The end of trauma as we know it?

Professor George A. Bonanno is author of The End of Trauma: How the New Science of Resilience is Changing How We Think About PTSD (Basic Books).

The conventional view is that people who have been through a terrible experience like a severe accident will be psychologically really badly affected for a long time. In your book, you tell the story of Jed who goes through a horrific accident which leads to the amputation of his leg. And after a few days, the intense psychological reaction to his memories subsided and he was actually doing okay. And he asked himself why he didn't have PTSD, as the narrative is so clear that that's what will happen. And you explain that Jed's response is more common than we think. So why is it that we have this idea that these awful life changing events lead to PTSD?

There are a number of reasons. A lot of the early work on trauma and PTSD came from the clinical realm, from people who were looking for a way to treat highly severely traumatised individuals. And that led to the development of PTSD and treatment initiatives. All of the focus was primarily on psychological damage. Mental health professionals were seeing mostly traumatised individuals, and they assumed that it's more prevalent in the general population than it actually is. 

Also, media outlets play their role. Something attention grabbing is more likely to get people to read or click. Algorithms focus on what's provocative – like trauma.

As human beings, we're drawn to the idea that trauma is common because it grabs our attention. When we hear about a trauma it's much more memorable than when we hear about someone who was okay. And often people who are okay don't even talk about the event. 

I think those are the primary factors that contribute this idea that trauma is ubiquitous and happens when you're exposed to one of these events.

In your keynote at the 2021 BPS conference you described events as potentially traumatic rather than traumatic.

Yes. I think there's a lot of misconception there, when people talk about 'trauma histories' – the idea that most of us are carrying past traumas. It's not true. There's a big focus now on trauma-informed care. I understand the intent there, but I think it's not a good idea and I think it's quite misleading, because it allows a misinterpretation of one's past as traumatic. The research is very clear on this. The epidemiological research has shown that when people experience potentially traumatic events but are not traumatised, they do not carry the event forward as a traumatic experience.

And you're not talking about post-traumatic growth, you're talking about simply not being traumatised by the event. What would you say to psychologists who argue that anyone who goes through one of these events is traumatised at some level, and there are just degrees of covering that up?

That would mean, essentially, that the entire world is traumatised, which of course makes no sense. If we were all carrying with us hidden traumas, how could we ever possibly function? What's more, epidemiological research has shown that almost everyone experiences at least one, and often several, 'potentially' traumatic events in their lifetime. And my research, and the research of others, has repeatedly shown that the majority of people exposed to these events move on with no lasting psychological damage.

You argue that flexibility, and not resilience, helps people get through potentially traumatic events because the traits and behaviours that help in one scenario might not work in another. How do you define flexibility?

One major component is a way of thinking, a mindset. It's conviction and a kind of optimism that we will be able to get through something. If you have that attitude, you're more likely to engage with the stressor and get into the steps of flexibility. The event becomes less threatening. When I've had disturbing, difficult, or painful events happen to me in recent years, it's been easy to think that I'll have a terrible life now. But I've ultimately been able to look at the challenge at hand and focus on getting through the moment, one step at a time, as it were. It's less threatening and more manageable this way.

It's not just empty optimism, it really helps us engage with the second component which I call the flexibility sequence. It is a series of steps where we embrace the challenge. We first look at the situation and ask what's really happening. It's not easy because sometimes these situations are very painful or make us very frightened. But we need to understand what is happening to get past it. That first step is context sensitivity.

The second step is called repertoire, when we try to decide what we can do with the skills and tools at our disposal. And the third step is the feedback monitoring step. We pay attention to what happens when we use a strategy. We ask if it worked, if it's helping. If not, we go back to the first step and try something else.

You're not done there because usually events go on for a while, or there may be another event the next day, week or month. This is applicable to both everyday difficulties and more severe difficulties. It means addressing the problem as it happens. 

Is your thinking around this that if people develop their flexibility, that will lead to 'the end of trauma', which is the title of your book?

No, actually I don't think anything will lead to the end of trauma. The title was deliberately provocative. It's really a call for a new way to think about trauma – it's the end of trauma as we know it.

But there is evidence that people can develop the pieces of flexibility. We've done research on the individual pieces, and they are amenable to both practice and education. Several of my colleagues use this in their clinical practice already, so I think it's learnable. But most people have these tools to some degree already, only they may not know it. I think the book itself may help to people to become more flexible, through learning about these things in depth – that's part of my hope.

You've interviewed so many people who have gone through awful events, including survivors of the 9/11 terrorist attack. Has that had any impact on you, and have you needed flexibility to cope?

I think it's actually had a positive impact on me. In my research we try to include interviews, even when we're doing experimental and psychophysiological studies, because people like to tell their story. It's also endlessly fascinating. Pretty much from the beginning, it made me feel much more hopeful about our capacities in the face of the worst things.

I assumed that over time, it would get harrowing.

Well, I don't watch TV or read books about grief and trauma in my spare time because I can't saturate myself too much with it.

Where next in your work on trauma?

I really want to further understand flexibility and how it works. I'm engaged in more and more computational analysis and machine learning with colleagues, and I think it's possible to do a lot more sophisticated analyses to try to understand how people use flexibility over time. And if we can find ways to harness the enormous amounts of data in smartphones, we can further understand how it works in real time.

I also want to understand why people are so resistant to the idea that we're not so traumatised. Right now, the idea that we all have hidden trauma is very popular. I'd like to do more research on that.

Finally, after your BPS keynote, I told my partner about your concept of 'coping ugly' – using an unhealthy strategy to get through a situation. Now whenever something bad happens, he says, 'I'm having a beer, it's allowed, I'm coping ugly'… So he asked me to thank you.

Totally. You can tell him I said totally, especially if it's a good beer. It should be a good beer.