Reprinted from "Trauma and Victimization" issue of Visions Journal, 2007, 3 (3), pp. 24-25
Pat is running late. She can barely wait for the light to change. When it does, she instantly accelerates across the intersection. In a split second she is engulfed in a wave of deafening noise, ripped out of her seat and smashed against a wall of shattering glass, with metal and limbs spinning around violently. Her senses all seem in overdrive yet her mind is blank. Pat feels like she’s watching a film in slow motion. She watches passively as her car rotates in the air, landing on its roof. Hanging upside down in the overturned vehicle, she can see its underbelly as if watching it from above. Later she learns that she is actually looking at the chassis of the truck that smashed into her. Despite the high speed impact, Pat lives, suffering only non-life-threatening physical injuries.
Motor vehicle crashes, in addition to being one of the top causes of death and injury in Canada and around the world, can sometimes trigger or worsen existing psychological conditions. These conditions may include anxiety, depression, anger, grief, guilt, travel phobias and post-traumatic stress disorder (PTSD).
If Pat were to develop PTSD, she may suffer from insomnia. When she does sleep, she may “re-experience” the crash in nightmares. She may try to avoid driving, particularly through intersections, fearing another similar crash. When she does drive, she is likely to constantly check and recheck all cars, buses and trucks (especially the trucks)—to the point of being worn out by the intense, indiscriminating watchfulness (i.e., hypervigilance), which can actually cause her attention to drift.
Will Pat develop PTSD?
The good news is that simply being in a crash, even a serious crash, will not automatically afflict Pat with PTSD. In fact, the odds are generally in her favour.
Only about one in 10 individuals who describe their collision as “traumatic” actually develop PTSD. Most crash victims recover within a few months; however, some continue to report chronic symptoms of post-traumatic stress, which hinder their psychological and physical recovery.
Of those who do develop some PTSD symptoms, most recover within the first year. About half of those meeting PTSD criteria at one year following the crash recover by the end of the third year.
The relationship between crashes and PTSD is not simple because it depends on the type of crash, the type of individual involved, as well as on the social, economic and legal issues that emerge following a crash. While the severity of Pat’s crash may put her at greater risk of PTSD, how she perceives the crash will likely play an even larger role.
“Traumatic” crashes are often described as sudden, unexpected, unpredictable, uncontrollable and scary. Crashes seem to be more stressful when the actions of other drivers are perceived to be intentionally directed at the victim (such as in road rage incidents), when the driver feels responsible for the crash, when close friends or family are in the vehicle, and when someone is trapped in the vehicle after the crash.
Pat’s history with other traumatic events, including other crashes, as well as pre-existing conditions such as anxiety, emotional problems, depression and excessive health concerns also influence her risk of developing crash-related PTSD.
How she responded emotionally during and immediately following the crash is also relevant. If her reaction suggests some type of dissociative experience, such as feeling numb, dazed or watching the crash from the outside looking in, she may be at a greater risk of PTSD.
The way she “processes” the crash (i.e., how she appraises or interprets the event in the context of her emotions and actions at the time) might affect how she forms an autobiographical memory of the event, which might in turn enable more involuntary “flashbacks” of the crash as time goes on. If her memory of the crash is disorganized or fragmented, she is also more likely to experience PTSD.
Pat might also be more at risk if she views any intrusive thoughts and memories of the crash negatively (e.g., “I’m going out of my mind” vs. “These are just uncomfortable but temporary thoughts I am willing to accept for now.” She would also be at greater risk if she used common (and often natural) coping strategies that actually promote the maintenance of PTSD symptoms—for example, if she tried hard to suppress all intrusive thoughts, ruminated about the crash, or dwelled on why the crash happened to her specifically. (Try as hard as you can not to think of a big black truck that is about to hit you).
If Pat receives very little support from her friends and family, if she has financial difficulties and if she becomes involved in a legal case, she will be more likely to develop and maintain PTSD. Legal action, with its emphasis on psychological injury rather than recovery, has particularly been shown to be a risk factor.
Finally, although we have focused on Pat, the driver, it is important to remember that post-crash stress reactions can sometimes develop in people who simply witness a traumatic crash. This is one reason care must be taken in designing prevention programs that use mock accidents to raise awareness of crash consequences.
Treatment and outlooks
If Pat does develop full PTSD, there are many effective therapies available:
Exposure therapy appears to be effective in reducing the re-experiencing symptoms and travel phobias1
Relaxation therapy may be especially useful for managing hypervigilance1
Eye movement desensitization and reprocessing (EMDR) therapy has also been shown to reduce PTSD symptoms1
Recent research also confirms what many crash victims have been saying for years: confronting a life-threatening event like a motor vehicle crash can lead to very positive psychological changes. Pat may experience such “post-traumatic growth” if she begins to re-evaluate her priorities in life, build more meaningful relationships with friends and family, and gain strength and confidence from her difficulties.2
The simplest way to reduce the negative psychological impacts of crashes is, of course, to prevent crashes in the first place. Simply checking for cross traffic before entering the intersection, even if the light was green, might have been Pat’s most effective strategy for eliminating the risk of crash-related PTSD.
About the authorJohn is a Consulting Psychologist with ICBC, focusing on the application of research on psychological issues arising from motor vehicle accidents—in particular, assessments, risky driving behaviours and crash prevention. Also a Registered Psychologist in private practice, John specializes in educational, vocational and disability-related assessments and therapeutic interventions.
Taylor, S., Thordarson, D.S., Maxfield, L. et al. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71(2), 330-338.
Rabe, S., Maercker, A., Zollner, T. et al. (2006). Neural correlates of post-traumatic growth after severe motor vehicle accidents. Journal of Consulting and Clinical Psychology, 74(5), 880-886.