Traumatic experiences can have a profound and lasting impact on the mental health of children and adolescents. In this meta-analysis, psychosocial interventions for children and adolescents who have been exposed to traumatic experiences were systematically reviewed. Twelve main intervention components were identified. Of the main intervention components, cognitive Behavioural Therapy (CBT) was the most common and the most effective at reducing Post-traumatic Stress Disorder (PTSD) /Post-traumatic Stress Symptoms (PTSS) in children and adolescents. These findings on the effectiveness of CBT add to the findings of previous reviews on intervention effectiveness on alleviating trauma symptoms in children and adolescents. Components of Cognitive Behavioural Therapy (CBT), Exposure Therapy, Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing Therapy (EMDR), Meditation- Relaxation Therapy, Family-Focused Therapy, Psychological Debriefing, Resiliency-Focused Therapy, Sensory Therapy, Psychoeducational Therapy, Time-Limited Dynamic Therapy (TLDP-A), and general unspecific counselling were used in the various treatments. Taking into account methodological quality, there was evidence for effectiveness for school-based and sexual trauma-based interventions in alleviating trauma symptoms. More research is needed to understand the effect of methodological quality on effect sizes based on intervention type. The implications for researchers and clinicians are discussed.

The main goal of this research project was to explore the question “What is the crisis responder’s experience with youth suicide?” The primary researcher was a crisis responder who, over the course of seven years, worked in the field of crisis intervention and encountered situations involving youth suicidality. Research has shown that exposure to youth suicide can produce dramatic effects upon the perceptions and meaning of work for crisis responders. A self-case study approach based upon heuristic concepts and processes was utilized for the present study because a first-person account enabled the uncovering of phases of effects of exposure to suicidality, including immersion, incubation, and illumination. These phases were applied to clarify the nature of the lived experience of a crisis responder working in Manitoba, Canada on a mobile crisis team. Insight into the phenomenon was gained by synthesizing the personal experiences of being a crisis responder, and contextualizing it within the theoretical and empirical literature on exposure to suicidality. Based on current findings, directions for future research and implications for the professional development of crisis responder practitioners experiencing youth suicide were provided. The ramifications of long term service within this area were also explored.

When will people empathize with and help others? The goal of this research was to determine whether a prosocial orientation results from experiencing trauma. Recent research suggests there may be positive consequences to suffering. Under certain conditions, such as when people experience post-traumatic growth, past suffering can lead to personal benefits. Building on this body of research, one aim of this thesis was to investigate the impact of subjective traumatic suffering and psychological distress on post-traumatic growth and empathy. The second aim of this research was to examine whether objective trauma severity predicts post-traumatic growth. Finally, the third aim of this research was to examine the relationship between post-traumatic growth and empathy and the simultaneous impact of these variables on a prosocial orientation. Study 1 assessed these aforementioned relationships and Study 2 included a manipulation of post-traumatic growth and a behavioural outcome measure of prosocial behaviour. Structural equation models for Study 1 and 2 indicated that subjective traumatic suffering and objective trauma severity positively predicted post-traumatic growth, and post-traumatic growth positively predicted empathy. In turn, empathy positively predicted several prosocial outcomes. Thus, empathy mediated the link between post-traumatic growth and a prosocial orientation. In contrast to subjective traumatic suffering, psychological distress was unrelated to post-traumatic growth and negatively predicted empathy. Study 2 further indicated that focusing on one’s growth in regards to trauma resulted in greater post-traumatic growth scores, but the manipulation had no direct impact on empathy or a prosocial orientation. The current findings have important social and clinical implications.

Following exposure to trauma, stress reactions are initially adaptive. However, some individuals’ psychological response can become maladaptive with long-lasting impairment to functioning. Most people with initial symptoms of stress recover, and thus it is important to distinguish individuals who are at risk of continuing difficulties so that resources are allocated appropriately. Investigations of predictors of PTSD development have largely focused on relational and combat-related trauma, with very limited research looking at natural disasters. This study assessed the nature and severity of psychological difficulties experienced in 101 people seeking treatment following exposure to a significant earthquake that killed 185 people. Peritraumatic dissociation, posttraumatic stress symptoms, symptoms of anxiety, symptoms of depression, and social isolation were assessed. Descriptive analyses revealed the sample to be a highly impaired group, with particularly high levels of posttraumatic stress symptoms. Path analysis was used to determine whether the experience of some psychological difficulties predicted experience of others. As hypothesised, peritraumatic dissociation was found to predict posttraumatic stress symptoms and symptoms of anxiety. Posttraumatic stress symptoms then predicted symptoms of anxiety and symptoms of depression. Depression and anxiety were highly correlated. Contrary to expectations, social isolation was not significantly related to any other psychological variables. These findings justify the provision of psychological support following a natural disaster and suggest the benefit of assessing peritraumatic dissociation and posttraumatic stress symptoms soon after the event to identify people in need of monitoring and intervention.

