The Difference Between A Trip Up The Stairs and PTSD
We’ve all experienced it in some form. The sweaty palms, the pounding chest, the gasp of breath: the reliving of some unfortunate memory. Maybe it was a trip up the stairs, or a poorly executed class speech. These minor traumas delay our hectic lives for a moment; give us a second’s pause. But for some people, that pause lasts years instead of seconds.
So where is the distinction between these inconsequential daily events and a true trauma? What constitutes a true trauma for people our age? In 2006, Dorthe Berntsen and David Rubin designed a study to establish that distinction between a trip up the stairs and Post Traumatic Stress. The formal American Psychiatric Association (APA) definition for PTSD is “a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms” (APA, 2000). In other words, a mental roadblock.
In “When Trauma Becomes a Key to Identity” Berntsen and Rubin take the distinction between PTSD and small traumas a step further. The focus of their study is the point in time when a stressful past becomes engrained in the way people see themselves and the world. For example, say a Maine snowstorm caused your car to skid off the road. Instead of getting the damage repaired and moving on, you are unable to get behind the wheel of a car. The accident has become part of your identity as a driver, and is interfering with your daily life. We traditionally believe that the less we acknowledge the memory causing us pain, the more it will affect us. The idea of repressed memories working their way to the surface and causing problems permeates popular culture and psychological TV dramas. Bernsten and Rubin agree that traumatic events change our perceptions, but hypothesize that further integration (thinking about them more) actually escalates the symptoms of PTSD (Berntsen and Rubin, 2006). They judge this by creating the Centrality of Event Scale (CES) which has participants rate the truthfulness of a statement like “I feel that this event has become part of my identity” on a scale of 1-5 (Berntsen and Rubin, 2006). The CES is meant to gauge the significance of a traumatic event on a person’s life.
Two studies were conducted. The first included 247 Danish psychology students (mean age of 26.8). Each undergraduate took the CES quiz, the Posttraumatic Stress Disorder Checklist (PCL), and the Dissociative Experience Scale (DES). Each of these are meant to categorize an event as traumatizing or ordinary. The participants were grouped, and each subset received an additional stress test to ensure their categorization was correct. In the first study, correlations were found between the PCL and the CES, and the PCL and the DES. This meant that the CES (the rating of how significant an event is) is undeniably related to symptoms of Post Traumatic Stress. However, the first study failed to qualify if the traumas they were testing for satisfied the APA definition of PTSD. Thus, a second study was developed. This time around, 442 Duke college students participated (mean age of 17.8). The same tests were used as in the first trial, with an added assessment to determine the level of trauma sustained by the students (if they fit the APA definition). This step was taken to ensure that one 18-year-old student didn’t classify failing a chemistry test as trauma, while another worked off of a car crash trauma.
Ultimately, Bernsten and Rubin’s study aimed to disprove the traditional stereotype that the only way to cognitively address emotional trauma is to fully integrate it into our memories. Instead, they found that when the undergraduates rated these incidents high on the CES scale (how much influence it has on them), they also tested positively for signs of PTSD across the board. They had reached mental roadblocks. These roadblocks meant that the students had integrated the traumatic events into their identities and relationships with other people – and they displayed symptoms such as anxiety and depression.
What does this mean? Integrating the traumatic incident makes it an anchor for our future interactions, and the way we live our lives. It becomes part of our identity. The more credit we give these experiences, the more difficult it is for us to cognitively progress. When we get stuck, mentally revisiting the trauma is counterproductive, and we should instead focus our energies on moving forward.
Bernsten, Dorthe and David C. Rubin (2006). When a Trauma Becomes a Key to Identity: Enhanced Integration of Trauma Memories Predicts Posttraumatic Stress Disorder Symptoms. Applied Cognitive Psychology, 21, 417-431.
This is a shocking finding. I wonder if it’s been reflected in therapy protocol for PTSD patients. Does this suggest that the actual incident potentially causing the PTSD shouldn’t be addressed at all in a therapeutic setting? Instead, should patients attempt to rid themselves completely of these experiences and move forward? It’ll be interesting to see whether or not these strategies play out, and whether they’re effective relative to prior PTSD treatments that presumably targeted the source of the illness.
I think the results of this study are particularly interesting, as so many people experiencing traumatic events, such as the death of a family member or witnessing a crime. I wonder how easy it is to simply put something in the past? Evidence has shown that rumination can lead to depression. So how can people who have experienced something traumatic effectively move forward and think positively? Especially in the case of rapes, rehearsing the event can be very scary and difficult for a victim. I hope further research is conducted to find a way to accept these influential incidents so that people can learn to move past them.
Kimberly makes a good point, that although Berntsen and Rubin show that there is a correlation between further integration of stressful memories and PTSD symptoms, they do not provide a treatment alternative. I do think that traditional therapy must be adapted to these findings – merely forcing trauma victims to talk about their pasts will not serve them well in the long run.
Although initially these findings seemed surprising to me, the more I’ve thought about this article, the more I’ve realized that the results really suggest finding a moderate, balanced approach to dealing with trauma. It is already a well-known fact, for instance, that rumination on negative events can have unhealthy effects, and it seems like the authors are essentially warning against the effects of rumination, which can lead to individuals assigning an unhealthy level of significance to traumatic events. They are not, however, suggesting that PTSD patients suppress their negative emotions, which has also been shown to yield a variety of negative emotional and physiological effects. The results of this study instead point to finding a way to effectively work through traumatic experiences and recognizing that they do not have to define who the individual is.