Category Archives: Post-Traumatic Stress Disorder

**Warning: this post is about trauma and trauma responses. Given the number of folks who have had traumatic experiences, it stands to reason that some readers may find the post below troubling (nothing graphic though!) because they struggle with the aftereffects of trauma in their lives. If you do read, make sure to read to the bold print at the bottom. I write to highlight to counselors that we still do not fully understand why some seem to be resilient and others struggle after a trauma.** 

There is an assumption in the counseling world that everyone who faces tremendous loss or trauma will experience serious side effects. They will need to “work through” their grief or trauma. Those who show absent grief are just in denial or avoiding reality or they had superficial attachments. Absent grief means that the person will surface these problems later in a delayed fashion. Finally, counselors tend to believe that everyone who experiences grief or trauma could benefit from professional help and active coping mechanism.

Enter George Bonanno of Columbia University. He’s researched and written extensively on the topics. I highlight his 2004 American Psychologist article where he makes these three points in his critique of the above beliefs, which he finds little to no support for. He makes these three points in the article:
1. Resilience is different from recovery. Some people are resilient in the face of distressing events. It doesn’t mean they don’t feel sadness or have other evidences of grief, but they do not lose their equilibrium for long periods of time. Some people do suffering chronic grieving and instability that takes time to recover from (e.g., 1-2 years). Some research suggests offering debriefing of trauma experiences or “working through” grief can be harmful to the resilient population. Those struggling will benefit from counseling help (those showing prior trauma, low social support, and/or hyperarousal). Therefore, we need to do a better job screening for risk factors rather than forcing everyone into debriefing work.
2. Resiliences is common. Some believe that those not showing prolonged distress from a death of a close loved one are experiencing a pathology called “absent grief.” One study showed 65% of therapists believe the above assumption. Unfortunately, there is not only no data to support this but real data to support the opposite. Some people are quite resilient. About 10-15% show chronic depression and distress after a loss. About 50% of participants in another study showed only low levels of depression and grief through 18 months after their loss and not problems 5 years later. The same is true with trauma responses. Some 80% exposed to serious trauma do not evidence PTSD. A very small percentage of that group may show delayed trauma symptoms but the vast majority cope well without therapy.
3. There are multiple pathways to resilience. So, what promotes resilience? We know that prior trauma, poor social support and family violence increase the likelihood of chronic symptoms from a future traumatic event. Bonanno says the research points to

a. Hardiness (defined as having a commitment to finding meaningful purpose in life, belief that one can influence outcome of events, and that belief that one can grow from positive and negative events). Makes sense. Also makes sense that victims of repeated child sexual abuse experience more trauma symptoms as the second and third parts to hardiness do not get formed. They do not have the power, in their experiences, that they can influence the outcome of events.
b. Self-enhancement. Those who have more narcissistic tendencies may experience less trauma. Does denial protect us from some trauma symptoms? Put a better way, those who have positive biases in favor of themself (high self-esteem) may be able to maintain confidence that they will survive and be successful. Of course, it may come at a cost of losing one’s friends as self-centered folks can be quite full of themselves. I wonder how one’s confidence in God’s sovereignty and goodness would help here. I suspect it would. Maybe its less about self-esteem and more about confidence in God’s economy of love.
c. Repressive coping. Sounds bad…but some people seem to be able to avoid unpleasant thoughts, memories and emotions. This group may experience more physical symptoms and autonomic arousal. I question whether this is truly a sign of good coping. Further, repression, as defined here is not the inability to recall bad events but a cognitive capacity to avoid thinking about something. We still don’t know why some people are able to not think about something but others ruminate against their will.
d. Positive Emotion and laughter. Those that express more gratitude, interest, and love seem to be more resilient than those who cannot smile and laugh when speaking about some of their life during the traumatic events.

While Bonanno has helped us to see that those who exhibit resilience in the face of grief and trauma are less rare than we thought, we still do not have great details on the personal, genetic, and environmental factors that help individuals respond well to difficult events. It would be easy for those who do struggle to become even more self-condemning after reading this. I warn against this as healthy trauma response is not merely a matter of the will. In fact, I have met many victims of trauma that have suffered many symptoms. In my estimation, they still show a great capacity to survive despite the evil perpetrated against them. For therapists, it’s helpful to remember not to force everyone into the same treatment mode or to suggest that those who seem to be doing well faster than what we might expect are somehow dysfunctional.    

Bonanno, G.A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59:1, 20-28.