Traumatic Incident Reduction:
Cognitive-Emotive Resolution of the Post-Traumatic Stress Disorder by Robert H. Moore, Ph. D.

Problem Profile | Primary and Secondary Trauma | PTSD and Cognition |
Traumatic Incident Reduction | Notes | Bibliography | The Author

Primary and Secondary Trauma

What makes PTSD a particularly persistent and pernicious variety of disturbance is the occurrence, at the time of its acquisition trauma, of significant physical and/or emotional pain. Such pain, in association with the other perceptual stimuli, thoughts, and feelings one experiences at the time, constitutes the "primary" traumatic incident. The composite memory of the primary incident, therefore, contains not only the dominant audio/visual impressions of that moment, but also one's mind­set (motives, purposes, intentions) and visceral (emotional and somatic) reactions. Thus, whenever one subsequently encounters a "restimulator" ­­ any present­time sensory, perceptual, cognitive, or emotive stimulus similar to one of those contained in the memory of an earlier trauma ­­ one is likely to be consciously or unconsciously "reminded" of and, therefore, to re­activate its associated pain or upset. It is this subsequent painful reminder, the involuntary "restimulation" of the primary trauma, that constitutes the painful secondary experience we recognize as PTSD (Foa, 1989).

In the Pavlovian model, the occurrence of the restimulator (trigger stimulus) equates to the ringing of the bell; the stress reaction itself equates to salivation. The mechanism is almost indefinitely extendible by association. Once the dog has been conditioned to salivate to the ringing of the bell, for example, the bell may be paired with a new perceptual stimulus ­­ say, the flashing of a light ­­ so that the dog will then salivate to the light as well as to the bell. If one next flashes the light and pulls the dog's tail, the dog will learn to salivate when his tail is pulled (Hilgard, 1962). By sequencing stimuli so as to create a "conditioned response chain" in this manner, we expand the domain of stimuli that will elicit the salivation response.

This process may be illustrated by the following common example: A veteran originally injured in an artillery attack (the primary trauma) will often tend to be restimulated, even years later, by such things as smoke and loud noises. So it's no surprise when he panics, post­war, in response to fireworks. However, should he happen to be triggered into a full­blown panic reaction by a fireworks display while eating fried chicken one day at a picnic in the park, he is likely thereafter, as strange as it seems, to get panicky around fried chicken (whether he flashes back to the park at the time or not). In such a circumstance, fried chicken gets added to the domain of toxic secondary restimulators of his war experience, and the "picnic in the park" incident acquires

secondary trauma status and is itself subject to later restimulation. If, for instance, fried chicken subsequently gets (or previously had gotten) associated with his mother­in­law (who prepares it for his every visit), his contact with her also becomes subject to PTSD toxicity by association. The dynamic effect of such repeated reactions over a period of time is a gradual increase in the client's toxic secondary reactions. This, in turn, produces a corresponding reduction of his day­to­day rationality and an inability both to comprehend and to break out of his increasingly volatile reactive pattern (see Hayman et al, 1987).

The more reactions one experiences, the more new toxic secondary stimuli develop. The more new toxic stimuli there are, the more reactions one has, which suggests that those experiencing PTSD would eventually come to spend most of their time with their attention riveted painfully on past trauma. In point of fact, that does happen. The longer and more complex the chains or sequences of secondary incidents become over time, however, the less likely one is to flash all the way back to the primary trauma. This is why so many PTSD clients who appear to succeed in getting their attention off their primary traumata nevertheless withdraw from many of the life activities they previously enjoyed. Because they flash back to "the big one" a lot less, their PTSD cases are presumed to have abated. In reality such clients are in worse shape overall because a lot of little things in their traumatic incident networks (all the secondary restimulators or "cues" they picked up in the years following their primary traumata) bother them much more than they did in the past (Gerbode, 1989).