Understanding traumatic stress reactions - The linking of phenomenology, aetiology and treatment plan


One of the most intriguing aspects of traumatic stress has been the repeated learning and forgetting of lessons about its importance as a cause of psychopathology. It remains the case that the broader body of psychiatry and psychology has an ambivalent relationship with the field of traumatic stress and the nature of posttraumatic stress disorder. The origins of this ambivalence and their impact will be discussed. It is important that practitioners in the field of traumatic stress be aware of these barriers and how to address them in a research setting and clinical practice.

The underlying phenomenology of posttraumatic stress disorder will be explored and its neurobiological origins will be highlighted. It is important to deconstruct posttraumatic stress disorder into the different symptom components, as they have substantially different mechanisms underpinning their intensity and presentation. Posttraumatic stress disorder is a dynamic condition in which symptoms fluctuate with time and are substantially influenced by the environmental demands placed upon the individual.

It is often forgotten that somatic symptoms are a core element of the experience of individuals with PTSD. The nature of these somatic dimensions of distress and their significance will be discussed.

The epidemiology of posttraumatic stress disorder highlights how the prevalence of these conditions is seemingly increasing. However, this reflects the developments in the measurement of the effects of trauma in research settings. This has major implications for clinicians as to how best take a history about exposures to traumatic events. The evidence is that systematic investigation is critical and that unless questions are asked, symptoms will frequently go unreported. Recent evidence suggests that PTSD may be in fact more common than major depressive disorders. Equally, it should not be forgotten that depression is an important dimension of posttraumatic reactions. There is also an associated comorbidity with substance abuse. The risks associated with trauma exposure have a long tale of effect and these will be described.

The challenges of treatment will be discussed in the context of early intervention and workplace intervention. Treatment needs to be a sequential process where there are a variety of strategies, including EMDR, which can be used in treatment. The sequence of these strategies in treatment is a challenging question that has not been systematically addressed in research.

It remains the case that one of the primary issues in treatment is early identification, and this raises questions about the importance of screening in at-risk populations. Again, there are significant differences in opinion; however, the militaries around the world are now regularly screening populations returning from deployment. A recent novel approach to considering the issues of treatment is whether a staging approach should be used for conditions such as PTSD.

In summary, it is critical that clinicians have an explicit model of the mind and its neurobiology. Posttraumatic stress disorder can best be understood as an information processing disorder, which both impacts upon an individual's ability to engage with their day to day environment as well as integrate past experiences as a source of information to influence current behaviour. The integration and modulation of neural systems that manage environmental input is critical to adaptive functioning. The ways that these systems become dysregulated in PTSD will be highlighted and how these underlying deficits can be addressed in treatment will be focused upon.

A further issue that needs to be considered in the treatment of PTSD is the long-term risk of individuals, who have developed this condition, to have relapses after a successful intervention. Some long-term treatment outcome data will be presented.






Alexander McFarlane

Original Work Citation

McFarlane, A. (2010, June). Understanding traumatic stress reactions - The linking of phenomenology, aetiology and treatment plan. Preconference presentation at the 11th EMDR Europe Association Conference, Hamburg, Germany



“Understanding traumatic stress reactions - The linking of phenomenology, aetiology and treatment plan,” Francine Shapiro Library, accessed September 21, 2021, https://emdria.omeka.net/items/show/19555.

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