Psychosocial perspectives on post-traumatic stress

Although exposure to a traumatic event is a necessary etiological factor in the development of posttraumatic stress disorder, it is not thought to be sufficient and there remains much debate over what other factors may be associated with more severe and chronic distress. The present paper summarizes empirical work with survivors of various traumatic events. Evidence is reviewed for an integrative model of psychosocial factors relating to adjustment following traumatic stressors. The components of this model are stimulus factors, appraisal factors, personality factors, state factors, and activity factors. It is also argued that some forms of intrusion and avoidance constitute normal processes of appraisal and activity that mediate between the traumatic event and symptoms of increased arousal and negative affect. The social context of the traumatic event is also considered to be an important determinant of appraisal and activity. Methodological issues and implications for therapeutic intervention are addressed.