives—whether that be developing greater wisdom, greater compassion, or greater resiliency.
References:
Aurelius, M. (1900). The meditations of Marcus Aurelius (G. Long, Trans.). Lupton. (Original work published ca. 180 C.E.)
Epictetus. (108 C.E./2014 C.E.). Discourses, fragments, handbook (R. Hard, Trans.). Oxford University Press.
Sallatha Sutta: The Arrow. (2013). Accesstoinsight.org. https://www.accesstoinsight.org/tipitaka/sn/sn36/sn36.006.than.html