What's true and what's myth about trauma? (with George Bonnano)
Professor George Bonanno discusses the true nature of trauma, differentiating it from ordinary distress and common misconceptions. He explores resilience, flexibility, and effective approaches to dealing with potentially traumatic events and PTSD.
Deep Dive Analysis
14 Topic Outline
Defining Trauma and Its Impact
Reactions to Potentially Traumatic Events
Misconceptions About Childhood Trauma and ACEs
Critique of 'The Body Keeps the Score'
Understanding PTSD Symptoms and Diagnosis
Memory and Forgetting Traumatic Events
Modern Misuse of the Word 'Trauma'
Resilience and Flexibility as Coping Mechanisms
Trauma, Addiction, and Avoidance
Effective Therapies for PTSD
Historical and Cultural Perspectives on Trauma
COVID-19 as a Chronic Stressor, Not Mass Trauma
Delayed PTSD and Symptom Progression
Advice for Individuals and Loved Ones with PTSD
9 Key Concepts
Potential Trauma
Events outside normal experience that are violent, life-threatening, or involve sexual violation. These events are not inherently traumatizing, as most people do not develop lasting harm from them.
Resilience
The ability of individuals to experience potentially traumatic events without developing lasting psychological harm. It is event-specific, meaning resilience to one event does not guarantee resilience to another.
Flexibility (Psychological)
A set of adaptive tools and processes that enable individuals to cope with challenges and be resilient. It involves context sensitivity, repertoire of responses, and feedback evaluation.
Context Sensitivity
The first component of psychological flexibility, involving focusing on and accurately identifying the specific, immediate problem at hand, rather than being overwhelmed by a larger, vague issue.
Repertoire of Responses
The second component of psychological flexibility, referring to the range of coping tools and strategies an individual has available to address a specific problem.
Feedback Stage (Coping)
The third component of psychological flexibility, where an individual evaluates whether a chosen coping strategy is working. If not, they try a different approach, emphasizing trial-and-error adaptation.
Fragmented Memories
Memories of traumatic events that are incoherent and lack a clear narrative, often due to the brain's initial focus on threat-relevant details and the temporary blocking of long-term memory by cortisol during extreme stress.
Resilience Blind Spot
A phenomenon where, during widespread events like pandemics, mental health professionals and the public tend to over-forecast overwhelming psychological consequences, often underestimating people's actual coping abilities.
Coping Ugly
A term describing the use of less-than-ideal coping mechanisms, such as having a drink, to get through a difficult moment. It is considered natural in the short term but problematic if used chronically or inflexibly.
14 Questions Answered
Trauma is defined as an event outside the realm of normal everyday experience that is violent, life-threatening, or involves sexual violation, but these are "potential traumas" as they don't always lead to lasting harm.
No, events are considered "potential traumas" because most people do not develop lasting psychological harm or PTSD, even after experiencing severe events like school shootings.
Initial symptoms like nightmares or intrusive thoughts are normal for a few weeks as the brain processes the event, but if they persist beyond a month and interfere with functioning, it indicates long-term trauma or PTSD.
The exact reasons are not fully understood but involve factors like cortisol levels, life experiences, genetics, and whether a person is already in a high-stress situation when the event occurs.
While population-level studies show a correlation between higher ACEs and increased adult depression/anxiety, individual-level prediction is poor, as many people with high ACEs are resilient and function well.
According to George Bonanno, the brain keeps the score, and the body is merely the scorecard, meaning the brain drives physical reactions to what it tracks, rather than the body holding hidden traumatic memories.
PTSD is a psychiatric diagnosis given when an individual experiences a potentially traumatic event and, after about a month, continues to suffer from symptoms like intrusive thoughts, nightmares, avoidance, and hyperarousal that significantly interfere with their life.
No, if an event is truly traumatizing and causes lasting harm, it is highly unlikely to be forgotten; people may try to avoid thinking about it, but they remain aware it happened.
No, constantly labeling everyday distress as 'trauma' is psychologically unhealthy because it can over-activate the brain's threat detection system, leading to chronic anxiety and making individuals feel constantly vulnerable.
CPTSD is a concept referring to PTSD resulting from chronic exposure to traumatic events (e.g., prolonged abuse or wartime), often including additional symptoms like emotional dysregulation, but its definition and distinction from long-term PTSD are not yet well-defined scientifically.
Professional interventions in the immediate aftermath (first hours/days) have often backfired or made things worse; it's generally better to allow the brain to process initial symptoms naturally, as they are adaptive.
