Understanding continuous traumatic stress

The origins of understanding traumatic stress have focused on the impacts of time-limited traumatic experiences such as those of war veterans (Zoromba, 2024).

However, incidences or times of traumatic stress can have long lasting impacts on our bodies (van der Kolk, 2014) and impacts can live on in how we see ourselves and the world (Janoff-Bulman, 2011). However, for some, the source of the traumatic stress is continuing. What then?

Clients experiencing ongoing traumatic stress have shared that they feel unseen in the materials regarding traumatic stress as the cause of stress is not in the past, rather, it is very much ongoing. Eagle and Kaminer (2013) note that the majority of mental health literature assumes that the causes of trauma are in the past. For example, for those living in an active war zone exposure to violence and trauma is a daily occurrence and there are no safe spaces available (Eagle and Kaminer, 2013) and for those living with continuing interpersonal abuse, such as within their home, it can also feel that they are beyond sources of support.

One of the biggest differences between continuing and post traumatic stress is that there is a much greater need to focus on current safety and future safety rather than addressing the longer term impacts or impact of past trauma (Diamond et al, 2010). Anticipatory anxiety and vigilance can be high as the source of trauma is ongoing (Eagle and Kaminer, 2013). This can lead to energy being focused on managing the anxiety about what is to come rather than unprocessed experiences from the past (Eagle and Kaminer, 2013). As a result, what is needed when traumatic stress is continuing is going to be rather different in terms of support from when the source of stress has ended. For example, many trauma strategies assume the individual is now in a place of safety and that it is acceptable to reinforce the idea that the person is safe.

It is normal in the face of continuing traumatic stress to self-question about the perceived threat and associated anxiety. It can be helpful to consider threat discrimination with a therapist to explore what is the right level of alertness to the challenges being faced, what plans can be in place for safety, and whether there are any potential sources of respite for even a short time. Looking carefully for protective factors can also be helpful so that whatever supports there are can be available at short notice (Eagle and Kaminer, 2013).

Assumptions made by others about traumatic stress can be unhelpful or incorrect. For example, given the proportion of those ending relationships where there was abuse then experiencing post separation abuse, which continues the traumatic stress, it is not helpful to assume that ending such as relationship means all is OK (Hulley et al, 2023). Parents and carers of children and adults with additional support needs may experience continuing traumatic stress in advocating for support and this stress is rarely acknowledged (Griffin, 2021).

Helpful factors including retaining a sense of control and agency (Hulley et al, 2023) and in the case of interpersonal violence or abuse, it can help to have a trusted other to share the situation with as self-belief and perception of reality can become skewed due to abuse. Compliant behaviours are a key coping strategy to preserve what safety there can be and it can be hard to reduce reliance on this later if abuse does stop or reduce (Hulley et al, 2023). Nurturing self- talk can also be helpful as well as taking any safe steps towards work or study. One of the challenges of coping with continuing traumatic stress is that there is relatively little material about steps that can be taken even while it is occurring and the focus on post traumatic stress can feel alienating. However, good therapeutic relationships can support the growth of compassion for ourselves, helps us to see our strengths and it can be positive and validating to be seen and understood as we are.

References

Diamond, G.M., Lipsitz, J.D., Fajerman, Z. and Rozenblat, O. (2010). Ongoing traumatic stress response (OTSR) in Sderot, Israel. Professional Psychology: Research and Practice, 41(1), pp.19–25. doi:https://doi.org/10.1037/a0017098.

Eagle, G. and Kaminer, D. (2013). Continuous traumatic stress: Expanding the lexicon of traumatic stress. Peace and Conflict: Journal of Peace Psychology, 19(2), pp.85–99. doi:https://doi.org/10.1037/a0032485.

Griffin, J. (2021). Day by day : emotional wellbeing in parents of disabled children. London, England: Free Association Books.

Hulley, J., Wager, K., Gomersall, T., Bailey, L., Kirkman, G., Gibbs, G. and Jones, A.D. (2022). Continuous Traumatic Stress: Examining the Experiences and Support Needs of Women After Separation From an Abusive Partner. Journal of Interpersonal Violence, 38(9-10), pp.6275–6297. doi:https://doi.org/10.1177/08862605221132776.

Janoff-Bulman, R. (1989). Assumptive Worlds and the Stress of Traumatic Events: Applications of the Schema Construct. Social Cognition, 7(2), pp.113–136. doi:https://doi.org/10.1521/soco.1989.7.2.113.

Mohamed Ali Zoromba, Selim, A., Ateya Megahed Ibrahim, Mohamed Gamal Elsehrawy, Alkubati, S.A., Abousoliman, A.D. and Heba Emad El-Gazar (2024). Advancing Trauma Studies: A Narrative Literature Review Embracing a Holistic Perspective and Critiquing Traditional Models. Heliyon, 10(16), pp.e36257–e36257. doi:https://doi.org/10.1016/j.heliyon.2024.e36257.

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. London: Penguin Books.