Research Stories

by Diane Boudreau

Everyone has experienced stress at some point. We all know the feeling of stage fright or deadline pressures or arguing with a loved one. But a few people undergo stresses that most of us can’t even imagine. Think about soldiers who witness the atrocities of war or victims of violent crimes.

Many people who experience such extreme stresses suffer from post-traumatic-stress-disorder, or PTSD. Symptoms of PTSD can include flashbacks, nightmares, emotional numbness, sleep disturbances, and trouble concentrating.

But not everyone who suffers trauma suffers from PTSD. Martha Kent wants to know what helps some people avoid it, and whether similar tools can help others overcome it.

“Both resilience and trauma occur in extreme situations,” explains Kent, a neuropsychologist at the Carl T. Hayden VA Medical Center in Phoenix and a member of ASU’s Resilience Solutions Group. “I am interested in understanding good survival in extreme situations.”

For example, one inmate at a Nazi concentration camp had seen his wife and five children executed before he was imprisoned. He spent six years in captivity, but he resolved at the outset that he would not hate anyone—not even the people who had killed his family. When his camp was liberated, his rescuers assumed he had only been there a few weeks because he seemed so healthy and in good spirits.

Or consider the case of Eugenia Ginzburg, who spent 18 years in a Soviet Gulag. She spent the first year and a half in solitary confinement. While there, she chanted poetry that she had memorized from earlier years. She said that as she chanted, she could sense the poets in her cell with her.

“The resilient people couldn’t change their circumstances, but they did something to make their lives better,” says Kent.

Kent wanted to know if people with PTSD could make their lives better after the fact. She enlisted the help of endocrinologist Kathy Matt, a stress researcher at ASU, and Mary Davis, an ASU professor of psychology. Together they set out to learn if they could help trauma victims eliminate their pain and suffering.

Trauma happens when people have no control over their environments. But resilience can occur in these situations as well. For example, the people mentioned above had no control over being imprisoned. What they could control was how they responded to their situations.

People react to their environments in different ways. On one end of the spectrum is approach/engagement. This is characterized by curiosity, interest, and social connectedness. On the other end is defense/withdrawal. This is the basic “fight or flight” response, characterized by fear and disconnectedness.

People who respond to situations with approach/engagement rather than defense/withdrawal are more likely to avoid PTSD. Can such an approach help other victims even after the trauma has occurred?

“During the experiment, I had people recall experiences of approach/engagement they had as children or young adults. I had them re-experience those and take them into their traumatic experiences. We’re simulating resilience,” explains Kent.

The intervention consisted of 90-minute weekly meetings over 12 weeks. Kent had the subjects first become aware of the bodily sensations they feel during both positive and stressful experiences. Then they identified examples of approach and engagement. Finally they integrated the approach/engagement experience with their traumatic experiences.

For example, one Vietnam vet recalled the first time he ever encountered a frog when he was five years old. Holding the frog, he was filled with curiosity and delight. He then mentally returned to a traumatic battle scene holding that frog in his hands.

It might seem hard to believe that holding a remembered frog could erase the trauma of war. But the researchers’ results have been astounding. The treatment group showed significant improvements on measures of depression, anxiety, well-being, and cognitive tests. By comparison, the control group showed no change or a decline in these areas. The team is now analyzing physiological indicators of stress, such as cortisol levels and heart rate variability.

Kent has some ideas about why the treatment was so effective.

“The structure of social interactions is actor-action-object. An actor acts on an object. It’s encoded in a modular way within the brain. It’s ubiquitous. It’s in our sentences—subject/verb/object. It’s the structure of episodic memory, of stories,” she says.

But in traumatic situations, the structure gets inverted. The victim becomes an object.

“They don’t experience themselves as actors, because they’re not. They’re the object,” says Kent. “What the intervention winds up doing—the patient goes back to the traumatic scene not as an object but as an agent. It restores agency.”

Matt says that a sense of agency can help everyone deal with stress, not just people with PTSD.

“People who believe they are responsible for their own lives are more resilient,” she says. “You have all these environmental factors coming into your brain. Whether they result in a negative or positive response depends on how your brain filters them. It’s how you interpret things and how you translate things. You have to exercise the ability to let go of things you can’t control, and manage the things you can, and savor the best parts.”

Read more about stress research at ASU:
"Stress...out!"
"Trickle-down health"