A broader view of trauma: A biopsychosocial-evolutionary view of the role of the traumatic stress response in the emergence of pathology and/or growth
Introduction
In recent years, there has been an explosion of research into the biology of human stress response, particularly the traumatic stress response. During this same period, there has been tremendous progress in the integration of biological, psychological, and sociocultural research of all kinds within an evolutionary framework. Taken separately, these advances have tremendous implications for clinical psychology, which are only just beginning to be articulated. However, taken together, the implications are even greater because they offer a framework for understanding the very complex relationship between psychological development and pathology.
This paper is a very tentative attempt at using a review of some of these advances to articulate, for clinical psychologists, a broad theoretical framework for a better understanding of the very complex role of the human stress response, particularly the traumatic stress response, in psychological adaptation and pathology. In general, I argue that the normal trauma response is better understood as an evolutionarily inherited mechanism for metalearning, which shatters and reconstitutes the metaschema (i.e., concepts of self, society, and nature), in which learning normally takes place. Although I focus on the biological dimensions of this mechanism, the inherent assumption of this model is that this process is always simultaneously biological, psychological, and social. In fact, from the perspective of evolutionary psychology, the self and the mind are emergent properties of the sociobiological interaction of the brain's individual subsystems, each of which evolved and expresses itself, in adaptation with the environment (Cosmides & Tooby, 1997). I have articulated this perspective to clinical psychologists because I believe that a bio-psycho-sociocultural evolutionary perspective can provide a more sophisticated framework for psychological diagnosis and treatment by focusing our attention on the interaction of these systems and their subsystems, rather than on decontextualized symptomology. I do not address diagnosis or treatment in this article, although I will point out important implications for both. Rather, it is my hope that clinical psychologists will find this a useful integrative framework for grounding their work in the biological, psychological, sociological, and evolutionary sciences.
Reviewing and synthesizing the trauma literature from this perspective, I offer seven empirically based theoretical conclusions. Some of these conclusions are consensus positions, while others remain controversial, but all can, with more research, be empirically validated or invalidated. These conclusions may be surprising to many clinical psychologists, who have a tendency, because of the care-taking nature of their work, to view stress from a fairly narrow and negative perspective.
First, research from biology, psychology, and sociology suggests that stress is best understood as the primary prerational form of biopsychological feedback regarding the individual's relationship with his/her environment. Second, the research shows rather conclusively that the normal outcome of traumatic stress is growth rather than pathology. Third, most psychopathology is a function of the maladaptive modulation of the stress response. Fourth, whether stress produces an adaptive or maladaptive outcome, it always leaves the individual transformed on a biological, as well as psychological, level. Fifth, the general biological process underlying psychological and social responses to stress is universal, but the specific dynamics is always a function of the unique sociocultural environment and psychological makeup of the individual. Sixth, sometimes changing biopathological conditions underlie stable psychopathological symptoms. Seventh, rationality is humanity's evolutionarily newest and most sophisticated stress-reduction behavioral mechanism.
From the perspective articulated in this paper, the same systemic discontinuity between brain systems which evolutionary psychologists argue generates the emergence of the self and mind, can also transform the normal adaptive trauma response into various pathological trauma responses. Pathology can emerge whenever the actual environment deviates too far from what evolutionary psychologists call the environmental of evolutionary adaptiveness (EEA; Cosmides & Tooby, 1997), without the development of the individual and the collective cognitive schema needed to modulate the resulting mismatch between the biology of self and the sociology of self. It is this built-in brain discontinuity, as well as the discontinuity between the mind and the environment, which drives the general development of self and the specific development of our responses to stress. The difference between the outcome of the normal development-inducing stress response and the pathological stress responses seems to be determined by a matrix of three categories of factors needed to turn stress into adaptation and development: (1) whether the organism is sufficiently biologically healthy to make use of the resources available to it; (2) whether the cognitive schema are available to transform stress and anxiety into learning, meaning, and adaptive behavior; and (3) whether social relationships are complex, responsive, and flexible enough to adequately dampen stress arousal. All three rely on an adaptive attunement of neural networks (which constitute cognitive schema) and on the endocrine system (which modulate emotions), with their environment.
