Social Scientists Identify New Paths to Mental Health for Trauma Victims
On a sunny spring afternoon, Kate Jones was anxiously waiting to see her husband cross the finish line at the most prestigious marathon in the world.
Then came the boom.
Cheers of excitement immediately turned into blood-curdling screams as hundreds of people rushed from the clouds of smoke. Lost in the sea of chaos, Jones frantically searched for her husband, desperately hoping he wasn’t among the many victims sprawled on the bloodied streets.
“All I wanted was to find my husband, but I got lost in the crowd,” says the 36-year-old elementary school teacher who requested her real name not be used in this story. “I kept looking over my shoulder, waiting for another bomb to go off as hundreds of people were screaming at me to move.”
Since the Boston Marathon in April 2013, she continues to experience that terrifying scene in the safety of her own home.
“I sometimes have the same dream where a bomb is about to go off, and I’m trying to run for my life, but I’m paralyzed in fear,” says Jones, who is also a marathon runner. “I’m also very sensitive to loud, sudden noises. Fourth of July will never be the same.”
It’s difficult to imagine what the future holds for Jones and many others who have endured such horrors. How many will suffer from a crippling constellation of flashbacks, nightmares, severe anxiety and other symptoms of post-traumatic stress disorder (PTSD)?
Not as many as you would think, says Michael Telch, professor of psychology and leading expert on anxiety disorders. Just as ecosystems can withstand serious shock and come back stronger, so can humans. In fact, a report from the PTSD Alliance shows that 70 percent of adults in the United States have experienced a traumatic event at least once in their lives, yet only 20 percent go on to develop PTSD.
So why do most people bounce back from trauma while others falter? Is there a way to combat PTSD, depression and other psychological disorders before the trauma begins? Researchers at The University of Texas at Austin are seeking answers to these questions and compiling strategies for building resilience. Among them are early diagnosis, drawing new perspectives, strengthening social ties and psychological intervention.
Results from Telch’s ongoing Texas Combat PTSD Risk Project lend new insights into PTSD and other psychological disorders. The goal of the project is twofold: Find the factors that predispose service members to combat-related stress disorders, then develop more effective screening and prevention programs.
“I sometimes have the same dream where a bomb is about to go off, and I’m trying to run for my life, but I’m paralyzed in fear.”Kate Jones
For several years, Telch and a team of researchers have put nearly 200 Fort Hood soldiers through more than a dozen tests before their first yearlong deployment. The process includes surveys, clinical interviews, brain scans, genetic testing and a carbon dioxide stress challenge. While overseas, they fill out stress symptom and combat experience logs every 30 days, then go through all the tests again upon their return.
In the CO2 challenge, the participants inhale a mixture of 35 percent carbon dioxide and 65 percent oxygen for 30 seconds—which induces breathlessness and dizziness. Those who showed an increased fear response during the challenge were much more likely to develop anxiety and PTSD symptoms, Telch says. However, with CO2 therapy, that predisposition can be modified.
“If we find people are sensitive to the CO2 challenge, we can easily fix it by repeatedly exposing them to the test until they can control their reactions—and this can be applied to other stressful situations,” Telch says. “Just like with high cholesterol and heart disease, we’re able to identify a risk factor that can be modified before the illness sets in.”
This technique is one of the many forms of exposure therapy, where patients learn to process memories of fear differently by experiencing trauma again and again in a safe, controlled environment. As therapy progresses, the fear of the memory weakens and patients begin to feel more in control of their emotions and their lives in general. Typically about two-thirds of PTSD patients treated with prolonged exposure therapy during ten 90-minute sessions no longer exhibit the disorder.
“The success rates for patients receiving exposure therapy for PTSD are significantly higher than for people who are being treated for many other forms of mental illness,” Telch says. “Since we have such powerful treatments that can really make a difference so quickly, it’s important for patients to get help early on.”
Knowing When to Get Help
Of course, the first step toward recovery is knowing when to get help. But how do you know if those recurring nightmares and blue phases are natural parts of the healing process, or early signs of a mental illness?
It’s normal to feel down for days, or even weeks, after trauma says Christopher Beevers, professor of psychology and director of the newly established Institute for Mental Health Research at The University of Texas at Austin. But if feelings of sadness, lethargy and loss of interest persist for longer than a month, it may be time to get some help.
Some of the hallmarks of depression include sleepless nights, lack of interest in hobbies and social activities, lethargy and hopelessness. PTSD, however, can be much more difficult to detect, because the symptoms can linger under the surface for months after the trauma, Beevers says.
And when those symptoms appear, people with PTSD often go to great lengths to avoid anything in their personal or physical environment that reminds them of the trauma. In fact, findings from Beevers’ eye-tracking experiments demonstrate two stark differences between depression and PTSD.
