Stress Versus Post-Traumatic Stress Disorder (PTSD)

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CHAPTER 3 LITERATURE REVIEW: THE PHENOMENON OF TRAUMA

INTRODUCTION

This chapter included a literature review on the phenomenon of trauma to gain information and insight into the following aspects of trauma:

• The definition of trauma;
• The nature of trauma;
• Trauma’s effect on a person’s being as a “whole”;
• Symptoms and effects of trauma;
• Stages of recovery from trauma;
• Regaining control after trauma;
• Adaption and coping after trauma;
• Defence mechanisms in dealing with trauma;
• Corresponding aspects and the relationship between trauma and mental toughness;
• The role of psycho-education in the development of mental toughness to better deal with trauma.

TRAUMA DEFINED

Preston (2013: 2), Roos et al. (2002: 91), Unisa (2002: 8-10, 22, 30), Tedeschi and Calhoun (2004: 2) and Keeton (2009: 1) define trauma as stressful events, over which a person has no control. This stressful events cause high levels of anxiety which threatens or harms a person’s emotional, physical and/or social well-being and interferes with his normal daily functioning in such a way that a re-evaluation of his actions and thoughts are needed. These strong emotional reactions have the potential to interfere with a person’s ability to function either at the scene or later (Mitchel 1983).
Preston (2012: 2) states that any situation where a person experiences feelings of being overwhelmed and loneliness could be traumatic, even if there’s no indication of physical harm. Keeton (2009:1) provides a good example, which support Preston’s (2012: 2) statement: A child, while growing up, who had been humiliated by a parent or teacher, may have experienced a trauma.

CATEGORIES OF TRAUMA

According to Preston (2011: 2; 2013: 2), Roos et al. (2002: 42, 45), Unisa (2002: 8-10, 22, 23, 30) and Tedeschi and Calhoun (2004: 2) trauma is categorised as follows:

• Short-term traumatic events

Short-term traumatic events are known as once-off traumatic events, and these include:
ØØ Natural disasters: e.g. earthquakes, floods, severe tropical storms, hurricanes and mining disasters.
ØØ Manmade (accidental/unintentional) disasters: e.g. airplane accidents, car accidents and fires.
ØØ Manmade (intentional) disasters, which are deliberately caused: e.g. shooting, robbery, physical attack, sexual assault, rape, hostage taking, robbery, mugging, kidnapping and hi-jacking.

• Long-term traumatic events

Long-term traumatic events refer to prolonged exposure to trauma and consists of two sub-categories, which are:
ØØ Natural and technological disasters: e.g. nuclear accidents, toxic spills, epidemics and chronic and/or life-threatening illness.
ØØ Manmade (intentional) disasters: e.g. repeated sexual abuse as a child.

• Vicarious exposure

Vicarious exposure to trauma implies indirect exposure to trauma and therefore it is known as secondary traumatisation. The person is not the direct victim of the trauma, but he witnessed the event or heard about it from others and in this way distress arises in him; for example disaster, unexpected witnessing of a dead body learning about the unexpected death of a family member or friend and observation of parents with chronic stress effects. Secondary traumatisation could also be caused by exposure to closely avoided traumatic incidences (Clarke 2008: 14-16; Roos et al. 2002: 42, 46; Tedeschi & Calhoun 2004: 2).

TYPES OF TRAUMA

• Type I taumas

Examples of Type I traumas are hi-jackings, rape and nuclear accidents. Type I traumas are characterised in Table 3.1 (Meichenbaum 1995: 20; Roos et al. 2002: 43 and James & Gilliland 2013: 189).

• Type II traumas

Examples of Type II traumas are repeated sexual abuse as child and chronic illness.

STRESS VERSUS POST-TRAUMATIC STRESS DISORDER (PTSD)

Stress is defined and described in detail in Chapter 2. From the discussion of the perspective of stress, stress is seen in terms of a stressor (amount of pressure) which leads to a stress reaction. It is not possible to determine a person’s precise breaking point, as two different persons experience the same stressor differently (Roos et al. 2002: 15-16, 46). If a traumatic event is not dealt with and integrated into a person’s awareness system, the initiating stressor will re-emerge as stress symptoms months or years after the trauma took place and is called delayed or post-traumatic stress disorder (PTSD) (James & Gilliland 2013: 150, 160, 189; Roos et al. 2002: 46 ).
The DSM-5 pays attention to the behavioural symptoms that accompany PTSD and contains four distinct diagnostic clusters, namely re-experiencing, avoidance, negative cognitions and mood and arousal (U.S. Department of Veterans Affairs: 2013; American Psychiatric Publishing: Post Traumatic Stress Disorder: 2013; Roos et al. 2002: 41-42; Unisa 2002: 10). All of the conditions included in this classification as diagnostic criteria require exposure to a traumatic or stressful event (James and Gilliland 2013: 152; Unisa 2002:10). For the purpose of this study the focus was on stressors that trauma causes, and not on PTSD as such. Research carried out by Mol, Arntz, Metsemakers, Dinant, Vilters-Van Montfort and Knottnerus (2005: 494, 497) and Scott and Stradling (2006, as cited in Clarke 2008: 15) provides evidence that there is a connection between negative life events—for example divorce, chronic illness and bullying at work—and many symptoms of PTSD as caused by trauma itself. The difference between the impact of a life event and a traumatic event in terms of PTSD is that the impact of a life event decreases over years while the impact of a traumatic event is more stubborn (Mol et al.2005: 498).
Another concept that should be noted when dealing with stress and PTSD is Acute Stress Disorder (ASD). The most important difference between ASD and PTSD is in onset. ASD symptoms manifest within two days to weeks weeks after a trauma, while PTSD can only be diagnosed from a period of four weeks after the event (Sue et al. 2003: 157-158; Bryant, Friedman, Spiegel, Ursano & Strain 2011: 335-336; Scott & Stradling 2006: 3).