When the hypothalamic–pituitary–adrenal (HPA) axis is out of tune with its environment, the psyche is vulnerable to either depressive or anxiety disorders, depending on the cognitive schema and social attachment patterns of the individual. In this article, I focus on how the HPA axis modulates itself with the cortisol releasing system. However, a truly biopsychosocial evolutionary understanding of the stress response would entail an understanding of how cognitive schema and social-interaction patterns of attachment and affiliation modulate the HPA axis through other neuroendocrine systems. This would entail articulating such dynamics as how the stress response is modulated by attachment behavior through the hormones of oxytocin and vassopressin, how dominance hierarchy modulates stress through the serotonergic system, how sexuality and aggression modulate the stress response with testosterone, and how the various reward systems modulate the stress response with opiod hormones. However, for the purposes of this paper, I simply want to state that I recognize that the stress response system is not self-contained and, therefore, the traumatic stress response cannot be adequately understood without embedding the outline that I have sketched in this paper within the larger biopsychosocial evolutionary context.
Having said that, we will see that research shows that a biological mistuning of the HPA axis can result from inherited factors or prior experience, but in each case, the individual ends up facing trauma with a biological deficiency, which predisposes them to pathology. This dysfunction appears to result from a change in the number and sensitivity of glococorticoid receptors, with increases leading to anxiety disorders and decreases leading to depressive disorders.
I will not be addressing all of these conclusions equally in this paper; however, they are all sufficiently interwoven with each other such that they must be at least recognized as part of the perspective, if this perspective is to be adequately appreciated. I begin by using this approach to define the difference between an adaptive and maladaptive response, then move on to examine the biology of the normal stress response. After that, I address the issue of the distinction between stress and trauma as a precursor to speculating on the biology of the normal adaptive trauma response of posttraumatic growth (PTG). Because of the limits of space and because there is more recent research on the biology of posttraumatic stress disorder (PTSD; or at least, I am more familiar with it) as compared with other stress pathologies, I focus primarily on the relationship between PTSD and PTG.
Section snippets
Stress
As I use the term, stress is a state of arousal (in response to an environmental stressor), characterized by biopsychological changes that may have negative or positive consequences for adaptation, adjustment, and well-being. As with all species, humans have inherited highly complex biological systems for responding to environmental stressors. From an evolutionary perspective, the primary stress response in mammals is what Canon (1914) first described as the “fight or flight” response. The
Adaptive versus maladaptive stress responses
While it has long been recognized that stress plays a major role in numerous psychopathologies, it is increasingly recognized that stress also has biopathological effects ranging from the suppression of the immune system to neural damage Costello, 1997, Wong, 2002. At the same time, it is also increasingly recognized that stress plays a critical role in cognitive and emotional development Bjorklund & Pellegrini, 2002, McEwen, 2002, Teicher et al., 2002.
