Victims' Response to Trauma and Implications for Interventions: A Selected Review and Synthesis of the Literature

2. LITERATURE REVIEW (cont'd)

2. LITERATURE REVIEW (cont'd)

2.3 Cognitive Processing Effects of Trauma

To date there has been very little research examining cognitive changes related to crime victimization. One would prefer to see research on issues of how cognitive processes such as memory (short and long term), perception, problem solving, decision-making, etc. might change as the person moves from a pre-victim state, immediate effects of the criminal act to post-victimization period. However, most research has focused on specific symptomatolgy and on coping strategies related to victimization. These issues are related to cognitive changes, but do not specifically examine how victimization affects the cognitive structure of the individual. However, coping and symptoms are both important in that we can extrapolate certain underlying cognitive changes. The current section will adopt a conservative perspective on what is meant by cognitive change. Specifically, cognitive change relates to changes in perception, interpretation, problem solving and decision-making related to crime victimization. Coping responses stand as an outflow of cognitive changes.

Possibly one of the most useful pieces of research that specifically examines cognitive changes in victimization is a multi-method study conducted by Greenberg and Ruback (1992). These researchers used surveys, official data and quasi-experimental methods to examine people's reactions to being victimized, subdividing crimes into theft, burglary, assault and sexual assault. They examined several outcome variables to examine the underlying cognitive processes associated with victimization. These outcomes included: deciding to report the crime, susceptibility to influence and the impact of emotions on decision-making. First, in relation to deciding to report a crime, they found that victims tend to be the one who reports the crime (Greenberg & Ruback, 1992). Although this may seem to be a simple finding, it has important implications. If decision-making is compromised after victimization, the victim may not be in the best state to decide how best to proceed. In examining reporting the crime, the percent of victims deciding to report can range from as little as 24% for battered women to as high as 96% for sexual assault victims (Greenberg & Ruback, 1992). In understanding why people report the crime to authorities, they found that crime and situational variables are more important than personal variables. This is consistent with research on sexual assault, wherein knowing the perpetrator (acquaintance, date, and marital sexual assault) seems to decrease reporting and help seeking (Ullman, 1999). In addition to directly impacting victim's reluctance to report, Campbell et al. (1999) reported victims who know their perpetrators have more difficulty obtaining services and may be more at risk for negative reactions such as victim-blaming. It is understandable that victims may be reluctant to report if they fear this reaction, especially if they first seek out the advice of significant others who are unsupportive (Greenberg & Ruback, 1992; Nolen-Hoeksema & Davis, 1999). Thus, crime characteristics and situational variables appear to be used by the victim to determine whether or not to report a crime, but advice from others is also a very important factor.

When the characteristics of the crime and situation are held constant, victims are very susceptible to social influence with respect to reporting (Greenberg & Ruback, 1992). In their surveys, they found that most victims spoke to others, to seek support and advice, before contacting authorities. Using a field quasi-experimental design wherein naïve research participants had their payment "stolen", these authors found that 58% of the "victims" followed the advice of confederates regarding reporting. Non-reporters followed the advice 77% of the time and reporters 50% (Greenberg & Ruback, 1992). The authors point out that these results are particularly interesting given that the advice came from total strangers. However, they also found if the stranger was also a "co-victim" (a confederate of the researchers who also had his or her money stolen), it increased the likelihood of following advice. In other words, if the "co-victim" minimised the crime, and said they were not going to report, then the victim typically agreed. With respect to differential reporting, their survey research showed rates of reporting of 85% for burglary, 88% for theft and 90% for sexual assault. Advice from others also seems to affect how active the victim will be in the criminal justice process over the long-term (Greenberg & Ruback, 1992).