Individual responses to natural disasters are highly variable. The psychological and behavioural response trajectories of those who manage to cope well with adverse life events are in need of further investigation. Increased alcohol use is often observed in communities exposed to mass traumas, particularly among those exposed to severe levels of trauma, with males drinking more than females. The current study examined patterns of alcohol use and motivations for drinking among a sample of psychologically resilient individuals with varying levels of exposure to the Canterbury earthquakes (N = 91) using structured and semi-structured interviews and self-report measures. As hypothesised, there was a significant increase in alcohol consumption since the earthquakes began, and males reported significantly higher levels of pre-earthquake and current alcohol consumption than females. Contrary to expectations, there was no association between traumatic exposure severity and alcohol consumption. While participants reported anxiety-based coping motives for drinking at levels comparable to those reported by other studies, depression-based coping motives were significantly lower, providing partial support for the hypothesis that participants would report coping motives for drinking at levels comparable to those found by other researchers. No gender differences in drinking motives were found. As expected, current alcohol consumption was positively correlated with anxiety and depression-based coping motives for drinking. Psychological resilience was not significantly associated with alcohol use, however resilience was negatively associated with depression-based coping motives for drinking. These findings have inter-generational and international implications for post-traumatic intervention.

Following World War II the novel faced a crisis in its mode of address. How could the human and humane function of language and artistic representation be lent to the depiction of historical terror or trauma? Who has the right to speak on behalf of – or to assume the voice of – victims of such real atrocity? And to what extent can a writer attend to another's pain without aestheticising extreme vulnerability, or losing the reader to indifference or repulsion? The difficulties confronted by the writer of fictional works when addressing such issues as war, rape, domestic abuse, colonisation, slavery, even genocide are not rooted in an inadequacy of syntax; rather they are borne out of the disjunction between the idealistic assumptions that linked language to a sense of humanity, intelligence and the pursuit of goals beneficial to society as a whole, and the extremity of recent acts of human atrocity as conducted not by the savage Other but by modern societies with which the reader would otherwise identify. Since the mid-twentieth century a number of writers have responded to these challenges by forgoing the traditional dialogic form of the novel and electing characters that cannot or will not speak in order to convey, through their speechlessness and – at times – their damaged physicality, the extent of the violence and oppression to which they have been subjected, and the difficulty of assimilating such violence into the stories by which communities, indeed whole nations, define themselves. The unexpectedly large cast of mute characters suggests that silence has a vital role in the literary portrayal of historical trauma. The prevalence of silence in contemporary fiction related to the Holocaust, for example, shows how this group of writers recognises the extent to which this event tested and continues to test literary exploration. Writers the world over continue to refuse to ignore these subjects – indeed, the broken images and fragmented forms common to many of the novels studied in the following pages can be seen as an apt response to the chaos of war and human aggression – but, as is evident from the number of contemporary works of fiction incorporating a mute character, silence has become an accepted and effective tool for the portrayal of historical events of terror or trauma that continue to challenge the ethical boundaries of the imagination.

Current theorising of trauma continues to suffer from Post-Holocaust understandings that render trauma as indefinable, yet the myriad representations produced across different discursive domains – testimony, documentary, film and art – challenge such claims. Rather it is difficult to define, plagued by the parameters of trauma – as having no “beginning”, “ending”, “during” or “after” as Laub contends – and is further hampered by its clinically inadequate categorisation as Post Traumatic Stress Disorder (PTSD) within the Diagnostic Statistical Manual (DSM). While the inclusion of PTSD in the DSM-III in 1980 promised to normalise the long history of trauma resulting from combat experience, its increasing and continuing expansion of categories since then has undermined this combat-specific diagnosis. Particularly, it fails to recognise the specific traumas intrinsic to soldiers who wage war as an occupation (specifically the act of killing), and the complex way in which PTSD is triggered in veterans (the political deceit and denial that accompanies the experience of the initial event). With 1 in 5 returned soldiers currently screening for PTSD, and more veterans having committed suicide than have died in combat, it is clear that there is a crisis in the way PTSD is theorised, recognised and understood. This thesis provides a discursive analysis of contemporary media texts, proposing that discourses produced within these domains challenge, undermine and potentially remedy combat trauma’s current “crisis of representation.” While professionally produced documentaries and current affairs programmes were found to align with the political and ideological discourses prominent within the military and psychiatric professions, soldier-produced content – through raw video, art and digital pastiche – functioned as traumatic performances that produced personal articulations of trauma. Moreover, the televisual flashback succeeds in conveying the “traumatised subjectivity” through cinematic and aesthetic conventions that allow the viewer to see beyond the confines of the body and into the flashback as it is experienced by the eye-witness. In doing so, these texts help to construct social and cultural knowledge of trauma and PTSD and facilitate acts of bearing witness. Such articulations allow veterans to understand their own disorder as normal and are influential in the processes of healing and recovery.