I haven’t really slept for twenty years. I lie down but I don’t sleep. I’m always watching the door, the window, then back to the door. … It’s like that until the sun begins to come up, then I can sleep for an hour or two. … Once a guy was burned real bad when some hydraulic fluid caught fire. … I got through Vietnam without a scratch (but) the smell of burning flesh f***ed me up real bad afterward. … I didn’t notice it at the time the guy caught fire, but for the next few weeks I kept having flashbacks. … I don’t deserve my wife. What kind of life it is for her married to me? … I once threw her out of bed. … I thought there was an NVA potato-masher [a North Vietnamese Army hand grenade] come in on us.

—Shay (1994, pp. xiv–xv)

This Vietnam veteran experienced an emotional trauma and is paying the price. He is not alone. Among many people, traumas trigger trauma-related disorders, those in which people experience any of a wide range of disturbances in emotional life (anxiety, depression, anger, loss of interest in social life) following a stressful traumatic event (American Psychiatric Association, 2013).

Psychologists have studied the psychological effects of trauma throughout the field’s history. In the late 1800s, cases in which patients reported traumatic sexual abuse were the foundation for Freud’s theory of personality (Chapter 13). In the 1970s, the study of trauma advanced when psychologists studied soldiers returning from the Vietnam War (Boscarino & Figley, 2012). They identified, in many veterans, a syndrome known as posttraumatic stress disorder.

DEFINING FEATURES AND PREVALENCE. Posttraumatic stress disorder, or PTSD, develops when people encounter extremely high levels of stress (e.g., military combat experience or a sexual assault; Nemeroff et al., 2006). Months or even years after the stressful event, people with PTSD experience flashbacks, which are vivid memories of past traumas. A crime victim may frequently re-experience the sights and sounds of the crime. A war veteran may uncontrollably relive the images and feelings of battle. The flashbacks can trigger intense anxiety that interferes with everyday life—as you read in the case of the Vietnam veteran quoted earlier. Symptoms of PTSD also include alterations in emotions, including anxiety when encountering anything that reminds one of the traumatic event, persistent negative emotions (anger, guilt, horror), and high levels of arousal that cause people to easily startle.

697

Many people experience PTSD symptoms; at any given time, its prevalence among adults in the United States is 3.5% (American Psychiatric Association, 2013). Rates are considerably higher if one examines populations in which all individuals have experienced a trauma. For instance, more than 12% of rescue and recovery volunteers who assisted at the World Trade Center after the 9/11 attacks experienced PTSD (Perrin et al., 2007).

TREATMENT. Fortunately, therapy can help people cope with the disorder (Foa, Keane, & Friedman, 2000). One popular therapy strategy is a cognitive-behavioral approach in which clients learn how to cope with their traumatic memories effectively. For example, in a therapy for female combat veterans (Schnurr et al., 2007), women were encouraged to think about the traumatic events they had experienced rather than avoiding such thoughts. As they maintained their mental focus on the events, their emotional distress gradually reduced. They thus learned that they were able to think about past traumas without losing control of their thoughts and emotions. A meta-analysis of therapy effectiveness shows that when therapy alters people’s beliefs about the traumatic event and its consequences, PTSD symptoms are reduced (Bisson et al., 2007).

Modern technology can enhance the effectiveness of PTSD therapy. Rather than relying on clients’ ability to form mental images of traumatic events, therapists use virtual reality technologies to present images of trauma (e.g., military combat scenes; Rizzo et al., 2013). Virtual reality immerses clients in vivid computer-generated environments (see photo). They thus can develop skills for coping with their emotions while experiencing lifelike representations of traumatic events.