One reason victims may seek and follow advise is because they recognize that they are in a stressful state which may affect their normal cognitive functioning and result in poor decision-making (Casarez-Levison's Victimization/ Disorganization Stage). Across several studies and methods, Greenberg and Ruback (1992) found that anger and fear were the most common emotional responses to victimization. These emotions may have an effect on cognitive skills. Anger seems to be related to the underlying belief or cognition that one has been wronged and fear is associated with the belief or cognition that one is vulnerable. Furthermore, these emotions/cognitions were related to behaviour. Anger was more likely to occur with property crime victimization and was directly related to reporting (i.e., the more angry the person the more likely they were to report the crime). Thus, the belief that one has been wronged may increase reporting behaviour. Fear, on the other hand, was more related to sexual assault. However, Greenberg and Ruback (1992) indicated that there is a gender effect in that women tend to be more likely to report feelings of fear than men, even with respect to property crimes (Greenberg & Ruback, 1992). There are two possible explanations to this sex difference. Either women actually do experience fear more often as a result of criminal victimization, or men are more reluctant to report fear, even if they feel fear (perhaps from the perspective of social desirability). In any case, it is clear that fear of crime or fear related to hypersensitivity regarding future victimization is a common reaction.

With respect to perception, Greenberg and Ruback (1992) found that crime victims tend to be more accurate in same-race identifications and that self-reported confidence and accuracy are not strongly related. However, they did find that victims who were accurate in their description of the thief initially, remained accurate. Further, in a 2-month follow-up they found that those who reported crime were more accurate and confident than non-reporters in their description of offenders and specific details about the theft. With respect to accuracy of reporting, Stillwell and Baumeister (1997) randomly assigned students to take the perspective of a victim, a perpetrator or a neutral stance (control) in a story that focused on a betrayal of a promise to help another student study. They found distortions in the initial retelling of the story after an interval of 3 to 5 days. They found that both victims and perpetrators re-told the story, casting themselves in the more sympathetic role. Specifically, perpetrators were more likely to focus on extenuating circumstances and victims were more likely to focus on the negative impact of the behaviour and distorted the event to make the event seem worse. It is interesting to note that these researchers found that perpetrators and victims distorted to the same degree, but in different directions. That this study was closer to true laboratory experiment wherein there was no true victimization limits its applicability to the present discussion. However, it is important to note that these researchers asked each group to provide an accurate account of a relatively innocuous story and those who took a particular perspective spontaneously introduced bias favouring their position (Stillwell & Baumeister, 1997). Given that there is little motivation for either group to distort, these authors conclude that memory and recall is affected by perspective.

Finally, Greenberg and Ruback (1992) reported a small, but interesting, effect of anger related to accuracy and confidence in the victims report. Victims who reported more anger at the time of the theft were more accurate and confident in identifying the offender. This has interesting implications for underlying cognitive-emotional processes related to encoding and memory. One hypothesis might be that the arousal associated with anger (hypervigilance, attention to threat, etc.) may help "imprint" specific details and influence encoding into long-term memory. An alternate hypothesis may involve the importance the victim places on the event. Anger is often a reaction to feeling that one has been wronged. This "righteous" anger may motivate the person to maintain certain details of the crime in his or her memory, thereby improving recall. These memory/recall differences are an interesting result for understanding post-crime behaviour.

As Greenberg and Ruback (1992) indicated, many researchers and clinicians view decision-making ability as compromised when the person is under stress, especially the extreme stress associated with victimization. In developing a model of crime victim decision-making these authors point out that victims will often not consider all possible options and pick the best but, rather, focus on the first option that meets their minimum requirements. They note:

The option the victims choose to examine first probably depends on the option's momentary salience or availability, which is, in turn, a function of characteristics of the victim (e.g., previous experiences and self-concept) and the situation (e.g., access to a telephone and identification of suspect). The examination of the option itself is likely to be cursory, with the final choice often appearing to the victim as 'automatic' or 'reflective'. (Greenberg & Ruback, 1992, p. 196).

They developed a model of decision-making that has several stages wherein the victim is faced with a decision-making task at each step (Greenberg & Ruback, 1992). All stages are influences by external pressures of information, social norms and social/emotional variables.

