A traumatic event is an often unexpected occurrence that causes a person to feel an intense sense of fear, helplessness, and horror. A person may be seriously injured or face the threat of serious injury. Both someone who experiences the event firsthand and someone who witnesses an event, such as abuse happening to someone else, can be traumatized. Traumatic events can range from experiences such as interpersonal violence to war and natural disasters, and include occurrences such as being mugged, subjected to gang violence, and being sexual assaulted or raped.
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Many people experience traumatic events throughout their lifetime, such as the loss of a loved one or a car accident. Since traumatic events often occur in a context that is outside of a person’s control, they can be disorienting and violate one’s understanding of how the world works or should work. Sometimes, a specific person has broken a sense of trust; other times, a system (such as the state’s natural disaster planning mechanisms) has failed to protect people from harm. Experiencing a traumatic event can cause a host of symptoms, as are detailed below. While many people may experience a traumatic event in their lifetimes, only a fraction develop post-traumatic stress disorder (PTSD).
What is PTSD?
Post-traumatic stress disorder is classified as an anxiety disorder and can be acute (short-term) or chronic (long-term). While many people experience something traumatic and are able to move beyond it, a person with PTSD may feel “stuck”, intense physiological and psychological reactions to things that remind her/him of the trauma, and/or unable to control his/her emotions in response to reminders of the trauma. It can be difficult to focus on daily tasks or assignments, and traumatic memories may surface without warning or appear repeatedly in dreams. The Centers for Disease Control and Prevention (CDC) estimate that about half of the people who develop PTSD immediately after an event recover within 3 months, but one-third of people diagnosed with PTSD have symptoms that persist beyond two years. Factors that influence how long someone experiences PTSD include a history of past trauma, severity of the trauma, direct exposure to trauma, seriousness of threat to safety or life, number of times an event happened, and psychological problems existing before the trauma.
While PTSD itself is treatable, it often exists alongside other disorders, which are clinically referred to as ‘comorbidities.’ The term comorbidity means that a person has two or more disorders simultaneously, such as PTSD and depression, or PTSD and panic disorder. For example, researchers have found between a two-fold and three-fold increase in lifetime occurrence of depression in people with PTSD as compared to people who do not have PTSD. Sexual assault survivors with PTSD have higher rates of substance abuse disorders as well, and alcohol and drug use may be used as coping mechanisms for trauma. Treating comorbidities is more complex than just PTSD, but techniques used to treat PTSD can help reduce the burden of other disorders. PTSD can exacerbate the symptoms of another health problem that existed prior to the assault, and so survivors with a well-managed prior health or mental health condition may see previously addressed issues resurface. There are different treatment options for PTSD, some of which can also reduce symptoms of other disorders.
What do the symptoms look like?
Recognizing symptoms of PTSD is an important component of treating the disorder and can help prevent further harm. For example, people with PTSD are five times more likely to have suicidal ideation than people without PTSD--knowledge of this information can help someone better understand where their feelings are coming from and seek assistance in processing them. Recognizing symptoms can also help loved ones be more supportive to a survivor.
The CDC classifies PTSD symptoms into three categories: re-living, avoidance, and increased arousal (details below). People may exhibit some or all of these symptoms. Other symptoms include panic attacks, depression, suicidal thoughts, drug abuse, difficulty in completing tasks, and feelings of isolation and estrangement.
- Emotional and physical reactions to 'triggers' (reminders of the event)
- Feelings of guilt
- Emotional numbness
- Extreme fear of harm
- Uncontrollable shaking
- Heart palpitations
- Tension headaches
- Staying away from places, thoughts, activities, feelings related to the trauma
- Feelings of detachment
- Feelings of estrangement
- Overly alert
- Easily startled
- Difficulty sleeping
- Irritability and angry outbursts
- Inability to concentrate
PTSD/Trauma Treatment Options and Coping Strategies
Sexual assault is a very disorienting experience. You may feel that you do not completely remember what happened to you, or how it happened, or you may feel that you were somehow responsible for the assault. It was not your fault. No one should feel that they are entitled your body without your explicit permission, and no one deserves to be assaulted or raped. You may know this logically, and believe in your heart that it was not your fault. You may know this logically, but still feel blame, either from the things you think you should have done or not done, or from others who may not be as supportive as you hoped. While friends can offer some support and solace, you may need help with topics such as feeling safe in your own body, hopefulness, and trusting yourself and others.
There are a variety of mental health professionals and therapy techniques used to help survivors of sexual assault. Everyone is different, and some forms of therapy may be more or less helpful for you. Many health insurance companies allow you to search by specialty when seeking a provider, or the mental health professionals at your college may have some recommendations for social workers, counselors, or psychiatrists who may be able to help you process and cope with the trauma that has happened to you. If you were diagnosed with another mental health disorder, such as substance/alcohol use disorder, (borderline) multiple personality disorder, or depression prior to being assaulted, you can work with a counselor on addressing both. We include a list here with some key elements of the technique, discussions on effectiveness, and further links if you would like to learn more.
