Although a necessary condition for the development of PTSD, exposure to trauma per se does not inevitably lead to chronic PTSD. Prospective studies of traumatized individuals indicate that PTSD symptoms, general anxiety, depression, and disruption in social functioning are common immediately after the traumatic event. Over the subsequent weeks and months, the majority of individuals recover naturally, with symptoms declining most rapidly during the 1- to 3-month period immediately following the trauma. This pattern of natural recovery has been documented for female rape victims (Atkeson, Calhoun, Resick, & Ellis, 1982; Calhoun, Atkeson, & Resick, 1982; Resick, Calhoun, Atkeson, & Ellis, 1981; Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992), male and female victims of nonsexual assault (Riggs, Rothbaum, Foa, 1995), and victims of motor vehicle accidents (Harvey & Bryant, 1998).
Foa and Cahill (2001) suggested that, over time, trauma survivors encounter situations that include trauma-relevant stimuli and activate their trauma memory structures. The activation of the trauma structure is reflected in reexperiencing symptoms such as intrusive thoughts, flashbacks, and emotional distress. Because these situations are safe and the feared consequence (e.g., repeated trauma) does not occur, the trauma-related associations are repeatedly disconfirmed, resulting in changes in the fear structure and corresponding reductions in PTSD symptom severity. Corrective information is also provided through experiences such as talking about the trauma with friends and confidants.
A significant minority of trauma victims does not recover naturally after the trauma. For these individuals, PTSD becomes a chronic condition that may last for many years (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Within the framework of emotional processing theory, the development of chronic PTSD is conceptualized as a failure to adequately process the traumatic memory. According to Foa and Kozak (1986), this failure is due to inadequate activation of the fear structure in the wake of the trauma and/or the unavailability of corrective information. Survivors with chronic PTSD appear to access their trauma memory structure quite easily, as evidenced by reexperiencing symptoms (Foa et al., 1989). Therefore, the most likely reason for the development of chronic PTSD is the failure to incorporate corrective information into the fear structure. Foa and Cahill (2001) suggest that the absence of corrective information is due to extensive use of avoidance strategies to manage distress. Avoidance limits activation of the fear structure and the availability of corrective information, thereby hindering natural recovery. The goal of treatment is to help patients overcome their tendency to avoid and encourage them to fully activate the trauma fear structure in order to incorporate corrective information about the world and themselves into it.
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