One of the world’s leading experts on the effects of traumatic experience is the psychologist Mardi Horowitz, and it is he who proposed the five stage model of how we respond and adjust to traumatic experience. The five stages that Horowitz describes are as follows :
HOROWITZ’S FIVE STAGE MODEL OF HOW WE RESPOND AND ADJUST TO TRAUMATIC EXPERIENCE :
A) Outcry
B) Numbness and denial
C) Intrusive re-experiencing of the traumatic experience
D) Working through the traumatic experience
E) Completion
Let’s look at each of these five stages in turn :
A) Outcry : this first stage occurs in the immediate aftermath of the traumatic experience – it involves a disorganized and confused mental state in which the individual is likely to feel overwhelmed and disorientated.
B) Numbness and denial : this second stage is essentially self-protective – the brain attempts to banish thoughts and feelings related to the traumatic experience from conscious awareness leading to a state of numbness and denial. This can include psychological states known as ‘depersonalization’ (this is a sense of being cut off from, or somehow separate from, one’s real self) and ‘derealization’ (this is the sensation of being cut off from reality ; it generates the feeling the trauma was not real – as if it had just happened in a film or play : the individual finds it hard to accept the traumatic event/s did actually occur).
C) Intrusive re-experiencing : however, the above protective stage can only endure for so long until the memories start to powerfully re-assert themselves. It should also be noted that, paradoxically, the more an individual actively attempts to suppress the painful memories, the more forceful they will tend to become – this is a process called ‘rebound’ (click here for one of my articles related to this phenomenon).
Because this stage involves re-experiencing the traumatic event/s, it can be very distressing ; to reduce the power of the memories and the psychological pain that they bring, it is necessary to start to process them.
People often vascillate between stages 2 (B) and 3 (C) and it is often only possible to start assimilating what has happened into long-term memory in a slow and gradual manner, bit by bit. This assimilation process is stage 4 (D) – Horowitz referred to it as ‘working through’.
D) Working through : during this stage, which involves coming to terms with what occurred, making sense of it, understanding its meaning and implications and integrating the traumatic experiences into long-term memory, both denial and intrusive memories, together with the pain associated with the trauma, start to diminish
E) Finally, completion occurs – the previously intrusive memories become fully integrated into long-term memory and begin to lose their power to cause emotional distress.
GETTING STUCK AT A PARTICULAR STAGE OF RECOVERY :
However, sometimes the recovering individual may become stuck at a particular stage, not infrequently at stage 3 (C) – the ‘intrusive memories’ stage ; this may involve disturbing thoughts, images, flashbacks and nightmares. In such a case, appropriate therapy may be essential.
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David Hosier BSc Hons; MSc; PGDE(FAHE).