Thus the person/victim moves through these stages in understanding their experience. From the above discussion, the importance of emotion, others' reactions and prior learning can have a profound affect on this decision-making process. Furthermore, one can easily extrapolate this model to include how victims seek support, rather than simply reporting. To generalize the model, victims, under the distress of being harmed, will likely take the same approach in seeking help or receiving services. The concern is that if victimization has compromised this decision-making, then the victim may not choose the best solution. In an effort to "put it behind them" they may take the first solution that allows them to avoid or ignore their victimization and possible trauma. More on this topic will be discussed in subsequent sections.

Other researchers have examined cognitive changes in combat veterans who have post-traumatic stress disorder that may be generalized to crime victims. Litz, Orsillo and Weathers (2000) theorized that PTSD patients are not generally numb and unresponsive, but that periods of high emotion from trauma cues cause problems in emotional processing. In other words, when trauma reminders result in distress, those with PTSD are more reactive to negative cues and experience less intense positive feelings. Further, they tested a model that theorized that in trying to cope with trauma, people would alternate between problematic thoughts (intrusion) and denial/numbing until they have resolved the trauma. It is believed that such alternating in thinking/feeling events helps the person cope with the trauma by stopping him or her from being overwhelmed by intrusive thoughts and feelings (Litz et al., 2000).

To test this theory, Litz et al. (2000) exposed two groups of Vietnam combat veterans (with and without PTSD) to trauma-related video and to a neutral comparison video. After the video they assessed the veteran's emotional reactions to a set of positive, neutral and negative photographs and measured reactions via monitoring of peripheral autonomic activity, expressive-motor responses, and self-reported emotional reactions. After exposing the two groups to the neutral video, both groups responded in a similar manner to all photographs. After exposing both groups to the trauma-related video, there was no indication that those with PTSD suppressed emotional responses. However, they did find that after trauma-related exposure, those veterans with PTSD were less responsive to the positive photographs. This suggests that reminders of trauma do not necessarily result in the person numbing or blunting their emotions, but it may interfere with their ability to experience positive emotions (Litz et al., 2000). Thus, the veteran's intrusive thoughts may be interfering with his or her ability to appropriately perceive and/or interpret positive stimuli. One caveat to this research is the finding that combat veterans do seem to handle trauma differently than civilians (Brewin, Andrews & Valentine, 2000). Thus, it is possible that gender issues, military screening, social support (natural and professional), economic resources or combat training influence the manifestation of PTSD. It would be useful to replicate this study among different groups of crime victims to see if the underlying cognitive-emotional processes are similar.

Finally, cognitive models of coping with negative life events may be useful in this discussion. Greenberg and Ruback (1992) described a model wherein the person works to develop cognitive "simulations" of possible events to practice coping strategies or to cope after a stressful event. These simulations also help the person problem-solve and regulate emotions by helping them to understand the event and avoid future victimization. Greenberg and Ruback (1992) indicated that the majority of victims display this strategy when they report that the victimization "could have been worse" or engage in revenge fantasies. Further, these authors point out that creation of these simulations, or fantasies, may motivate the person into taking action if the results of the simulation are positive. Anticipatory feelings of satisfaction could encourage the victim to go to authorities or seek further help. However, anticipatory fears of failure would have the opposite effect. Under this model, the motivational strength of "righteous anger" cannot be underestimated, as it is more likely to motivate the person to action (Greenberg & Ruback, 1992). Thus, treatments that focus solely on anger reduction may do a disservice to some victims who need the anger to help maintain motivation and a sense of control. In fact, anger may help the victim cope with certain difficult elements of the criminal justice process. However, this does not mean that intervention should overcompensate in the other direction to increase feelings of anger, perhaps under the guise of "empowerment". Chronic anger can be negative and very detrimental to the victim, if it is not handled properly. The managing of angry emotions is a delicate clinical issue that cannot be covered in a blanket statement. The one conclusion is that each victim needs to be treated as an individual, helping them learn to manage all emotions in a way that help them cope with challenges while remaining healthy. This balancing act has profound implications for public education, victim education and service delivery.