38 MONITOR ON PSYCHOLOGY • SEPTEMBER 2013
Up to 60 percent of American adults have experienced at least one traumatic event in their life, such as child maltreatment, interpersonal violence, natural disaster,
war or serious accident. Although most people who experience
a traumatic event do not have long-term negative consequences,
a substantial minority develop significant health difficulties.
Traumatic exposure has been implicated as a risk factor for
numerous mental disorders, including depression, substance
abuse and post-traumatic stress disorder (PTSD). Trauma is
also associated with such physical health problems as heart,
chronic lung and liver diseases; negative health behaviors,
such as smoking and overeating; poor social and occupational
functioning; and overall decreased quality of life.
As a result of the 9/11 terrorist attacks, Hurricane Katrina,
the Iraq and Afghanistan wars and other recent tragedies,
policymakers now recognize trauma and its consequences as
serious public health risks. Growing awareness is expected to
increase the number and proportion of trauma survivors who
seek treatment for trauma and its effects.
Most mental health professionals — including psychologists
— do not have formal education and training in trauma mental
health. To address this problem, APA members Joan Cook, PhD,
of Yale University, and Elana Newman, PhD, of the University
of Tulsa, spearheaded a national effort to articulate empirically
informed knowledge, attitudes and skills that mental
health practitioners should have to treat trauma survivors
In April, the two hosted 60 national experts in psychology,
social work and psychiatry for “Advancing the Science of
Education, Training and Practice in Trauma,” a consensus
conference at Yale School of Medicine in New Haven, Conn.
The conference was modeled after previous national psychology
conferences on training issues such as the Hilton Head
conference on child clinical psychology, the Houston conference
on neuropsychology, the Arden House conference on health
psychology and the Pikes Peak conference on geropsychology.
People with post-traumatic stress disorder, or PTSD, cope with the effects of past trauma that manifest themselves in such debilitating symptoms as flashbacks, hypervigilance
and insomnia. But what happens to people who face trauma on
an ongoing basis — the millions who live with the daily reality of
genocide, war, displacement or community violence?
Psychologists and other researchers tackle that question
from theoretical, empirical and applied perspectives in the
May issue of Peace and Conflict: Journal of Peace Psychology,
the journal of APA’s Div. 48 (Peace). In 11 articles examining a
construct called “continuous traumatic stress,” 35 authors from
Israel, Germany, South Africa, the United States and Zimbabwe
argue that the current traumatic stress framework must be
supplemented with one that considers the reality and effects
of the many ongoing traumas people face, particularly in the
world’s poorer, politically unstable regions, as well as in urban
areas marked by poverty and violence in the United States and
“We wanted to adopt a less individual, less pathologizing
understanding of trauma, and also to address its social and
political implications,” says Debra Kaminer, a University of
Cape Town psychologist who was the special issue’s lead editor.
“In our view, it’s quite problematic to pathologize individuals in
contexts that are normatively toxic and dangerous.”
The term continuous traumatic stress was coined in the
1980s by South African mental health professionals working
in the Apartheid era. Their goal was to give psychological
support to victims who were repressed by the government.
The original construct of continuous traumatic stress
focused on the intervention implications of working with
traumatized clients in politically unstable contexts, specifically
by developing a single, powerful intervention session. In revisiting the continuous traumatic stress concept, the special
issue authors sought to expand that framework by describing
the characteristics of contexts in which continuous traumatic
stress occurs; exploring the psychological impacts of continuous
Traumatic stress in a violent world
Psychologists and others explore how best to treat
victims of continuous traumatic stress.
BY TORI DEANGELIS