Venting Emotions After Trauma Predicts Worse Outcomes
After suffering a traumatic experience, 'common sense' has it that immediately 'venting' or 'letting off steam' by talking about the experience helps protect against future psychological problems. But is this really true?
That's the question Dr Mark Seery from the University of Buffalo and colleagues ask in a study that examined how people coped with the aftermath of the '9/11' terrorist attacks on the World Trade Center in New York.
The answer to this question is particularly pressing now as the recent earthquake in China has left huge numbers both physically and psychologically traumatised. The Chinese government clearly thinks that psychological intervention is useful as they have launched their biggest ever programme of counselling for those affected.
Yet the new research, to be published in the Journal of Consulting and Clinical Psychology, suggests that talking about thoughts and feelings after a trauma may not help. Worse, it may be psychologically damaging (Seery et al., 2008).
A collective trauma
This study's first set of data was collected on the day of September 11th 2001. As people sat at home trying to digest the shocking events of the day, 36,000 people were contacted through the internet. These people were part of a pre-selected nationally representative sample of participants who had already agreed to receive regular requests for surveys.
They were simply prompted to express whatever thoughts and emotions were currently on their minds, should they choose to do so. Of all these people, 2,138 people were followed up over a period of two years after 9/11 to see how they coped with the collective trauma.
The aim of the researcher's prompt was to make it similar to a psychologist asking someone to share their experience after they witness a traumatic event. Naturally some people choose to share and others don't. In this study 1,559 chose to respond while 579 remained silent.
The results make surprising reading.
What they found was that choosing to respond to the prompt was a significant predictor of suffering post-traumatic stress (PTS). What's more, the longer the response, the greater the level of subsequent PTS.
This suggests that, contrary to popular expectations, expressing thoughts and emotions soon after a traumatic event - 'letting off steam' or 'venting' - might actually predict a worse psychological outcome.
Alternate explanations
Although this is a strong finding in a large nationally representative sample, some alternate explanations are possible. Here are the main ones the authors consider:
- Did those who didn't respond to the prompt express themselves elsewhere? Probably not: other measures suggested that those who didn't respond naturally stayed quiet in these situations.
- Did those who did respond do so because they couldn't talk to anyone else? Probably not: having fewer social networks was not associated with a greater chance of responding to the prompt.
- Were those who responded already more traumatised? Probably not: there was still a relationship between responding to the prompt and PTS symptoms even when lifetime trauma was taken into account.
It's important to note that this study is NOT strong evidence that talking about an event actually CAUSES a worse psychological outcome, just that remaining silent isn't necessarily a bad thing.
Junking the hydraulic metaphor
If accurate these results stand in stark contrast to what has become the accepted wisdom. Offering psychological counselling in the aftermath of traumatic events has now become a normal, automatic official response. Popular techniques include 'Critical Incident Stress Debriefing' which is thought to reassure trauma sufferers that their responses are normal and help reduce the chances of PST.
These techniques are in line with the 'hydraulic theory' of the emotions - a popularly held view of how the emotions work. In this view, people's emotions work in the same way as a pressure cooker. Emotions build up inside until the mind can no longer contain the pressure. Then steam is 'let off', releasing the pressure inside and improving the mood.
People who choose not to let off steam in this way are popularly seen as being in denial, and this denial is often seen as pathological.
In recent years, however, the hydraulic metaphor and the therapies that implicitly rely on it have been seriously questioned. Studies on 'Critical Incident Stress Debriefing' have not only found that the technique may provide no benefit to trauma sufferers, but that it also may be harmful.
The strong silent type
Dr Seery's study extends these criticisms to attack the broader idea that talking about a traumatic event soon after it has occurred is usually beneficial. Mounting evidence suggests that those who do not talk about a traumatic event are simply more resilient, rather than being in a state of pathological denial.
This study is also backed up by previous work carried out by Professor Bernard Rime from the Universite Catholique de Louvain. Rime and colleagues have found that despite the fact that people are likely to share their feelings after an emotional event, this sharing does not promote recovery.