As part of the Texas Combat PTSD Risk Project, Beevers presented various images to study participants and directly measured their line of gaze. He found those who are prone to depression linger longer on upsetting images of violent situations and unpleasant facial expressions. Yet people with a propensity for PTSD quickly cut away from negative images.
“Habitual avoidance of negative stimuli can increase vulnerability to anxiety,” Beevers says. “Whereas people with depression have trouble shifting away negative information, which leads to repetitive negative thinking.”
Like a broken bone or an infected wound, these debilitating mental illnesses rarely heal themselves without treatment. Laura Ebady, outreach coordinator and staff psychologist at UT Counseling and Mental Health Center, says untreated mental illnesses can lead to a host of problems, including substance addiction, unemployment, divorce and suicide. The first step, she says, is to understand what’s normal, and when it’s time to get help.
“When I talk about trauma, I often make this analogy: If you have no knowledge about the flu and end up getting sick, you’re likely to think that you’re going to die,” Ebady says. “After experiencing trauma for the first time, people don’t understand the pain they’re feeling is normal—and that they will get better in time.”
Ebady recommends calling upon previous coping strategies that have worked in the past, whether it be going for a jog, engaging in a hobby, journaling or seeking support from others.
“Sometimes it’s hard for other people to understand what you’re going through, so it can be really helpful to connect with people who’ve shared similar experiences,” Ebady says.
Another way to move forward is returning to a daily routine, Ebady says. But in the wake of a high profile tragedy, that comforting sense of normalcy can be thwarted by a barrage of upsetting media reports.
“After 9/11, there was an intense need to make sense out of what happened,” Ebady says. “But once you have the basic information, all those extra details can be very upsetting. The images and videos can cause more confusion and create a sense that the world is not safe.”
Marlone Henderson, assistant professor of psychology, says the media feeds our natural desire to make sense out of tragedy. In a recent study, he found that people are more likely to find clarity by turning away from detailed reports in the news and adopting a simplified understanding of the event.
“As time passes, people naturally gain more certainty about events,” Henderson says. “If you’re trying to give yourself a feeling of meaning, you can distance yourself from the incident with time and space. And this also applies to personal problems, such as troubles at work or a bad breakup.”
In the study, Henderson altered the participants’ sense of time by framing the Sandy Hook shooting around different reference points. For example, the shooting appears to be much more recent when compared to the Sept. 11 attacks. But in comparison to a similar incident that occurred just two weeks prior, the Sandy Hook shooting seems much farther away. He found the participants who perceived the shooting as farther away in time were less concerned about the small details and more confident in their understanding about why the event happened.
Henderson says results from the study have important implications—not just for mental health professionals—but for the media as well.
“It’s in the media’s interest to keep coming up with new reasons because these things are novel and exciting,” Henderson says. “But reporters could actually help bring people comfort by incorporating a sense of distance in their reports.”
In the age of instant communication, it’s almost impossible to avoid the nuanced accounts of devastating storms, school shootings and terrorist attacks. Looking back at the barrage of images of dazed bombing victims on the streets of Boston and the tear-streaked children evacuating classrooms at Sandy Hook, it’s easy to believe violent crime is on the rise.
In fact, the rates of crime in the United States are much lower than they were four decades ago, and they’re continuing to drop over time, Warr says.
Unfortunately, reporters often fail to put this perspective in their coverage of crime and violence, causing people to believe the world is much more dangerous than it really is, Warr says. They also fail to adjust the raw data of crime rates into the increasing population.
“Rarely do crime reporters have scientific training in criminology, so they don’t know any more about crime than the people they’re reporting to,” Warr says. “And what’s so scary about that is that these reporters have the power to go on TV and scare an entire city.”
Of course there are risks to worry about, but for the most part people are worrying about the wrong ones.
“Crime is utterly predictable,” Warr says. “In rough terms I could tell you how many homicides will happen tonight, who will commit them and where they will happen. There’s an epidemiology to these crimes, but we occasionally get crimes that don’t fit the pattern. Randomness and unpredictability are powerful tools of terrorism. But people need to realize that these events are exceedingly rare.”
Choosing to stay “safely” at home instead of cheering on runners at a marathon or catching a midnight screening at the local movie theater may seem rational in light of recent national headlines. But the fact is, people who go out of their way to err on the safe side are robbing themselves of their personal freedom, Warr says.
“The tragedy of the United States is that we give up much of our freedom needlessly,” Warr says. “We fought for freedom in this country and to lose it to unfounded ideas about risk is a real shame.”
As for Jones and her husband, who have both added several race medals to their collection since the Boston Marathon, they refuse to let fear get in the way of their passion for competitive running.
“If I stopped running marathons in fear of another attack, the terrorists win,” Jones says. “It feels great to get out there and run hard. I feel like I’m able to leave all my uncertainty on the pavement as I run. Every time I start a race, I’m able to prove that I don’t quit, I’m not afraid, and I have the strength to push through what us runners like to call ‘the wall of pain.’”