The relationship between adaptive and
The evolutionary nature of the human stress response
When psychologists speak of the “stress response” they are usually not referring to the general evolutionarily inherited set of responses to the environment that make up human nature, but rather to a specific range of biopsychological responses to stressors that involve the activation of the HPA axis. Nonetheless, this research has its roots in an evolutionary orientation. The Nobel Laureate, Hans Seyle, first conceptualized the stress response as a three-stage process, which he called the
Stress versus trauma
The relationship between stress and trauma has been at the center of clinical psychology's diagnostic and prescriptive models since its inception, but it has not always been an easy distinction to define. The common sense model of the relationship is that trauma is simply an extreme form of stress. However, this model is complicated by the fact that as a result of the high road to the amygdala, where an event that is located on this continuum has as much, and often more, to do with subjective
The evolutionary and biological basis of PTG and PTSD
From an evolutionary perspective, Eberly, Harkness, and Engdahl (1991) argue that hypervigilance, cognitive resimulation, and emotional dissociation, the hallmark behaviors of PTSD (and common features of others psychopathologies), are all adaptive behaviors to extreme threats, which, under certain sociocultural conditions, can become pathological. These same adaptive behaviors, which can become pathological, can also be viewed as the foundation of what Tedeschi et al., 1996, Tedeschi et al.,
Biosocial determinants and consequences of maladaptive versus adaptive stress responses
Eberly et al. (1991) postulate that the difference between the adaptive and maladaptive responses to trauma is often a function of how far our actual environments deviate from the EEA. Compared with the EEA, the type and frequency of traumatic stressors found in contemporary postindustrial societies are far more varied and common because the modern environment is so much more discontinuous, complex, and changing than that of the EEA. Biological responses to threat, which were adaptive in the
Psychobiological determinants of the maladaptive versus adaptive traumatic responses
At the biological level of inquiry, one of the most studied of the pathological responses to stress is PTSD. However, other forms of psychopathology are increasingly being studied at the biological level and are being understood as pathological stress responses. At the biological level, the normal fear response and PTSD have much in common, but there are important biological differences. For instance, PTSD patients exhibit an enhanced, but otherwise normal, startle response to both neutral- and
Concluding remarks
The purpose of writing this paper was to provide clinical psychologists with a sketch of a bio-psychosocial evolutionary perspective for understanding the traumatic stress response, in terms of its role in adaptation, maladaptation, pathology, and growth. I offered seven theoretical conclusions: (1) Stress is best understood as the primary prerational form of biopsychological feedback regarding the individual's relationship with its environment; (2) The normal outcome of traumatic stress is
References (130)
- et al.
Power spectral analysis of heart rate variability in posttraumatic stress disorder patients
Biological Psychiatry
(1997) The role of the amygdala in fear-potentiated startle: Implications for animal models of anxiety
Trends in Pharmachological Sciences
(1992)- et al.
Neurophysiological processes in post-traumatic stress disorder
Psychiatric Clinics of North America
(2002) - et al.
Post-traumatic stress disorder in victims of disasters
Psychiatric Clinics of North America
(1994) Substance abuse among sexually abused adolescents and their families
Journal of Adolescent Health
(1992)- et al.
Emotional processing in survivors of the Jupitor cruise ship disaster
Behavioral Research and Therapy
(1995) - et al.
Salivary cortisol in Operation Desert Storm returnees
Biological Psychiatry
(1997) - et al.
Psychological condition hormone levels in war trauma
Journal of Psychiatry Research
(1996) Allostasis and allostatic load: Implications for neuropsychopharmacology
Neuropsychopharmacology
(2000)The neurobiology and neuroindocrinology of stress: Implications for post-traumatic stress disorder from a basic science perspective
Psychiatric Clinics of North America
(2002)
Autonomic response to stress in Vietnam combat veterans with posttraumatic stress disorder
Biological Psychiatry
Psychophysiologic and neuroendocrine findings in posttraumatic stress disorder: A review of theory and research
Journal of Anxiety Disorders
Biologic models of traumatic memories and post-traumatic stress disorder: The role of neural networks
Psychiatric Clinics of North America
Twenty-four hour urinary cortisol and catecholamine excretion in combat-related PTSD
Biological Psychiatry
Increased pituitary and adrenal reactivity in premenopausal women with posttraumatic stress disorder
Biological Psychiatry
Auditory startle response in help-seeking trauma survivors
Psychiatry Reserves
Enhanced dexamethasone suppression of plasma cortisol in adult women traumatized by childhood sexual abuse
Biological Psychiatry
Causal and control cognitions in parents' coping with chronically ill children
Journal of Social and Clinical Psychology
Causal attributions, perceived benefits, and morbidity after a heart attack: An 8 year study
Journal of Consulting and Clinical Psychology
Vulnerability and resilience to combat exposure: Can stress have lifelong effects?