Studies showed playing Tetris after viewing disturbing movies reduced intrusive symptoms by occupying working memory, but this doesn't mean it prevents PTSD after real-life trauma or that the effect is unique to Tetris.
While the biological basis for trauma reactions may be universal, the recognition, interpretation, and societal response to these symptoms have varied significantly across history and cultures, as evidenced by historical accounts like Samuel Pepys' diary.
The idea of someone suddenly developing PTSD out of the blue years later is a myth. However, some individuals may struggle with sub-threshold symptoms for a long time, slowly worsening until they eventually meet the criteria for a PTSD diagnosis.
14 Actionable Insights
1. Seek Professional Help for Persistent PTSD
If potential trauma symptoms persist for more than one or two months and interfere with daily functioning, consult a psychiatrist or psychologist for diagnosis and treatment.
2. Employ a Flexible Coping Strategy
When facing a problem, identify the immediate issue, try a coping tool from your repertoire, and then evaluate if it worked; if not, try something else, as adaptation is a trial-and-error process.
3. Avoid Over-Labeling Everyday Events
Constantly viewing the world as full of potential traumas is psychologically unhealthy, as it can over-activate the brain’s threat detection system and lead to chronic anxiety.
4. Limit Internet Consumption for Anxiety
Recognize that the internet often feeds content designed to elicit strong reactions; take control by limiting ‘doom scrolling’ to prevent unnecessary anxiety and mental overload.
5. View Initial Trauma Symptoms as Adaptive
Intrusive thoughts and nightmares in the first few weeks are the brain’s way of processing and making sense of a life-threatening event, not necessarily a sign of lasting harm.
6. Understand Brain’s Role in Physical Symptoms
Recognize that the brain drives physical reactions to stress and trauma, meaning physical symptoms are a reflection of what the brain is tracking, not hidden trauma in the body itself.
7. Don’t Rush Early Professional Help
Early intervention by professionals immediately after a potential trauma can inadvertently suggest one has PTSD, even when initial symptoms are normal and will resolve naturally.
8. Self-Monitor Coping Mechanisms
Observe and reflect on your actual coping strategies over a week or two to become more aware of your personal repertoire of tools and how you naturally adapt.
9. Avoid Single Coping Mechanism Over-Reliance
Using any single coping strategy, such as drugs or alcohol, all the time is inflexible and will likely fail in the long term, as effective coping requires adapting to diverse situations.
10. Use Avoidance and Distraction Strategically
While avoiding or distracting from a problem can be adaptive in specific moments, it is not effective as a constant strategy and can hinder long-term resolution.
11. Practice Deep Breathing for Clarity
Taking deep breaths can help relax muscles, oxygenate the body, and improve clear thinking, especially when feeling tense or anxious.
12. Use Grounding Techniques for Anxiety
When feeling overwhelmed or panicking, focus on your body or the immediate environment to shift attention away from distressing thoughts and regain composure.
13. Teach Children Rights and Protections
When discussing sensitive topics like sexual abuse, emphasize that such acts are violations, not the child’s fault, and that they have rights and should tell trusted adults.
14. Consider Prolonged Exposure Therapy
This highly effective, structured therapy involves repeatedly recounting the traumatic event in a safe setting to process fragmented memories and reduce the sense of present danger.
5 Key Quotes
The brain keeps the score. The body is the scorecard.
Lisa Feldman Barrett (quoted by George Bonanno)
Time does heal a lot of things, but time is in no hurry.
George Bonanno
Intrusions are not evil. They're not bad, especially in the first week or two... Our brain needs to make sense of that.
George Bonanno
We cannot control language. Language is, especially English, especially American English. We love to play with words in this country.
George Bonanno
Using any kind of coping mechanism all the time is very inflexible because you're not adapting to the situation.
George Bonanno
2 Protocols
Flexible Coping Process
George Bonanno- Context Sensitivity: Focus on what is happening right now and identify the specific, immediate problem (e.g., 'I'm feeling uneasy,' not 'I have PTSD').
- Repertoire: Select a coping tool from your available responses to address the identified problem (e.g., talk to friends, distract yourself, do research).
- Feedback: Evaluate whether the chosen coping tool worked. If not, try something else, understanding that adaptation is a trial-and-error process.
Prolonged Exposure Therapy for PTSD
George Bonanno- Preparation: The therapist explains the structured process, emphasizing the patient's strength and what to expect.
- Recounting the Event: The patient tells the story of the traumatic event from beginning to end, often repeatedly, in the safety of the therapist's office.
- Processing: After each session, there is a buffer period for the patient to wind down, and the process helps organize fragmented memories into a coherent narrative.