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Section 1
Symptoms of Posttraumatic Stress Disorder (PTSD)

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The Meaning of Stress
Walton T. Roth
First, let us look at victims of terrorism and factors that determine the stress of the experience for them. Walton Roth’s ideas underline the ethical need for individualization of the client as a unique person. After a terrorist siege has ended, physicians may describe the bodily damage in terms of physical injuries, but, as you know, in addition to any direct injuries, each participant in a terrorist incident has been exposed to a situation in which many subtle changes may have taken place in response to the stressor. We’ll look at these stressors in terms of four losses: loss of invulnerability, loss of an orderly world, loss of self-image, and loss of trust. As I am outlining these ideas, you might think about how they apply to clients you treated immediately following the September 11th Twin Towers attack.

♦ Treating the Loss of Invulnerability:
A client, whom a colleague treated, had an uncle shot in a local mosque immediately following the September 11th attacks. The client stated, “This couldn’t happen to me. This couldn’t happen to my uncle,” she thought. Her next thoughts were, “But it did happen to you and your uncle, therefore you no longer feel the world is a safe place.” She stated, “I feel less safe than I did before his shooting. Even when others assure me that it can’t happen again, I know that it could and fear that it will.”

2 Symptoms of Post Traumatic Stress Disorder (PTSD)

As you know, these feelings of vulnerability indicate two symptoms of PTSD, Post Traumatic Stress Disorder:
1. A sense of doom or an expectation of a foreshortened future, and
2. An intense fear that the trauma will repeat itself.
Thus, the ethical need for individualization to the client as a unique person is called for here, especially related to the client’s use of psychological defense mechanisms.

Hijacked Planes
In the case of the hijacked planes that crashed, the passengers were, of course, taken hostage. In the case of a hostage, the hostage’s first response might be, “I don’t believe this” or “This can’t be happening to me.” Loss of invulnerability is initiated. According to Ochburger the individual unconsciously and automatically refuses to comprehend the situation. For brief periods, denial helps. It permits time to lapse and protects the individual from physical collapse. Panic reactions are forestalled or made less likely. The temporary effects of denial give the victim an opportunity to gradually assess the situation and perhaps formulate coping strategies.

Counterphobic Mechanism
The individual who utilizes this counterphobic mechanism reduces stress and anxiety which may cause excessive and sometimes rash responses that actually oppose his basic inclinations for safety in a threatening situation. A simple example would be the case of a man with a fear of heights who insists on peering over the edge of a cliff. Counterphobic psychological defenses may serve the individual well in some stress situations, but in violent circumstances such as a hijacking incident, counterphobic behavior in these situations is sometimes termed bravery. But, as you know, this bravery can increase the chances that the victim will be injured or killed.

♦ Reaction Formation
Closely related to the counterphobic mechanisms are those that are usually described as reaction formation and identification with the aggressor. However, these usually occur over longer periods of time and, thus, involve later phases of hostage situations. Reaction formation may be described as an adaptive process in which an individual adopts attitudes and behaviors that are, in fact, opposite to the impulses he harbors, either consciously or unconsciously.

For example, fear of the terrorist is transformed into approval or admiration. In a situation where one person is victimized by another, this process may extend to identification with the aggressor. When observed in the victims of terrorists, the process may be described in different terms, such as “identification with the captor,” or “identification with the controller.”

The victim unconsciously incorporates... the characteristics of the feared person and becomes psychologically allied with him. Thus, the victim transformed himself or herself from the person threatened into the person who makes the threat; thus, the victim reduces his anxiety. Should the victim seek therapy, an ethical issue may arise if the therapist finds himself or herself being judgmental regarding the victim’s attitude of identification with his or her captors.
Reviewed 2023

Peer-Reviewed Journal Article References:
Gil, S., & Weinberg, M. (2015). Coping strategies and internal resources of dispositional optimism and mastery as predictors of traumatic exposure and of PTSD symptoms: A prospective study. Psychological Trauma: Theory, Research, Practice, and Policy, 7(4), 405–411.

Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2021). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5. Psychological Trauma: Theory, Research, Practice, and Policy, 13(2), 133–141.

Kaufman, J. S., Allbaugh, L. J., & Wright, M. O. (2018). Relational wellbeing following traumatic interpersonal events and challenges to core beliefs. Psychological Trauma: Theory, Research, Practice, and Policy, 10(1), 103–111

Larsen, S. E., Fleming, C. J. E., & Resick, P. A. (2019). Residual symptoms following empirically supported treatment for PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 11(2), 207–215.

Macdonald, A., Pukay-Martin, N. D., Wagner, A. C., Fredman, S. J., & Monson, C. M. (2016). Cognitive–behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial. Journal of Family Psychology, 30(1), 157–162. 

QUESTION 1: What behaviors are closely related to the counterphobic mechanisms? To select and enter your answer go to Test.