[This was an excerpt from a paper I wrote as an MSW student]
The concept of “Continuous Traumatic Stress” (CTS) emerged from research in Apartheid South Africa and later in conflict areas to discuss traumatic stress that is not in the past, but is present and is reasonably foreseeable into the future. It has been offered as a way of explaining the “psychological impact of living in conditions in which there is a realistic threat of present and future danger, rather than only experiences of past traumatic events” (Stevens, et al., 2013). CTS is seen as occurring on top of, or instead of PTSD, as “past experiences of trauma are … overlaid or even supplanted by exposure to continuing threat and danger” (Kaminer, Eagle & Crawford-Browne, 2016).
Although originally conceived of to cover conflict regions, its application to Apartheid South Africa suggests its possible utility to discuss issues encountered by individuals exposed to the criminal justice system. Eagle and Kaminer (2013) refer to CTS occurring in contexts in which “danger and threat are largely faceless and unpredictable, yet pervasive and substantive,” and included contexts in which “repressive state forces operate with impunity.”
The collateral consequences discussed above, in particular the discrimination experienced by individuals with a criminal record, can certainly be viewed as “faceless and unpredictable, yet pervasive and substantive.” And while the incident that resulted in an individual having a criminal record may be in the past, the fact of having a criminal record is very much present and permanent for most. Individuals subject to incarceration or post-incarceration controls can certainly and reasonably feel the presence of “repressive state forces” which “operate with impunity.”
The impact of CTS, due to exposure to prolonged and repeated trauma, is characterized by “disturbances in sense of identity, unstable interpersonal relationships, and deficits in emotion regulation.” Others may experience flashbacks and/or nightmares related to past experiences of trauma; constant vigilance to real, objective, present threats in the external environment; and avoidance behaviors (Kaminer, Eagle & Crawford-Browne, 2016).
What may be an initial requirement of working in a counseling setting with an individual in these circumstances is to help them identity and cultivate even limited safe spaces, without which “hyperarousal, catastrophic thinking, and retriggering of traumatic associations” is likely to exacerbate existing issues (Stevens, et al., 2013).
Anxiety management, rather than exposure-based intervention, is recommended as exposure is likely to increase anxiety levels. Anxiety management, including psychoeducation, attention to internal and external “safe zones,” self-management of arousal states, developing enhanced threat discrimination capacities, and mobilization of support systems (Kaminer, Eagle & Crawford-Browne, 2016) can be helpful.
With respect to “threat discrimination capacities,” what is called for with an individual experiencing CTS is realistic, as opposed to exaggerated, appraisal of future threat, to “weigh the interpretation of threat perceived by the individual with the apparent ‘facts’ about their environment” (Eagle & Kaminer, 2013). It is vital to remember that, unlike individuals experiencing PTSD, the threats experienced by individuals experiencing CTS are real, the question is how likely they are to manifest. A person with a criminal record is vulnerable to discrimination, for example, the question is how likely they are to experience it in any given circumstance.
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