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Section 2
Posttraumatic Distress

Question 2 | Test | Table of Contents

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In the last section, we discussed identifying the way trauma affects a client concerning the extent of the trauma, feelings of anger, and feelings of guilt.  We also presented two techniques:  The Trauma Questionnaire and Benefits and Costs.

In this section, we will examine the three ways clients re-experience traumatic events in the areas of sleep disturbances, flashbacks, and emotional recall. We will also include a technique to help you identify what type of trauma reexperience your client is undergoing. In this section, we will discuss PTSD as a result of natural disasters and combat. 

3 Ways of Re-experiencing a Traumatic Event

♦ Re-experience #1 - Sleep Disturbances
Have you found like I have that the first way a client may re-experience trauma is through sleep disturbances such as dreams, nightmares or insomnia? Clients who exhibit sleep disturbances may have dreams or nightmares about the traumatic events. Sometimes, these dreams play out the event exactly. Other dreams or nightmares may just replicate the feelings experienced during the trauma such as guilt, anger, and, of course, fear. 

In many instances of clients experiencing trauma nightmares, shaking, shouting, and thrashing about have been reported.  Even though they don’t remember the nightmare when they awake, the feelings that transpired while asleep may stay with them throughout the day, as you know. With Katrina, insomnia manifested itself through difficulty in falling and staying asleep.  As you know, this may also indicate a biochemical depression. 

Katrina is a 19 year old college student living in a dorm on campus with a roommate. Earlier that year, Katrina had been on a plane that had nearly crashed when the landing gear failed to deploy. 

Since then and all throughout the school year, Katrina’s roommate has been woken up almost every night to Katrina groaning and crying in her sleep. Finally, the roommate told Katrina about the night terrors that were verbalizing themselves while she slept. Katrina felt that her nightmares most likely had something to do with her escape from death, and she decided to seek help. During therapy, Katrina reported that when she woke up, she often felt afraid that she was in danger. 

As you can see, Katrina’s nightmares were bringing the emotions that she felt during the plane accident to the surface. 

Do any of your clients ever experience nightmares or dreams about their trauma? Do they ever report having trouble falling asleep or staying asleep? Perhaps PTSD might be considered.

♦ Re-experience #2 - Flashbacks
The second way a client might re-experience a trauma is through flashbacks. As you are aware, flashbacks occur when the client feels as though they are physically transported back to the time and location that the trauma took place. Vividly, they remember the trauma and react to it. As you know, this kind of re-experiencing is common among war veterans who went through difficult or bloody combat. 

Often, these flashbacks are accompanied by the same smells, sounds, and sights as the traumatic event. Are you treating a war veteran like Seth that would hear the bomb shells and even smell the gunpowder? 

Seth, a 25 year old PTSD client of mine, had flashbacks of his short time in Iraq. He stated that, although he doesn’t always consciously know when he is experiencing a flashback, his friends or the people that he is around at the time, tell him later that he had been acting strangely. They say that he begins to cry and sometimes to shout, "Oh my god!  Oh my god!" 

Seth stated, "I saw a friend of mine torn apart by insurgent bullets. Another buddy, one I knew since I was a kid, was killed by a homemade gasoline grenade. I saw him burned alive. It was awful. Sometimes, when I smell gas, that’s when they tell me I get a scared look on my face." 

To help Seth articulate the trauma he had been re-experiencing, I asked him to write daily in his journal about the event, adding in details he remembered along the way. As he gradually faced the event more and more, Seth experienced the flashbacks less and less. 

Many times, this simple journal technique may be helpful in other instances of clients re-experiencing trauma, including sleep disturbances and the next type of re-experiencing, emotional recall. 

Think about your PTSD client. Would he or she benefit from daily writing in a journal or notebook?

