Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society
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narrowing of attention onto sources of potential challenge or threat. Children and adults with such hyperarousal tend to experience sleep problems, both because they are unable to quiet themselves sufficiently to go to sleep, and because they deliberately wake themselves u p in order to avoid having traumatic nightmares. Perhaps the most distressing aspect of this hyperarousal is the generalization of threat. T h e world increasingly becomes an unsafe place: Innocuous sounds provoke an alerting
people with histories of psychological trauma suffer from a range of problems with information processing, fully effective treatment is likely to require a strategically staged, multimodal treatment approach, m o r e thoroughly described in Part VI of this book. This includes overcoming (1) the patients' fear of confronting their helplessness and shame, (2) their fear of the traumatic memories, and (3) their fear of involvement with life itself (van der Hart, Steele, B o o n , & Brown, 1993).
the meaning of the trauma is secret, forbidden, or unacceptable (as in intrafamilial abuse or government-sanctioned violence), the trauma is unlikely to result in the mobilization of external resources, in restitution, or in the meting out ofjustice. Because of the lack of validation and support, traumatic memories are m o r e likely to continue to prey on the victims' minds, and to be expressed as anger, withdrawal, or otherwise disrupted and disrupting behaviors. RELIGION, C O M M U N I T Y ,
(Elliot & Briere, 1994). Most cases of sexual abuse probably go unreported and never come to the attention of either mental health professionals or the legal system. Child custody issues greatly complicate the issue of false accusation, since they provide a motive for making them: Schetky and Green (1988) estimate that as many as 2 5 % of sexual abuse allegations in child custody cases are false. Although the occurrence of delayed memories following just about every conceivable form of trauma has
conflicting results m a y be attributable to the fact that successful coping, rather than any particular coping strategy, m a y ultimately moderate the effect of stress. Effective coping results in relief of personal distress, maintenance of a sense of personal worth, conservation of one's ability to form rewarding social contacts, and sustained capability to meet the requirements ofthe task (Pearlin & Schooler, 1978). In order to succeed, however, coping efforts must match the circumstances of