SUSCEPTIBILITY TO PTSD OR THE SYMPTOMS THEREOF

Sensitivity to PTSD is determined by different personal aspects such as genetic predisposition, personal history, personality traits, self-esteem, strengths, weaknesses, state of mind, past life experiences, coping skills, social support systems, the intensity of the event, the perception of the event, conflict, stress management skills and flexibility. Some people have extremely good coping skills and they can deal with severe traumatic incidences much better than other people who might be traumatised by a less upsetting incident. A more detailed description of the personal aspects as an important determining factor, of whether a person will find an event traumatic or not, is discussed later in this chapter (A person’s interpretation of the traumatic event) (Sue et al. 2003:160-161; Roos et al. 2002: 42, 45, 55; James & Gilliland 2013: 156, 158; Unisa 2002:16; Scott & Stradling 2006: 27).

SYMPTOMS AND EFFECTS OF TRAUMA ON A PERSON

Stress reactions after a traumatic incident are not pathologic, but normal. To support a traumatised person, is to support a survivor as a “normal and healthy person in an abnormal situation” (Meichenbaum 1995: 350; Roos et al. 2002: 90-91; Tedeschi and Calhoun 2004: 2; Roets 2009). As mentioned before, the focus of this study is not on PTSD. It is however important to be familiar with the symptoms of PTSD in order for the therapist to be able to observe whether a traumatised client is only experiencing possible symptoms of PTSD, or whether he should be referred to a clinical psychologist. Knowledge of the symptoms of PTSD is also of importance as there is a similarity between the symptoms of PTSD and the “normal” stress that is caused by traumatic incidents (Mol et al. 2005: 494-498; Scott and Stradling 2006, as cited in Clarke 2008:15; Scott & Stradling 2006: 8-13; Roos et al. 2002: 90; Unisa 2002: 9-14, 26-27).
Kleber and Brom (1992: 4-6) focus on three important aspects for individuals who face traumatic experiences, namely powerlessness, extreme discomfort and an acute disruption of his existence.

CHAPTER 1 ORIENTATION TO THE STUDY
1.1 Introduction
1.2 Awareness and Motivation for the Study
1.3 Demarcation of Research
1.4 Research Question
1.5 Research Paradigm
1.6 Aims of Study
1.7 Research Method
1.8 Definition of Important Terms
1.9 Division of Chapters
1.10 Conclusion
CHAPTER 2 LITERATURE REVIEW: THE PHENOMENON OF MENTAL TOUGHNESS
2.1 Introduction
2.2 Mental Toughness Defined
2.3 A Brief History of Mental Toughness
2.4 Theoreticl Constructs and Origins of Mental Toughness
2.5 Four Scales of Mental Toughness
2.6 The Mental Toughness Questionnaire 48 (MTQ48)
2.7 Applications of Mental Toughness
2.8 Implications of Mental Toughness
2.9 The Role of Stress in Mental Toughness
2.10 The Development of Mental Toughness
2.11 Conclusion from Literature Review
CHAPTER 3 LITERATURE REVIEW: THE PHENOMENON OF TRAUMA
3.1 Introduction
3.2 Trauma Defined
3.3 Categories of Trauma
3.4 Types of Trauma
3.5 Stress Versus Post-Traumatic Stress Disorder (PTSD)
3.6 Susceptibility to PTSD or the Symptoms Thereof
3.7 Symptoms and Effect of Trauma on a Person
3.8 Symptoms of increased nervous system arousal (hyper-arousal)
3.9 Stages or Sequences of Recovery from Trauma
3.10 Defence Mechanisms in Dealing with Trauma
3.11 Trauma’s Impact on the Brain and Body
3.12 The Difference Between Traumatic Growth (PG) and the Concepts of Resilience, Hardiness and Optimism
3.14 Adaptation and Coping after a Trauma
3.15 The Role of Psycho-Education in the Development of Mental Toughness in dealing with Trauma
3.16 Conclusion from Literature Review
CHAPTER 4 RESEARCH DESIGN AND METHODOLOGY
4.1 Introduction
4.2 Aims of the Empirical Study
4.3 Research Design
4.4 Data Collection
4.5 Sampling
4.6 Ethical Considerations
4.7 Conclusion
CHAPTER 5 PSYCHO-EDUCATIONAL PROGRAMME
5.1 Introduction
5.2 Psycho-Educational Programme
5.3 Conclusion
CHAPTER 6 RESULTS OF THE EMPIRICAL RESEARCH
6.1 Introduction
6.2 Intervention Implementation
6.3 Participants: Information, Quantitative Results (MTQ48) and Qualitative Results (Therapy Sessions)
6.5 Action Research Evaluation Feedback from Participants
6.6 Conclusion
CHAPTER 7 SUMMARY, CONCLUSION AND RECOMMENDATIONS OF STUDY
7.1 Introduction
7.2 Summary and Findings of the Literature Review
7.3 Summary of the Psycho-Educational Intervention Programme
7.4 Summary and Findings of the Empirical Study
7.5 Limitations of the Empirical Study and Suggestions for Further Studies
7.6 Contributions of the Study
7.7 Recommendations for Future Research
7.8 Conclusion
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THE PSYCHO-EDUCATIONAL USE OF MENTAL TOUGHNESS IN DEALING WITH TRAUMA