LITERATURE REVIEW

Literature Review

Literature Review

Posttraumatic stress disorder (PTSD) is a relatively common psychiatric disorder, with an overall lifetime prevalence of about seven to twelve percent in the general US population (e.g. Kessler 1995). More specifically, five to six percent of men and ten to twelve percent of women suffer from PTSD at some point in their lives, making it the fourth most common psychiatric disorder (Breslau et al., 1991, Kessler et al., 1995 & Resnick et al., 1993). In patients with PTSD, studies have shown alterations in brain structures and functions, dysregulation in the neuroendocrine system, psychophysiological abnormalities as well as increased somatic symptoms and illnesses (Rasmusson, et al., 2004). There is clear evidence that not every adult copes with potential trauma in the same way (Aldwin and Yancura, 2004). Research has indicated that most of individuals exposed to trauma do not develop PTSD, depression or other psychiatric or physical disorders (Kessler et al., 1995). After trauma exposure, about 10% of people are dysregulated in such a way that they develop PTSD (Breslau et al., 1998). Clearly, examining the interrelationships among trauma, appraisal and coping processes, neuroendocrine stress responses, and mental health outcomes may provide important implications for psychosocial and pharmacological interventions designed to alleviate posttrauma symptoms.

Coping with trauma

Generally, humans react with distinct coping strategies to different types of stress. Active coping strategies (e.g. confrontation, fight, escape) are usually elicited if the stressor or threat is controllable or escapable. Passive coping strategies (e.g. immobility, disengagement) are evoked if the stressor is uncontrollable or inescapable. Interestingly, recent anatomical studies indicate that different neural circuits mediate active and passive emotional coping strategies (e.g. Bandler et al., 2000 & Keay & Bandler, 2001).

In the context of traumatic stress, active or instrumental coping strategies, such as positive thinking or dealing actively with problems have been associated with a (good) adaptation to stress, while passive coping strategies such as avoidance are most often considered as maladaptive coping strategies (e.g. Resnick, 1988, Sharkansky et al., 2000, North et al., 2001 & Silver et al., 2002; see also the review of Linley & Joseph, 2004). For example, after exposure to a mass murder episode three types of active coping strategies—i.e. active outreach, informed pragmatism, and reconciliation—were associated with decreased risk for psychiatric disorders over time (North et al., 2001). Similar results were reported by Resnick (1988), who collected coping data one month after a sexual assault and prospectively assessed symptoms: Use of more active resistance (e.g. behavioral focused active coping) during sexual assault was related to lower levels of PTSD symptoms at 12-months post-assault. In addition, actively coping in the immediate aftermath of the September 11th terrorist attacks was the only strategy that appeared to be protective against ongoing distress (Silver et al., 2002).

Seeking social support is another active coping strategy in dealing with traumatic stress. It significantly protects against PTSD as evidenced in a recent meta-analysis (Ozer et al., 2003). More specifically, beneficial effects of disclosing or discussing the event have consistently been reported among individuals who ...