When we are forced to endure what we cannot endure, something breaks inside our minds. That broken-mindedness is commonly called trauma.”  ―John A. Macdougall 

Trauma can occur in many ways.

Whether it happens while on a military tour of duty in a war zone, being the victim of assault, surviving a natural disaster, or growing up in an abusive household, the consequences can last a lifetime and, in many cases, can mean a drastically shortened lifespan. 

Numerous studies have demonstrated the impact that trauma can have on the mind and body. Trauma survivors are often vulnerable to a wide range of psychiatric and medical conditions including cardiovascular disease, diabetes, chronic pain disorders, cancer, depression, and social anxiety. Studies also show that repeated exposure to trauma across the lifespan has a cumulative effect that makes survivors even more susceptible to health problems over time.

Still, despite the cumulative harm that can arise from long-term trauma exposure, there are also protective factors that can boost the body's ability to recover. One of the most important of these factors is high perceived control, or the belief in one's own ability to overcome whatever adversity is being faced. In the same way that  learned helplessness plays a role in depression, perceived control can be critical in the ability to handle whatever stressful experience you might encounter. 

And this sense of control can also moderate the impact that trauma has on the body, both in terms of the direct effects of trauma as well as reducing the likelihood of risky behaviors that people often engage in to cope with stress. These can include risky sexual practices, substance abuse, or smoking which, not coincidentally, can also lead to a shortened lifespan in many people.

A comprehensive new study published in the journal Health Psychology provides clear evidence of the important role that perceived control can play in moderating cumulative trauma. In this study, Ari J. Elliot of the University of Rochester and a team of co-researchers used data taken from the Midlife Development in the United States Study (MIDUS).

MIDUS represents one of the most ambitious longitudinal study of its kind following 7000 Americans aged 25 to 74 from 1995 to the present day. Of the original sample, 4,963 participated in a second wave of the study (MIDUS 2) conducted between 2004 and 2006. The MIDUS 2 results included survey items measuring:

  • Lifetime trauma exposure focusing on twelve specific types of traumatic experiences including parental substance abuse, parental death, emotional or physical childhood abuse, parental divorce, physical or sexual assault, experiencing combat, serious accident or injury, or death/serious illness of a child. Along with reporting on how often one or more of these experiences occurred, participants were also asked the age when it occurred and how it affected them in the long run.
  • Perceived control was measured by looking at two dimensions of control often used in research. The first of these, mastery, is defined as how people perceive their ability to achieve a given goal while the second factor, perceived constraints, is defined as the belief that life is controlled by outside forces rather than the actions people can take. With the MIDUS 2 study, mastery was measured with survey items such as "“I can do just about anything I really set my mind to” while perceived constraints was measured with items such as "What happens in my life is often beyond my control.”
  • Demographic factors such as gender, age, parental education, ethnic background, and socioeconomic status.  
  • Health status including whether participants suffered from any of the 29 different medical conditions listed. They were also asked to rate how their health issues affected their ability to carry out basic activities of daily living (bathing, carrying groceries, climbing stairs, etc.). Participants were also questioned about how they perceived their own physical health in general on a five-point scale ranging from poor to excellent.  
  • Psychosocial factors such as whether they were feeling depressed, how they scored on a test of neuroticism, and level of social support from family, spouse, and friends, were also measured for each participant.  
  • Participants were also asked about risky health behaviors such as smoking and alcohol use and the period in life when this was most severe. Survey items measuring psychological problems stemming from alcohol use were also included.

In addition to the survey questions, mortality data for each participant up until October 2015 was collected by checking the National Death Index as well as conducting closeout interview with family members of the deceased.  

Overall results showed that at least half the participants in the study reported experiencing at least one traumatic event with thirty percent reporting two or more.  For deceased participants, the average age at time of death was 74.9 years though results showed a significant link between amount of lifetime trauma and higher mortality for all causes.   

When looking at the role that perceived control played in mortality, results showed that the impact of trauma was much less for people reporting high levels of mastery (belief in one's ability to achieve a goal). As well, participants reporting higher levels of perceived constraints (belief in external forces beyond one's control) were also more likely have experienced trauma in childhood (such as abuse), though this had less of an effect on later mortality.

In summary, these results appear consistent with previous research suggesting that the sense of being in control is a key factor in coping effectively with traumatic events. Studies looking at resilience (positive or better-than-expected
outcomes despite exposure to significant risk or adversity) have shown that perceived control can help prevent many of the health problems that might otherwise occur due to traumatic stress. On the other hand, people who believe themselves to be unable to control their lives are much more likely to develop health problems depending on the amount of stress they accumulate over time.  

So, why would perceived mastery make people less vulnerable to stress?  According to social learning models developed by Albert Bandura and his colleagues, perceived control is linked to other aspects of self-efficacy, including problem-solving ability, being able to manage negative thoughts and emotions, and having a pragmatic viewpoint that allows us to "keep cool" during crises. Not only does this enable us to handle stress that might otherwise be overwhelming, but it helps us avoid many of the physiological changes that are often associated with extreme stress.   

These changes can include repeated activation of the "fight or flight mechanism" and disruption of the autonomic nervous system, increased telomere shortening, and increased inflammation (which can compromise the immune system).  Reduced stress can also mean being less dependent on unhealthy coping behaviors such as using tobacco, alcohol, or drugs though little evidence of this was found in the present study.

As Ari Elliot and his co-authors point out in their conclusions, providing treatment programming to boost perceived mastery in people exposed to trauma can have tremendous health benefits, including helping them live longer. As one example, research has already shown that cognitive behavioral therapy can help adult survivors of childhood trauma take control of their lives and is also extremely effective in treating PTSD. Teaching coping skills such as stress management and problem-solving can also help boost resilience in trauma survivors.  

While exposure to trauma is something that everyone faces sooner or later (and often more than once), it's the ones who give in despair and lose hope that they can improve their lives who seem to be most at risk for health problems. Having confidence in your own ability to survive may well be the key to overcoming adversity and having a long and normal life.  

References

Elliot, A. J., Turiano, N. A., Infurna, F. J., Lachman, M. E., & Chapman, B. P. (2018, January 25). Lifetime Trauma, Perceived Control, and All-Cause Mortality: Results From the Midlife in the United States Study. Health Psychology. Advance online publication. http://dx.doi.org/10.1037/hea0000585

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