Understanding Post-Traumatic Stress Disorder from the Cognitive Approach to Personality
POST-TRAUMATIC STRESS DISORDER
Post-traumatic stress disorder, also known as PTSD, is a mental health disorder that is triggered by experiencing or witnessing a traumatic life event (NIMH, n.d.). It is known to particularly affect combat veterans and was given the nickname “shell shock,” referring to the disturbance that some veterans sensed after the dreadful effects of World War I and II, but can occur in anyone. Most people who have experienced trauma inevitably recover from the shock, but a small number of people who continue to be in shock even long after the event can be diagnosed with PTSD. Currently, PTSD affects approximately 3.5% of American adults, and it is estimated that 1 in 11 people will experience PTSD in their lifetimes (Parekh, 2017).
There are three types of PTSD: acute, chronic, and delayed onset (Swierzewski, 2001). The differences between these types vary in duration of symptoms. In acute PTSD, symptoms do not last longer than 3 months. In chronic PTSD, symptoms last longer than 3 months, and can often last for years. In delayed onset PTSD, symptoms do not appear until after at least 6 months after the traumatic event (Swierzewski, 2001). In order to be diagnosed with PTSD, the adult must have all of the following for at least one month:¬ at least one re-experiencing symptom, at least one avoidance symptom, at least two arousal and reactivity symptoms, and at least two cognition and mood symptoms. Re-experiencing symptoms include recurring bad thoughts, nightmares, and flashbacks. They often negatively impact the person’s everyday lives. Avoidance symptoms include avoiding people or places that are reminders of the event. Arousal and reactivity symptoms include feeling tense, having angry outbursts, and feeling on edge. Cognition and mood symptoms include pessimistic thoughts, feelings of guilt or blame, and loss of interest. (NIMH, n.d.)
The cognitive approach to personality focuses on mental processes such as memory and problem solving (Psychology Today, n.d.). It particularly emphasizes the view that people’s personalities and actions are a reflection of how they mentally process information. While there is no known singular origin of this perspective, George Kelly (1905-1967) was one of the first psychologists to adopt the cognitive approach (Burger, 2015). He created the personal construct theory, which was based on his comparison of people to scientists. He believed that we are all similar to scientists because we continuously generate and test our predictions about people and the outcome of events, similar to how scientists continuously generate and test their hypotheses in the laboratory. He labeled “the cognitive structures we use to interpret and predict events” as personal constructs (Burger, 2015). Because there are many ways to view an event, personal constructs vary from person to person. Ultimately, Kelly believed that our perspectives are largely shaped by our subjective views rather than an objective reality (Burger, 2015).
Personal constructs are not unlike prototypes and schemas, which are two central concepts of cognitive psychology. In the cognitive approach, a prototype is a cognitive representation of something with all of its expected qualities present (Psychologia, n.d.). For example, a prototype of an apple would be perfectly red, round, and shiny, even though we are aware that there are many types of apples that stray far from this prototype. Not all prototypes, however, are so universal. Most prototypes are subjective to culture, society, and personal views. For instance, the prototype of breakfast will be different for someone in France versus someone in Japan: a French person may envision brioche or a baguette, whereas a Japanese person may envision rice and miso soup. On the other hand, a schema is a “pattern of thought that organizes categories of information and relationships among them” (Psychologia, n.d.). A schema is very similar to a prototype in that both can help organize as well as lead to stereotyping—for this reason, the two are often used interchangeably; however, there is a small difference. A schema is more general and flexible in definition and a broader term than a prototype (Psychologia, n.d.). Both are nonetheless helpful in cognitive organization and improve our ability to make quick judgments.
COGNITIVE APPROACH TO PTSD
Using the cognitive approach to personality, we can recognize that many of the causes of PTSD derive from our mental processes. PTSD is essentially a mental disorder in which the victim is severely affected by trauma—the memories and thought processes of these victims after experiencing trauma are what make up the symptoms of PTSD. For example, when these victims experience symptoms such as flashbacks, the memories are being recorded such that the victims feel that they continue to be under continuous, serious threat (Hughes, 2006). When they feel threatened, the symptoms continue to persist.
Our schema play a large role in the manner in which we deal with trauma. We can perceive the stimulus, form beliefs about the events, and store negative memories of them, but it is ultimately up to us to form schema. Under normal conditions, we form a positive, or at least neutral, schema of our world. It is only when the victim experiences trauma that his or her schema of any given person, place, or event is destructively altered, inevitably causing the symptoms of PTSD. When the victim holds a negative schema of the trauma and has a memory possibly characterized by lack of clarification or correct context, the feeling of threat arises (Hughes, 2006). Unfortunately, change in the schema of the trauma and tainted memory is hindered by the victim’s cognitive strategies. In order to correct the negative schema, the victim must eliminate his or her recurring negative beliefs about himself, his environment, and any other associated figures (Hughes, 2006).
TREATMENT FOR PTSD
Although treatment for PTSD may be challenging due to the large variation in symptoms and severity for patients, cognitive-behavioral therapy, also known as CBT, has been known to be an effective treatment for PTSD. CBT is a type of therapy that focuses on patients’ thoughts, feelings, and behaviors. It gives patients an opportunity to form new healthy beliefs about their environments or circumstances, allowing them to practice healthy behaviors (Recovery Ranch, 2004). It also encourages patients to eliminate negative thinking and expand their ability to cope (APA, 2017). By doing so, the patients are able to reshape their understanding of their traumatic experiences and establish a more positive schema of their circumstances. Usage of CBT may also include controlled exposure to the traumatic experience as a method to reduce the patient’s avoidance of the topic and cause the patient to comfortably adapt to otherwise painful memories and associations.