♦ Re-experience #3 - Emotional Recall
In addition to nightmares and flashbacks, the third and final type of re-experiencing trauma is, as you know, emotional recall. Emotional recall is similar to a flashback, except that it is more unconscious than a regular flashback. It occurs when a trauma client manifests the emotions he or she felt during the event such as anger, fear, or irritability; even physical pain associated with the trauma may be experienced. These emotional recalls never seem clearly related to any memory of the trauma.  

Many clients feel that these emotions are just reactions to arbitrary circumstances. 

Frank, a police officer was going through this emotional recall. Frank stated, "I can understand why I sulk or explode about hearing about another cop being killed in the line of duty. But many times I get moody or angry for no reason at all." 

What Frank didn’t understand, and what I explained to him, was that his mind was reacting to the deaths or injuries of officers that he has personally known. Also, Frank’s sudden emotional tumultuousness may be a result of his fear that he too might one day be the victim of violence. 

♦ Technique:  Trauma Re-experiencing Quiz
Many times, I have found that a client who experiences nightmares, flashbacks, or emotional recall does not even know he or she is re-experiencing a trauma when they first come to me. To help clients who I believe are suffering from PTSD, I ask them to fill out a "Re-experiencing Trauma Quiz" to help me and them understand just how the trauma is manifesting itself and affecting their lives. 

I ask clients to answer the following questions that relate to their traumatic event in detail:

  1. Do you, on a persistent or recurring basis, find yourself having intrusive or voluntary thoughts of the traumatic event? Do you find yourself thinking about the trauma when you don’t mean to or when you are trying hard not to think about it? Do visions or pictures of the trauma pop into your mind?
  2. Do you have dreams or nightmares about the event?
  3. Do you have dreams or nightmares that are not replays of the actual event, but that take place in the location where the event occurred, contain some of the actions involved in the event, or include some of the feelings you felt during the event?
  4. Do you find yourself suddenly acting or feeling as if you were back in the original trauma situation? For example, do you have flashbacks, visions, or hear sounds of the event? Do you have waves of strong feelings about the trauma or otherwise feel as if you have just lived through the trauma again, even without having a flashback or a vision?
  5. Do you become extremely upset at people, places, or events that resemble an aspect of the original trauma?
  6. Do you become distressed around the anniversary date of the trauma?

In this section, we discussed the three ways clients re-experience a traumatic event: sleep disturbances, flashbacks, and emotional recall. We also included a technique to help you identify what type of trauma re-experience your client is undergoing via the "Re-experiencing Trauma Quiz."

In the next section, we will examine four types of adaptation reactions to trauma. These are emotional numbing, trigger avoidance, hypervigilance, and the calming breath technique.
Reviewed 2023

Peer-Reviewed Journal Article References:
Blackie, L. E. R., Roepke, A. M., Hitchcott, N., & Joseph, S. (2016). Can people experience posttraumatic growth after committing violent acts? Peace and Conflict: Journal of Peace Psychology, 22(4), 409–412.

Groleau, J. M., Calhoun, L. G., Cann, A., & Tedeschi, R. G. (2013). The role of centrality of events in posttraumatic distress and posttraumatic growth. Psychological Trauma: Theory, Research, Practice, and Policy, 5(5), 477–483.

Khayyat-Abuaita, U., Paivio, S., Pascual-Leone, A., & Harrington, S. (2019). Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma. Psychotherapy, 56(4), 526–536. 

Lehmann, C., & Steele, E. (2020). Going beyond positive and negative: Clarifying relationships of specific religious coping styles with posttraumatic outcomes. Psychology of Religion and Spirituality, 12(3), 345–355.

Lehrner, A., & Yehuda, R. (2018). Trauma across generations and paths to adaptation and resilience. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 22–29. 

Thomas, E., & Savoy, S. (2014). Relationships between traumatic events, religious coping style, and posttraumatic outcomes. Traumatology: An International Journal, 20(2), 84–90.

QUESTION 2
What are three ways that a client might re-experience trauma? To select and enter your answer go to Test.

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