Cognitive Behavioral Therapy (CBT):
Cognitive behavioral therapy is the umbrella term for a few different kinds of techniques that focus on changing a person’s beliefs and attitudes towards a particular problem or difficulty. Cognitive behavior therapy is an “active” therapy, which means that the client and therapist are working together with the goal of dealing with a particular disorder, fear, or problem. This form of therapy usually includes work within sessions between the client and therapist and homework or assignments for the client to complete outside of the sessions. Prolonged Exposure Therapy and Cognitive Process Therapy are two forms of cognitive behavioral therapy. Cognitive behavioral therapy has been shown to reduce symptoms for people who have both PTSD and Substance Use Disorder, and to be effective for patients with depression.
Prolonged Exposure (PE):
Developed by Edna Foa, Prolonged Exposure is generally a 12-week therapy program that has four main components: education about PTSD and the treatment, breathing techniques to manage short-term distress, practice navigating real-world situations that may be triggering or stressful, and talking through the trauma. Prolonged exposure therapy addresses physical sensations and thoughts related to a traumatic event and helps survivors change the way they react to the traumatic event and related stresses. This therapy includes a “homework” component that involves writing and doing exercises outside of the sessions held with the therapist. Prolonged exposure was developed specifically to treat victims of sexual violence, and has since expanded to other traumas. There is clinical evidence that this therapy reduces PTSD symptoms. For people with both PTSD and Substance Use Disorder, prolonged exposure has demonstrated effectiveness in reducing symptoms of PTSD without increasing Substance Use Disorder symptoms.
Cognitive Process Therapy (CPT):
Pioneered by Dr. Patricia Resick, Candice Monson, and Kathleen Chard, Cognitive Process Therapy was originally developed as a 12-week treatment program for use for sexual assault survivors and has since been adapted for use by military veterans. Cognitive Process Therapy works by helping survivors become aware of PTSD symptoms, then by addressing thoughts and feelings around the trauma, understanding how trauma impacts one’s feeling of safety, self-esteem, and trust (amongst other emotions), and developing new strategies for processing the trauma and coping with symptoms. This technique specifically focuses on topics such as guilt, shame, and difficulties in interpersonal relationships. Cognitive Process Therapy been shown to help reduce symptoms for people living with both PTSD and depression, and has been used to treat veterans with both PTSD and Alcohol Use Disorder.
Eye-Movement Desensitization Reprocessing (EMDR):
The primary goal of EMDR is to reduce symptoms related to trauma by encouraging the brain to reprocess events so that they no longer trigger anxiety and related emotions. EMDR is a technique that combines elements of cognitive behavior therapy with bilateral stimulation. The goal is to redirect neuronal processes that are involved in increased physiological reactions to stimuli or events that are triggering (i.e. events that remind someone of the trauma). There are eight phases of treatment, and therapists who have been trained by Shapiro can be found on the EMDR International Association website. One of the differences between techniques such as Prolonged Exposure and EMDR is that EMDR does not include a “homework” component, so the client does not have assigned tasks to work on between sessions. EMDR has clinical effectiveness in treating PTSD symptoms in patients without a history of trauma, but it is best to work with a seasoned therapist in using EMDR to treat complex PTSD.
In addition to the treatment options outlined above, there are different coping strategies that survivors can engage in to help reduce symptoms, create structure, and feel more positive or productive. Participating in activities that feel empowering and uplifting can help a survivor feel in control of his/her own emotions and body, and provides an opportunity to meet new people or find a new network of support.
1. Mindfulness Treatments:
2. Trauma-Sensitive Yoga
3. Group Therapy/Support groups
For survivors of sexual assault, the experience of both being assaulted and trying to cope and heal afterwards can be isolating. Gathering with a group of people with similar experiences can help one feel like (s)he is not alone, allows participants to share strategies and techniques with each other, and provides emotional support during rough periods. It is recommended that a person attend some individual therapy sessions prior to engaging in a support group or group therapy to reduce the potential of traumatization by hearing the stories of others.
Further links on PTSD and treatment:
 Walsh, Wells, Lurie, and Koenen (forthcoming).
 Breslau et al. A second look at comorbidity in in victims of trauma: the posttraumatic stress disorder-major depression connection. Biological Psychiatry 48(9), 2000, p.902-909.
 Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of general psychiatry, 52(12), 1048.
 Miranda, R., Meyerson, L. A., Long, P. J., Marx, B. P., & Simpson, S. M. (2002). Sexual assault and alcohol use: Exploring the self-medication hypothesis. Violence and Victims, 17(2), 205-217.
 Kessler, RC. (2000). Posttraumatic Stress Disorder: The burden to the individual and to society. The Journal of Clinical Psychiatry, 61, 4–12.