Opinion: Researching coping strategies for PTSD

The Anxiety and Depression Association of America maintains a database of “Personal Stories of Triumph.” It’s a curated collection of stories about how people have suffered anxiety, depression, OCD, and/or trauma-related disorders — yet coped and triumphed. If you’re looking for a little lift, it’s worth checking out.

One of these is the story of a woman named P.K. Phillips.

It begins with a retrospective look at her former life; she recalls being young, talented, beautiful. Life was normal, her world seemed comfortable and safe, and she felt as if she knew how it worked.

And then at some point all of that flew right out the window. She suffered physical, mental and sexual abuses, including a near-deadly knife attack. And all of this left her with a sense of extreme fear and helplessness, ultimately diagnosed as PTSD at age 35.

Unfortunately, many of us endure these sorts of traumatic events at various points. We tend to go along thinking that life is totally fine, until one day something serious happens and life is suddenly not fine.

So, how can we understand these post-traumatic stress symptoms? What might they tell us about how traumatic experiences change the way that people engage with themselves and the world around them?

To better understand the first part of Phillips’ story, before trauma entered the picture, consider that decades of research suggests that people are able to function effectively in the world and live the good life, at least in part, by engaging in sociocultural anxiety-buffer systems to shield against the awareness that life is fleeting and fragile.

The idea here is that some sociocultural belief systems offer a sense of permanence via secular legacies (raising families, teaching students, contributing to government, science, technology, art, etc.) and some through religious and spiritual ideas about eternal souls and afterlives. Self-esteem then functions, in those systems, as an indicator of how well we feel we’re doing at living up to those beliefs, standards and values — at earning our permanence.

Think about a levee: a big embankment that people build to keep rivers from overflowing and destroying their homes. Indeed, research suggests that, normally, our psychological levee is in place and working well, and everything’s fine.

To better understand the second part of Phillips’ story, think about traumatic experience as a “psychological storm” that can flood our normally functioning sociocultural anxiety buffers.

Natural disasters, assault/abuse, war/political violence, serious medical events and other traumas can disrupt our anxiety-buffering sociocultural worldviews by vividly demonstrating that, despite successfully living up to our standards and values, the world remains a dangerous and chaotic place in which our symbolic religious or secular activities do little or nothing to protect against the reality of our mortality.

When that happens, a person’s worldviews and self-esteem will cease to function as effective buffers against death-related thoughts and anxieties. When the psychological storm hits and the levee breaks, in washes a flood of death-related thoughts and anxieties.

My colleagues and I recently conducted an experiment to put them to the test to find out if it really works this way.

We recruited one group of people with no post-traumatic stress, and a second group of people with high post-traumatic stress. Then, we administered a carefully controlled experimental protocol to each group.

Here’s what the results revealed:

In the low post-traumatic stress group, death (versus pain) reminders led people to express more death-related thoughts; but this effect was eliminated when we first allowed them to engage in a self-affirmation task, writing about how their sociocultural beliefs are important, and meaningful, and make them feel good about themselves. This reflects the idea that, in the absence of post-traumatic stress, people are normally able to buffer against death-thought. The levee’s in place; things are fine.

However, in the high post-traumatic stress group, death reminders led to more death-related thoughts even after engaging in the self-affirmation task (versus neutral task). The continued presence of this effect means that this typically effective sociocultural buffer failed. This is like the second part of Phillips’ story. The existential storm (trauma) hit, broke the levee, and now it’s not as able to effectively shield us against increased death awareness.

And this process could bear important implications for the current understanding of PTSD and its treatment, because failure to manage manage death awareness effectively is known to cause anxiety and exacerbate anxiety-related symptoms, and may potentially represent a key ingredient of PTSD symptoms.

So, what can we do about it?

More research is needed, of course, but if post-traumatic stress stems (at least in part) from anxiety-buffer disruption, then treatment might also aim to restore effective sociocultural functioning — helping people restore faith and participation in their worldviews; or helping people encounter and adopt new replacement worldviews capable of a meaningful and enduring sense of personal value and permanence.

The challenge, of course, is to determine whether and how that can be successfully and ethically accomplished.

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