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Symptoms of Posttraumatic Stress Disorder (PTSD)
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Meaning of Stress
Walton T. Roth
First, let us look at victims of
terrorism and factors that determine the stress of the experience for them. Walton
Roths ideas underline the ethical need for individualization of the client
as a unique person. After a terrorist siege has ended, physicians may describe
the bodily damage in terms of physical injuries, but, as you know, in addition
to any direct injuries, each participant in a terrorist incident has been exposed
to a situation in which many subtle changes may have taken place in response to
the stressor. Well look at these stressors in terms of four losses: loss
of invulnerability, loss of an orderly world, loss of self-image, and loss of
trust. As I am outlining these ideas, you might think about how they apply to
clients you treated immediately following the September 11th Twin Towers attack.
Treating the Loss of Invulnerability:
A client, whom a colleague treated,
had an uncle shot in a local mosque immediately following the September 11th attacks.
The client stated, This couldnt happen to me. This couldnt happen
to my uncle, she thought. Her next thoughts were, But it did happen
to you and your uncle, therefore you no longer feel the world is a safe place.
She stated, I feel less safe than I did before his shooting. Even when others
assure me that it cant happen again, I know that it could and fear that
2 Symptoms of Post Traumatic Stress Disorder (PTSD)
As you know, these feelings of vulnerability indicate two symptoms
of PTSD, Post Traumatic Stress Disorder:
1. A sense of doom or an
expectation of a foreshortened future, and
2. An intense fear that
the trauma will repeat itself.
Thus, the ethical need for individualization
to the client as a unique person is called for here, especially related to the
clients use of psychological defense mechanisms.
the case of the hijacked planes that crashed, the passengers were, of course,
taken hostage. In the case of a hostage, the hostages first response might
be, I dont believe this or This cant be happening
to me. Loss of invulnerability is initiated. According to Ochburger the
individual unconsciously and automatically refuses to comprehend the situation.
For brief periods, denial helps. It permits time to lapse and protects the individual
from physical collapse. Panic reactions are forestalled or made less likely. The
temporary effects of denial give the victim an opportunity to gradually assess
the situation and perhaps formulate coping strategies.
individual who utilizes this counterphobic mechanism reduces stress and anxiety
which may cause excessive and sometimes rash responses that actually oppose his
basic inclinations for safety in a threatening situation. A simple example would
be the case of a man with a fear of heights who insists on peering over the edge
of a cliff. Counterphobic psychological defenses may serve the individual well
in some stress situations, but in violent circumstances such as a hijacking incident,
counterphobic behavior in these situations is sometimes termed bravery. But, as
you know, this bravery can increase the chances that the victim will be injured
♦ Reaction Formation
related to the counterphobic mechanisms are those that are usually described as
reaction formation and identification with the aggressor. However, these usually
occur over longer periods of time and, thus, involve later phases of hostage situations.
Reaction formation may be described as an adaptive process in which an individual
adopts attitudes and behaviors that are, in fact, opposite to the impulses he
harbors, either consciously or unconsciously.
For example, fear of the terrorist is transformed into approval or admiration. In a situation where one person is
victimized by another, this process may extend to identification with the aggressor.
When observed in the victims of terrorists, the process may be described in different
terms, such as identification with the captor, or identification
with the controller.
The victim unconsciously incorporates... the characteristics
of the feared person and becomes psychologically allied with him. Thus, the victim
transformed himself or herself from the person threatened into the person who
makes the threat; thus, the victim reduces his anxiety. Should the victim seek
therapy, an ethical issue may arise if the therapist finds himself or herself
being judgmental regarding the victims attitude of identification with his
or her captors.
Peer-Reviewed Journal Article References:
Gil, S., & Weinberg, M. (2015). Coping strategies and internal resources of dispositional optimism and mastery as predictors of traumatic exposure and of PTSD symptoms: A prospective study. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 405–411.
Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133–141.
Kaufman, J. S., Allbaugh, L. J., & Wright, M. O. (2018). Relational wellbeing following traumatic interpersonal events and challenges to core beliefs. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 103–111
Larsen, S. E., Fleming, C. J. E., & Resick, P. A. (2019). Residual symptoms following empirically supported treatment for PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 11(2), 207–215.
Macdonald, A., Pukay-Martin, N. D., Wagner, A. C., Fredman, S. J., & Monson, C. M. (2016). Cognitive–behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. Journal of Family Psychology, 30(1), 157–162.
What behaviors are closely related to the counterphobic mechanisms? To
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