So it's time to throw out the old hydraulic metaphor and its attendant rapid intervention therapies. Just because some people prefer to deal with a trauma quietly on their own doesn't mean there's anything wrong with them. While most people do choose to share with others, this immediate sharing probably isn't a major contributor to psychological recovery.
» Related: Rime's work on social sharing of emotions and how it ties in with the potential benefits of expressive writing.
[Image credit: assbach]
References
Seery, M. D. et al. (2008). Expressing Thoughts and Feelings Following a Collective Trauma: Immediate Responses to 9/11 Predict Negative Outcomes in a National Sample. Journal of Consulting and Clinical Psychology.
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But still.. Are those who talk also generally more prone to PTS? IT is explicitly pointed out that it doesn't tell us anything about the CAUSE of PTS. Then why make causal conclusions?
Maybe those who remain silent cope better with stress and PTS. And maybe those who talk would experience even more PTS if they DIDN'T talk about traumatic experience... Is general coping taken into account?
It is a normal phenomenon that when we talk about something we visualize it. When these respondents were a part of therapy, they might have tried to provide as much detail as they could recover, which unforunatly have reinforced the cruel memories of the tragic event.
I believe repeating the event to someone has nothing to do with PTS unless it does not reinforce the memories. And eventually it does reinforce, hence it could be dangerous. Moreover, after-effects also depend upon the person's attitude whether they look the better side of the future life, or they fear another such event. The people who tried this therapy to forget such event might have reinforced it because they were continuously thinking about the same thing. We need to remove the systematic errors in such a study.
One thing that does not appear to have been considered here is that people who already feel more traumatized BY THE EVENT IN QUESTION may also feel a higher need to talk about it. The extent of the responses to the survey was positively linked to the chance of PTSD: the more traumatized by the event someone was, the higher their need to talk about it at length and in depth. What this study shows is nothing more and nothing less than that people feel the need to talk about things that are bothering them acutely, and they don't feel the need to talk about things that aren't particularly bothering them.
Rather than looking at this from the perspective of whether survivors of potentially traumatic events should or should not talk about their traumas, it might be more valuable to look at it from the perspective that the desire to talk about traumatic events is apparently an effective clinical screening marker for the risk of PTSD, allowing support efforts to be targeted where they are most likely to be needed.
I work in the treatment of trauma. I see hundreds of patients a year. I think that the researchers do not understand how traumas are cured or they would see that talking or not talking can be relevant or irrelevant depending on what they talk about concerning their traumas.
Effective trauma resolution involves reframing and processing the original trauma memory. This can be done via any of the following modalities: visual, auditory, and kinesthetic. To the degree a person talking or "venting" about their trauma gets close to the exact trauma event being embedded in them, to that extent there is resolution.
It is possible to get totally different results because the venting being done is not guided but haphazard or spontaneous. In other words, it is disorganized and not necessarily focusing on the exact trauma moment where the reframe has to take place to be neutralized.
Samuel Lopez De Victoria, Ph.D.
http://www.DrSam.tv
I would have to agree with Dr. Sam and Vaibhav to a certain extent.
First of all just expressing whatever emotion happens to show up and recalling their story about what happened certainly could have a serious negative affect.
Research seems to demonstrated that connecting strong emotion to any learning experience will reinforce the memories related to the experience.
When the individual subjected to the event creates a story through their own filters they may be simply amplifying, reliving and reinforcing the events and beliefs from which their filters were created. I believe it's possible there was already some sort of emotional trauma present and the current event simply amplified what was there.
The reframing Dr. Sam mentioned may need to take into account framing that was in place prior to the most current trauma.
Sounds like a great place to use an fMRI so we can take a lot of the guess work out of this. If that's possible?
What I understand, from basic knowledge of how the human brain works, is that when we vent we are reliving our negative emotions, in actual real-time. When we talk or dwell on negative emotion after an event or about a person, we strengthen those bad feeling connections in our brain and make the same negative emotions more likely to arise via association when thinking of the event or person in the future. Does anyone who studies the actual brain (not pop psychology) have any information on this? (myelination of dendrites?)