Trauma Reconsidered in Light of Compelling Research

Therapists learn early in training how frequently traumatic stressors occur in people’s lives. The way people process potentially traumatizing events is critical. Some people are more resilient and others more disrupted by events. It is important to understand both groups. One of the leading experts in this area, Dr George Bonanno, recently summarized his research. His conclusions will surprise many.

Therapists are exposed to a biased sample in that they see people so distressed that they develop clinical disorders like post-traumatic stress disorder (PTSD). They do not see those who adjust well. Dr Bonanno is a Columbia University psychologist dedicated to understanding trauma and resilience. His new book, The End of Trauma, shows that a resilient outcome is the most common one in the face of major stressful events.

Some may be surprised that the norm is for people to adjust reasonably well to potentially traumatizing events. The finding across many studies is that two-thirds of people show resilience in the face of significant stressors. It is not that they are essentially resilient people or have resilient personalities. They find a path to a resilient outcome. He describes the “resilience paradox” in non-technical terms:

There is no “magic bullet,” no single best way to cope for everyone. Every trait, every resource, every behavior, has both costs and benefits. What works in one situation for one person may not be effective for another person, or even for the same person in another situation or at another point in time. (p. 259)

Bonanno’s position on resilience is based on robust findings. His evidence is overwhelming in that it encompasses trauma of every type and severity. As the head of an academically based institute devoted to trauma, he is a therapist/researcher who has gathered information from clients, research studies, and general surveys. He studies diverse populations of survivors over long periods of time.

Bonanno is not suggesting we should minimize psychological disorders like PTSD. The book’s subtitle, “How the new science of resilience is changing how we think about PTSD,” conveys his clinical message. His research identifies the pathway to resilience as a “flexible mindset” and a willingness to try out various solutions. His findings offer a unique direction for those working with trauma patients.

The other problem he addresses is conventional wisdom. Cultural beliefs about trauma (found widely in books and films) set false expectations for those who experience a potentially traumatizing event. Popular media would have us think resilience is rare and chronic distress is the norm. In addition, fiction overflows with trauma tales where an early life event is revealed as the underlying root of all pain.

Clinicians can fall into this trap as well. Clinicians may be treating the minority who survive with chronic distress while mistakenly assuming this is the majority. They may be assuming that most people exposed to catastrophic events have hidden traumas driving their lives. Bonanno is sharing population-based knowledge. More people than we might expect escape clinical symptoms or impairment.

One implication of this research is making poor predictions when awful events occur. Bonanno studied psychological reactions in New York City after 9/11. He found the dire warnings by most experts about traumatic reactions were unfounded. Is a corollary error having inflated assumptions about hidden trauma? Do we pursue hidden trauma due to exaggerated estimates of traumatic responses?

This is a question for clinicians specializing in trauma to debate. Yet some of this needs a public airing. Our field needs to publicly correct some basic, widespread misconceptions about trauma and resilience. A clinical background is not needed for such scientific literacy, and so our executives could take the lead here. We need to show the public we share data when it is clear and overwhelming. This is science.

It is a clinical question whether Bonanno’s scientific models prove to be valuable in therapy. His notion of a flexibility mindset may be helpful getting traumatized people to shift into a more resilient frame of mind. Likewise, his findings on how resilient people test out various behavioral strategies may be worthwhile. His research findings may translate well into therapeutic models, or not.

However, clinical questions are distinct from those about population health. When tragedy hits, most people find a way to adapt. This finding represents optimism at a population level, and we need to broadcast a public message to clarify these separate levels of analysis. While our field helps the many who are traumatized, we must acknowledge those who find a path to resilience unaided.

The fortunate ones who find a resilient outcome should not be waiting for trauma to strike. They should not be wondering if they are in denial. These people do not need therapy, but they do need science. We owe them a commitment to asking how data supports our assumptions. We must all embrace this scientific mandate, and yet not confuse it with the interpersonal work of therapy. We care about both.

Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as President at ValueOptions and Chief Clinical Officer at PacifiCare Behavioral Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.