Psychology and Aging
Long-term adjustment and adaptation mechanisms in severely burned adults
Journal of Nervous and Mental Disease
Implications of psychological research on stress and technological accidents
American Psychologist
Psychological and endocrine abnormalities in refugees from East Germany, pt 2: Serum levels of cortisol, prolactin, luteinizing hormone, follicle stimulating hormone and testosterone
Psychiatric Reserves
Risk society: Towards a new modernity
Ecological enlightenment: Essays on the politics of the risk society
Community violence and children on Chicago's south side
Psychiatry
The synaptic self
Monitor on Psychology
The origins of human nature: Evolutionary developmental psychology
PTSD, exposure to combat, and lower plasma cortisol among Vietnam Veterans: Findings and clinical implications
Journal of Clinical Consultation Psychology
Elevated CSF corticotropin-releasing factor concentrations in posttraumatic stress disorders
American Journal of Psychiatry
Dimensions of recovery from rape: Focus on growth outcomes
Journal of Interpersonal Violence
Beta-adrenergic activation and memory for emotional events
Nature
A correlational test of the relationship between posttraumatic growth, religion, and cognitive processing
Journal of Traumatic Stress
Positive aspects of critical life problems: Recollections of grief
Omega
Facilitating posttraumatic growth: A clinician's guide
Emergency function of adrenal medulla in pain and major emotions
American Journal of Physiology
Relationships among cardiovascular, muscular, and oxytocin, responses during human sexual activity
Archives of Sexual Behavior
Culture and mental illness: A client-centered approach
Violent death and injury in U.S. children and adolescents
American Journal of Disease Control
An exploration of the “Reflex” in reflexive modernity: The rational and prerational social causes of the affinity for ecological consciousness
Organization and Environment
The concepts of stress and stress system disorders: Overview of physical and behavioral homeostasis
JAMA
A better world or a shattered vision? Changes in life perspectives following victimization
Social Cognition
Making sense of loss and benefiting from the experience: Two construals of meaning
Journal of Personality and Social Psychology
Multiple changes of immunologic parameters in prisoners of war
JAMA
Neurohypophyseal hormone influences on learning and memory processes
The need for meaning following disaster: Attributions and emotional upset
Personality and Social Psychology Bulletin
An adaptational view of trauma response as illustrated by the prisoner of war experience
Journal of Traumatic Stress
Combat experiences and emotional health: Impairment and resilience in later life
Journal of Personality
Cited by (118)
Stress generation in social anxiety and depression: A two-study community assessment
2023, Journal of Affective DisordersProcess-based functional analysis can help behavioral science step up to novel challenges: COVID - 19 as an example
2020, Journal of Contextual Behavioral ScienceHyperarousal and hypervigilance in African American male adolescents exposed to community violence
2020, Journal of Applied Developmental PsychologyCitation Excerpt :These men noted that hypervigilance allowed them to stay “on point,” which they described as being mindful of their surroundings, staying alert at all times, and not letting their guard down (Smith & Patton, 2016). This increase in attention towards potential threats allows individuals to not only prioritize maintenance of resources and plan for escape routes, but also to avoid potentially dangerous situations (Cantor, 2009; Christopher, 2004; Kimble et al., 2013). According to the adaptive calibration model's conceptualization of how adversity can direct development, environments with threatening, unpredictable and uncontrollable stressors may shape the stress response system towards vigilance to maintain safety (Ellis et al., 2017).
Psychological Adjustment to Spousal Bereavement in Older Adults: A Systematic Review
2023, Omega (United States)A Scoping Review of the Relationship Between Physical Activity and Mental Health Among Immigrants in Western Countries: An Integrated Bio-Psycho-Socio-Cultural Lens
2023, Journal of Immigrant and Minority HealthExploring the Association of Burning Mouth Syndrome with Depressive and Anxiety Disorders in Middle-Aged and Older Adults: A Systematic Review
2023, Journal of Personalized Medicine