Relieving acute stress from trauma may be a matter of thinking it through

Apr 27 2004

Many people experience serious trauma in their lives - only the fortunate will avoid events such as a serious car accident, the death of a close relative or a physical or sexual assault.

Such events inevitably have psychological consequences, but according to Flinders psychologist Dr Reg Nixon, a number of people respond by manifesting a range of symptoms and behaviours beyond the "normal" range.

These responses, classified as Acute Stress Disorder (ASD), include high levels of anxiety, resulting in nightmares and insomnia. People experiencing ASD also suffer intrusive thoughts about the event, may avoid the scene of the trauma and talking about it, as well as people or circumstances that act as a reminder of it.

In a high proportion of the sufferers of ASD - up to 80 per cent - the range of responses continues beyond a month, at which point their condition is classified as Post Traumatic Stress Disorder (PTSD), a chronic psychological state that may extend for years after the causative events.

"Vietnam veterans are perhaps the best known group who are at risk of suffering chronic PTSD, in some cases up to 30 years after the war ended," Dr Nixon said. Dr Nixon is overseeing a new study at Flinders that aims to limit the on-going effects of trauma through a program of early intervention.

"As a psychologist, I would be concerned if there wasn't an immediate reaction to the high impact stressors of a car accident or being the victim or witness of a hold-up," he said.

"But with Acute Stress Disorder, we're talking about a number of these systems persisting for more than several days and which cause significant distress, and that are impairing people from getting on with their lives, affecting their work and their relationships."

The study is seeking about 30 adults who have experienced interpersonal traumatic events such as armed hold-ups or physical or sexual assault within the past four weeks.

Alongside the more standard approach of offering supportive counselling, the study will trial cognitive processing therapy, a strategy that encourages people to analyse their own responses to the events.

"People tend to catastrophise: they may think that because they are having nightmares or thinking about the trauma when they don't want to, they are going crazy or that there is something seriously wrong with them, which is actually not the case," Dr Nixon said.

"We try to get them to examine their thinking, so to speak, so that they can evaluate things a little more realistically.

"We also try to get people to realise that the trauma is over, that it is a past event, and that reactions such as nightmares and thoughts about the trauma, while distressing, are not actually harmful."

Dr Nixon said cognitive processing therapy has been used with success in treating PTSD in rape victims in the United States.

"But it hasn't been trialed for people who have been recently traumatised, so what we're interested in is whether this technique is as effective for an acute intervention as it is for a chronic problem like PTSD," Dr Nixon said.

"We will be comparing it with a more conventional problem-solving approach, often used in crisis management, that centres on managing anxiety through techniques such as relaxation, and which we know can be useful.

"The study is a very much a pilot project: we are hoping to demonstrate that the cognitive approach is worth researching on a larger scale."

Dr Nixon said that most people have the capacity to bounce back from traumatic events, and to recover swiftly from adverse psychological reactions.

"It is important to recognise that although these traumas can be quite common, we generally cope quite well, and the majority of people overcome these problems without formal intervention from counsellors, psychologists, or psychiatrists.

"Instead, they draw on their own strengths and social support networks." Through his research, Dr Nixon hopes eventually to identify underlying conditions that may make people more susceptible to ASD and PTSD.

"Most of us in our lives will experience a stressor that could potentially cause PTSD, but we know that only a subset of people go on to develop PTSD," he said. "My research is very much concerned with why some people develop that reaction and others don't.

"While it is likely to have something to do with certain vulnerabilities or some predisposition, a lot of it is to do with what is happening at the time of the trauma and afterwards - how people process information and the interpretations they make."

People interested in volunteering for the post-trauma treatment program should contact researcher Melissa Oxlad on 8201 2324.